Pulmonary tuberculosis: radiological features in west Africans coinfected with HIV.
ABSTRACT A retrospective study was performed to document and compare the radiological appearances of newly diagnosed pulmonary tuberculosis (PTB) in groups of West African patients with (n = 86) and without (n = 106) human immunodeficiency virus (HIV) coinfection. Analysis of chest radiographs showed that the HIV-positive group had less consolidation (mean 3.1 zones vs 3.7 zones; p < 0.05), less apical involvement (64.0% vs 85.5%; p < 0.001), less bronchopulmonary spread (27.9% vs 58.5%; p < 0.001), less volume loss (53.5% vs 76.4%; p < 0.001) and less pleural thickening (46.5% vs 61.3%; p < 0.05) compared with the HIV-negative group. However, HIV-positive patients more commonly had pleural effusions (17.4% vs 6.6%; p < 0.05) and lymphadenopathy (9.3% vs 1.9%; p < 0.05). Previous studies on this subject from sub-Saharan Africa have focused either on selected patient groups likely to have more advanced immunosuppression or on smear-positive cases only, or where there has been only limited radiological documentation. This study suggests that the highly significant differences that exist may not be as frequent as previously shown. The lower frequencies of bronchopulmonary pattern of consolidation and pleural thickening in HIV-positive subjects have not previously been documented. The possible reasons for the altered radiographic appearance of PTB in HIV positive subjects are discussed.
- SourceAvailable from: Ballah Akawu Denue[Show abstract] [Hide abstract]
ABSTRACT: We compared the pattern and distribution of pulmonary lesion on chest radiograph of HIV patients with CD4 count < or ≥200cells/μl and HIV-1RNA viral load < or ≥ log105. Of the 133 patients consecutively recruited, 84 (63.2%) had CD4 count <200 cells/μl. Patients with CD4 count <200 cells/μl had consolidation (15.5% vs 28. P = 0.054) and streaky changes 39.3% vs 55.9%, P = 0.049) less often. Pulmonary lesions involving upper and middle radiological zones were less common in cohort with CD4 count < 200cells/μl (11.9% vs 30.5%, P = 0.006), conversely middle and lower zone involvement were most often seen in them (27.4% vs 15.3%, P = 0.008). Patients with HIV-1 RNA viral load ≥105copies/ml had nodular lesions less often (31.7% vs 55.1%, p = 0.038) and more often had hilar or mediastinal lymphadenopathy (22.0% vs 7.3%, P = 0.012). Lower zone involvement was predominantly seen in cohort with HIV-1 RNA viral load ≥105copies/ml (19.5% vs 0.01%, p = 0.000). Our study demonstrates association between HIV disease stage with pattern and distribution of certain tuberculosis lesion on chest radiograph. Knowledge of immunological and virological parameters is important to clinicians and radiologist when evaluating CXR findings in HIV-infected patients.
- [Show abstract] [Hide abstract]
ABSTRACT: Wasting remains an important condition in HIV-infected patients receiving highly active antiretroviral therapy (HAART). In this study, 120 patients with newly diagnosed HIV infection were prospectively evaluated to determine the effect of HAART on body mass index (BMI). Eighty-nine (83.1%) patients gained weight, 5 (4.7%) had no weight change, and 13 (12.2%) lost weight. There was a significant increase in overweight and obese patients. On multivariate analysis, time-updated CD4 count and higher baseline BMI were associated with a greater increase in BMI. Anaemia at diagnosis was associated with a significant increase in BMI. There were no significant effects of age, sex, disease severity, viral load or educational status on BMI changes. About 27% of the HIV patients presented with weight loss, which emphasizes that weight loss and wasting remain important AIDS-defining conditions, despite the advent of HAART. A linear association was observed between time-updated CD4 count and increase in BMI. The association between time-updated CD4 count and greater increase in BMI suggests that BMI could be a surrogate for CD4 count in monitoring treatment response in resource-limited settings.
- [Show abstract] [Hide abstract]
ABSTRACT: Objective: To describe the differences in the clinical and radiological presentation of tuberculosis in the presence or absence of HIV infection. Methods: A sample of 231 consecutive adults with active pulmonary tuberculosis admitted to a tuberculosis hospital were studied, assessing HIV infection, AIDS, and associated factors, as well as re-evaluating chest X-rays. Results: There were 113 HIV-positive patients (49%) Comparing the 113 HIV-positive patients (49%) to the 118 HIV-negative patients (51%), the former presented a higher frequency of atypical pulmonary tuberculosis (pulmonary lesions accompanied by intrathoracic lymph node enlargement), hematogenous tuberculosis, and pulmonary tuberculosis accompanied by superficial lymph node enlargement, as well as presenting less pulmonary cavitation. The same was found when HIV-positive patients with AIDS were compared to those without AIDS. There were no differences between the HIV-positive patients without AIDS and the HIV-negative patients. Median CD4 counts were lower in HIV-positive patients with intrathoracic lymph node enlargement and pulmonary lesions than in the HIV-positive patients with pulmonary lesions only (47 vs. 266 cells/mm 3 ; p < 0.0001), in HIV-positive patients with AIDS than in those without AIDS (136 vs. 398 cells/mm 3 ; p < 0.0001) and in patients with atypical pulmonary tuberculosis than in those with other forms of tuberculosis (31 vs. 258 cells/mm 3 ; p < 0.01). Conclusion: Atypical forms and disseminated disease predominate among patients with advanced immunosuppression. In regions where TB prevalence is high, the presence of atypical pulmonary tuberculosis or pulmonary tuberculosis accompanied by superficial lymph node enlargement should be considered an AIDS-defining condition.