Community-acquired pneumonia in HIV patients

The objective: To study the frequency and nature of community-acquired pneumonia (CAP) in HIV patients. Subjects and methods: The continuous longitudinal retrospective study of all cases of respiratory diseases among HIV patients (n = 185), who received in-patient treatment in the therapy department. Results. CAP was diagnosed in 38.4% (n = 71) of patients and it was the most frequent respiratory disease among HIV patients. The median CD4 count in CAP made 197.5 cells/μL, 9.1% of patients received antiretroviral therapy before hospital admission. 74.7% of CAP patients (n = 53) had lesions disseminated to several lobes. Laboratory parameters revealed in severe CAP (leukocytosis > 12 × 109/L, leukopenia 0.05). Bacteremia in CAP was detected in 20.8% of patients and it was associated with the failure of standard empiric antibiotic therapy (p < 0.05). 9.9% of CAP patients (n = 7) were diagnosed with polymicrobial infection. Lethal outcomes of CAP were recorded in 5.6% of cases (n = 4), all with severe immunosuppression (the median of CD4 count was 5 cells/μL), 2 cases had bilateral subtotal CAP and 2 suffered from polymicrobial infection. © 2021 New Terra Publishing House. All rights reserved

Chronic obstructive pulmonary disease in patients infected with human immunodeficiency virus [Хроническая обструктивная болезнь легких у больных, инфицированных вирусом иммунодефицита человека]

The aim of the study was to examine the role of COPD in the structure of respiratory diseases in HIV patients and the course of these comorbidities among hospitalized patients with HIV infection. Methods. A continuous longitudinal retrospective study was conducted in the Holy Great Martyr George the Victorious Novokuznetsk City Clinical Hospital No.2 and included all HIV patients with respiratory diseases (n = 185) hospitalized in the therapeutic department in 2017 - 2018. About 2% of population in the Kemerovo region (with the population 2.7 million people) is known to be HIV-infected. The regional COPD incidence is 124.7/100 000. Results. COPD was diagnosed in 19 (10.3%) of all HIV patients hospitalized with respiratory diseases. 73.7% of patients with COPD were aged ≤ 40 years, the mean age was 37.6 ± 5.0 years. All patients (100.0%) were known to have smoking and intravenous drug use as potential risk factors for the development and progression of COPD. The ART coverage was low (21.1%). 68.5% of patients with COPD had severe bronchial obstruction with a decrease in FEV1 &lt; 50% of predicted values (GOLD grades III - IV). 73.7% of the patients were assigned to COPD group B, the rest 26.3% - to group D. In 31.6% of patients, the main cause of hospitalization was COPD itself, in 68.4% - COPD combined with other lung diseases (community-acquired pneumonias, septic embolism, tuberculosis and pneumocystosis). The CD4-lymphocyte count in cases of COPD combined with other respiratory diseases (median 214.0 cell/μl) was lower than in COPD as the only respiratory disease (median 495.5 cells/μl) (p = 0,014). Conclusion. The socio-economic significance of both HIV-infection and COPD argues the further study of the course and treatment of COPD in persons with HIV-infection. © 2021 Medical Education. All rights reserved

Tuberculosis in patients with hiv infection in a therapeutic hospital in a region with high hiv prevalence

Objective. To analyze the role and character of tuberculosis (TB) among all respiratory diseases in HIV-infected patients treated in a therapeutic hospital Patients and methods. This longitudinal retrospective study included all consecutive HIV-positive patients with respiratory diseases (n = 185) treated in the Therapeutic Department of the City Hospital No 2 in Novokuznetsk in 2017–2018. Results. TB was diagnosed in 50 HIV-infected patients (27.0%) admitted to hospital. Median CD4 count was 124 cells/µL. Only 14.3% of patients were adherent to antiretroviral therapy. Sputum smear microscopy in TB dispensary was positive twice as often as in the therapeutic hospital (54.4% vs 23.4%). Abdominal lymphadenopathy was detected in 52.8% of patients examined, regardless of the pulmonary lesion pattern (p >0.05); 25.0% of patients were diagnosed with endobronchial TB. The main radiological syndromes of TB in the HIV-infected population included dissemination (52.0%), infiltration (26.0%), and intrathoracic lymphadenopathy (10.0%). Pleural lesions were identified in 28% of participants with TB and HIV coinfection. Conclusion. TB was the only cause of focal dissemination (100.0%, p < 0.001), while pleural lesions and intrathoracic lymphadenopathy were significantly more common in TB patients than in individuals with non-tuberculosis diseases (11.6% and 0.8%, respectively, p < 0.05). Hospital mortality rate among TB patients in a therapeutic hospital was 8.0%. © 2020, Dynasty Publishing House. All rights reserved