Impact of immunosuppression on radiographic features of HIV related pulmonary tuberculosis among Nigerians

Objective: The impact of immunosuppression on radiographic manifestation of HIV related pulmonary tuberculosis among Nigerians was studied. Material and Method: We recruited 127 cases of HIV related pulmonary tuberculosis at the Federal Medical Centre Yola Adamawa state, Nigeria. Demographic information, smoking history and results of sputum smear for AAFB, chest radiographic findings and blood CD4 counts were obtained. Subjects were subdivided into two groups: Group I (CD4 count < 200cell/mm3) and Group II (CD4 count ≥ 200cell/mm3). Results: Of the 127 subjects, 74 were males and 53 were females. The mean age of the subjects was 35.1±8.4 years and the mean CD4 count was 166±100 cell/mm3. There were 93(73.2%) in Group I and 34(26.8%) in Group II. Mediastinal lymphadenopathy, middle and lower lung zone involvement, bilateral lung involvement, miliary or disseminated patterns as well as normal chest radiographs were found more frequently in Group I. Cavitations, upper lung zone involvement, pleural effusion and bilateral lung infiltrate were found more frequently in Group II. Conclusion: Severe immunosuppression was significantly associated with atypical radiological findings of TB, while mild immunosuppression was significantly associated with typical pulmonary tuberculosis. The physician needs to be aware of the impact of immunosuppression on radiographic manifestation of HIV related pulmonary tuberculosis.