Tuberculosis - I.T. Pyatnochka 2005

Pulmonary tuberculosis in combination with other diseases and pregnancy
Tuberculosis and AIDS

Acquired Immunodeficiency Syndrome (AIDS) has gained significant medical and social importance due to the steady rise in its incidence. Globally, the total number of infected individuals doubles every year. Currently, there are 40 million people worldwide living with HIV and AIDS. Around the world, approximately 60 million people suffer from tuberculosis, and this number grows with every passing second. Every day, 6,000 people worldwide are infected with the AIDS virus, and every third AIDS patient dies from tuberculosis. According to various literature sources, up to 90% of AIDS patients may simultaneously suffer from tuberculosis. Practically speaking, an epidemic of AIDS and tuberculosis has already begun, given that the global average tuberculosis incidence rate is 70.7 per 100,000 population. Both HIV carriers and full-blown AIDS patients contract tuberculosis, most frequently male drug users aged 30–50.

In Ukraine, over the past 15 years (1987–2002), 52,659 HIV infection cases have been registered, with 4,278 developing AIDS and 2,378 dying. In 2002, 8,756 Ukrainian citizens were newly registered as HIV-positive, 1,353 developed AIDS, and 834 died.

Pathogenesis. Tuberculosis in HIV-infected individuals may develop As a result of the reactivation of post-tuberculosis changes or a fresh Mycobacterium tuberculosis (MTB) infection. This is primarily caused by a decline in anti-tuberculosis immune defense, a deficiency of immune T-lymphocytes (T-helper Cells), and an altered helper-to-suppressor ratio. The suppression of cellular Immunity promotes the reactivation of tubercular lesions and the progression of an active process. In AIDS patients, pulmonary involvement occurs as a result of infection with MTB or atypical mycobacteria, which become pathogenic to humans under conditions of immunodeficiency.

Pathological anatomy. In AIDS patients, tuberculosis presents as severe generalized forms affecting the Lungs, intrathoracic Lymph Nodes, and other Organs. Extrapulmonary tuberculosis foci with atypical lesion localization are characteristic; alongside typical tubercular granulomas, non-necrotic granulomas may also be present. When infected with opportunistic mycobacteria, a diffuse interstitial inflammatory process develops in the lungs without granulomas or cavities of destruction.

The clinical picture is characterized by pronounced prolonged intoxication, diffuse pulmonary infiltrates, enlarged intrathoracic lymph nodes, and diverse extrapulmonary lesions (Central Nervous system, Bone Marrow, Liver, Kidneys, Pleura, lymph nodes). In more than half of the cases, the Mantoux test is negative and MTB is absent in the sputum.

The Diagnosis of tuberculosis using Traditional Methods is often unsuccessful, which is why many patients are treated for other diseases before a tuberculosis diagnosis is established.

Diagnosing tuberculosis is challenging. To establish a diagnosis of tuberculosis in AIDS patients, it is frequently necessary to use bronchoscopy, transthoracic needle aspiration biopsy, or open lung biopsy. Immunological examination of patients reveals a characteristic AIDS-related disruption of the T-helper to T-suppressor ratio down to 1:1 or lower (compared to the normal 2:1). All HIV-infected individuals and AIDS patients must undergo fluorographic screening at least once a year.

Mycobacterioses are characterized by generalized involvement of all organs, with diffuse interstitial Changes in the lungs lacking granulomas and destruction. Clinical signs include fever, abdominal pain, chronic diarrhea, obstructive jaundice, and bilateral dissemination in the middle and lower lung zones.

Treatment of tuberculosis in AIDS patients is carried out according to standardized WHO regimens, utilizing 4–5 antimycobacterial drugs for 8–12 months, along with simultaneous AIDS treatment. The efficacy of pyrazinamide at 1,500 mg daily combined with ciprofloxacin at 750 mg twice daily for 4 months has been proven. In treating AIDS, preference is given to triple-drug combination therapy consisting of indinavir, saquinavir, and ritonavir.

Regarding the treatment of mycobacterioses, efficacy is quite low and mortality is high (up to 20%), even when using optimal regimens such as rifabutin combined with isoniazid and ethambutol, or rifampin, ethambutol, and clofazimine.