Tuberculosis in patients with different HIV-status in Novokuznetsk

Goal. To study the results of treatment for newly diagnosed tuberculosis in patients with different HIV status. Materials and methods. A retrospective study of all new TB cases among adults (n = 1036) registered in 2013-2014: 664 patients with HIV-free tuberculosis (TB) and 372 patients with HIV (HIV) and TB. Results. The average age of the patients was 39 ± 13 years; of men was 63.8% (n = 661). The median number of CD4-lymphocytes was 185 cells / jl (0-2064 cells / jl). most patients with HIV and (69.8%, n = 260) did not receive antiretroviral therapy. TB in HIV-1 and more often than in patients without HIV and was detected by treatment (74.7%, n = 278 vs. 49.4%, n = 328) (P <0.001), and among the clinical forms more often disseminated TB (43.1%, n = 156 vs 15.8%, n = 103) (P <0.001). Bacteriovenectomy by any of the methods for HIV and / or TB was detected more often than in patients without HIV without TB (72.1%, n = 261 vs 54.7%, n = 356) (P <0.0001), including number when sowing on dense nutrient media (64.1%, n = 232, vs 46.0%, n = 299) (P <0.001). For HIV and TB with preserved drug sensitivity, it was less common (31.9%, n = 67 vs 50.9%, n = 137) (P <0.001), and with primary multidrug resistance (MDR) 1.5 times more often than with monoinfection (51.4% and 33.5%, respectively) (P <0.001). In the absence of data on drug resistance, patients were treated with drugs of the main series. Treatment of MDR TB was conducted 64.4% (n = 58) in patients with TB and 42.6% (n = 46) with HIV and / or TB patients; in the remaining cases, MDR preparations of the reserve were not assigned because of refusal, lack of commitment or obtaining information about drug resistance after death. Cure for HIV / TB was less frequent than with monoinfection of TB (38.2% vs 61.7%) (P <0.001), and the share of deaths from all causes in HIV-TB was significantly higher (40.9% % vs 12.1%) (p <0.001). The conclusion. In patients with HIV, tuberculosis in most cases was detected during treatment, they were more often registered with bacterial excretion and primary MDR, and the effectiveness of treatment for HIV and / or TB was significantly lower than in patients with negative HIV status, mainly due to high mortality.

туберкулез, ВИЧ-инфекция, бактериовыделение, множественная лекарственная устойчивость, tuberculosis, HIV infection, bacterial excretion, multiple drug resistance

1. World Health Organizations (WHO). Global Tuberculosis Report 2015. Geneva: WHO; 2015.

2. Нечаева О. Б. Эпидемическая ситуация по туберкулезу среди лиц с ВИЧ-инфекцией в Российской Федерации. //Туберкулёз и болезни лёгких - 2017. - 95(3). - С.13-19. doi.10.21292/2075-1230-2017-95- 3-13-19

3. Teshome Kefale A., Anagaw Y.K. Outcome of tuberculosis treatment and its predictors among HIV infected patients in southwest Ethiopia. // International Journal of General Medicine. - 2017. -10. - С.161-169. doi:10.2147/IJGM.S135305.