Prognostic Model for Progradient Tuberculosis Course in HIV-Infected Children.

The aim of the study was to define independent predictors and create a prognostic model for the progradient course of tuberculosis in HIV-infected children. MATERIALS AND METHODS: The prospective observational study of tuberculosis cases of HIV-infected children under 15 years of age has been carried out over 2000-2014 using a continuous sampling method (n=65). Two observation groups were formed: the main group comprising children with a progradient (progressive) type of tuberculosis (n=37) and the comparison group of children with a regradient (regressive) type of the disease (n=28). The logistic regression method was used to create a prognostic model. The quality of model approximation was assessed using maximum likelihood function. Indicators of model goodness of fit are the coefficient of concordance (a permissible level of frequency disagreement is less than 20%) and Hosmer-Lemeshow test. RESULTS: As a result of a paired comparative analysis based on 17 medico-biological, epidemiological and social signs, 11 statistically different parameters have been distinguished. On their basis, a functional prognostic model has been created including six independent predictors: flaws in children observation in the general medical network (b=23.962), absence of Bacillus Calmette-Guérin vaccination (b=20.404), fatal course of tuberculosis in the human source of infection (b=2.762), tuberculosis identification in children under 3 years of age (b=2.620), absence or low adherence to therapy of the latent tuberculosis infection before tuberculosis detection (b=1.859), marked or severe immunodeficiency (b=1.693). The degrees of the risk factors for the progradient tuberculosis course have been established at the following probability values (decile): at 0.3-0.4 the risk is minimal; at 0.5-1.0 the risk is high; at values of 0-0.2 there is no risk of the disease. Programs for quantitative and qualitative assessment of the risk of progradient tuberculosis course in children with HIV infection have been designed to facilitate the model use. CONCLUSION: The presented prognostic model is based on the analysis of the obligatory data in the diagnostic search making its use convenient at any stage of rendering medical aid to HIV-infected children.

Undertreated HIV and drug-resistant tuberculosis at a referral hospital in Irkutsk, Siberia.

SETTING: A referral hospital for tuberculosis (TB) in Irkutsk, the Russian Federation. OBJECTIVE: To describe disease characteristics, treatment and hospital outcomes of TB-HIV (human immunodeficiency virus). DESIGN: Observational cohort of HIV-infected patients admitted for anti-tuberculosis treatment over 6 months. RESULTS: A total of 98 patients were enrolled with a median CD4 count of 147 cells/mm(3) and viral load of 205 943 copies/ml. Among patients with drug susceptibility testing (DST) results, 29 (64%) were multidrug-resistant (MDR), including 12 without previous anti-tuberculosis treatment. Nineteen patients were on antiretroviral therapy (ART) at admission, and 10 (13% ART-naïve) were started during hospitalization. Barriers to timely ART initiation included death, in-patient treatment interruption, and patient refusal. Of 96 evaluable patients, 21 (22%) died, 14 (15%) interrupted treatment, and 10 (10%) showed no microbiological or radiographic improvement. Patients with a cavitary chest X-ray (aOR 7.4, 95%CI 2.3-23.7, P = 0.001) or central nervous system disease (aOR 6.5, 95%CI 1.2-36.1, P = 0.03) were more likely to have one of these poor outcomes. CONCLUSION: High rates of MDR-TB, treatment interruption and death were found in an HIV-infected population hospitalized in Irkutsk. There are opportunities for integration of HIV and TB services to overcome barriers to timely ART initiation, increase the use of anti-tuberculosis regimens informed by second-line DST, and strengthen out-patient diagnosis and treatment networks.

[Sanitary-Epidemiological Status of Siberian Population (Medico-Demographical and Epidemiological Characteristics)].

Review on the problem of sanitary-epidemiological welfare of the population in the Siberian Federal District (SFD) was conducted based on literature data and authors own research in the period of 2002−2014. Authors provided broad information on the health and demographic and epidemiological characteristics of SFD population. SFD in comparison with other regions of the Russian Federation overcomes one of the most adverse situations including mortality rates from external causes. SFD population's infectious and somatic morbidity rates were analyzed. Analysis demonstrated that the situation relating to priority epidemiologically and socially important infections (HIV-infection, parenteral viral hepatitis, tuberculosis etc.) on the territory of the SFD remains tense. Authors provided information on the increase in the level of the actual for Siberian regions natural-foci tick-borne infections. Detailed analysis for the environment anthropogenic pollution impact for the epidemic, infectious and vaccine induced processes. Authors suggest that anthropogenic (biological) environmental pollution is one of the most important factors influencing the epidemiological welfare of the Siberian population. A new strategic direction in epidemiological research associated with the problem of comorbid diseases is planned.

Administrative interventions associated with increased initiation on antiretroviral therapy in Irkutsk, Siberia.

A bundle of initiatives to integrate human immunodeficiency virus (HIV) and tuberculosis (TB) services was assessed for the impact on antiretroviral therapy (ART) initiation at a TB referral hospital in Irkutsk, Russian Federation, from February 2014 to December 2015. The ART initiation rates in 166 ART-naïve patients undergoing anti-tuberculosis treatment (34.1% with multidrug or extensively drug-resistant TB) increased significantly from 14 (17%) pre-intervention to 44 (54%) post-intervention (P < 0.001). A survey of TB hospital staff identified administrative prioritisation as the most important initiative for increasing ART initiation.

Un ensemble d'initiatives visant à intégrer les services relatifs au virus de l'immunodéficience humaine (VIH) et à la tuberculose (TB) a été évalué en termes d'impact sur la mise en route du traitement antirétroviral (TAR) dans un hôpital de référence de la TB à Irkoutsk, Fédération de Russie, entre février 2014 et décembre 2015. Les taux de mise en route du TAR chez 166 patients n'en ayant jamais reçu et traités pour TB (34,1% avec une TB multi-résistante ou ultra-résistante) ont significativement augmenté de seulement 14 (17%) avant l'intervention à 44 (54%) après l'intervention (P < 0,001). Une enquête auprès du personnel de la TB a identifié la priorisation administrative comme l'initiative la plus importante dans l'augmentation de l'initiation du TAR.

Se evaluó un conjunto de iniciativas encaminadas a integrar los servicios de atención de la infección por el virus de la inmunodeficiencia humana (VIH) y la tuberculosis (TB), con el objeto de determinar la repercusión de la integración sobre el comienzo del tratamiento antirretrovírico (TAR) en el hospital de referencia de la TB de Irkutsk, en la Federación de Rusia, de febrero del 2014 a diciembre del 2015. La tasa de iniciación del TAR en 166 pacientes que nunca lo habían recibido y que estaban en curso de tratamiento antituberculoso (34,1% con TB multirresistente o extremadamente multirresistente) aumentó de manera significativa de solo 14 pacientes antes de la intervención (17%) a 44 pacientes después de la misma (54%; P < 0,001). Al interrogar al personal encargado de la TB en este hospital de referencia, se puso en evidencia que la priorización administrativa del TAR constituía la iniciativa de más había influido en el incremento de su utilización.

[Manifestations of immune deficiency in children with perinatal HIV infection in the treatment dynamics].

Clinical and immunological parameters in the children with perinatal HIV infection were investigated in the dynamics of the long-term prospective observation. It was revealed, that all the HIV infected children had clinical signs of immunodeficiency and laboratory signs of combined damage of the immune system. The complex of therapeutic measures, including antiretroviral therapy, prevention of opportunistic and acute respiratory infections, rational immunotherapy to stimulate production of endogenous interferon and normalization of the balance of cytokines significantly reduced the frequency of the clinical manifestations of the infectious syndrome and improved the patients resistance to infections.