Radiographic manifestations of Tuberculosis in HIV positive patients: Correlation with CD4+ T-cell count

Mehrdad Bakhshayesh-Karam; Payam Tabarsi; Seyed Mehdi Mirsaiedi; Majid Valiollahpour Amiri; Soheila Zahirifard; Seyed Davood Mansoori; Mohammad Reza Masjedi; Ali Akbar Velayati

doi:10.1016/j.ijmyco.2016.11.027

Radiographic manifestations of Tuberculosis in HIV positive patients: Correlation with CD4+ T-cell count

Int J Mycobacteriol. 2016 Dec:5 Suppl 1:S244-S245. doi: 10.1016/j.ijmyco.2016.11.027. Epub 2016 Dec 5.

Authors

Mehrdad Bakhshayesh-Karam¹, Payam Tabarsi², Seyed Mehdi Mirsaiedi², Majid Valiollahpour Amiri², Soheila Zahirifard³, Seyed Davood Mansoori², Mohammad Reza Masjedi⁴, Ali Akbar Velayati⁵

Affiliations

¹ Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: mehrdadbakhshayeshkaram@hotmail.com.
² Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁴ Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁵ Mycobacteriology Research Center(MRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

PMID: 28043583
DOI: 10.1016/j.ijmyco.2016.11.027

Abstract

Background: Observations on Tuberculosis/HIV co-infection in addition to epidemiologic molecular studies have recently provided strong evidence for the state of immune system as the major determinant of the TB imaging spectrum. However, the presence of any correlation between radiographic findings and the degree of immunosuppression in HIV+ patients still remains controversial. The present study aimed to investigate the TB radiographic manifestation in HIV+ patients and its relationship to the CD4 cell count.

Method and material: Chest radiography of 15 HIV+ patients with a definite diagnosis of pulmonary Tuberculosis in Masih Daneshvari Hospital, between 2013 and 2014, were retrospectively reviewed. Radiographic findings and severity were categorized as typical (upper lobe infiltration/cavity) and atypical (middle/lower lobe opacity, adenopathy, pleural effusion and normal X-ray). Demographics and CD4+ cell count were also recorded. Data analysis was performed using SPSS version 23 (frequency and mean for descriptive quantitative variables and Logistic regression analysis for correlation, p<0.05).

Results: Of a total 15 patients (86.7% men and 13.3% women), 78.6% had CD4+ counts <350 (mean±SD; 229.15±199.45). The most common radiographic findings in descending order of frequency were adenopathy (53.3%), pleural effusion (26.7%) and cavitation (6.7%) with an overall atypical presentation of 93.3%. This study failed to reveal any statistically significant correlation between CD4+ cell count and radiographic manifestation as well as severity.

Conclusion: In CD4+ cell count <500, the dominant radiographic pattern of Tuberculosis is atypical presentation. At this level of immunity, CD4+ T cell dysfunction may play a deterministic role in TB radiographic manifestation.