Analysis of Chest X-ray in Active Pulmonary Tuberculosis for Individuals Co-infected with HIV, and the Relationship with CD4 Counts in RSUP Dr. Sardjito

Chandrika Maulida Hutami, Prof. Dr.dr. Lina Choridah, Sp.Rad.(K); dr. Naela Himayati Afifah, M.Sc, Sp.Rad; Dr.dr. Nurhuda Hendra Setyawan., Sp.Rad

2026 | Skripsi | PENDIDIKAN DOKTER

Latar Belakang: Tuberkulosis (TB) masih merupakan masalah kesehatan global yang utama, terutama pada individu dengan koinfeksi Human Immunodeficiency Virus (HIV). Imunosupresi yang disebabkan oleh HIV mengubah gambaran klinis dan radiologis tuberkulosis paru, sehingga sering menimbulkan temuan foto toraks yang atipikal dan menyulitkan proses diagnosis. Jumlah CD4 merupakan indikator penting status imun pada pasien HIV dan diduga berpengaruh terhadap manifestasi radiologis TB. Namun demikian, data mengenai hubungan antara gambaran foto toraks dan jumlah CD4 pada pasien TB-HIV di Indonesia masih terbatas.

Tujuan: Menganalisis pola gambaran foto toraks pada pasien tuberkulosis paru aktif dengan koinfeksi HIV serta menentukan hubungannya dengan jumlah CD4 di RSUP Dr. Sardjito.

Metode: Penelitian ini menggunakan desain observasional analitik. Data dikumpulkan dari pasien TB-HIV yang dirawat di RSUP Dr. Sardjito. Gambaran foto toraks yang dinilai meliputi bayangan nodular, konsolidasi, kavitas, limfadenopati, efusi pleura, pola milier, serta keterlibatan zona paru. Temuan radiologis tersebut dikorelasikan dengan kadar CD4. Analisis statistik meliputi analisis univariat, analisis bivariat menggunakan uji Kruskal–Wallis, serta analisis regresi multivariat untuk menilai hubungan antara gambaran radiologis dan jumlah CD4.

Hasil: Pasien dengan jumlah CD4 yang lebih rendah cenderung menunjukkan gambaran foto toraks yang atipikal, seperti konsolidasi, bayangan milier, limfadenopati, serta keterlibatan zona paru bagian tengah hingga bawah, sedangkan lesi kavitas lebih jarang ditemukan. Terdapat hubungan yang bermakna secara statistik antara kadar CD4 dan beberapa karakteristik radiologis, yang menunjukkan bahwa status imun memengaruhi manifestasi radiologis tuberkulosis paru pada pasien HIV.

Kesimpulan: Gambaran foto toraks tuberkulosis paru pada pasien dengan koinfeksi HIV berhubungan secara signifikan dengan jumlah CD4. Kadar CD4 yang rendah berkorelasi dengan pola radiologis yang lebih atipikal. Pemahaman terhadap hubungan ini dapat meningkatkan akurasi diagnosis serta membantu pengelolaan klinis pasien TB-HIV, khususnya di daerah dengan beban penyakit yang tinggi.

Background: Tuberculosis (TB) remains a major global health problem, particularly among individuals co-infected with Human Immunodeficiency Virus (HIV). HIV-induced immunosuppression alters the clinical and radiological presentation of pulmonary TB, often leading to atypical chest X-ray findings that complicate diagnosis. CD4 count is a key indicator of immune status in HIV-infected patients and is believed to influence radiographic manifestations of TB. However, data regarding the relationship between chest X-ray findings and CD4 counts in TB-HIV co-infected patients in Indonesia remain limited.

Objective: To analyze chest X-ray patterns in patients with active pulmonary tuberculosis co-infected with HIV and to determine their relationship with CD4 counts at RSUP Dr. Sardjito.

Methods: This study employed an observational analytical design. Data were collected from TB-HIV co-infected patients treated at RSUP Dr. Sardjito. Chest X-ray findings, including nodular shadows, consolidation, cavitation, lymphadenopathy, pleural effusion, miliary pattern, and lung zone involvement, were evaluated and correlated with CD4 count levels. Statistical analyses included univariate, bivariate (Kruskal–Wallis), and multivariate regression analyses to assess the association between radiological features and CD4 counts.

Results: Patients with lower CD4 counts tended to present with atypical chest X-ray findings, such as consolidation, miliary shadows, lymphadenopathy, and involvement of middle to lower lung zones, while cavitary lesions were less frequently observed. Statistically significant associations were found between CD4 count levels and several radiographic features, indicating that immune status influences the radiological presentation of pulmonary TB in HIV-infected patients.

Conclusion: Chest X-ray manifestations of pulmonary tuberculosis in HIV co-infected patients are significantly associated with CD4 counts. Lower CD4 levels are correlated with more atypical radiographic patterns. Understanding this relationship can improve diagnostic accuracy and clinical management of TB-HIV co-infected patients, particularly in settings with high disease burden.

Kata Kunci : HIV, Chest X-ray, CD4 Count, Pulmonary Tuberculosis