Author(s): Post FA, Wood R, Pillay GP
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Abstract SETTING: An adult HIV outpatient clinic in Cape Town, South Africa. OBJECTIVE: To investigate the relationship between the radiographic appearance of pulmonary tuberculosis (PTB) in HIV infected patients and CD4+ T-lymphocyte count. DESIGN: Pretreatment radiographs of 150 patients with newly diagnosed PTB were reviewed. CD4+ T-lymphocyte count was used as a marker of HIV disease progression. RESULTS: Upper zone infiltrate typical of PTB reactivation was present in 18 patients. This pattern was associated with early HIV infection (mean CD4+ T-cell count 389) and had 78\% positive predictive value for identifying patients with > 200 CD4+ T-lymphocytes/microL. Pleural effusion was present in 32 patients and occurred over a wide intermediate range of CD4+ T-cell counts (mean 185). Lower or midzone infiltrates, adenopathy, interstitial pattern or normal radiograph occurred in 136 patients and were associated with advanced HIV disease (mean CD4+ T-cell count 105). These patterns had 84\%, 89\%, 89\% and 100\% positive predictive value, respectively, for identifying patients with < 200 CD4+ T-cell/microL. CONCLUSION: Pulmonary tuberculosis in African HIV-positive patients presents with a spectrum of radiographic abnormalities predictive of stage of HIV disease progression. In patients dually infected with HIV and PTB, chest radiographs are a useful adjunct to clinical staging.
This article was published in Tuber Lung Dis
and referenced in Journal of Medical Microbiology & Diagnosis