Specifics of surgical treatment of patients with limited pulmonary tuberculosis depending on their HIV-status

BACKGROUND: Pulmonary tuberculosis presents a serious problem in HIV-infected patients, as it often progresses to severe forms and increases the risk of death. Surgical treatment of this category of patients is difficult because of a high risk of complications associated with immunodeficiency and specifics of the course of tuberculosis. AIM: To analyze the features of surgical treatment of patients with limited pulmonary tuberculosis (LPT) depending on their HIV-status. METHODS: The study included 62 patients with LPT, divided into two groups: HIV-infected (main group; n = 27 individuals, CD4 level 200 cells/μl) and HIV-negative (comparison group; n = 35). In both groups, men predominated: 55.6% (15/27) in the main group and 62.8% (22/35) in the comparison group. The mean age in the groups was 39.2 ± 0.9 and 40.3 ± 1.1 years respectively (p 0.05). The groups were comparable in the duration of anti-tuberculosis therapy; in both groups, the majority of patients had a history of anti-tuberculosis treatment for 2 years or more. Only in 11.1% (3/27) of cases in the main group and in 14.3% (5/35) in the comparison group, the surgical stage of treatment was performed during the first year of anti-tuberculosis chemotherapy. RESULTS: HIV-infected patients more often presented with prominent fibrous alterations in the lung tissue and lymph nodes, which created technical difficulties during surgery and increased the risk of intraoperative complications (33.3% versus 11.4% in HIV-negative patients, p 0.05). A tendency to a higher incidence of postoperative complications was recorded in HIV-infected patients with LPT (22.2% versus 8.6%, p 0.05). The effectiveness of surgical treatment was comparable in both groups (92.6% in HIV-infected and 97.1% in HIV-negative, p 0.05). CONCLUSION: HIV-infection in patients with LPT is a risk factor for the development of intra- and postoperative complications. Surgical treatment of this category of patients requires particular care and attention to potential difficulties conditioned by specifics of the course of the disease.