[Organization of hospital care to patients with tuberculosis concurrent with HIV infection in Tuberculosis care hospital No. seven].

HIV-infection morbidity rates continue to increase in Moscow, the Moscow Region, and in the whole country. The epidemiological situation associated with tuberculosis concurrent with HIV infection remains tense in Moscow and its region, as judged from the data of an analysis of this disease at tuberculosis hospital seven (TH-7) over 9 years. A total of 411 patients with tuberculosis concurrent with HIV infection were treated at TH-7 in 1996 to December 2004. Among them, 49.6% were Moscow residents, 15.1 and 26.5% of the patients lived in the Moscow Region and other regions of the Russian Federation, respectively; 6.8% were homeless persons and 2% foreigners. The number of patients with tuberculosis concurrent with HIV infection has been annually increasing at TH-7. Among the total number of patients, their proportion was 13.4% in 2004. In the structure of patients with comorbidity, the proportion of surgical patients has been on the rise and it was 51.8% in 2004. Among the surgical patients with tuberculosis concurrent with HIV, the proportion of patients with generalized (multiple organ) tuberculosis has increased; it was 50% in 2004. Patients with tuberculosis concurrent with HIV infection need a greater scope of surgical interventions al number of patients for therapeutic and diagnostic purposes.

[Characteristics of tuberculosis running with HIV infection]. / Osobennosti techeniia tuberculeza, sochetannogo s VICh infektsiei.

AIM: To analyse social, clinical, x-ray and immunological features of tuberculosis (TB) in 117 patients from the Moscow region with concurrent HIV-infection. MATERIAL AND METHODS: The patients were divided into 3 groups depending on the time of TB and HIV-infection detection in relation to each other. Group 1 patients (20.5%) had suffered from TB for 2 years before detection of HIV-infection, group 2 patients (51%) were diagnosed simultaneously for 1-2 years to have both diseases, group 3 patients (28%) had suffered from HIV-infection for 2 years before the diagnosis of TB. RESULTS: It was established that the course of TB with associated HIV-infection depends not only on severity of immunodeficiency caused by HIV but also on characteristics of M. tuberculosis and social status of the patients. Most of TB/HIV patients were drug addicts, alcoholics, convicts. Unfavourable social status in the above patients, contact with TB (70%) and its realization in a penitentiary carry a high risk of drug-resistant TB. High prevalence of destructive TB forms (64%), among them large caverns were in 77%, may result from M. tuberculosis resistance to antituberculous drugs and unfavourable social status of the patients. Reduction of the number of CD4-cells lowers the ability to form caverns and fibrosis and promotes dissemination of M. tuberculosis bacteria with formation of inflammation foci in different organs and systems. CONCLUSION: Four clinical models of TB/HIV onset and course are suggested.

[Course of tuberculosis in patients with HIV infection]. / Techenie tuberkuleza u bol'nykh s VICh-infektsiei.

AIM: To evaluate clinical features of tuberculosis in correlation with HIV-infection duration. MATERIAL AND METHODS: 117 patients with HIV-infection were divided into three groups: HIV-infected in the presence of long-standing tuberculosis (group 1), HIV- and tuberculosis-infected simultaneously (group 2), tuberculosis-infected 5-10 years after getting HIV-infection. CONCLUSION: Clinical picture and course of tuberculous infection in HIV-infected patients depend on the time of getting HIV-infection and are determined by the severity of T-cell immunodeficiency. RESULTS: Tuberculosis runs its usual course in patients of groups 1 and 2. In group 3 tuberculosis ran atypically, had lethal outcome due to either tuberculosis or opportunistic infections.