Correlation Of Radiographic Patterns Of Pulmonary Tuberculosis With CD4+ Cell Counts Among Patients With HIV/AIDS In Maiduguri, Nigeria

Abstract

Background: Tuberculosis remains an important infection in patients with human immunodeficiency virus (HIV) infection. It may develop at any stage of HIV infection, but most patients have been shown to have CD4+ counts of between 200 and 500/l. Patients with higher CD4+ counts often present in \"classic\" fashion (upper zone infiltrates cavities) whereas those with low CD4+ counts are more likely to present atypically. The chest radiographic appearances of HIV-seropositive patients presenting with pulmonary tuberculosis (PTB) are diverse, creating difficulty in diagnosis and treatment. While some studies reported correlation between CD4+ cell counts and radiographic patterns, others have failed to demonstrate that

Objectives: The aims of this study was to determine the relationship between CD4+ cell counts and the various radiographic patterns of pulmonary tuberculosis in HIV-infected patients.

Methods: Sixty consecutive confirmed HIV-seropositive patients with newly diagnosed sputum smear positive pulmonary tuberculosis were enrolled from September 2001 to August 2002. Anteroposterior chest x-rays were evaluated for the presence of apical opacities with or without cavitation (typical) or miliary, lower or mid-zone and reticulonodular opacities, pleural effusion, hilar adenopathy and normal radiograph (atypical).

Results: The age range of the patients was 18-55 years (Mean ± SD: 33.9 ± 8.42) and they comprised of 34 males and 26 females.

All those with CD4+ cell counts <200 cells/μl (43%) had atypical pattern whereas typical was seen only in those with CD4+ counts ≥200 cells/μl (p<0.01). Nine of 34 patients (26%) with CD4+ counts ≥ 200 cells/μl had typical pattern. The mean CD4+ cell counts of those with typical versus atypical pattern were 442.2 ± 89.2 cells/μl and 202.2 ± 76.2 cells/μl (n=51), respectively (p<0.01). Hilar adenopathy was noted in 5 (8%) patients and all but one had CD4+ count <200 cells/μl. Pleural effusion was noted in 10 (16.7%) patients (mean 194.5 ± 82.9/μl). Lower/mid-zone and reticulonodular opacities and normal radiographs occurred in 7 (11.6%), 2 (3%) and 15 (25%) patients with mean CD4+ counts of 236 ± 46.2, 200 ± 42.2, and 173.9 ± 67.8/μl, respectively. It was concluded that radiographic patterns of PTB in HIV varied over a spectrum and may be related to the stage of HIV infection. Hilar adenopathy was the best predictor of low CD4+ counts and atypical radiographic patterns have no predictive value with regard to CD4+ counts.

Key words: HIV, tuberculosis, radiographic patterns, CD4+ cell counts, Nigerians

Highland Medical Research Journal Vol.2(2) 2004: 9-18