Chronic Viral Hepatitis, Tuberculosis, and Hiv as Comorbidity:  From Theory to Practice

Nechaev, V. V.; Иванов, А. К.; Sacra, A. A.; Romanova, Elena S.; Lyalina, L. V.; Pozhidaeva, L. N.

doi:10.22625/2072-6732-2017-9-4-126-132

Cited by 5 publications

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“…С одной стороны, все вышеназванные инфекционные заболевания, как правило, имеют прогрессирующее течение и высокий риск неблагоприятного исхода при отсутствии терапии [1].…”

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“…С другой стороны, лекарственные средства, используемые для противотуберкулезного лечения, для комплексного лечения ВИЧ-инфекции (сочетание антиретровирусной терапии с другими лекарственными средствами) и химиотерапии прямыми противовирусными препаратами (лечение ХВГС), имеют противопоказания и вызывают нежелательные явления, их совместный прием дополнительно потенцирует опасность неблагоприятного лекарственного взаимодействия [1].…”

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“…При лечении коморбидной ВИЧ-инфекции причиной развития токсического гепатита могут стать ко-тримоксазол и такие компоненты АРТ, как невирапин и др. [1,6].…”

Section: результаты и обсуждениеunclassified

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Efficacy of Anti-Tuberculosis Treatment for Drug Resistant Tuberculosis Combined with HIV and Virus Hepatitis C

Ветушко¹,

Скрягина²,

Жаворонок³

et al. 2022

Рецепт

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Преобладание в структуре заболеваемости туберкулезом в Республике Беларусь случаев, вызванных лекарственно-устойчивыми штаммами возбудителя, делает особенно актуальным совершенствование профилактики и лечения заболевания у иммунокомпрометированных лиц, включая пациентов с коморбидными вирусными инфекциями, такими как ВИЧ-инфекция и хронический вирусный гепатит С. Проведен ретроспективный анализ эффективности противотуберкулезного лечения пациентов с тройной коинфекцией – лекарственно-устойчивый туберкулез, ВИЧ-инфекция, хронический вирусный гепатит С (ЛУ-ТБ/ВИЧ/ХВГС), находившихся на лечении в РНПЦ пульмонологии и фтизиатрии в 2016–2020 гг. и продолживших лечение в противотуберкулезных организациях здравоохранения по месту жительства (всего 53 пациента, в том числе 44 мужчины и 9 женщин) с использованием «старых» и «новых» схем лечения. Все пациенты с лекарственно-устойчивым туберкулезом характеризовались наличием бактериовыделения. У 33 (62,3%) пациентов бактериовыделение было установлено при проведении микроскопии и культурального исследования мокроты, у 20 (37,7%) – только при проведении культурального исследования мокроты. Диагноз ВИЧ-инфекции у 24 из 53 пациентов (45,3%) был установлен в течение первого года на момент выявления туберкулеза, у 28 (52,8%) – от 3 до 10 лет, у 1 пациента с впервые выявленным туберкулезом длительность заболевания ВИЧ-инфекцией составила 22 года (1,9%). Установлено, что противотуберкулезные схемы лечения с использованием новых и перепрофилированных лекарственных средств у пациентов с ЛУ-ТБ/ВИЧ/ХВГС по сравнению со «старыми» схемами, применяемыми ранее, были более эффективными по критерию «достижение абациллирования» (в 1,3 раза, χ2=4,908; р=0,027) и характеризовались более низкой летальностью (χ2=4,908; р=0,027) с наличием тенденций более частого развития нежелательных явлений (в 1,1 раза, р>0,05) и более высокой эффективности по критерию «излечен» (в 1,4 раза, или 73,7±7,2%, р>0,05). The predominance of cases caused by drug-resistant strains of the pathogen in the structure of tuberculosis incidence in the Republic of Belarus makes it especially important to improve the prevention and treatment of the disease in immunocompromised individuals, including patients with comorbid viral infections such as HIV infection and chronic viral hepatitis C. A retrospective analysis of the effectiveness of anti-tuberculosis treatment of patients with triple co-infection – drug-resistant tuberculosis, HIV infection, chronic viral hepatitis C, who were treated at the State Institution "Republican Scientific and Practical Center of Pulmonology and Phthisiology" in 2016–2020 and continued treatment in anti- tuberculosis healthcare organizations at the place of residence (a total of 53 patients, including 44 men and 9 women) using "old" and "new" treatment regimens. All patients with drug-resistant tuberculosis were characterized by the presence of bacterial excretion. 33 (62.3%) patients, bacterial excretion was established during microscopy and sputum culture, in 20 (37.7%) – only during sputum culture. The diagnosis of HIV infection in 24 out of 53 patients (45.3%) was established within the first year at the time of detection of tuberculosis, in 28 (52.8%) – from 3 to 10 years, in 1 patient with newly diagnosed tuberculosis, the duration HIV infection was 22 years (1.9%). It was established that anti- tuberculosis treatment regimens with using new and repurposed drugs in DR-TB/HIV/ CVHC patients compared to the "old" regimens used previously were more effective in terms of "achieving abacillation" (by 1.3 times, χ2=4.908; p=0.027) and were characterized by lower mortality (χ2=4.908; p=0.027) with tendencies for more frequent development of adverse events (1.1 times, p>0.05) and higher efficiency according to the criterion "cured" (by 1.4 times or 73.7±7.2%, p>0.05).

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Efficacy of Anti-Tuberculosis Treatment for Drug Resistant Tuberculosis Combined with HIV and Virus Hepatitis C

Ветушко¹,

Скрягина²,

Жаворонок³

et al. 2022

Рецепт

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Results of implementation of viral hepatitis B elimination program in the North-West Russia

Лялина

Эсауленко

Хорькова

et al. 2021

Russian Journal of Infection and Immunity

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Introduction. Vaccination contributed to reduce the incidence of acute hepatitis B in the territories of the North-West Russia. The urgency of this problem remains due to the high incidence of chronic hepatitis B. This accounted for the need to develop a hepatitis B elimination program in the district discussed that was approved in 2013 by the head of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing. Objective is to characterize the results of the program for the elimination of acute hepatitis B virus implemented in the North-Western Federal District. Materials and methods. The 2010–2020 incidence rate of acute and chronic hepatitis B virus (HBV) infection in the regions of the North-West Russia was carried out. To determine HBV genotypes and subgenotypes, 160 blood plasma samples from patients with acute hepatitis B were studied using molecular genetic methods (PCR, sequencing). The prevalence of latent hepatitis B in various population groups was assessed. The 2016–2020 hepatitis B vaccination coverage and relevant serological monitoring in adults was carried out. Results. While implementing the program, it was found that the incidence rate of acute hepatitis B in the district decreased by 4.5-fold, revealing in 2020 no cases of the disease in 5 regions, with incidence rate in the 6 subfederal units being lower than 1.0 per 100,000 population. Moreover, the incidence rate for chronic hepatitis B decreased by 2.6 times. The 2020 vaccination coverage of children under 17 and adults in all territories comprised more than 95% and 90%, respectively. In addition, it was shown the circulation of genotypes D and A of hepatitis B virus is dominated by genotype D (91.8%), subgenotype D2 (47.8%). The prevalence of latent hepatitis B among migrants was 6.5%, pregnant women — 4.9%, hemodialysis patients — 1.7%. Conclusion. Implementation of the program on elimination of acute viral hepatitis B in the territory of the North-West Russia contributed to raise in the vaccination coverage in adult population and lowered incidence rate of acute and chronic HBV infection.

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Selected clinical and epidemiological features of tuberculosis coinfection, infection caused by human immunodeficiency virus and viral hepatitis

Dantsev,

Karpushchenko,

Lascheva

et al. 2023

Bulletin of the Russian Military Medical Academy

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The study estimated the prevalence of human immunodeficiency virus infection and viral hepatitis in patients admitted to the tuberculosis hospital in 20182020. Among patients admitted for the treatment of tuberculosis, 36.8% had human immunodeficiency virus infection. Markers of viral hepatitis were also detected in 78.8% of patients with human immunodeficiency virus infection associated with tuberculosis. The most common coinfection was tuberculosis human immunodeficiency virushepatitis C, which was confirmed in 28.2% of the admitted patients. Clinical, X-ray, laboratory, and sonographic indicators were analyzed in 43 patients with tuberculosis having human immunodeficiency virus infection and viral hepatitis in various combinations. All patients were divided into three groups: group 1 included patients with tuberculosis, human immunodeficiency virus infection, and viral hepatitis, group 2 included patients with tuberculosis and human immunodeficiency virus infection, and group 3 included patients with tuberculosis and viral hepatitis. Anti-tuberculosis therapy was prescribed to all patients based on the spectrum of drug sensitivity of Mycobacterium tuberculosis, and when a human immunodeficiency virus infection was detected, antiretroviral therapy was prescribed during the first 2 weeks. Patients with viral hepatitis, if indicated, were prescribed hepatoprotective drugs. Control laboratory tests were conducted once every 2 months or more often in the presence of indications. Groups 1 and 2 were more likely to have multiple organ involvement and generalized forms, which determined the severity of the clinical course. In group 1, the activity of alanine aminotransferase and aspartate aminotransferase exceeded the normal limits upon hospital admission. Bilirubin levels were significantly higher in group 3 than in groups 1 and 2. The analysis of sonographic characteristics revealed increased size of the right liver lobe in all groups, without statistically significant differences between the groups. Adverse hepatotoxic reactions were reported in 5 (33.3%) patients of group 1, 4 (26.6%) of group 2, and 4 (30.7%) of group 3. The main manifestations of these reactions were pain in the right hypochondrium and increased activities of alanine aminotransferase and asparate aminotransferase. Patients with hepatotoxic reactions were prescribed hepatoprotective drugs, which made it possible to avoid the cancellation of complex etiotropic therapy

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Chronic Viral Hepatitis, Tuberculosis, and Hiv as Comorbidity: From Theory to Practice

Cited by 5 publications

References 1 publication

Efficacy of Anti-Tuberculosis Treatment for Drug Resistant Tuberculosis Combined with HIV and Virus Hepatitis C

Efficacy of Anti-Tuberculosis Treatment for Drug Resistant Tuberculosis Combined with HIV and Virus Hepatitis C

Results of implementation of viral hepatitis B elimination program in the North-West Russia

Selected clinical and epidemiological features of tuberculosis coinfection, infection caused by human immunodeficiency virus and viral hepatitis

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