CD4 T-LYMPHOCYTE COUNT AND THE RADIOGRAPHIC PRESENTATION OF PULMONARYTUBERCULOSIS - A STUDY OF THE RELATIONSHIP BETWEEN THESE FACTORS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Background: Pulmonary infection and tumor in the AIDS population has a variable clinical and radiographic presentation. The association betw een the radiographic presentation of pulmonary tuberculosis and CD4 T lymphocyte count in the HIV-infected patient is investigated in order to provide an empirical approach for early diagnosis, treatment, and i solation of infected subjects. Methods: A retrospective analysis of ch est radiographs, CD4 T lymphocyte counts, and clinical history of 35 s ubjects from 3 urban hospitals was performed. All subjects were HIV-se ropositive and had culture-proven pulmonary tuberculosis. Radiographs were evaluated for the presence of either a pattern characteristic of post-primary tuberculosis (typical pattern) or a pattern uncharacteris tic of post-primary infection (atypical pattern). Results: Twenty-one of 26 subjects with a CD4 T lymphocyte count less than 0.20X10(9) cell s/L, whereas only 1 of 9 subjects with a CD4 T lymphocyte count of 0.2 0X10(9) cells/L or more presented with an atypical pattern of pulmonar y tuberculosis (p<0.001). The mean CD4 T lymphocyte counts of those su bjects presenting with atypical versus typical radiographic pattern of post-primary pulmonary tuberculosis were 0.069 x 10(9) cells/L (n=22) and 0.323X10(9) cells/L (n=13), respectively (p<0.01). Twenty-one of the 22 subjects with an atypical radiographic pattern of pulmonary tub erculosis were significantly immunosuppressed (CD4<0.20 x 10(9) cells/ L). Atypical radiographic pattern included diffuse and lower lobar opa cities, pleural effusion, mediastinal adenopathy, interstitial nodules , and a normal chest radiograph. Conclusion: AIDS patients presenting with CD4 count less than 0.20X10(9) cells/L and an atypical radiograph ic pattern for pulmonary tuberculosis are at risk for tuberculous infe ction requiring appropriate treatment and isolation until the diagnosi s of pulmonary tuberculosis has been excluded.