Tuberculosis in new cases: the impact of HIV status on clinical manifestations

Abstract

Introduction. Tuberculosis continues to be the primary cause of death among individuals living with human immunodeficiency virus, with co-infection significantly influencing the clinical course, severity, and outcomes of the disease. Although the interaction between the two conditions is well recognized, regional data from Eastern Europe remain insufficient. Material and methods. A retrospective, cross-sectional comparative study was carried out in the Republic of Moldova in 2021. A total of 320 patients with newly diagnosed pulmonary tuberculosis were included and divided into two matched groups: the study group consisted of 160 patients with confirmed human immunodeficiency virus co-infection, and the control group included 160 patients without human immunodeficiency virus infection. The groups were comparable in terms of age, sex, residence, and resistance profile of Mycobacterium tuberculosis. Data were collected from national clinical records and analyzed using descriptive statistical methods. Results. Among 320 patients, those with HIV co-infection had significantly higher rates of generalized TB (28.8% vs. 2.5%; p < 0.0001), subacute onset (71.9% vs. 22.5%; p < 0.0001), and severe/very severe condition at diagnosis (27.4% vs. 10.6%; p = 0.0017). Anemia (58.8% vs. 23.1%; OR = 4.73, p < 0.0001), leukopenia (16.3% vs. 1.3%; OR = 15.33, p < 0.0001), and ESR >60 mm/h (25.0% vs. 5.6%; OR = 5.59, p < 0.0001) were significantly more common in co-infected patients. Bilateral lung lesions were more frequent (65.6% vs. 59.4%), while cavitary destruction predominated in TB-only patients (59.4% vs. 34.4%; p < 0.0001). Smear positivity was lower in the HIV group (38.8% vs. 55.0%; p = 0.0036). Complications (48.1% vs. 20.6%; p < 0.0001) and opportunistic infections (17.5% vs. 0%) were more prevalent in co-infected patients. Mortality was significantly higher among HIV-positive cases (28.1% vs. 6.9%; OR = 5.20, p < 0.0001). Conclusions. Human immunodeficiency virus infection significantly modifies the clinical presentation of tuberculosis, favoring more severe, atypical, and extrapulmonary forms, along with higher complication rates and mortality. These findings highlight the urgent need for early diagnosis, adapted diagnostic approaches, and integrated treatment strategies in patients with dual infection, particularly in high-burden settings.