Severe and Comorbid Conditions in Hiv Patients: An Analysis of Adverse Outcomes

Леонова, О. Н.; Степанова, Елена В.; Беляков, Н. А.

doi:10.22328/2077-9828-2017-9-1-55-64

Cited by 20 publications

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“…Анализ отечественной литературы и клинических материалов, накопленных с момента повсеместного применения АРВТ, сопоставления их с материалом аутопсий людей, умерших на фоне ВИЧ, свидетельствует о том, что диагноз СВИ ставится достаточно редко. Это расходится с ростом летальных исходов на фоне АРВТ на продвинутых стадиях ВИЧ-инфекции, в том числе от туберкулеза и оппортунистических инфекций [1, 7,11,48].…”

Section: выявление и диагностика свиunclassified

“…В большинстве случаев гибель наступает в течении первого года или нескольких месяцев с начала АРВТ [7,11,14,16,19,20,48]. При анализе литературы возникает по меньшей мере несколько закономерных вопросов:…”

Section: выявление и диагностика свиunclassified

“…Мы находимся на пике эпидемии с рос том заболеваемости, поздним выявлением ВИЧ и, соответственно, с поздним назначением АРВТ, недостаточным охватом лечения этой категории больных, с большим числом пациентов с коморбидными состояниями, включая туберкулез, наркоманию, вирусный гепатит и др. [1,3,4,5,7,11,16,19,23]. Совокупность этих факторов дополняет возможность негативного исхода СВИ или способствует его тяжелому течению.…”

Section: течение и прогнозunclassified

“…Их перечень совпадает по многим клиническим проявлениям, в частности воспалительным инфекционным заболевания, имеющим бактериальную, вирусную, грибковую природу, а также ВИЧобусловленным онкологическим болезням [42]. Тот и другой синдром характерен для пациентов с длительным анамнезом ВИЧ-инфекции, возможным сопутствующим употреблением психоактивных веществ и для лиц, ведущих асоциальный образ жизни [11]. У таких пациентов в процессе заболевания возможны по меньшей мере 3 сценария развития патологичес ких процессов: успешное проведение АРВТ с пролонгированием жизни на годы, летальный исход без АРВТ через СПИД, и ухудшение состояния с возможным неблагоприятным исходом через СВИ, являющегося эквивалентом АРВТиндуцированного СПИДа.…”

Section: спид и свиunclassified

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Immune Reconstitution Inflammatory Syndrome in Hiv Infection

Боева

Беляков

2018

Russian Journal of Infection and Immunity

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Antiretroviral therapy (ART) leads to suppression of HIV replication, contributes to increase in the number of CD4-lymphocytes count and partial restoration or activation of the immune system. The consequence is a reduction of incidence of opportunistic diseases, increase in the duration and quality of life of people living with HIV (PLHIV). However, in some patients with severe immunosuppression, this may be accompanied by a worsening of the condition and risks of formation of the immune reconstitution inflammatory syndrome (IRIS), which manifests itself in the development of new or previously treated opportunistic, secondary and exacerbating non- infectious diseases against a virologically effective ART. The frequency of the development of IRIS varies widely, in cases of tuberculosis-associated manifestation it can reach 50%. Risk factors for the development of IRIS are low initial CD4-lymphocyte count and a high load of HIV RNA in the blood, the presence of opportunistic infections during the initiation of ART. Discussed terminology issues, other possible risk factors for the development of the syndrome, regularities of the pathological process are considered. Epidemiological statistics of IRIS, pathogenetic bases, variants of clinical and laboratory manifestations of complications are given. The criteria for diagnosis of the syndrome, as well as the necessary conditions for its occurrence, are considered. Particular attention is paid to the most common opportunistic infections that cause the manifestation of IRIS, the peculiarities and polymorphism of clinical manifestations and the prevention of their occurrence. Currently, there is an increasing incidence of HIV infection in the late stages. Laboratory and clinical differences in the manifestations of acquired immunodeficiency syndrome (AIDS) and IRIS have been sanctified. In view of the blurring of the diagnostic criteria, in the Russian Federation specialists rarely expose IRIS to clinical or pathological diagnoses, therefore it is rather difficult to trace the frequency of occurrence of this condition. Clinical and laboratory manifestations are systematized, which allows to formulate this diagnosis on the basis of their totality. Prevention of IRIS is the prudent prescription of antiretroviral drugs. It is neces sary to conduct a qualitative and timely diagnosis of concomitant diseases of infectious and non-infectious nature before the initiation of ART and during treatment, the appointment of effective etiotropic therapy for opportunistic and secon dary infections. In order to improve the prognosis of HIV infection, preferably early onset of ART with stable CD4-lym phocyte counts and low HIV RNA levels in the blood.

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Section: выявление и диагностика свиunclassified

Section: течение и прогнозunclassified

Section: спид и свиunclassified

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Immune Reconstitution Inflammatory Syndrome in Hiv Infection

Боева

Беляков

2018

Russian Journal of Infection and Immunity

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“…Настоящий этап ВИЧ-инфекции характеризуется формированием тяжелых и коморбидных форм заболевания, так как, начиная с середины 90-х гг., в эпидемию вошли инъекционные наркопотребители, принесшие в популяцию вирусный гепатит С [1][2][3]. По мере развития у больных иммуносупрессии появились оппортунистические и СПИД-индикаторные болезни, включая туберкулез (ТБ) [2,8]. Заболеваемость ТБ, сочетанным с ВИЧ-инфекцией, неуклонно увеличивается.…”

Section: Introductionunclassified

Analysis of medical and social factors affecting the formation and course of co-infection HIV, tuberculosis and viral hepatitis

Азовцева¹,

Пантелеев²,

Карпов³

et al. 2020

Russian Journal of Infection and Immunity

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Currently, HIV infection is characterized by emergence of its severe and comorbid forms. Mid-1990 HIV epidemics was expanded due to injection drug users who brought viral hepatitis C to the cohort. Along with developing immunosuppression, opportunistic and AIDS-defining diseases, including tuberculosis emerged. Various combinations of coinfections (HIV infection+tuberculosis±viral hepatitis) affect clinical manifestations and clinical score, reduce the therapeutic efficacy and worsen disease prognosis.Objective: to study an impact medical and social factors on course of TB-co-infection associated with immunosuppression related to HIV infection and viral hepatitis.Materials and methods. Comorbid cases (HIV infection, tuberculosis and chronic hepatitis) dominated by verified TB-infection (n = 137) were analyzed.Results. It was shown that socially maladapted young people with previous experience of intravenous drug and alcohol abuse dominated among subjects with co-infections, half of which were held in penal institutions. More-over, the mean CD4 lymphocyte level in generalized tuberculosis was significantly lower than in patients with significantly reaching 164±21.5 cells. In addition, lung-specific lesions were observed in 73.4% of patients with generalized tuberculosis that developed by initial targeting of the lymphoid system followed by affecting other organs, mainly the central nervous system, urinary system and abdominal organs. Introduction of antiretroviral drugs to anti-TB therapy reduced mortality rate by 8 times. Viral hepatitis was the most common concomitant disease found in co-infected patients, with dominating viral hepatitis C both as a mono-infection (86.8%) as well as in combination with viral hepatitis B (9.43%). In addition, co-morbid viral hepatitis resulted in progression of TB infection affected due to intra-thoracic lymph nodes being involved in tuberculosis process as well as development of opportunistic diseases due to a markedly decreased CD4 cell count. Analysis of potentially aggravating risk factors for developing hepatotoxicity (viral hepatitis, combined treatment with anti-TB and anti-retroviral drugs) did not reveal their any additional negative impact on hepatic functions. Thus, use of a combination therapy with anti-TB and anti-retroviral drugs in co-infected patients was shown to be safe and not accompanied by a high rate of hepatotoxic reactions.

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Comorbidity in patients with HIV infection and tuberculous spondylitis as a risk factor for infectious complications

Шувалова

Vishnevskiĭ

2020

Hir. pozvonoč.

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Objective. To determine how the presence of comorbidity, including the fact of the presence of HIV infection, affects the risks of developing infectious postoperative complications in patients with tuberculous spondylitis. Material and Methods. A monocenter comparative retrospective analysis of 116 HIV-infected patients and 158 HIV-negative patients operated on for tuberculous spondylitis was carried out, with an analysis of risk factors for postoperative complications-concomitant diseases, the Charlson comorbidity index, the anesthesia-related and operative risk according to the ASA scale. Results. Concomitant pathology and classes 3 and 4 according the ASA criteria were observed in 88.3 % of patients in the general cohort. In class 4 patients, infectious complications occurred 1.5 times more often, primarily due to early complications of immunodeficiency, while in the group of HIV-negative patients, the frequency of complications did not differ significantly between these classes. In HIV-infected patients with a moderately higher operative and anesthesia-related risk (risk increase factor = 1.19), the risk of postoperative complications increased by 1.76 times. Specific postoperative complications in HIV-infected patients were more common than in the control group (2 = 4.53, OR = 2.76). Conclusion. The presence of HIV infection in patients with tuberculous spondylitis in comparison with HIV-negative patients is a risk factor that significantly increases the risk of early (occurring up to 1 year after surgery) postoperative complications, such as postoperative pneumonia, exacerbation (progression) of spondylitis and the development of tuberculous meningitis. At that, the risk of developing late postoperative complications does not depend on the fact of HIV infection.

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Severe and Comorbid Conditions in Hiv Patients: An Analysis of Adverse Outcomes

Cited by 20 publications

References 0 publications

Immune Reconstitution Inflammatory Syndrome in Hiv Infection

Immune Reconstitution Inflammatory Syndrome in Hiv Infection

Analysis of medical and social factors affecting the formation and course of co-infection HIV, tuberculosis and viral hepatitis

Comorbidity in patients with HIV infection and tuberculous spondylitis as a risk factor for infectious complications

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