[The specific features of the detection, clinical manifestations, and treatment of tuberculosis in the HIV-infected].Probl Tuberk Bolezn Legk. 2005PT
The present study has explored the specific features of the detection, clinical manifestations, and treatment of tuberculosis (TB) in 425 patients with TB and HIV infection. According to the time of joining the infections, the patients with TB and HIV infection are divided into 2 basic groups: 1) HIV infection is primary, TB develops at any stage of HIV infection and 2) TB is primary, HIV injections joins different forms of TB at its any stage. The social makeup of patients with TB/HIV infection is unfavorable: the unemployed, 50%; homeless persons, 26.5%; employees, 5%; workers, 9%; pensioners, 1.5%; the disabled, 5%; pupils, 3%. As compared with Group 2, Group 1 shows more employees and pupils and fewer homeless persons, which is associated with the younger age of patients in this group and their greater social security. In the pattern of clinical forms of tuberculosis in Group 1, there are prevalent forms of primary tuberculosis with lesion of intrathoracic and peripheral lymph nodes (12.8%), acutely progressive disseminated and miliary tuberculosis of the lung and extrapulmonary systems and organs (49%), among them, meningitis accounts for 4%, lesions of the liver, spleen, kidney, and other organs form 17%. In patients with tuberculosis and HIV infection, bacterial isolation has been established in 58% of cases; primary and multidrug resistances have been found in 53 and 8.9%, respectively. Multidrug resistance tends to increase: 2% in 2001, 3.4% in 2002, 4.6% in 2003, and 8.9% in 2004. Bacteria have been more frequently isolated in Group 2 than in Group 1 (81% vs 19%), which is accounted for by the magnitude of destructive changes in them in the presence of infiltrative TB and by the high incidence of fibrocavernous tuberculosis. The patients with TB/HIV infection have a concomitance of 3 infectious diseases: HIV infection, TB, and, in 74% of the patients, sexually transmitted infections (syphilis, chlamydiosis, gonorrhea) that, in accordance with Resolution No. 188 passed by the Government on April 2, 2003, are in the list of infectious diseases constitute a serious hazard to other people. The proportion of TB/HIV patients with drug abuse (65%), hepatitis B and C (47%), and nervous and mental diseases is extremely high, which makes these patients more hazardous to the healthy population. The efficiency of treatment for TB and HIV infection is satisfactory. Continuous therapy for 4 months or more provides positive clinical and X-ray changes in most patients; bacterial isolation ceases in 75%, and decay cavities close in 44% of cases. Abacillation and cavity closures have been observed in 76.3 and 38% and 47 and 14% of cases in Groups 1 and 2, respectively. Six-eight-month therapy with first-line drugs in combination with reserve ones in patients with pulmonary TB and HIV infection is well tolerated and highly effective. A decision on the duration of anti-TB treatment for the HIV infected should be taken into account the program resources and the probability of refusing long-term therapy in 50% of cases. Mortality rates in patients with TB and HIV infection are gradually on the rise and equal to 11.2% of the treated patients in 2001, 5% in 2002, 15.2% in 2003, and 19.6% in 2004. In patients with HIV/TB, the rates are higher than those in patients with TB/HIV and are 19.2 and 14.5%, respectively. Acutely progressive pulmonary TB and miliary TB of the lung and extrapulmonary organs and systems are a cause of death in most (76%) patients with TB/HIV.