Chest radiological features of pulmonary tuberculosis in HIV-positive and HIV-negative patients

Background: Pulmonary tuberculosis (PTB) is a leading cause of illness and death in individuals with HIV. While chest X-rays are commonly used for diagnosing PTB, HIV can alter X-ray findings, potentially delaying diagnosis and leading to misinterpretation, which can exacerbate disease progression and complications. Material and Methods: This prospective, single-center observational study was conducted at The Aga Khan University Hospital in Karachi, Pakistan from May 2023 to April 2024. This study compared the radiological features of PTB in HIV-positive and HIV-negative patients using chest X-rays, CT scans (when CXRs were unavailable), and blood tests, including HIV results and CD4 counts. Statistical analysis was performed using SPSS version 19, with significance set at p < 0.05. Ethical approval and data confidentiality were ensured. Results: A total of 116 patients (mean age 52.23 years; 70.7% male) were analyzed. PTB was diagnosed via sputum in 75.9% of cases, with HIV co-infection present in 16.4% (median CD4 count 119 cells/mm³). The PTB + HIV group was younger (42.16 vs. 54.21 years, p < 0.0001) and had a higher male proportion (94.7% vs. 66.0%, p = 0.012). Alveolar infiltrates were more common in the co-infection group (78.9% vs. 45.4%, p = 0.007), while cavitary infiltrates were exclusive to the PTB-only group (27.8%, p = 0.006). Upper lobes were predominantly affected in the PTB-only group, whereas lower lobes were more involved in the co-infection group. Conclusions: Recognizing atypical radiological patterns is essential for the timely diagnosis and treatment of PTB in HIV-positive patients, as co-infection complicates management due to drug interactions and the increased risk of drug resistance, particularly in TB-endemic areas. Keywords: HIV, Pulmonary tuberculosis, Co-infection, Chest radiography