Clinic, laboratory and radiological features of urogenital tuberculosis in HIV-patients

This study aimed to identify the clinic, laboratory and radiological features of urogenital tuberculosis in HIV-patients (UGTB).
Methods. Retrospective descriptive study over a Jan 2012 – June 2018. All patients hospitalized for UGTB in the Moscow Research and Clinical Center for TB Control were included in the study. The study focused on 199 cases (> 18years of age). HIV-coinfection registered in 102 (51.2%) cases (I group), 97 (48.8%) patients were HIV-negative (II group).
Results. TB of renal parenchyma prevailed in the I group (62.8%) vs 12.4% in the II group. Polycavernous renal TB revealed in 6.9% HIV-coinfected patients vs 25.8% in HIV-negative, cavernous renal TB – in 2.9% and 13.4%, tuberculous papillitis – in 10.8% and 24.7% cases respectively (p < 0.05). Sectional study detected miliary renal TB in 5 (4.9%) patients of the I and in one (1.0%) of the II group. Isolated tuberculous epididymitis took place in 7.8% and 18.6% cases, prostate TB – in 3.9% and 4.1% respectively. Multispiral computed tomography (MSCT) revealed the signs of UGTB significantly less often in HIVpositive persons vs HIV-negative ones: cavities – in 11.7% vs 36.4%, hydronephrosis – in 10.6% vs 38.6%, ureteral strictures – in 5.3% vs 20.4%, pelvic wall thickening – in 8.5% vs 30.7%, ureteral wall thickening – in 12.8% vs 42.0%, bladder wall thickening – in 7.4% vs 21.6%, bladder scarring – in 4.2% vs 14.8% respectively (p < 0.05). MSCT recognized several (more than one) signs of UGTB significantly more often than excretory urography (EU): 123 (61.8%) vs 65 (32.0%) cases (p < 0.05). Pathological examination helped to confirm the diagnosis of UGTB twice rare in HIV-positive vs HIV-negative patients (24,5% vs 54,6%), contrariwise cultural methods identified M. tuberculosis 1,5 times more often (66,7% vs 40,2%, p < 0.05), molecular genetic methods – 2,5 times more often (79,4% vs 31,9%, p < 0.01).
Conclusion. Tissue destruction and scarring are less common for UGTB in HIV-positive patients vs HIV-negative. Bacteriology played the leading role in UGTB verification. Radiologic findings (urothelium thickening, cavities, ureteral strictures and microcyst) are identified better by MSCT vs EU.

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