ACTIVE PULMONARY TUBERCULOSIS IN PATIENTS WITH AIDS - SPECTRUM OF RADIOGRAPHIC FINDINGS (INCLUDING A NORMAL APPEARANCE)

PURPOSE: To assess the efficacy of chest radiography in the detection of active pulmonary tuberculosis in patients with acquired immunodefic iency syndrome (AIDS). MATERIALS AND METHODS: Initial interpretations of chest radiographs of 133 adult patients with AIDS and positive sput um or bronchoalveolar lavage cultures for Mycobacterium tuberculosis w ere reviewed. Radiographic findings were correlated with CD4 T-cell co unts, sputum stains for acid-fast bacilli (AFB), and antituberculous d rug sensitivity. RESULTS: Forty-eight (36%) patients had a primary M t uberculosis pattern, 38 (28%) had a postprimary M tuberculosis pattern , 19 (14%) had normal radiographs, 17 (13%) had atypical infiltrates, seven (5%) had minimal radiographic changes, and four (3%) had a milia ry pattern. Normal chest radiographs were seen for 10 (21%) of 48 pati ents with less than 200 T cells per microliter and one (5%) of 20 pati ents with more than 200 T cells per microliter. Drug sensitivity and s putum staining for AFB did not correlate with radiographic findings. O verall, 19% of cases had multidrug resistance to antituberculous medic ations. CONCLUSION: Chest radiographs did not suggest active tuberculo sis in 43 (32%) of 133 AIDS patients with active pulmonary tuberculosi s.