PULMONARY TUBERCULOSIS IN HIV-INFECTION - RADIOGRAPHIC APPEARANCE IS RELATED TO CD4(-LYMPHOCYTE COUNT() T)

Setting: An adult HIV outpatient clinic in Cape Town, South Africa. Ob jective: To investigate the relationship between the radiographic appe arance of pulmonary tuberculosis (PTB) in HIV infected patients and CD 4(+) T-lymphocyte count. Design: Pretreatment radiographs of 150 patie nts with newly diagnosed PTB were reviewed. CD4(+) T-lymphocyte count was used as a marker of HIV disease progression. Results: Upper zone i nfiltrate typical of PTB reactivation was present in 18 patients. This pattern was associated with early HIV infection (mean CD4(+) T-cell c ount 389) and had 78% positive predictive value for identifying patien ts with > 200 CD4(+) T-lymphocytes/mu L. Pleural effusion was present in 32 patients and occurred over a wide intermediate range of CD4(+) T -cell counts (mean 185). Lower or midzone infiltrates, adenopathy, int erstitial pattern or normal radiograph occurred in 136 patients and we re associated with advanced HIV disease (mean CD4(+) T-cell count 105) . These patterns had 84%, 89%, 89% and 100% positive predictive value, respectively, for identifying patients with < 200 CD4(+) T-cells/mu L . Conclusion: Pulmonary tuberculosis in African HIV-positive patients presents with a spectrum of radiographic abnormalities, and specific p atterns are predictive of stage of HIV disease progression. In patient s dually infected with HIV and PTB, chest radiographs are a useful adj unct to clinical staging.