IRON METABOLISM IN DISSEMINATED PULMONARY TUBERCULOSIS AND PNEUMOCYSTIS PNEUMONIA IN PATIENTS WITH HIV INFECTION

Abstract

Introduction. The main disease that complicates HIV is Pneumocystis pneumonia. It often requires differential diagnosis with tuberculosis. Aim. The aim of the study was to conduct a comparative analysis of the clinical features and main indicators of iron metabolism in HIV infection with disseminated pulmonary tuberculosis and Pneumocystis pneumonia and to identify potential differential diagnostic markers of tuberculosis. Material and methods. The study included two groups of patients with HIV infection: 42 patients with disseminated pulmonary tuberculosis and 44 patients with Pneumocystis pneumonia. The clinical and laboratory data was carried out, the main indicators of iron metabolism were determined: iron concentration, hepcidin, ferritin. Statistical data processing was performed using the MedCalc 19.2.6 statistical software. Results and discussions. In the group of patients with Pneumocystis pneumonia, the proportion of patients with a severe condition is greater, the level of CD4-lymphocytes is significantly lower - 5 times less than in tuberculosis (p <0.001). Statistically significant differences between the groups were found for hepcidin and serum. The median for hepcidin is 1.4 times higher in group 1 than in group 2 (p <0.001), for serum - 1.5 times less in group 1 than in group 2 (р<0,001). In patients with HIV and pulmonary dissemination, a higher probability of tuberculosis was revealed with hepcidin more than 13810 pg/ml (sensitivity 80.95%, specificity 75%, ROC AUC 0.854) and with an iron concentration less than 10 μmol / L (sensitivity 85.7%, specificity 59.1%, ROC AUC 0.733). Conclusion. When examining patients with HIV infection and pulmonary dissemination syndrome who have a common anamnesis, clinical and radiological, laboratory data and a high degree of suspicion of tuberculosis, it was established by the analysis of ROC curves that the peptide hormone hepcidin has the greatest practical value for its further comprehensive study as a potential and a promising marker for the diagnosis of tuberculosis.