Abstract
The aim was to study the causes of death in HIV patients in the Novokuznetsk tuberculosis dispensary in 2016 (population is 550 thousand people; about 2% of population are HIV-positive). Materials and methods: Protocols of all autopsies of HIV-infected patients (n=221) performed in 2016 in the Novokuznetsk tuberculosis dispensary. Results: The mean age of the deceased was 37 Ѓ }6,9 years. HIV and tuberculosis (TB) co-infection was in 83,3% of patients (n=184), HIV/TB and other opportunistic or severe somatic diseases – in 10,4% (n=23), non-tuberculous opportunistic diseases – in 6,3% (n=14). The new tuberculosis cases were in 71,1% (n=147), relapses – in 7,2% (n=15), chronic tuberculosis cases – in 21,7% of patients (n=45). Disseminated form prevailed among the cases of respiratory tuberculosis; generalized tuberculosis (3 and more localizations) occurred in 87,0% (n=180), tuberculosis meningitis was found in 17,9% (n=37). Positive fluorescent sputum microscopy was in 72.5%, sputum cultures on Loewenstein-Jensen medium – in 78,3% with HIV/TB. Primary multidrug resistance was detected in 60,7% (including in 5,8% of them with primary extensively drug resistance). Severe opportunistic infections or malignancies were in 9,2% of HIV/TB (n=19) and in 78,7% of non-TB patients (n=11). Data on the CD4 level was known in 68,8% of cases (n=152): the median count was 75,5 cells/ μ l; 38,9% of new TB cases (n=46) were diagnosed with HIV in time of TB detecting. Antiretroviral therapy was performed only 13% of patients (n=29). Conclusion: There is a need for the optimization of HIV detecting approaches and early initiation of antiretroviral therapy before the appearance of incurable opportunistic diseases, as well as for comprehensive TB prevention.
Highlights
The aim was to study the causes of death in HIV patients in the Novokuznetsk tuberculosis dispensary in 2016
Кемеровская область в течение нескольких лет удерживает лидирующие позиции по заболеваемости ВИЧ-инфекцией (ВИЧ-и)
Госпитальная летальность больных ВИЧ-инфекцией в 2016 г. составила 29,9%
Summary
Резюме Цель: изучение структуры и причин летальных исходов у больных ВИЧ-инфекцией (ВИЧ-и) в противотуберкулезном диспансере города Новокузнецка за 2016 г. Чел., около 2% населения города инфицированы ВИЧ). Материалы и методы: протоколы всех аутопсий случаев смерти больных ВИЧ-и (n=221), выполненных в 2016 г. Коинфекция ВИЧ-и/туберкулез (ТБ) была у 83,3% больных (n=184), ВИЧ-и/ТБ в сочетании с другими тяжелыми соматическими или вторичными заболеваниями – у 10,4% (n=23), нетуберкулезные заболевания – у 6,3% (n=14). Впервые выявленный туберкулез был у 71,1% (n=147), рецидивы – у 7,2% (n=15), случаи хронического туберкулеза – у 21,7% (n=45). Люминесцентная микроскопия мокроты была положительной у 150 из 207 больных с туберкулезом (72,5%), положительные посевы мокроты на плотные питательные среды – у 162 человек (78,3%). У 38,9% умерших от новых случаев туберкулеза (n=46) ВИЧ-и была установлена впервые при выявлении туберкулеза.
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