The role of combined opportunistic infections in the formation of fatal outcomes in patients with HIV-associated tuberculosis

The purpose. To study the structure and evaluate the role of isolated and combined opportunistic infections in the formation of lethal outcomes in patients with HIV-associated tuberculosis.

Materials and methods. Comparative clinical and morphological analysis of deaths in patients with HIV-associated tuberculosis (group No. 1) and in patients with HIV infection without tuberculosis (group No. 2).

Results. The study included 87 cases, including 57 in group 1 and 30 in group 2. There were no significant differences in the groups by sex, age, duration of HIV infection and underlying comorbid pathology. In group No. 1, diseases of the cardiovascular system were more often detected (78.9 and 46.7%, p=0.002). CD4 lymphocyte levels were 23.0 (8.2; 73.4) cells/ml in group 1 and 10.3 (3.7;21.5) cells/ ml in group 2. In group 1, generalized tuberculosis was diagnosed in 45 patients (78.9%), including tuberculosis of the central nervous system in 20 patients. 33 (57.9%) patients in group 1 did not receive antiretroviral therapy. The main causes are death before the start of TB therapy (16 patients) and in the first weeks of therapy (14 patients), treatment of opportunistic infections (3 patients). In group 1, tuberculosis as the only as a single opportunistic infection was detected in 17 patients (29.8%); combined opportunistic infections were diagnosed in 40 (70.2%) patients, including two infections in 20 (35.1%), three in 14 (24.6%), four in 6 (10.5%) patients. Esophageal candidiasis (26 cases) and pneumocystis pneumonia (15 cases) were most often opportunistic infections detected together with tuberculosis. Distribution by causes of deaths among patients in group 1: HIV-associated tuberculosis – 39 (68.4%) patients, a combination of opportunistic infections, including tuberculosis – 7 (12.3%) patients, opportunistic infections in the background of tuberculosis – 9 (15.8%) patients, progression of other diseases without a significant role of tuberculosis – 2 (3.5%) of patients.

Conclusion. A combination of several opportunistic diseases has been found in the majority of deceased patients with HIV-associated tuberculosis, which has an negative effect on the prognosis, timing of appointment and the likelihood of temporary discontinuation of antiretroviral therapy.

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