Investigation of invasive fungal infection in tuberculosis/hiv coinfected patients

Abstract 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 frequence of investigation of invasive fungal infection (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 diseases investigation. Of the 194 TB/HIV coinfected patients, 77.8% (n = 151) were investigated for at least one IFI. Co-infection was confirmed in16.7% (25/151), being 44% (n = 11) of the patients diagnosed with cryptococcosis, followed by histoplasmosis (40%; n = 10) and colonization/infection by Aspergillus (32%; n = 8). Furthermore, some patients presented more than one fungal co-infection (16%; n = 4). CD4 T cell count < 200 cells/mm3 represented a risk factor for the development of IFI (P = 0.022) and the unfavorable outcome (interruption/death) was higher in the TB/HIV/IFI group, as well as 32% of patients died. Even without a sistematic 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.