Possibilities of endoscopic diagnosis of opportunistic infections in patients with HIV/tuberculosis co-infection

Aim of the study: To establish the incidence of opportunistic infections (OI) in patients with HIV/tuberculosis co-infection depending on the severity of immunosuppression and to evaluate the role of endoscopy in the diagnosis of concomitant diseases.
Materials and methods: A retrospective analysis was performed of the inpatient medical records of 170 patients with HIV/tuberculosis co-infection in 2023 who underwent diagnostic bronchoscopy and esophagogastroduodenoscopy with sampling for the diagnosis of OI.
Results: The spectrum and frequency of occurrence of concomitant OIs, except for tuberculosis, were as follows:esophageal candidiasis in 37 patients (21.8%), CMV infection in 24 patients (14.2%), Pneumocystis pneumonia in 6 patients (3.6%), mycobacteriosis in 4 patients (2.4%), Kaposi's sarcoma in 4 patients (2.4%), and CNS toxoplasmosis in 2 patients (1.2%). The sensitivity and specificity of endoscopic biopsy for the diagnosis of esophageal candidiasis was 100%; Pneumocystis pneumonia and pulmonary mycobacteriosis were verified in 100% of cases using bronchoalveolar lavage. A comparative analysis of the frequency of secondary infectious lesions depending on the form of pulmonary tuberculosis showed that patients with disseminated tuberculosis were more often diagnosed with esophageal candidiasis (36.1% of cases, p=0.005), while patients with disseminated tuberculosis and caseous pneumonia were significantly more likely to have manifest CMV infection (13.9% and 50%, respectively, p=0.006).
An analysis of the incidence of concomitant diseases in patients with different numbers of CD4 lymphocytes in the blood showed a significant predominance of esophageal candidiasis (p<0.001) and manifest CMV infection (p=0.01) in patients with immunosuppression, while in patients with CNS toxoplasmosis, Kaposi's sarcoma, nontuberculous mycobacteria, Pneumocystis pneumonia and active CMV infection no differences in the frequency of detection were obtained (p>0.05).
Conclusions: Thus, endoscopic diagnostic methods have great diagnostic value for identifying acute respiratory infections in patients with HIV/tuberculosis coinfection. Disseminated pulmonary tuberculosis was a significant predictor of the development of such acute respiratory infections as esophageal candidiasis, overt CMV infection, Pneumocystis pneumonia, and mycobacteriosis in patients with late-stage HIV infection.With a decreased CD4 count, the most common findings during examination were candidiasis and overt CMV infection.

1. Zagdyn Z.M., Kobesov N.V., Verbitskaya E.V., Denuyshenkov V.L. The global burden of HIV/AIDS in Russia in terms of public health. Part 1. HIV Infection and Immunosuppressive Disorders, 2023, No. 15 (2), pp. 69–80 (In Russ.). doi: https://doi.org/10.22328/2077-9828-2023-15-2-69-80.

2. Meng S., Tang Q., Xie Z., Wu N., Qin Y., Chen R., Chen X., Chen X., Li Y., Shi M., Ye L., Liang H., Jiang J., Zhou B., Lin J. Spectrum and mortality of opportunistic infections among HIV/AIDS patients in southwestern China // Eur. J. Clin. Microbiol. Infect. Dis. 2023. Vol. 42, No. 1. Р. 113–120. doi: https://doi.org/10.1007/s10096-022-04528-y.

3. Smirnov N.A., Nagibina M.V., Martynova N.N., Bessarab T.P., Nabiulina D.R. The structure of fatal outcomes in HIV infected patients during hospitalization in Moscow hospitals from 2015 to 2019. Infectious Diseases: News, Opinions, Training, 2024, Vol. 13, No. 3, pp. 37–43 (In Russ.). doi: https://doi.org/10.33029/2305-3496-2024-13-3-37-43.

4. Belyakov N.A., Ogurtsova S.V., Azovtseva O.V., Kurganova T.Yu., Melnikova Т.N., Leonova O.N., Stepanova E.V., Kovelenov А.Yu., Asadullayev М.R., Rassokhin V.V. Analysis of the main epidemiological indicators of HIV infection and results of multiyear application of antiretroviral therapy (by the materials from the North-West of Russia). Infectious Diseases: News, Opinions, Training, 2020, Vol. 9, No. 1, pp. 19–27 (In Russ.). doi: https://doi.org/10.33029/2305-3496-2020-9-1-19-27.

5. Valladales-Restrepo L.F., Oyuela-Gutiérrez M.C., Díaz-Arteaga C., Torres-Campo M.A., Rengifo-Montes A., Erazo-De Los Ríos A.S., Sabogal- Ortiz A., Machado-Duque M.E., Gaviria-Mendoza A., Machado-Alba J.E. Coinfections and In-Hospital Mortality in a Group of Patients With HIV/AIDS: A Longitudinal Study // Inquiry. 2024. Vol. 61. 469580241288429. doi: https://doi.org/10.1177/00469580241288429.

6. Mollel E.W., Todd J., Mahande M.J., Msuya S.E. Effect of tuberculosis infection on mortality of HIV-infected patients in Northern Tanzania // Trop. Med. Health. 2020. Vol. 48. P. 26. doi: https://doi.org/10.1186/s41182-020-00212-z.

7. Sime T., Oljira L., Diriba A., Firdisa G., Gezimu W. Effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy at public hospitals of Eastern Ethiopia: A retrospective cohort study // PLoS One. 2022. Vol. 17, No. 10. e0277021. doi: https://doi.org/10.1371/journal.pone.0277021.

8. Xie B., Huang W., Hu Y., Dou Y., Xie L., Zhang Y., Qin S., Lan K., Pang X., Qiu H., Li L., Wei X., Liu Z., Meng Z., Lv J. Anemia and opportunistic infections in hospitalized people living with HIV: a retrospective study // BMC Infect Dis. 2022. Vol. 22, No. 1. P. 912. doi: https://doi.org/10.1186/s12879-022-07910-5.

9. Ali M., Razok A., Gassim M., Elmaki N., Goravey W., Alkhal A., Almaslamani M., Alsoub H. HIV and AIDS-defining opportunistic illnesses in the state of Qatar: A cohort population-based retrospective study covering 17 years (2000–2016) // Ann. Med. Surg. (Lond.). 2022. Vol. 78. 103842. doi: 10.1016/j.amsu.2022.103842.

10. Weldearegawi T.Z., Gerensea H., Berihu H., Gidey G., Welearegay M.Z. The magnitude of opportunistic infections and associated factors in HIVinfected adults on antiretroviral therapy in southern zone Tigray, Ethiopia: a cross-sectional study // Pan. Afr. Med. J. 2020. Vol. 35. P. 126. doi: 10.11604/pamj.2020.35.126.17839.

11. Wills N.K., Lawrence D.S., Botsile E., Tenforde M.W., Jarvis J.N. The prevalence of laboratory-confirmed Pneumocystis jirovecii in HIV-infected adults in Africa: A systematic review and meta-analysis // Med. Mycol. 2021. Vol. 59, No. 8. Р. 802–812. doi: https://doi.org/10.1093/mmy/myab002.

12. Yanagisawa K., Wichukchinda N., Tsuchiya N., Yasunami M., Rojanawiwat A., Tanaka H., Saji H., Ogawa Y., Handa H., Pathipvanich P., Ariyoshi K., Sawanpanyalert P. Deficiency of mannose-binding lectin is a risk of Pneumocystis jirovecii pneumonia in a natural history cohort of people living with HIV/AIDS in Northern Thailand // PLoS One. 2020. Vol. 15, No. 12. e0242438. doi: https://doi.org/10.1371/journal.pone.0242438.

13. Getaneh Y., Getnet F., Rashid A., Kang L., Chu Q., Li S., Yi F., Shao Y. The spectrum of opportunistic infections and malignancies among women on antiretroviral therapy in Ethiopia // Emerg. Microbes Infect. 2023. Vol. 12, No. 2. Р. 2271065. doi: https://doi.org/10.1080/22221751.2023.2271065.

14. Shchelkanova A.I., Sinitsyn M.V., Chistyakova N.I., Dolgova E.A., Kulko A.B., Kravchenko A.V. Medical and social characteristic of patients with TB/HIV co-infection, at the stage of providing specialized patient care. Infectious Diseases: News, Opinions, Training, 2019, Vol. 8, No. 1. pp. 40–46 (In Russ.). doi: https://doi.org/10.24411/2305-3496-2019-11005.

15. Kirkoyun Uysal H., Koksal M.O., Sarsar K., Soguksu P., Erkose Genc G., Yapar G., Ozdemir E., Onel M., Mese S., Demirci M., Erturan Z., Yurtseven E., Eraksoy O.H., Agacfidan A. Distribution of Opportunistic Pathogens in People Living with HIV at a University Hospital in Istanbul over a One-Year Treatment Period and Its Association with CD4 T Cell Counts // Pathogens. 2023. Oct 9. Vol. 12, No. 10. P. 1226. doi: https://doi.org/10.3390/pathogens12101226.

16. Шахгильдян В.И., Домонова Э.А., Ядрихинская М.С., Орловский А.А., Шипулина О.Ю., Тишкевич О.А., Яровая Е.Б. Диагностическое значение качественного и количественного определения ДНК ЦМВ в биологических материалах у больных ВИЧ-инфекцией с легочной патологией // Лабораторная служба. 2023. Т. 12, № 1. С. 7–13.

17. Баженова Ю.В., Зоркальцева Е.Ю., Жданова С.Н., Воробьева О.А., Рожкова Н.Ю. Клинико-рентгенологическая характеристика ВИЧ-ассоциированного туберкулеза легких в регионе с высоким распространением коинфекции // Туберкулез и болезни легких. 2021. Т. 99, № 9. С. 23–29.

18. Бородулина Е.А., Кузнецова А.Н., Бородулин Б.Е. Лучевая диагностика туберкулеза в скрининге пациентов с ВИЧ-инфекцией // Acta Biomedica Scientifica. 2023. Т.8, №. 1. С. 58–65.

19. Филинюк О.В., Логинова Ю.А., Рюмкина И.В., Аллилуев А.С. Медико-социальный портрет впервые выявленного больного туберкулезом с ВИЧ-инфекцией в Томской области // ВИЧ-инфекция и иммуносупрессии. 2024. Т. 16, № 4. С. 81–89.

20. Юдин А.Л., Афанасьева Н.И., Мясников Д.А., Юматова Е.А. Рентгенологические проявления туберкулеза у ВИЧ-инфицированных лиц // Лучевая диагностика и терапия. 2016. № 4. С. 35–45.

21. Мишина А.В., Мишин В.Ю., Эргешов А.Э., Собкин А.Л., Романов В.В., Кононец А.С. Особенности клинических проявлений и диагностики сочетания туберкулеза органов дыхания с оппортунистическими инфекциями легких у взрослых больных на поздних стадиях ВИЧ-инфекции с иммунодефицитом // Consilium Medicum. 2020. Т. 22, № 11. С. 78–86.