HIV-Associated Tuberculosis in Russia
The goal of the work was to study the socio-demographic and clinical profile of the patients with TB/ HIV co-infection, as well as the treatment effectiveness to understand what shortcomings in the work of TB and HIV services are needed to be corrected. A retrospective study was performed among 377 patients with dual co-infection TB/HIV between January 2015 and December 2016. TB diagnoses were based on clinical symptoms, sputum microscopy, and radiological analyses. The patients were diagnosed as HIV seropositive by ELISA and by Western blot. Out of 377 individuals with co-infection HIV/TB there were 56.8% of patients with newly diagnosed TB. About 30.8% of individuals with newly diagnosed TB did not know they were HIV-positive and attended the hospital for TB treatment. It was revealed that the most predominant TB-form was disseminated pulmonary tuberculosis in the phase of infiltration/decay both among newly diagnosed HIV positive patients and the HIV/ TB patients registered in specialized care centers-50.5% and 49.7%, respectively. The active TB-form (MbT+) accounted for 40.3%. Cavities in the lungs were revealed in 19.9% of patients. The treatment effectiveness cessation of the Mycobacterium tuberculosis allocation was 75.2% in newly diagnosed TB patients and 55.3% in registered patients. Cavity closure had occurred in 54.1% in patients with newly diagnosed TB and 34.2% in registered patients. Only half of the patients (51.1%) constantly took prescribed medications.
study thus revealed that the majority of patients with TB/ HIV co-infection were maladapted individuals, many of whom abused alcohol (32.1%) and used drugs (18.3%). For those patients was characteristic the significantly reduced motivation for treatment. The treatment effectiveness cessation of the M. tuberculosis allocation was 75.2% in newly diagnosed TB patients and 55.3% in registered patients. Cavity closure had occurred in 54.1% in patients with newly diagnosed TB and 34.2% in registered patients. The results of the therapy were largely determined by the low adherence of patients to treatment – in the total 48.9% of patients were discharged after 2-3 months/or less of their stay in the hospital- and by the high rate of MDR-TB/ XDR-TB (34.2%). The patients' categorical refusal to undergo medical treatment (4.5%) or discontinuation of the HAART shortly after been diagnosed with HIV (50.9%) remains a serious problem and demonstrates poor knowledge about the importance of earlier access to HIV/TB treatment. Evidently there are some aspects of HIV/AIDS which still need clarification through more detailed and specific HIV/TB educational programmes targeting all population groups and aimed at increasing the interest of the population in maintaining their health.
The fact that there were 56.8% HIV-infected patients with newly diagnosed TB indicates insufficient effectiveness of programmes for early TB testing. Also alarming is the fact that about 30.8% of individuals with newly diagnosed TB were not aware of their HIV positive status. The reinforcement of TB diagnosis is necessary among HIV-infected individuals as well as the better interaction between TB and HIV services.