[The clinical and morphological features of the course of tuberculosis in HIV infection].

The development of an acutely progressing process of varying extent to the point of total damage to both lungs is typical of a patient with tuberculosis concurrent with HIV infection due to progressive immunodeficiency. There is an apparent need for dividing patients with comorbidity into 2 groups: (1) HIV/TB, in patients HIV infection is a primary disease; (2) TB/HIV, in whom tuberculosis is accordingly primary. These groups differ in clinical manifestations, forms of tuberculosis, and pathomorphological changes. Group 1 patients are mostly typified by the primary forms of tuberculosis with involvement of lymph nodes of all groups and by miliary processes at the sites of multiple organs (the lung, abdomen, and central nervous system). Most patients from Group 1 are observed to have fever, progressive intoxication, and morphologically necrotic foci without signs of differentiation and in the absence of typical granulomas. Multiple drug resistance is noted in more than 20% of the patients; in these patients, the efficiency of an intensive therapy phase in arresting bacterial discharge is 26.9%. In Group 2 patients, comorbidity takes a less acute course, pulmonary symptoms are less marked; there is a preponderance of infiltrative, disseminated, firocavernous pulmonary tuberculosis, and caseous pneumonia. In this group, the signs of a prior tuberculous process with phenomena of a slight or moderate productive reaction and with resolution elements are morphologically detectable. In late-stage HIV infection--AIDS, the patients from both groups develop a generalized tuerculous process. Both patient groups are typified by the severe progressive course with identical clinical and pathomorphological manifestations, which results in death.