Why are HIV-infected people prescribed anti-tuberculosis therapy? HIV and tuberculosis - how to completely recover. Congratulations! The likelihood that you are more tuberculosis is approaching zero

Detection of tuberculosis in HIV-infected
HIV and TB

HIV and tuberculosis are very malignant. As soon as a person is diagnosed with widespread and progressive tuberculosis, there is an urgent need for a targeted examination of the patient for HIV infection. Whereas AIDS sufferers should be considered as those who can be infected with tuberculosis.

Tuberculosis and HIV can be combined in several of the following cases:

primary occurrence of tuberculosis in an HIV-infected patient;
the simultaneous occurrence of the diseases described here;
development of the process of tuberculosis against the background of immunodeficiency in AIDS.

People who are simultaneously infected with AIDS are at the highest risk of getting TB. At the same time, the annual probability of this disease is equivalent to 10%, but for the rest, this probability is no more than 5% throughout their lives.

In countries with high rates of AIDS infection, more than 40% of those infected with tuberculosis are HIV-positive.

The source of HIV infection is the one who is infected with this disease. A high probability of transmission of the virus is noted from those who are in the final stage of the incubation period, this also applies to those who have just begun to show the primary signs of the disease. Patients who have advanced infection are actively transmitting the virus.

Almost all biological fluids of a person suffering from HIV contain viral elements to varying degrees. But the greatest epidemiological danger is found in blood and semen.

The factors that determine the regularity of the combination of HIV with tuberculosis are the features of the mechanisms of the pathogenesis of these ailments.

HIV significantly affects the immunoreactivity in tuberculosis, while the relationship in cellular immunity changes, the differentiation of macrophages is impaired.

It is recommended, after the establishment of HIV infection and until the moment when immunodeficiency is developed, to identify those who are at risk of tuberculosis, for the implementation of dynamic monitoring of the phthisiatrician. This doctor will be able to prescribe the course of treatment necessary for this patient in the later stages of HIV development, when immunodeficiency occurs.

In order to determine which persons are at a special risk zone for tuberculosis with HIV infection, measures are being taken.

Patients who have been diagnosed with HIV for the first time are examined by a phthisiatrician. The person in the doctor's office is informed about tuberculosis and measures to prevent it. In case of symptoms characteristic of tuberculosis, the patient should contact a phthisiatrician for an immediate examination and examination. At the time of registration and subsequently with a frequency of 1-2 times a year, radiation diagnostics of the chest cavity should be carried out. If the patient has been registered for HIV infection, a tuberculin test should be performed.

In the course of dynamic monitoring of a patient with HIV, when hyperergia, bend or an increase in the response to tuberculin are detected, the doctor individually, in view of the specific stage of HIV, decides whether to prescribe anti-tuberculosis drugs for the patient.

Patients who produce phlegm are screened for tuberculosis bacteria.

Patients with HIV who are at risk of developing TB should be hospitalized if their condition worsens.

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Screening examination

At the stage of the early stage of AIDS, tuberculosis proceeds as usual, this necessitates a screening examination according to the same scheme as in persons who have not been diagnosed with HIV.

When tuberculosis is detected in patients with HIV, the clinical diagnosis suggests:

stage of HIV infection;
complete diagnosis of tuberculosis and secondary diseases.

In favor of the latter, it should be noted that if a patient with HIV in the stage of primary symptoms due to a transient decrease in immunity has developed tuberculosis, then the diagnosis is made: HIV infection at the stage of primary manifestations.

If a patient with HIV after a stage of primary manifestations and in the absence of clinical symptoms that would indicate a deficiency of the immune system develops a limited process of tuberculosis, it is not considered as a secondary disease. In this case, the diagnosis sounds like a latent stage of HIV.

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Features of the treatment

If a person has been infected with tuberculosis, then he will have to be cured within 6 months. Whereas multidrug-resistant tuberculosis is characterized by high resistance to a number of antibiotics, which implies the need to carry out its treatment continuously for two years. At the same time, there is a need for the use of more expensive and hazardous drugs for health. But refusal of treatment leads to the fact that the patient simply dies.

Multi-drug resistant tuberculosis should only be treated on an empty stomach, which is why it should be taken every day before and after meals. Quite often, patients have to take up to 6 drugs at the same time. In this case, it is necessary to provide an enhanced diet.

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HIV and TB

There are two main forms of tuberculosis, the first of which is called latent, while the second is active. In the first case, bacteria acting as pathogens are present in the body, but do not cause further active development of the disease and the onset of symptoms; this form of tuberculosis is extremely common. When a patient suffers from active or open tuberculosis, bacteria multiply rapidly and become the cause of the development of a disease that is dangerous for the patient, and also infectious for all other people who do not suffer from this ailment. In patients with HIV and infected with tuberculosis, there is a probability of the course of open tuberculosis, which becomes 10 times higher than in a healthy person. This risk increases with certain factors, among them are:

pregnancy;
poor nutrition;
alcoholism;
drug addiction;
the person's age is less than 5 or more than 65 years.

It is possible to distinguish the symptoms that appear in TB and HIV patients, they are similar to those observed in other patients: a cough that does not go away with appropriate treatment within 2-3 weeks; secretion of sputum or blood when coughing up; severe chest pain; weakening of the body and unexplained increased fatigue; sharp weight loss; lack of appetite; high temperature; excessive sweating, especially at night.

Tuberculosis in HIV-infected people manifests itself very strongly, in some cases this leads to the fact that a person almost loses the ability to live normally.

All patients who have been diagnosed with HIV are advised to have a tuberculin test done as soon as possible. Diagnosis through the Mantoux test can be difficult, especially when a patient has recently contracted TB or is extremely immunocompromised, which can lead to a skin test being negative but false.

Often, after taking a skin test, diagnostic procedures are performed, including x-rays of the chest, blood and sputum tests. If a person who has been diagnosed with HIV infection has not been diagnosed with TB, then they will have to undergo planned appropriate examinations every year. Patients who have given birth after they have been diagnosed with HIV infection will have to undergo a medical examination of their children for TB; such tests should be carried out in young patients aged 9-12 months.

With AIDS, TB is extremely dangerous and treatment should be started immediately if the disease is detected. If left untreated, HIV infection is fatal.

TB is the leading cause of death among AIDS patients.

Patients with HIV are much more likely to develop TB than ordinary people. Thus, 2010 was the time when 8.8 million new TB cases were detected, of which 1.1 million cases were detected in patients with AIDS.

Tuberculosis in HIV-infected patients is malignant with numerous complications. That is why, when tuberculosis is detected, the patient urgently needs to undergo an examination for HIV infection.

HIV appears before tuberculosis infection. Quite often it happens that a patient is unaware of HIV until he develops tuberculosis. The fact is that many neglect the annual outpatient examination and therefore simply cannot be diagnosed with a positive HIV status.
The onset of ailments at the same time.

Symptoms

As medical practice shows, carriers of a dual disease complain of the same symptoms as patients infected with only tuberculosis infection. It is important to understand that the signs of the manifestation of the disease depend on the degree of development of the disease, as well as on the period of the infection in the body.

A list of the most common factors that indicate infection:

Lethargy, drowsiness, lack of concentration, poor performance.
Unsatisfactory work of the gastrointestinal tract (diarrhea, diarrhea, constipation, and so on).
Coughing. Coughing up phlegm with blood.
Fever and seizures.
Heat.
Heart rhythm disorder.
Unreasonable sharp decrease in body weight.
Severe pain in the sternum: burning; sharp, pulling, pressing, wave, aching pain.

It is also worth paying attention to the lymph nodes, since HIV-infected patients often have negative side effects and complications associated with them. Lymph nodes increase significantly, it is difficult to find them on palpation, since touching causes acute pain, arises.

If you find at least two regularly observed symptoms, you should immediately consult a doctor, as there is a high probability of a lung infection. The lack of timely diagnosis and treatment is dangerous not only for the infected person, but also for all people with whom he comes in contact.

Survey

Medical workers adhere to one correct scheme: when a person is diagnosed with HIV infection, he is prescribed an examination for infection with tuberculosis. The same is done in the opposite case: if a person is sick with tuberculosis, he is immediately sent for HIV testing. Such tests are carried out to exclude all negative circumstances that may accompany both ailments.

Action plan for getting positive HIV tests.

Informing the patient about the high probability of contracting tuberculosis. Visual examination by a specialist in the field without a complete medical examination.
The patient must be registered with a phthisiatrician without fail.
Chest ultrasonography is done every six months.
The patient monitors the dynamics of his physical condition every day. If any symptomatology appears, indicating infection with tuberculosis, he should consult a specialist for competent advice.
If the general condition of a person has significantly deteriorated in a short period, immediate hospitalization in a specialized hospital is required.

Prevention of tuberculosis in HIV-infected people is simply necessary, because the patient's life expectancy directly depends on it.

Classification

At the moment, two main forms have been identified: latent and active (open).

The first form is the most common. With it, pathogenic bacteria are present in the human body, but do not cause the development of the disease.
With the open type, the development of tuberculosis occurs as actively as possible. All symptoms appear quickly enough, the general condition of the body deteriorates sharply. Bacteria multiply and become more and more dangerous every day.

In people suffering from HIV and tuberculosis, the possibility of an active type of illness increases tenfold. There is also a list of side factors that can worsen the situation:

pregnancy or breastfeeding;
lack of vitamins;
age before fourteen years or after seventy;
deadly habits (drug addiction or alcoholism).

Treatment

It is important to understand that pulmonary tuberculosis and HIV are not a death sentence. If you go to a doctor, then at any stage of the disease, he will be able to prescribe the correct course of medication, which can improve the general condition of the patient.

The main thing is no self-medication. Do not use traditional medicine, especially without consulting your doctor. So you can only harm yourself.

If tuberculosis is detected against the background of HIV infection, the doctor prescribes drugs such as Rifabutin and Rifampicin. They are allowed to be received simultaneously. If the patient has an individual intolerance to the components, then the doctor can replace them with drugs with analogous action.

The further treatment plan is selected for each specific case. It completely depends on the patient's condition, the stage of development of the disease and on other side factors. Do not rely on the fact that there is a universal method of treatment.

Curing one of the diseases presented does not mean getting rid of it forever. Often, the prognosis is not reassuring, as relapses are possible. Therefore, after the course of treatment, it is necessary to strictly observe the constructed rehabilitation plan. Otherwise, you will lose all positive results in the fight against infection.

Prevention of tuberculosis of the lungs and lymph nodes in HIV infection is also an important aspect. There are several stages of preventive action. After a recovery period, patients undergo a course of chemopreventive procedures, and in the future, all measures to prevent re-infection will be reduced to visiting a phthisiatrician.

Today tuberculosis and HIV are among the most common diseases among the population that require compulsory therapy. This will help improve the quality of life, and in the first case, heal completely. Therefore, everyone should know the main signs of these diseases in order to diagnose in a timely manner and begin to eliminate them.

HIV and tuberculosis together proceed in a rather aggressive form, since against the background of immunodeficiency there is a rapid development of complications from almost all internal organs. In this case, there are a number of features that we will consider further.

If a patient is diagnosed with a malignant course of tuberculosis, HIV (AIDS) is necessarily suspected by a doctor and appropriate tests are carried out to confirm it. At the same time, AIDS patients are considered as possible carriers of mycobacteria.

Tuberculosis in HIV-infected people can proceed according to the following options:

Tuberculosis and HIV infection entered the body at the same time.
Lung pathology arose against the background of an already existing immunodeficiency.
The immunodeficiency virus entered the body that was infected with mycobacteria earlier.

Patients who fall into the first category are at greatest risk, since their diseases progress rapidly and in a short period of time can lead to irreparable conditions.

In order to prevent the development of serious conditions, one should consider whether tuberculosis can be cured with HIV infection, as well as the main signs of these pathologies.

The reasons for the development of tuberculosis in the presence of HIV

The immunodeficiency virus enters the body through infected biological fluids, it can be blood, semen, and particles of the infectious agent are contained in the urine and breast milk of the patient.

Although tuberculosis and AIDS have completely different routes of infection, they can be infected at the same time. And all because the first is transmitted by airborne droplets, and for mycobacterium to enter the body, it is not necessary to have sexual intercourse or use one needle, as is often the case with drug addicts. It is enough just to be in close contact with the source of pulmonary tuberculosis. With HIV, it will undoubtedly begin to multiply immediately and provoke the occurrence of the corresponding symptoms, because due to the reduced immunity, the body is not able to cope with the pathogen.

Forms of tuberculosis in combination with HIV infection

The disease against the background of immunodeficiency can occur in the following forms:

Latent... In this case, mycobacteria multiply in the body of an infected person, however, there are no pronounced symptoms from the internal organs. This form is common.
Active... Such a course of tuberculosis in HIV-infected people is much more common. In this case, there is a rapid multiplication of mycobacteria, pronounced symptoms of pathology are observed. Pathogens are released into the external environment, which increases the risk of spreading to others.

With AIDS, the disease quickly passes from a latent to an active form. This may be due to the following factors:

The patient's age is over 65 or children under 5.
Unbalanced diet.
Pregnancy.
The presence of bad habits, in particular, drug addiction, alcoholism.

In the latter case, tuberculosis, HIV and hepatitis often occur together, since it occurs not only due to reduced immunity, but also against the background of a systemic toxic effect on hepatocytes of alcohol and drugs.

Clinical picture

Symptoms and signs of tuberculosis in HIV in most cases do not differ from the typical course of this disease in non-immunocompromised patients. However, their severity is determined by the degree of neglect of the process and periods of infection.

With pulmonary tuberculosis and HIV, the clinic depends on the order of infection with these diseases. The first one proceeds in a malignant form if it develops in an organism suffering from immunodeficiency. The less stable the cellular immunity, the more pronounced the signs of the disease will be and the more unfavorable the prognosis.

Typically, the following symptoms are observed:
Fever, excessive sweating, especially at night.
Weakness, decreased performance.
A cough that does not go away for more than 21 days and does not respond to conventional treatment.
Disruption of the digestive system.
Cachexia (severe emaciation). Patients lose about 10-20 kg, usually at least 10% of their body weight before the onset of the disease.
In advanced cases, hemoptysis is observed.
Chest pain.

In addition to lung damage, tuberculosis of the lymph nodes can be observed in HIV-infected people. At the same time, they become quite dense, it is difficult to displace them by at least a few millimeters during palpation. Lumpy to the touch, increased in size.

HIV, tuberculosis and hepatitis C can also develop at the same time, since the former affects not only the lungs, but any other internal organs. Among them are the liver, spleen, nails, skin, bones, genitals. The production of antibodies to HIV in extrapulmonary tuberculosis follows exactly the same pattern.

How does tuberculosis progress in HIV-infected children?

A child often becomes infected with these diseases from the mother even during gestation or during childbirth. This is possible if a woman was sick before pregnancy or became infected after pregnancy.

Babies born to HIV-infected mothers are sure to separate immediately after giving birth to reduce the likelihood of infection, if this has not already happened. HIV and tuberculosis in children proceeds with approximately the same symptoms, however, it is very difficult for an immature body to fight pathogens. At the same time, a decrease in body weight is noted and it is restored for a long time.

If the baby has not been in contact with the mother, BCG is vaccinated. When it is impossible to do it, a preventive course of chemotherapy is prescribed. The same applies to children who have been in contact with an infected mother. In this case, BCG is contraindicated.

If the baby was in contact with a sick mother, then dispensary observation is shown to him, since the risk of developing a disease caused by mycobacteria is quite high.

Diagnosis of tuberculosis in HIV-infected

It is possible to identify pathology with immunodeficiency using standard studies that are used in such cases. Typically used:

Taking anamnesis: the duration of the symptomatology, its severity, the presence of contact with the source of infection is determined.
Objective examination. Allows you to determine the localization of pain, the state of the lymph nodes.
Clinical examination of blood, urine. Used to detect traces of pathogens.
Chest x-ray. Shows the localization of the pathological process, allows for differential diagnosis with other diseases with similar symptoms.
Microscopy of sputum, culture on a nutrient medium. It is used to establish the type of pathogen and its resistance to certain groups of drugs.
ELISA. Allows you to determine antigens and antibodies to pathology.

A biopsy of certain organs may also be prescribed, such as the liver, spleen, lymph nodes, and skin. This is carried out in cases when it comes to the extrapulmonary form of pathology.

Sometimes, some of the above tests need to be done multiple times. This is explained by the fact that with the secondary form of AIDS, a false negative result is possible. Also, this is possible in the initial stage of the disease, when the symptoms are not expressed, and antibodies have not yet had time to develop and spread throughout the body.

In addition, all patients with HIV should have regular screening examinations, which include chest fluorography. This will help identify pathology at an early stage and promptly start treating tuberculosis and HIV infection.

Treatment methods for tuberculosis in HIV-infected

Therapeutic measures are prescribed to patients immediately after confirmation of the diagnosis. You should be prepared for the fact that they will take a fairly long period, which lasts at least six months. However, with an aggressive course, as is the case against the background of immunodeficiency, the treatment of HIV patients with tuberculosis can take up to 2 years.

The direct treatment of HIV and tuberculosis involves taking anti-tuberculosis drugs and antiretroviral therapy. The former include such medications:

Isoniazid, streptomycin. Drugs are prescribed at any stage of treatment.
Rifampicin, parasinamide. Used as the main anti-tuberculosis therapy for HIV after 2 months of using the above medications.

In HIV, chemoprophylaxis of tuberculosis, as well as its treatment, is carried out mainly with rifampicin and rifabutin. For best results, in most cases, these drugs are prescribed at the same time. The dosage should be determined only by a doctor, since they have a lot of reactions and have contraindications.

HIV-associated tuberculosis also requires antiretroviral therapy, this is the only way to completely cope with the pathology. It is carried out with the following goals:

Improving the quality of life, as well as extending it.
Reducing the likelihood of the spread of the virus.
Reducing the risk of secondary manifestations of tuberculosis, AIDS and cancer, which often develops against the background of these two diseases.

Therapy for AIDS and tuberculosis of the lungs or other organs involves the use of a huge number of toxic medications. To reduce the likelihood of complications, you should eat right, take medications after meals.

Chemoprophylaxis of tuberculosis in HIV-infected people allows you to completely recover from the disease, despite the reduced immunity.

In addition to taking medications, in the house where the patient lives, disinfection against HIV tuberculosis is carried out, which will help prevent infection of other family members, as well as the development of relapse.

Prognosis for tuberculosis and HIV

Many patients are interested in the question of life expectancy in tuberculosis and HIV infection. It depends on many factors, primarily on the neglect of the pathology and the presence of secondary lesions of internal organs, which can be seen in the photo. The prognosis for HIV and pulmonary tuberculosis depends on the CD4 count, the lower they are, the sooner a lethal outcome occurs.

It should be noted that in the terminal stage of AIDS, any therapy does not bring the desired result.

With pulmonary tuberculosis and HIV, disability is formalized according to the results of studies if they show that the patient has completely lost vital functions and cannot take care of himself.

Prevention of tuberculosis in HIV-infected

It is worth remembering that the prevention of tuberculosis in HIV should be in the first place for every patient. It provides for the timely vaccination of BCG, this is important for children. However, if the baby has already become infected with immunodeficiency, such manipulation is contraindicated, as this can provoke the development of secondary pathologies.

It is also necessary to follow the rules of personal hygiene, be sure to wash your hands thoroughly after visiting public places. It is there that it is often possible to pick up mycobacteria.

If a person already has AIDS, it is important to adhere to antiretroviral therapy and strictly follow the doctor's instructions to reduce the chance of contracting various infections.

Tuberculosis and AIDS, the prevention of which is not so difficult, often run together, thereby complicating the condition of patients. To prevent this from happening, it is recommended not to neglect the advice of doctors and use all prescribed medications, because against the background of a weakened immune system, any infection can become fatal.

Human immunodeficiency virus and tuberculosis are among the most terrible and dangerous diseases.

Together, these pathologies can cause great, and sometimes irreparable damage to the entire body. According to statistics every year 10-15% of the population with HIV infection become infected with tuberculosis.

HIV infection and tuberculosis together

The immune system of an HIV-infected person is very weakened, therefore his body is more susceptible to various diseases, including tuberculosis.

It is known that the tubercle bacillus can be in a dormant state for many years, but as soon as favorable conditions appear, for example, HIV, it begins multiply rapidly. Tuberculosis in combination with HIV is dangerous because it affects not only the lungs, but also other organs.

Early diagnosis is often impossible due to psychological factors. Often, patients, visiting a phthisiatrician, hide their HIV status, thereby knocking the doctor out of making the correct diagnosis. Symptoms of the disease in HIV carriers usually appear only in the later stages, and the usual hemoptysis may not be present.

Reference! According to statistics, the cause of death in 40% of people with HIV - tuberculosis.

How long do they live with the diagnosis?

The life expectancy of an HIV-infected patient with tuberculosis may be 20 and even 30 years, provided that the patient follows all the doctor's prescriptions and does not take drugs. If a person is not treated, in addition, continues to use drugs, then his life span is reduced up to 6-8 months.

Can TB with HIV be cured?

You can get rid of the disease only with the help of a rather serious and long-term therapy. If HIV is aggressive, the fight against tuberculosis can continue two years or longer.

With early detection of this disease the forecast will be more promising, however, the treatment process can still take many months.

Treatment principles

If an HIV-infected person has tuberculosis, then it is most advisable to use comprehensive control measures with two diseases at once.

Features of therapy

Treatment for tuberculosis and HIV infection usually includes two steps:

Destruction of the causative agent of tuberculosis... If the therapy is carried out correctly and the patient strictly followed all the doctor's recommendations, then a positive effect should be observed. Clinical studies will tell about this: with successful treatment, microbacteria will be absent in the patient's sputum, and the general condition of the body will significantly improve. This will move on to the next event.
The second stage is directly consolidation of the result obtained.

It is worth noting that in most cases the first phase lasts about six months, while maintenance therapy can last for several years.

Medication

To combat tuberculosis and HIV in combination, the doctor usually prescribes Rifampicin, Rifabutin, Isoniazid and Pyrazinamide, and antimicrobials and anticonvulsants.

The specialist should monitor the effectiveness of treatment in order to increase or decrease the dosage of prescribed drugs if necessary.

If tuberculosis therapy does not bring the desired result, and after some time after its start, no positive dynamics is observed, then all further actions are carried out in a hospital under the constant supervision of medical personnel in an isolated room.In this case, drugs such as Kanamycin, Amikacin, Clarithromycin, Capriomycin are prescribed.

Important! All drugs for tuberculosis should be prescribed only by a specialist; self-medication for such pathologies is strictly prohibited. The slightest delay or the wrong treatment regimen is fraught with very serious consequences up to death.

What medications help and how are they treated

The main therapy is the continuous daily intake of anti-tuberculosis drugs. Usually, treatment during treatment is combined 4-5 drugs of the first line against tuberculosis: Isoniazid (N), Rifampicin (R), Streptomycin (S), Pyrazinamide (Z), Ethambutol (E).

Photo 1. Anti-tuberculosis drug Etambunol, 400 mg, 50 tablets, from the manufacturer of PJSC "Borshagovskiy KhFZ".

Treatment is carried out in two steps:

intensive - 2 months, includes a set of measures to prevent the emergence of multi- and multi-resistant strains of MBT;
supporting - continues for another 4 months.

Bone tuberculosis is treated 9 months, urinary system - 10 months, and tuberculous meningitis - 12 months.

Attention! It is important to remember that being cured does not mean getting rid of the disease forever. With such complex and dangerous pathologies, constantly there is a risk of relapse... In this regard, it is very important to strictly follow all the doctor's recommendations, not only during treatment, but also after it.

Side effects. What determines life expectancy

Any medicinal product has a number of side effects that should be considered before starting treatment for tuberculosis. So, when using Isoniazid, headaches, dizziness, paresthesia, and peripheral neuropathy can be observed.

With a strong effect of Isoniazid on the central nervous system, it is possible to replace this drug with Phenazid. Long-term use of Pyrazinamide and Rifampicin threatens development of drug-induced hepatitis... In the treatment of tuberculosis with Pyrazinamide, nausea, vomiting, and allergic reactions are often observed.

Photo 2. A drug for the treatment of tuberculosis Pyrazinamide, 0.5 g, 100 tablets, from the manufacturer "Valenta".

The lifespan of a patient who contracted tuberculosis in the presence of HIV infection depends on how early the disease was diagnosed and how accurately the patient followed all the doctor's recommendations.

Particular attention should be paid to factors that can trigger the development of tuberculosis.

Today in the world there is a simultaneous development of two epidemics provoked by tuberculosis infection and the human immunodeficiency virus. Very often, these diseases in humans develop at the same time, so many believe that one pathology necessarily implies another. But is it?

Tuberculosis and HIV in the structure of infectious diseases are seen as natural allies. The regularity of their simultaneous development lies, first of all, in the predominant distribution among a certain contingent of the population.

Since 2001, tuberculosis has claimed the lives of 1 million people living with HIV every year, according to figures released by the World Health Organization. It has long been proven that the immunodeficiency virus can increase the risk of developing tuberculosis, and, conversely, with tuberculosis infection, the course of HIV is significantly complicated.

So, 25% of HIV-infected people get sick with tuberculosis. Of all cases, 30% die within the next three years. This once again reminds us that it is necessary to detect and treat tuberculosis as early as possible in everyone without exception.

Tuberculosis is an infectious disease that belongs to the class of opportunistic infections, since it can cause morbidity and death among HIV patients.

The etiological factor in the development of the disease is mycobacterium tuberculosis (Koch's tubercle bacillus). The bacterium is very resistant to environmental conditions. According to statistics, a third of the world's population is a carrier of Koch's bacillus.

But its activation occurs only in the case of a decrease in general immunity, in particular, in those infected with the immunodeficiency virus. Active mycobacterium is capable of forming a kind of granulomas in various organs. Consequently, a varied clinical picture appears.

Disease course

When tuberculosis is combined with the immunodeficiency virus, various symptom complexes arise, which are not always considered possible to predict. This is due to the fact that each of these diseases has a separate clinical picture and proceeds independently of the other. You can become infected with HIV while you are sick with tuberculosis and, conversely, tuberculosis can join HIV.

The second option has an extremely severe course, since in HIV-infected people, the ingestion of a tubercle bacillus into the body causes depression of the already low immunity. As a result, the ability to resist various environmental factors is lost.

Against this immune background, opportunistic infections very easily join - pneumocystis pneumonia, cryptosporidiosis, cryptomeningitis, which can be fatal. In such a situation, tuberculosis is an indirect cause of death. Over the past 15 years, the incidence rate of tuberculosis has increased by 3.5 times, and HIV - dozens of times.

Symptoms

The interaction of mycobacterium tuberculosis with the immunodeficiency virus forms a special clinical picture of the disease, which is distinguished by a malignant course and the originality of symptoms. The most common are the following:

persistent asthenic syndrome;
constant or periodic increase in temperature;
prolonged unproductive cough, possibly streaked with blood;
significant decrease in body weight (more than 10%);
with the development of AIDS, indigestion, vomiting, inflammation of all groups of lymph nodes join.

Early manifestations of tuberculosis HIV

At the initial stage of the disease, tuberculosis with HIV has a clinical and radiological picture that does not differ in any way from that of HIV-negative patients. Symptoms characteristic of standard pulmonary tuberculosis develop.

Most often at this stage, an infiltrative form of tuberculosis develops, affecting the upper lobes of the lung. Focal symptoms join in a few days. Radiographically, they can be different - with or without decay. The use of specific therapy at this stage stops the development of further changes in the lung tissue.

As the number of lymphocytes in the blood decreases, the pulmonary form of tuberculosis associated with HIV infection manifests itself in atypical (lower lobe) localization, damage to other organs.

At the stage of AIDS itself, when opportunistic infections develop, extrapulmonary forms of tuberculosis appear along with pulmonary formations. The picture of tuberculosis infection at this stage is characterized by:

severe prolonged intoxication;
the presence of diffuse infiltrates that are located in the upper, middle and lower parts of the lungs;
generalized lymphadenopathy;
the presence of extrapulmonary lesions of the pleura, lymph nodes, kidneys, liver;
questionable or negative reaction to the Mantoux test due to the suppression of the main links of cellular immunity.

Other features

The features of the X-ray picture of pulmonary tuberculosis in HIV patients are:

a significant frequency of medium- or lower-lobe localizations with the presence of a two-sided process due to seeding;
the presence of areas of caseous necrosis;
decrease in the frequency of destructive changes in all clinical forms;
frequent accession of pulmonary tuberculosis to pleural lesions.

In patients with HIV, when joining tuberculosis, complications often develop:

exudative pleurisy;
heart failure;
peritonitis;
fistulas;
pulmonary bleeding;
swelling of the brain.

There is a regularity that in patients with tuberculosis with the attachment of the immunodeficiency virus, a fibrous-cavernous form of lung damage most often occurs, and in HIV-infected patients with the attachment of a tuberculous bacillus - infiltrative and disseminated.

Diagnostic measures

The principles for determining tuberculosis in HIV patients remain the same as in those with normal immunity, and include the entire list of standard general clinical examination. For an accurate diagnosis, you must first communicate with the patient - to study whether there are complaints, to clarify the history of the development of the disease.

Next, you should proceed to an objective examination - to assess the patient's appearance, to conduct physical research methods (palpation, percussion, auscultation). From laboratory methods, a general analysis of blood and urine will be required, as well as to examine the patient's sputum three times in a bacteriological laboratory. Also very indicative is tuberculin diagnostics - an assessment of the Mantoux reaction.

Early diagnosis, especially at the stage of AIDS, presents significant difficulties, since these diseases, by and large, have a similar clinical picture. For both diseases, fatigue, night sweats, fever, prolonged cough with blood streaks, and weight loss are quite common manifestations.

In order to diagnose tuberculosis, in addition to the presence of clinical symptoms, it is important to determine the etiological factor of the disease. To do this, all patients who have this disease are suspected of having a microscopic examination of sputum every 2 months for six months (3 times in total).

You can also use other biological materials. The method detects the presence of acid-fast bacteria. Sputum collection takes place in the morning. If the patient cannot cough up sputum, then inhalation of the oropharynx with 3% hypertonic sodium chloride solution should be used. Thus, there will be stimulation of its discharge.

Detection of tuberculosis in HIV-infected persons

An obligatory method is the identification of mycobacteria in culture. The seeding result is considered negative if the pathogen has not been sown. The total duration of the study is 6-8 weeks. Such a long determination period is due to the fact that mycobacteria grow very poorly. The growth itself lasts about 4 weeks. The remaining 2-4 weeks fall on the determination of sensitivity, therefore, the diagnosis of tuberculosis with this method is considered difficult.

They also carry out bronchoscopy, which is important in situations where it is necessary to differentiate tuberculosis with other diseases.

Features of therapy and prognosis

Treatment of tuberculosis in HIV infection consists in the simultaneous administration of a combination of antimycobacterial drugs with symptomatic treatment of opportunistic infections with antiretroviral drugs. The dosage of anti-tuberculosis drugs is selected by the doctor individually. The classic antiretroviral therapy regimen involves the administration of three drugs at the same time.

HIV treatment in pregnant women

In pregnant women, a thorough diagnosis of the existing symptoms is necessary according to the same principle as in ordinary women. A treatment plan must be drawn up. When compiling it, the following points are taken into account:

The maximum reduction in viral activity should be sought. This reduces the chances of HIV transmission from mother to child; therefore, timely perinatal prevention of HIV transmission is an important link in the treatment of the disease in pregnant women.

Treatment in newborns for tuberculosis and HIV infection

In all children with confirmed virological status of tuberculosis and HIV, the principles of therapy are to slow down the progression of the disease. From 18 months of age, the child is prescribed antiretroviral therapy. Prevention and treatment of opportunistic infections are also required.

It is necessary to treat all children with an obvious clinical picture. The prescription of anti-TB drugs directly depends on the chosen HIV treatment regimen. Medicines are selected by the doctor individually for each person, based on the prevalence of certain symptoms. It should be remembered that tuberculosis and HIV in children can proceed with lightning speed, leading to sad consequences.

The dangers of tuberculosis for people with HIV and prevention

According to statistics, the life expectancy of people with a combination of diseases such as tuberculosis and HIV infection decreases several times. Since each disease presented has the property of significantly impairing the functioning of the body, the danger lies precisely in their interaction with each other.

An organism with reduced immunity will not be able to resist them in any way. Only timely diagnosis and correctly selected early treatment can improve the life prognosis of such patients.

The most effective method of preventing the addition of these diseases with one available is the use of chemicals (chemotherapy). Its essence consists in the use of Isoniazid 2 tablets once a day for a year. If all stages of prevention are carried out correctly, the incidence rate of tuberculosis among HIV-infected people decreases by 4 times.

The mechanism of action of chemoprophylaxis is based on the elimination of latent tuberculosis infection in the body. She is appointed by TB doctors at TB dispensaries only after a comprehensive examination. It is also possible to use immunoprophylaxis. It consists in the introduction of the BCG vaccine.

Children born to women with a positive HIV status are subject to compulsory vaccination in the maternity hospital. The vaccine is given in a standard dose. Before use, you should definitely clarify the status of the child and the presence of clinical signs of immunodeficiency. If symptoms are still present, administration will have to be postponed.

The likelihood of HIV transmission depends on the viral load of both the woman and the child, therefore improving the immune status of a pregnant woman is the most important preventive measure.

Considering the above, we can conclude that the combination of tuberculosis with HIV is an urgent problem all over the world. Early detection and treatment of tuberculosis in all HIV-infected people is a prerequisite for successful life extension. And timely prevention can prevent such sad consequences.