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Comparative Study
. 2010 Oct;14(10):1295-302.

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

G Chamie  1 , A Luetkemeyer, M Walusimbi-Nanteza, A Okwera, C C Whalen, R D Mugerwa, D V Havlir, E D Charlebois
Affiliations
Comparative Study

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

G Chamie et al. Int J Tuberc Lung Dis. 2010 Oct.

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.

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Figures

Figure 1
Figure 1
Distribution of pulmonary tuberculosis cases by CD4 cell count in HIV-infected persons. TB = tuberculosis; HIV = human immunodeficiency virus.
Figure 2
Figure 2
Proportion of HIV-infected patients with culture-confirmed pulmonary TB with negative AFB smear on initial presentation, by CD4 cell count. Error bars: 95% CIs (binomial exact) for the proportion of subjects with AFB smear-negative TB infection by CD4 strata. AFB = acid-fast bacilli; HIV = human immunodeficiency virus; TB = tuberculosis; CI = confidence interval.
Figure 3
Figure 3
Proportion of HIV-infected patients with culture-confirmed pulmonary TB with cavitation on chest X-ray at initial presentation, by CD4 cell count. Error bars: 95% CIs for the proportion of subjects with TB infection and cavitation on chest X-ray at initial presentation by CD4 strata. HIV = human immunodeficiency virus; TB = tuberculosis; CI = confidence interval.
Figure 4
Figure 4
Proportion of HIV-infected patients with culture-confirmed pulmonary TB with a normal chest X-ray at initial presentation, by CD4 cell count. Error bars: 95% CIs for the proportion of subjects with TB infection and a normal chest X-ray at initial presentation by CD4 strata. HIV = human immunodeficiency virus; TB = tuberculosis; CI = confidence interval.
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Comment in

References

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