Analysis of lethal outcomes in patients with newly-diagnosed tuberculosis of the respiratory organs in combination with HIV-infection


Cite item

Full Text

Abstract

Aim. To analyse lethal outcomes in patients with newly-diagnosed respiratory tuberculosis comorbid with HIV-infection depending on initial count of CD4+ lymphocytes.
Material and methods. Of 304 HIV patients with newly-diagnosed tuberculosis treated in Moscow Tubercusis Hospital N 7 in 2006-2010, 40 (13.2%) patients died. Tuberculosis diagnosis was made after detection of M.tuberculosis (MT) by different tests, MT DNA in different biological material, histological verification or by effectiveness of specific antituberculous therapy. Postmortem examinations were made according to the protocol.
Results. Significant differences were detected in patients with initial count of CD4+ lymphocytes less than 50 in 1 mcl. Specific CNS affection was found in patients with initial lymphocyte count CD4+ less than 100 in 1 mcl. Most of autopsy examinations registered generalized acutely progressive tuberculosis with multiple lesions of internal organs and lymph nodes (LN). Microscopy revealed obscure morphological picture of specific inflammation with prevalence of alternative-exudative tissue reactions in the absence of a productive inflammation component. Cases with submiliary dissemination which was invisible in macroscopic examination due to a bright picture of exudative tissue reaction (rare plethora of the lungs, alveolar and interstitial edema, perifocal inflammatory reaction of nonspecific reactive nature) and small size of the lesions. The comparison of clinical and autopsy diagnoses revealed that involvement of intrathoracic LN and miliary dissemination, according to autopsy, occurred much more frequently than shown by antemortem standard x-ray examination of the chest.
Conclusion. It is strongly recommended to perform computed tomography of the chest in all HIV-infected patients with long-term fever but without visible alterations on chest x-ray.

About the authors

Vera Nikolaevna Zimina

Email: vera-zim@yandex.ru

Aleksey Viktorovich Kravchenko

Email: kravtchenko@hivrussia.net

Yuliya Rashidovna Zyuzya

Farit Akhatovich Batyrov

Email: tkb7@mosgorzdrav.ru

Anna Anatol'evna Popova

Email: asya_med.ророvа@yandex.ru

Grigoriy Vladimirovich Klimov

Email: grea75@mail.ru

Yuriy Georgievich Parkhomenko

Email: morfolhum@mail.ru

Irina Anatol'evna Vasil'eva

Email: vasil39@list.ru

V N Zimina

Central Research Institute of Tuberculosis, Moscow

Central Research Institute of Tuberculosis, Moscow

A V Kravchenko

Central Research Institute of Epidemiology, Moscow

Central Research Institute of Epidemiology, Moscow

Yu R Zyuzya

Tuberculosis hospital N 7, Moscow

Tuberculosis hospital N 7, Moscow

F A Batyrov

Tuberculosis hospital N 7, Moscow

Tuberculosis hospital N 7, Moscow

A A Popova

Central Research Institute of Epidemiology, Moscow

Central Research Institute of Epidemiology, Moscow

G V Klimov

Tuberculosis hospital N 7, Moscow

Tuberculosis hospital N 7, Moscow

Yu G Parkhomenko

Research Institute of Human Morphology, Moscow

Research Institute of Human Morphology, Moscow

I A Vasilieva

Central Research Institute of Tuberculosis, Moscow

Central Research Institute of Tuberculosis, Moscow

References

  1. Кравченко А. В. Современные подходы к началу высокоактивной антиретровирусной терапии и выбор оптимальной схемы лечения первой линии. Фарматека 2008; 19: 79-83.
  2. Klautau G. B., Kuschnaroff T. M. Clinical forms and outcome of tuberculosis in HIV-infected patients in a tertiary hospital in Sao Paulo-Brazil. Braz. J. Infect. Dis. 2005; 9 (6): 464-478.
  3. Lopez-Cortes L. F., Marin-Niebla A., Lopez-Cortes L. E. et al. Influence of treatment and immunological recovery on tuberculosis relapses in HIV-infected patients. Int. J. Tuberc. Lung Dis. 2005; 9 (12): 1385-1390.
  4. Burman W., Benator D., Vernon A. et al. Acquired rifamycin resistance with twice-weekly treatment of HIV-related tuberculosis. Am. J. Respir. Crit. Care Med. 2006; 173 (3): 350-356.
  5. Jones B. E., Otaya M., Antoniskis D. et al. A prospective evaluation of antituberculosis therapy in patients with human immunodeficiency virus infection. Am. J. Respir. Crit. Care Med. 1994; 150 (6, Pt 1): 1499-1502.
  6. Tabarsi P., Baghaei P., Amiri M. et al. Treatment outcome of tuberculosis patients diagnosed with human immunodeficiency virus infection in Iran. Yn: 17th European congress of clinical microbiology and infectious diseases. Münich: 2007. Abstr. N 1733.
  7. Akpaka P. E., Tulloch-Reid M., Justiz-Vaillant A., Smikle M. F. Prevalence of human immunodeficiency virus infection in patients with pulmonary tuberculosis at the National Chest I Iospital in Jamaica. Rev. Panam. Salud. Publ. 2006; 9 (1): 38- 43.
  8. Swaminathan S., Deivanayagam C. N., Rajasekaran S. et al. Long term follow up of HIV-infected patients with tuberculosis treated with 6-month intermittent short course chemotherapy. Natl Med. J. India. 2008; 21 (1): 3-8.
  9. Chaisson R. E., Clermont H. C., Holt E. A. et al. Six-month supervised intermittent tuberculosis therapy in Haitian patients with and without HIV infection. Am. J. Respir. Crit. Care Med. 1996; 154 (4): 1034-1038.
  10. Rocha M., Pereira S., Ferreira L., Barros H. The role of adherence in tuberculosis HIV-positive patients treated in ambulatory regimen. Eur. Respir. J. 2003; 21: 785-788.
  11. Abdool Karim S., Naidoo K., Grobler A. et al. Initiating ART during ТВ treatment significantly increases survival: results of a randomized controlled clinical trial in TB/HIV-co-infected patients in South Africa. Yn: 16th CROI. Montreal, Canada; February 8-11, 2009. Montreal; 2009. Abstr. 36a.
  12. Blanc F. X., Sok Т., Laureillard D. et al. Significant enhancement in survival with early (2 weeks) vs. late (8 weeks) initiation of highly active antiretroviral treatment (HAART) in severely immunosuppressed HIV-infected adults with newly diagnosed tuberculosis. Jn: XVIII International AIDS conference, 2010, Vienna, Austria. Vienna; 2010. Abstr. THLBB106.
  13. Havlir D., Ive P., Kendall M. et al. International Randomized Trial of Immediate vs Early ART in HIV+ Patients Treated for ТВ: ACTG 5221 STRIDE Study. Jn: 18th Conference on retroviruses and opportunistic infections, 2011, Boston, USA. Boston; 2011. Abstr. 38.
  14. Кравченко А. В., Щелканова А. И., Ермак Т. Н. и др. Анализ больных туберкулезом, сочетанным с ВИЧ-инфекцией, в Московском регионе. Пробл. туб. 2005; 10: 34-37.
  15. Sujit Suchindran, Emily S. Brouwer, Annelies Van Rie. Is HIV Infection a Risk Factor for Multi-Drug Resistant Tuberculosis? A Systematic Review//www.plosone.org 7 May 2009 / Volume 4 /Issue 5 /e5561.
  16. Фролова О. П. Особенности течения туберкулеза у ВИЧ-инфицированных и меры его профилактики: Автореф. дис. ... д-ра мед. наук. СПб.; 1998.
  17. Colebunders R., John L., Huyst V. et al. Tuberculosis immune reconstitution inflammatory syndrome in countries with limited resources. Int. J. Tuberc. Lung Dis. 2006; 10 (9): 946-953.
  18. da Silva R. M., da Rosa L., Lemos R. N. Radiographic alterations in patients presenting human immunodeficiency virus/tuberculosis coinfection: correlation with CD4+ T cell counts. J. Bras. Pneumol. 2006; 32 (3): 228-233.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2011 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

 © 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies