Identification of additional ways to reduce the incidence of tuberculosis in patients with human immunodeficiency virus infection

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Abstract

BACKGROUND: According to official statistics from the Russian Federation in 2021, human immunodeficiency virus (HIV) infection was more often registered in the general population than in vulnerable groups.

AIMS: This study aimed to determine the characteristic patient cohorts with tuberculosis (TB) and HIV coinfection in dynamic epidemiological environments and propose additional organizational approaches to reduce TB incidence in patients with HIV.

MATERIALS AND METHODS: We investigated the complete medical data of patients with TB and HIV coinfection in three Russian regions. Additionally, we analyzed the cohort of patients with TB and HIV coinfection through sexual transmission. Furthermore, confidential interviews with patients with TB and HIV coinfection were undertaken. Specifically, reasons for refusing clinical examination at a Russian Federal AIDS Center (RFAIDSC) were clarified.

RESULTS: Among patients with TB and HIV coinfection, parenteral transmission remains the primary HIV infection route. Moreover, patients who acquired infection through sexual contact are also primarily socially disadvantaged, leading to the refusal of clinical examination and a consequent late detection of TB. On the contrary, patients who are unemployed report that they do not have the financial means to travel to the regional RFAIDSC. Widespread, rapidly progressive MDR TB infections more often occurred in patients with TB and HIV coinfection than in patients with TB but without HIV. Considering that every fourth patient with TB in Russia has been diagnosed with HIV. Moreover, there are specific features regarding the development and course of TB, and the generally accepted criteria for assessing the quality of TB without HIV care often become biased for patients with coinfection. 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 and solve the issue of travel for patients who are unemployed to medical examinations and in emergency cases. It is also important to introduce adjustments for the criteria in assessing the quality of TB care, thereby accounting for the pathogenesis of TB in patients with HIV coinfection.

 

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About the authors

Olga P. Frolova

Institute of Clinical Medicine named N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University); Pirogov Russian National Research Medical University

Email: opfrolova@yandex.ru
ORCID iD: 0000-0002-2372-5341
SPIN-code: 2681-9353

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

Tatiana I. Sharkova

Pirogov Russian National Research Medical University

Email: tisharkova@mail.ru
ORCID iD: 0000-0003-4224-6060
SPIN-code: 7439-4520

MD, Cand. Sci. (Med), Associate Professor

Russian Federation, Moscow

Olga V. Butylchenko

Institute of Clinical Medicine named N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University)

Email: olga16.53@list.ru
ORCID iD: 0000-0001-9082-0624
SPIN-code: 1841-7813

MD, Associate Professor

Russian Federation, Moscow

Lyudmila P. Severova

Institute of Clinical Medicine named N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University)

Email: lyudmila.severova.1992@mail.ru
ORCID iD: 0000-0002-7488-5281
SPIN-code: 1894-0820
Russian Federation, 4, Bldg. 2, Dostoevskogo St., Moscow, 127473

Anna V. Abramchenko

Pirogov Russian National Research Medical University

Author for correspondence.
Email: av.abramchenko@mail.ru
ORCID iD: 0000-0002-9621-9271
SPIN-code: 7560-6306
Russian Federation, Moscow

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  2. Frolova OP, Shinkareva IG, Kazennyi AB, Novoselova OA. Monitoring of tuberculosis associated with HIV infection. Problems of Tuberculosis in Patients with HIV Infection. 2010;(9): 12–22. (In Russ).
  3. HIV infection in the Russian Federation as of June 30, 2021 [Internet]. Federal Scientific and Methodological Center for the Prevention and Control of AIDS. [cited 28 Sept. 2022]. Available from: http://www.hivrussia.info/wp-content/uploads/2021/08/Spravka-VICH-v-Rossii-1-polugodie-2021-g..pdf. (In Russ).
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  7. Vasilyeva IA, Testov VV, Sterlikov SA. Tuberculosis Situation in the Years of the COVID-19 Pandemic – 2020–2021. Tuberculosis and Lung Diseases. 2022;100(3):6–12. (In Russ). doi: 10.21292/2075-1230-2022-100-3-6-12
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  9. Sterlikov SA, Nechaeva OB, Son IM, et al. Industry and economic indicators of TB work in 2019–2020. Analytical review of key indicators and statistical materials. Sterlikov SA, editor. Moscow: RIO TsNIIOIZ; 2021. 63 p. (In Russ).
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