Deadly mix: TB, opportunistic infections and COVID-19 in advanced HIV patients

A team led by corresponding author Ivan V. Shashenkov set out to study how tuberculosis (TB), opportunistic respiratory infections (ORI) and COVID-19 act together in people with advanced HIV infection and immunodeficiency (ID). The researchers followed patients prospectively for two years to examine how these infections were diagnosed, how the illnesses progressed and what outcomes patients experienced. The study enrolled 58 people aged 26–56 and randomized them into two equal groups of 29. The first group contained patients with comorbidity of TB, ORI and COVID-19; these patients were described as being at the 4B stage of HIV infection in the progression phase and were not receiving antiretroviral therapy (absence of ART). The second group of 29 patients was selected by the "copy-pair" principle to match the first group in key characteristics but did not have COVID-19. The work focused on comparing course and outcomes between the two matched groups over the follow-up period, aiming to identify patterns in diagnosis, disease progression and final outcomes in this severely ill population.

The study was a prospective two-year follow-up with 58 patients randomized into two groups of 29. Group 1 included patients with TB, ORI and COVID-19 comorbidity; group 2 were matched patients without COVID-19. The researchers documented a pattern of marked immunodeficiency and generalization of tuberculosis among patients with the three-way comorbidity, noting multiple extrapulmonary manifestations. Drug resistance was frequent: levels of MDR and BDR exceeded 70%. When outcomes were compared, significant improvement occurred in 24.1% of patients in group 1 and 20.7% in group 2. Disease progression was observed in 31.0% of the first group and 41.4% of the second group. Death occurred in 41.3% of patients in group 1 and 37.9% in group 2. The study identified factors associated with progression and death: lack of treatment adherence, drug dependence, severe generalized TB and progression of ORI. These findings paint a stark picture of poor outcomes in this population during the study period.

The findings reported by Ivan V. Shashenkov and colleagues have clear implications for care of people with advanced HIV and coexisting infections. Patients who have TB, ORI and COVID-19 together in the late stages of HIV with immunodeficiency form a high-risk group for severe disease and death. The study highlights that, beyond clinical severity, social maladjustment and lack of adherence to examination and treatment contribute importantly to poor outcomes. The authors conclude that active and early examination of such patients is required. They stress the need to establish an etiological diagnosis quickly so that these patients can be urgently hospitalized in a specialized infectious diseases hospital for adequate, comprehensive treatment. In short, the work underscores both medical and social barriers that must be addressed to improve survival in this vulnerable group.