Identification of additional ways to reduce the incidence of tuberculosis in HIV-infected patients. Retrospective Continuum Study.

Abstract

Background: HIV infection was more often registered in the general population than in vulnerable groups according to official statistics from the Russian Federation in 2021.
 Aims: to determine the characteristic patient cohorts coinfected with tuberculosis (TB) and HIV in dynamic epidemiological environments, and propose additional organizational approaches for reducing TB incidence in patients with HIV.
 Materials and methods: we have investigated complete medical data for patients coinfected with TB and HIV in three Russian regions. Additionally, we analyzed the cohort of patients with TB, combined with HIV infection via sexual transmission. Furthermore, confidential interviews with patients coinfected with TB and HIV were undertaken. In particular, reasons for refusing clinical examination at a Russian Federal AIDS Center (RFAIDSC) were clarified.
 Results: among patients coinfected with TB and HIV, parenteral transmission remains the primary HIV infection route. At the same time, patients who become infected through sexual contact are also primarily socially disadvantaged, leading to the refusal of clinical examination and a consequent late detection of TB. On the other hand, patients report that due to unemployment, they do not have the financial means to travel to the regional RFAIDSC.
 More often, widespread, rapidly progressive MDR TB infections occurred among patients coinfected with TB and HIV, than for patients with TB but without HIV. Considering that every fourth TB patient in Russia has been diagnosed with HIV, and, at the same time, there are specific features regarding the development and course of TB, the generally accepted criteria for assessing the quality of TB without HIV care often become biased for coinfected patients. This can lead to unreasonably negative assessments of the antituberculosis system and its work.
 Conclusions: in view of the above, it is important to modify regulatory documents regarding informing patients about the importance of seeking timely medical help, solve the issue of travel for unemployed patients to medical examinations and in emergency cases. Additionally, it is important to introduce adjustments for the criteria in assessing the quality of patient TB care, thereby accounting for the pathogenesis of TB in patients with HIV coinfection.