Пандемия, вызванная распространением вируса иммунодефицита человека (ВИЧ), вызывающего синдром приобретенного иммунного дефицита (СПИД), начавшаяся в конце 70-х годов прошлого века и пока еще не достигшая своего апогея, создала новые серьезные проблемы, или, как теперь выражаются, «вызовы» для здравоохранения всех стран.

The tuberculosis and HIV infection epidemic situation in 2009-2012 was studied. In 2012, the incidence of tuberculosis in HIV-infected patients among the resident population registered in 2012 was 35 times higher, its prevalence at the end of the year was 32 times higher, and its mortality rates were 28 times higher than the average Russian rates. Mortality rates in patients with HIV infection were directly related to the prevalence of tuberculosis in a region.

The impact of HIV infection on the epidemic process in tuberculosis will increase. By 2020, among the first registered tuberculosis patients, there will be as high as 30% with HIV infection in Russia as a whole and as high as 40-50% in individual subjects of the Russian Federation. The procedure and time of prophylactic examinations of HIV-infected patients to detect tuberculosis are not observed although there has been recently an increase in examination coverage (79.4% in 2012). Tuberculosis chemoprophylaxis is made only in late-stage (4B, 4C, and 5) HIV infection only in one-third of the indicated cases.

It is necessary to continue organizational work to set up specialized tuberculosis departments, including that with surgical methods, to treat patients with tuberculosis concurrent with HIV infection. 

In the Republic of Belarus, there is a significant exponential rise in the incidence of HIV-associated tuberculosis (TB) (p < 0.001) and an increase in notified new HIV/TB cases among the new TB cases from 0.68 ± 0.12% in 2002 to 7.0 ± 0.4 in 2012. The concentration of coinfections in the Gomel Region was 60.7 ± 2.0% (95% CI, 56.9-64.6). TB is one of the leading opportunistic infections leading to death in the HIV-infected: there is a significant rise in the proportion of TB in the structure of AIDS mortality (from 16.7% to 2001 to 40.3% in 2012). Cohort analysis reveals that the efficiency of treatment is significantly lower (p < 0,001) in the patients with HIV/TB than in those with TB nonconcurrent with HIV infection (successful treatment cases were twice fewer and mortality was 5-fold).

Among 298 examinees with TB/HIV, there were most (86.2%) male patients aged 25-44 years. Social migrants were 65.7%. The infiltrative (25.8%) and disseminated (23.8%) forms of tuberculosis were common in its clinical structure. Extrapulmomary tuberculosis was diagnosed in 15.4% of cases. There were generalized lesions in 20.1%, including tuberculous meningitis (12.5%). 48.1% of the patients were found to be drug-unresponsive, mainly to isoniazid and rifampicin (59.6%). When CD4 counts were below 200 cells per µl of blood, extensive lung injuries were seen in 69.9%. Death occurred more frequently in disseminated (37.7%) and infiltrative (18.8%) pulmonary tuberculosis: its generalized process was a cause of death in one third of the patients.

The purpose of the investigation was to evaluate the efficiency of delivery of sociopsychological and legal care to former prisoners with tuberculosis concurrent with HIV infection. Examinations were made at the specialized unit of Tuberculosis Hospital Eleven. A total of 240 former prisoners with tuberculosis concurrent with HIV infection were examined. Active tuberculosis had developed in almost half (47.1%) of them when they were in prison and in 12.5% within the first two years after their release. In the remaining 40.4%, the incidence of tuberculosis was unassociated with their being in prison. Sociopsychological care was rendered to all these patients; a social reference was made for each patient and a direction of social rehabilitation was defined for each patient. A set of psychodiagnostic and psychocorrectional procedures traditionally used by medical psychologists when working with this patient contingent was employed to determine the specificity of psychological and behavioral characteristics in these patients. Main sociopsychological characteristics were identified to define the tasks of and volume of work on patient resocialization. As a result, a model was proposed for the multiprofessional interaction of specialists at a specialized hospital: a phthisiatrician, an infectiologist, physicians of other specialties, medical psychologists, social work specialists, a legal adviser, and occupational therapy instructors. The main directions of sociopsychological care, which could increase the efficiency of treatment, by enhancing patient adherence to treatment, were defined. The leading factor that changed attitudes towards treatment was to improve quality of life in patients and their psychoemotional status through resocialization with complete or partial recovery of a patient’s socioeconomic status (documentation, pension provision, and solution of housing problems.

The paper analyzes the structure of HIV-infected children who was ill with tuberculosis in the Sverdlovsk Region in 2004-2012. The incidence of tuberculosis in children aged 0 to 14 years in the Sverdlovsk Region showed a 79.4% increase in the above period due to the introduction of Russian innovative technologies for the diagnosis of this disease in children. At the same time there was a rise in both the number of HIV-infected children aged 0 to 14 years and the proportion of same-age children with late-stage HIV infection. Simultaneously, the incidence of tuberculosis in the non-HIV-infected children aged 0 to 14 years was 55.2-193.2 times lower than that in the HIV-infected children. In 2004-2014, the Sverdlovsk Region notified fewer new cases of tuberculosis among the children without HIV infection than among those with its late stages. Non-HIV-infected children of both sexes were also ill with tuberculosis less frequently than HIV-infected boys and girls. HIV-infected children 1-3 and 7-14 years of age proved to be most vulnerable to tuberculosis. Among those who fell ill with tuberculosis, there was a preponderance of patients with late-stage HIV infection; moreover, the majority (79.6%) received highly active antiretroviral therapy. 63.3% of the cases were in contact with a tuberculosis patient, only every five patients had chemoprophylaxis for this disease. High-quality vaccination against tuberculosis prevented complications and bacterial excretion in children with comorbidity. Out of the clinical forms of tuberculosis in children with HIV infection, there was a predominance of primary tuberculous complex and intrathoracic lymph node tuberculosis. The latter was less common in children without HIV infection than in those with this disease; the same was true of bacterial excretion in respiratory tuberculosis.

The paper gives the results of examination in 322 patients excreting bacteria (148 patients with pulmonary tuberculosis and HIV infection and 174 patients with pulmonary tuberculosis) by culture methods and the 12 locus MIRU-VNTR genotyping (WHO, 2009), by using the open database MIRU-VNTRplus (Weniger T. et al., 2010). Drug resistance in Mycobacterium tuberculosis is encountered in inpatients with tuberculosis and in those with tuberculosis concurrent with HIV infection equally frequently (76.4 and 85.1%, respectively). In patients with tuberculosis and HIV infection, resistance to reserve drugs is seen less frequently than in those with tuberculosis. The Beijing genotype was identified in 76.3% of patients with tuberculosis and HIV infection and in 65.5% of tuberculosis patients without comorbidity. The Beijing MIT17 genotype is associated with multidrug resistance in 48.8% of cases.

In vitro and in vivo preclinical studies of the antituberculosis activity of thiozonide designed at the ZAO “Farn-Sintez” (Moscow) were conducted at the Central Research of Tuberculosis, Russian Academy of Medical Sciences. The in vitro study indicated that thiozonide exerted an antimycobacterial effect that was comparable with the inhibitory activity of isoniazid (INH) and rifampicin (RIF) suppressed the growth of a cultured virulent laboratory M. tuberculosis H37Rv strain that was susceptible to all antituberculosis drugs, a cultured M. tuberculosis CN-40 strain that was monoresistant to INH, and a cultured M. tuberculosis MS-115 strain that was multidrug resistant The in vivo study established that the survival of the experimental animals receiving thiozonide monotherapy did not differ from that of the animals given INH and RIF. Combined therapy with thiozonide and ethionamide (ETH) and that with thiozonide and pyrazinamide (PZA) versus PZA or ETH monotherapy caused a significant increase in the survival of the experimental animals in these groups. M. tuberculosis colonyforming units in the lung of the experimental mice taking thiozonide suggested that the drug administered in vivo in a dose of 25 mg/kg produced an effective antituberculous effect that was comparable with those in the lung of the animals receiving RIF in the same dose.

Clinical, X-ray, and bacteriological analyses versus a morphological examination of the following organs: meninges, lung, liver, spleen, adrenal glands, pancreas, heart, and mesenteric lymph nodes in 29 deceased patients with respiratory tuberculosis concurrent with HIV infection of mainly stages 4C and 5 show the particular severity of tuberculosis, a tendency towards a generalized process involving the majority of vital organs, morphologically characterized principally by an exudative and necrotic process with a preponderance of leukocyte infiltration without a tendency towards productive inflammation.

This all causes death in patients. To improve the prognosis of tuberculosis in HIV-infected people, there is a need for the timely diagnosis of tuberculosis at HIV centers, antituberculosis therapy, and, if indicated, chemoprophylaxis. 

HIV infection concurrent with tuberculosis continues to remain an important health problem leading to high fatality rates. This paper analyzes 63 autopsy cases of tuberculosis concurrent with HIV in those who died at the Botkin Clinical Infectious Diseases Hospital in 2012 and 63 cases of the same lesions in those who died at Irkutsk somatic hospitals in 2008-2012. Tuberculosis is shown to be a leading cause of death in 51.6% of the HIV cases in Saint Petersburg. The clinical diagnosis was not verified in some cases. At present there are no absolutely valid methods for the detection of mycobacteria in tissues. The clinical and morphological manifestations of tuberculosis were highly diversified and were mainly generalized forms and did not often fit in the existing classifications. Of great importance were lesions to the central nervous system (22.4%) and intestine (15.3%), which are not virtually recognized clinically. According to the Irkutsk data, there was a preponderance of strains belonging to the Beijing genotype (70%). Assessing the mycobacterial genotype and accounting the whole complex of mixed infections are noted to be important among the promising problems to be studied.

A simple prospective investigation studied the efficacy of reamberine used to prevent antituberculosis drug-induced hepatitis in 144 patients with new-onset infiltrative pulmonary tuberculosis who were divided into 2 groups: 1) those who received a 1-2-week reamberine cycle (a study group) and 2) those who did not (a comparison group). In the study group, arrest of the symptoms of intoxication (by the leukocyte index by 35.3%) occurred in a shorter periods; drug-induced hepatitides, whose course was more favorable, were noted to develop less commonly (16.6 versus 36%). In the study group, therapeutic effectiveness was higher than that in the comparison group in terms of both the decay cavity closure index (by 30.2%) and the bacterial cessation index (by 24.8%), including in patients with multidrug-resistant in the pathogen, decay cavities were closed 13.9% more frequently and bacterial excretion cessation was seen 27.8% more often; transformation to fibrocavernous tuberculosis was also observed less commonly. The findings allow one to recommend the use of reamberine as an agent for the prevention of hepatitis caused by the intake of antituberculosis drugs during patients’ adaptation to chemotherapy (1-2weeks of treatment).

Среди социально значимых инфекций туберкулез и ВИЧ-инфекция играют ведущую роль. Ситуация по туберкулезу имеет неблагоприятный прогноз в связи с неуклонным ростом мультирезистентного туберкулеза. Своевременное назначение IV режима химиотерапии больным туберкулезом с впервые выявленной множественной лекарственной устойчивостью микобактерий туберкулеза (МЛУ МБТ) позволяет в короткие сроки добиться рассасывания инфильтративных изменений и закрытия полостей распада. А. С. Борзенко и др. подчеркивают, что эффективность лечения больных туберкулезом с первичной МЛУ МБТ зависит не только от химиотерапии, но и от соблюдения больничного режима [2]. Также эффективность лечения больных туберкулезом с МЛУ МБТ повышается при применении методов коллапсотерапии [3, 7].

Эпидемическая ситуация по туберкулезу (ТБ) и ВИЧ/СПИДу в Европейском регионе ВОЗ (ЕР) остается напряженной. Хотя число впервые выявленных ТБ в ЕР составляет всего 5,6% от глобального бремени, их число в 2009 г. достигло 329 391, а число умерших от ТБ составило 46 241, 85 и 92% соответственно в 18 высокоприоритетных странах ЕР (ВПС)1 . С 2005 г. наметилась благоприятная тенденция к снижению показателя регистрационной заболеваемости ТБ (впервые выявленные больные и рецидивы). Однако в 18 ВПС регистрируемая заболеваемость ТБ (73 на 100 тыс. населения) в 8 раз превышает этот показатель по сравнению с остальными странами ЕР (9,2 на 100 тыс. населения) и вдвое выше среднерегионального (36,8 на 100 тыс. населения). Данные официальной статистики свидетельствуют о драматическом распространении ВИЧ – в ЕР выявлено 53 427 человек, инфицированных ВИЧ.