DIAGNOSTIC SURGERY IN HIVINFECTED PATIENTS WITH DAMAGE OF CHEST ORGANS

Abstract

The current epidemiological situation in the world, characterized by a constant increase in the number of HIV-infected. The steady progression of HIV infection, even in the presence of antiretroviral therapy (ART), is accompanied by the development of opportunistic diseases. Tubercolosis most often affects patients with HIV infection, as the risk of their illness is 20–37 times higher. Basically, radiation tests and immunological tests are used for the diagnostic of tuberculosis. The main diagnostic criterion for establishing the diagnosis of tuberculosis is detection of the causative agent (Mycobacterium tuberculosis by bacteriological or molecular genetic method. Other diseases with respiratory organs, pleura, and hilar lymph nodes may also occur In patients with HIV infection, which requires differential diagnostic, including surgical methods. It is often necessary to resort to a biopsy of pulmonary tissue, pleura, and hilar lymph nodes to establish a diagnosis. Among surgical methods, the use of minimally invasive operations using endoscopic techniques is most justified. Purpose of the study. Study of safety and effectiveness of the use of surgical methods in the diagnostic of chest diseases in patients with HIV infection. Materials and methods. The results of 105 diagnostic thoracic surgeries in patients with HIV infection which were performed in Moscow Research andClinicalCenterfor Tuberculosis Control of Moscow city Department in period between 2014–2017 were studied. All patients underwent diagnostic surgical interventions. Minimally invasive methods were predominantly used. The obtained diagnostic material was subjected to morphological, molecular-genetic and bacteriological analysis. Results of the research. After surgical interventions in patients with HIV infection with pathological changes in chest organs, unclear etiology, diagnosis of tuberculosis was established in 74 (70,5%) patients, nontuberculous etiology of the disease was detected in 31 (29,5%). Differential diagnosis of chest diseases in patients with HIV infection is an integral part of the work of phthisiatrician, pulmonologist and infectiologist. Surgical interventions in HIV-infected patients do not create a significant risk of changes in the immune status, respectively, their performance is independent of the level of lymphocytes and produced even with severe immunodeficiency. The use of surgical methods in diagnostic of chest diseases is safe, effective and does not lead to a significant number of complications and mortality in patients with HIV infection, regardless of the initial immune status. In addition, in number of patients, the operation is not only diagnostic, but also therapeutic, allowing significantly shortening the duration of treatment, avoiding the appointment of trial therapy. The conclusion. In case of tuberculosis, morphological verification of pathological changes in combination with bacteriological and molecular genetic research of the operation material makes it possible to assign an adequate regime of antituberculous chemotherapy in accordance with the sensitivity of the pathogen. The establishment of non-tuberculous etiology of the identified changes, changes the routing of an HIV-infected patient from an anti-tuberculosis institution to a specialized medical organization of the appropriate profile.