X-ray diagnostics of tuberculosis in the screening of patients with HIV infection

Background . The main method of screening of patients with HIV infection to detect pulmonary tuberculosis is X-ray diagnostics. A comparative assessment of changes in lung tissue in different methods of X-ray diagnostics and at different levels of CD4 + cells seems relevant. The aim of the study . To compare plain radiography and computed tomography of the lungs as screening methods for detecting tuberculosis in patients with HIV infection at various stages of immunosuppression. Materials and methods . 396 patients with HIV registered at the AIDS Center were examined using plain lung radiography (PLR) and computed tomography (CT). To search for mycobacterium tuberculosis, we used bacterioscopy of a smear with Ziehl – Neelsen staining; HAIN-GenoType MTBDRplus technique; inoculation of BACTEC MGIT 960 liquid media; inoculation of Löwenstein – Jensen dense medium. Statistical processing of numerical material was carried out using the Statistica 5.5 program with a significance level p ≤ 0.05; Pearson χ 2 criterion was used for the analysis of qualitative features Results . When comparing the results of PLR and CT, the differences were found. When using PLR, the focal lung lesions were described more often (χ 2 = 40.79; p = 0.00001), according to CT data, they turned out to be fibrosis (χ 2 = 2.33; p = 0.1269). When comparing the PLR and CT data, the differences were obtained in the description of pulmonary fibrosis (χ 2 = 20.78; p = 0.00001), focal lung lesions (χ 2 = 40.79; p = 0.00001), dissemination (χ 2 = 9.16; p=0.0025). Conclusion . When screening HIV-infected patients (at the standard of using plain radiography twice a year) it should be taken into account that CT provides more precise differentiation of focal lung lesions and pulmonary fibrosis, earlier detection of dissemination syndrome and ground-glass, especially at severe immunodeficiency with a decrease in CD4+ T lymphocytes down to 200 cells and less. Timely appointment of CT study will improve the effectiveness of tuberculosis detection at the stage of screening in AIDS centers.