Integrating hepatitis C treatment into multidrug-resistant TB care.

BACKGROUND: Direct-acting antivirals (DAAs) are not widely used for patients with chronic hepatitis C virus (HCV) infection and multidrug- or rifampicin-resistant TB (MDR/RR-TB). We describe the implementation aspects of a new integrated model of care in Armenia and the perceptions of the healthcare staff and patients. METHODS: We used qualitative methods, including a desktop review and semi-structured individual interviews with healthcare staff and with patients receiving HCV and MDR/RR-TB treatment. RESULTS: The new integrated model resulted in simplified management of HCV and MDR/RR-TB at public TB facilities. Training on HCV was provided for TB clinic staff. All MDR/RR-TB patients were systematically offered HCV testing and those diagnosed with HCV, offered treatment with DAAs. Treatment monitoring was performed by TB staff in coordination with a hepatologist. The staff interviewed had a positive opinion of the new model. They suggested that additional training should be provided. Most patients were fully satisfied with the care received. Some were concerned about the increased pill burden. CONCLUSION: Integrating HCV treatment into MDR/ RR-TB care was feasible and appreciated by patients and staff. This new model facilitated HCV diagnosis and treatment among people with MDR/RR-TB. Our results encourage piloting this model in other settings.

CONTEXTE: Les antiviraux à action directe (DAA) sont peu prescrits aux patients atteints d'hépatite C (HCV) chronique et de TB multirésistante ou résistante à la rifampicine (MDR/RR-TB). Nous décrivons la mise en place d'un nouveau modèle de soins intégrés en Arménie, ainsi que l'opinion du personnel soignant et des patients. MÉTHODES: Nous avons utilisé des méthodes qualitatives, comprenant un examen électronique de la documentation et des entretiens individuels semi-structurés avec le personnel soignant et les patients sous traitement pour HCV et MDR/RR-TB. RÉSULTATS: Le nouveau modèle intégré a permis de simplifier la prise en charge du HCV et de la MDR/RR-TB dans les centres de soins publics de la TB. Une formation sur le HCV a été dispensée au personnel des centres antituberculeux. Tous les patients atteints de MDR/RR-TB se sont vu systématiquement proposer un test de dépistage du HCV, et un traitement par DAA a été proposé à ceux dont le résultat était positif. Le suivi du traitement a été réalisé par le personnel des centres antituberculeux, conjointement à un hépatologue. Les membres du personnel interrogés avaient une opinion positive du nouveau modèle et suggéraient de dispenser d'autres formations. La plupart des patients étaient pleinement satisfaits des soins reçus, mais certains étaient inquiets au vu du nombre accru de comprimés à prendre. CONCLUSION: L'intégration du traitement du HCV aux soins de la MDR/RR-TB s'est avérée possible et a été appréciée par les patients et le personnel soignant. Ce nouveau modèle a facilité le diagnostic et le traitement du HCV chez les patients atteints de MDR/RR-TB. Ce modèle devrait être testé dans d'autres contextes.

THE MOLECULAR MECHANISM OF DIABETES MELLITUS - RELATED IMPAIRMENT OF CARDIOVASCULAR HOMEOSTASIS (REVIEW).

Today, diabetes mellitus is an urgent and topical medical and social problem of modern medicine. In the era of industrialization, this endocrine disorder's incidence increases exponentially, affecting more broadly, especially the young cohorts of the population, thereby exerting a substantial burden on the health system. Comprehension and full-fledged study of the pathophysiological mechanisms and remodeling dynamics in the diabetic continuum will ensure further advances in modern diabetology to set it to a potentially new level. It is noteworthy that diabetes mellitus triggers various vicious cycles that impair cardiovascular homeostasis and becomes an independent risk factor for such comorbidities as coronary heart disease, arterial hypertension, diabetic cardiomyopathy, etc. Unfavorable prognosis common manifestations are the micro-and macroangiopathies, particularly the diabetic angio-, neuro-, and nephropathy. In this respect, the vision impairment associated with angiopathy becomes a predictor of the early onset and/or exacerbation of already developed cardiovascular pathology. Summing up the mentioned above, a study of the molecular mechanisms of diabetes-driven impairment of the cardiovascular system is becoming a fundamentally relevant research area. Simultaneously, it will serve as the driving force for finding new pharmacological influences with improving both the quality of life and the prognosis of diabetic patients.

[ORAL HEALTH STATUS IN HIV-POSITIVE PATIENTS].

Oral manifestations of HIV infection are diverse and not still not completely studied. HIV-associated diseases can occur as the first symptoms of infection, these are characterized by high frequency, clinical polymorphism and pronounced course. Periodontal aspects are also neglected in the literature. No papers on the condition of different areas of the oral mucosa, tongue and periodontium where they were studied simultaneously and according to various criteria have been found in the available literature. The objective of the research is to evaluate the condition of periodontium and the oral mucosa in different parts of the oral cavity in HIV-positive patients. Total number of the HIV-positive patients observed was 90, among them 81 males and 9 females between the age range of 24-62. An average age of the patients was 45.2±8.34, with male patients prevailing (p<0.001). HIV infection was diagnosed by Western-blot reaction. Clinical examination as well as probing and determination of the pocket depth by means of the periodontal probe was carried out to assess the health status of the oral cavity. Periodontal indices were also determined. It has been found that immunocompromised condition due to HIV infection contributes to the oral mucosa lesions. Namely, coated tongue was observed in 100% of cases, the oral mucosa relief impairment was seen in 75.6% of cases, lip cracks of different location and bright red color of the mucous membrane were observed in 73.3% and 82.2%, respectively (р<0.001). Examination of the tongue revealed the symptoms which were not found in the control group, such as tongue coating - in 100% (90 patients observed), epithelial desquamation foci - in 54.4% (49) (p<0.001). Inflammatory diseases of periodontium, particularly catarrhal and hypertrophic gingivitis and periodontitis of moderate severity were also revealed.