Ministry of education and science of Ukraine 
V.N. Karazin Kharkiv National University 

 
 
 
 
 
 
 
 
 
 
 
 
 
 

MANAGING PATIENTS WITH  
TUBERCULOSIS AND HIV INFECTION 

 
Methodical recommendations  

for self-study for practical classes of students of higher medical education  
of the 5th year of study in the discipline "Phthisiology" 

 
 
 

Electronic resource 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Kharkiv – 2024  



УДК 616-002.5+616.98:578.828ВІЛ](072) 
М 24 

 
 
Reviewers: 

A.V. Rogozhyn – PhD, Associate Professor of the Department of Infectious Diseases, 
Phthisiology and Pulmonology, Educational and Research Institute of Postgraduate 
Education, Kharkiv National Medical University; 
K.V.	 Voloshyn	 –	 PhD,	 Associate	 Professor	 of	 the	 Department	 of	 Paediatrics,		
V.	N.	Karazin	Kharkiv	National	University. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Approved for distribution in the  Internet by the decision of the Scientific and Methodical Council 
of V. N. Karazin Kharkiv National University 

(Protocol № 8 of May 21,	2024) 
 
 

 
М 24 

Managing patients with tuberculosis and HIV infection : methodical recommendations 
for self-study for practical classes of students of higher medical education of the 5th year of 
study in the discipline "Phthisiology" [Electronic resource] / compiled by P. I. Poteiko, 
I. I. Hrek, O. S. Konstantynovska, O. V. Volobuieva, T. I. Lyadova, V. B. Kushnir. –
Kharkiv : V. N. Karazin Kharkiv National University, 2024. – (PDF 32 р.) 

 
The methodical recommendations were developed by the team of teachers of the 

Department of General and Clinical Immunology and Allergology of the Medical Faculty 
of V.N. Karazin Kharkiv National University. An indicative map of the work of candidates 
for higher medical education is provided, which clearly defines, consistently and in detail 
describes the recommendations for preparation at each stage of practical teaching. The list 
of basic theoretical issues and practical skills, structure and content of the subject, test tasks 
for control of initial and final level of knowledge, basic and additional literature, the 
appendices contain links to electronic resources of educational materials of the department. 

 
УДК 616-002.5+616.98:578.828ВІЛ](072) 

 
© V. N. Karazin Kharkiv National University, 2024 
© Poteiko P. I., Hrek I. I., Konstantynovska O. S., 

Volobuieva O. V., Lyadova T. I., Kushnir V. B., compil., 2024 



 

3  

CONTENTS 

 

Indicative map of the work for applicants of higher medical education in preparation for 

practical classes............................................................................................................. 4 

The purpose and main tasks of work on the topic of practical training “Managing 

patients with tuberculosis and HIV infection” ............................................................... 5 

Key issues (basic theoretical issues and basic practical skills on the topic of the practical 

session) ......................................................................................................................... 6 

Test tasks to control the initial level of knowledge: ....................................................... 9 

Structure and content of the topic ................................................................................ 11 

Test tasks to control the final level of knowledge: ....................................................... 24 

Independent classroom work of applicants for higher medical education in the 5th year 

of study on the topic of practical class ......................................................................... 26 

Recommended literature ............................................................................................. 27 

Appendix 1. Official site of V. N. Karazin Kharkiv National University and the 

Department of Infectious Diseases and Clinical Immunology of the School of Medicine

 .................................................................................................................................... 29 

Appendix 2. Electronic archive of V. N. Karazin Kharkiv National University eKhNUIR 

 .................................................................................................................................... 30 

 

  



 

4  

INDICATIVE MAP OF THE WORK FOR APPLICANTS OF HIGHER 

MEDICAL EDUCATION IN PREPARATION FOR PRACTICAL CLASSES 

Preparatory stage: 

1. 
 

 

 
 

Know the interdisciplinary integration of the topic of practical training with 
acquired theoretical knowledge and practical skills in basic disciplines (medical 

biology, medical and biological physics, Latin, human anatomy, normal and 

pathological physiology, biological and bioorganic chemistry, pathological 
anatomy, pharmacology, philosophy). To know the terminology (and in Latin 

transcription). 

2. Motivational characteristics and substantiation of the topic of practical 

training for the formation of clinical thinking, in particular for the further 

formation of skills to apply knowledge in diagnosing the main symptoms and 
syndromes and the possibilities of modern laboratory and instrumental methods 

of examination in further study and future professional activity. 

3. Get acquainted with the types of educational activities, information on which is 

provided on the reference stands of the department: thematic- calendar plans of 

lectures, practical classes and extracurricular independent work of students 

of higher medical education of the 5th year of study, corresponding to the 
syllabus of the discipline «Phthisiology». 

4. Use of the corresponding basic and additional educational and methodical 

literature: 

• textbooks and manuals (printed and electronic versions), the list of which is 

provided in these guidelines after the theoretical section; 
• educational and methodical materials of the department (methodical 

recommendations for independent preparation of applicants for higher medical 

education of the 6th year of study in the discipline "Management of tuberculosis 
patients in combination with HIV infection" for practical classes and for 

extracurricular independent work); 

• attending lectures (classroom lecture support of the educational process using 

multi-media presentations) - according to the thematic-calendar plan. 
For preparation to use the printed editions which can be received in library, and 

or electronic versions of these editions which are placed on the official website 

of V.N. Karazin KhNU http://www.univer.kharkov.ua/en/departments - see 
Appendix 1; and in the open interactive database of the electronic archive of 

resources of the Repository of VNKarazin KhNU 

http://ekhnuir.univer.kharkov.ua (navigation: Medical faculty / Educational 

editions. Medical faculty) - see Appendix 2. 
It is desirable to note the main issues in the form of abstracts. 

http://www.univer.kharkov.ua/en/departments
http://ekhnuir.univer.kharkov.ua/


 

5  

Main stage: 

1. To achieve the educational goal of the practical lesson and master the theoretical 

part of the topic - you need to STUDY and KNOW the answers to the main 

theoretical questions on the topic of the lesson (see list of basic theoretical 

questions), which will be checked by the teacher by oral and / or written 

questioning(correction, clarification, addition of answers) at the main stage of the 
practical lesson. 

2.  BE ABLE to solve with explanations theoretical, test (to control the initial and 

final level of knowledge), situational problems that are proposed for mastering 

the topic. 

3.  MASTER PRACTICAL SKILLS on the topic of the class: 

● Take an active part in the demonstration by the teacher of the methodology of 

studying a case patient, and practice practical skills at the patient's bedside under 

the supervision of the teacher.  
● Supervise patients, give interpretation of the obtained laboratory and 

instrumental research methods, be able to use the necessary devices, instruments, 

and instruments. 

● Establish a syndromic diagnosis, make a differential diagnosis, analyze the 
principles of treatment, write prescriptions for basic medicines. 

4. PERFORM obligatory tasks provided for independent classroom and 

extracurricular work. 

Final stage: 

1. On the basis of mastering theoretical knowledge and practical skills on the topic 

to define methods of microbiological diagnostics, etiotropic therapy and 
prophylactics of the infections caused by pathogenic M.tuberculosis for further 

training in the medical profession. 

 

The purpose and main tasks of work on the topic of practical training  

“Managing patients with tuberculosis and HIV infection” 

 

To study the features of diagnosis of co-infection with tuberculosis / HIV, their 
interaction on the course and prognosis of treatment of both diseases, to teach graduates 

of higher medical education in the 5th year of training modern tactics of management of 
patients with co-infection with TB / HIV. 

 



 

6  

KEY ISSUES: 

Applicants for higher medical education in the 5th year of study must KNOW  

(basic theoretical issues): 

 

1. etiology of tuberculosis and HIV infection, pathogenic factors of pathogens; 

2. epidemiology of tuberculosis and HIV infection; 
3. pathogenesis of tuberculosis in HIV-infected people; 

4. clinical manifestations of tuberculosis and HIV infection; 

5. laboratory diagnosis of tuberculosis and HIV infection; 
6. the impact of tuberculosis on the course of HIV infection 

7. principles of treatment; 

8. principles of prevention; 

9. tactics in case of emergencies; 
10. prognosis of tuberculosis / HIV co-infection; 

11. medical examination rules. 

 
Applicants for higher medical education in the 5th year of study must BE ABLE 

(basic practical skills on the topic of practical training): 

 

1. follow the basic rules of work at the bedside of a patient with co-infection with 
tuberculosis / HIV; 

2. collect a history of the disease with an assessment of epidemiological data; 

3. examine the patient and identify the main symptoms and syndromes of tuberculosis 
/ HIV, justify the clinical diagnosis for timely referral to the hospital; 

4. conduct a differential diagnosis of tuberculosis and HIV infection; 

5. on the basis of clinical examination to timely identify possible complications of co-

infection with tuberculosis / HIV, emergencies; 
6. draw up medical documentation on the fact of establishing a preliminary diagnosis 

of “tuberculosis / HIV” (emergency notification to the district epidemiological 

department); 
7. make a plan for laboratory and additional examination of the patient; 

8. interpret the results of laboratory tests; 

9. analyze the results of specific diagnostic methods depending on the material and 

duration of the disease; 
10. make an individual treatment plan taking into account epidemiological data, stage 

of the disease, the presence of complications, severity, allergy history, 

comorbidities; provide emergency care at the pre-hospital stage; 
11. make a plan of anti-epidemic and preventive measures in the center of infection 

  



 

7  

Materials of pre-classroom independent work 

Basic knowledge, skills, abilities necessary for studying the topic  

(interdisciplinary integration) 

 

Discipline To know Be able to do 

Previous disciplines 

Microbiology 

Properties of human 

Immunodeficiency virus 
Properties of M. tuberculosis; 

methods of diagnosing 

Tuberculosis and HIV infection 

Interpret the results of 

methods of diagnosis of 

tuberculosis and HIV 

infection. 

Physiology 

Parameters of physiological norm 

of human organs and systems; 
normal indicators of laboratory 

examination (general analysis of 

blood, urine, biochemical analysis 

of blood, parameters of urine, 
electrolytes, etc.). 

Evaluate laboratory test 

data 

Pathophysiolog
y 

The mechanism of dysfunction of 

organs and systems in the 

development of TB and HIV 

Interpret pathological changes 

in the results of laboratory 

examination in disorders of 

organs and systems of 
different genesis. 

Immunology 

and allergology 

The basic concepts of the subject, 

the role of the immune system in 

the 

infectious process, the impact on 
the elimination of the pathogen 

from the human body. 

Evaluate immunological data. 

Epidemiology 

Epidemic process (source, 

mechanism of infection, 

routes of transmission) in TB and 
HIV, the concept of epidemic, 

pandemic; 

prevalence of TB and HIV in the 
world and in Ukraine. 

Collect epidemiological 

history, carry out anti-

epidemic and preventive 
measures in the center of 

infection; follow the rules of 

work in a TB and HIV 
hospital. 

Neurology 
Clinical and laboratory signs of 

tuberculosis meningitis. 

Timely diagnose, assess the 
extent of the lesion. Prescribe 

appropriate examination and 

treatment. 



 

8  

Surgery 

Clinical and laboratory signs of 

hemoptysis, pulmonary 
hemorrhage, spontaneous 

pneumothorax, emergency care 

tactics. 

Diagnose these complications 

in a timely manner, prescribe 

appropriate examination, and 
provide emergency care. 

Propaedeutics 
of internal 

diseases. 

Methods and main stages of 
clinical examination of the 

patient. 

Collect anamnesis, conduct a 

clinical examination of the 
patient, identify pathological 

symptoms and syndromes. 

Analyze the obtained data 

Clinical 
pharmacology 

Pharmacokinetics and 

pharmacodynamics, side 
effects of antituberculosis and 

antiretroviral drugs 

Prescribe treatment depending 

on the categorical 
classification, individual 

characteristics, age of the 

patient, choose the optimal 
method, speed and volume of 

drug administration. 

Resuscitation 

and intensive 
care 

Emergencies: 

• spontaneous pneumothorax 

• pulmonary hemorrhage 

• hemoptysis 

• atelectasis 

• acute pulmonary failure 

Timely diagnose and provide 

emergency care in 

emergencies: 
•spontaneous pneumothorax 

• pulmonary hemorrhage 

• hemoptysis 

• atelectasis 

• acute pulmonary 

failure 

Intra-subject integration 

Infectious 
diseases 

Features of infectious diseases. 

Principles of diagnosis, treatment, 

prevention of infectious diseases. 
Pathogenesis, epidemiology, 

clinical manifestations, laboratory 

diagnosis, possible complications 

of TB and HIV co-infection. 
Features of clinical manifestations 

of TB/HIV. Principles of 

prevention and treatment. 

Carry out differential 

diagnosis of TB with other 
infectious diseases. Recognize 

TB, its complications, 

interpret laboratory test data. 

Prescribe treatment. Provide 
emergency care at the 

prehospital stage. 

  



 

9  

Test tasks to control the INITIAL LEVEL OF KNOWLEDGE: 

1. What is the most important diagnostic sign of joining tuberculosis in an AIDS 
patient? 

A. Positive tuberculin sensitivity after Mantoux test. 

B. Detection of the MTB in sputum. 

C. The presence of symptoms of tuberculosis intoxication. 
D. Information on past tuberculosis. 

E. The presence of focal shadows on the X-ray. 

2. What is the sensitivity to tuberculin after the Mantoux test with 2 TO PPD-L 
for characteristic of patients with HIV / AIDS? 

A. Mostly negative. 

B. Doubtful. 

C. Weakly positive. 
D. High or hyperergic. 

E. Vesiculo-necrotic. 

3. The appearance of which symptoms (complaints) may indicate a complication 
of AIDS by tuberculosis? 

A. Intoxication. 

B. Weight loss. 

C. Cough. 
D. Chest pain. 

E. All of these symptoms accompany AIDS / TB. 

4. What disease can contribute to the development of tuberculosis? 

A. Hypertensive disease. 
B. Infectious mononucleosis. 

C. HIV infection. 

D. All these diseases. 
E. None of the above. 

5. Diagnosis of HIV / AIDS-associated tuberculosis is based on: 

A. detection of HIV antibodies, anemia, leukopenia, lymphopenia, thrombocytopenia 

B. a decrease in the number of CD4 lymphocytes less than 500 cells / ці of blood 
C. decrease in the ratio of SD4 / SD8 less than 1 

D. negative reaction to tuberculin at MBT + in sputum 

E. all these criteria 
6. Patients with which diseases belong to the risk group for tuberculosis: 

A. HIV-infected; 

B. patients with diabetes mellitus; 

C. patients with occupational lung diseases; 
D. patients who are constantly taking corticosteroids, radiation therapy; 

E. all of the above 



 

10  

7. Which of the following is characteristic of the tuberculosis process in the late 
stages of HIV infection? 

A. prolonged intoxication with a negative reaction to the Mantoux test is expressed; 

B. diffuse infiltrates with localization in both the upper and middle and lower lungs; 
C. mainly extrapulmonary lesions, enlargement of intrathoracic lymph nodes, 

generalized lymphadenopathy; 

D. in half of patients - lack of MBT in sputum; 

E. all of the above is characteristic. 
8. In an AIDS patient, X-ray examination revealed massive focal-infiltrative 

shadows in the lower lobes of both lungs. The reaction to the Mantoux test with 2 TO 

PPD-L is negative. What diagnosis is most likely in the patient? 
A. bilateral lower lobe pneumonia; 

B. miliary tuberculosis; 

C. carcinomatosis; 

D. bronchiectasis; 
E. mycobacteriosis. 

9. At the level of which population of lymphocytes is assessed the state of the 

immune system in HIV / AIDS infection? 
A. CD 6 

B. CD 4 

C. CD 2 

D. CD 8 
E. CD 3 

10. The patient is 38 years old, extrapulmonary tuberculosis, candidiasis of the 

esophagus, trachea and bronchi, cachexia. HIV-positive for 8 years. Subsequently, on the 

left leg there were cherry-colored spots with a cyanotic tinge, painless, dense to the touch. 
The development of any AIDS-associated disease should be considered: 

A. skin vasculitis 

B. skin lesions caused by herpes simplex viruses 
C. Kaposi's sarcoma 

D. hair leukoplakia 

E. erysipelas 

Standards of answers: 1 - В. 2 - А. 3 - E. 4 - C. 5 - E. 6 - Е. 7 - Е. 8 - Е. 9 - B. 10 - С. 

  



 

11  

STRUCTURE AND CONTENT OF THE TOPIC 

Background. Tuberculosis and HIV / AIDS are a global problem in the public health 
system. Tuberculosis is the leading cause of death for people living with HIV / AIDS, and 

HIV is the most important factor in the development of the TB epidemic in countries with 

high HIV prevalence. The WHO estimates that about 20 million people have died in the 

25 years since the HIV pandemic. Today, more than 50 million people, or more than 1% 
of the world's adult population, are infected with HIV. In the period 1987-2007, 122,314 

cases of HIV infection were officially registered in Ukraine, including 22,424 cases of 

AIDS and 12,490 deaths from AIDS-related diseases. In Ukraine, the rapid spread of HIV 
infection has been registered since 1997 (8913 cases), which is due to the introduction of 

HIV among injecting drug users. 

Another group at high risk of HIV infection in Ukraine are young people in prisons 

(penitentiaries). Analysis of the structure of secondary (opportunistic) diseases showed 
that at the beginning of the HIV epidemic (1987-1992), when AIDS patients were still 

few, the structure of opportunistic diseases was dominated by Kaposi's sarcoma (32%), 

manifest forms of CMV infection). In recent years, tuberculosis has become the most 
common opportunistic disease in Ukraine. HIV infection increases the risk of developing 

active tuberculosis and, conversely, tuberculosis adversely affects HIV-associated 

tuberculosis. More than 30% of HIV-infected people have tuberculosis and about 30-40% 

of those who die from tuberculosis. The number of TB patients among HIV-infected 
patients is constantly growing. Such interaction between the two infections requires 

healthcare institutions to pay special attention to the fight against tuberculosis among HIV-

infected people within the framework of the overall strategy for combating HIV infection. 

The impact of HIV infection on the development of tuberculosis. Both HIV 
infection and tuberculosis affect the immune system, mainly the cells of the lymphatic 

system and especially the lymph nodes. The difference is that the pathogen of HIV directly 

affects CD4 - T-lymphocytes. The tuberculous process destroys primarily the lymph node 
tissue. Tuberculosis has a negative effect on the progression of HIV infection. In vitro 

studies have shown an increase in the ability of HIV to replicate under the influence of 

MBT antigens, which is confirmed by an increase in the number of copies of RNA virus 

in the peripheral blood. 
Most cases of tuberculosis in HIV-infected patients are associated with reactivation 

of latent tuberculosis infection, a significant number of cases of tuberculosis in HIV-

infected adults are associated with endogenous reinfection. When the immune system is 
affected by HIV infection, the Office, without encountering obstacles to its development, 

begin to actively multiply in the lymph nodes, followed by the development of specific 

granulomas and caseosis. Hence the peculiarities of the clinical course of tuberculosis in 

patients with HIV infection, lymph nodes are involved in the process, tuberculosis 
infection spreads in the body by lymphogenic and lymphohematogenous routes. 

Tuberculosis is characterized by severe lymphotropy, the development of exudative 



 

12  

reactions and progressive course. 
Absolute and relative decrease in the number of CD4 - T-lymphocytes changes the 

relationship in the cellular immune system, which is the main course of tuberculosis: the 

differentiation of macrophages and the formation of specific granulation tissue is 
disrupted. If in the early stages of HIV infection, the morphology of tuberculous 

inflammation changes, then in the late period of AIDS specific granulomas do not form. 

Influence of tuberculosis on the course of HIV infection. Infections affecting 

HIV-infected people, their clinical manifestations depend on the stage of HIV infection 
and the degree of reduced immunity. Highly pathogenic pathogens, such as pneumococci, 

salmonella (other than typhus and parasites) and M. tuberculosis, can cause the disease at 

any stage of HIV infection. Tuberculosis is the most virulent infection that occurs earlier 
than others, including earlier mycobacteriosis, which causes M.avium complex. Less 

pathogenic, including opportunistic pathogens (Candida spp, Cryptococcum neoformans, 

Toxaplasma gondii and atypical MBT) cause the disease with a more pronounced decrease 

in immunity. Disseminated infections develop in the late stages of HIV infection with 
significant immunodeficiency. 

In HIV-infected people, the presence of any infection, including tuberculosis, 

provokes a faster spread of HIV infection. This can manifest itself in its rapid progression 
and development of AIDS. HIV infection causes the spread of tuberculosis by increasing 

the risk of developing tuberculosis during primary infection and due to reactivation of 

endogenous infection. During the year, 5-15% of co-infected with HIV and M. 

tuberculosis develop tuberculosis. 
Signs and criteria for diagnosing the disease. All HIV-infected patients should be 

screened for or at risk of developing tuberculosis, and all TB patients should be offered 

counseling and testing for HIV. The main reasons for this assessment are: 

- HIV-infected patients are at risk for the presence or development of active 

tuberculosis as one of the leading causes of death; 

- HIV infection affects the course of tuberculosis and the effectiveness of treatment; 

- active tuberculosis affects the course of HIV infection and the effectiveness of 

antiretroviral therapy; 

- Tuberculosis can be one of the manifestations of stage III or IV HIV infection, 

which requires treatment. 
Risk assessment and diagnosis of tuberculosis in HIV-infected people. 

Tuberculosis patients are identified by examining HIV-infected patients who have sought 

medical help at a regional AIDS center or public health facilities with a network and / or 

symptoms of tuberculosis; the diagnosis of tuberculosis is confirmed by a tuberculosis 

specialist; registration of a case of tuberculosis is carried out in the regional anti-

tuberculosis dispensary, in accordance with the current legislation. Particular attention 

should be paid to patients with: 

- respiratory symptoms; 



 

13  

- bronchopulmonary symptoms and symptoms of intoxication lasting more than 2 

weeks; 

- known contact with a patient with active pulmonary tuberculosis at home or in the 

immediate environment; 

- the presence of additional factors of increased risk of infection (injecting drug 

users, alcohol abuse, imprisonment). 

Symptom complexes that require mandatory examination for 

tuberculosis 

Bronchopulmonary symptoms 
Symptoms of intoxication lasting more 

than 2 weeks 

Cough dry or with sputum for more than 2 

weeks 
Febrile, subfebrile fever 

Chest pain associated with breathing 
Weight loss, loss of appetite, night 

sweats 

Hemoptysis, pulmonary hemorrhage Weakness 
 

In HIV-infected individuals, pulmonary tuberculosis must be differentiated from 
other pulmonary pathology. A number of diseases can occur in HIV-infected people and 

were accompanied by a similar course, cough, fever, sometimes chest symptoms and 

changes in the radiographic picture. 

Radiological signs and the most probable etiology of the disease 

Focal M. tuberculosis, Pneumocystis carinii 

Diffuse 
M. tuberculosis, P. carinii, cytomegalovirus, fungi, Kaposi's 

sarcoma, hypoproteinemia 

Dissemination 
Kaposi's sarcoma (large nodes), M. tuberculosis (miliary), 

fungi 

Pneumothorax P. carinii 

Mediastinal 
lymphadenopathy 

M. tuberculosis, M. avium, M. intracellulare, Kaposi's 
sarcoma, lymphoma, fungi 

Pleural effusion 
Parapneumonic effusion, M. tuberculosis, Kaposi's sarcoma, 

lymphoma, fungi, cardiomyopathy 

Formation of 

cavities 

M. tuberculosis (high level of CD4 +), Pneumocystis Carinii 

(low level of CD4 +), Pseudomonas Aeruginosa (low level of 
CD4 +), R.egui, fungi, lymphoma 

 



 

14  

Depending on the periods of development of HIV infection and histopathological 
immune reactions in combined forms of tuberculosis and HIV infection in the 

development of the disease there are 3 stages: 

1. Early (granulomatous): formation of specific granulomatous tissue reactions and 
relatively intact cellular immunity with a decrease in the number of CD4 -T cells from 500 

to 250. In the affected areas a significant number of epithelial and giant Langhans cells 

with accumulation of CD4 -T lymphocytes macrophages with active cytoplasm. The most 

common clinical form is local pulmonary tuberculosis. 
2. Tuberculosis, HIV infection with moderate HIV immunosuppression 

(hyporeactivity): disappearance of giant Langhans cells, reduction of epithelioid cells, 

CD4 -T-lymphocytes and macrophages with active cytoplasm. In the center of an infection 
the zone of a necrosis increases and the quantity of KSB increases. Clinical forms:

 common pulmonary tuberculosis and extrapulmonary 

tuberculosis. 

3. Tuberculosis, HIV infection with severe immunosuppression (miliary process 
with anergy): no specific granulation tissue reaction of epithelioid and giant Langhans 

cells and a small number of CD4 -T cells in the affected area. Instead of caseous necrosis, 

coagulation necrosis and melting with a large number of CSBs are observed, which 
continue to multiply in bacteriophages. Clinical forms - miliary, generalized tuberculosis 

with multiorgan lesions, including meningitis with early death. 

HIV infection not only causes the spread of tuberculosis, but also changes its clinical 

picture, which depends on the stage of HIV infection and the degree of immunodeficiency. 

Features of tuberculosis at each stage of HIV infection 

Stage of HIV 
infection 

Features of tuberculosis 

І 
Typical course of pulmonary tuberculosis: infiltrates and foci in the 

upper lobes, cavities, fibrosis, detect AFB and MTB in sputum 

ІІ 
Typical course of pulmonary tuberculosis: infiltrates and foci in the 
upper lobes, cavities, fibrosis, detect AFB and MTB in sputum 

III 

Atypical course of pulmonary tuberculosis: infiltrates in the lower 

lobes, no cavities, no fibrosis, rarely detect AFB and MTB in sputum. 
Atypical granuloma and the absence of typical morphological signs of 

tuberculosis determine the AFB and MTB in the affected organs. 

Extrapulmonary forms of tuberculosis. 

IV 

The primary form of tuberculosis has a septic character: the Office is 

determined in the case of blood seeding (miliary tuberculosis, 

tuberculous meningoencephalitis).  



 

15  

In the early stages of mild and moderate immunodeficiency, secondary tuberculosis 
develops due to reactivation or reinfection, which is little different from normal 

tuberculosis. With a decrease in immunity, pulmonary tuberculosis without bacterial 

excretion, which resembles primary pulmonary tuberculosis and extrapulmonary 
tuberculosis, develops more often. The more pronounced the immunodeficiency, the more 

often miliary tuberculosis occurs, the more difficult it is to diagnose. Due to this, it is 

easier to diagnose tuberculosis in the early stages of HIV infection: bacterial excretion is 

more often determined during this period; in the later stages of HIV infection, pulmonary 
tuberculosis without bacterial excretion and extrapulmonary (including miliary) are more 

common. 

One of the reasons for the delay in the diagnosis of tuberculosis in HIV- infected 
and AIDS patients is the atypical course of tuberculosis and its clinical features as an 

associated disease. In the early stages of HIV infection, the course of tuberculosis is not 

much different from tuberculosis in vilnegative individuals with a predominant lung 

lesion. In the later stages of HIV infection, tuberculosis in 50-60% of patients has 
extrapulmonary localization and joins AIDS more often when the number of CD4-T 

lymphocytes decreases to 200 cells per 1 mm3 or less. Miliary tuberculosis and 

tuberculous meningitis develop mainly when the number of CD4-T lymphocytes is about 
100 in 1 mm3 or less. 

The structure of tuberculosis does not differ between HIV-negative and HIVpositive 

people, except that HIV-infected patients are less likely to find focal forms, more often 

infiltrative, fibro-cavernous and generalized forms, which is not due to the peculiarities of 
tuberculosis, but insufficient contingent preventive fluorographic examination of the 

chest. In AIDS patients, the frequency of infiltrative form of tuberculosis remains the same 

(51.7%) as in HIV-positive and vilnegative persons, but the frequency of disseminated 

form increases (41.4%), the frequency of focal (5.2%) and fibrous -cavernous (1.7%) 
forms of tuberculosis. The proportion of disseminated tuberculosis and tuberculosis of 

intrathoracic lymph nodes is 50-70%. 

Clinical picture of tuberculosis in the early and late stages of HIV infection 

Manifestation of 

pulmonary 

tuberculosis 

Stage of HIV infection 

early late 

The clinical picture 
Often resembles a 
secondary one 

Pulmonary tuberculosis 

often resembles primary 

pulmonary tuberculosis 

MTB in sputum 

(bacterioscopically) 
Often detected Rarely detected 



 

16  

Radiological signs 
Destruction of a pulmonary 

parenchyma is often found. 

Infiltration without 

Disintegration is often 
found. 

 

The main clinical manifestations of tuberculosis in HIV-infected: 

- asthenia; 

- constant or intermittent fever (more than 1 month); 

- sharp sweating; 

- weakness; 

- prolonged dry or with a small amount of sputum cough (more than 3 weeks); 

- hemoptysis; 

- chest pain, shortness of breath; 

- significant weight loss; 

- diarrhea; 

- in 1/3 of cases at inspection in 2-4 weeks. from the beginning of the disease 

lymphadenopathy is detected, enlarged mainly cervical and axillary, intrathoracic, rarely 

inguinal. Peripheral l / nodes, dense, bumpy, immobile on palpation. (In HIV-negative 

patients, peripheral lymph nodes are not enlarged). 

Clinical symptoms typical of HIV infection in patients with TB 

Anamnesis 

History of sexually transmitted diseases; Herpez zoster 
(shingles); recurrent pneumonia; bacteremia (Salmonella 

thphimurium) 

Symptoms 

Weight loss (more than 10 kg or 20% of primary weight); 
diarrhea (more than a month); pain when swallowing

 (characteristic of oropharyngeal 

candidiasis); burning pain in the lower extremities (peripheral 
sensory neuropathy) 

Objective signs 

Traces of scars from Herpez zoster; papular rash; 

Kaposi's sarcoma; symmetrical generalized 
lymphadenopathy; oral candidiasis; oral hair 

leukoplakia; persistent painful genital ulcers 

It was found that HIV-negative people are more likely to have an inflammatory 
reaction, parenchymal disintegration, bronchial lesions than HIVpositive people. This 



 

17  

means that coughing and hemoptysis are more common in HIV-negative people, while 
weight loss and fever are more common in HIVpositive people. In general, the symptoms 

of intoxication (weight loss, fever) and respiratory symptoms (dry cough and sputum, 

shortness of breath) in HIV- infected and HIV-negative patients differ little, but are more 
common in AIDS patients. In HIV-infected and AIDS patients, the symptoms of 

intoxication are determined 2-3 times more often, they occur later and last more than 5 

months, and the symptoms of respiratory disorders join earlier and last 1-3 months. until 

the diagnosis of tuberculosis. HIV-negative people, on the other hand, first develop 
symptoms of intoxication and last 1-3 months, and symptoms of respiratory disorders last 

equally often - from 1 month. and more than 5 months. until the diagnosis of tuberculosis. 

The peculiarities of the course of tuberculosis, depending on the HIV status, can be 
the cause of untimely diagnosis and treatment of tuberculosis. In addition to the 

peculiarities of the course of tuberculosis, the reason for late diagnosis in HIV-infected 

people may also be an atypical localization of the tuberculosis process in the lungs. HIV-

infected people with prolonged fever and other symptoms of intoxication should be 
screened for tuberculosis. Diagnosis of tuberculosis is extremely necessary in patients with 

a high risk of developing TB in patients with a small number of CD4 -T-lymphocytes in 

the blood (less than 100 in 1 mm3). 

Examination methods for suspected TB on the background of HIV infection:  

Mandatory examinations 
Additional examinations (in level 3 

medical institutions) 

Collection of complaints and medical 
history 

Computer tomography of the chest 

3-times done analysis of sputum or other 

biological material by Ziel- Nielsen 

microscopy 

Fibrobronchoscopy with BAL for 
microscopic and bacteriological 

examination and biopsy of the affected 

areas 

Chest Xray. Tomography of the 
affected parts of the lungs 

Transthoracic or transbronchial or open 

puncture lung biopsy; biopsy of enlarged 
lymph nodes with sampling for microscopic 

and bacteriological examination 

3-time analysis of sputum or other 
biological material by culturing 

Thoracoscopy with pleural biopsy with 

sampling for microscopic and 

bacteriological examination 

 

Pathohistological examination of biopsy 

material (in case of suspected 

extrapulmonary TB) 



 

18  

 

Fibroscopic methods of research at defeat of 

concrete bodies and systems (gastro-; 

colonolaparoscopy) 
 Ultrasound of the abdominal cavity 

 
Accelerated bacteriological methods 

of MTB detection: BACTEC 

 
Molecular genetic laboratory methods: 
nucleic acid amplification tests (PCR) 

 Trial antimycobacterial therapy 
 Tuberculin diagnostics (Mantoux test) 

 

 

Features of the reaction to tuberculin depending on the stage of HIV infection 

I-II stages of HIV infection: 

- reaction and tuberculin are typical; 

- positive or hyperergic tests are detected during infection or active disease. 

Negative tests - in the absence of infection with M. tuberculosis or severe common 

forms of tuberculosis. 
Late stages (III-IV) of HIV infection: 

- reaction to tuberculin is atypical; 

- in 70% of patients negative tuberculin tests can be determined regardless of M. 

tuberculosis infection, the presence of active disease. Some patients (30%) respond 
positively to tuberculin when infected with M. tuberculosis or the presence of active 

tuberculosis. 

Diagnosis of HIV infection 

Clinical examination of patients with tuberculosis with a positive HIV test is 

carried out by tuberculosis specialists together with specialists from the regional AIDS 

center in the following order: 

- assessment of the clinical condition and personal characteristics of the patient, 

which could influence the choice of therapy (history of tuberculosis, contraceptive 
methods, liver and kidney condition); 

- physical examination; 

- blood test to determine the formula; 

- determining the number of CD4 cells; 

- determination of viral load; 

- pregnancy test in women; 

- serological tests to determine markers of hepatitis B and C, especially in patients 

with tuberculosis who are injecting drug users; 

- determination of the level of alanine aminotransferase (ALT) in the blood and 

bilirubin (the level of ALT, which exceeds the control values by more than 3 times will 



 

19  

affect the choice of antimycobacterial and antiretroviral drugs); 

- other examinations depending on the patient's condition; 

- consultations of specialists. 

For screening studies: determination of antibodies to HIV (ELISA: enzyme- linked 

immunosorbent assay). In the case of a positive analysis in the laboratory is performed 
twice (with the same serum). Upon receipt of at least one positive analysis, the serum is 

sent for test confirmation. In this case, the confirmatory laboratory test is the method of 

immune blotting (IB), which detects antibodies to individual proteins of the virus. 

Bacterial excretion is less common in HIV-infected patients with pulmonary 
tuberculosis and AIDS than in HIV-negative patients. AIDS patients have a higher level 

of multi- and polyresistance than HIV-negative patients. 

The sensitivity of the skin tuberculin test in HIV-infected people is inversely 
proportional to the degree of immunosuppression, ie the number of CD4 -T lymphocytes 

in the blood. A negative tuberculin test does not rule out a diagnosis of tuberculosis 

because more than 50% of HIV-infected people with active tuberculosis have a negative 

reaction to tuberculin. 
The course of pleurisy in HIV-infected patients is more severe (more often with 

exudation) than in non-HIV-infected patients, they die more often before the end of 

treatment and they are more likely to have MBT in the pleural fluid. 
The development of meningitis is especially characteristic of HIV-infected 

patients. The most rapid course of tuberculous meningitis is characteristic of HIV-

positive young people (18-24 years), in whom, along with CT, changes in the brain are 

observed. 
HIV-infected people and AIDS patients are characterized by both typical and 

medium- and lower-partial localization of tuberculous infiltrates in contrast to HIV-

negative patients, in whom the upper-partial typical localization predominates. Lower 

partial localization of tuberculous infiltrate in HIV-infected and AIDS patients may be 
the cause of low diagnosis of tuberculosis and overdiagnosis of community-acquired 

pneumonia. 

 
 

 

 

Radiological features of clinical forms of tuberculosis in HIV-positive 

individuals 

Form of 

tuberculosis 
Characteristics of the radiological picture 

Disseminated 

Small and medium foci without a tendency to fusion and caseous 

necrosis with a low frequency of destruction of lung tissue and 

involvement in the pathological process of intrathoracic lymph 

nodes. 



 

20  

Focal 
Atypical mid-lobe and lower lobe localization, often bilateral 

lesions. 

Infiltrative 

As in patients with AIDS, mid-lobe, low-lobe localization with a 

low frequency of destructive forms, mainly hematogenous 
dissemination and involvement in the pathological process of 

intrathoracic lymph nodes. 

Small-focal and medium-focal dissemination predominates in the lungs of AIDS 

patients. In HIV-infected patients, the extent of dissemination in the lungs is the same as 

in HIV-negative individuals. 
Atypical localization, prevalence of lesions, propensity to disseminate with multiple 

extrapulmonary localizations are considered to be the main distinguishing features in HIV-

infected and AIDS patients. Detection of them should raise suspicions of severely reduced 
immunity, even if the reactions to HIV are negative. 

Detection of extrapulmonary tuberculosis is performed in patients with intoxication 

syndrome, enlarged peripheral lymph nodes, pleurisy, meningitis, bone and joint damage, 

pathological changes in the urine, diarrheal syndrome, enlarged mesenteric l / nodes, etc. 

• Biopsy of enlarged peripheral lymph nodes with histological examination and 

culture of the material; 

• Thoracoscopy with pleural biopsy and exudate culture for the presence of MBT in 

patients with exudative pleurisy; 

• CT of the chest in patients with prolonged fever of unknown origin; 

• Ultrasound of the abdominal cavity in persons with prolonged fever of unknown 

origin with examination of l / nodes of the abdominal cavity or CT of this area; 

• Five urine cultures for the presence of MBT in the case of persistent pathological 

changes in the urine in the absence of growth of non-specific flora and a positive response 

to broad-spectrum antibiotics; 

• Cerebrospinal fluid culture for the presence of MBT in meningoencephalitis, 

regardless of the isolated pathogen, as the course of tuberculous meningitis can be 

combined with cryptococcal. 

Typical signs of tuberculosis in the terminal stage of AIDS are: 
1. Prolonged persistent increase in body temperature to 39-40 ° C on the background 

of active anti-TB treatment; 

2. Significant weight loss of almost 10 kg for 2-3 months; 
3. Liquid, light, up to 400 ml foamy sputum, which "easily pours out of the lungs" 

during coughing; 

4. Increased ESR (> 45 mm / h), leukocytosis up to 20 x 109 / l; 

5. X-rays in the lungs on the background of localization of the tuberculous process 
in the upper lobe reveal diffuse infiltrates, mainly in the lower middle lobes, which quickly 

(up to 3 months) turn into multiple cavities (with a picture of "destroyed lungs"). anti-

tuberculosis therapy, even with the preserved sensitivity to these drugs; 
6. In all patients determine candidiasis of the oral cavity; 



 

21  

7. Tuberculin test loses its informativeness; 
8. Complications of the late stage of AIDS with pneumocystis pneumonia (8085%). 

9. 15 days before the lethal end of the HIV test is negative. 

The course of HIV infection in the form of a mixed infection (frequent combination 
with pneumocystis pneumonia or CMV infection, etc.) also affects the radiographic 

picture. In this case, typical signs of tuberculosis are rarely detected (infiltrates in typical 

places, usually at the apex); more often define diffuse changes with signs of basal, 

paratracheal or mediastinal lymphadenopathy. If possible, it is advisable to perform a CT 

scan, especially if there is a suspicion of extrapulmonary process. 

Algorithm for assessing the risk of TB in HIV-infected people 

Atypical course, frequency of extrapulmonary localization, combination with other 

opportunistic diseases complicate, and sometimes make impossible, timely diagnosis of 

tuberculosis in HIV-infected patients, which affects the conduct of adequate therapy, as 

well as the quality and duration of life. 

Treatment of HIV-infected patients with tuberculosis 

Currently, there are no means by which to cure AIDS, but there are only those that 

can slow the progression of the disease, prolong the life of the patient. When HIV is not 

detected during treatment, it is due to a decrease in the level of HIV in the blood below 
the threshold concentration that can be detected by methods available to the doctor, or the 

virus is contained in cells in the form of provirus, remaining inaccessible to drugs. As 

there is currently no possibility of complete elimination of HIV from the human body, the 

goal of therapy is to prolong the life of infected people and maintain its quality for a long 
time. 

The following approaches are followed in the organization of treatment of patients 

with a combination of tuberculosis and HIV infection (TB / HIV coinfection): 

• Treatment for active tuberculosis is clinically and epidemiologically more 

important than treatment for HIV infection, so treatment of patients with coinfection 
begins mainly with the appointment of anti-tuberculosis therapy; 

• Treatment of tuberculosis in HIV-infected patients is carried out according to the 

same regimens and duration as in non-HIV-infected patients; 

• If the patient is already receiving ART, it is continued, and if necessary, adjust the 

treatment to take into account the compatibility of ARV drugs and antimycobacterial 
therapy (AMBT); 

• After completion of the main course of AMBT antirelapse prophylactic treatment 

is not used; 

• Prophylactic treatment with cotrimazole prevents death from other infections in co-

infected patients. 
Treatment of patients with TB / HIV co-infection is carried out: 

• In the case of pulmonary tuberculosis with bacterial excretion - in antituberculosis 



 

22  

institutions; 

• In case of detection of tuberculosis of different localization without bacterial 

excretion: 

• for the period of intensive treatment in the conditions of a tuberculosis hospital, 

dispensary / office (outpatient) or in regional AIDS centers, depending on the course and 
severity of the disease; 

• for the period of the main course of supportive chemotherapy - in health care 

facilities of the general network or in regional AIDS centers under the direct supervision 
of medical workers (DOTS) under the condition of supervising the process of treatment 

by the district TB doctor. 

Standard regimens of the main course of chemotherapy depend on the dispensary 
group of patients with tuberculosis. The main course of chemotherapy is a long continuous 

combination treatment with AMB drugs in a full daily dose for 1 dose. The standard course 

of AMBT is carried out using 4-5 antituberculosis drugs of the I series (isoniazid, 

rifampicin, streptomycin, pyrazinamide, ethambutol), which includes an intensive stage 
(2 months and longer to prevent the emergence of multidrug-resistant strains of MBT, 

duration - depending on the clinic sensitivity of the Office to drugs) and the maintenance 

phase (prescribe isoniazid and rifampicin for at least 4 months, depending on the effect 
obtained).At decrease in cellular immunity it is inexpedient to apply pyrazinamide (as its 

action extends to intracellularly located MBT). The choice of the appropriate AMBT 

regimen depends on the results of the bacterioscopic examination before treatment, the 

previous course of AMBT and the severity of the disease. 
If the MTB is resistant, at least 2 main drugs active to the MTB should be prescribed, 

and reserve - ciprofloxacin (750 mg 2 times a day) or ofloxacin (400 mg 2 times a day). 

Standard treatment regimens for patients with tuberculosis 

Case of the disease Initial phase (daily) Continuation phase (daily) 

New case** 2 HRZE 4 HR 

Previously treated 

patients* 
2 HRZE 4 HR 

Notes: 

* - before starting OKHT in previously treated patients with TB it is necessary to conduct cultural 

studies (preferably on a liquid medium) and DST MTB (at least for sensitivity to H and R, if possible, by 

molecular genetic methods) ** - except for patients with TB of the nervous system, bones and joints 

Treatment of HIV patients 

Highly active antiretroviral therapy (HAART) involves the use of a combination of 

three antiretroviral drugs (ARVs) and makes it possible to suppress the replication of HIV, 
to restore the function of the immune system. HAART is an integral part of providing 

comprehensive health care to people living with HIV. 

The appointment of ARV drugs in patients with pulmonary tuberculosis, in which 



 

23  

the number of CD4 + lymphocytes> 200 in 1 mm3 should be postponed until the end of 
treatment for tuberculosis. In patients at high risk of progressive HIV infection (in case of 

extrapulmonary tuberculosis or if the number of CD4 + lymphocytes <200 per 1 mm3 of 

ART should be performed in parallel with treatment for tuberculosis). However, 
traditional treatment of patients with pulmonary tuberculosis in the terminal stage of AIDS 

is ineffective - the prognosis remains unfavorable, as patients die from various infectious 

complications of AIDS (more often from pneumocystis pneumonia). 

Adverse reactions to antimycobacterial drugs and their management 

Adverse reactions to anti-TB drugs in HIV-positive people develop more often than 

in HIV-negative people. Some side effects can be prevented. For example, peripheral 

neuropathy may occur with isoniazid, especially during pregnancy, alcohol abuse, 
diabetes, chronic liver disease, and malnutrition. The risk of drug intolerance increases 

with increasing immunosuppression. Most side effects occur in the first 2 months of 

treatment. The most common manifestation of an adverse reaction is each reaction. Fever 

often precedes and accompanies a skin rash. Most often, skin reactions occur to 
thioacetozone (WHO does not recommend its use due to the risk of severe intoxication 

with dermatological complications with a fatal outcome in 12-20%), as well as to 

streptomycin and rifampicin. Among other reactions, the most common are 
gastrointestinal disorders and hepatitis. The development of rifampicin-associated shock 

and thrombocytopenia is possible. Patients are prescribed pyridoxine 20-40 mg per day, 

along with antimycobacterial drugs. 

  



 

24  

Test tasks to control the FINAL LEVEL OF KNOWLEDGE: 

1. What is active detection of HIV / AIDS-associated tuberculosis? 
A. diagnosis of tuberculosis in patients with HIV / AIDS at registration of a new case 

of HIV infection at the annual preventive examination of patients of this contingent 

B. Diagnosis of tuberculosis in patients with HIV / AIDS when visiting a medical 

institution with symptoms similar to tuberculosis 
 

2. What is passive detection of HIV / AIDS-associated tuberculosis? 

A. diagnosis of tuberculosis in patients with HIV / AIDS at registration of a new case 
of HIV infection at the annual preventive examination of patients of this contingent 

B. Diagnosis of tuberculosis in patients with HIV / AIDS when visiting a medical 

institution with symptoms similar to tuberculosis 

 
3. How many times should a sputum test be performed on the MTB if tuberculosis 

is suspected in a patient with HIV / AIDS? 

A. one 
B. two 

C. three 

D. five 

E. does not need to be conducted 
 

4. A patient registered in the AIDS Prevention and Control Center has a wet cough 

for two months. Is it necessary to perform an X-ray examination of the chest, if this 

examination was performed 4 months ago? 

A. no 

B. yes 

C. not required 

 

5. Are HIV / AIDS complaints mandatory? 

A. required  
B. optional, the presence of complaints depends on the form, phase of the tuberculosis 

process, the presence of complications 

 

6. In a patient with HIV infection, a round shadow was found in the lungs by 
fluorographic examination. What diseases should be considered in the first place and what 

additional tests should be done to determine the origin of the target? 

A. tuberculosis, to conduct an X-ray examination of the chest 

B. pneumocystis pneumonia, to conduct X-ray examination of chest 
C. benign lung tumor, conduct an X-ray examination of chest 

 



 

25  

7. A patient with HIV infection has bronchopulmonary syndrome. No pathological 
changes were detected on the OGK radiograph. Is it necessary to perform sputum 

research? 

A. no 
B. yes 

C. not required 

8. A patient with HIV infection has bronchopulmonary syndrom. No pathological 

changes were detected on the chest Xray, MTB (-) three times. What should be the doctor's 
tactics in this case? 

A. conduct a survey in a year 

B. prescribe chemoprophylaxis for tuberculosis if the patient is infected with the MTB 
C. prescribe broad-spectrum antibacterial drugs 

 

9. What method is used to detect antibodies to HIV? 

A. enzyme-linked immunosorbent assay 
B. polymerase chain reaction 

C. radioallergosorbent test 

D. immunoblotting 
 

10. What investigation should be performed on an AIDS patient with suspected 

pulmonary tuberculosis? 

A. Xray scopy 
B. fluorography 

C. chest Xray 

D. tomography 

E. bronchography 
 

Standarts of answers: 1. А. 2. В. 3. С. 4. В. 5. В. 6. А. 7. В. 8. С. 9. А. 10. С. 

  



 

26  

INDEPENDENT CLASSROOM WORK 

of applicants for higher medical education of the 5th year of study 

on the topic of the practical lesson 

 

• Master the method of examination of a patient with TB / HIV 

• Supervise a TB / HIV patient 

• Carry out differential diagnosis of TB / HIV 

• Make a plan for a laboratory test 

• Interpret the results of a specific examination of a TB / HIV patient 

• Recognize complications of TB / HIV 

• Make a treatment plan for a TB / HIV patient. 

• Determine medical tactics in case of emergencies. 

• Draw up medical documentation upon diagnosis of TB / HIV. 

  



 

27  

Recommended literature: 

Obligatory literature 

1. Ministry of Health of Ukraine. Tuberculosis. Evidence-based clinical guideline. 

2023. https://www.dec.gov.ua/wp-content/uploads/2023/01/klinichna-nastanova-

tuberkuloz-sichen-2023.pdf  

2. Evidence-based clinical practice guideline "HIV infection", 
https://www.dec.gov.ua/wp-content/uploads/2022/11/2022_2092_kn_vil_1.pdf.  

3. Order of the Ministry of Health of Ukraine of November 16, 2022, No. 2092 "On 

Approval of the Standards of Medical Care "HIV Infection" 
4. Boyko MG Phthisiology: a textbook for students of medical and pediatric faculties 

of higher medical educational institutions of the IV level of accreditation / M.G. 

Boyko, A.G. Yareshko, А.К. Vorodyukhina, MV Kulish - Poltava: Techservice 

Company Ltd., 2015. - 276 p. 
5. Feshchenko YI, Melnik VM Organization of anti-tuberculosis care for the 

population - K .: Health, 2006. - 654 p. 

6. Feshchenko YI, Melnik VM Modern methods in the diagnosis of tuberculosis. - K 
.: Health, 2002.- 654p. 

7. Phthisiology. / В.І. Petrenko, LD Todoriko, L.A. Grishchuk et al .; - К .: ВСВ 

«Medicina», 2015. - 472 с. 

8. Phthisiology. Textbook. Edited by VI Petrenko. - Vinnytsia: New book, 2006. - 
504 p. 

9. Tsyganenko AY, Zaitseva SI Tuberculosis. The textbook for university students. 

10. Kharkiv: Fakt, 2004. - 390 p 

 
Additional literature: 

1. Boyko MG Practical skills in the study of tuberculosis: textbook for interns / MG 

Boyko, A.G. Yareshko, М.В. Kulish [etc.]. - Poltava: Techservice Company Ltd., 
2015. - 258 p. 

2. Zhdan V.M. Tuberculosis: textbook for family doctors / V.M. Zhdan, [etc.]. - 

Poltava: Techservice Company Ltd., 2015. - 234 p. 

3. John Malcolm Dowling, Chin-Fang Yap. Communicable Diseases in Developing 
Countries Stopping the Global Epidemics of HIV/AIDS, Tuberculosis, Malaria 

and Diarrhea. ISBN 978-1-349-46999-4 ISBN 978-1-137-35478-5 (eBook), DOI 

10.1057/9781137354785, 2014. – 219 с. 
4. Irini Sereti, Gregory P. Bisson, Graeme Meintjes. HIV and Tuberculosis: A 

Formidable Alliance. – Springer International Publishing, 2019. ISBN 

9783030291082  – 341 с. 

 
Information resources 

1. Website of the Ministry of Health of Ukraine: www.moz.gov.ua. 

http://www.moz.gov.ua/


 

28  

2. Centers for Disease Control and Prevention »http://www.cdc.gov/ 
3. Ukrainian Center for Control of Socially Dangerous Diseases of the Ministry of 

Health of Ukraine: online training. - Access mode: 

http://tb.ucdc.gov.ua/navchannya-onlayn.  
4. USAID Project "Strengthening Tuberculosis Control in Ukraine": textbooks, 

training materials. - Access mode: http://stbcu.com.ua/resources/guidelines/.  

5. Stop TB in Ukraine: books and textbooks. - Access mode: 

http://stoptb.in.ua/uk/tip-publikacii/knigi-ta-pidruchniki.  
6. National Tuberculosis Resource Center http://tb.ucdc.gov.ua/ 

7. Website of the Center for Public Health of the Ministry of Health of Ukraine 

http://phc.org.ua/ 
8. Tuberculosis issues on the WHO website http://www.who.int/tb/en/ 

9. Ukrainian Center for Socially Dangerous Diseases Control of the Ministry of 

Health of Ukraine: online training - Access 

mode:http://tb.ucdc.gov.ua/navchannya-onlayn 
  

http://tb.ucdc.gov.ua/
http://phc.org.ua/
http://www.who.int/tb/en/


 

29  

Appendix 1 

The official website http://www.univer.kharkov.ua/ua/departments 

 

Department of Infectious diseases and clinical immunology 

http://medicine.karazin.ua/departments/kafedra-zagalnoi-ta-klinichnoi- imunologii-ta-

alergologii 

 
  

http://www.univer.kharkov.ua/ua/departments
http://medicine.karazin.ua/departments/kafedra-zagalnoi-ta-klinichnoi-imunologii-ta-alergologii
http://medicine.karazin.ua/departments/kafedra-zagalnoi-ta-klinichnoi-imunologii-ta-alergologii
http://medicine.karazin.ua/departments/kafedra-zagalnoi-ta-klinichnoi-imunologii-ta-alergologii


 

30  

 

Appendix 2 

ELECTRONIC REPOSITORY 

of V. N. Karazin Kharkiv National University 

http://ekhnuir.univer.kharkov.ua/ 

 

 

eKhNUIR - Electronic Kharkiv National University 

Institutional Repository 

Ласкаво просимо до Електронного архіву 

Харківського національного університету імені 

В.Н.Каразіна! 

Електронний архів Харківського національного 

університету імені В.Н. Каразіна наповнюється 

наступними матеріалами: наукові публікації 
працівників та студентів Каразінського 

університету, статті з наукових журналів, 

монографії, дисертаційні матеріали, навчально-
методичні розробки. Наукові публікації студентів 

розміщуються за умови наявності рецензії 

наукового керівника. 

Репозитарій Харківського національного 

університету імені В.Н. Каразіна має власний ISSN 

2310-8665. Тим самим, репозитарій отримав статус 

повноцінного електронного видання (ресурсу, що 
постійно оновлюється), в якому можна публікувати 

результати досліджень як в першоджерелі, нарівні з 

друкованими періодичними виданнями. 

 

                                                    

http://ekhnuir.univer.kharkov.ua/


 

31  

 



Електронне навчальне видання комбінованого використання 
Можна використовувати в локальному та мережному режимі 

 
 
 
 

Потейко Петро Іванович 
Грек Іван Ігорович 

Константиновська Ольга Сергіївна 
Кушнір Василь Борисович 
Лядова Тетяна Іванівна 

Волобуєва Ольга Вікторівна 
 
 
 
 

ВЕДЕННЯ ХВОРИХ НА ТУБЕРКУЛЬОЗ 
У ПОЄДНАННІ З ВІЛ-ІНФЕКЦІЄЮ 

 
Методичні рекомендації 

для самостійної підготовки до практичних занять здобувачів 
вищої медичної освіти 5-го року навчання з дисципліни «Фтизіатрія» 

 

(Англ. мовою) 
 
 
 
 
 
 

 
В авторській редакції 

 
 

 
 
 
 
 

Підписано до розміщення 21.05.2024. Гарнітура Times New Roman. 
Ум. друк. арк. 1,75. Обсяг 0,652 Мб. Зам. № 148/24. 

 
 

Харківський національний університет імені В. Н. Каразіна, 
61022, м. Харків, майдан Свободи, 4. 

Свідоцтво субʼєкта видавничої справи ДК № 3367 від 13.01.2009 
Видавництво ХНУ імені В. Н. Каразіна