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ORIGINAL ARTICLE
Year : 2012  |  Volume : 4  |  Issue : 5  |  Page : 221-225

HIV-Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count


Department of Medicine, Kasturba Medical College, Mangalore, Karnataka, India

Correspondence Address:
Mahesha Padyana
Flat No. 104, Roshni Apartments, Opposite to MCODS, 6th Cross, Attavar, Mangalore, Karnataka - 575 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1947-2714.95904

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Background : Fight against human immunodeficiency virus (HIV) is incomplete without addressing problems associated with difficult diagnosis of tuberculosis in HIV-Tuberculosis coinfected patients. Chest X-ray is a primary tool to evaluate tuberculosis in HIV. Aim: To assess and compare various radiological patterns of pulmonary tuberculosis in HIV patients and compare these patterns in relation to CD4 counts. Materials and Methods : Prospective cohort study was conducted in a tertiary hospital in South India from September 2009 to July 2011 with 200 HIV positive patients. WHO guidelines were used for diagnosis of HIV and tuberculosis. Results : 27% of the patients had sputum positive pulmonary tuberculosis, with higher incidence (33%) among CD4 less than 200 as compared to CD4 more than 200 (14%). Infiltration (39%) followed by consolidation (30%), cavity (11%), and lymphadenopathy (9%) seen with CD4 less than 200. Infiltration (37.5%) followed by cavity (25%) and miliary (25%) with CD4 above 200. Bilateral (68.5%) and mid and lower zones or all zone involvement more commonly seen. Conclusion : In patients with CD4 lower than 200 noncavitory infiltration and consolidation predominated. Involvement of lungs was atypical; diffuse or mid and lower zone involvement than classical upper lobe involvement. A high index of suspicion is necessary for the accurate and timely diagnosis of tuberculosis in HIV positive patients.


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