Are MRI Findings Different in HIV Positive Tuberculosis Spine Patients

Background: Tuberculosis of the spine is a serious manifestation of the disease that causes debilitating injury. In HIV positive patients the incidence of skeletal tuberculosis increases to 60%. The MRI has become the gold standard for diagnosis and preoperative planning in spinal TB. The objective of this study was to assess the impact of HIV status on MRI findings in spinal tuberculosis patients at a tertiary public hospital in Pune, India. Methods: This was retrospective study of spinal TB patients admitted to a tertiary public hospital in Pune, India. Fifty patients with histopathological confirmation of spinal tuberculosis, HIV status and available MRI scans from 2017-2020 were identified. HIV status was positive in 16 and negative in 34. Males were predominant (27:23). Site, extent of disease, type of lesion, abscess volume, kyphotic deformity and skip lesions were reported. Results: There is no statistical difference in age and sex of the patients. The average abscess size in HIV positive group is more (9.63 sq.cm) as compare to (2.29 sq. cm) non HIV group. Average numbers of vertebrae involved in both groups are almost same (2.4:2.26). Average kyphotic angle is significantly more in non HIV group as compare to HIV group (10.8:15.38). skip lesions were more common in HIV group (6 out of 10 as compare to 6 out of 20). There was a positive correlation between abscess size and CD4 count in HIV patients. Conclusion: HIV negative patients have greater tubercular destruction as measured by resultant kyphosis. There is no difference in the incidence of location, type of vertebral involvement and number of vertebrae involved. Skip lesions were more common in HIV positive patients in our study. HIV positive patients show greater epidural abscess volume and are showing correlation with CD4 count.