Specific features of tuberculosis relapses in HIV infected patients

• Main Authors: A. M. Senin, I. D. Medvinskiy
• Format: Article
• Language: Russian
• Published: NEW TERRA Publishing House 2018-11-01
• Series: Tuberkulez i Bolezni Lëgkih
• Subjects: tuberculosis relapse; hiv infection; dispensary follow-up
• Online Access: https://www.tibl-journal.com/jour/article/view/1185
• ISSN: 2075-1230; 2542-1506

The growing number of people with advanced stages of HIV infection determines the specific course of newly diagnosed tuberculosis cases and relapses and accordingly, it requires a special approach to follow-up of such patients respective their dispensary group.The objective of the study: to define the specific features of tuberculosis relapses in HIV patients.Subjects and methods. 205 patients from Sverdlovsk Region were enrolled into a retrospective study. In all the patients, a relapse of respiratory tuberculosis was diagnosed (there were some single cases of combinations with other localizations of tuberculosis). Of them, 104 patients were diagnosed with HIV infection (Group I) and 101 patients were HIV negative (Group II). The groups were compatible respective the age and gender of the patients.Results. HIV positive patients develop tuberculosis relapses earlier versus the HIV negative ones (in 31.5 ± 3.0 months and 55.1 ± 5.7 months respectively, p < 0.001).When tuberculosis relapse was diagnosed, 49.0% (95% CI 47.1-77.7) of patients with HIV infection had their CD4 count < 200 cells/mcl, and most often such a low count was observed among the patients who had CD4 count of 200-349 cells/mcl at the moment when tuberculosis was cured. By the time when tuberculosis relapse was diagnosed among HIV positive patients, the level of antiretroviral therapy failure increased and made 31.7%, and there was a tendency (nearly statistically significant) towards the increase of the portion of ARVT courses lasting for less than 6 months. In case of tuberculosis relapse, HIV positive patients developed disseminated and generalized tuberculosis more often versus HIV negative ones. The most frequent defects of dispensary follow up (dispensary follow-up group III) over the patients cured of tuberculosis, were the lower frequency of X-ray and bacteriological examinations and underestimation of clinical manifestations. It results in the postponed diagnostics of relapse long after its manifestations, less frequent diagnostics of relapses during planned examination, especially in HIV patients. Probably, it is worth reconsidering the tactics of dispensary follow-up over HIV positive patients with TB history and following them up longer as active dispensary groups. The following could be the additional criteria for dispensary follow-up extension: CD4 count of 200 cells/mcl and lower and laboratory confirmed failing ARVT.