[Correlation of the manifestations of tuberculosis and the degree of immunosuppression in patients with HIV]

Rev Mal Respir. 2013 Sep;30(7):549-54. doi: 10.1016/j.rmr.2013.01.003. Epub 2013 Jan 30.
[Article in French]

Abstract

Context: Correlation of the manifestations of tuberculosis and the degree of immunosuppression in patients with HIV.

Background: The advent of HIV has contributed to the increase in the number of people with tuberculosis. The clinical and paraclinical of TB/HIV co-infected are polymorphic and function of immune status.

Objectives: To determines the clinical and paraclinical characteristics of TB related to different levels of CD4 lymphocytes.

Methodology: A retrospective case series based on analysis of 450 patients with both TB/HIV co-infections. It focused on the records of patients with pulmonary smear-positive (TPM +) with a positive HIV status. The effect of immunosuppression was analyzed in groups based on the CD4 count (<200/mm(3), of 200-350/mm(3) and>350/mm(3)), in a chronological fashion from April to September 2010 until there were 150 patients in each CD4 group.

Results: Among the 450 patients, 71.1% were between 25 and 45years old. The clinical signs were more significant as the level of CD4 fell. The clinical signs were predominantly fever (93%) and weight loss (62.7%). Pulmonary cavitation (59.3%), infiltrates (38.7%) and the location of the lesions at the lung apex (72%) were more common in the third group patients. By contrast, extra pulmonary lesions (mediastinal lymphadenopathy, pleurisy) and normal x-ray (9.3%) were more frequent in patients of the first group. The scarcity of cavitations (22.3% compared to 59.3% CD4>350) and the increase in associated lesions became more marked if patients were immunocompromised. Hematologic, hepatic, renal disorders were more frequent and severe in the most immunocompromised patient group.

Conclusion: HIV-associated tuberculosis has an atypical clinical, radiological, biological presentation and is more severe when there is significant immunosuppression.

Keywords: Biologie; Biology; CD4; Clinical radiology; Clinique; Côte d’Ivoire; HIV; Radiologie; Tuberculose; Tuberculosis; VIH.

MeSH terms

  • AIDS-Related Opportunistic Infections* / diagnostic imaging
  • AIDS-Related Opportunistic Infections* / immunology
  • AIDS-Related Opportunistic Infections* / pathology
  • Adult
  • Coinfection / immunology
  • Female
  • HIV Infections / complications*
  • HIV Infections / immunology*
  • HIV-1*
  • Humans
  • Immune Tolerance*
  • Male
  • Middle Aged
  • Radiography
  • Retrospective Studies
  • Severity of Illness Index
  • Socioeconomic Factors
  • Tuberculosis, Pulmonary* / diagnostic imaging
  • Tuberculosis, Pulmonary* / immunology
  • Tuberculosis, Pulmonary* / pathology
  • Young Adult