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Clinical manifestations of tuberculosis in HIV-infected patients
1Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong. Kevin333@netvigator.com
Insights
HIV infection significantly impacts tuberculosis presentation, often leading to advanced disease with common extrapulmonary and disseminated tuberculosis. Radiographic findings in pulmonary tuberculosis can be atypical in these co-infected patients.
Area of Science:
- Infectious Diseases
- Immunology
- Pulmonology
Background:
- Tuberculosis (TB) remains a significant global health challenge.
- Human Immunodeficiency Virus (HIV) co-infection alters the clinical and radiological presentation of TB.
Purpose of the Study:
- To investigate the clinical presentation of tuberculosis in patients with HIV infection.
- To understand how HIV impacts the manifestations of TB.
Main Methods:
- Retrospective study of 60 patients co-infected with HIV and TB.
- Analysis of clinical data, CD4 cell counts, TB site involvement, and radiographic findings.
Main Results:
- Most patients (93%) had advanced HIV with CD4 counts < 200/mm3.
- Extrapulmonary (50%) and disseminated tuberculosis (25%) were common.
- Pulmonary TB showed atypical radiographic patterns in 38% of cases.
Conclusions:
- HIV co-infection frequently presents with advanced immunodeficiency.
- Extrapulmonary and disseminated TB are prevalent in this population.
- Atypical radiographic findings are characteristic of pulmonary TB in HIV-infected individuals.
Objective:
The purpose of the present study was to evaluate the impact of HIV infection on the clinical presentation of tuberculosis.
Methodology:
We retrospectively studied the impact of HIV infection on the clinical presentation of tuberculosis. A total of 60 consecutive patients co-infected with HIV and tuberculosis were identified.
Results:
Majority were male (88.3%) and the most common transmission category was heterosexual contact (80%). Most were in the advanced stage of HIV infection; 93% had CD4 cell count less than 200/mm3. Concerning the site of tuberculosis involvement, 37% had pulmonary involvement alone, 13% had extrapulmonary disease involving one single site, 50% had both pulmonary and extrapulmonary involvement. Fifteen (25%) patients also met the criteria of disseminated tuberculosis, who had a significantly lower mean CD4 cell count than those with pulmonary involvement alone (mean 40 vs 102; P = 0.048). Chest radiographs comprised a wide spectrum of manifestations. A considerable proportion had primary pulmonary tuberculosis pattern (38%) and normal radiographs (8.5%).
Conclusions:
Our patients generally had advanced HIV infection; 93% of those had CD4 lymphocyte count < 200/mm3. Extrapulmonary involvement and disseminated disease were common. Radiographic manifestations of pulmonary tuberculosis were often 'atypical' due to the greater proportion of primary tuberculosis among our patients.