OPPORTUNITIES OF IMMUNODIAGNOSTICS OF TUBERCULOSIS IN THE PATIENTS AT ADVANCED STAGES OF HIV INFECTION

Abstract

The significance of lipoarabinomannan (LAM) level in blood serum for the confirmation of tuberculosis was analyzed in 106 patients at the advanced stages of HIV infection. In 63 of 106 (59.4%) persons tuberculosis was diagnosed based on clinical signs. Patients with co-infection (HIV/TB) had confidently higher level of LAM in their blood serum versus HIV patients (13.75 ± 1.5 pg/ml; CI ± 2.97 and 7.49 ± 0.5 pg/ml; CI ± 0.96, respectively; Р = 0.000163). In general, sensitivity of the test of LAM level in blood serum of HIV patients made 85.7%, and specificity made 79.1%. It was found out that in TB/HIV patients, LAM level in blood serum was not influenced by such factors as extent of tuberculous lesions in respiratory organs (a positive result of LAM test in case of disseminated and local respiratory lesions was in 86% (37/43) and 85% of cases (17/20) respectively) and bacillary excretion (a positive result of LAM test in case of bacillary excretion and without was in 89.2% (33/37) and 76.9% (20/26) of cases respectively). The part of positive results when performing LAM test was in 87.5% of cases (54/63), while results of skin test with tuberculous recombinant allergen were positive only in 14.4% (9/63). The presented results allow concluding than it would be sensible to test LAM level in blood serum in the patients at the advanced stage of HIV infection. The informativeness of LAM test increases depending as the immune deficiency progresses and it becomes a valuable diagnostic tool at the level of CD4 < 200 cells per mcl.

Keywords

• туберкулез
• вич-инфекция
• иммунодиагностика
• липоарабиноманнан