Patients with HIV and tuberculosis coinfection, treated in the Specialized Hospital for infectious and Parasitic Diseases in Sofia, Bulgaria, for the period 2017-2019
DOI:
https://doi.org/10.2478/AMB-2024-0047Keywords:
MTB, MDR-TB, HIV, Xpret MTBAbstract
Background. Infection with human immunodeficiency virus (HIV) is the most powerful risk factor known to predispose to Mycobacterium tuberculosis infection and further progression to active disease, which increases the risk of latent TB reactivation. TB
is one of the most common opportunistic infections worldwide. Aim. The objective of the study was to describe the main clinical characteristics of the HIV – positive patients, examined for TB for 2 years (January 2017-January 2019), as well as to delineate the clinical characteristics and treatment of patients with bacteriologically confirmed TB who were treated for it, analyze characteristics of the results from the microbiological tests performed and, further, describe the patients with multidrug – resistant tuberculosis. Study design. This was a prospective cohort study. Methods. Diagnosis was based on clinical, radiological, and microbiological data, such as smear microscopy, culture, and rapid molecular methods (Xpert MTB/RIF). Results. The baseline CD4+ count of the patients was significantly lower compared with the other patients without coinfection (86 ±138 cells/µcl). Acute inflammatory response syndrome was observed in 9 patients (30%). Multidrug-resistant (MDR) M. tuberculosis was presented in three patients (20%). The predominant localization was pulmonary tuberculosis in 12 patients (80%). Six of them (50%) tested positive for MTB. The extrapulmonary involvement engaged lymph nodes in two patients and the CNS – in one. Conclusion. TB is a disease of advanced immune suppression. Factors predicting the development of IRIS syndrome included low CD4 count, delay of diagnosis, HIV/HCV coinfections, infection with MDR Mycobacterium tuberculosis. The principal location was pulmonary; MTB was isolated in 50% of those cases. TB meningitis should be suspected in patients with advanced immune deficiency presented with progressive neurologic deficiency, changes of consciousness, and meningeal irritation.
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Copyright (c) 2024 D. Strashimirov, Vl. Milanov, `R. Yordanova, T. Tcherveniakova, N. Yancheva-Petrova (Author)
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Journal Acta Medica Bulgarica 
