DOI: 10.1097/bn9.0000000000000159 ISSN: 3066-8905

Radiographic and MRI Features of Tuberculous Spondylitis in Patients With and Without HIV Infection: A Multicenter Nigerian Cohort Study

Mutaleeb A. Shobode, Rami Rajjoub, Oladapo Ekundayo, Raphael Ayorinde, Muhammad N. Salihu
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Objective:

To compare clinical and imaging characteristics of tuberculous spondylitis in patients with and without human immunodeficiency virus (HIV) infection.

Background:

Tuberculous spondylitis is the most common form of skeletal tuberculosis and a major cause of spinal deformity and neurological disability. The effect of HIV on its radiologic phenotype remains unclear.

Materials and Methods:

Demographic, clinical, and imaging data were collected from 835 patients from tertiary centers in Nigeria using a standardized protocol. Radiographic and magnetic resonance imaging (MRI) features were compared by HIV status. Multivariable logistic regression assessed independent associations between HIV status and radiologic findings.

Results:

Ninety-two patients (11.0%) were HIV positive. The thoracolumbar spine was the most frequently involved region (41.0%), with similar anatomic distributions between groups. Major imaging findings were comparable between HIV-negative and HIV-positive patients, including disc space narrowing (83.0% vs . 83.7%; P =0.91), vertebral destruction (72.3% vs . 66.3%; P =0.23), neural compression (76.7% vs . 77.2%; P =0.92), and Modic changes (94.1% vs . 92.4%; P =0.52). Compensatory deformity was more frequent in HIV-positive patients on unadjusted analysis (76.1% vs . 65.5%; P =0.043); however, this association was not statistically significant after multivariable adjustment (aOR: 1.66, 95% CI: 1.00–2.76; P =0.051). Radiologic severity, including canal compromise and deformity, was not associated with neurological impairment. After multivariable adjustment, HIV status was not independently associated with disc space narrowing, vertebral destruction, instability, neural compression, Modic changes, or abscess formation.

Conclusion:

The radiologic phenotype of tuberculous spondylitis is similar across HIV status. The radiologic severity measures evaluated were not significantly associated with neurological impairment, suggesting that structural imaging findings alone may not fully account for neurological dysfunction.

Level of Evidence:

Level II.

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