Prognosis of survival of patients with pulmonary tuberculosis combined with HIV infection

Despite the global success of antiretroviral therapy in increasing the life expectancy of patients with HIV infection, the co-occurrence of HIV and tuberculosis remains a dominant factor in mortality and significant socioeconomic losses in the working-age cohort. Despite the overall decline in tuberculosis incidence, uncertainty remains regarding the factors determining the long-term prognosis and mortality risk of patients with TB/HIV coinfection in the post-treatment period. The use of multivariate statistical modeling methods to identify independent risk factors will enable the development of scientifically validated patient stratification algorithms, which is relevant for optimizing healthcare resources and personalizing follow-up protocols. The aim. A comprehensive analysis of mortality and survival in patients with pulmonary tuberculosis combined with HIV infection. Materials and methods. A single-center, retrospective, two-stage cohort study was conducted among patients who completed treatment at the Moscow Regional Clinical Tuberculosis Dispensary in 2024. The first stage included 268 patients with TB/HIV coinfection to determine factors increasing the likelihood of a fatal outcome among TB/HIV patients. The second stage, to assess the survival of patients with TB/HIV coinfection, included 172 patients with TB and TB/HIV who died from anti-tuberculosis therapy. Statistical analysis was performed using IBM SPSS Statistics v.27.0 (USA). Survival analysis was conducted using life tables and the Kaplan-Meier method. Results and discussion. The greatest impact on the likelihood of death in patients with TB/HIV coinfection was demonstrated by low CD4 counts, predominantly disseminated TB, the presence of multidrug-resistant or extensively drug-resistant Mycobacterium tuberculosis, extensive lung disease, and the absence of positive radiographic dynamics. A statistically significant difference in survival time between patients with TB/HIV coinfection and TB after initiation of therapy was identified. After the ninth month of therapy, a sharp decrease in the number of successfully cured patients with coinfection and a multiple increase in the likelihood of death (1.5-fold at the twelfth month, 2-fold at the fifteenth month) were observed. For patients with TB, the risk of death during the recommended follow-up period is minimal. Conclusion. A survival analysis revealed that TB/HIV patients requiring longer anti-TB therapy (an extended intensive phase) are at increased risk of death. These findings highlight the importance of active early screening of patients with TB/HIV coinfection, as well as timely clinical and radiographic examinations.

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