Pulmonary Tuberculosis in Kigali, Rwanda: Impact of Human Immunodeficiency Virus Infection on Clinical and Radiographic Presentation

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Abstract
The aim of the present study was to compare the clinical and radiographic presentation as well as the therapeutic outcome of pulmonary tuberculosis (PT) in adult patients with and without human immunodeficiency virus type 1 (HIV-1) infection in Kigali, Rwanda. Over a 17-month period 59 consecutive patients with bacteriologically and/or histopathologically documented PT were enrolled. Of these, 48 (81%) patients were HIV seropositive. Among these, 35 fit the WHO clinical criteria for AIDS (WHOCCA) at the time of admission. Significant differences were found between the HIV-seropositive and HIV-seronegative groups of patients: fever (85 versus 36%; p < 0.001), tuberculin skin test anergy (69 versus 0%; p < 0.01), mediastinal and/or hilar adenopathles (31 versus 0%; p = 0.05), and pleural effusion (43 versus 9%; p < 0.05) were more frequently encountered in the HIV-seropositive group, and upper lobe infiltrates (55 versus 16%; p < 0.02) and cavitation (91 versus 39%; p < 0.003) were more often seen in the HIV-seronegative group. However, HIV-seropositive patients not meeting WHOCCA were less frequently anergic (0 versus 100%; p < 0.001) and feverish (53 versus 97%; p < 0.01) and more often had cavitation (69 versus 28%; p < 0.02) and less often mediastinal and/or hilar adenopathies (7 versus 40%; p < 0.04) compared with HIV-seropositive patients meeting WHOCCA. Under antituberculosis treatment, clearance of fever was slower in HIV-seropositive compared with HIV-seronegative patients, and among the HIV-seropositive group it was slower in those fitting WHOCCA. Data collected from this study suggest that the clinical severity and the radiographic pattern of HIV-associated PT are strongly related to the degree of progression of HIV infection. Although slower in advanced HIV infection, a favorable response to antituberculosis treatment was observed in all these groups of patients.