Association of chest radiographic abnormalities with tuberculosis disease in asymptomatic HIV-infected adults

• Published in: The international journal of tuberculosis and lung disease Vol. 14; no. 3; pp. 324 - 331
• Main Authors: AGIZEW, T, BACHHUBER, M. A, NYIRENDA, S, MAKWARUZI, V. Z. S. A. M, TEDLA, Z, TALLAKSEN, R. J, PARKER, J. E, MBOYA, J. J, SAMANDARI, T
• Format: Journal Article
• Language: English
• Published: Paris International Union against Tuberculosis and Lung Disease 01-03-2010
• Subjects: Adolescent; Adult; Aged; AIDS-Related Opportunistic Infections - diagnostic imaging; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Botswana - epidemiology; Female; HIV Infections - complications; Human bacterial diseases; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Isoniazid - therapeutic use; Lung - pathology; Lymphatic Diseases - diagnostic imaging; Lymphatic Diseases - etiology; Male; Mass Chest X-Ray - methods; Mediastinal Diseases - diagnostic imaging; Mediastinal Diseases - etiology; Medical sciences; Middle Aged; Mycobacterium; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Sensitivity and Specificity; Tuberculosis - diagnostic imaging; Tuberculosis - etiology; Tuberculosis - prevention & control; Tuberculosis and atypical mycobacterial infections; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult; Botswana; screening; Disease; Asymptomatic; Mycobacterial infection; Association; Adult; Pneumology; Human; Immunopathology; Radiodiagnosis; Respiratory disease; Retroviridae; Exploration; AIDS; Thorax; Medical screening; Immune deficiency; Lentivirus; Infection; Virus; Radiography; Tuberculosis; HIV; Viral disease; Bacteriosis; Human immunodeficiency virus; chest radiograph
• ISSN: 1027-3719; 1815-7920

Francistown and Gaborone, Botswana.
Chest radiography is used to screen for tuberculosis (TB) in asymptomatic persons living with the human immunodeficiency virus (PLWH) seeking isoniazid preventive therapy (IPT). We describe radiographic features in PLWH in a TB-endemic setting and identify features associated with TB disease.
Asymptomatic PLWH seeking IPT under program conditions for a clinical trial between 2004 and 2006 received chest radiographs (CXRs) that were read using the standardized Chest Radiograph Reading and Recording System (CRRS). Clinical characteristics, including TB disease, were compared with the radiographic findings.
From 2732 screening CXRs, 183 had one or more abnormalities and were scored using CRRS, with 42% having infiltrates (36% upper lobes), 35% parenchymal fibrosis and 32% adenopathy. TB disease status was determined in 129 (70%) PLWH, of whom 22 (17%) had TB disease. TB disease was associated with upper lobe infiltrates (relative risk [RR] 3.0, 95%CI 1.5-6.2) and mediastinal adenopathy (RR 3.9, 95%CI 1.8-8.4). The sensitivity and specificity of either upper lobe infiltrates or mediastinal lymphadenopathy for TB disease were respectively 64% and 82%.
A combination of CXR features was useful for predicting TB disease in asymptomatic PLWH. CRRS should be used more frequently in similar studies.