RADIOLOGIC MANIFESTATIONS OF PULMONARY TUBERCULOSIS IN HIV-1-INFECTED AND HIV-2-INFECTED PATIENTS IN ABIDJAN, COTE-DIVOIRE

Objectives: To compare the radiologic manifestations of pulmonary tuberculosis in HIV-1-infected, HIV-2-infected, and HIV-negative patients; and to assess the impact of HIV-related immunosuppression on the radiologic manifestations of pulmonary tuberculosis. Methods: We compared chest radiographs from consecutive HIV-1-positive, HIV-2-positive and seronegative patients with pulmonary tuberculosis, Differentiation between HIV-1 and HIV-2 antibodies was based on a synthetic peptide-based enzyme immunoassay. A subset of patients had CD4+ lymphocyte levels estimated by flow cytometry; in these patients, abnormalities on chest radiographs were analysed in relation to the severity of CD4+ lymphocyte depletion. Results: HIV-1-infected patients were significantly more likely to have extrapulmonary tuberculosis than were HIV-2-infected or HIV-negative patients (20% vs 8% and 9%). Among patients with pulmonary tuberculosis, no differences were observed in the rates of specific abnormalities on chest radiographs between HIV-1- and HIV-2-infected patients; both HIV-1- and HIV-2-infected patients had a higher frequency of pleural effusion than did HIV-negative patients (8% and 9% vs 4%). Among HIV-infected patients with CD4+ counts of greater than or equal to 400/mm(3), 200-399/mm(3), and <200/mm(3), respectively, the proportions with non-cavitary infiltrates and hilar adenopathy increased significantly (33% to 44% to 58%, and 0% to 14% to 20%), while the proportion with cavitary lesions decreased significantly (63% to 44% to 29%). Conclusions: The radiologic manifestations of pulmonary tuberculosis in HIV-infected patients varied significantly over the spectrum of immune deficiency, HIV-infected patients with tuberculosis and relatively high CD4+ counts showed only slight differences from HIV-negative persons, HIV-1-positive patients had a higher frequency of extrapulmonary tuberculosis at presentation than those infected with HIV-2, Radiographic abnormalities were broadly similar in HIV-2-infected and HIV-1-infected patients, Clinicians and radiologists must be alert to the altered radiologic spectrum of pulmonary tuberculosis in immunosuppressed HIV-infected patients.