Differences in the clinical and radiological presentation of intrathoracic tuberculosis in the presence or absence of HIV infection

• Published in: Jornal brasileiro de pneumologia Vol. 33; no. 4; pp. 429 - 436
• Main Authors: Picon, Pedro Dornelles, Caramori, Maria Luiza Avancini, Bassanesi, Sérgio Luiz, Jungblut, Sandra, Folgierini, Marcelo, Porto, Nelson da Silva, Rizzon, Carlos Fernando Carvalho, Ferreira, Roberto Luiz Targa, Freitas, Tânia Mariza de, Jarczewski, Carla Adriane
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil 01-07-2007
• Subjects: Acquired Immunodeficiency Syndrome - diagnosis; Acquired Immunodeficiency Syndrome - diagnostic imaging; Adult; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - diagnostic imaging; CD4 Lymphocyte Count; Epidemiologic Methods; Female; HIV Infections - diagnosis; HIV Infections - diagnostic imaging; Humans; Male; Mycobacterium Infections, Nontuberculous - diagnosis; Mycobacterium Infections, Nontuberculous - diagnostic imaging; Mycobacterium Infections, Nontuberculous - epidemiology; Radiography; Tuberculosis, Lymph Node - diagnosis; Tuberculosis, Lymph Node - diagnostic imaging; Tuberculosis, Lymph Node - epidemiology; Tuberculosis, Pulmonary - diagnostic imaging; Tuberculosis, Pulmonary - immunology; Tuberculosis, Pulmonary - pathology
• ISSN: 1806-3756
• DOI: 10.1590/s1806-37132007000400012

To describe the differences in the clinical and radiological presentation of tuberculosis in the presence or absence of HIV infection.
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.
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/mm3; p < 0.0001), in HIV-positive patients with AIDS than in those without AIDS (136 vs. 398 cells/mm3; p < 0.0001) and in patients with atypical pulmonary tuberculosis than in those with other forms of tuberculosis (31 vs. 258 cells/mm3; p < 0.01).
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.