Prediction of the development of respiratory tract tuberculosis recurrence in HIV-positive patients
Senin A.M.1, Medvinskiy I.D.2
1ТB dispensary, Yekaterinburg
2Ural research Institute of Phthisiopulmonology, Yekaterinburg
Aim: clarify the risk factors for TB relapse and additional criteria for determining the clinical cure of TB in patients with HIV/TB co-infection.
Patients and Methods: two groups of patients were studied. The 1 group (main) consists of the 1A subgroup — 104 people living with HIV with TB relapse of respiratory organs and 1B subgroup — 101 HIV-negative patients with TB relapse. A comparison of some of their medical and social characteristics and the duration of the period from the moment of ascertainment of clinical cure of tuberculosis to its relapse was made and additional criteria for the assessment of clinical cure of HIV-infected people were found. These proposals were cheсked in the second (test) group of patients with HIV infection (68 people), who in 2012–2013 were diagnosed the clinical cure, and the assessment of the duration of TB remission was carried out in 2018.
Results: relationship between the duration of the remission period, on the one hand, and the state of immune status (CD4+ level) and the efficacy of highly active antiretroviral therapy (HAART), on the other hand, in 1A-subgroup patients. On the basis of the obtained data, additional criteria for establishing clinical cure of tuberculosis in HIV-infected patients were proposed (CD4+ ≥350 cells, effective HAART), which were tested in group II patients with HIV infection.
Conclusion: direct (CD4+ level) and indirect (HAART efficacy) immunodeficiency characteristics in HIV-infected patients have the most significant effect on the duration of remission in tuberculosis. The use of indicators such as «CD4+ (cells/μl) level» and «efficacy of HAART» as additional criteria for establishing clinical cure of tuberculosis is justified.
Keywords: tuberculosis, HIV, coinfection, risk factors, remission, tuberculosis relapse, clinical cure.
For citation: Senin A.M., Medvinskiy I.D. Prediction of the development of respiratory tract tuberculosis recurrence in HIV-positive patients. RMJ. Medical Review. 2019;2(I):18–22.
References
1. Нечаева О.Б., Гордина А.В., Стерликов С.А. и др. Ресурсы деятельности противотуберкулезных организаций Российской Федерации в 2016–2017 гг. (статистические материалы). М.: РИО ЦНИИОИЗ, 2018. [Nechaeva O.B., Gordina A.V., Sterlikov S.A. et al. Resources for the activities of anti-tuberculosis organizations of the Russian Federation in 2016–2017 (statistical materials). M.: RIO FRIHOI; 2018:58–61 (in Russ.)].
2. ВИЧ-инфекция и СПИД: национальное руководство. Под ред. акад. РАМН В.В. Покровского. М.: ГЭОТАР-Медиа; 2013. [HIV and AIDS: national guidelines. Еd. acad. RAMS V.V. Pokrovsky. M.: GEOTAR-Media; 2013 (in Russ.)].
3. Пантелеев А.М. Патогенез, клиника, диагностика и лечение туберкулеза у больных ВИЧ-инфекцией. Дис. … докт. мед. наук. СПб.; 2012. [Panteleev A.M. Pathogenesis, clinic, diagnosis and treatment of tuberculosis in patients with HIV infection. Thesis. SPb.; 2012 (in Russ.)].
4. Сенин А.М., Эйсмонт Н.В. Сравнение особенностей выявления рецидивов туберкулеза у пациентов с ВИЧ-инфекцией и без наличия таковой. Фтизиатрия и пульмонология. 2017;2(15):116–133. [Senin A.M., Eysmont N.V. Comparison of the features of tuberculosis relapse detection in patients with and without HIV infection. Phthisiology and pulmonology. 2017;2(15):116–133 (in Russ.)].
5. Арефьева Э.В. Социально-гигиеническое исследование причин и факторов развития рецидивов туберкулеза по данным мониторинга в субъекте Российской Федерации. Дисс. … канд. мед. наук. М.; 2009. [Arefyeva E.V. Social and hygienic study of the causes and factors of tuberculosis recurrence development according to the monitoring data in the Russian Federation subject. Thesis. M.; 2009 (in Russ.)].
6. Пантелеев А.М. Рецидивы туберкулеза у больных ВИЧ-инфекцией: материалы 9-го съезда фтизиатров России. Туберкулез и болезни легких. 2011;5:97–98. [Panteleev A.M. Relapses of tuberculosis in patients with HIV infection: materials of the 9th Congress of phthisiologists of Russia. Tuberculosis and lung disease. 2011;5:97–98 (in Russ.)].
7. Инструкция о проведении обязательных профилактических медицинских осмотров на туберкулез и порядке допуска к работе в некоторых профессиях лиц, больных туберкулезом (утв. Минздравом СССР от 27.12.1973 N 1142а-73). [The instruction about carrying out obligatory preventive medical examinations on tuberculosis and the order of the admission to work in some professions of the persons sick with tuberculosis» (approved Ministry of health of the USSR of 27.12.1973 N 1142 a-73) (in Russ.)].
8. Зимина В.Н. Совершенствование диагностики и эффективность лечения туберкулеза у больных с ВИЧ-инфекцией при различной степени иммуносупрессии. Дисс. … докт. мед. наук. М.; 2012. [Zimina V.N. Improving the diagnosis and treatment of tuberculosis in HIV patients with varying degrees of immunosuppression. Thesis. M.; 2012 (in Russ.)].
9. ВИЧ-инфекция и СПИД: клинические рекомендации. Под ред. акад. РАМН В.В. Покровского. М.: ГЭОТАР-Медиа; 2010. [HIV infection and AIDS: clinical guidelines. Ed. acad. RAMS V.V. Pokrovsky. М.: GEOTAR-Media; 2010 (in Russ.)].
2. ВИЧ-инфекция и СПИД: национальное руководство. Под ред. акад. РАМН В.В. Покровского. М.: ГЭОТАР-Медиа; 2013. [HIV and AIDS: national guidelines. Еd. acad. RAMS V.V. Pokrovsky. M.: GEOTAR-Media; 2013 (in Russ.)].
3. Пантелеев А.М. Патогенез, клиника, диагностика и лечение туберкулеза у больных ВИЧ-инфекцией. Дис. … докт. мед. наук. СПб.; 2012. [Panteleev A.M. Pathogenesis, clinic, diagnosis and treatment of tuberculosis in patients with HIV infection. Thesis. SPb.; 2012 (in Russ.)].
4. Сенин А.М., Эйсмонт Н.В. Сравнение особенностей выявления рецидивов туберкулеза у пациентов с ВИЧ-инфекцией и без наличия таковой. Фтизиатрия и пульмонология. 2017;2(15):116–133. [Senin A.M., Eysmont N.V. Comparison of the features of tuberculosis relapse detection in patients with and without HIV infection. Phthisiology and pulmonology. 2017;2(15):116–133 (in Russ.)].
5. Арефьева Э.В. Социально-гигиеническое исследование причин и факторов развития рецидивов туберкулеза по данным мониторинга в субъекте Российской Федерации. Дисс. … канд. мед. наук. М.; 2009. [Arefyeva E.V. Social and hygienic study of the causes and factors of tuberculosis recurrence development according to the monitoring data in the Russian Federation subject. Thesis. M.; 2009 (in Russ.)].
6. Пантелеев А.М. Рецидивы туберкулеза у больных ВИЧ-инфекцией: материалы 9-го съезда фтизиатров России. Туберкулез и болезни легких. 2011;5:97–98. [Panteleev A.M. Relapses of tuberculosis in patients with HIV infection: materials of the 9th Congress of phthisiologists of Russia. Tuberculosis and lung disease. 2011;5:97–98 (in Russ.)].
7. Инструкция о проведении обязательных профилактических медицинских осмотров на туберкулез и порядке допуска к работе в некоторых профессиях лиц, больных туберкулезом (утв. Минздравом СССР от 27.12.1973 N 1142а-73). [The instruction about carrying out obligatory preventive medical examinations on tuberculosis and the order of the admission to work in some professions of the persons sick with tuberculosis» (approved Ministry of health of the USSR of 27.12.1973 N 1142 a-73) (in Russ.)].
8. Зимина В.Н. Совершенствование диагностики и эффективность лечения туберкулеза у больных с ВИЧ-инфекцией при различной степени иммуносупрессии. Дисс. … докт. мед. наук. М.; 2012. [Zimina V.N. Improving the diagnosis and treatment of tuberculosis in HIV patients with varying degrees of immunosuppression. Thesis. M.; 2012 (in Russ.)].
9. ВИЧ-инфекция и СПИД: клинические рекомендации. Под ред. акад. РАМН В.В. Покровского. М.: ГЭОТАР-Медиа; 2010. [HIV infection and AIDS: clinical guidelines. Ed. acad. RAMS V.V. Pokrovsky. М.: GEOTAR-Media; 2010 (in Russ.)].
This work is licensed under a Creative Commons «Attribution» 4.0 License.
Previous article
Next article
