Molecular and genetic features of pathogens in patients with unfavorable course of tuberculosis and HIV infection

Objective. To study molecular and genetic features of M. tuberculosis (MTB) and human immunodeficiency virus (HIV) in patients with unfavorable course of HIV infection and tuberculosis. Materials and Methods. A total of 105 patients with HIV infection and newly diagnosed tuberculosis in whom tuberculosis was confirmed by microbiological and molecular genetic methods were included. The follow-up period was at least 6 months. Based on the results of the examination during treatment, all patients were divided into two groups: group 1 – patients with favorable course of HIV infection and tuberculosis (n = 78), group 2 – patients with unfavorable course of HIV infection and tuberculosis (n = 27). The study analyzed molecular and genetic features of HIV and MTB in patients with unfavorable/favorable course of HIV infection and tuberculosis. Results. In patients with an unfavorable course of HIV infection and tuberculosis (group 2), the frequency of detection of drug resistance mutations in the DNA of MTB was higher and the number of drugs to which mutations were present was greater than in patients with a favorable course of HIV infection and tuberculosis (group 1) (p = 0.030 and 0.019, respectively). The spectrum of drug resistance mutations was more diverse. Also, mutations of drug resistance to antiretroviral drugs (p = 0.042) were detected more often in HIV in group 2 patients, including to antiretroviral drugs of the non-nucleoside reverse transcriptase inhibitors and protease inhibitors classes, which pose high risk of antiretroviral therapy failure. Conclusions. In patients with HIV/TB unfavorable course, both MTB and HIV studies are required to identify mutations of drug resistance and prescribe treatment regimens based on the resistance profile. The optimal solution is to determine resistance profile before starting HIV/TB treatment, which requires a powerful laboratory base.