Tuberculosis and HIV co-infection in inpatients of phthisio-pulmonological profile: frequency, form of lesion, diagnostic features (according to data of highly specialized institution)

Abstract

Objective — to clarify the prevalence of tuberculosis infection in HIV-positive inpatients of the TB hospital for 2014—2018 and features of its diagnosis in the affection of the chest cavity organs.Materials and methods. The method of retrospective analysis was used to process medical records of the Institute’s clinic for the period 2014—2018. A database has been formed that includes all patients with HIV infection treated in the hospital, from which a group of patients with a final clinical diagnosis of co-infection tuberculosis and HIV was subsequently selected.Among them were 195 (68.9 %) men and 88 (31.1 %) women. The average age of men was (37.0 ± 0.5), women — (38.0 ± 1.2) years. Separate subgroups of patients were selected, taking into account the localization of the tuberculous process in the chest cavity. The general clinical data of patients, the presence of comorbidities, diagnostic methods, localization and prevalence of the tuberculous process were taken into account.Results and discussion. Among 496 hospitalized HIV-positive patients with various pathologies of the chest cavity, the diagnosis of tuberculosis, that is, the presence of HIV-TB co-infection, was established in 283 (57.1 %) cases. In 46 (16.3 %) cases the diagnosis of HIV infection was established for the first time during hospitalization. Comorbid pathology was present in 184 (65.0 %) patients.Specific lung damage prevailed, 123 (44 %) cases, most often infiltrative tuberculosis (48.8 %). In 33 % of cases, there was a widespread tuberculous lesion — pulmonary and extrapulmonary (pleura or lymph nodes were involved). Isolated pleural lesion was diagnosed in 13 % of cases. The main methods of laboratory diagnostics were classical bacteriological methods — simple direct light microscopy and MBT culture, the positive results of which were obtained in only half of all studies, as well as molecular-genotypic tests. Prevalence of multidrug-resistant MBT strains was found (66.7 %).In about half of the cases, (44.9 %), additional mini-invasive procedures or surgical interventions with therapeutic and diagnostic purposes were performed. Histological examination confirmed the diagnosis of tuberculosis in 92 % of cases, whereas in the absence of signs of tuberculosis, diagnoses of other opportunistic diseases were most often specified/established.Conclusions. In HIV-positive inpatients of a phthisiopulmonary profile, tuberculosis infection prevails in the structure of opportunistic morbidity, 57.1 %. The largest proportion of patients consist cases with pulmonary tuberculosis (44 %), is also a large group (33 %), formed by patients with the extended lesion of the organs of the chest cavity.Positive results of traditional bacteriological studies were obtained in approximately half of the cases, which required an expansion of the diagnostic algorithm with the implementation of mini-invasive diagnostic procedures with biopsy of the affected tissues and subsequent histological examination.Analysis of the results of laboratory diagnostics of tuberculosis in cases of TB/HIV co-infection showed that the use of not only different microbiological research methods is most effective, but an important component in the diagnostic search is the histological examination of biopsy material.