Background & Aim: HIV infected persons are at risk of developing disseminated forms of TB, such as tuberculous meningitis (TBM). As the HIV infection primarily impairs the cell mediated immunity (CMI), the immune responses to TB bacilli seen in HIC infected may be different and may manifest in different clinical, radiological and CSF findings. Moreover as the immunity varies with CD4 count, there could be differences in clinico-radiological features at different CD4 counts. The present study was conducted to assess the clinical, CSF and radiological features of TBM in HIV positives and to study its relation with CD4 count.

Materials and Methods: Clinical, radiological and CSF features of 100 HIV positive TBM patients were studied and its relation with CD4 count was analyzed.

Results: The findings are notable by the difference in radiological findings between different CD4 count groups. Basal meningeal enhancement and hydrocephalus was conspicuously less common in those with CD4 count less than 50. Radiological findings are also remarkable by the presence of normal radiological findings in a sizeable proportion of patients with low CD4 count. CSF protein and total cell count is significantly less in those with CD4 count less than 50.

Conclusion: Like tuberculosis of other organs (notably lung), clinical, CSF and radiological findings in HIV patients can be quite different especially in those with severe immunosuppression. Therefore, a high degree of suspicion is required when interpreting radiological and CSF findings of HIV positive TBM patients.

Keywords: HIV, TBM, CD4 Count.

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Dr Tejpal Singh

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