English: Background: Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV). Lymphogenic tuberculosis (tuberculous lymphadenitis) is the most common form of extrapulmonary TB in this cohort. Diagnosis is often delayed due to atypical clinical presentations and low sensitivity of conventional smear microscopy. This study evaluates the diagnostic utility of modern imaging (Ultrasound, CT) combined with molecular assays (GeneXpert) and histopathology for early detection. Methods: A prospective diagnostic study involving 120 HIV-positive patients presenting with lymphadenopathy was conducted at the Andijan Regional Center of Phthisiology. Patients underwent a stepwise diagnostic algorithm: High-resolution Ultrasound (US), Computed Tomography (CT), and Ultrasound-guided Fine Needle Aspiration Cytology (FNAC). Aspirates were tested using GeneXpert MTB/RIF. Excisional biopsy was performed in inconclusive cases. Results: Ultrasound features such as hypoechoic texture, matting, and intranodal necrosis had a sensitivity of 78% for TB lymphadenitis. CT was superior for detecting deep mediastinal and abdominal lymphadenopathy. GeneXpert MTB/RIF on lymph node aspirates demonstrated a sensitivity of 85% and specificity of 96%, significantly outperforming smear microscopy (25%). Histological analysis confirmed diagnosis in seronegative cases, revealing characteristic caseating granulomas, though granuloma formation was poor in severely immunocompromised patients (CD4 <200). Conclusion: A multimodal approach integrating US-guided aspiration with molecular PCR testing (GeneXpert) allows for rapid and accurate early diagnosis of lymphogenic TB in HIV patients, facilitating timely initiation of ART and anti-TB therapy.

HIV-associated tuberculosis, tuberculous lymphadenitis, GeneXpert MTB/RIF, ultrasound diagnostics, computed tomography, biopsy, differential diagnosis.

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