Журнал «Актуальная инфектология» Том 9, №1, 2021
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Influence of some opportunistic infections on the course of HIV infection in association with tuberculosis
Авторы: Moskaliuk V.D., Kolotylo T.R.
Bukovynian State Medical University, Chernivtsi, Ukraine
Рубрики: Инфекционные заболевания
Разделы: Медицинские форумы
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Background. Currently in Ukraine there is an increase in the incidence of tuberculosis. Indirect data show that our country is the undisputed leader in the prevalence of not only tuberculosis, but also its multidrug-resistant forms. The problem of the combined course of HIV infection and tuberculosis is especially relevant today. Tuberculosis in HIV-infected patients is malignant, prone to generalization and progression due to severe immunodeficiency. Although tuberculosis is the most common and earliest opportunistic infection in AIDS patients, these individuals are usually accompanied by many other secondary diseases, which inevitably leave their mark on the course of such an associated infection. The purpose of the study was to establish the features of the course of HIV infection in association with active tuberculosis in the presence of other secondary diseases and opportunistic infections.
Materials and methods. 231 persons were monitored — 184 (79.7 %) men and 47 (20.3 %) women aged 23 to 60 years. The mean age was (38.8 ± 1.2) years. All patients underwent a comprehensive laboratory examination and were divided into the following groups: uninfected HIV (immunocompetent) individuals with active newly diagnosed tuberculosis — 76 patients (TB group); HIV-infected with active newly diagnosed tuberculosis — 155 patients (HIV/TB group).
Results and discussion. There were no other secondary diseases or opportunistic infections in the group of patients with TB monoinfection, and 58 people (37.4 %) in the group of HIV/TB. The level of HIV load, indicators of CD4+ T-lymphocytes IL-4, IFN-γ for some secondary infections and conditions in patients with HIV/TB were assessed. Given the fact that several diseases inevitably leave their mark on the studied indicators, from all patients we selected only those persons who were diagnosed with only one opportunistic infection. Among opportunistic infections most often found shingles, oropharyngeal candidiasis or mycosis of the hands and feet, cerebral toxoplasmosis, cachexia. It was found that the lowest number of CD4+ T-lymphocytes was in patients with frequent recurrences of shingles, which led to the formation of “herpes label” — (102.0 ± 10.3) cells/mm3, compared, for example, with a group of people in which oropharyngeal candidiasis or mycosis of the hands and feet (P < 0.05) was detected. The concentration of spontaneous production of IL-4 was characterized by a statistically significant increase in the case of registration of cerebral toxoplasmosis, continuously recurrent shingles and cachexia (P < 0.05–0.01). The level of serum IFN-γ was the lowest in cerebral toxoplasmosis — (7.8 ± 1.6) pg/ml, and spontaneous production of this cytokine — in patients with frequent recurrences of shingles — (2.4 ± 0.6) pg/ml/106 compared with all other secondary diseases and opportunistic infections (P < 0.05–0.001). Viral load was highest in cerebral toxoplasmosis, continuously recurrent herpes infection and cachexia, and lowest in fungal lesions of the oropharynx, hands, and feet. Thus, the most significant increases in spontaneous production of IL-4, serum concentration of IFN-γ, viral load and decrease in spontaneous production of IFN-γ are observed in such extensive symptoms as cerebral toxoplasmosis, recurrent herpes infection with the formation of “herpetic label” more than 10 % within 6 months) — cachexia. Less significant deviations were found in the localized form of mycosis and in the case of clinically manifest reactivation of cytomegalovirus infection.
Conclusions. The association of HIV and tuberculosis in 37.4 % of cases is accompanied by other secondary diseases and opportunistic infections. In the presence of secondary diseases and opportunistic infections, the number of CD4+ T-lymphocytes was significantly lower, and the level of serum concentration and spontaneous production of IL-4, IFN-γ and viral load - higher compared with patients without these diseases (P < 0.05–0.02). The most significant increases in spontaneous production of IL-4, serum concentration of IFN-γ, viral load and decrease in spontaneous production of IFN-γ are observed in such extensive symptoms as cerebral toxoplasmosis, recurrent herpes infection with the formation of “herpes mark” over 10 %, loss of silence for 6 months) — cachexia. Less significant deviations were found in the localized form of mycosis and in the case of clinically manifest reactivation of cytomegalovirus infection.