Correlation Between Chest Radiographic Features and Time to Culture Conversion in Patients Co-infected with Multidrug-Resistant Tuberculosis and HIV in Khyber Pakhtunkhwa

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) compounded by Human Immunodeficiency Virus (HIV) infection presents a significant challenge in clinical management, particularly in high-burden regions such as Peshawar, Pakistan. The link between findings on chest radiograph and conversion of conversion is crucial for treatment selection and predicting patient outcomes.Objective: To evaluate the relationship between time of sputum culture conversion to that of chest radiograph abnormalities in patients with MDR-TB co-infected with Human Immunodeficiency Virus co-infection in Khyber Pakhtunkhwa.Methods: A study with retrospective desing study was conducted, including data of patients diagnosed with MDR-TB and HIV from April 2012 to December 2019. Chest radiographs and microbiological culture results were analyzed to assess radiographic findings and their association with the duration of culture conversion. Key radiographic features (e.g., cavitary lesions, consolidations) were correlated with the time required for conversion of ist sputum culture from negative to positive.Results: The present study included data of 45 patients with a mean age of 45 years, including 63.3% males. Radiographic findings varied, with 40% showing extensive cavitary lesions and 30% presenting with significant consolidation. The median time to culture conversion was 6 months. Patients with extensive cavitary lesions experienced a significantly longer time to culture conversion compared to those with less severe radiographic abnormalities (p < 0.01). Adjustments for HIV status indicated that patients with CD4 counts <200 cells/mm³ had a more prolonged time to conversion compared to those with higher CD4 counts (p < 0.05). Conclusion: Chest radiograph abnormalities, particularly extensive cavitary lesions, are associated with a prolonged time to culture conversion in MDR-TB patients co-infected with HIV. These findings highlight the need for modifying treatment plans for approaching and closer monitoring of patients with severe radiographic manifestations and low CD4 counts. Further research is warranted to explore the implications of these findings on treatment efficacy and patient outcomes.