Specific Features of Tuberculosis Relapses in Hiv Infected Patients

The objective: to analyze treatment efficacy and causes of tuberculosis relapses in HIV-infected patients with severe immunosuppression who have started antiretroviral therapy (ART). Subjects and methods. 139 case histories were studied, those case history belonged to the patients with TB/HIV co-infection and CD4 count below 100 cells/μl, a median of 33.2 cells/μl – 4.2%, who started ART in the in-patient unit. The efficacy of inpatient treatment was assessed; 89 patients were followed up after discharge from hospital. The follow-up period lasted from January 2011 to May 2019. Results. ART did not increase the efficacy of the in-patient stage of TB/HIV treatment due to the development of immune reconstitution inflammatory syndrome, which occurred in 34.5% of patients and accounted for 70.0% of hospital lethality cases. After discharge from hospital, 69.7% of patients successfully completed anti-tuberculosis chemotherapy, 25.8% died before completing treatment, the main cause of death was tuberculosis (56.5%), including multiple drug resistance in 30.8% of cases. At the outpatient stage, 29.1% of patients interrupted ART, their death rate was higher (p = 0.007), and tuberculosis and HIV-associated diseases became the cause of death more often (p = 0.042) versus the compliant patients. Tuberculosis relapses developed in 17.7% after 16.7 ± 1.7 months after completion of treatment; 63.6% had multiple drug resistance, patients with tuberculosis relapses interrupted ART more often (p = 0.002), had a lower CD4 count (p = 0.030) versus patients without relapses. As of May 2019, 46.1% of patients survived and had no signs of active tuberculosis; 42.7% died, tuberculosis dominated among the causes of death – 50.0% (in 52.6% – multiple drug resistance) as well as HIV-associated diseases (21.1%).

Treatment efficacy and tuberculosis relapses in HIV infected patients with severe immunosuppression who started antiretroviral therapy

Корж

Подчос²,

Стрига³

et al. 2020

Relapses of urogenital tuberculosis

Кульчавеня

Шевченко

Kholtobin

et al. 2020

The objective of the study: to characterize the cases of tuberculosis relapses with lesion in urogenital organs.Subjects and methods. Out of 140 case histories of patients with urogenital tuberculosis (UGTB; tuberculosis of the urinary and male reproductive system), registered for follow-up by the phthisiourologist, all files of patients with tuberculosis relapses were picked up, totally, there were 13 of them.Results. Men prevailed among cases of relapses (61.5%). Patients at the age of 30-50 years old made 46.1%, and 53.9% were 51 years old and above. In the first episode of tuberculosis, lesions of the genitourinary system were observed in 53.9% of patients, bacterial excretion was found in 38.5%. On the average, the relapse developed in 9.1 years after successful cure of the first episode of tuberculosis: after respiratory tuberculosis – in 5.6 years and after UGTB – in 12.3 years. In 3 (23.1%) patients with relapse, mycobacteriuria was documented, in 1 of them, drug resistance (to streptomycin and isoniazid) was detected. In general, in the relapse of tuberculosis with urogenital lesions, the kidneys were most often (69.2%) affected. The treatment of relapse was effective in 12 out of 13 patients. During chemotherapy of tuberculosis, 3 (23.1%) patients developed toxic and allergic reactions that required treatment interruption or cancellation of the drug.

Long-term comparative analysis of the main epidemiological indicators for tuberculosis in combination with HIV infection in the Udmurt Republic

Афанасьев

Russkikh

2020

The objective of the study: to assess changes of epidemiological indicators for TB/HIV co-infection in the Udmurt Republic (UR) and the Russian Federation (RF) from 2008 to 2017 and make the prognosis for the next 5 years.Subjects and methods. The main epidemiological indicators for TB/HIV infection were retrospectively analyzed, the data were taken from annual reports of Republican TB Dispensary, Regional Center for AIDS and Infectious Diseases and Federal Research Institute for Health Organization and Informatics by the Russian Ministry of Health.Results. From 2008 to 2017, the incidence of respiratory tuberculosis both in the Russian Federation and in the Udmurt Republic decreased by 43.0%. While the incidence of HIV infection among the population of the Udmurt Republic increased by 148.5%, in the Russian Federation by 79.7%. From 2011 to 2017, the TB/HIV incidence increased in the UR by 76.6%, in the RF by 48.2%. The mortality of tuberculosis patients died of HIV infection increased by 147.6% in the RF, and by 400% in the UR. Trends in forecasts for investigated indicators of TB/HIV co-infection in the Udmurt Republic and the Russian Federation demonstrate their further growth.