Abstract
The combination of HIV infection with tuberculosis and chronic obstructive bronchitis (COPD) is characterized by a variety of clinical manifestations with a tendency toward generalization of the specific process, viz. chronic and recurrent inflammation. A syndrome of mutual aggravation is observed.
Objective: to compare changes in the respiratory tract mucosa and bronchoalveolar lavage (BAL) data during bronchoscopy in patients with COPD combined with pulmonary tuberculosis, both with and without HIV infection. To determine the relationship between respiratory tract changes and viral load and antiretroviral therapy (ART).
Methods. Two groups of patients were compared, each consisting of 80 subjects. The patients’ ages ranged from 34 to 75 years. The following parameters were assessed: the duration of COPD, tuberculosis, and HIV infection, and the sequence of their onset. Based on bronchoscopy data, an assessment of the visualization of the bronchial tree and BAL was made.
Results. HIV-positive patients more often had caseous, granular, and ulcerative endobronchitis, as well as grades 2 and 3 endobronchitis, and more frequently had cicatricial changes in the bronchi. HIV-negative patients had nonspecific bronchitis, edematous, and hyperemic endobronchitis. With a high viral load, HIV-positive patients more often had grade II endobronchitis. In case of low viral load, grade 1 endobronchitis predominated. Individuals taking ART more often had grade 1 endobronchitis and fewer cicatricial changes. Individuals without ART more often had grades 2 and 3. BAL fluid from HIV-positive patients showed lower white blood cell and neutrophil counts and increased macrophages. HIV-negative patients had increased white blood cell and neutrophil counts and decreased macrophage counts.
Conclusion. It has been established that patients with comorbidities are significantly more likely to experience bronchial changes, including massive infiltration and epithelial hyperplasia. A high viral load and lack of ART influence the severity of respiratory damage.