Tuberculosis and HIV infection

The spread of HIV infection has brought about radical changes in the epidemiology of tuberculosis in the world. HIV infection is the most serious risk factor for the development of tuberculosis in people infected with MBT in the last century. According to WHO, by 2002 the number of citizens with HIV infection was more than 40 million, presumably a third of them will develop tuberculosis.

In the USSR, HIV infection began to be registered in 1987. By 2004, the number of registered cases of HIV infection exceeded 300 thousand. Almost 80% of HIV-infected people are young people aged 15 to 30 years, of which more than 12 thousand are children under 14 years old.

The prevalence of tuberculosis among both the general population and HIV-infected individuals varies across countries

Symptoms of tuberculosis in HIV-infected patients

HIV infection not only provokes the development of tuberculosis, but also has a pronounced effect on its symptoms and course. According to a number of studies, clinical manifestations of various opportunistic infections in HIV-infected patients occur with varying degrees of immune suppression. Tuberculosis is the most virulent infection, occurring earlier than others. Clinical and radiological manifestations of tuberculosis in HIV-infected patients depend on the degree of immune suppression. In this case, the number of CD 4 cells is considered as a marker of the immunocompetence of the macroorganism. In the early stages of HIV infection (stages II, III, IV A), in the absence of severe immunodeficiency, tuberculosis proceeds as usual, and the effectiveness of its treatment during this period does not differ significantly from that in tuberculosis patients not infected with HIV.

Tuberculous changes in HIV-positive patients are characterized by more frequent development of hilar adenopathy, miliary rashes, and formation of pleural effusion. At the same time, they have less frequent lesions of the upper parts of the lungs, less frequent formation of cavities and atelectasis. At later stages of HIV infection (IV B, IV C, V) against the background of severe immunodeficiency (CD4 <0.2x10 ⁹ /l), the tuberculous process becomes more widespread with a tendency to dissemination with multiple extrapulmonary localizations, including the central nervous system. In 30% of cases, such patients are diagnosed with generalized tuberculosis with lesions of six or more groups of organs. The presence of severe opportunistic infections significantly complicates the course of the tuberculous process and complicates the organization of full-fledged chemotherapy, which leads to high mortality of patients from tuberculosis at the late stages of HIV infection.