Diagnostic thoracoscopic methods of respiratory system diseases in patients with HIV infection

Introduction. In the absence of non-invasive methods morphological verification is required to establish a diagnosis of diseases of pulmonary system. The most importance is the early diagnostic HIV-infected patients. The aim of this work is to study the results and safety of surgical diagnostics of patients with undifferentiated pulmonary and intrapleural processes not diagnosed with traditional examination methods. Materials and methods. In the period 2014-2019, 404 diagnostic thoracic interventions were performed at the Clinic 2 of Moscow Research and Clinical Center for Tuberculosis Control to verify the diagnosis, 111 of them were HIV-infected. Results. Tuberous tumor-like rashes on parietal pleura were in 69.4% of patients with pleurisy during thoracoscopy. In 65% of cases of histological examination verified the formation of classical granulomas. Acid-fast bacilum were identified in 48%. DNA of tuberculosis mycobacteria in altered pleura was found in 84%. Resistance to rifampicin was found in 23.5% of patients. In six cases patients without HIV defined pleural mesothelioma. In the group of lung resection 40% of patients confirmed pulmonary tuberculosis, 15.7% of patients had benign lung tumors, 20.2% of patients had malignant lung tumors, 23.8% had rare and atypical pathological pulmonary processes. Conclusion. Surgical diagnostic methods of pulmonary and pleura diseases is safe, effective and does not lead to a significant number of complications and mortality among patients with HIV infection, regardless of the initial immune status. The low detection of the pathogen in the exudate allows considering thoracoscopy biopsy to be the only reliable diagnostic method for pleurisy which also has a medical character. Using the T-SPOT®.TB test system of pleural fluid increases the clinical sensitivity to 91.3% compared with the analysis of peripheral blood (83.7%).