Analysis of medical and social factors affecting the formation and course of co-infection HIV, tuberculosis and viral hepatitis

Abstract

Currently, HIV infection is characterized by emergence of its severe and comorbid forms. Mid-1990 HIV epidemics was expanded due to injection drug users who brought viral hepatitis C to the cohort. Along with developing immunosuppression, opportunistic and AIDS-defining diseases, including tuberculosis emerged. Various combinations of coinfections (HIV infection+tuberculosis±viral hepatitis) affect clinical manifestations and clinical score, reduce the therapeutic efficacy and worsen disease prognosis.Objective: to study an impact medical and social factors on course of TB-co-infection associated with immunosuppression related to HIV infection and viral hepatitis.Materials and methods. Comorbid cases (HIV infection, tuberculosis and chronic hepatitis) dominated by verified TB-infection (n = 137) were analyzed.Results. It was shown that socially maladapted young people with previous experience of intravenous drug and alcohol abuse dominated among subjects with co-infections, half of which were held in penal institutions. More-over, the mean CD4 lymphocyte level in generalized tuberculosis was significantly lower than in patients with significantly reaching 164±21.5 cells. In addition, lung-specific lesions were observed in 73.4% of patients with generalized tuberculosis that developed by initial targeting of the lymphoid system followed by affecting other organs, mainly the central nervous system, urinary system and abdominal organs. Introduction of antiretroviral drugs to anti-TB therapy reduced mortality rate by 8 times. Viral hepatitis was the most common concomitant disease found in co-infected patients, with dominating viral hepatitis C both as a mono-infection (86.8%) as well as in combination with viral hepatitis B (9.43%). In addition, co-morbid viral hepatitis resulted in progression of TB infection affected due to intra-thoracic lymph nodes being involved in tuberculosis process as well as development of opportunistic diseases due to a markedly decreased CD4 cell count. Analysis of potentially aggravating risk factors for developing hepatotoxicity (viral hepatitis, combined treatment with anti-TB and anti-retroviral drugs) did not reveal their any additional negative impact on hepatic functions. Thus, use of a combination therapy with anti-TB and anti-retroviral drugs in co-infected patients was shown to be safe and not accompanied by a high rate of hepatotoxic reactions.

Clinical pattern and diagnostic of comorbidity of respiratory tuberculosis and viral pneumonia caused by Herpesvirus Simplex, Human Cytomegalovirus and SARS-CoV-2 in patients with late-stage HIV infection with immunodeficiency

“…Infectious lung damage of various etiologies is one of the main causes of pneumonia in patients with HIV infection especially in the late stages with immunodeficiency [1][2][3][4][5]. An important role in this category of patients plays tuberculosis if combined with other opportunistic lung infections [6] among which important is a viral pneumonia (VP) etiologically associated with Herpesvirus Simplex of type 1 (HVS-1) and Human Cytomegalovirus (CMVH) that significantly affects the severity of clinical manifestation and the therapy efficacy because of absence of specific treatment [7][8][9][10][11][12] COVID-19 has created certain problems in HIV-infected patients due to severe damage to the respiratory system and development of coronavirus pneumonia (CVP) which is one of the main reasons for hospitalization of HIV-infected patients and the most common cause of their death [13][14][15][16][17]. However, the greatest problems arise in cases of comorbidity of respiratory tuberculosis and herpesvirus pneumonia (HVP) caused by HVS-1, cytomegalovirus pneumonia (CMVP) caused by CMVH and CVP caused by SARS-CoV-2 in patients with late-stage HIV infection with immunodeficiency in terms of clinical and radiological manifestations and timely diagnosis for selection of adequate etiological treatment and anti-epidemic measures.…”

Epidemiological analysis of factors influencing the course of multidrug-resistant tuberculosis in HIV-infected patients with concomitant viral hepatitis

“…В настоящее время течение мультирезистентного туберкулеза (МРТБ) характеризуется формированием тяжелых форм заболевания, поскольку социально дезадаптированный контингент принес в эпидемический процесс хронические вирусные гепатиты (ВГ) и ВИЧинфекцию [1,9]. Полиморбидные состояния искажают клинические проявления туберкулеза (ТБ), снижают эффективность противотуберкулезной терапии (ПТП) и ухудшают прогноз заболевания [2,10]. Социальная и экономическая значимость сочетанных инфекций требует эффективных мер, направленных на их профилактику [8].…”