Incidence of tuberculosis among HIV-positive persons in the Czech Republic between 2000 and 2020.

AIM: The aim is to characterize in more detail the group of HIV-positive persons in the Czech Republic diagnosed with tuberculosis (TB) in 2000-2020. MATERIAL AND METHODS: Data sources were mainly the national online TB register (RTBC), which is part of the information system of the Public Health Service, and the national electronic register of HIV-positive persons (RHIV) maintained by the National Reference Laboratory for HIV/AIDS of the National Institute of Public Health. RESULTS: Of 3,763 TB cases reported to the RHIV since 1985 and 16,212 TB cases reported to the RTBC since 2000, 91 occurred in 88 HIV-positive persons (69 males and 22 females) between 2000 and 2020. Sixty-five (74%) of the 88 HIV-positive persons were foreign born. Twenty-six per cent of TB cases were screened for HIV. The mean age of patients with TB/HIV coinfection was 35 years. The largest number of coinfected persons (35 cases) were from the capital city of Prague. Pulmonary TB was detected in 84 cases. Ninety-two per cent of the TB cases were bacteriologically confirmed, and 10 cases were multidrug-resistant TB. At the time of TB diagnosis, the median CD4+ lymphocyte count was 91.5 cells per mm3 of blood. TB was the most common reason for HIV testing in the analysed cohort (23 cases). The most common mode of HIV transmission was sexual intercourse (heterosexual in 39 cases and homosexual in 13 cases). Treatment success at 12-month follow-up was only recorded in 32% of cases of culture-positive pulmonary TB in HIV-positive patients. CONCLUSIONS: TB/HIV co-infection remains a serious health concern, especially in the foreign-born residents of the Czech Republic. Of foreign-born persons with TB, 42% were tested for HIV over the 21-year study period, with their percentage increasing over the years. Almost 6% of them tested HIV positive. The most relevant finding is that treatment success was only recorded for less than one third of HIV-positive persons with culture-positive pulmonary TB and that every fourth patient with TB/HIV died before or during TB treatment.

Immune status in patients with subclinical forms of genitourinary tuberculosis.

The study aim was to determine whether there is a correlation between subclinical forms of genitourinary tuberculosis (GUTB) and immune status. All patients admitted to the Pneumology Clinic of the Thomayer Hospital, Prague with lung tuberculosis (LTB) were enrolled in the study. The study group consisted of 102 patients, 75 males and 27 females, median age of 46.8 years. In a previously published part of the study, 6.9 % of LTB patients were diagnosed with subclinical forms of GUTB. In the present part of the study, immune status was determined in patients with subclinical forms of GUTB by measuring circulating immunoglobulin G and CD4 T cell levels. The comparison of the immunological results did not show a statistically significant difference between the patients diagnosed with GUTB and other LTB patients..

[How to continue in the treatment of tuberculosis in the Czech Republic?]. / Jak pokracovat v dalsím zdolávání tuberkulózy u nás?

BACKGROUND: The Czech Republic belongs to low TB burden countries in last years with incidence around 10/100,000. In such countries TB control consist in not only finding and effective treatment of new TB cases but in identification and containment of pool for new TB cases (latent or subclinical TB infection-LTBI) as well. Recently amended recommendations for TB control in other low TB burden countries, US and England and Wales, were published. The objective of the paper was to determine which of the amended recommendations could be used in our country. METHODS AND RESULTS: In England and Wales the BCG vaccination is recommended only in newborns from families with higher TB risk. In these groups it is necessary to seek out new TB cases as well. In TB diagnostic, emphasis is now placed in England and Wales and also in the US on the use of several diagnostic methods. Drug use self check is more appropriate in all health responsible patients. Liquid drug forms or fixed-dose combination tablets are recommended as well. In both above mentioned countries the LTBI diagnostic is done either by tuberculin skin tests (TST) or by in vitro immunological IGRA tests. In England and Wales positive TST is followed by IGRA test, in the U.S. either TST or IGRA test is recommended. LTBI persons are preventively treated. CONCLUSIONS: In the Czech Republic the introduction of IGRA tests for LTBI diagnostic should have, due to the BCG policy, even higher benefit. Introduction of IGRA tests seems to be inevitable. Persons with supposed LTBI should be offered either preventive treatment or intensive follow up care with the objective to detect early even incipient signs of TB. As TB develops most often soon after LTBI conception this follow up care should last several years after LTBI detection.