Clinical and epidemiological features and measures limiting the spread of HIV+TB co-infection in the republic of Karelia

The features of the epidemiological situation of HIV+TB co-infection in the Republic of Karelia were studied and 91 patients' case histories and patient cards of the individuals with this pathology, who are registered in the Republic AIDS Center and in the Tuberculosis Dispensary (in 2001-13) were analyzed.
The trouble of the epidemiological situation is due to a high level of TB distribution with wide and plural drug resistance, and to a large reservoir of co-infection (HIV+TB) in the system of UFSIN, which is situated in the Republic of Karelia (every year 120 people are released).

Among the cases of HIV + TB co-infection the main percentages are the persons aged from 20 to 39 years (maximum active population), this fact is particularly troubling, as the rapid spread of infections by sexual transmission becomes possible. Among the patients co-infected with HIV+TB the persons, which form the main risk groups (people who use drug (39,6%), and those who are released from the UFSIN system (25,3%), dominated. The situation is exacerbated by the late detection: in 80% of patients tuberculosis was diagnosed in addressing with complaints (with the development of the bright clinical picture, in the late stages), almost 44% of them were revealed in hospitals of general health services, this is associated with late revealing of TB patients at the outpatient level. The situation is compounded because patients took antiretroviral therapy (ARVT) irregularly, with the interruption of treatment, which led to the formation of drug resistance. Also there are cases of refusing treatment. In this regard, sever forms of tuberculosis prevail: generalized TB and disseminated TB of lungs. Difficulties in diagnostics of TB are associated with secondary infections, among which CMV infection, candidiasis and herpes infection predominate. Hepatitis is prevalent among comorbidities. This makes difficult the administration and tolerance of anti-TB and antiretroviral drugs. Despite this unfavorable situation 43% of the patients achieved an effective treatment, and the main reason for the ineffectiveness is indiscipline of patients. The death rate remains at a high level (33%).

To decrease the spread of TB in the population, including HIV-infected it is necessary to prevent the transmission of TB infection as a result of the rapid detection of TB open forms by smear microscopy. To attract the main risk groups to the research it is advisable to conduct informational support of target groups, as well as to combine the survey with various forms of social supports. For early detection of tuberculosis in HIV-infected patients it is necessary to use modern methods of diagnosis: SKT (spiral computed tomography), PCR diagnostics (polymerase chain reaction). To control the replenishing reservoir of co-infected with TB and HIV who released from the UFSIN system, it is important to create a single computer register for such patients, as well as to engage the development of social support programs for released from the UFSIN . To reduce mortality in HIV-infected from TB it is necessary to improve the organization of prevention.

D.D. Novikova, E. V. Pahomova, О. N. Savinova