Significant variation in presentation of pulmonary tuberculosis across a high resolution of CD4 strata

Int J Tuberc Lung Dis. 2010 Oct;14(10):1295-302.


Background: The human immunodeficiency virus (HIV) alters the presentation of pulmonary tuberculosis (PTB), but it remains unclear whether alterations occur at a CD4 cell threshold or throughout HIV infection.

Objective: To better understand the relationship between CD4 count and clinical and radiographic presentation of PTB.

Setting and design: Initial presentations of culture-confirmed PTB patients evaluated at a Ugandan national TB referral center and an affiliated research unit were compared by HIV status and across 11 CD4 cell count strata: 0-50 to >500 cells/μl.

Results: A total of 873 HIV-infected PTB cases were identified. Among HIV-infected PTB cases with CD4 < 50, 21% had a normal chest X-ray (CXR) vs. 2% with CD4 > 500, with a continuous trend across CD4 strata (test for trend, P < 0.001). All radiographic manifestations of PTB displayed significant trends across CD4 strata. HIV-infected vs. non-HIV-infected patients had no significant difference in CXR findings of miliary patterns or pleural effusion at CD4 > 100, normal CXR or fibrosis at CD4 > 150, adenopathy at CD4 > 250, and cavitation or upper lung disease at CD4 > 300. Twenty-three per cent of co-infected cases with CD4 < 50 and 1% with CD4 > 500 had negative acid-fast bacilli (AFB) smears, with a significant trend between (P < 0.001).

Conclusion: Variations in CXR appearance and AFB smear correlate with CD4 decline in significant, continuous trends.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Bacteriological Techniques
  • CD4 Lymphocyte Count*
  • Chi-Square Distribution
  • HIV Infections / complications
  • HIV Infections / immunology*
  • HIV Infections / virology
  • Humans
  • Logistic Models
  • Mycobacterium tuberculosis / isolation & purification
  • Predictive Value of Tests
  • Radiography, Thoracic
  • Retrospective Studies
  • Sputum / microbiology
  • Tuberculosis, Pulmonary / complications
  • Tuberculosis, Pulmonary / diagnosis*
  • Tuberculosis, Pulmonary / diagnostic imaging
  • Tuberculosis, Pulmonary / immunology
  • Tuberculosis, Pulmonary / microbiology
  • Uganda