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Current HIV Research

Editor-in-Chief

ISSN (Print): 1570-162X
ISSN (Online): 1873-4251

Research Article

Correlation Between Clinical Manifestation and Radiological Findings In Pulmonary Tuberculosis-Human Immunodeficiency Virus Coinfection Patients In Sanglah Hospital, Bali, Indonesia

Author(s): Putu Satyakumara Upadhana*, Haikal Hamas Putra Iqra, I Gusti Agung Ayu Chintya Cahyarini, I Ketut Agus Somia and Pande Putu Yuli Anandasari

Volume 18, Issue 6, 2020

Page: [426 - 435] Pages: 10

DOI: 10.2174/1570162X18666200804152126

Price: $65

Abstract

Background: Tuberculosis (TB) mono-infection has radiological features and typical clinical manifestations that are easily recognized by clinicians. These radiological features and clinical manifestations are often found to show atypical features in subjects coinfected with Tuberculosis- Human Immunodeficiency Virus (HIV), making TB diagnosis and early management challenging to establish.

Objective: The aim of this study was to determine the relationship between the clinical and radiological presentation of pulmonary TB patients with HIV coinfection at the Central General Hospital Sanglah, Bali.

Methods: This research was an observational analytic study with a cross-sectional method. A total of 54 TB-HIV coinfected patients were analyzed to their sociodemographic characteristics, clinical manifestations and chest radiographic features.

Results: The majority of subjects were of productive age (26-61 years), male (64.8%) and belonged to the heterosexual group (90.7%). Weight loss (75.9%), cough (64.8%) and oral candidiasis (53.7%) are the most common clinical manifestations found in subjects, especially in subjects with CD4+ >200 cells/mm3. Atypical radiological features such as infiltration/consolidation (59.3%), fibrosis (16.7%) and hillar lymphadenopathy (14.8%) are the most commonly obtained radiological features of the subjects. From the results of the bivariate analysis, it was found that radiological features in the form of infiltration/consolidation were more commonly found in subjects with CD4+ <200 cells/mm3 (OR=1.254; 95% CI 1.059-1.568).

Conclusion: Based on the research that has been done, it can be concluded that there are no typical radiological features and clinical manifestations in patients with TB-HIV infection.

Keywords: Tuberculosis, human Immunodeficiency virus, chest radiological features, clinical manifestation, TB-HIV coinfection, CD4+ levels.

Graphical Abstract
[1]
Centers for Disease Control and Prevention. TB   HIV Coinfection 2020.https://www.cdc.gov/tb/topic/basics/tbhivcoinfection.htm
[2]
World Health Organization. Tuberculosis (TB) 2020.https://www.who.int/tb/en/
[3]
Mohanty T, Meher BK, Jayakumar R, Pattnaik J, Dash MR. Patterns of Presentations (Clinicoradiological) in HIV-TB Co-infection. Indian Journal of Research 2017; 6(9): 85-7.
[4]
Campbell IA, Bah-Sow O. Pulmonary tuberculosis: diagnosis and treatment. BMJ 2006; 332(7551): 1194-7.
[http://dx.doi.org/10.1136/bmj.332.7551.1194] [PMID: 16709993]
[5]
Bruchfeld J, Correia-Neves M, Källenius G. Tuberculosis and HIV Coinfection. Cold Spring Harb Perspect Med 2015; 5(7): a017871.
[http://dx.doi.org/10.1101/cshperspect.a017871] [PMID: 25722472]
[7]
Tuberculosis and HIV World Health Organization 2020.https://www.who.int/hiv/topics/tb/en/
[9]
Pusat Data dan Informasi - Kementerian Kesehatan Republik Indonesia kemkes.go.id2020.https://pusdatin.kemkes.go.id/article/view/17020100001/situasi-penyakit-hiv-aids-di-indonesia.html
[10]
Januraga PP, Wulandari LP, Muliawan P, et al. Sharply rising prevalence of HIV infection in Bali: a critical assessment of the surveillance data. Int J STD AIDS 2013; 24(8): 633-7.
[http://dx.doi.org/10.1177/0956462413477556] [PMID: 23970574]
[11]
Profil Kesehatan Provinsi Bali Tahun 2015 - Dinas Kesehatan Provinsi Bali Dinas Kesehatan Provinsi Bali 2020.https://www.diskes.baliprov.go.id/download/profil-kesehatan-provinsi-bali-tahun-2015/
[12]
Muliawan P, Sawitri A. Prevalence of HIV Infection Among Tuberculosis Patients in Bali, Indonesia. Bali Medical Journal 2016; 5(1): 75.
[http://dx.doi.org/10.15562/bmj.v5i1.272]
[13]
Arsana US. Characteristics of TB-HIV coinfection sufferers in the VCT / CST Polyclinic at Sanglah Hospital In: Proceeding book of Konas PETRI XVII: 2011; Semarang, Indonesia. 2011.
[14]
Nyoko YO, Eka Putra IW, Sarwitri AA. Hubungan karakteristik demografi, klinis dan faktor risiko terinfeksi HIV dengan koinfeksi HIV/TB di Klinik Amertha Yayasan Kerti Praja Denpasar. Public Health and Preventive Medicine Archive 2014; 2(2): 124-32.
[http://dx.doi.org/10.15562/phpma.v2i2.131]
[15]
de Albuquerque MdeF, Albuquerque SC, Campelo AR, et al. Radiographic features of pulmonary tuberculosis in patients infected by HIV: is there an objective indicator of co-infection? Rev Soc Bras Med Trop 2001; 34(4): 369-72.
[http://dx.doi.org/10.1590/S0037-86822001000400010] [PMID: 11562731]
[16]
Ravi N, Nagaraj B, Singh B, Kumar S. A study of various chest radiological manifestations of pulmonary tuberculosis in both human immunodeficiency virus-positive and human immunodeficiency virus-negative patients in south Indian population. West Afr J Radiol 2017; 24(1): 14.
[http://dx.doi.org/10.4103/1115-3474.192751]
[17]
Padyana M, Bhat RV, Dinesha M, Nawaz A. HIV-Tuberculosis: A study of chest x-ray patterns in relation to CD4 count. N Am J Med Sci 2012; 4(5): 221-5.
[http://dx.doi.org/10.4103/1947-2714.95904] [PMID: 22655281]
[18]
Pawlowski A, Jansson M, Sköld M, Rottenberg ME, Källenius G. Tuberculosis and HIV co-infection. PLoS Pathog 2012; 8(2): e1002464.
[http://dx.doi.org/10.1371/journal.ppat.1002464] [PMID: 22363214]
[19]
Kistan J, Laher F, Otwombe K, et al. Pulmonary TB: varying radiological presentations in individuals with HIV in Soweto, South Africa. Trans R Soc Trop Med Hyg 2017; 111(3): 132-6.
[http://dx.doi.org/10.1093/trstmh/trx028] [PMID: 28633335]
[20]
Fite R, Chichiabellu T, Demissie B, Hanfore L. Tuberculosis and HIV Co-infection and associated factors among HIV reactive patients in Ethiopia. Journal of Nursing and Midwifery Sciences 2019; 6(1): 15.
[http://dx.doi.org/10.4103/JNMS.JNMS_50_18]
[21]
RI Ministry of Health. National Guidelines for Tuberculosis Control. Jakarta: Ministry of Health RI 2014.
[22]
Nachiappan AC, Rahbar K, Shi X, et al. Pulmonary tuberculosis: Role of radiology in diagnosis and management. Radiographics 2017; 37(1): 52-72.
[http://dx.doi.org/10.1148/rg.2017160032] [PMID: 28076011]
[23]
Sterling TR, Pham PA, Chaisson RE. HIV infection-related tuberculosis: clinical manifestations and treatment. Clin Infect Dis 2010; 50(s3)(Suppl. 3): S223-30.
[http://dx.doi.org/10.1086/651495] [PMID: 20397952]
[24]
Vasilyeva E, Lozovskaya M, Klochkova L, Yarovaya Y. Clinical Presentation, Diagnosis and Management of TB-HIV Comorbidity in Children Advances in HIV and AIDS Control 2018.
[25]
Patel AK, Thakrar SJ, Ghanchi FD. Clinical and laboratory profile of patients with TB/HIV coinfection: A case series of 50 patients. Lung India 2011; 28(2): 93-6.
[http://dx.doi.org/10.4103/0970-2113.80316] [PMID: 21712939]
[26]
Montales MT, Chaudhury A, Beebe A, Patil S, Patil N. HIV-Associated TB Syndemic: A growing clinical challenge worldwide. Front Public Health 2015; 3: 281.
[http://dx.doi.org/10.3389/fpubh.2015.00281] [PMID: 26779470]
[27]
Liberato IR, de Albuquerque MdeF, Campelo AR, de Melo HR, Melo D. Characteristics of pulmonary tuberculosis in HIV seropositive and seronegative patients in a Northeastern region of Brazil. Rev Soc Bras Med Trop 2004; 37(1): 46-50.
[http://dx.doi.org/10.1590/S0037-86822004000100012] [PMID: 15042183]
[28]
Kamat AG, Hesarur V. Clinical and Laboratory Profile of Sputum Positive Pulmonary Tuberculosis Among HIV Seropositive and HIVSeronegative Patients- A Cross-Sectional Study. Journal of Evidence Based Medicine and Healthcare 2017; 4(41): 2461-7.
[http://dx.doi.org/10.18410/jebmh/2017/486]
[29]
Dravid A, Natarajan K, Medisetty M, et al. Incidence of tuberculosis among HIV infected individuals on long term antiretroviral therapy in private healthcare sector in Pune, Western India. BMC Infect Dis 2019; 19(1): 714.
[http://dx.doi.org/10.1186/s12879-019-4361-0] [PMID: 31409289]
[30]
Prado TN, Rajan JV, Miranda AE, et al. Clinical and epidemiological characteristics associated with unfavorable tuberculosis treatment outcomes in TB-HIV co-infected patients in Brazil: a hierarchical polytomous analysis. Braz J Infect Dis 2017; 21(2): 162-70.
[http://dx.doi.org/10.1016/j.bjid.2016.11.006] [PMID: 27936379]
[31]
Ruiz L, Maya MA, Rueda ZV, López L, Vélez LA. [Current characteristics of tuberculosis and human immunodeficiency virus co-infection in a cohort of hospitalized patients in Medellín, Colombia]. Biomedica 2018; 38(0): 59-67.
[http://dx.doi.org/10.7705/biomedica.v38i3.3862] [PMID: 30184364]
[32]
Călărașu C, Niţu M, Olteanu M, Golli AL, Dumitrescu F, Olteanu M. Pulmonary tuberculosis with atypical presentation because of unknown previous HIV infection – case report. Pneumologia 2019; 68(1): 41-5.
[http://dx.doi.org/10.2478/pneum-2019-0011]
[33]
Trinh QM, Nguyen HL, Nguyen VN, Nguyen TV, Sintchenko V, Marais BJ. Tuberculosis and HIV co-infection-focus on the Asia- Pacific region. Int J Infect Dis 2015; 32: 170-8.
[http://dx.doi.org/10.1016/j.ijid.2014.11.023] [PMID: 25809776]
[34]
Mabunda TE, Ramalivhana NJ, Dambisya YM. Mortality associated with tuberculosis/HIV co-infection among patients on TB treatment in the Limpopo province, South Africa. Afr Health Sci 2014; 14(4): 849-54.
[http://dx.doi.org/10.4314/ahs.v14i4.12] [PMID: 25834493]
[35]
Straetemans M, Bierrenbach AL, Nagelkerke N, Glaziou P, van der Werf MJ. The effect of tuberculosis on mortality in HIV positive people: a meta-analysis. PLoS One 2010; 5(12): e15241.
[http://dx.doi.org/10.1371/journal.pone.0015241] [PMID: 21209936]
[36]
Podlekareva DN, Panteleev AM, Grint D, et al. HIV/TB study group. Short- and long-term mortality and causes of death in HIV/tuberculosis patients in Europe. Eur Respir J 2014; 43(1): 166-77.
[http://dx.doi.org/10.1183/09031936.00138712] [PMID: 23766333]
[37]
Gagiya A, Doctor N, Gamit S, Patel A, Patel K, Patel P. Manifestations of tuberculosis in HIV/AIDS patients and its relationship with CD4 count. Int J Med Sci Public Health 2014; 3: 215-8.
[http://dx.doi.org/10.5455/ijmsph.2013.061220132]
[38]
Takhar RP, Mirdha K, Purohit G, Maan L, Bainara MK. Impact of HIV co-infection on clinical presentation in patients with TB and correlation of the findings with level of immune suppression. Tanaffos 2018; 17(3): 188-97.
[PMID: 30915136]
[39]
Zhu Y, Wu J, Feng X, et al. Patient characteristics and perceived health status of individuals with HIV and tuberculosis coinfection in Guangxi, China. Medicine (Baltimore) 2017; 96(14): e6475.
[http://dx.doi.org/10.1097/MD.0000000000006475] [PMID: 28383411]
[40]
Molaeipoor L, Poorolajal J, Mohraz M, Esmailnasab N. Predictors of tuberculosis and human immunodeficiency virus co-infection: a case-control study. Epidemiol Health 2014; 36: e2014024.
[http://dx.doi.org/10.4178/epih/e2014024] [PMID: 25358465]
[41]
Horton KC, MacPherson P, Houben RM, White RG, Corbett EL. Sex differences in Tuberculosis burden and notifications in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 2016; 13(9): e1002119.
[http://dx.doi.org/10.1371/journal.pmed.1002119] [PMID: 27598345]
[42]
Marçôa R, Ribeiro AI, Zão I, Duarte R. Tuberculosis and gender - Factors influencing the risk of tuberculosis among men and women by age group. Pulmonology 2018; 24(3): 199-202.
[http://dx.doi.org/10.1016/j.pulmoe.2018.03.004] [PMID: 29754721]
[43]
Wei W, Wei-Sheng Z, Ahan A, Ci Y, Wei-Wen Z, Ming-Qin C. The characteristics of TB epidemic and TB/HIV co-infection epidemic: A 2007-2013 retrospective study in Urumqi, Xinjiang Province, China. PLoS One 2016; 11(10): e0164947.
[http://dx.doi.org/10.1371/journal.pone.0164947] [PMID: 27768740]
[44]
Padmapriyadarsini C, Narendran G, Swaminathan S. Diagnosis & treatment of tuberculosis in HIV co-infected patients. Indian J Med Res 2011; 134(6): 850-65.
[http://dx.doi.org/10.4103/0971-5916.92630] [PMID: 22310818]
[45]
Kalonji D, Mahomed OH. Health system challenges affecting HIV and tuberculosis integration at primary healthcare clinics in Durban, South Africa. Afr J Prim Health Care Fam Med 2019; 11(1): e1-7.
[http://dx.doi.org/10.4102/phcfm.v11i1.1831] [PMID: 31170790]
[46]
Osei E, Akweongo P, Binka F. Factors associated with DELAY in diagnosis among tuberculosis patients in Hohoe Municipality, Ghana. BMC Public Health 2015; 15: 721.
[http://dx.doi.org/10.1186/s12889-015-1922-z] [PMID: 26220804]
[47]
Sawadogo B, Tint KS, Tshimanga M, Kuonza L, Ouedraogo L. Risk factors for tuberculosis treatment failure among pulmonary tuberculosis patients in four health regions of Burkina Faso: case control study Pan Afr Med J 2015; 21-152.
[48]
Osei E, Der J, Owusu R, Kofie P, Axame WK. The burden of HIV on Tuberculosis patients in the Volta region of Ghana from 2012 to 2015: implication for Tuberculosis control. BMC Infect Dis 2017; 17(1): 504.
[http://dx.doi.org/10.1186/s12879-017-2598-z] [PMID: 28724359]
[49]
Mahendradhata Y, Ahmad RA, Lefèvre P, Boelaert M, Van der Stuyft P. Barriers for introducing HIV testing among tuberculosis patients in Jogjakarta, Indonesia: a qualitative study. BMC Public Health 2008; 8(1): 385.
[http://dx.doi.org/10.1186/1471-2458-8-385] [PMID: 19014468]
[50]
Abbara A, Collin SM, Kon OM, et al. Time to diagnosis of tuberculosis is greater in older patients: a retrospective cohort review. ERJ Open Res 2019; 5(4): 00228-2018.
[http://dx.doi.org/10.1183/23120541.00228-2018] [PMID: 31720296]
[51]
Kumar M, Singh T, Zia F, Yadav A, Pal K. Clinico radiological profile of HIV positive TBM patients and its correlation with CD4 count. Journal of Medical Science And clinical Research 2018; 6(12): 1016-21.
[52]
Restrepo CS, Katre R, Mumbower A. Imaging Manifestations of Thoracic Tuberculosis. Radiol Clin North Am 2016; 54(3): 453-73.
[http://dx.doi.org/10.1016/j.rcl.2015.12.007] [PMID: 27153783]
[53]
Busi Rizzi E, Schininà V, Palmieri F, Girardi E, Bibbolino C. Cavitary pulmonary tuberculosis HIV-related. Eur J Radiol 2004; 52(2): 170-4.
[http://dx.doi.org/10.1016/j.ejrad.2004.04.007] [PMID: 15489075]
[54]
Behera A, Pothal S, Manjhi R, Dutta P, Behera BS. Radiological manifestations of Pulmonary Tuberculosis in HIV Sero-Positive adult patients. Annals of International Medical and Dental Research 2017; 3(4): 1.
[http://dx.doi.org/10.21276/aimdr.2017.3.4.PM1]
[55]
KT PN. Malhotra B, Kajal NC, Pandhi A. Comparative study of radiological appearances in patients of pulmonary Tuberculosis in HIV positive and negative patients. J Chest Pulm Med 2019; 1(1): 101.
[56]
Mathur M, Badhan RK, Kumari S, Kaur N, Gupta S. Radiological manifestations of pulmonary tuberculosis-a comparative study between immunocompromised and immunocompetent patients. J Clin Diagn Res 2017; 11(9): TC06-9.
[http://dx.doi.org/10.7860/JCDR/2017/28183.10535] [PMID: 29207803]
[57]
Badie BM, Mostaan M, Izadi M, Alijani MA, Rasoolinejad M. Comparing radiological features of pulmonary tuberculosis with and without HIV infection. J AIDS Clin Res 2012; 3(10): 188.
[http://dx.doi.org/10.4172/2155-6113.1000188]
[58]
Klautau GB, Kuschnaroff TM. Clinical forms and outcome of tuberculosis in HIV-infected patients in a tertiary hospital in São Paulo - Brazil. Braz J Infect Dis 2005; 9(6): 464-78.
[http://dx.doi.org/10.1590/S1413-86702005000600004] [PMID: 16410941]
[59]
Jaryal A, Raina R, Sarkar M, Sharma A. Manifestations of tuberculosis in HIV/AIDS patients and its relationship with CD4 count. Lung India 2011; 28(4): 263-6.
[http://dx.doi.org/10.4103/0970-2113.85687] [PMID: 22084539]
[60]
Akinbami AA, Adegboyega AO, Oshinaike OO, et al. Chest X- ray findings in HIV patients in relation to the CD4 count. Nig Q J Hosp Med 2011; 21(4): 306-11.
[PMID: 23175897]
[61]
Kouassi B, N’Gom A, Horo K, et al. Corrélations des manifestations de la tuberculose pulmonaire avec le degré d’immunodépression au VIH. Rev Mal Respir 2013; 30(7): 549-54.
[http://dx.doi.org/10.1016/j.rmr.2013.01.003] [PMID: 24034459]
[62]
Lawn SD, Evans AJ, Sedgwick PM, Acheampong JW. Pulmonary tuberculosis: radiological features in west Africans coinfected with HIV. Br J Radiol 1999; 72(856): 339-44.
[http://dx.doi.org/10.1259/bjr.72.856.10474493] [PMID: 10474493]
[63]
Post FA, Wood R, Pillay GP. Pulmonary tuberculosis in HIV infection: radiographic appearance is related to CD4+ T-lymphocyte count. Tuber Lung Dis 1995; 76(6): 518-21.
[http://dx.doi.org/10.1016/0962-8479(95)90527-8] [PMID: 8593372]
[64]
Kisembo HN, Boon SD, Davis JL, et al. Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus. Br J Radiol 2012; 85(1014): e130-9.
[http://dx.doi.org/10.1259/bjr/70704099] [PMID: 21976629]
[65]
Jaiswal A, Ahmad R. A clinico-radiological presentation of pulmonary tuberculosis in hiv positive patients in a tertiary care hospital. Int J Sci Res (Ahmedabad) 2019; 8(2)
[66]
Horo K, Koné A, Koffi MO, et al. Diagnostic comparé des pneumopathies bactériennes et de la tuberculose pulmonaire chez les patients VIH. Rev Mal Respir 2016; 33(1): 47-55.
[http://dx.doi.org/10.1016/j.rmr.2015.01.004] [PMID: 25770360]
[67]
Schutz C, Meintjes G, Almajid F, Wilkinson RJ, Pozniak A. Clinical management of tuberculosis and HIV-1 co-infection. Eur Respir J 2010; 36(6): 1460-81.
[http://dx.doi.org/10.1183/09031936.00110210] [PMID: 20947678]
[68]
Lee MP, Chan JW, Ng KK, Li PC. Clinical manifestations of tuberculosis in HIV-infected patients. Respirology 2000; 5(4): 423-6.
[http://dx.doi.org/10.1111/j.1440-1843.2000.00287.x] [PMID: 11192558]
[69]
Walters E, Cotton MF, Rabie H, Schaaf HS, Walters LO, Marais BJ. Clinical presentation and outcome of tuberculosis in human immunodeficiency virus infected children on anti-retroviral therapy. BMC Pediatr 2008; 8(1): 1.
[http://dx.doi.org/10.1186/1471-2431-8-1] [PMID: 18186944]
[70]
Keshinro B, Diul MY. HIV-TB: epidemiology, clinical features and diagnosis of smear-negativeTB. Trop Doct 2006; 36(2): 68-71.
[http://dx.doi.org/10.1258/004947506776593396] [PMID: 16611435]
[71]
Yudin A, Afanasyeva N, Myasnikov D, Yumatova E. Clinical and radiological manifestations of tuberculosis in HIV-positive patients. Diagnostic radiology and radiotherapy 2016; (4): 35-45.
[72]
Olowe OA, Makanjuola OB, Adekanmi AS, Adefioye OJ, Olowe RA. Epidemiological characteristics and clinical outcome of HIV-related tuberculosis in a population of TB patients in South-Western Nigeria. Eur J Microbiol Immunol (Bp) 2017; 7(2): 127-32.
[http://dx.doi.org/10.1556/1886.2017.00003] [PMID: 28690879]
[73]
Kobashi Y, Mouri K, Yagi S, et al. Clinical features of immunocompromised and nonimmunocompromised patients with pulmonary tuberculosis. J Infect Chemother 2007; 13(6): 405-10.
[http://dx.doi.org/10.1007/s10156-007-0558-Z] [PMID: 18095090]
[74]
Drobniewski F, Nikolayevskyy V, Balabanova Y, Bang D, Papaventsis D. Diagnosis of tuberculosis and drug resistance: what can new tools bring us? Int J Tuberc Lung Dis 2012; 16(7): 860-70. [State of the art series. New tools. Number 1 in the series].
[http://dx.doi.org/10.5588/ijtld.12.0180] [PMID: 22687497]
[75]
Lanzafame M, Vento S. Tuberculosis-immune reconstitution inflammatory syndrome. J Clin Tuberc Other Mycobact Dis 2016; 3: 6-9.
[http://dx.doi.org/10.1016/j.jctube.2016.03.002] [PMID: 31723680]

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