ОСОБЕННОСТИ КЛИНИЧЕСКОЙ КАРТИНЫ ОСТРОГО ПЕРИТОНИТА У ПАЦИЕНТОВ С ВИЧ-ИНФЕКЦИЕЙ

Abstract

Background. The clinical picture of acute peritonitis in HIV-positive patients has its own specific features and is characterized by a blurred and multifaceted character, which significantly complicates the diagnosis of this disease. Purpose. To identify the features and specifics of the clinical picture of acute peritonitis in patients with HIV infection. Materials and methods. An analysis of the literature data was carried out, based on the outcome of which three syndromes were selected, which maximally included the known symptoms of acute peritonitis: abdominal pain syndrome, intestinal insufficiency syndrome and systemic inflammatory response syndrome (SIRS). The study included 158 patients with HIV infection who had a preliminary diagnosis of acute peritonitis. All patients underwent diagnostic laparoscopy, according to the results of which they were divided into the main and control groups. In the main group, 83 patients with a confirmed diagnosis of acute peritonitis were selected . The control group included 75 patients whose diagnosis of acute peritonitis was not confirmed. The analysis of the symptoms of acute peritonitis in HIV-infected patients was carried out within the framework of individual syndromes and their combination. Results. In the main group, abdominal pain syndrome was found in 20.5% of the patients, intestinal insufficiency syndrome was detected in 59%, and SIRS — in 61.4%. The following results were obtained in the control group: abdominal pain syndrome — 14.7% of the patients, intestinal insufficiency syndrome — 48%, SIRS — 33.3%. The study shows that a combination of “classic” criteria for acute peritonitis occurs in a small number of HIV-infected patients with acute peritonitis and is not always an absolute sign of the diagnosis. It was also noted that the presence of acute peritonitis in patients with HIV infection is possible even in the absence of all the “classic” criteria for this disease. Conclusion. The clinical picture of acute peritonitis in HIV-infected patients is atypical, characterized by mild or no “classic” symptoms, masked by the manifestation of opportunistic infections and HIV-indicative diseases, and requires further study to improve diagnosis and treatment.