Treatment efficacy and tuberculosis relapses in HIV infected patients with severe immunosuppression who started antiretroviral therapy

The objective: to analyze treatment efficacy and causes of tuberculosis relapses in HIV-infected patients with severe immunosuppression who have started antiretroviral therapy (ART). Subjects and methods. 139 case histories were studied, those case history belonged to the patients with TB/HIV co-infection and CD4 count below 100 cells/μl, a median of 33.2 cells/μl – 4.2%, who started ART in the in-patient unit. The efficacy of inpatient treatment was assessed; 89 patients were followed up after discharge from hospital. The follow-up period lasted from January 2011 to May 2019. Results. ART did not increase the efficacy of the in-patient stage of TB/HIV treatment due to the development of immune reconstitution inflammatory syndrome, which occurred in 34.5% of patients and accounted for 70.0% of hospital lethality cases. After discharge from hospital, 69.7% of patients successfully completed anti-tuberculosis chemotherapy, 25.8% died before completing treatment, the main cause of death was tuberculosis (56.5%), including multiple drug resistance in 30.8% of cases. At the outpatient stage, 29.1% of patients interrupted ART, their death rate was higher (p = 0.007), and tuberculosis and HIV-associated diseases became the cause of death more often (p = 0.042) versus the compliant patients. Tuberculosis relapses developed in 17.7% after 16.7 ± 1.7 months after completion of treatment; 63.6% had multiple drug resistance, patients with tuberculosis relapses interrupted ART more often (p = 0.002), had a lower CD4 count (p = 0.030) versus patients without relapses. As of May 2019, 46.1% of patients survived and had no signs of active tuberculosis; 42.7% died, tuberculosis dominated among the causes of death – 50.0% (in 52.6% – multiple drug resistance) as well as HIV-associated diseases (21.1%).