Significant variation in presentation of pulmonary tuberculosis across a high resolution of CD4 strata
Abstract: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.
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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