Alterations of phospholipid fractions in patients with HIV/tuberculosis coinfection under different treatment regimens

BACKGROUND: Alterations in phospholipid fraction balance represent one of the mechanisms underlying lipid metabolism disorders in HIV infection. AIM: To investigate the dynamics of phospholipid fractions in patients with HIV/tuberculosis coinfection undergoing monotherapy with antitubercular agents versus combined antiretroviral and anti-tuberculosis therapy. MATERIAL AND METHODS: A comparative study of phospholipid fractions (sphingomyelin, phosphatidylcholine, lysophospholipids, phosphatidylethanolamine) was conducted using chromatography in two groups of patients with HIV-associated tuberculosis: Group 1 (100 patients) received tuberculosis chemotherapy (isoniazid, rifampicin, pyrazinamide, ethambutol), while Group 2 (100 patients) received antiretroviral therapy (tenofovir, lamivudine, efavirenz) alongside treatment with antitubercular agents. The control group consisted of 50 healthy individuals. CD4 lymphocyte counts and HIV RNA viral load were measured in all patients. Assessments were performed before treatment initiation and after 1 and 2 months of therapy. Statistical analysis was conducted using parametric methods, with differences considered significant at p 0.05. RESULTS: Before treatment initiation, both groups of patients with HIV/tuberculosis coinfection had higher levels of sphingomyelin, lysophospholipids, and phosphatidylcholine compared to healthy individuals (p=0.001). In Group 1, receiving only anti-tuberculosis therapy, levels of sphingomyelin, lysophospholipids, and phosphatidylcholine significantly increased (p=0.001), with no change in the number of patients exhibiting bacterial shedding. In Group 2, after one month of antiretroviral therapy combined with anti-tuberculosis treatment, levels of sphingomyelin, lysophospholipids, and phosphatidylcholine decreased below those of the control group (p=0.001). A significant reduction in patients with bacterial shedding was observed (from 100% to 18%, p=0.001). CONCLUSION: In the group of patients receiving combined antiretroviral and anti-tuberculosis therapy, a reduction in sphingomyelin and lysophospholipid levels was observed, along with a decrease in the number of patients exhibiting bacterial shedding.