Clinical Variants and Outcomes of Respiratory Tuberculosis Detected by Different Routes in HIV-Positive Patients

The objective: to assess the impact of detection routes (active screening and self-referral) on clinical characteristics and outcomes of respiratory tuberculosis (RTB) in HIV-positive patients. Subjects and Methods. A continuous cohort retrospective study was conducted. Continuous sampling was used to include 446 tuberculosis patients aged 18 years and older, detected in the general medical services (GMS) from 2017 to 2024. Patients were divided into 2 groups: TB+HIV Group included 150 patients with TB/HIV co-infection, while TB Group consisted of 296 HIV-negative tuberculosis patients. Results. It was found out that in HIV-positive patients, the probability of detecting respiratory tuberculosis by self-presentation to a medical unit exceeded that with active screening (OR=2.8). During preventive screening of HIV-positive patients, limited, uncomplicated and anatomically reversible forms of respiratory tuberculosis were predominantly (78%) detected; clinical cure was achieved in 78.4% of cases. In the patients diagnosed with respiratory tuberculosis by self-referral to outpatient units, disseminated and/or complicated forms in combination with extrathoracic localizations were detected in 73.2% of cases. When respiratory tuberculosis was detected upon admission to hospital, in 62.5% of cases, generalized, anatomically irreversible acutely progressive or chronic forms with a high vital threat were foun. The ratio of cured patients to deceased ones was 1:1 when detecting tuberculosis by visits to outpatient units and it was 1:2 when the patient was taken to hospital. In HIV-positive patients, the chances of a fatal outcome within three or more years when respiratory tuberculosis was detected by active screening is 3.3 times lower versus self-referral to outpatient units and 6.4 times lower versus inpatient treatment.