Firstly diagnosed HIV/AIDS-associated tuberculosis: clinical peculiarities and causes of patients` deaths

Abstract

Introduction. According to the literature, HIV infection increases the risk of tuberculosis, and tuberculosis causes an adverse effect on the course of HIV infection. Tuberculosis is the direct cause of death of patients up to 30.0% with HIV infection and in 90.0% of cases at AIDS. That’s why studying the clinical course of HIV/AIDS-associated tuberculosis and analysis of causes of death in these patients is highly actual today.

The aim of the study. To determine the clinical course and causes of death in patients with primarily diagnosed HIV/AIDS-associated tuberculosis.

Materials and methods. 22 patients cards who died of primarily diagnosed HIV/AIDS-associated tuberculosis were analyzed in this article.

The results of research. Among patients with primarily diagnosed HIV/AIDS-associated tuberculosis there were 12 men (54.6%), and 10 (45.4%) women. The average age was 39.5 ± 1.5 years. There were 90.9% of unemployed patients (20 patients), 4 patients (18.2%) were former prisoners, 1(4.5%) – shelterless person, 5 patients (22.7%) suffered from drug addiction and alcoholism. 9 (40.9%) patients lived antisocial life. HIV-infection had started after tuberculosis in 1 patient (4.5%), before tuberculosis - in 15 (68.2%), the simultaneous detection of co-infection was found in 6 cases (27.3%).

Prevailed disseminated (60 %) and infiltrative forms of lung tuberculosis (33,3 %) were significantly (P <0.05) more often registered among patients with co-infection of primarily diagnosed HIV/AIDS-associated tuberculosis. 5 (33.3%) patients had pulmonary tuberculosis combined with extrapulmonary, that significantly complicated the course of co-infection.

There were 3 patients (13.6%), who interrupted treatment, 1 patient refused treatment completely. 6 patients had received antiretroviral therapy (27.3%), 5 patients (22.7%) renounced, in 11 (50.0%) - antiretroviral therapy was not intended.

The autopsy determined that 14 (63.6%) patients died from progressive worsening of tuberculosis (8 (57.1%) - pulmonary, 6 (42.9%) - extrapulmonary) and 8 (36.4%) - due to progression of HIV infection. It was found, that late diagnosis of HIV infection occurred in 4.5% of cases, late diagnosis of tuberculosis (TB was established only at autopsy) - in 5 patients (22.7%). It was found, that all of these patients died from progression of a specific process.

Conclusion. It was determined that most of the patients lived the anti-social way of life, and suffered from alcoholism or drug addiction, tuberculosis more often had started after HIV-infection. Disseminative and infiltrative forms of pulmonary tuberculosis were more often determined in patients who died of co-infection. In one-third of patients combined pulmonary and extrapulmonary localization of tuberculosis were determined,  most patients had noncompliance with a specific anti-TB and antiretroviral treatment and had a significant immunodeficiency. Death came more often from progression of tuberculosis.   

 Key words: firstly diagnosed HIV/AIDS-associated tuberculosis.