Pulmonary tuberculosis in HIV positive individuals: preliminary report on clinical features and response to treatment

Abstract

Objectives: To study the clinical, radiological and immunological profile of pulmonary tuberculosis in HIV infected patients and assess the response to short-course chemotherapy regimens. Methods: Seventy eight patients (68 males and 10 females) with HIV infection and having symptoms suggestive of tuberculosis attending the Government Hospital for Thoracic Medicine, Tambaram or the Tuberculosis Research Centre, Chennai were studied. The diagnosis of tuberculosis was based on clinical evaluation, bacteriological examination including sputum smear and culture and chest skiagram. HIV diagnosis was based on two tests (rapid/ELISA), detecting different antigens. CD4+ T cell counts were done on all patients initially and at the end of treatment. Blood tests and skiagrams were repeated at 2 months and at the end of treatment. All the patients were treated with standard (RNTCP) short course regimens. Patients were given all the doses under supervision during the initial intensive phase and through community DOTS providers in the continuation phase. Results: Sixty five patients had culture confirmed pulmonary tuberculosis, of whom 54 had smear positive disease, initially. The radiological manifestations were varied, with 11 subjects having miliary tuberculosis, 54 with non-homogeneous opacities and 10 with cavitation. The mean CD4 cell count at intake was 192 ± 172 cells/cumm. Patients showed good initial response to treatment with significant weight gain. At the end of 2 months of treatment, 91% of patients had sputum cultures negative for Mycobacterium tuberculosis. However, the CD4 % fell significantly by the sixth month. The study is being continued to assess the long-term response to SCC of patients with HIV and tuberculosis. Conclusions: Tuberculosis has a varied clinical presentation in patients with HIV infection. The spectrum of radiographic features ranges from normal to a miliary pattern. Inspite of clinical and bacteriological improvement during treatment, immunologic deterioration may continue.