Diagnosis, course and outcomes of comorbidity of tuberculosis, opportunistic respiratory infections and COVID-19 in patients with advanced HIV infection with immunodeficiency

Purpose. To study the features of the diagnosis, course and outcomes of comorbidity of tuberculosis (TB), opportunistic respiratory infections (ORI) and COVID-19 in patients with advanced HIV infection with immunodeficiency (ID). Materials and methods. The prospective two-year follow-up study included 58 patients aged 26-56 years who were randomized into 2 groups. The 1st group included 29 patients with TB, ORI and COVID-19 comorbidity, of 4B stage of HIV infection in the progression phase and in the absence of ART. Group 2 - 29 patients selected according to the "copy-pair" principle, identical to patients of Group 1, but without COVID-19. Results. The comorbidity of TB, ORI, and COVID-19 in patients with advanced HIV infection is characterized by marked immunodeficiency and generalization of tuberculosis with multiple extrapulmonary manifestations and high levels (more than 70%) of MDR and BDR. Significant improvement in patients of the 1st and 2nd groups was established in 24.1% and 20.7% of cases, progression in 31.0% and 41.4%, respectively, death in 41.3% and 37.9%. Progression and death were associated with lack of treatment adherence, drug dependence, severe generalized TB and ORI progression. Conclusion. Patients with TB, ORI and COVID comorbidity in the late stages of HIV infection with ID represent a high risk group for severe disease and death, due to, among other things, social maladjustment and lack of adherence to examination and treatment, active examination of such patients. It is required to establish an etiological diagnosis necessary for their emergency hospitalization in a specialized infectious diseases hospital for adequate comprehensive treatment.