Lavanya Devi Palaniswamy1, Moogaambiga Solai Raja Pandiyan2, Punitha Murugesan3
BACKGROUND
Tuberculosis is often more difficult to diagnose and more complicated to treat
among people who are human immunodeficiency virus (HIV) positive. This study
was conducted to assess the clinical, microbiological, laboratory and radiological
spectrum of tuberculosis (TB) in HIV seropositive patients, and explore its possible
correlation with their CD4 count.
METHODS
A total of 104 patients who were western blot positive for HIV and co-infected with
tuberculosis were studied in Salem district of Tamil Nadu. A detailed history was
obtained and patients were examined clinically. CD4 count, sputum smear for acid
fast bacilli (AFB), chest x-ray, and tuberculin test, were done along with other
relevant investigations. The relationship between CD4 count, and the type of
tuberculosis, sputum smear, chest x-ray, and tuberculin test, were analysed
statistically, and P < 0.05 was considered significant.
RESULTS
Most of the patients were between 30 to 39 years. Males (84.6 %) outnumbered
females (15.4 %). Pulmonary tuberculosis alone was seen in 47 patients, while
extra pulmonary tuberculosis in 36 cases, and both pulmonary and extra
pulmonary occurred in 21 cases. They had a mean CD4 count of 237.7 cells / μL,
135.2 cells / μL and 120.9 cells / μL respectively. Extrapulmonary tuberculosis and
combined forms were associated with lower CD4 counts (P-value 0.005). The
mean CD4 count of sputum positive, sputum negative, and multiple drug resistant
(MDR) tuberculosis were 294.2, 168.3 and 90.2 cells / μL respectively. Lower CD4
count was associated with sputum - ve TB (P < 0.041). Lower CD4 counts were
associated with atypical chest X-ray findings (P < 0.006) and negative tuberculin
test (P < 0.001).
CONCLUSIONS
Sputum smear positivity for AFB decreases as CD4 count reduces. Involvement of
lungs tend to be atypical in immunocompromised patients. The diagnosis of TB in
HIV positive individuals is complex and a high index of suspicion is needed.
