Clinical features of chronic obstructive pulmonary disease in patients with pulmonary tuberculosis and HIV infection

Aim. To conduct a comparative assessment of clinical, functional and laboratory parameters in patients with COPD and pulmonary tuberculosis with and without HIV infection. Methods . 160 patients with COPD and pulmonary tuberculosis were examined, including 80 with HIV infection and 80 without HIV infection. The patients were hospitalized in the State Budgetary Healthcare Institution “City Anti-Tuberculosis Dispensary” (Saint Petersburg). The clinical symptoms (shortness of breath according to the mMRC, CAT), laboratory parameters, the viral load (the number of virus copies and CD4 cells in 1 ml of blood and as a percentage of lymphocytes) and the lung function were assessed. Results . All examined patients had severe COPD with 2 or more exacerbations per year. More than 90% of the patients were current or former smokers. The HIV-positive patients with COPD and tuberculosis were younger than the HIV-negative (the mean age was 44 (41; 48) years versus 53 (45; 63) years, p < 0.001). The body mass index in the HIV-negative patients was higher than in the HIV-positive (22.15 (19.85; 25.13) kg/m 2 vs 21.2 (19.3; 22.95) kg/m 2 , p = 0.050). The HIV-positive patients with low viral load (40 copies/ml and below) statistically significantly differed from the HIV-positive patients with high viral load (above 40 copies/ml) in the CD4 cell count (p < 0.001). Both the “younger” (aged 50 years or less) and “older” (aged over 50 years) HIV-positive patients with COPD and tuberculosis had more severe dyspnea compared to the HIV-negative patients (p < 0.001). COPD symptoms according to the CAT test were more severe in both “younger” and “older” HIV-positive patients (p < 0.001), and the score was higher in the HIV-positive patients compared to the HIV-negative patients (p < 0.05). The severity of COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria was significantly higher in both “younger” and “older” HIV-positive patients compared to the HIVnegative patients (p < 0.05). Conclusion. Patients with COPD, tuberculosis, and HIV infection have decreased body weight, more pronounced dyspnea and symptoms of COPD and obstructive pulmonary ventilation disorders compared to the patients without HIV infection.