Coordinator: Kézdi- Zaharia E. Iringó First author: Magyar Júlia Coauthor: Gyerő Réka

 The acquired immunodeficiency syndrome (AIDS) is the consequence of the Human immunodeficiency virus (HIV) infection, a condition in which progressive failure of the immune system allows life- threatening opportunistic infections and cancers to thrive.  HIV1 and HIV2 are retroviruses, belonging to the lentiviruse subfamily. In Romania and eastern Europe the HIV1 type is dominating.

 In Romania, the first AIDS case in adults has been diagnosed in  By the end of 1998 there were 801 adults and 5288 children with AIDS. 688 adults and 3381 children were asymptomatic HIV seropositive.  60% of the children with AIDS in Europe were romanian. Most of this infections acquired nosocomial.

 In developing countries TB is the most common life- threatening opportunistic infection in patients with HIV/AIDS.  About % patients with HIV/AIDS have tuberculosis of any organ.  By the end of 2000, about 11.5 million people were co-infected with HIV and M. tuberculosis, globally.  TB accounts for about 13% of all HIV related deaths worldwide.

 This co-infection it’s a bidirectional interaction. HIV infection is the strongest of all known risk factors for the development of TB. HIV infected persons are at increased risk for progressive disease following primary TB infection, as well as reactivation of latent tuberculosis infection.  Th1 type immune response characterised by adequate cell-mediated immunity is the crucial host defence against M.tuberculosis. HIV infection primarily affects those components of host immune response responsible for cell-mediated immunity.

 Diagnosis of TB in HIV-infected pateints is often difficult due to several reasons: frequently negative sputum smears, atypical radiographic findings, higher prevalence of extrapulmonary TB, resemblance to other opportunistic pulmonary infections.  Invasive diagnostic procedures are often required to establish the diagnosis.  Attempts should be directed towards arriving at a bacteriological diagnosis, since multiple pathogens often coexists, and it is not possible to distinguish from atypical mycobacterial infections based on clinical and radiological findings alone.

 A retrospective study was performed, which included all the HIV infected patients admitted in Infectious Disease Hospital nr.1 between The patients were divided in two groups: patients with HIV infecton and patients with HIV an TB co-infection.

 During the studied period 24 HIV and TB co- infected patients were admitted. 5 of this patients were readmitted more then 4 times (a total of 45 admissions).  196 patients with HIV infection were admitted. We chosed randomly 24 patients from this group.

 HIV and TB co-infected patients spent in hospital a total of 467 days, in average 19 days.  HIV infected patients were in hospital a total of 273 days, in average 11 days.

 HIV and TB co-infected patients cost of treatment was in average 10446,23 ron.  HIV infected patients cost of treatment was in average 6282,25 ron.

 The CD4 level is significantly lower in patients with HIV and TB co-infection.  In average, a HIV- TB co-infected patients CD4 level is 275 and HIV infected patients CD4 level is 337.

 16% of the patients infected with HIV are in stage B2, and 54% are in stage C3.

 Only 8% of the HIV-TB co-infected patients are in stage B2 and 75% of them are in stage C3.

 75% of patients (both groups) are under the age of 30.  38% of patients got infected when they were under the age of 10.  66% of the patients got infected when they were under the age of 18.  33% of the patients got infected over the age of 18.

 3 patients with HIV and TB co-infection died in the hospital during the studied period.  1 patient with HIV infection (from the control group) died during the studied period.

 The treatment of HIV infected patients is 35% cheaper and they spent 42% less days in hospital.  The mortality of HIV and TB co-infected patients is comparatively higher than the HIV infected patients, or HIV negativ TB patients.  The mortality depends upon the type of diseas and the degree of underlying immunosupression.

 Other opportunistic infedtions which often go undiagnosed are a common cause of death in patients with HIV-TB co-infection, especially those dying later during antituberculosis treatment.  Earlier studies from Europe have documented a median survival of 22 to 24months in HIV infected patients with TB.

 Treatment of HIV-TB co-infection requires strong commitment and a focused approach.  Appropiate use of HAART to preserv immunity and treat HIV infection, ensuring high levels of coverage and compliance is required to prevent TB.  A strong coordination between the national TB and the AIDS control programmes is required for effective management of HIV-TB co-infected patients.