Possibilities and risks of diagnostic chest surgery in HIV-positive patients

Introduction. Differential diagnosis of lung lesions in individuals living with HIV presents significant challenges, as the clinical, radiological, and laboratory findings for various diseases are nonspecific, requiring morphological verification in some cases.

The purpose of this study is to study the feasibility and safety of diagnostic lung surgery in HIV-infected patients with varying immune status.

Materials and Methods. From 2014 to 2023, 404 diagnostic surgical interventions were performed to verify the diagnosis at the Department of Phthisiology of the Kemerovo State Medical University of the Russian Ministry of Health, using clinical data from the I.F. Kopylova Kuzbass Clinical Phthisiopulmonology Medical Center and the Moscow Scientific and Practical Center, including 111 in HIV-infected individuals.

Results. The examination of surgical material allowed us to establish a definitive diagnosis in all 404 patients (100 % success rate). In the study group (HIV+), tuberculosis was the predominant disease, accounting for 69 (62,2 %) cases. Among non-tuberculous diseases (42 patients, 37,8 %), the most common were non-tuberculous mycobacterioses (21,4 %) and non-specific pleurisy (21,4 %). Sarcoidosis accounted for 11,9 % of cases, and lung cancer, up to 14,3 %. In the control group (HIV–), tuberculosis was diagnosed in 141 (48,1 %) patients. Among non-tuberculous processes (152 patients, 51,9 %), lung cancer (34,2 %) and sarcoidosis (17,8 %) predominated.

Conclusion. Modern surgical procedures for diagnosing chest diseases are safe for patients with HIV infection and highly effective for establishing a definitive diagnosis, which is critical for appropriate treatment.

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