High-Resolution Computed Tomographic Evaluation of Pulmonary Diseases in Human Immunodeficiency Virus Positive Patients: A Study of 30 Cases

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1 Originl Article DOI: /ijss/2015/359 High-Resolution Computed Tomogrphic Evlution of Pulmonry Diseses in Humn Immunodeficiency Virus Positive Ptients: A Study of 30 Cses Mnoj Hzrik 1, Nnit Dek 2, Gutm Goswmi 3 1 Assistnt Professor, Deprtment of Rdiology, Guhti Medicl College & Hospitl, Guwhti, Assm, Indi, 2 Assistnt Professor, Deprtment of Rdiology, Guhti Medicl College & Hospitl, Guwhti, Assm, Indi, 3 Professor, Deprtment of Rdiology, Guhti Medicl College & Hospitl, Guwhti, Assm, Indi Astrct Bckground: The ssocition etween tuerculosis (TB) nd humn immunodeficiency virus (HIV) presents n immedite nd grve pulic helth nd socio-economic thret, prticulrly in the developing world. Purpose: The im of given study ws to utilize high resolution computed tomogrphy (HRCT) for the detection of pulmonry disese in HIV ptients coming with suspected pulmonry complictions, nd then to rrive t conclusive or differentil dignosis on the sis of HRCT finding. Mterils nd Methods: The cses were selected sed on ll ptients referred to the Deprtment of Rdiology, Guhti Medicl College with proven HIV/cquired immunodeficiency syndrome (AIDS) infection which ws cliniclly suspected of pulmonry infections. HRCT ws done. Results: Totl 30 cses of HIV/AIDS with suspected pulmonry disese were studied. Out of which 21 were mle nd 9 were femle. Out of which 60% of ptients were dignosed s hving pulmonry TB, followed y cteril infection in 16.6% cses nd Pneumocystis crinii pneumoni in 10% ptients, while 13.3% of our study did not revel ny significnt normlity. Nodulr opcities in HRCT were the most common findings in ptients with pulmonry TB (77.7%). Conclusion: Vrious findings such s pulmonry TB eing the most common infection nd most common HRCT finding in pulmonry TB were nodulr opcity cn e otined from the present study. HRCT is highly sensitive tool for detecting prenchyml normlities nd llows etter chrcteriztion of the lesions, with etter reproduciility nd less interoserver difference. Key words: Bronchiectsis, Enzyme-linked immunosorent ssy, Miliry tuerculosis, Mortlity, Pulmonry tuerculosis INTRODUCTION Humn immunodeficiency virus (HIV)/cquired immunodeficiency syndrome (AIDS) is mjor world helth concern nd is mjor cuse of moridity nd mortlity. 1 It is serious disorder of the immune system in which the ody s norml defenses ginst infection rekdown, Access this rticle online leving it vulnerle to host of life-thretening infections/ conditions including unusul mlignncies. The persons with severe opportunistic infections (OIs) nd unusul mlignncies re t the one end of the spectrum of disese, while helthy seropositive (for HIV) individuls re t the other end. 2 The ssocition etween tuerculosis (TB) nd HIV presents mjor pulic helth nd socio-economic thret, prticulrly in the developing world including Indi. 3 Month of Sumission : Month of Peer Review : Month of Acceptnce : Month of Pulishing : The estimted dult HIV prevlence in Indi is to e 0.27% ccording to Ntionl AIDS Control Orgniztion s (NACO) 2013 report which is the third highest urden in the world. Indi is the highest TB urden country in the world with n estimted 2.2 million new TB cses Corresponding Author: Mnoj Hzrik, Deprtment of Rdiology, Guhti Medicl College & Hospitl, Guwhti , Assm, Indi. Phone: E-mil: mnojhzrik23@gmil.com Interntionl Journl of Scientific Study August 2015 Vol 3 Issue 5 118

2 occurring nnully. While TB is commonest OIs in HIVinfected individuls, HIV infection is n importnt risk fctor for cquiring TB infection nd its progression to ctive TB. HIV/TB together is ftl comintion with extremely high deth rtes (15-18%) reported mong HIV-infected TB cses notified under Revised Ntionl TB Control Progrm. Overll, TB is estimted to cuse out 25% of ll deths mong HIV infected cses in Indi. Erly detection of HIV/TB cses nd timely dministrtion of nti-retrovirl tretment (ART) nd nti-tb tretment re key interventions to reduce mortlity rtes significntly. 4 Imging plys vitl role in the dignosis nd mngement of lung of complictions ssocited with HIV. Accurte dignosis is sed on n understnding of the pthogenesis of the processes involved nd their imging findings. 1 High-resolution computed tomogrphy (HRCT) comines the use of thinly collimted CT slices tht re to 2 mm in thickness, with high sptil frequency lgorithm tht enhnces edge detection. Thin collimtion decreses prtil volume verging nd improves the ility of the CT to demonstrte smll pulmonry lesions. HRCT llows delinetion of the lung prenchym down to the level of the secondry pulmonry loule. Advntge of HRCT over rdiogrph is tht it there is etter delinetion nd chrcteriztion of the lesion nd less oserver vrince. HRCT helps in reveling pulmonry prenchyml chnges efore they re evident on chest rdiogrph nd lso helps in etter chrcteriztion of the lesions nd thus helps in differentil dignosis of pulmonry complictions seen in these ptients. 1 Empowered with n dvnced modlity like the HRCT, it ws deemed essentil to undertke study on the HRCT evlution of the pulmonry diseses in HIV/AIDS ptients with the following ims nd ojectives in view: 1. To utilize HRCT for the evlution of pulmonry prenchym in HIV ptients coming with suspected pulmonry complictions. 2. To detect nd ctegorize the pttern of involvement of the pulmonry prenchym with the help of HRCT findings nd then to rrive t conclusive or differentil dignosis on the sis of HRCT findings. 3. Post-tretment follows up of HIV/AIDS ptients. MATERIALS AND METHODS The present study ws crried out in the Deprtment of Rdiology, Guhti Medicl College nd Hospitl, Guwhti from My 2013 to April The cses were selected from ART center of Guhti Medicl College nd Hospitl sed on their HIV-positive sttus nd suspicion of pulmonry disese. The cses were evluted y using the HRCT. The ge group the ptients rnged from 8 to 52 yers. Both sexes hd their shre of cses. The primry clinicl fetures were of weight loss, fever, nd cough oth productive nd non-productive, nd dyspne. Methods A thorough clinicl history of ll the HIV positive ptients presenting with suspicion of pulmonry disese ws tken. The history minly comprised of cough whether productive or non-productive, fever whether low grde or high grde, weight loss, nd dyspne durtion of symptoms ws lso recorded. Then, meticulous record of ll the ville lortory investigtions including HIV sttus, CD4 counts, routine lood exmintion, sputum exmintions, pleurl fluid nlysis, fine needle spirtion cytology, nd other ville investigtions ws kept. Then, chest X-rys of the ptients were studies for the presence of ny normlity. Generl nd systemic exmintions of ll the ptients were done. HRCT scn of the thorx ws done in ll the cses tken up in the study. Preprtion of the Ptient The procedure nd ojectives of performing the highresolution scns were explined to the ptients nd written consent of the ptient or the ttendnt were tken. The ptient ws explined nd demonstrted the procedure of reth holding during the cquisition of HRCT scns. CT Protocol The mchine used is PHILIPS MX16 (16 SLICE CT) scnner. CT scn ws performed using the following protocols: 1. Positioning: Ptients were scnned in the supine position with their rms ove their heds. Scns were performed in the xil xis from cephlic to cudl levels. 2. Scnning: After positioning the ptient, the topogrm or scnogrm ws tken. Spirl scnning were done with following protocols: Collimtion = 1 mm Feed = 10 mm Scn time = 1 sec KVp = ma = 240 Mtrix size = Interntionl Journl of Scientific Study August 2015 Vol 3 Issue 5

3 RESULTS AND OBSERVATIONS Age nd Sex Distriution In the present study of 30 ptients with HIV/AIDS with suspected pulmonry disese, 21 ptients were mle nd 9 ptients were femle. So, mles ccounted for 70% nd femles ccounted for 30% of cses. In the present study, mximum numer of cses re seen etween 31 nd 40 yers ge group (46.6%), followed y 9 cses in yers (30%) (Tle 1). So, the most common pulmonry disese in the present study is pulmonry TB (60%) followed y cteril infection (16.6%) (Tle 2). So, the most common presenting symptom in our present study is weight loss seen in 80% of cses followed y cough with expectortion seen in 70% of cses (Tle 3). So, the most common mode of HIV trnsmission in the present study is sexul (90%) (Tle 4). Pthologicl Investigtions 1. Enzyme-linked immunosorent ssy (ELISA): All ptients hd undergone 2 or more ELISA tests nd re found to e positive. 2. CD4 counts: Are ville in ll the ptients. The rnge Tle 1: Age distriution Age No. of ptients Percentge < > Tle 2: Different pulmonry disese noted Pulmonry disese Numer of ptient Percentge Pulmonry tuerculosis Bcteril infection Pneumocystis crinii 3 10 No normlity Tle 3: Clinicl findings Clinicl findings Numer of ptients Percentge Weight loss Cough with expectortion Non productive cough Low grde fever High grde fever 6 20 Dyspne of CD4 counts vried from 21 to 382 with men count of cells/cumm. Pulmonry TB A totl of 18 ptients in the preset study re dignosed to e suffering from pulmonry TB. So, the most common clinicl symptom in ptient with pulmonry TB were cough with expectortion (88.9%) followed y weight loss (83.3%) (Tle 5). CD4 Counts in Ptient with Pulmonry TB The CD4 count in these ptients vried from 21 to 382 cells/cumm, with men count of cells/cumm. Six ptients hd CD4 count >200 cells/cumm, while 12 ptients hd CD4 counts < 200 cells/cumm (Tle 6). So, sputum positive cses in the present study re 33.3% (Tle 7). Other Investigtions All 18 ptients hve high ESR counts (counts >20 cid fst cilli [AFB]), totl of 7 ptients hs pleurl effusion, nd in six of these ptients pleurl nlysis revel findings suggestive of pulmonry TB. Tle 4: Mode of HIV trnsmission Mode of trnsmission Numer of ptient Percentge Sexul (heterosexul) IV drug users Verticl infection (mother to child) IV: Intrvenous Tle 5: Clinicl symptoms in ptients with pulmonry tuerculosis Clinicl symptoms No. of ptients Percentge Cough with expectortion Dry cough Fever low grde Fever high grde Weight loss Dyspne Tle 6: CD4 counts CD4 count (cells/cumm) No. of ptients Percentge > < Tle 7: Ptient with sputum positive for AFB Sputum for AFB No. of ptients Percentge Positive Negtive AFB: Acid fst cilli Interntionl Journl of Scientific Study August 2015 Vol 3 Issue 5 120

4 Imging Findings Chest rdiogrphs re done in ll 18 ptients. All ptients hve some rdiogrph normlity detectle in the rdiogrph. HRCT re done in ll the cses (Tle 8). So, the most common HRCT finding in pulmonry TB in present study is nodulr opcities seen in 77.7% cses followed y consolidtion seen in 50% cses, ronchiectsis in 44.4% cses, pleurl effusion in 38.8% cses, lymphdenopthy in 33.3% cses, Cvittions seen in 22.2% cses nd miliry TB in 16.6% cses (Figures 1-6). So, centriloulr nodules re seen in mximum cses (Tle 9). Bcteril Infections A totl of 5 ptients in the present study re dignosed to e suffering from cteril infections. Tle 8: HRCT findings in pulmonry tuerculosis HRCT findings No. of ptients Percentge Nodulr opcities Consolidtion 9 50 Pleurl effusion Lymphdenopthy Cvittion Miliry tuerculosis Bronchiectsis Septl thickening Interloulr Intrloulr Pleurl thickening HRCT: High resolution computed tomogrphy Tle 9: Clssifiction of nodules in pulmonry tuerculosis Nodules (distriution) No. of ptients Centriloulr 9 Tree in ud 6 In clusters 4 Rndom 5 So, the most common clinicl mnifesttion in the present study is high grde fever nd cough with expectortion oth in 80% cses (Tle 10). CD4 Counts in Ptient with Bcteril Infections The CD4 count in these ptients vried from 121 to 366 cells/cumm with men count of cells/cumm. Other Investigtions Sputum culture is done in one ptient nd it revels presence of pneumococcus. None of the ptients hs AFB in their sputum. Imging Findings Chest rdiogrphs re done in ll 5 ptients. Four ptients hve some rdiogrph normlity detectle in the rdiogrph. So, the most common HRCT finding in cteril infection is lor consolidtion seen in 60 % cses (Tle 11 nd Figure 7). Pneumocystis crinii Pneumoni (PCP) A totl of 3 ptients in present study re dignosed to e suffering from PCP. So, the most common clinicl symptoms in ptients with PCP re dry cough, weight loss nd dyspne in 100% cses (Tle 12). CD4 Counts in Ptients with PCP The CD4 count in these ptients vried from 24 to 47 cells/cumm, with men count of 32.7 cells/cumm, i.e., ll these ptients re severely immunocompromised (Tle 13). Imging Findings Chest rdiogrphs re done in ll 3 ptients. All ptients hve some rdiogrph normlity detectle in the rdiogrphs. Figure 1: Cse of tuerculosis - humn immunodeficiency virus () Axil, ( nd c) coronl HRCT imges revel multiple nodules some re conforming to tree-in-ud nodules c 121 Interntionl Journl of Scientific Study August 2015 Vol 3 Issue 5

5 So, the most common HRCT finding in ptients with PCP re diffuse ground glss opcities in mosic pttern of distriution noted in 100% cses, followed y crzy pving noted in 66.6% cses (Tle 14 nd Figure 6). Follow up Two out of three ptients with PCP re followed up fter tretment, one ptient shows complete resolution of normlities, while in nother ptient rdiologicl resolution lgged ehind clinicl resolution. Figure 2: () Axil HRCT nd () Corresponding medistinl window showing consolidtion in the right middle loe with pleurl effusion nd in cse of pulmonry tuerculosis Tle 10: Clinicl symptoms in ptients with cteril infections Clinicl symptoms No. of ptients Percentge Cough with expectortion 4 80 Dry cough 0 0 Fever low grde 1 20 Fever high grde 4 80 Weight loss 3 60 Dyspne 0 0 Tle 11: HRCT findings in cteril infections HRCT findings No. of ptients Percentge Lor consolidtion 3 60 Bronchiectsis 1 20 Nodules 1 20 HRCT: High resolution computed tomogrphy Figure 3: () Axil HRCT imges revel multiple discrete nodules in ilterl lung fields. () Medistinl window showing medistinl lymphdenopthy Tle 12: Clinicl symptoms in ptients with PCP Clinicl symptoms No. of ptients Percentge Cough with expectortion 0 0 Dry cough Fever low grde Fever high grde Weight loss Dyspne PCP: Pneumocystis crinii pneumoni Figure 4: () Axil HRCT nd () corresponding medistinl window showing cvitry lesion with ir fluid level nd multiple nodules in ptient with pulmonry tuerculosis Tle 13: CD4 counts CD4 counts No. of ptients Percentge <200 cells/cumm >200 cells/cumm 0 0 Figure 5: () Sgittl, () xil nd (c) coronl HRCT imges revel cvitry lesion nd tree in ud nodules in cse of pulmonry tuerculosis c Interntionl Journl of Scientific Study August 2015 Vol 3 Issue 5 122

6 cses; cough with expectortion seen in 80% of cses. The cumultive dt pulished y NACO 4 in 5204 AIDS ptients indictes tht 89% ptient hd weight loss, 88% hd fever nd cough ws seen only in 68%. Figure 6: () Axil HRCT imge revels ground glss ttenution with crzy pving pttern nd multiple cysts in ilterl lung fields which is clssic of Pneumocystis crinii pneumoni. () HRCT imge revels miliry tuerculosis in ilterl lung fields in different cse As per NACO 4 recommendtion HIV infection is dignosed on the sis of 3 ELISA/rpid single lood tests using different ntigen preprtions. AIDS is dignosed on the sis of 2 ELISA/rpid tests nd presence of AIDS-relted OI. All ptients hve undergone 2 or more ELISA tests nd re found to e positive. Hence, ll ptients in the present study mtched the NACO 4 recommendtion. The rnge of CD4 counts vried from 21 to 382 with men count of cells/cumm. Hence, mximum numers of ptients re in dvnced stge of immunosuppression in the present study. Figure 7: () Axil nd () Sgittl HRCT imges showing consolidtion in the left lingulr segment in cse of cteril infection Tle 14: HRCT findings of PCP HRCT findings No. of ptients Percentge Diffuse ground glss opcity Mosic ttenution Crzy pving Consolidtion HRCT: High resolution computed tomogrphy, PCP: Pneumocystis crinii pneumoni DISCUSSION In present study, mximum numer of cses ws seen etween 31 nd 40 yers ge group numering 14 cses, followed y 9 cses in yers of ge group. Hence, mximum numer of cses in the present study re lso noted in the ge group yers comprising out 76.7% of cses. This correltes well with study y Shrm et l. 5 who reported tht most of the HIV-positive ptients were in the ge group yers. In the present study, out of 30 ptients, 21 ptients re mle nd 9 ptients re femle. So mles ccounted for 70% nd femles ccounted for 30% of cses. In ntionlevel sttistics of the HIV/AIDS cses reported to the NACO, 4 74% were mles. Kumrsmy et l. 6 reported mle prepondernce with 72.9% cses eing mles. In the present study, most common presenting symptom ws weight loss seen in 80% of cses, fever (low grde) seen in 66.6% of cses nd high grde fever in 20% of In present study of 30 ptients, 18 ptients re dignosed s hving pulmonry TB ccounting for 60% of cses, 5 ptients re dignosed s hving cteril infection ccounting for 16.6% of cses nd 3 ptients re dignosed s hving PCP (10%). An nlysis of vrious OIs reported to NACO 4 from different prts of the country shows tht out 64% of the AIDS cses were found to e suffering from pulmonry TB, cteril infection in 7.6% cses, nd PCP in 3% cses. Lnjewr nd Duggl. 7 in n utopsy study to evlute pulmonry pthology in ptients with AIDS identified the cuse of e TB in 59% cses, cteril pneumoni in 18% cses, nd PCP in 5% cses. Hence, the present study firly correltes with the ove-mentioned studies. Pulmonry TB A totl of 18 ptients in the present study re dignosed to e suffering from pulmonry TB nd re the most common disese noted. Worldwide, TB is the most common OI ffecting HIV-seropositive individuls nd it remins the most common cuse of deth in ptients with AIDS. 8 Mohr et l. 9 stted tht it is lso possile tht TB msked the recognition of other OIs. Kumr et l. 10 reported cough nd expectortion in 97.6% ptients, while 90.4% of the ptients hd low- grde fever, nd significnt weight loss ws oserved in 78.6% of the ptients. In the present study, most common clinicl mnifesttion is cough with expectortion (89%), followed y weight loss (83%), nd low-grde fever (78% cses). Slight vrition in present study could e ttriuted to smll smple size. The CD4 count in these ptients vried from 21 to 382 cells/cumm with men count of cells/cumm. 123 Interntionl Journl of Scientific Study August 2015 Vol 3 Issue 5

7 6 ptients hs CD4 count >200 cells/cumm, while 12 ptients hs CD4 count <200 cells/cumm. Kumr et l. 10 reported tht direct smer exmintion for AFB in sputum specimens ws positive in 21.4% ptients. In the present study, 33.3% hs AFB in their sputum. The most common HRCT finding in pulmonry TB re nodulr opcities seen in 77.7% cses, followed y consolidtion in 50%, pleurl effusion in 38.8%, lymphdenopthy in 33.3%, nd cvittion in 22.2% cses. Lissy et l. 11 lso noted tht nodulr opcities, minly centriloulr in distriution were the most common finding seen in 72% cses. In present study 50% ptients with pulmonry TB hs consolidtion visile on HRCT scns nd it most commonly involved the right middle loe nd right lower loe which correlted with study y Leung et l. 12 who noted consolidtion in 43% cses nd it ws predominntly right sided. In present study ground glss opcity re noted in 22% of ptients which correlted well with study y Hrtmn et l. 13 who noted presence of ground glss opcity in 19% of cses. Leung et l. 12 detected cvittion in 19% of ptients with pulmonry TB. In present study, cvities re seen in 22% ptients. Lissy et l. 11 noted tht 24% ptients with pulmonry TB demonstrted presence of cvittion. Furthermore, cvittion re more common in ptients who hd CD4 counts >200 cells/cumm. The men CD4 count in these 24% ptients is cells/cumm. Hrtmn et l. 13 noted pleurl effusions in 38% ptients with pulmonry TB. Relkin et l. 14 reported n incresed prevlence of pleurl effusion in AIDS - relted TB compred with the TB in HIV - negtive ptients. In present study, pleurl effusions re seen in 38.8% ptients with pulmonry TB. Kumr et l. 10 oserved lymphdenopthy in 16.8% cses with pulmonry TB. In present study, lymphdenopthy is noted in 33.3% ptients with pulmonry TB. Leung et l. 12 noted tht miliry disese ws more frequent in HIV seropositive ptients with 17% their cses showing miliry pttern. In present study, miliry ptterns re noted in 16.7% ptients. Mcguinness et l. 15 mentioned tht ronchiectsis nd ronchil wll thickening is common in HIV ptients occurring in oth primry nd rectivtion disese. In present study, ronchiectsis is noted in 44.4% ptients. Bcteril Infections A totl of 5 ptients in present study re dignosed to e suffering from cteril infections. Brecher et l. 16 noted tht ptients with cteril infection typiclly present with reltively rpid onset of clinicl symptoms such s productive cough, fever, shking chills, pleuritic chest pin, nd dyspne. The most common clinicl mnifesttion in present study is high grde fever (80%) nd cough with expectortion (80%). Hirschtick et l. 17 oserved tht lthough cteril pneumoni often occurs in the erly stges of HIV infection, the risk of cteril infection increses stedily with declining CD4 lymphocyte counts. In present study, the CD4 counts vried from 121 to 366 cells/cumm with men count of cells/cumm. Boiselle et l. 18 nd Mgnent et l. 19 reported tht focl consolidtion ws oserved in pproximtely 45-60% of ptients with pyogenic infection. In present study, lor consolidtions re seen in 60% cses with cteril infection. Boiselle et l. 18 noted tht cteril infections my lso present s solitry or multiple lung nodules. In present study, nodules were noted in 20% ptients. The nodules re rndomly distriuted; some re ssocited with cvittion. McGuinness et l. 15 noted tht HIV-infected ptients re t incresed risk for developing infectious irwys disese, with ronchiectsis eing noted to develop in reltively short time fter n episode of pulmonry pyogenic infection. In present study, ronchiectsis is noted in one out of five ptients with cteril infections nd it is ssocited with presence of ir fluid level. PCP A totl of 3 ptients in present study re dignosed to e suffering from PCP. Thoms nd Limper 20 mentioned tht common symptoms of PCP include the sutle onset of progressive dyspne, non-productive cough, nd low-grde fever. In present study, most common clinicl mnifesttion re dyspne (100%), nd then cough without expectortion (66.6%), low grde fever (66.6%), nd high grde fever (33.3%). Phir et l. 21 noted tht PCP occurs more frequently when the CD4 count level flls elow 200 cells/cumm. In present study, CD4 counts in ll ptients with PCP re <200 cells/cumm, with men count of 32.7 cells/cumm. Hrtmn et l. 13 noted ground glss opcities in 92% of ptients with PCP. Kuhlmn et l. 22 noted tht PCP Interntionl Journl of Scientific Study August 2015 Vol 3 Issue 5 124

8 clssiclly results in ground-glss infiltrte, often in geogrphicl distriution. In present study, ground glss opcity is noted in 100% ptients with PCP. Here the ground glss opcities extended from the picl to sl regions ilterlly. In ddition to diffuse disese, distinct mosic pttern cn e identified in ll three ptients. Bergin et l. 23 noted crzy-pving pttern in 50% of ptients with PCP. In present study, 66.7% ptients demonstrted crzy-pving pttern. Slight vrition in present study could e ttriuted to smll smple size. Hrtmn et l. 13 noted consolidtion in 38% ptients with PCP. In the present study, consolidtion is seen in 33.3% cses. CONCLUSION From our present study of 30 HIV-positive ptients coming with suspected pulmonry disese the following conclusions cn e drwn: The most common HRCT finding in pulmonry TB were nodulr opcity, lor consolidtion in cteril infection nd diffuse ground glss opcities in mosic pttern of distriution in PCP. The dignosis of HIV/AIDS ptients presenting with pulmonry disese remins chllenge s the signs nd symptoms re non-specific nd tend to e typicl. HRCT is highly sensitive modlity for detecting prenchyml normlities, nd it llows etter delinetion nd chrcteriztion of the lesions. Hence, HRCT should e incorported into the mngement protocols of HIV/AIDS ptients coming with suspected pulmonry complictions. REFERENCES 1. Allen CM, Al-Jhdli HH, Irion KL, Al Ghnem S, Goud A, Khn AN. Imging lung mnifesttions of HIV/AIDS. Ann Thorc Med 2010;5: UN AIDS Report on the Glol AIDS Epidemic; p Nrin JP, Rviglione MC. HIV ssocited tuerculosis in developing countries: Epidemiology nd strtegies for prevention. Tuerculosis 1992;73: NACO. Ntionl Frmework for Joint HIV/TB Collortive Activities. 2013; Shrm SK, Kdhirvn T, Bng A, Goyl T, Bhti I, Sh PK. Spectrum of clinicl disese in series of 135 hospitlised HIV-infected ptients from north Indi. BMC Infect Dis 2004;4: Kumrsmy N, Solomon S, Flnign TP, Hemlth R, Thygrjn SP, Myer KH. Nturl history of humn immunodeficiency virus disese in southern Indi. Clin Infect Dis 2003;36: Lnjewr DN, Duggl R. Pulmonry pthology in ptients with AIDS: An utopsy study from Mumi. HIV Med 2001;2: Luetkemeyer A. HIV in site knowledge se chpter. HIV in site. Comprehensive upto Dte Informtion on HIV/AIDS Tretment, Prevention, nd Policy from the University of Cliforni Sn Frncisco. Jnury, Mohr A, Romo J, Slido F, Jessurun J, Ponce de León S, Reyes E, et l. The spectrum of clinicl nd pthologicl mnifesttions of AIDS in consecutive series of utopsied ptients in Mexico. AIDS 1992;6: Kumr P, Shrm N, Shrm NC, Ptnik S. Clinicl profile of tuerculosis in ptients with HIV Infection/AIDS. Indin J Chest Dis Allied Sci 2002;44: Lissy JP, Cdi M, Cinqulre A, Boudif ZE, Lriven S, Cslino E, et l. Mycocterium tuerculosis versus non-tuerculous mycocteril infection of the lung in AIDS ptients: CT nd HRCT ptterns. J Comput Assist Tomogr 1997;21: Leung AN, Bruner MW, Gmsu G, Mlik-Cnne N, Ben Romdhne H, Crette MF, et l. Pulmonry tuerculosis: Comprison of CT findings in HIV-seropositive nd HIV-seronegtive ptients. Rdiology 1996;198: Hrtmn TE, Primck SL, Müller NL, Stples CA. Dignosis of thorcic complictions in AIDS: Accurcy of CT. AJR Am J Roentgenol 1994;162: Relkin F, Arnd CP, Gry SM, Smith R, Berkowitz KA, Rom WN. Pleurl tuerculosis nd HIV infection. Chest 1994;105: McGuinness G, Gruden JF, Bhll M, Hrkin TJ, Jgirdr JS, Nidich DP. AIDS-relted irwy disese. AJR Am J Roentgenol 1997;168: Brecher CW, Avirm G, Boiselle PM. CT nd rdiogrphy of cteril respirtory infections in AIDS ptients. AJR Am J Roentgenol 2003;180: Hirschtick RE, Glssroth J, Jordn MC, Wilcosky TC, Wllce JM, Kvle PA, et l. Bcteril pneumoni in persons infected with the humn immunodeficiency virus. Pulmonry complictions of HIV infection study group. N Engl J Med 1995;333: Boiselle PM, Avirm G, Fishmn JE. Updte on lung disese in AIDS. Semin Roentgenol 2002;37: Mgnent JL, Nicod LP, Auckenthler R, Junod AF. Mode of presenttion nd dignosis of Bcteril pneumoni in humn immunodeficiency virusinfected ptients. Am Rev Respir Dis 1991;144: Thoms CF Jr, Limper AH. Pneumocystis pneumoni. N Engl J Med 2004;350: Phir J, Muñoz A, Detels R, Kslow R, Rinldo C, Sh A. The risk of Pneumocystis crinii pneumoni mong men infected with humn immunodeficiency virus type 1. Multicenter AIDS cohort study group. N Engl J Med 1990;322: Kuhlmn JE, Kvuru M, Fishmn EK, Siegelmn SS. Pneumocystis crinii pneumoni: Spectrum of prenchyml CT findings. Rdiology 1990;175: Bergin CJ, Wirth RL, Berry GJ, Cstellino RA. Pneumocystis crinii pneumoni: CT nd HRCT oservtions. J Comput Assist Tomogr 1990;14: How to cite this rticle: Hzrik M, Dek N, Goswmi G. High-Resolution Computed Tomogrphic Evlution of Pulmonry Diseses in Humn Immunodeficiency Virus Positive Ptients: A Study of 30 Cses. Int J Sci Stud 2015;3(5): Source of Support: Nil, Conflict of Interest: None declred. 125 Interntionl Journl of Scientific Study August 2015 Vol 3 Issue 5