Endoscopic features of respiratory tract lesions in chronic obstructive pulmonary disease, pulmonary tuberculosis and HIV infection: a comparative analysis

Abstract. Introduction. Chronic obstructive pulmonary disease (COPD) characterized by chronic, persistent, and irreversible airflow limitation, represents a significant global health challenge. Chronic respiratory symptoms, structural lung changes detected via imaging, and decreased lung function are observed in 30–50% of patients with tuberculosis. This disease remains a leading cause of mortality among HIV-infected individuals. In clinical practice, bronchoscopy is widely used as a diagnostic tool and for identifying pulmonary pathogens in patients with respiratory diseases. Cellular patterns in bronchoalveolar lavage (BAL) reflect immune processes and the condition of the airways. Aim. To conduct a comparative analysis of the endoscopic findings and bronchoalveolar lavage results in patients with COPD and pulmonary tuberculosis, both HIV-infected and non-infected. Materials and Methods. The study included 160 patients with COPD and pulmonary tuberculosis, of whom 80 were HIV-positive, and 80 were HIV-negative. Patients were hospitalized at the State Institution “City Tuberculosis Dispensary” (St. Petersburg). Bronchoscopy with BAL sampling for cytology was performed, along with an assessment of the severity of endobronchitis and bronchial scarring. Results and Discussion. Among the analyzed indicators, neutropenia in BAL was observed more frequently in HIV-positive patients compared to HIV-negative ones: 79 [59.5; 89.78]% versus 85.5 [68.75; 92.28]% (p=0.038), respectively. No significant differences were found between the groups in terms of eosinophil, lymphocyte, and macrophage counts (p>0.05). HIV-positive patients with COPD and tuberculosis had more severe endobronchitis compared to HIV-negative patients: grade II was detected in 53 patients (66% (95% CI 55–76%)) versus 37 patients (46% (95% CI 36–57%)) (p=0.001). HIV-positive patients exhibited less frequent scarring compared to HIV-negative patients: 43 patients (54% (95% CI 42–65%)) versus 28 patients (35% (95% CI 25–47%)) (p=0.026). Additionally, among HIV-positive patients with low viral loads receiving antiretroviral therapy (ART), scarring was less common compared to those with high viral loads not receiving ART: 24 (67% (95% CI 49–81%)) versus 19 (43% (95% CI 29–59%)) (p=0.044). Conclusions. HIV-infected patients with COPD and tuberculosis exhibit reduced neutrophil counts in BAL, more pronounced bronchial scarring, and more severe endobronchitis on bronchoscopy compared to HIV-negative patients.