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

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/mm3, of 200-350/mm3 and > 350/mm3), 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 45 years 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. © 2013 Published by Elsevier Masson SAS on behalf of SPLF.