The Role of Cell-Mediated Immunity Deficiency in the Clinical Evolution of Patients with Tuberculosis Associated with HIV Infection

Abstract

HIV infection induces severe immunosuppression, considered the major risk factor for tuberculosis (TB). Objective — to evaluate the clinical characteristics of patients with TB-HIV co-infection based on the level of immune deficiency to establish recommendations for improving clinical case management. Materials and methods. A prospective, selective study included 86 TB patients, divided into the study group with 38 cases of TB evolved into acquired immunodeficiency syndrome (AIDS), established with a CD4+ level ≤ 200/μL and the control group with 48 TB cases having CD4+ ≥ 200/μL. Results and discussion. The study assessed the impact of the severity of the cell mediated immune deficiency associated with HIV infection on the clinical evolution of TB and the final therapeutic outcome. Laboratory indicators characterizing TB in AIDS included general leukocytosis, lymphocytopenia, eosino­philia, anemia and, in rare cases, thrombocytopenia. All AIDS patients were untreated with ARV, and only one-third were in the early stages of symptomatic HIV infection. Risk factors for TB in AIDS included rural residence, low education levels and mental disorders. Treatment success was low, and the death rate was high in both groups, emphasizing the impact of associated conditions. Despite differences in the serum level of CD4+ cells, the rate of therapeutic success was equally low in both groups, with one-third continuing antituberculosis treatment. The death rate was insignificantly higher in the TB on AIDS group (23.4 %) vs. 18.7 % in early HIV stages due to comorbidities associated with HIV infection. Conclusions. The study identified risk factors for TB in patients diagnosed with AIDS stage of symptomatic HIV infection, including residence in rural areas, low education levels and mental and behavioral disorders associated with multiple causes such as alcohol consumption, drug use and toxoplasmosis of the central nervous system. Recommendations include complex screening for TB and HIV in all socially vulnerable groups, reinforced by primary prevention and an individualized therapeutic approach.