Bone destruction and radiologic features in surgically treated human immunodeficiency virus-negative and -positive patients with tuberculosis of the spine

Abstract

Background: The aim of this study is to compare the extent of bone destruction and radiologic parameters in human immunodeficiency virus (HIV)-negative and -positive patients with spinal tuberculosis (TB). The rate of HIV co-infection among patients with TB is rising in sub-Saharan Africa. There are conflicting views in the clinical literature regarding the pathology and the extent of bone destruction in HIV-positive patients with spinal TB. This study makes a contribution to the literature addressing this problem.
Methods: A prospective multicentre study was conducted on 61 consecutive patients who underwent spinal surgery for spinal TB. Clinical, laboratory and radiographic parameters, including MRI, were examined in both HIV-negative and HIV-positive patients.
Results: A total of 31 males and 30 females participated in the study. Seventy percent (43 patients) were HIV-positive and 18 were HIV-negative. There was no difference in clinical parameters between the two patient groups. The amount of vertebral body loss was significantly higher in HIV-positive patients (p = 0.01). The amount of pus was marginally higher in HIV-positive patients (p = 0.16). There was no statistically significant difference in the kyphosis, skip lesions and cord compression between the two groups.
Conclusion: Human immunodeficiency virus-positive patients exhibit more vertebral body destruction and a marginal increase in pus formation. This enhanced bone destruction is attributed to the activation of the receptor activator of the nuclear factor-κ ligand pathway by cytokines, a process that is more pronounced in the context of HIV infection.
Contribution: This clinical study supports the findings by laboratory studies that there is more bone destruction in HIV-positive patients than in HIV-negative patients with tuberculosis of the spine.