Impact of HIV infection on radiographic features in patients with pulmonary tuberculosis.

Swaminathan, S.; Narendran, G.; Menon, P.A.; Padmapriyadarsini, C.; Arunkumar, N.; Sudharshanam, N.M.; Ramesh Kumar, S.; Chandrasekhar, S.

Indian Journal of Chest Diseases and Allied Sciences; 2007; 49; 133-136.

Background: There is insufficient data on the radiographic presentation of tuberculosis in human immunodeficiency virus (HIV) infected patients from India.

Methods: We examined the chest radiographs of 181 patients including 82 HIV positives with newly diagnosed sputum culture positive pulmonary tuberculosis before and after the completion of anti-tuberculosis treatment (ATT). Patients with smear/culture positive pulmonary tuberculosis were treated with Revised National Tuberculosis Control Programme (RNTCP) Cat-I regimen (2EHRZ3/4HR3). An independent assessor blinded to HIV and clinical status of patients read the radiographs.

Results: At presentation, HIV seropositive patients were significantly more likely to have normal chest radiographs (14.2% vs 0), miliary tuberculosis (10.7% vs 1%) and pleural effusion (16.6% vs 3%), and less likely to have cavitation (17.8% vs 39.4%) as compared to HIV negative patients. At the end of treatment, HIV positive patients were more likely to have normal radiographs (42.8% vs 1.2%), and less likely to have fibrosis (17.8% vs 42.5%).

Conclusions: The radiographic presentation of pulmonary tuberculosis in HIV-infected patients is atypical with less cavitation, and more dissemination. On completion of ATT, patients with HIV have less radiographic sequelae in the form of fibrosis. These features may be due to the reduced inflammatory response that patients with HIV infection may be able to mount.

Keywords: HIV/AIDS, Tuberculosis, Chest radiography.


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