CD4 T Lymphocyte Count and the Radiographic Presentation of Pulmonary Tuberculosis

A Study of the Relationship Between These Factors in Patients With Human Immunodeficiency Virus Infection

¹ From the Department of Diagnostic Radiology, Hospital of the University of Pennsylvania, Philadelphia
² From the Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia

Background: Pulmonary infection and tumor in the AIDS population has a variable clinical and radiographic presentation. The association between the radiographic presentation of pulmonary tuberculosis and CD4 T lymphocyte count in the HIV-infected patient is investigated in order to provide an empirical approach for early diagnosis, treatment, and isolation of infected subjects.

Methods: A retrospective analysis of chest radiographs, CD4 T lymphocyte counts, and clinical history of 35 subjects from 3 urban hospitals was performed. All subjects were HIV-seropositive and had culture-proven pulmonary tuberculosis. Radiographs were evaluated for the presence of either a pattern characteristic of post-primary tuberculosis (typical pattern) or a pattern uncharacteristic of post-primary infection (atypical pattern).

Results: Twenty-one of 26 subjects with a CD4 T lymphocyte count less than 0.20x10⁹ cells/L, whereas only 1 of 9 subjects with a CD4 T lymphocyte count of 0.20x10⁹ cells/L or more presented with an atypical pattern of pulmonary tuberculosis (p<0.001). The mean CD4 T lymphocyte counts of those subjects presenting with atypical versus typical radiographic pattern of post-primary pulmonary tuberculosis were 0.069 x 10⁹ cells/L (n=22) and 0.323x10⁹ cells/L (n=13), respectively (p<0.01). Twenty-one of the 22 subjects with an atypical radiographic pattern of pulmonary tuberculosis were significantly immunosuppressed (CD4<0.20 x 10⁹ cells/L). Atypical radiographic pattern included diffuse and lower lobar opacities, pleural effusion, mediastinal adenopathy, interstitial nodules, and a normal chest radiograph.

Conclusion: AIDS patients presenting with CD4 count less than 0.20x10⁹ cells/L and an atypical radiographic pattern for pulmonary tuberculosis are at risk for tuberculous infection requiring appropriate treatment and isolation until the diagnosis of pulmonary tuberculosis has been excluded.

Key Words: AIDS • CD4 lymphocyte • chest radiograph • HIV infection • pulmonary tuberculosis

Submitted on November 12, 1993
Accepted on May 17, 1994

This article has been cited by other articles:

				H. M. Kizza, B. Rodriguez, M. Quinones-Mateu, M. Mirza, H. Aung, B. Yen-Lieberman, C. Starkey, L. Horter, P. Peters, J. Baseke, et al. Persistent Replication of Human Immunodeficiency Virus Type 1 despite Treatment of Pulmonary Tuberculosis in Dually Infected Subjects Clin. Vaccine Immunol., November 1, 2005; 12(11): 1298 - 1304. [Abstract] [Full Text] [PDF]

				P. R. Skolnik and E. J. Mark Case 5-1999- A 37-Year-Old Man with Fever and Diffuse Lymphadenopathy N. Engl. J. Med., February 18, 1999; 340(7): 545 - 554. [Full Text] [PDF]

				Am. J. Respir. Crit. Care Med., April 1, 1998; 157(4): 1348 - 1350. [Full Text] [PDF]

				B. E. JONES, R. RYU, Z. YANG, M. D. CAVE, J. M. POGODA, M. OTAYA, and P. F. BARNES Chest Radiographic Findings in Patients with Tuberculosis with Recent or Remote Infection Am. J. Respir. Crit. Care Med., October 1, 1997; 156(4): 1270 - 1273. [Abstract] [Full Text] [PDF]

				S.R. Benatar and E.J. Mark Case 23-1995- A 44-year-old woman with pulmonary infiltrates, respiratory failure, and pancytopenia N. Engl. J. Med., July 27, 1995; 333(4): 241 - 248. [Full Text] [PDF]