Radiological features of pulmonary tuberculosis in patients infected with human immunodeficiency virus

We tested 120 consecutive admissions with sputum positive pulmonary tuberculosis for antibodies to the human immunodeficiency virus type I (HIV-1). Pre-treatment chest x-ray appearances were recorded. Seventy one patients (59%) were males and 49 (41%) were females. 43 (35.8%) patients were seropositive for HIV, and were all in the age range 16-45 years. The seropositivity for the 56 males and 44 females in the age range 16-45 years were 53 and 26 percent respectively. Atypical x-ray features were found in 21 of 43 cases compared to 15 of 57 referents (p less than 0.025). Radiographic features typical of reactivation pulmonary tuberculosis in the adult were found in 73% and 51% of referents and cases respectively (P less than 0.025). Pulmonary lesions localized to the mid and or lower zones were seen in 20 percent of cases and 3.3% of referents (P = 0.01). Mediastinal and or hilar adenopathy alone or with pulmonary infiltrates occurred more frequently among cases but the results were not significant. Our findings indicate that radiological appearances of pulmonary tuberculosis in patients seropositive for HIV-1 antibodies tend to be atypical in type of lesion and or anatomic distribution, even for patients from communities with high prevalence rates of tuberculosis.