The article presents the data on the formation of the WHO global statistics on tuberculosis with concurrent HIV infection, which is given in the Global TB Reports. The information published on this issue in the WHO Global Reports for the WHO regions and countries of the world is compared to the data in the relevant reporting forms in the Russian Federation. The article contemplates the estimate of the main rates reflecting HIV infection prevalence among TB patients and mortality in TB/HIV patients in the countries of the world and registration of cases of TB/HIV co-infection and deaths of TB/HIV patients due to manifestations of tuberculous infection. The data presented in this article include the comparison of the values estimated by WHO, which are needed for organization of control over TB/HIV transmission, and their registered values in the Russian Federation, various countries of the world and countries of the WHO European Region. The article analyzes the data of the WHO Global Reports on the coverage with regular screening and preventive TB treatment of the people living with HIV and coverage of TB/HIV patients with antiretroviral therapy. When studying the data on treatment outcomes in TB/HIV patients in the WHO regions and the world, it was supposed that obtained results greatly depended on the way of the cohort formation in different countries of the world.

The goal of the study: to find the best approaches to surgical treatment of perforated tuberculous intestinal ulcers in those at the advanced stage of HIV infection. Surgeries in 136 patients suffering from HIV infection and tuberculous intestinal ulcers were analyzed. Patients were divided into four groups depending on the type of surgery and post-operative tactics. In patients with HIV infection and perforated tuberculous intestinal ulcers, resection of the part of intestine with ulcers and delayed anastomosis (after remitting of peritonitis manifestations) or suturing of perforated ulcers, nasointestinal tube placement and programmatic sanitation of abdomen are the best options of surgical treatment, and when they are combined anti-tuberculosis therapy it reduces the number of post-operative complications and mortality.

Goal: to analyze clinical manifestations and treatment efficiency in those suffering from TB/HIV co-infection and chronic hepatitis.

Materials and methods. Medical cards of 129 patients with TB/HIV co-infection treated in TB units of Saratov Region were retrospectively analyzed. Patients were divided into 2 groups: Group 1 included 27 patients with TB/HIV co-infection and chronic hepatites B, C and others, Group 2 included 102 patients with TB/HIV co-infection and without hepatitis.

Results. It was found out that TB/HIV co-infection and hepatitis were the most often registered in the people from 41 to 55 years old, while the highest incidence of TB/HIV co-infection was observed in the younger people – from 21 to 40 years old. There was no significant difference in the clinical forms of tuberculosis, bacillary excretion and destruction of the lung tissue between the Groups. However, bacillary excretion was much more frequent compared to the level of destructive changes in the lungs in patients of both Groups. The patients with TB/HIV co-infection and hepatitis had a confidently higher level of MDR – 64.3% versus 17.3% in the patient with TB/HIV co-infection, which was especially high in the patients concurrently receiving anti-tuberculosis treatment and antiretroviral therapy (ART). The mortality related to HIV was the highest in the Group of patients with TB/HIV co-infection and hepatitis receiving no ART, which was 4 times higher than the same rate in TB/HIV patients without hepatitis.

The goal of the study: to evaluate treatment efficiency of pulmonary tuberculosis patients resistant to rifampicin when treatment was prescribed based on the results of Xpert MBT/RIF. The social and clinical structure was retrospectively analyzed in 165 new pulmonary tuberculosis patients, treated in the in-patient unit of Municipal Clinical Phthisiopulmonary Hospital (Kishineu Mun.). Patients were divided into 2 groups: the main group included 85 patients, in whom the result of Xpert MTB/RIF was positive and resistant to rifampicin, the control group included 80 patients in whom the result of Xpert MTB/RIF was positive and susceptible to rifampicin; certain parameters of the groups were compared. Only 65/80 (81.2%) patients of the control group had a complete treatment course, and 61/85 (71.8%) of the main group, the rest of the patients was lost to follow-up. Evaluation of the outcomes of the complete treatment course showed no confident difference between drug susceptible tuberculosis patients and those resistant to rifampicin, provided that treatment was prescribed with the consideration of Xpert MBT/RIF data.

According to the data of screening with tuberculous recombinant allergen (Diaskintest), 2.2% of children and adolescents in 29 regions of the Russian Federation in 2012-2013 (n = 810,107) belonged to the group facing a higher risk to develop tuberculosis. The frequency of minor forms such as focal tuberculosis (58.3%) increased in adolescents, detected by the test with TRA compared to the other methods: by Mantoux test (16.7%), by fluorography (13.0%) and by self-referral for medical help (10.0%). Screening with TRA allows forming Group VI of dispensary follow-up with the maximum accuracy. Results of Mantoux test and the test with TRA in tuberculosis patients were equitable. However, the test with TRA is more specific versus Mantoux test when used for differential diagnostics of tuberculosis.

In order to detect risk groups for drug-induced liver lesions and to develop the procedure for differential monitoring of liver tests during tuberculosis chemotherapy, a prospective study was performed including 435 new tuberculosis patients. The one-dimensional and regression analysis helped to identify risk factors of drug-induced liver lesions (female sex, poor nutrition, absentation from smoking, history of medicamentous allergy), and based on them scores for risk assessment before the start of chemotherapy were worked out and validated. Drug-induced liver lesions developed in 110 patients (25.3%, 95% CI 21.4-29.6), of them 45 (40.9%) developed liver lesion during first 14 days after the start of chemotherapy. The group facing a higher risk of drug-induced liver lesions developed them after a longer period of time; the number of early liver lesions made 18.5% in the high-risk group, and 6.6% (p = 0.02) in the low-risk group. The procedure of laboratory monitoring depending on the degree of risk was offered for early diagnostics of drug-induced liver lesions.

The goal of the study: to evaluate efficiency and safety of the anti-tuberculosis drug of bedaquiline in the multimodality therapy of patients with HIV-associated tuberculosis with multiple/extensive drug resistance (MDR/XDR).

Materials and methods. 14 patients were treated with the regimens containing bedaquiline. The majority of patients (12; 85.7%) received antiretroviral therapy. 11 (78.6%) patients were diagnosed with the generalized form of tuberculosis affecting two organs and more. All 14 patients were infectious: 2 had MDR TB and 12 had XDR TB, and of them, 11 had XDR TB with resistance to 8-10 anti-tuberculosis drugs.

Results. 12 out of 14 patients completed the intensive phase with administration of bedaquiline. By the end of the first month of treatment intoxication symptoms disappeared in 50.0% of patients, and by the end of the second month, they remitted in 83.5%. The positive X-ray changes were observed in 50% of patients, and they manifested through the partial resolution of focal infiltrate changes in the lungs. Cessation of bacillary excretion was documented by the end of the second month in 6 patients, by the end of the 3rd month in 1 patient, by the end of the 6th month in 3 patients, totally in 10 out of 12 patients (83.3%). During treatment, all patients had an electrocardiogram, and none of them had prolongation of QT interval.

The goal of the study: to evaluate changes in localizations, prevalence and clinical forms of tuberculosis in children over a 30-year period of follow-up.

Materials and methods. Documents on the treatment of 2,306 children in the age from 0 to 14 years old treated from 1985 to 2015 in Specialized Children Tuberculosis Clinical Hospital were analyzed. The following was analyzed: the age of patients, the structure of clinical forms of tuberculosis and changes in them, level of extrapulmonary and generalized tuberculosis, the frequency of bacillary excretion, and complications.

Results. In 2006-2015 in Omsk Region there was 21.6% increase in the number of children of the tender age who fell with TB, infiltrate tuberculosis in the structure of all forms increased from 1 to 7%, complications of tuberculosis – from 4.5 to 8.0%, bacillary excretion from 3.2 to 6.4%, generalized forms – from 2.9 to 7.2% with rare cases of meningitis. Extrapulmonary tuberculosis was registered confidently rarer compared to previous decades.

The clinical case demonstrates the cure of pulmonary tuberculosis with multiple drug resistance and massive bilateral cavities in a female patient of 31 years old with a severe disorder of pulmonary ventilation of the mixed type, hypoxemic respiratory failure, post-tuberculosis bullous changes in both lungs. Treatment lasted for 4 years. Treatment included anti-tuberculosis chemotherapy, artificial pneumoperitoneum, three endobronchial valves in the bronchi for draining of massive cavities and extrapleural sealing with silicon plug.