THE COURSE OF A COMBINATION OF HIV INFECTION, TUBERCULOSIS, KAPOSI’S SARCOMA IN A PATIENT WHO ARRIVED FROM THE PENITENTIARY SYSTEM (CLINICAL CASE)
The article discusses the problems of polymorbidity in HIV infection, the causes of the unfavorable course of combined diseases, and the influence of social factors on the outcome of diseases. An epidemic variant of Kaposi's sarcoma develops against the background of immunosuppression and is a clinical marker of AIDS. In the first years of the pandemic, it occurred in every third patient and was one of the most common AIDS indicator diseases. In recent years of the HIV and AIDS epidemic, the incidence of Kaposi's sarcoma has decreased by more than 10 times. The course of HIV-associated Kaposi's sarcoma can vary, from long-term stable, lasting for years, to progressive, leading to the patient's death in a few months. The introduction of ARV therapy into practice has also changed the clinical course of Kaposi 's sarcoma, its forms with aggressive malignant course are now rare. However, they do occur. A clinical case of a combination of HIV infection, tuberculosis, Kaposi's sarcoma in a patient who arrived from the penitentiary system is presented. It is emphasized that social status and social maladaptation, including stay in prison, has a significant impact on the outcome of combined pathology, along with other aggravating factors. In a patient who has previously had tuberculosis, from the moment of HIV detection to the manifestation of Kaposi’s sarcoma, 4 years passed, from the appearance of the first signs of Kaposi's sarcoma to the fatal outcome - 4 months. The clinical case demonstrates the difficulties of differential diagnosis of disseminated pulmonary tuberculosis with Kaposi's sarcoma in a patient with severe immunodeficiency due to HIV; and reflects the influence of social factors on the rapidly progressive course of the combined pathology.