HIV-infection is a
factor that has a negative impact on the epidemiology of
tuberculosis. According to the World Health Organization (WHO) and
other sources since 2006 and at present, the number of cases of
tuberculosis with concurrent HIV-infection has increased by 2.9 times [1,
2]. This is due to the fact that the possibility of
tuberculosis contraction in HIV-positive individuals is 100
times higher than in HIV-negative people [3, 4]. Increasing number of
comorbid TB diseases/HIV is associated with high mortality [5-11]. The
disease affects mainly people of young and working-age [5, 10, 11].
The search for optimal methods of treatment is an actual problem [12,
13]. Surgical treatment is one of the methods in complex treatment that
allows increasing the effectiveness of treatment [14-17]. The
surgical methods of treatment effectiveness for patients
with tuberculosis combined with HIV-infection is still to be studied
Material and methods
in 2016-2017, 572
radical lung resections were performed for pulmonary tuberculosis, while the
proportion of operations in patients with HIV-infection was 4.4% (25
cases). There was held an analysis of surgeries in patients with pulmonary
tuberculosis combined with HIV-infection. To assess the effectiveness of the inclusion
of surgical methods in treatment, two comparison groups of patients
were formed: 1 - group of 23 patients who were operated, 2 - group of
25 patients without surgical treatment. Efficacy was evaluated by the
criterion of deregistration after recovery.
the gender and age
characteristics of patients, social aspects and the method of detecting
pulmonary tuberculosis in the comparison groups were studied. In the 1st group,
there were 11 men (47.8%), 12 women (52.2%). In the 2nd group,
there were 12 (52.2%) men and 11 (42%) women, respectively (χ2=0.08;
p=0.7817). The average age of
the 1st group was 32.6±1.52 [95%; confidence
interval (CI) 25.48-35.79] and the 2nd group was 33.16±1.36 [95%;
CI 30.34; 35.98] (U=280.5; p=0.893). In terms of social
characteristics and the methods of detecting pulmonary tuberculosis, the
comparison groups did not have significant differences. In both
groups, most patients were unemployed, 15 (65.2%) patients in 1st group,
and 15 (60.0%) patients in 2nd group. A history of drug
abuse was observed in 8 (34.8%) patients in the 1st group
and in 10 (40.0%) patients in the 2nd group. 5 (21.7%)
patients in 1st group and 5 (20.0%) patients in 2nd group
stayed in a correctional labor institution. The groups are comparable for
In the 1st group,
tuberculosis was detected using annual large picture frame
photoroentgenography 9 (39.1%), during examination at the AIDS center
6 (26.1%), during complaints in the general medical network 5
(21.7%), during examination at a tuberculosis dispensary as contact 3 (13.0%).
In the 2nd group,
tuberculosis was detected using annual large picture frame
photoroentgenography 8 (32.0%), during examination at the AIDS center
7 (28.0%), during complaints in the general medical network 6
(24.0%), during examination at a tuberculosis dispensary as contact 4 (16.0%).
The main method
for detecting tuberculosis in both groups was annual large picture frame
In most cases, 11
(47.2%) patients in 1st group and 14 (56.0%) patients in 2nd group,
HIV-infection was diagnosed before pulmonary tuberculosis. The index
did not have significant differences between groups, but in the first
group there were more patients and amounted to 56% χ2=0.32 (р=0.57).
detected during examination for tuberculosis in 8 (34.8%) patients from the 1st group
and 7 (28.0%) patients in the 2nd group, all these
patients were tested for HIV for the first time χ2=0.26 (p=0.6125). Much less often patients were already
registered with a phthisiatrician with a diagnosis of pulmonary tuberculosis,
in the 1st group there were 4 (17.4%) people and in the 2nd group
- 4 (16.0%) people χ2=0,02 (р=0.8972).
count was determined in all patients at the time of admission. In the 1st group 459.09+46.41
[95% CI 362.84; 555.33], in the 2nd -429.64±47.07 [95% CI
332.49; 526.79] (p=0.476).
patients received antiretroviral therapy before surgery. Before the operation,
the level of CD4+-T-lymphocytes averaged 459.09±46.41 cells/ml.
characteristics of the clinical forms of tuberculosis in the groups had no
According to the
forms of the tuberculous process, the patients were diagnosed with: tuberculoma
in the 1st group - 19 (82.6%), in the 2nd group
- 19 (76.0%), fibrous-cavernous pulmonary tuberculosis 3 (13%) and 4
(16.0), χ2=0.08 (р=0.7719), cavernous tuberculosis 1 (4.4%) and 2 (8.0%)
χ2=0.27 (р=0.6015) (see Table 1).
Table 1. Clinical forms of tuberculosis in patients of the
Note. ABS - absolute; DST - drug susceptibility testing.
* - including DST
analyzes obtained from surgical material.
tuberculoma was detected to be the main form χ2=q.32 (p=0.5733). According to
the characteristics of the prevalence of the tuberculous process,
decay cavities in the operated lung among all patients were χ2=0.17 (p=0.6828) equally in the majority
of those observed in the groups. Fibrous-cavernous pulmonary tuberculosis was
limited in volume of the lesion within one lobe of the lung.
This allowed them to apply surgical treatment, there were a minimum
number of such patients.
operation, a macroscopic examination of the surgical material was carried out;
the presence of a cavity of destruction in tuberculoma (or
tuberculomas) was observed in 12 of 19 cases (63.1%). At the time of
registration, mycobacterium tuberculosis (MBT+) was detected in 11
(47.8%) patients in the 1st group and 12 (48.0%) in the 2nd group,
χ2=0.0001 (p=0.9904). At the same
time, in all these cases, mycobacteria in sputum were detected by
bacterioscopy, molecular-genetic methods (GeneXpert MTB/RIF), on liquid
nutrient media with automatic registration BACTEC MGIT and inoculation on a
standard Lowenstein-Jensen medium. Among patients with a positive MBT
test, a drug susceptibility test (DST) of mycobacterium tuberculosis (MBT)
was performed. Multidrug resistance or extensive drug resistance was
detected in 11 (47.8%) patients of the 1st group and 9
(36.0%) of the 2nd group χ2=0.69 (p=0.4064).