The role of HIV co-infection in the severity and evolution of multidrug-resistant tuberculosis.

Abstract

Multidrug-resistant tuberculosis (MDR-TB) combined with HIV infection remains a critical public health challenge in the Republic of Moldova, where overlapping epidemics significantly complicate diagnosis and treatment.   Aim of the study. To describe the epidemiological, clinical, and therapeutic characteristics of patients with TB/HIV co-infection and drug-resistant TB during 2021. Materials and Methods. A retrospective descriptive study was conducted on 160 TB/HIV patients, of whom 57 had drug-resistant TB. Data were extracted from the national SIMETB database and hospital medical records. Results. MDR-TB was confirmed in 82.5% of drug-resistant cases. The majority were young men, socially vulnerable, and unemployed, with frequent behavioral risk factors such as alcohol consumption, smoking, and injection drug use. Most cases were diagnosed passively, at advanced stages, with 49.1% presenting severe immunosuppression (CD4 <200 cells/mm³). Treatment success was achieved in 59.6% of patients, while mortality reached 40.4%. Conclusions. MDR-TB in HIV-positive individuals in Moldova is marked by late diagnosis, severe immunosuppression, and poor outcomes. Strengthening active case-finding, integrating TB/HIV services, and improving adherence support are essential to reduce mortality and improve prognosis.