Epidemiological analysis of factors influencing the course of multidrug-resistant tuberculosis in HIV-infected patients with concomitant viral hepatitis

Cover Page

Cite item


The epidemiological significance of combined forms of especially dangerous infections has not been studied enough, unlike mono-infections. Currently, there is a tendency towards an increase in the incidence of multidrug-resistant tuberculosis. The formation of severe forms of the disease is caused by other widespread infections, such as chronic viral hepatitis and HIV. Polymorbid conditions distort the clinical manifestations of tuberculosis, reduce the effectiveness of anti-tuberculosis therapy and worsen the prognosis of the disease. Risk factors among patients in this category need analysis to carefully monitor patients and ensure infection control. Objective is to analyze the factors affecting the course of multidrug-resistant tuberculosis in HIV-infected patients with concomitant viral hepatitis. Materials and methods. Cases of the combined pathology of multiresistant tuberculosis, HIV infection and viral hepatitis with a dominant diagnosis of tuberculosis are analyzed. Results and discussion. The influence of the immunological status on the course of combined pathology was revealed. Since all the patients under study had clinical stage 4 of HIV infection, tuberculosis developed as an opportunistic infection. Severe immunosuppression (CD4 < 200 cells/ml) contributed to the progression of the generalized tuberculosis process. Long-term immunodeficiency was an unfavorable factor; in the overwhelming majority of cases, antiretroviral therapy was prescribed only after tuberculosis was detected. The dependence of the clinical form of tuberculosis on the level of CD4-lymphocytes was noted: isolated lesion of the chest organs prevailed in patients with a level of CD4-lymphocytes more than 200 cells/ml, generalization of TB process — with CD4 less than 200 cells/ml. Patients with miliary tuberculosis had a higher mortality rate compared to patients with other clinical forms, regardless of antiretroviral therapy. It was revealed that socially disoriented young people with viral hepatitis C prevailed in the structure of patients, the prevalence of which was due to the influence of aggravating factors, such as alcohol and drug abuse, and stay in prisons. Against the background of combined treatment, there was no significant effect of viral hepatitis on the course of polymorbid conditions and the effectiveness of the therapy.

About the authors

A. V. Kukurika

Makeevka Municipal Tuberculosis Dispensary

Author for correspondence.
Email: nastya_kukurika@mail.ru

Anastasia V. Kukurika,  TB specialist 

51005677, Makeevka, Sormovskaya str., 7

Phone: +380 (713) 76-72-55 


E. I. Yourovskaya

Republican Clinical Tuberculosis Hospital

Email: doctorstoptb@gmail.com

TB specialist 



V. A. Lyakhimets

Donetsk Municipal Tuberculosis Dispensary

Email: doctorstoptb@mail.ru

TB specialist 




  1. Азовцева О.В., Грицюк А.В., Гемаева М.Д., Карпов А.В., Архипов Г.С. ВИЧ-инфекция и туберкулез как наиболее сложный вариант коморбидности // Вестник Новгородского государственного университета. 2020. Т. 117, № 1. С. 79–84. [Azovtseva O.V., Gritsyuk A.V., Gemaeva M.D., Karpov A.V., Arkhipov G.S. HIV infection and tuberculosis as the most complex form of comorbidity. Vestnik Novgorodskogo gosudarstvennogo universiteta = Bulletin of Novgorod State University, 2020, vol. 117, no. 1, pp. 79–84. (In Russ.)] doi: 10.34680/2076-8052.2020.1(117).79-84
  2. Азовцева О.В., Пантелеев А.М., Карпов А.В., Архипов Г.С., Вебер В.Р., Беляков Н.А., Архипова Е.И. Анализ медикосоциальных факторов, влияющих на формирование и течение коинфекции ВИЧ, туберкулеза и вирусного гепатита // Инфекция и иммунитет. 2019. Т. 9, № 5–6. С. 787–799. [Azovtseva O.V., Panteleev A.M., Кarpov А.V., Arkhipov G.S., Veber V.R., Belyakov N.A., Arkhipova E.I. Analysis of medical and social factors affecting the formation and course of co-infection HIV, tuberculosis and viral hepatitis. Infektsiya i immunitet = Russian Journal of Infection and Immunity, 2019, vol. 9, no. 5–6, pp. 787–799. (In Russ.)] doi: 10.15789/2220-7619-2019-5-6-787-799
  3. Бородулина Е.А., Вдоушкина Е.С., Кузнецова А.Н., Гладунова Е.П. Особенности коморбидной патологии (ВИЧ/ туберкулез) при летальных исходах // ВИЧ-инфекция и иммуносупрессии. 2019. Т. 11, № 4. С. 70–78. [Borodulina E.A., Vdoushkina E.S., Kuznetsova A.N., Gladunova E.P. Features of concomitant HIV/tuberculosis diseases with fatal outcomes. VICh-infektsiia i immunosupressii = HIV Infection and Immunosuppressive Disorders, 2019, vol. 11, no. 4, pp. 70–78. (In Russ.)] doi: 10.22328/2077-9828-2019-11-4-70-78
  4. ВИЧ-инфекция у взрослых и подростков: унифицированный клинический протокол медицинской помощи. Утвержден приказом МЗ ДНР № 1374 от 07.08.18. Донецк, 2018. С. 40–110. [HIV infection in adults and adolescents: unified clinical protocol of medical care. Approved by the Order No. 1374 of the Ministry of Healthcare of Donetsk People’s Republic on August 7th, 2018. pp. 40–110. (In Russ.)]
  5. Нечаев В.В., Иванов А.К., Яковлев А.А., Мусатов В.Б., Федуняк О.И., Васильева М.В., Беляков В.С., Кравцова А.И. Эпидемиология социально значимых сочетанных инфекций. Факторы риска летальных исходов. Pacific Medical Journal. 2018. № 3. С. 64–68. [Nechaev V.V., Ivanov A.K., Yakovlev A.A., Musatov V.B., Fedunyak O.I., Vasilieva M.V., Belyakov V.S., Kravtsova A.I. Epidemiology of socially significant co-infections. Risk factors for deaths. Pacific Medical Journal, 2018, no. 3, pp. 64–68. (In Russ.)] doi: 10.17238/PmJ1609-1175.2018.3.68–71
  6. Туберкулез: унифицированный клинический протокол медицинской помощи. Утвержден Приказом МЗ ДНР № 571 от 24.03.20. Донецк, 2020. С. 12–23. [Tuberculosis: unified clinical protocol of medical care. Approved by the Order No. 571 of the Ministry of Healthcare of Donetsk People’s Republic on March 3rd, 2020. pp. 12–23. (In Russ.)]
  7. Федеральные клинические рекомендации по профилактике, диагностике и лечению туберкулеза у больных ВИЧинфекцией. М.: Российское общество фтизиатров, 2016. 42 с. [Federal clinical guidelines for prevention, diagnosis and treatment of tuberculosis in patients with HIV infection. Moscow: Russian Society of Phthisiologists, 2016. 42 p. (In Russ.)]
  8. Dara M., Ehsani S., Mozalevskis A., Vovc E., Simões D. Tuberculosis, HIV, and viral hepatitis diagnostics in eastern Europe and central Asia: high time for integrated and people-centred services. Lancet, 2020, vol. 20, pp. 48–53. doi: 10.1016/S1473-3099(19)30524-9
  9. Flexner C., Thomas D.L., Swindells S. Creating demand for long-acting formulations for the treatment and prevention of HIV, tuberculosis, and viral hepatitis. Curr. Opin. HIV AIDS, 2019, vol. 14, no. 1, pp. 13–20. doi: 10.1097/COH.0000000000000510
  10. Truman B.I., Mermin J.H., Dean H.D. Measuring progress in reducing disparities in HIV, tuberculosis, viral hepatitis, and sexually transmitted diseases in the united states: a summary of this theme issue. Am. J. Public Health, 2018, vol. 108, no. S4, pp. S240–S241. doi: 10.2105/AJPH.2018.304761

Supplementary files

There are no supplementary files to display.

Copyright (c) 2021 Kukurika A.V., Yourovskaya E.I., Lyakhimets V.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies