The effectiveness of immunoglobulin G application in patients with drug­-resistant tuberculosis/HIV with CD4+ lymphocytes from 200 to 50 cells/µl according to biochemical data

Abstract

Objective — to study the effectiveness of immunoglobulin therapy in patients with co-infection of drug-resistant tuberculosis (DR-TB)/HIV at the level of CD4+ lymphocytes from 200 to 50 cells/μl, based on a study of the dynamics of biochemical parameters. Materials and methods. The study involved 52 patients aged 20 to 55 years, with a mean age of (37.2 ± 7.8) years. All patients were HIV-positive with laboratory-confirmed DR-TB with mycobacterial resistance to first- and second-line drugs. Patients with DR-TB/HIV were distributed as follows: 1 group (control) — 26 patients with DR-TB/HIV, receiving standard treatment of second-line AMBP and ARVT; group 2 (main) — 26 patients with DR-TB/HIV, who also received standard treat­ment of second-line AMBP and ARVT, with the addition of complex therapy with intravenous immunoglobulin G (IgG). Results and discussion. Against the background of treatment, the dynamics of changes in biochemical parameters was as follows: patients in the control group, after the first 2 weeks of AMBP, there was an increase in intoxication load on the hepatobiliary and urinary systems, which led, on the one hand, to dysfunction liver with hyperbilirubinemia, increased transaminase activity, thymol turbidity, and on the other — to the development of renal failure with hypercreatininemia, hyperuricemia, azotemia and oliguria. As a result, timely appointment of ARVT (2 weeks after AMBP) in 19 (73.1 %) patients was impossible and was carried out much later than desired (after 2—3 months).Treatment of patients with comorbid pathology of DR-TB/HIV, which included complex intravenous IgG on the background of complex therapy, was accompanied by positive clinical and laboratory dynamics, which created conditions for ARVT involvement after the second week of complex therapy according to the developed treatment method. Conclusions. The use of immunologically targeted treatment with intravenous IgG made it possible to successfully prescribe ARVT to patients of the main group in 2 weeks from the start of AMBT, which is very useful to prevent adverse reactions, increase treatment efficacy and reduce mortality in patients with comorbid DR-TB/HIV in a state of deep immunosuppression.