Prevalência da tuberculose urogenital em pacientes portadores do vírus HIV

Abstract

Urogenital tuberculosis (UGT) affects the urinary tract in a sequential manner. Due to its difficult and delayed diagnosis, it can lead to the destruction of the urogenital tract and even terminal renal failure. Although it is a rare disease, it can affect up to 10% of HIV-infected patients. The study aimed to identify the prevalence of UGT in HIV-infected patients. A prevalence study of UGT was conducted in two groups of HIVinfected patients: a) those with suggestive symptoms of UGT; and b) hospitalized patients regardless of symptoms. The individuals underwent anamnesis to characterize urogenital symptoms and evaluate the status of HIV infection. Sedimentoscopia and traditional urine culture, urine culture for acid-fast bacilli on Löwenstein-Jensen (LJ) medium on 6 samples from different days, and PCR tests for tuberculosis in urine were performed. UGT was considered positive if culture or PCR results were positive. A total of 181 patients were evaluated, including 100 outpatients and 81 inpatients. Hospitalized patients showed more uncontrolled HIV infection, with a higher percentage of patients with detectable viral load and CD4 count below 200 cells/mm³. Only one patient with UGT was diagnosed, with a positive PCR result but negative urine culture in all six samples. This patient was a 40-year-old male with CD4 count below 200 cells/mm³, who was hospitalized and diagnosed with disseminated tuberculosis, including miliary pulmonary tuberculosis, intestinal tuberculosis, and UGT, without urological symptoms but with the presence of hematuria and sterile pyuria in the urine examination. Abdominal computed tomography showed bilateral nephromegaly. With only this case, the overall prevalence of UGT in HIV-infected patients was 0.55%. However, when considering other subgroups, the prevalence of UGT was 1.9% in patients with detectable viral load, 2.6% in patients with CD4 count below 200 cells/mm³, and 5.3% and 6.7% for hematuria and sterile pyuria, respectively. Only one other patient also had abnormalities in sedimentoscopia (hematuria or sterile pyuria) and CD4 count below 200 cells/mm³, which would characterize a prevalence of 50% for UGT. The prevalence of UGT in HIV-infected patients is low. However, disseminated tuberculosis associated with UGT can still be found in patients with uncontrolled HIV infection. The prevalence of UGT in patients with CD4 count below 200 cells/mm³ and abnormalities in urine analysis may be high, but it could not be characterized in this study due to the small number of individuals with these characteristics