Objectives. The aim of the study was to investigate the cause of death of tuberculosis patients infected with the human immunodeficiency virus (HIV). Many researchers and experts note the urgency of the problem of tuberculosis combined with HIV infection in the world and in Russia. One of the main criteria for assessing the effectiveness of medical care for tuberculosis patients infected with the human immunodeficiency virus is the mortality rate.Materials and methods. For a detailed study of the causes of death of patients with tuberculosis in combination with HIV infection, we analyzed the causes of death of this contingent of patients in 5 regions of the Russian Federation.Results. The social characteristics of patients, the forms and course of the disease, the main and immediate causes of death of 223 patients with co-infection with HIV and tuberculosis were studied.Conclusion. Half of the deaths of tuberculosis patients infected with human im­munodeficiency virus were not associated with tuberculosis. Among these cases, there was either the presence of several infections at the same time, equally leading to death, or separate opportunistic infections (candidiasis, Pneumocystis pneumonia, toxoplasmosis), or cancer. In addition, the lifestyle of patients often became the cause of deaths, namely: drug poisoning and accidents, or cirrhosis of the liver, which develops as a result of alcoholism or hepatitis C infection which occurred during intravenous administration of drugs.

Резюме. Во взаимодействие возбудителя туберкулеза с организмом человека вовлечены многие звенья иммунной системы. Существует ряд публикаций о значимости интерферонов и других цитокинов при туберкулезе легких. Нами проведены исследования состояния системы интерферона и цитокинов у больных впервые выявленным инфильтративным туберкулезом легких. В результате наших исследований была показана прямая связь клинической и иммунологической эффективности комплексного лечения этих больных. Активная экспрессия гена IL-6 коррелирует с замедленной динамикой рассасывания инфильтратов в легочной ткани и длительным сохранением респираторных жалоб у больных в процессе лечения, экспрессия гена IL-12 -с малым объемом инфильтратов в легочной ткани до лечения, экспрессия гена IL-1β -с уменьшением сроков ликвидации интоксикации и респираторных жалоб у больных в процессе лечения. Знания о нарушениях в цитокиновой регуляторной сети необходимы для определения динамики развития заболевания и эффективности лечения, а также для назначения иммунотерапии.

No abstract

During the period of registration of tuberculosis associated with HIV infection in Russia (since 1999), its morbidity rate has increased 82.2 times. Changes in pathogenesis of tuberculosis in condition of deep immunodeficiency in patients with HIV infection require improvement of approaches to the training of medical workers who provide anti-tuberculosis care. Aim - improving approaches to personnel training on TB care for people with HIV infection. Methods. Accounting forms 263y-TB "Personal records of patients with TB comorbid with HIV infection" (65,000 records) and reporting forms of Rosstat No. 61 "Data on the population of patients with HIV infection" were analyzed for the period of their validity in the Russian Federation. The study included statistical analysis of the general totality using a computer database, revision of individual records and interview with patients. conclusions. In order to improve the training of personnel on the issues of TB care in HIV infected patients, it is essential to bring the textbooks and regulatory documents in line with the current medical knowledge.