UNTIMELY FOUND TB CASES AND CAUSES OF DEATH AMONG PATIENTS INFECTED WITH HIV/TB AND WITH TB ALONE IN THE LENINGRAD REGION
HIV infection and tuberculosis (TB) are related pathogenetically, epidemiologically and clinically and affect the same vulnerable social groups of population in Russia. In order to evaluate the demographic, social, epidemiological, and clinical characteristics of TB and to determine the main causes of death among persons infected with HIV/TB and with TB alone, 89 medical records of patients who died at an antituberculosis hospital in Leningrad Region (Russia) in 2006-2008 were analyzed retrospectively. The patients were divided into two groups: HIV/TB co-infected persons (the first group) and TB patients without HIV (the second group). HIV/TB co-infected individuals were younger than persons with TB alone. Almost all of the patients were men, were unemployed and suffered from alcoholism; however, injecting drug users were more prevalent in the first than in the second group (83% versus 12%). TB cases were found mostly incidentally and rated mainly as new cases. Generalized TB was the main clinical form in the HIV/TB co-infected persons (52%); whereas lung dissemination and infiltration were predominantly found in TB patients without HIV (38% and 27% respectively). However, destructive pulmonary tuberculosis occurred less often in the first group than in the second one (57% versus 88%), which is especially true for chronic fibro-cavernous tuberculosis (5% versus 35%). Mycobacterium tuberculosis (MT) detection rate was high in both groups. The occurrence of drug- resistant MT was higher in the first than in the second group (81% versus 65%), but MDR TB rates showed no difference between the groups (43% and 40% respectively). The time interval between HIV diagnosis and active TB development was 6 to 7 years (33,3% of cases); however, HIV was detected in about 1/4 of patients within 30 days before TB diagnosis. The leading cause of death among HIV/TB co-infected individuals was generalized TB (52%). Patients with TB alone also died mostly because of tuberculosis (81%), but there was no generalization of the infection. To reduce death rates in HIV/TB co-infected patients, it is expedient to promote social support to them and to improve TB screening and prevention