M. tuberculosis Infection in Patients with HIV Infection and Incidence of Tuberculosis: 8-year Follow-up

Relevance. Patients with HIV infection is of the leading risk groups for tuberculosis. According to WHO, the presence of HIV infection increases the likelihood of developing tuberculosis by 26 times and is the second factor in the world after malnutrition that affects the number of cases of tuberculosis. Aims. Study of primary infection with M. tuberculosis, spread of latent infection and incidence of tuberculosis in HIV-infected patients during 8 years of observation. Materials & Methods. An analysis of the data from the register of requests to the Cabinet was carried out. We studied a cohort of persons living with HIV who first visited the TB office in 2016. We studied information about screening for latent and active tuberculosis infection. We studied information about the course of HIV infection: the date of registration at the AIDS Center, the date of receiving a positive immunoblot result, the level of CD4+ lymphocytes, the stage of HIV infection, information about taking antiretroviral therapy. Results and discussion. The study was conducted on a large array of data obtained in a cohort of patients with HIV infection who first applied in 2016 to the office for the prevention and early detection of tuberculosis of the Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Department of Health and was observed for 8 years until 2023. For evaluation of the spread of tuberculosis infection among persons living with HIV, a subgroup of 5754 people was identified for whom the test results with recombinant tuberculosis allergen -ATR, were known in 2016, which amounted to 80.8%. A total of 6,733 ATR were administered, with 15.0% of patients not presenting for evaluation, 1.0% refusing the test, and 3.2% having a medical exemption from the skin test. In this group, over 8 years (2016-2023), 38 (13.1%) people out of 291 patients with ATR(+) and 55 (1.0%) people out of 5503 people with ATR(-) fell ill. During the first 4 years of observation in 2017-2020, 91.7% of all tuberculosis cases were registered for persons living with HIV with LTBI in 2017-2023. Conclusion. The presence of LTBI in patients with HIV infection increases the likelihood of developing tuberculosis by more than 10 times, while the chance of developing tuberculosis is more than five times lower in people with LTBI who have received a full course of preventive treatment for tuberculosis. The lack of preventive therapy for tuberculosis accelerates and increases the likelihood of persons living with HIV contracting tuberculosis: during the first year of observation, 70% of all cases become ill.

1. Global TB control WHO, 2015, page 78

2. Global TB report WHO, 2023, pages 35–36

3. Vasilyeva I.A., Belilovsky E.M., Borisov S.E., et al. Tuberculosis combined with HIV infection in countries around the world and in the Russian Federation // Tuberculosis and lung diseases. Volume 95, No. 9– 2017, pp. 8–18

4. Bogorodskaya E.M., Sinitsyn M.V., Belilovsky E.M., et al. The influence of HIV infection on the structure of newly diagnosed tuberculosis patients registered in the city of Moscow //Tuberculosis and lung diseases. 2017;95(10):17–26.

5. Epidemiology, prevention and treatment of tuberculosis in Moscow, 2022, ed. prof. E.M. Bogorodskaya, M.: MNPTSBT. – 2023. 300 p.

6. Wood R, Maartens G, Lombard CJ. Risk factors for developing tuberculosis in HIV-1-infected adults from communities with a low or very high incidence of tuberculosis. J Acquir Immune Defic Syndrome. 2000 Jan 1;23(1):75–80. doi: 10.1097/00126334-200001010-00010. PMID: 10708059.

7. Campbell JR, Winters N, Menzies D. Absolute risk of tuberculosis among untreated populations with a positive tuberculin skin test or interferon-gamma release assay result: systematic review and meta-analysis. BMJ. 2020 Mar 10;368:m549. doi: 10.1136/bmj.m549. PMID: 32156698; PMCID: PMC7190060.

8. Federal clinical recommendations for the prevention, diagnosis and treatment of tuberculosis in patients with HIV infection, ROF, 2016. M.

9. Sinitsyn M.V., Ayusheeva L.B., Belilovsky E.M., et al. Latent tuberculosis infection among HIV-infected persons in Moscow. Tuberculosis and socially significant diseases, No. 2, 2017 g., s. 42–49

10. Bogorodskaya E.M., Mazus A.I., Sinitsyn M.V., et al. Epidemiological effectiveness of organizing the prevention and early detection of tuberculosis among patients with HIV infection // Tuberculosis and socially significant diseases, No. 2, 2018, p. 4–15

11. Woldehanna S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev. 2004;(1):CD000171. doi: 10.1002/14651858.CD000171.pub2. Update in: Cochrane Database Syst Rev. 2010;(1):CD000171. PMID: 14973947

12. Slogotskaya L.V., Litvinov V.I., Kochetkov Ya.A., Senchikhina O.Yu. Potential of the new skin test «Diaskintest» in diagnostics of tuberculosis infection in children// Diagnostic issues in pediatrics. – 2011 – No. 2 – P. 20-24.

13. Slogotskaya L., Bogorodskaya E., Ivanova D., Sevostyanova T. Comparative sensitivity of the test with tuberculosis recombinant allergen, containing ESAT6-CFP10 protein, and Mantoux test with 2 TU PPD-L in newly diagnosed tuberculosis children and adolescents in Moscow // Plos ONE. – 2018. – Vol. 13(12). – e0208705

14. Vaneva T. V., Sinitsyn M. V., Kulikovskaya N. V. et al. Use of immunological tests for the diagnosis of tuberculosis infection in people living with HIV // Tuberculosis and socially significant diseases. 2017; 5 (4): 34-39

15. Houben R.M.G.J., Dodd P.J. The global burden of latent tuberculosis infection: a re-estimation using mathematical modeling // PloS Med. – 2016. – Oct 25;13(10). – https://doi.org/10.1371/journal.pmed.1002152

16. Slogotskaya L.V., Litvinov V.I., Seltsovsky P.P., et al. Use of a skin test with recombinant tuberculosis allergen (Diaskintest®) for the diagnosis of tuberculosis infection in patients with HIV infection // Pulmonology, 2011, 1, 60–64.

17. Vaneeva T.V., Kulikovskaya N.V., Krasnova M.A., et al. Results of using immunological methods for diagnosing tuberculosis in vivo and in vitro in patients with HIV infection // Tuberculosis and socially significant diseases, 2016, 2, 66–71.

18. Reader G.L. Epidemiological foundations of the fight against tuberculosis / Trans. from English – M.: Publishing house «Ves Mir», 2001. –192 p.

19. https://www.who.int/ru/news-room/fact-sheets/detail/tuberculosis. Accessed May 3, 2024.

20. Styblo K., Bumgarner J.R. Tuberculosis can be controlled with existing technologies: evidence. The Hague: Tuberculosis Surveillance Research Unit Progress Report; 1991. p. 60–72.