The actuality of the problem co-infection of HIV and tuberculosis in current epidemiological conditions

Abstract

The aim of the study. The analysis of clinical and epidemiological peculiarities of tuberculosis associated with HIV infection (TB+HIV), in the Tula region for 16 years from 1995 to 2012 to determine priority directions of the prevention and improvement of the quality of medical care. Materials and methods. There was executed the retrospective analysis of 818 inpatient medical records of TB+HIV patients and 645 outpatient medical cards (Tula regional antitubercular dispensary N1). Patients were observed and examined also in the Center for Prevention and Control ofAIDS and Infectious diseases. A study of HIV-associated TB was performed in 7 scientific and practical directions: clinical, radiological, immunological, microbiological, postmortem, statistical. Results and discussion. In the structure of TB+ HIV patients men (73.3%) prevailed, urban residents accounted for 76.76%, there is an increase in the dynamics of the proportion of women from 20.0% (2002) to 34.6% (2011), 83.38% ofpatients were aged of 21-40 years. Social portrait of the patient: the secondary (37.94%) or secondary special (32.65%) education and the lack of constant work (71.32%), 40.88% of the patients had previously been in prison. Two-thirds of patients (66.18%) were HIV infected due to the intravenous use of narcotics, however, during last 6 years of observation (from 2006 to 2012) the proportion of sexual transmission of HIV increased from 18.2% to 39.4%. The sexually transmitted HIV-infected cases most commonly occur in persons older than 41 years as well as in women. In most HIV cases TB appeared to be secondary infection, the average timespan between the onsets of these diseases was 6.3±2.77 years. In examined patients older 50 years HIV and tuberculosis were diagnosed simultaneously at the advanced stage of HIV infection. In 96.18% of cases (654 patients) tuberculosis had pulmonary localization, in most (67.1% of cases, 439patients) it was disseminated, including milliarytuberculosis, followed by infiltrative tuberculosis - 171 patients (26.1% ofpulmonary form cases). In long-term observation there was noted an increase in the proportion of infiltrative tuberculosis in the structure ofpulmonary forms. Conclusion. With taking in consideration the unfavorable epidemic situation, it is quite advisable to perform a comprehensive monitoring of social, medical and other factors, characterizing the patients suffered from TB associated with HIV infection.