Comparison of the Clinical and Chest X-ray Features of Smear Positive HIV-positive and HIV- negative Pulmonary Tuberculosis Patients on DOTS-therapy in a Tertiary Hospital in Nigeria
Keywords:
PTB, DOTSAbstract
Objective: The objective of this study is to determine the differences in the clinical and chest x-ray features of HIV-positive and HIV-negative pulmonary tuberculosis patients on DOTS at the National Hospital Abuja.
Methodology: The clinical features of all smear positive pulmonary tuberculosis patients were recorded at diagnosis, completion of intensive phase, at fifth, seventh month and at completion of DOTS. Samples seropositive with both stat-pak and determine were considered HIV positive while Genie was used as a tie-breaker. Chest x-rays were done at diagnosis, on completion intensive phase and at the end of DOTS treatment. The results were analysed using SPSS version 13.0
Results: Of the 390 patients studied heemoptysis was found in 68(36.9%) of the HIV-positive patients as against 144(75%) in the HIV-negative patients p=0.001. Lower number of the HIV- negative patients presented with night sweat at diagnosis. (HIV negative versus HIV- positive patients)was167(84%).versus160(87.0%) P=0.130.There was a no observed significant difference in the sputum AAFB density between the HIV positive and the HIV- negative patients. 17(7.2%) of HIV positive and 12(5.7%) of the HIV negative patients) had + sputum density (P=0.03. There was similarity in the clinical response in the two groups during the course of therapy. The mean CD4 cell count in the HIV positive patients was observed to rise progressively from (118.79 ±78.79) cells/mm3 at diagnosis to (203 ±85.99)cells/mm3 irrespective of whether they are on HAART or not. The chest x-rays features at diagnosis of the HIV positive patients showed fibrosis 59(29.9%), cavitory 41(22.3%), pleural effusion 10 (5.4%) and infiltrates 8(4.3%) as against fibrosis 84(40.7%), cavitary 65(31.2%), 5 (2.4%) and infiltrates 8(3.9%) in the HIV negative patients (p=0.143).
Conclusion: The significant difference in sputum AAFB density in the HIV-positive and HIV- negative patients, underscores the need for high index of suspicion of PTB in HIV-positive patient presenting with cough of >3 weeks. The less fibrosis, cavitory lesions and more infiltrates seen on chest x-rays of HIV positive patients though not statistically significant highlights the relevance of chest x-ray in the management of PTB in the HIV-positive patients.
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