Uncommon Pulmonary Tuberculosis as a Primary Sign of Severe HIV Progression

Waggoner Keane^*
*Correspondence: Waggoner Keane, Department of Pulmonary and Critical Care Medicine, University of Zurich, 8006 Zurich, Switzerland, Email:

Introduction

Artificial intelligence holds great promise in detecting missed or mislabeled findings in chest radiographs, offering the potential to significantly improve diagnostic accuracy and reduce errors. AI systems, particularly those based on deep learning, can assist radiologists in identifying subtle abnormalities that may otherwise go unnoticed, enhancing patient care and outcomes. However, challenges related to data quality, algorithm interpretability, and clinical integration remain, requiring ongoing efforts to ensure the safe and effective deployment of AI in medical practice. As technology continues to advance, AI's role in radiology will likely grow, supporting radiologists in their critical work and enhancing the overall quality of care delivered to patients. As AI continues to evolve, future advancements may lead to even more sophisticated models capable of detecting a broader range of conditions and providing more accurate second opinions. Collaboration between AI developers, radiologists, and clinicians will be essential in ensuring that these tools are effective and trusted. Ultimately, AI has the potential to augment the expertise of radiologists, ensuring that missed or mislabeled findings in chest radiographs are identified and addressed promptly, leading to better outcomes for patients.

Description

HIV/AIDS is a disease that causes the progressive deterioration of the immune system by targeting and destroying CD4+ T cells, which are essential for the immune response to pathogens. In the absence of adequate immune function, individuals living with HIV are particularly vulnerable to opportunistic infections, including tuberculosis, which remains one of the leading causes of morbidity and mortality in HIV-infected individuals. In fact, TB is one of the most common opportunistic infections in people living with HIV, with a significant overlap in regions where both diseases are prevalent, such as sub-Saharan Africa and Southeast Asia. The relationship between HIV and tuberculosis is multifactorial. The progressive depletion of CD4+ T cells in HIV-infected individuals significantly impairs their ability to mount an effective immune response to MTB. The CD4+ T cells, which are key in orchestrating the immune response to TB, are compromised in HIV infection, making it difficult for the body to control the mycobacterial infection. Additionally, HIV infection induces a state of immunosuppression that alters the immune environment, creating conditions that are more conducive to the activation of latent TB infection. Many people living with HIV who are latently infected with TB may not experience active disease until their immune system becomes severely compromised [2]. Uncommon presentations of pulmonary tuberculosis can serve as an important clue to the progression of HIV infection. These forms of TB may be more difficult to diagnose and manage, but they should raise suspicion for severe immunosuppression and the possible onset of full-blown AIDS. Some of these rare forms of PTB include miliary TB, cavitary TB, and TB with rapid clinical deterioration, often manifesting in patients with CD4+ T cell counts below 200 cells/mm³. Miliary tuberculosis is one of the most serious forms of TB, characterized by the widespread dissemination of Mycobacterium tuberculosis throughout the body via the bloodstream. It results in the formation of numerous small granulomas resembling millet seeds in size, hence the name "miliary." This form of TB is often seen in severely immunocompromised individuals, particularly those with advanced HIV disease. Miliary TB may involve the lungs, but it can also affect other organs such as the liver, spleen, bone marrow, and central nervous system. In patients with HIV, miliary TB may be the first presentation of undiagnosed HIV infection or can occur as a sign of severe immunosuppression in individuals already diagnosed with HIV. The clinical manifestations are nonspecific and can include fever, weight loss, fatigue, and dyspnea. Chest radiographs may show diffuse bilateral reticulonodular infiltrates, which can be mistaken for other conditions, such as viral pneumonia or other fungal infections [3]. Cavitary pulmonary tuberculosis is another uncommon but severe manifestation of TB that can indicate advanced HIV disease. Cavitary lesions are formed in the lungs when the body's immune system fails to control the growth of Mycobacterium tuberculosis, leading to tissue necrosis. These cavities are typically visible on chest X-rays or CT scans and are often associated with extensive lung damage. In HIV-positive individuals, cavitary TB may be present at the time of diagnosis or develop as the disease progresses. The cavities themselves provide a suitable environment for the persistence and propagation of the mycobacteria, exacerbating the infection. Cavitary TB is typically associated with more severe clinical symptoms, such as prolonged cough, hemoptysis, chest pain, and difficulty breathing. These symptoms, if not managed promptly, can lead to significant respiratory distress, respiratory failure, and even death. Individuals with advanced HIV disease are at higher risk of developing cavitary pulmonary tuberculosis due to their weakened immune defenses. A study has shown that HIV-infected individuals with a CD4+ count of less than 100 cells/mm³ have a significantly higher likelihood of presenting with cavitary TB compared to those with higher CD4+ counts. Another uncommon presentation of pulmonary tuberculosis as a sign of severe HIV progression is rapid clinical deterioration. In advanced stages of HIV disease, the body’s ability to fight TB becomes severely compromised. This results in aggressive and rapid disease progression, where patients develop widespread TB infection within a short period of time. This phenomenon is often observed in individuals who are late in seeking medical attention, those with poor adherence to ART, or those who have untreated or misdiagnosed HIV infection [4,5].

Conclusion

Uncommon pulmonary tuberculosis as a primary sign of severe HIV progression is an urgent and serious concern for healthcare providers managing individuals with HIV. Miliary TB, cavitary TB, and rapid clinical deterioration are often seen in individuals with advanced HIV disease and serve as indicators of the immunocompromised state brought about by HIV infection. Early identification and timely intervention are crucial to improving the outcomes of these patients, who are at high risk of mortality without appropriate care. Improved diagnostic strategies, a high index of suspicion for unusual TB manifestations in HIV-positive patients, and the prompt initiation of both TB treatment and ART are essential for improving patient survival and quality of life. As the global burden of HIV and TB continues to intersect, concerted efforts to address both diseases simultaneously, through integrated care, will be critical in mitigating the impact of these deadly infections on public health.

Acknowledgement

None

Conflict of Interest

None

References

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