Pulmonary tuberculosis: radiological features in west Africans coinfected with HIV

A retrospective study was performed to document and compare the radiologica l appearances of newly diagnosed pulmonary tuberculosis (PTB) in groups of West African patients with (n=86) and without (n=106) human immunodeficienc y virus (HIV) coinfection. Analysis of chest radiographs showed that the HI V-positive group had less consolidation (mean 3.1 zones vs 3.7 zones;p<0.05 ), less apical involvement (64.0% vs 85.5%; p<0.001), less bronchopulmonary spread (27.9% vs 58.5%; p<0.001), less volume loss (53.5% vs 76.4%; p<0.00 1) and less pleural thickening (46.5% vs 61.3%; p<0.05) compared with the H IV-negative group. However, HIV-positive patients more commonly had pleural effusions (17.4% vs 6.6%; p<0.05) and lymphadenopathy (9.3% vs 1.9%; p<0.0 5). Previous studies on this subject from sub-Saharan Africa have focused e ither on selected patient groups likely to have more advanced immunosuppres sion or on smear-positive cases only, or where there has been only limited radiological documentation. This study suggests that the highly significant differences that exist may not be as frequent as previously shown. The low er frequencies of bronchopulmonary pattern of consolidation and pleural thi ckening in HIV-positive subjects have not previously been documented. The p ossible reasons for the altered radiographic appearance of PTB in HIV posit ive subjects are discussed.