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Infectious disease

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Tuberculosis and HIV infection

Alexey Kryvenko, medical expert
Last reviewed: 20.11.2021

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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 tuberculosis in people infected with the Office in the last century. According to WHO, by 2002 the number of people with HIV infection was more than 40 million, presumably one third of them will develop tuberculosis.

In the USSR, HIV infection began to be registered since 1987. By 2004, the number of registered HIV cases exceeded the threshold of 300,000. Almost 80% of those infected with HIV are young people between the ages of 15 and 30, of whom more than 12,000 are HIV- children under 14 years.

The spread of tuberculosis both among the main population and among HIV-infected people varies from country to country

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 several studies, clinical manifestations of various opportunistic infections in HIV-infected patients occur with different degrees of suppression of immunity. Tuberculosis is the most virulent infection that occurs earlier than others. Clinico-radiological manifestations of tuberculosis in HIV-infected people depend on the degree of oppression of immunity. 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 occurs as usual, and the effectiveness of its treatment during this period does not differ significantly from that in patients with tuberculosis not infected with HIV.

Tuberculosis changes in HIV-positive patients are characterized by a more frequent development of radical adenopathies, miliary rashes, the formation of pleural effusion. At the same time, they have less lesions in the upper parts of the lungs, less often, cavities of decay and atelectasis are formed. In the later stages of HIV infection (IV B, IV B, V) against the background of severe immunodeficiency (CD4 <0.2x10 ⁹ / L), the tuberculosis process becomes more prevalent with a tendency to dissemination with multiple extrapulmonary localizations, including the central nervous system . In 30% of cases, these patients are diagnosed with generalized tuberculosis with the defeat of six or more groups of organs. The presence of severe opportunistic infections greatly complicates the course of the tuberculosis process and makes it difficult to organize full-fledged chemotherapy, which leads to high mortality of patients from tuberculosis in the late stages of HIV infection.