LETAL OUTCOMES IN PATIENTS WITH HIV INFECTION, PARALLELS WITH ADEQUACY OF DIAGNOSTICS, DISPENSER AND TREATMENT

Abstract

The goal is to consider the lethality as an indicator of the adequacy and success of timely detection, clinical examination and treatment of patients with HIV infection. Materials and methods. A retrospective analysis of 913 deaths of HIV-infected patients in the Novgorod Region was carried out for the period from 2001 to 2017. The study included patients with previously known HIV status and patients with newly diagnosed HIV infection. Age, time (from the time of detection of HIV infection to death), clinical (causes of deaths) and other characteristics were taken into account. The conclusion. Every year, the number of deaths of HIV-infected patients increases, while the number of deaths diagnosed with AIDS is increasing yearly. The structure of deaths is dominated by cases caused by severe immunosuppression, which is a characteristic feature of this stage of the epidemic. The most likely cause of increased mortality is the late onset of treatment, low coverage of therapy and a large number of late-identified patients. The age structure of the deceased is dominated by persons 30–39 years old. The main cause of death is tuberculosis. The increase in deaths from tuberculosis depends on the number of patients with unstable social status. Other common causes of death are bacterial infections (pneumonia, sepsis, etc.), malignant neoplasms, toxoplasmosis, pneumocystis pneumonia. A similar structure of deaths is associated with late diagnosis and atypical course (rapid progression) of tuberculosis. Among the causes of death not related to HIV, a significant proportion is occupied by viral hepatitis in the cirrhotic stage, cardiovascular diseases, malignant neoplasms, drug overdoses, alcohol poisoning. The annual increase in lethal outcomes in the region is due to inadequate coverage and late onset of ARVT, a low percentage of prevention of opportunistic diseases at a critically low level of CD4 cells, weak adherence to medical examination and treatment. To increase the life expectancy of HIV-infected people, it is necessary to improve and expand programs for the prevention and treatment of HIV infection.