Investigation of invasive fungal infection in tuberculosis/human immunodeficiency virus co-infected patients

Tuberculosis (TB) and human immunodeficiency virus (HIV) represent important public health problems. Suppression of the immune system, due to both diseases, predisposes to the development of opportunistic infections, such as invasive fungal infections (IFI). The aims of this study were to determine the frequency of investigation of IFI in TB/HIV co-infected patients, identify the most frequent IFI and evaluate the clinical-epidemiological characteristics of TB/HIV/IFI patients. A descriptive and retrospective study was conducted including patients assisted at Hospital Dr. Miguel Riet Corrêa Jr. (HU-FURG/Ebserh), in Rio Grande City, southern Brazil. All patients diagnosed with TB/HIV from 2017 to 2022 were included, and databases were analyzed for data regarding mycological exams for fungal disease investigation. Of the 194 TB/HIV co-infected patients, 77.8% (n = 151) were investigated for at least one IFI. Co-infection was confirmed in 13.9% (21/151), being 52.4% (n = 11) of the patients diagnosed with cryptococcosis, followed by histoplasmosis (47.6%; n = 10) and probable invasive aspergillosis (IA) (9.6%; n = 2). Furthermore, some patients presented more than one fungal co-infection (9.5%; n = 2). CD4 T cell count < 200 cells/mm3 represented a risk factor for the development of IFI (P = 0.006) and the outcome death was higher in the TB/HIV/IFI group, as well as 38% of patients died. Even without a systematic investigation for IFI in TB/HIV patients, a high rate of co-infection was shown. Therefore, it is necessary to investigate TB and IFI concomitantly, in people living with HIV, due to the worsening of the outcome when these infections are associated.