HIV-INFECTION AND MALNUTRITION CHANGE THE CLINICAL AND RADIOLOGICAL FEATURES OF PULMONARY TUBERCULOSIS

Patients with HIV infection have atypical clinical features of pulmona ry tuberculosis; however, our knowledge on how malnutrition affects th e clinical presentation is limited. We studied the influence of malnut rition and HIV infection on the clinical and radiological features of pulmonary tuberculosis (TB), We studied 239 consecutive acid fast baci llus-positive adult patients, Patients were investigated by clinical, radiological, anthropometric and laboratory methods. 78% of the patien ts were malnourished (BMI < 18.5) and 43% were severely malnourished ( BMI < 16). 20% were HIV-positive. HIV-positive TB had significantly mo re oral candidiasis (OR = 3.72), diarrhoea (OR = 2.71), generalized ly mphadenopathy (OR = 2.63), skin disorders (OR = 2.27), neuropsychiatri c illness (OR = 2.44), hilar lymphadenopathy (OR = 2.07), but less cav itation (OR = 0.64) and upper lung lobe involvement (OR = 0.70). HIV-n egative and severe malnourished patients presented more often with dys pnoea (OR=1.44), diarrhoea (OR=1.64), night sweat (OR=1.83), and less with haemoptysis (OR=0,58) and cavitation (OR = 0.61), The size of Man toux was associated with HIV infection and malnutrition. In a logistic regression analysis both HIV status and malnutrition were associated with atypical presentation of pulmonary tuberculosis. Malnutrition and HIV infection both contribute for atypical presentation of pulmonary tuberculosis. The risk of such atypical presentation is particularly h igh among the severely malnourished HIV-infected patients.