The continuous flow of new research articles on MDR-TB diagnosis, treatment, prevention and rehabilitation requires frequent update of existing guidelines. This review is aimed at providing clinicians and public health staff with an updated and easy-to-consult document arising from consensus of Global Tuberculosis Network (GTN) experts.The core published documents and guidelines have been reviewed, including the recently published MDR-TB WHO rapid advice and ATS/CDC/ERS/IDSA guidelines.After a rapid review of epidemiology and risk factors, the clinical priorities on MDR-TB diagnosis (including whole genome sequencing and drug-susceptibility testing interpretations) and treatment (treatment design and management, TB in children) are discussed. Furthermore, the review comprehensively describes the latest information on contact tracing and LTBI management in MDR-TB contacts, while providing guidance on post-treatment functional evaluation and rehabilitation of TB sequelae, infection control and other public health priorities.
В статье представлены сведения о формировании мировой статистики ВОЗ по туберкулезу, сочетанному с ВИЧ-инфекцией (ТБ/ВИЧ-и), которая приведена в глобальных отчетах по туберкулезу� Информация, публикуемая по данному вопросу в глобальных отчетах ВОЗ для регионов ВОЗ и стран мира, сравнивается с данными, приводимыми в соответствующих отчетных формах Российской Федерации� Рассматриваются вопросы оценки основных показателей распространения ВИЧ-инфекции среди больных туберкулезом и смертности боль-ных ТБ/ВИЧ-и в странах мира и регистрации случаев заболевания ТБ/ВИЧ-и и смерти больных ТБ/ВИЧ-и от проявлений туберкулезной инфекции� Данные, приводимые в статье, включают сравнение значений оценки ВОЗ показателей, необходимых при организации контроля распространения ТБ/ВИЧ-и, и их регистрируемых значений, полученных для РФ, различных стран мира и стран Европейского региона ВОЗ� Проводится анализ данных глобальных отчетов ВОЗ по охвату систематическим скринингом для выявления туберкулеза и превентивной терапией туберкулеза лиц, живущих с ВИЧ-инфекцией, и охвату антиретровирусной терапией больных ТБ/ВИЧ-и� При изучении сведений об исходах лечения больных ТБ/ВИЧ-и в регионах ВОЗ и странах мира выдвинуто предположение о существенной зависимости полученных результатов от способа формирования изучаемых когорт в разных странах� ключевые слова: туберкулез, бремя туберкулеза, ВИЧ-инфекция, сочетание туберкулеза и ВИЧ-инфекции, глобальный отчет ВОЗ, оценка ВОЗ эпидемиологических показателей 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�
ГБУЗ «Московский городской научно-практический центр борьбы с туберкулезом Департамента здравоохранения города Москвы», Москва, Россия Проведена оценка влияния распространения ВИЧ-инфекции на показатель заболеваемости туберкулезом в условиях мегаполиса по ин-формации из регистра мониторинга туберкулеза за 2015-2016 гг� Результаты исследования показали, что среди больных туберкулезом в сочетании с ВИЧ-инфекцией чаще, чем среди остальных больных туберкулезом, встречаются пациенты из постоянного населения города, из возрастной группы 31-40 лет, мужчины, неработающие, с отсутствием распада легочной ткани и наличием диссеминированной формы туберкулеза легких, для них также характерен факт пребывания ранее в заключении� Значительная доля этих больных имеют локализацию заболевания во внутригрудных лимфоузлах� Несмотря на общее снижение доли больных с ВИЧ-инфекцией среди больных туберкулезом в Москве, полученные данные указывают на значимое влияние сочетанной ВИЧ-инфекции на показатели заболеваемости туберкулезом и на состав впервые выявленных больных туберкулезом� Ключевые слова: ВИЧ-инфекция, туберкулез, мониторинг Для цитирования: Богородская Е� М�, Синицын М� В�, Белиловский Е� М�, Борисов С� Е�, Котова Е� А� Влияние ВИЧ-инфекции на струк-туру впервые выявленных больных туберкулезом, зарегистрированных в городе Москве // Туберкулёз и болезни лёгких� -2017� -Т� 95, № 10� -С� 17-26�
Aim. Study of the current state of problems of treatment of patients with tuberculosis based on literature data and their own experience. Materials and methods. In the Russian Federation, the number and proportion of patients with co-infection with HIV/tuberculosis continues to increase against the background of improvement in the main epidemiological indicants for tuberculosis. In 2017, 20.9% of newly diagnosed tuberculosis patients had HIV infection. The combination of the two infections significantly complicates the further improvement of the situation with tuberculosis, and the appearance of drug-resistant strains of Mycobacterium tuberculosis sometimes completely neutralizes the results of chemotherapy. The article describes the schemes of modern tuberculosis chemotherapy taking into account HIV/tuberculosis co-infection, as well as MDR in combination with surgical treatment methods, as well as analyzes the data of epidemiological monitoring of treatment of 1115 tuberculosis patients newly diagnosed in 2017 in Moscow, 360 tuberculosis patients with MDR MBT (cohort 20132014), the results of treatment with the use of new chemotherapy regimens for tuberculosis (bedaquiline, linezolid, moxifloxacin) in 36 patients, the effectiveness and safety of surgical methods in 192 patients. Results. The application of new individualized anti-TB chemotherapy schedules in patients with HIV co-infection/tuberculosis with MDR-MBT has allowed to improve the treatment efficacy. The surgical intervention combined with modern chemotherapy regimens in patients with HIV/tuberculosis co-infection with MDR MBT has been proved to be effective and safe, contributes to the improving the results of treatment for this category of patients. Conclusion. The confluence of two global problems of co-infection HIV/TB and MDR TB, significantly prevents from the end of the tuberculosis epidemic in the world. At the same time, advances in the development and implementation of new anti-TB drugs and surgical treatment methods give hope for significant progress for resolving this situation.
Women living with HIV-1 are at high risk of infection with human papillomavirus of high carcinogenic risk (HR HPVs). M. tuberculosis (TB) promotes HPV infection and increases the risk to develop HPV-associated cancer. Our knowledge of persisting HR HPVs genotypes, and of the factors promoting HR HPV infection in people living with HIV-1 with clinical TB manifestations is sparse. Here, we analyzed 58 women living with HIV-1 with clinical TB manifestations (WLWH with TB) followed up in specialized centers in Russia, a middle income country endemic for HIV-1 and TB, for the presence in cervical smears of DNA of twelve HR HPV genotypes. DNA encoding HPV16 E5, E6/E7 was sequenced. Sociodemographic data of patients was collected by questionnaire. All women were at C2-C3 stages of HIV-infection (by CDC). The majority were over 30 years old, had secondary education, were unemployed, had sexual partners, experienced 2–3 pregnancies and at least one abortion, and were smokers. The most prevalent was HPV16 detected in the cervical smears of 38% of study participants. Altogether 34.5% of study participants were positive for HR HPV types other than HPV16; however, but none of these types was seen in more than 7% of tested samples. Altogether, 20.7% of study participants were positive for several HR HPV types. Infections with HPVs other than HPV16 were common among WLWH with generalized TB receiving combined ART/TB-therapy, and associated with their ability to work, indirectly reflecting both their health and lifestyle. The overall prevalence of HR HPVs was associated with sexual activity of women reflected by the number of pregnancies, and of HPV 16, with young age; none was associated to CD4+-counts, route of HIV-infection, duration of life with HIV, forms of TB-infection, or duration of ART, characterizing the immune status. Thus, WLWH with TB—especially young—were predisposed to infection with HPV16, advancing it as a basis for a therapeutic HPV vaccine. Phylogenetic analysis of HPV16 E5, E6/E7 DNA revealed no common ancestry; sequences were similar to those of the European and American HPV16 strains, indicating that HPV vaccine for WLWH could be the same as HPV16 vaccines developed for the general population. Sociodemographic and health correlates of HR HPV prevalence in WLWH deserve further analysis to develop criteria/recommendations for prophylactic catch-up and therapeutic HPV vaccination of this highly susceptible and vulnerable population group.
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