Comparative analysis of fatal outcomes in hospitalized tuberculosis patients with and without HIV infection in the post-pandemic period

The slowdown in the decline of tuberculosis (TB) incidence and mortality following the coronavirus (COVID-19) pandemic has become a problem of considerable medical and socioeconomic importance.

The aim of this study was to compare mortality among hospitalized patients with HIV-associated TB and those with TB without HIV infection during the post-pandemic period.

Materials and Methods. We analyzed medical records and pathological reports of patients who died with a confirmed diagnosis of TB in 2023 at the S.P. Botkin Clinical Infectious Diseases Hospital (St. Petersburg). The study included 73 fatal cases: 57 (78.1%) with both TB and stage 4B HIV infection (Group 1) and 16 (21.9%) with TB monoinfection (Group 2). We assessed gender, demographic characteristics, and comorbidities using the Charlson Comorbidity Index. For HIV-positive patients, additional data on infection duration, degree of immunosuppression, and opportunistic conditions were evaluated. Diagnostic methods for TB and clinical characteristics of disease progression were compared between groups.

Results and Discussion. Most deceased patients were young to middle-aged men with HIV-associated TB. Among HIV-positive individuals, TB was either the direct cause of death (61.4%) or served as a concurrent opportunistic infection (38.6%). In contrast, HIV-negative patients typically had severe systemic comorbidities, reflected by a Charlson index of 3.8. TB was the primary cause of death in 75% of individuals in Group 2. Only 29.8% of microbiological tests identified highly sensitive Mycobacterium tuberculosis strains; more than half (54.4%) revealed multidrug-resistant or extensively drug-resistant strains. Generalized TB was diagnosed significantly more often among HIV-positive patients (77.2%) compared with HIV-negative patients (37.5%). Central nervous system involvement occurred in a quarter of all cases, including one case in a patient without HIV infection.

Conclusion. Our findings demonstrate a worsening course of TB in the post-COVID period in both HIV-positive and HIV-negative patients.

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