Selected clinical and epidemiological features of tuberculosis coinfection, infection caused by human immunodeficiency virus and viral hepatitis

The study estimated the prevalence of human immunodeficiency virus infection and viral hepatitis in patients admitted to the tuberculosis hospital in 2018–2020. Among patients admitted for the treatment of tuberculosis, 36.8% had human immunodeficiency virus infection. Markers of viral hepatitis were also detected in 78.8% of patients with human immunodeficiency virus infection associated with tuberculosis. The most common coinfection was tuberculosis — human immunodeficiency virus–hepatitis C, which was confirmed in 28.2% of the admitted patients. Clinical, X-ray, laboratory, and sonographic indicators were analyzed in 43 patients with tuberculosis having human immunodeficiency virus infection and viral hepatitis in various combinations. All patients were divided into three groups: group 1 included patients with tuberculosis, human immunodeficiency virus infection, and viral hepatitis, group 2 included patients with tuberculosis and human immunodeficiency virus infection, and group 3 included patients with tuberculosis and viral hepatitis. Anti-tuberculosis therapy was prescribed to all patients based on the spectrum of drug sensitivity of Mycobacterium tuberculosis, and when a human immunodeficiency virus infection was detected, antiretroviral therapy was prescribed during the first 2 weeks. Patients with viral hepatitis, if indicated, were prescribed hepatoprotective drugs. Control laboratory tests were conducted once every 2 months or more often in the presence of indications. Groups 1 and 2 were more likely to have multiple organ involvement and generalized forms, which determined the severity of the clinical course. In group 1, the activity of alanine aminotransferase and aspartate aminotransferase exceeded the normal limits upon hospital admission. Bilirubin levels were significantly higher in group 3 than in groups 1 and 2. The analysis of sonographic characteristics revealed increased size of the right liver lobe in all groups, without statistically significant differences between the groups. Adverse hepatotoxic reactions were reported in 5 (33.3%) patients of group 1, 4 (26.6%) of group 2, and 4 (30.7%) of group 3. The main manifestations of these reactions were pain in the right hypochondrium and increased activities of alanine aminotransferase and asparate aminotransferase. Patients with hepatotoxic reactions were prescribed hepatoprotective drugs, which made it possible to avoid the cancellation of complex etiotropic therapy