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Normally, primary tuberculosis does not show cavitatory lesions while secondary tb does- higher grade of immune activation in secondary tb causes parenchymal damage leading to cavitation.
Now, the scenario is HIV patients is very unique. With decreasing CD4 counts, they would be more prone to tb and rather, disseminated form of tb but they simply don't have immune cells! So, the risk of cavitatory tb lowers with decreasing CD4 counts. The problem- the patient may not present early as he or she may not have a productive sputum.
Pranav Patwardhan
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