Diagnosis, course and outcomes of tuberculosis comorbidity, opportunistic respiratory infections and COVID-19 in patients with late-stage HIV infection with immunodeficiency

Aim. To study the diagnostic features, course and outcomes of tuberculosis comorbidity, opportunistic respiratory infections and COVID-19 in patients with advanced stages of HIV infection with immunodeficiency.

Materials and methods. The prospective two-year follow-up included 58 patients aged 26–56 years who were randomized into 2 groups. Group 1 consisted of 29 patients with comorbidity of tuberculosis, opportunistic respiratory infections and COVID-19, stage 4 of HIV infection in the progressive phase and in the absence of ART, and group 2 consisted of 29 similar patients selected according to the “copy – pair” principle and completely identical to patients in group 1, but without COVID-19. To detect mycobacterium tuberculosis, the respiratory tract material was seeded on a dense Levenshtein–Jensen medium both in the automated BACTEC MGIT 960 system and with the determination of drug resistance to anti-tuberculosis drugs. Bacteriological, virological, immunological methods and a polymerase chain reaction of diagnostic material from the respiratory tract were used to detect the pathogens of opportunistic respiratory infections. To diagnose COVID-19, SARS-CoV-2 RNA amplification with reverse transcription and real-time fluorescence polymerase chain reaction detection of respiratory tract material (nasopharyngeal and oropharyngeal swabs, sputum and endotracheal aspirate) was used. Statistical data processing was carried out using the Microsoft Office Excel 2019 program, with the calculation of the average indicator in the group and the standard error of the average confidence interval.

Results. The comorbidity of tuberculosis, opportunistic respiratory infections and COVID-19 in patients with advanced HIV infection is characterized by severe immunodeficiency and generalization of tuberculosis with multiple extrapulmonary lesions and high levels (more than 70%) MDR and XDR. This determines the similarity of clinical manifestations and the visualization of CT changes in this comorbidity, which makes it difficult to distinguish them due to the simultaneous layering of several pathologies with the same type of clinical and computed tomographic manifestations. After 2 years of follow-up, no clinical cure has been established in all patients. Significant improvement in patients in groups 1 and 2 was found in 24.1 and 20.7% of cases, respectively, progression in 31.0 and 41.4%, and death in 41.3 and 37.9%. Progression and death are associated with lack of adherence to treatment, drug addiction, severe and generalized tuberculosis, and the progression of acute respiratory viral infections.

Conclusion. Patients with comorbidity of tuberculosis, opportunistic respiratory infections and COVID in the late stages of HIV infection with immunodeficiency represent a high risk group for severe course and death, due to not only comorbid disease, but also social maladjustment and lack of commitment to examination and treatment, this requires mandatory organization of an active examination of such patients to establish a diagnosis in tuberculosis treatment rooms. HIV-infected people in Tuberculosis dispensary for the purpose of their emergency hospitalization and isolation for adequate comprehensive treatment and reduction of mortality in this heavy contingent of patients.