Peculiarities of clinical course of HIV-associated tuberculosis

HIV-associated tuberculosis poses an immediate and serious public health threat, especially in developing countries. People living with HIV are at greater risk of developing tuberculosis due to decreased immunologic reactivity. According to WHO, the risk of developing tuberculosis is 20-30 times higher in HIV-infected individuals than in HIV-negative individuals. HIV infection is the most powerful known risk factor predisposing to infection with Mycobacterium tuberculosis and progression of the disease to active form, which increases the risk of reactivation of latent tuberculosis by 20 times. Tuberculosis is also the most common cause of AIDS-related deaths. Thus, tuberculosis and HIV act synergistically, accelerating the decline in immunologic function and leading to subsequent death if untreated. Patients with HIV infection often present with atypical clinical presentation of tuberculosis and an unfavorable outcome. Due to the atypical course of the disease, the diagnostic search in HIV-infected patients requires the use of additional methods of examination, such as MSCT of OHC at the stage of disease detection and PCR of diagnostic material for MBT DNA in addition to sputum bacterioscopy with Cyl-Nielsen staining for CUM. The course of tuberculosis in HIV-infected patients depends on the degree of immune response suppression; atypical clinical and radiologic features of tuberculosis in such patients are noted with a significant decrease in CD4+-lymphocytes. The course of pulmonary tuberculosis combined with HIV infection leads to a significant aggravation of clinical forms of tuberculosis with an increase in the number of disseminated and generalized forms. Thus, the above data confirm that tuberculosis in HIV-infected patients is an urgent problem of modern phthisiatry. The significance of this problem is related to the unfavorable prognosis of further spread of tuberculosis, which is caused, on the one hand, by high infection of the population with MBT, and on the other hand, by the wide spread of HIV infection in the world, including the Russian Federation. HIV infection is not only a risk factor for the development of tuberculosis, but also a cause aggravating the course of tuberculosis and reducing the effectiveness of treatment. Literature data on the course and effectiveness of tuberculosis treatment in HIV-infected patients are contradictory. In this regard, scientific research devoted to the study of various clinical and pathophysiological aspects of tuberculosis development in patients with HIV infection, as well as the development of scientifically substantiated methods of pathogenetic treatment of patients in this category remain in high demand.