Identification of additional ways to reduce the incidence of tuberculosis in HIV-infected patients. Retrospective Continuum Study.

O. Frolova, T. I. Sharkova, O. Butylchenko, L. Severova, A. Abramchenko
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Abstract

Background: HIV infection was more often registered in the general population than in vulnerable groups according to official statistics from the Russian Federation in 2021. Aims: to determine the characteristic patient cohorts coinfected with tuberculosis (TB) and HIV in dynamic epidemiological environments, and propose additional organizational approaches for reducing TB incidence in patients with HIV. Materials and methods: we have investigated complete medical data for patients coinfected with TB and HIV in three Russian regions. Additionally, we analyzed the cohort of patients with TB, combined with HIV infection via sexual transmission. Furthermore, confidential interviews with patients coinfected with TB and HIV were undertaken. In particular, reasons for refusing clinical examination at a Russian Federal AIDS Center (RFAIDSC) were clarified. Results: among patients coinfected with TB and HIV, parenteral transmission remains the primary HIV infection route. At the same time, patients who become infected through sexual contact are also primarily socially disadvantaged, leading to the refusal of clinical examination and a consequent late detection of TB. On the other hand, patients report that due to unemployment, they do not have the financial means to travel to the regional RFAIDSC. More often, widespread, rapidly progressive MDR TB infections occurred among patients coinfected with TB and HIV, than for patients with TB but without HIV. Considering that every fourth TB patient in Russia has been diagnosed with HIV, and, at the same time, there are specific features regarding the development and course of TB, the generally accepted criteria for assessing the quality of TB without HIV care often become biased for coinfected patients. This can lead to unreasonably negative assessments of the antituberculosis system and its work. Conclusions: in view of the above, it is important to modify regulatory documents regarding informing patients about the importance of seeking timely medical help, solve the issue of travel for unemployed patients to medical examinations and in emergency cases. Additionally, it is important to introduce adjustments for the criteria in assessing the quality of patient TB care, thereby accounting for the pathogenesis of TB in patients with HIV coinfection.
确定减少艾滋病毒感染者结核病发病率的其他方法。回顾性连续研究。
背景:根据俄罗斯联邦2021年的官方统计数据,艾滋病毒感染在普通人群中比在弱势群体中更常见。目的:确定动态流行病学环境中结核病和艾滋病合并感染的特征性患者队列,并提出减少艾滋病患者结核病发病率的其他组织方法。材料和方法:我们调查了俄罗斯三个地区结核病和艾滋病毒合并感染患者的完整医疗数据。此外,我们分析了通过性传播合并HIV感染的TB患者队列。此外,还对同时感染结核病和艾滋病毒的患者进行了保密访谈。特别是,明确了拒绝在俄罗斯联邦艾滋病中心(RFAIDSC)进行临床检查的原因。结果:在TB和HIV合并感染的患者中,肠道外传播仍然是HIV感染的主要途径。与此同时,通过性接触感染的患者也主要处于社会不利地位,导致拒绝进行临床检查,从而导致结核病的较晚发现。另一方面,患者报告说,由于失业,他们没有经济手段前往区域RFAIDSC。与未感染艾滋病毒的结核病患者相比,在合并感染结核病和艾滋病毒的患者中更经常发生广泛、迅速进展的耐多药结核病感染。考虑到俄罗斯每四名结核病患者中就有一名被诊断患有艾滋病毒,同时,结核病的发展和病程也有特定的特点,普遍接受的评估无艾滋病毒治疗结核病质量的标准往往对合并感染患者有偏差。这可能导致对抗结核系统及其工作的不合理的负面评价。结论:鉴于上述情况,必须修改有关告知患者及时寻求医疗帮助的重要性的规范性文件,解决失业患者进行医疗检查和急诊的旅行问题。此外,重要的是对评估结核病患者治疗质量的标准进行调整,从而解释合并感染艾滋病毒的患者的结核病发病机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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