Оценка эффективности антиретровирусной терапии у больных ВИЧ / туберкулез на основании показателей общих липидов сыворотки крови

Abstract

Under the ongoing epidemic of HIV-infection, the incidence of tuberculosis continues to grow without a visible tendency to decrease. It is necessary to improve treatment approaches that allow more flexibility in determining the effectiveness of antiretroviral therapy (ART) at the very beginning of treatment for HIV / tuberculosis coinfection. Lipids play an important role in the formation of a tuberculous lesion. The study of the total lipids dynamics in HIV/tuberculosis coinfection has the potential for an early assessment of the ART effectiveness. The purpose is to evaluate the effectiveness of the course of antiretroviral therapy in patients with HIV / tuberculosis at 4B stage based on the values of total serum lipids. Material and methods. The study included 300 patients with HIV / tuberculosis, of which 100 patients received only tuberculosis chemotherapy, 100 patients received ART and 1 TB therapy regimen (TBT), 100 patients received ART and 4 TBT regimen. Clinical and laboratory parameters were studied in all patients, the blood serum lipid spectrum was analyzed (total lipids (OL), total phospholipids (OFL), free cholesterol (CX), cholesterol esters (EH), triglycerides (TG), free fatty acids (FFA)) and the effectiveness of the ART was evaluated. To detect early changes in total lipids, the results were analyzed after 1 month. Results. It was found that ART in HIV/tuberculosis patients causes significant positive changes in the metabolism of total lipids (OL, OFL, CX, EH, TG, FFA), largely bringing their values closer to the level of healthy individuals, which is accompanied by a pronounced clinical and radiological effect in the form of more frequent abacylation. Against the background of ART, an inflammatory immunity restoration syndrome (IIRS) developed, which was stopped by pathogenetic therapy.