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Free Content Significant variation in presentation of pulmonary tuberculosis across a high resolution of CD4 strata

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BACKGROUND: The human immunodeficiency virus (HIV) alters the presentation of pulmonary tuberculosis (PTB), but it remains unclear whether alterations occur at a CD4 cell threshold or throughout HIV infection.

OBJECTIVE: To better understand the relationship between CD4 count and clinical and radiographic presentation of PTB.

SETTING AND DESIGN: Initial presentations of culture-confirmed PTB patients evaluated at a Ugandan national TB referral center and an affiliated research unit were compared by HIV status and across 11 CD4 cell count strata: 0–50 to >500 cells/μl.

RESULTS: A total of 873 HIV-infected PTB cases were identified. Among HIV-infected PTB cases with CD4 < 50, 21% had a normal chest X-ray (CXR) vs. 2% with CD4 > 500, with a continuous trend across CD4 strata (test for trend, P < 0.001). All radiographic manifestations of PTB displayed significant trends across CD4 strata. HIV-infected vs. non-HIV-infected patients had no significant difference in CXR findings of miliary patterns or pleural effusion at CD4 > 100, normal CXR or fibrosis at CD4 > 150, adenopathy at CD4 > 250, and cavitation or upper lung disease at CD4 > 300. Twenty-three per cent of co-infected cases with CD4 < 50 and 1% with CD4 > 500 had negative acid-fast bacilli (AFB) smears, with a significant trend between (P < 0.001).

CONCLUSION: Variations in CXR appearance and AFB smear correlate with CD4 decline in significant, continuous trends.

Keywords: CD4; HIV; chest X-ray; tuberculosis

Document Type: Regular Paper

Affiliations: 1: HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco, California, USA 2: Makerere University Medical School, Mulago Hospital Complex, Kampala, Uganda 3: National Tuberculosis and Leprosy Programme, Mulago Hospital Complex, Kampala, Uganda 4: Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA 5: Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA

Publication date: October 1, 2010

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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