The aim was to study the characteristics of community-acquired pneumonia in patients with HIV infection, depending on the outcome of the disease and to identify significant predictors of death. Materials and methods. The study included 80 patients with community-acquired pneumonia and HIV-infection. Two groups were formed in accordance with the outcome of community-acquired pneumonia. 1 group (study group) — 40 deceased patients, 2 group (comparison group) — 40 patients discharged from the hospital with improvement. Inclusion criteria: patients over 18 years of age, diagnosis of community-acquired pneumonia, diagnosis of HIV infection, informed consent of the patient. Patients with diagnosed pulmonary tuberculosis were excluded at the stage of examination and treatment. Results. Patients with HIV infection entered the hospital with community-acquired pneumonia of severe degree in 65% of cases, 71,25% of cases with respiratory insufficiency of II and III degrees, in 16,25% of cases with critically low oxygen saturation (less than 85%). The majority of patients had bilateral pneumonia (78,75%), in 28,75% of cases complicated by pleural effusion. Patients needed respiratory support at different levels-the chambers of the pulmonology ward in 3625% of cases, indications for noninvasive ventilation (NIV) in the intensive care unit (ICU) were noted in 80% of cases, ventilation in the ICU in 56,25% of cases. Deceased patients were significantly more likely to be injecting drug users, reported weight loss of more than 10% in six months, CD4+ cells did not exceed 50/μl, bilateral lung damage, pleural effusion, oxygen saturation less than 90%. The conclusion. Treatment and diagnosis of comorbid patients with community-acquired pneumonia and HIV infection is complex, in the stage of pronounced immunosuppression can lead to death. Early onset of NIV in the presence of severe respiratory failure may improve the survival prognosis.

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ОРИгИНаЛьНЫЕ ИССЛЕДОВаНИя Metelica VI. Spravochnik po klinicheskoj farmakologii 3. serdechno-sosudistyh sredstv [Reference book on clinical pharmacology of cardiovascular medicines]. M : Medpraktika. 1996: 784 р. Okorokov AN. Lechenie boleznej vnutrennih organov 4. [Treatment of diseases of internals]. Lechenie zabolevanij serdechno-sosudistoj sistemy [Treatment of diseases of cardiovascular system]. Mn: Vysh shk. 1997; 3 (1): 464 р. Chuchalina AG, Belousova JuB, Jasnecova VV editors. 5. Federal'noe rukovodstvo po ispol'zovaniju lekarstvennyh sredstv (formuljarnaja sistema) [Federal operating instructions of medicines (official system)]. 2nd ed. M.:

The aim of the study was to evaluate the efficacy of the new approach to the selection of respiratory support methods based on the analysis of arterial blood acid-base balance and gas composition in treatment of severe community-acquired pneumonia complicated by acute respiratory failure.Materials and Methods. Conventional pulse oximetry (SрО 2 ) was used (G40 Patient Monitor), arterial blood acid-base balance and gas composition were analyzed (EasyStat device) to detect hypoxemia. Respiratory support of three types was carried out: 1) oxygen therapy (О 2 -therapy) with the use of oral nasal oxygen masks; 2) non-invasive lung ventilation (VENTIlogic 2 and BiPAP Vision devices); 3) artificial lung ventilation (Engström Carestation device).The work was carried out in two sequential stages. At the first stage, a respiratory support method was selected according to the results of pulse oximetry (SрО 2 ). At the second stage, a respiratory support method was selected on the basis of arterial blood acid-base balance and gas composition indices (рО 2 , pH, рCО 2 ). Recovery of pulse oximetry indices, arterial blood acid-base balance, and gas composition indices as well as presence of positive clinical dynamics were considered to be criteria of treatment efficacy.Results. Comparative analysis of the results of the used methods has provided the possibility to develop the algorithm of choosing the respiratory support method in severe community-acquired pneumonia on the basis of arterial blood acid-base balance and gas composition with pulse oximetry indices equalling 91.0±0.8%. On admission of a patient to the intensive care unit, oxygen therapy is administered at рН≥7.3; рO 2 >60 mm Hg; рСО 2 ≤45 mm Hg; non-invasive lung ventilation -at pH<7.3; рO 2 ≤60 mm Hg; рСО 2 ≤45 mm Hg; artificial lung ventilation -at pH<7.3; рO 2 <60 mm Hg; рСО 2 >45 mm Hg. Selection of respiratory support based on blood acid-base balance and gas composition indices without taking into account pulse oximetry indices allows us to increase treatment efficacy, reduce the period of stay in the intensive care unit by 1.5 times, mortality -by 4.3 times.

Aim. To evaluate the sensitivity to tuberculin in patients with infiltrative pulmonary tuberculosis in combination with an infection, caused by the human immunodeficiency virus (HIV), using various different tests. Methods. Examined were patients with infiltrative pulmonary tuberculosis with HIV infection (134 patients, the main group) and without HIV infection (100 patients, control group). Tuberculin diagnostics included an intradermal Mantoux test with 2 tuberculin units, the skin prick test with a 100% solution of PPD-L and the intradermal test «Diaskintest». Results. In the main group, a positive reaction to the Mantoux test with 2 tuberculin units was reported significantly less frequently (56.0%) than in the comparison group (89.0%), the diagnostic value of the test decreased with a decrease in the number of CD4+ lymphocytes. The prick test was characterized by a complete correlation with the results of the Mantoux test, although having a number of advantages. The sensitivity of the «Diaskintest» in the main group was 48.3%, and in the control group - 84.6%, at the same time the sensitivity of the «Diaskintest» decreased to 17% in cases of pronounced immunodeficiency. Conclusion. The skin prick test can be used as a screening method for early detection of tuberculosis in HIV-infected individuals with CD4+ lymphocyte count of 300 cells in 1 ml or more with the aim of forming risk groups, followed by screening for tuberculosis.