Pathomorphosis of intestinal tuberculosis in the HIV infection ERA: clinical and morphological parallels and immune determinants

Intestinal tuberculosis (TEC) remains a disease with late verification and a high mortality rate (over 40%). The increase in the number of cases of HIV infection and immunosuppressive states determines the pathomorphosis of TEC, which requires a revision of clinical and morphological parallels.
The aim. To study the pathomorphosis of intestinal tuberculosis in modern conditions and to establish the interaction between its manifestations and the pathogenesis and immune status of patients.
Material and methods. A retrospective analysis of the diagnostic and treatment results of 217 patients with confirmed TEC was conducted (2016–2023). The morphological forms, clinical picture, HIV status, CD4-lymphocyte count, and nature of complications were assessed.
Results and discussion. All patients developed intestinal tuberculosis during the secondary period of tuberculosis infection, with 64,0% having disseminated pulmonary tuberculosis. HIV infection was detected in 60,8% of cases. The ulcerative form of intestinal tuberculosis predominated among HIV-positive patients (82,6% vs. 58,8%; p=0,00036), whereas the infiltrative and mixed forms were more common in HIV-negative patients. Diarrhea (94,9%) and intestinal bleeding (100,0%) were pathognomonic for ulcerative TEC. Complications were 2.4 times more frequently in HIV patients (p=0,003); perforation and bleeding appeared in CD4<200 cells/μL, and acute intestinal obstruction (AIO) occurred with intact immunity.
Conclusion. The morphological form of TEC reflects the severity of immunodeficiency. Ulcerative TEC should be considered as an opportunistic infection associated with HIV and severe immunosuppression. Active screening for abdominal tuberculosis is necessary in patients with disseminated pulmonary tuberculosis and HIV/TB co-infection.

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