The paper gives the results of examining 163 autopsy cases of tuberculosis in Irkutsk. The forms of the disease are characterized, by identifying generalized large focal necrotic focal tuberculosis. MIRU-VNTR genotyping defined M. tuberculosis genotypes and established the leading role of the Beijing genotype (65%) in the development of the most severe generalized alterative and exudative changes. 48% of all generalized large focal tuberculosis cases were shown to be HIV-infected. A DS-SIGN gene polymorphism at the -336 A/G position was studied; the most unfavorable combination of AG or GG polymorphism (in 84% of cases) was shown in a patient with the M. tuberculosis Beijing genotype. Not only the patient's immune status, but also the genotypes of mycobacteria and the host affect the most unfavorable course of tuberculosis with the development of generalized alterative and exudative lesions.