Somatic comorbidity in patients with HIV-associated tuberculosis: focus on gastrointestinal diseases

Background: Somatic diseases, HIV infection, and tuberculosis have a mutually aggravating effect, aggravating the condition of patients to varying degrees.

Objective: Assessment of the impact of gastrointestinal pathology on the risk of developing tuberculosis in HIV-infected patients living in rural areas, determining the likelihood of developing the disease depending on the nosological entities.

Materials and methods: The incidence of gastrointestinal pathology was retrospectively studied at the Omsk Central District Hospital among 593 patients with HIV infection and 85 patients with HIV infection and newly diagnosed tuberculosis (TB). Statistical analysis was performed using Microsoft Excel 2003 and Statistica 10.0. The odds ratio method was used to calculate the risk of developing tuberculosis.

Results: The incidence of somatic pathology in patients with HIV infection and TB was 2.5 times higher than in patients without TB. A similar trend was observed for gastrointestinal diseases (21.1% and 10%, respectively). The odds ratio for developing TB in HIV-infected patients with gastrointestinal disease was almost three times higher than the odds ratio for developing TB in HIV-infected patients without gastrointestinal disease (OR 2.9, CI 1.6–5.23; p<0.001).

Peptic ulcer disease was detected in 5.8% of patients in the HIV-infected group without TB and in 16.6% of those with HIV and TB. The OR for developing TB in HIV-infected patients with peptic ulcer disease was 21.6 (CI 2.2–210.6), with chronic gastritis – 2.4 (CI 1.2–4.9), and with chronic pancreatitis – 1.7 (CI 0.4–6.4).

Conclusion: Gastrointestinal pathology is significantly more common in patients with HIV infection and tuberculosis than in HIV patients without tuberculosis, significantly increasing the likelihood of developing tuberculosis infection. Patients with gastric or duodenal ulcers are at the highest risk of developing tuberculosis.