The clinical and morphological features of HIV-associated tuberculosis

Objective. To reveal the clinical and morphological features of tuberculosis in late-stage HIV infection. Subjects and methods. Based on the study of the clinical, radiological, bacteriological, and morphological data, the authors analyzed the causes of death in 74 patients divided into 2 groups: 1) 46 patients with confection (tuberculosis concurrent with HIV infection) (a study group) and 2) 28patients with monoinfection (tuberculosis) (a comparison group). Results. Examinations established that the process became particularly severe in patients with pulmonary tuberculosis concurrent with HIV infection mainly in stages 4B and 5. By taking into account the fact that 90% of the patients were admitted to hospital with a terminal stage of illness when a tuberculous granulomatous reaction had not just developed as a means of specific antituberculosis defense, the evolution of the process was characterized by acute generalized lymphohematogenic and hematogenic dissemination with simultaneous damage to many organs (meninges, lung, liver, spleen, adrenals, pancreas, heart, mesenteric lymph nodes). At the same time, the comparison group patients developed isolated lung lesions as tuberculous granuloma without involvement of other organs into the process. Conclusion. The patients with late-stage (4B and 5) coinfection and considerably lower CD4+- lymphocyte counts are not prone to developing tuberculous granuloma. This period shows a predominance of acute generalized lymphohematogenic dissemination with concurrent damage to a few organs. The specific process is chiefly present as focal or total caseous necrosis.

tuberculosis, HIV infection, patients