Analysis of peculiarities of identification, diagnostics and course of tuberculosis in patients with tuberculosis/HIV co-infection

Abstract

Objective – to analyse dynamics of detection of tuberculosis and HIV/AIDS in tuberculosis/HIV co-infection, to identify the main clinical forms of tuberculosis, the type of tuberculosis process and the structure of incidence of tuberculosis, to analyse dependence of a clinical form of tuberculosis on quantity of CD₄ cells.

Materials and methods. 155 patients with tuberculosis/HIV co-infection and 155 patients with tuberculosis without HIV infection were examined. All patients underwent general clinical examination, laboratory tests, X-ray, microbiological, histological studies (with extrapulmonary tuberculosis).

Results. In all patients, co-infection was detected mainly by respiratory tuberculosis (in 73 % of HIV-positive and 89 % of HIV-negative patients). In HIV-positive patients, tuberculosis was more often detected by the passive way (81 %), and in HIV-negative patients – by the active way (78 %). 66.5 % of patients had HIV infection first, 21.3 % had the first tuberculosis, and 12.2 % had HIV infection and tuberculosis at the same time. In clinical forms in patients with HIV-infection, infiltrative and disseminated tuberculosis prevailed. Pulmonary tuberculosis was diagnosed in 70.3 % of patients, extrapulmonary – in 11 %, pulmonary and extrapulmonary tuberculosis – in 18.7 %. In 28.4 % of patients, immunodeficiency was detected with CD₄ cells less than 100 in 1mm³, in 22.6 % of patients – 101–200 CD₄ cells in 1 mm³, in 10.3 % in 201–300 CD₄ in 1 mm³, in 14.8 % of patients – 301–500 CD₄ in 1 mm³ and in 23.9 % ≥ 500 CD₄ in 1 mm³. In 56.1 % of patients, first diagnosed tuberculosis was detected, 28.4 % had the relapse of tuberculosis, 7.7 % had tuberculosis after a previous ineffective treatment, 7.7 % had tuberculosis with treatment after the break. Bacterial excretion (by the scopic method) was detected in 42.6 % of patients, by the bacteriological method – in 73.9 %, by the molecular-genetic method – in 93.2 %, typical morphological changes (by the histological method) – in 10.0 % of patients.

Conclusions. Among patients with tuberculosis/HIV co-infection, 66.5% of patients have HIV infection is primarily detected, pulmonary tuberculosis is diagnosed in 70.3 % of cases and extrapulmonary tuberculosis is significantly underdetection. Atipical localization of pulmonary tuberculosis was in 47.7 % of patients. 51 % of patients had immunodeficiency (CD₄ < 200/mm³, 28.4 % of them had CD₄ < 100/mm³), among them, most were diagnosed with disseminated and miliary tuberculosis. Bacterial excretion in patients with tuberculosis/HIV co-infection by the scopy method was detected in 42.6 % of cases, what is 1.6 times less than in patients without HIV infection.