Early manifestations of vascular lesions of the retina in common forms of TB in the late stages of HIV

Background: Tuberculosis (TB) and HIV, especially in the later stages, can be accompanied by changes in microvessels. Aims and objectives: To study the state of retinal microvessels in patients with TB and HIV/TB using optical coherence tomography (OCT). Methods: Prospective clinical study of patients of both sexes, 25-35 years old with pulmonary and extrapulmonary TB and HIV/TB, receiving continuous TB chemotherapy (CT) 9 - 18 months. Patient groups: 1-N50 with HIV and TB, CD 4+ 200 - 400 in μl, viral load up to 5000, receiving ART (3 drugs) for no more than 2 years; group 2-N35 with TB. OCT Ivue-100, USA; the state of the vessels of the retina and the chorioretinal complex using the technology of linear scan and the calculation of the arteriovenous coefficient - the ratio of the diameter of the artery and vein (AVK) was assessed for six months. Statistics nonparametric tests Pearson χ2. Results: Diameter of the retinal vessels, its thickness in the macular zone, as well as the AVK make it possible to diagnose the pre-degenerative stage of angioretinopathy and the risks of developing clinically pronounced retinal pathology with loss of visual functions. Changes are more pronounced in HIV/TB patients compared with TB patients. Conclusions: Retinal vascular changes in HIV/TB patients reflect early manifestations of systemic angiopathy, probably as a result of infection activity, as well as complications of ART and CT. For the first time, a set of diagnostic criteria for preclinical signs of lesions of the chorioretinal complex in patients with TB and HIV/TB, which are not detected by standard ophthalmological examination, has been determined.