Clinical, laboratory and radiological characteristics of HIV infection associated with tuberculosis and treatment of such patients

Abstract

Objective: to analyze and explain the clinical, laboratory and radiological features of HIV infection associated with tuberculosis (HIV/TB) and on this basis to argue the principles of treatment of such patients.The development of active tuberculosis (TB) in HIV-infected patients is accompanied by an increase, while during its treatment, on the contrary, — a decrease in the concentration of viral RNA in the blood. The release of the virus into the blood is due to the activation of lymphocytes caused by mycobacterium tuberculosis (MBT). Therefore, the clinical manifestations of HIV infection and TB in the early stages are similar. TB increases the degree of immunodeficiency in HIV-positive patients, which leads to the associated opportunistic diseases: esophageal candidiasis, cryptococcal meningitis, pneumocystic pneumonia, Kaposhi sarcoma, and etc.With the development of immunodeficiency, the clinical picture of tuberculosis also changes. This is due to the fact that in the context of lowering the immune response, no typical tuberculosis granuloma is formed, the MBT easier spreads to other organs and systems. Therefore, in HIV-positive patientsthere are primary, extra-pulmonary and generalized forms of tuberculosis. According to chest X‑ray, tuberculous changes in HIV-infected patients (as in primary infections) are characterized by more frequent development of adenopathy of hilus, miliary rash, the presence of predominantly interstitial changes and the formation of pleural effusion. At the same time, they are reliably less likely to affect the upper lung parts, not so often formed destruction cavities and atelectasis. Over the past few years, approaches to the providing of antiretroviral treatment (ART) have changed dramatically in patients with HIV/TB. It has been shown that the use of ART in the first 2–8 weeks of treatment for tuberculosis significantly increases the patient's chances of recovery. Currently, ART is administered to all patients with TBregardless of the number of CD4 + T‑lymphocytes.Conclusions. So, the clinical manifestations of HIV infection and TB in the early stages are similar. However, with the development of immunodeficiency, the clinical picture of tuberculosis also changes. In HIV-infected diseases, TB increases the degree of immunodeficiency, which leads to association of other opportunistic diseases. When radiographing the chest cavity, changes in HIV-infected patients are characterized by frequent development of adenopathy of hilus, miliary rash, the presence of predominantly interstitial changes and the formation of pleural effusion. Also in recent years, approaches to prescribing antiretroviral therapy (ART) for patients with HIV/TB have changed. So, the relationship between HIV infection and tuberculosis at the cellular level appears to be very complex and insufficiently studied. Clinical and laboratory, especially immunological, aspects of the development of tuberculosis as a secondary disease in HIV-infected patients require additional studies.