Kolotylo T. Clinical and pathogenetic evaluation of associated forms of HIV infection with tuberculosis

In the dissertation work on the basis of complex clinical, radiological and laboratory examination the peculiarities of HIV infection associated with tuberculosis are evaluated. The study included the following groups of patients: non-HIV infected persons with various forms of tuberculosis (134 people), from which a group of patients with active newly diagnosed tuberculosis - 76 people (TB group), and a group of HIV-infected with various forms of tuberculosis - 217 people, of whom the group with active newly diagnosed tuberculosis was 155 people (HIV/TB group). It is established that the diagnostic criteria for secondary tuberculosis to HIV infection are: HIV infection over 3-5 years, the presence of other secondary diseases and opportunistic infections, registration of extrapulmonary (lymph node tuberculosis, tuberculous pleurisy and meningitis), generalized clinical disease, symptoms, atypical radiographic picture or no changes in it, energy in the reaction of delayed type hypersensitivity with tuberculin, the presence of monoresistance to anti-TB drugs. Of particular note is the infiltrative form of TB due to the possibility of rapid progression of changes in the lungs on the background of immunodeficiency and high HIV burden. To establish tactics for the management of HIV-associated TB patients and, above all, to assess the need for early combination therapy, the sequence of HIV and MBT infections should be clearly differentiated. Simultaneous administration of antiretroviral and antituberculous drugs is primarily needed by HIV/TB patients in whom tuberculosis has developed as a co- and superinfection, as the degree of immunodeficiency (decrease in CD4+T-lymphocytes) in these individuals is deeper and the HIV load is highest. Criteria for the progression of TB-associated HIV infection include a rapid decrease in CD4+T-lymphocyte levels, a CD4+/CD8+ ratio, an increase in HIV load, an increase in serum TNF-α and IFN-γ, and energy in the reaction of delayed type hypersensitivity with tuberculin