RADIOGRAPHIC FINDINGS IN HIV-POSITIVE PATIENTS WITH SENSITIVE AND RESISTANT TUBERCULOSIS

To facilitate early recognition of multi-drug resistant (MDR) Mycobact erium tuberculosis (MTB) disease in HIV-positive patients we evaluated the chest x-ray films of 72 patients in a tertiary care center in New York City. Thirty-three patients had sensitive MTB, 3 had single-drug resistant (SDR) MTB, and 36 patients had multidrug resistant (MDR) MT B. All chest x-ray films were reviewed and correlated with drug sensit ivities, additional diagnostic results, and clinical courses. There we re no significant radiographic differences among the 3 groups on initi al presentation (p>0.05). Cavities were found in 12 patients, upper lo be disease in 23, lower lobe disease in 15, possible intrathoracic lym phadenopathy in 30, diffuse infiltrates in 12, pleural effusion in 13, and a miliary pattern in 3 patients. Normal chest x-ray films were fo und in ten patients. After 2 weeks of therapy, 20 out of 35 MDR-MTB pa tients developed new effusions, possible intrathoracic lymphadenopathy , or worsening infiltrates. With deterioration, the probability of MDR MTB was 95 percent in our case control study. Thus, it would be reaso nable to adjust antituberculosis therapy in HIV-positive patients with deteriorating conditions shown on chest x-ray films after 2 weeks of therapy.