Clinical and laboratory characteristics of mycobacteriosis in persons with HIV and case report of severe generalized mycobacteriosis

Relevance. In the context of HIV epidemic, the number of cases of mycobacteriosis has increased.The objective was to study clinical and laboratory characteristics of mycobacteriosis in HIV patients; to present a clinical case of severe generalized mycobacteriosis.Methods and materials. Retrospective analysis of 48 cases from the archives of the St. Petersburg State Budgetary Healthcare Institution «S. P. Botkin Clinical Infectious Diseases Hospital» over the period from 2016 to 2018 was performed. The inclusion criterion was newly diagnosed mycobacteriosis. The following parameters were evaluated: HIV infection duration and stage; antiretroviral therapy (ART) duration; the primary syndrome and form of mycobacteriosis; laboratory and instrumental findings; causative pathogen verification methods.Results. Median number of CD4-lymphocytes (CD4 + ) was 6.9 cell/pl. In 33.3 % of patients, HIV infection was diagnosed within 1 year before the detection of mycobacteriosis. The primary syndromes were: febrile-toxic syndrome (72.9 %), bronchopulmonary syndrome (29.2 %), diarrhea syndrome (18.8 %), abdominal pain syndrome (10.4 %). Generalized myco-bacteriosis was diagnosed in 65.3 % patients. Anemia was registered in in 96 % patients, leukopenia — in 43.8 % patients. Lymphadenopathy of various localization was the most common instrumental finding (75 %). The diagnosis was confirmed bacteriologically in 70.8 % cases. Mycobacterium avium complex group was predominant (62.5 %). There were 18.8 % deaths.Conclusion. Mycobacteriosis developed in patients with advanced immunodeficiency. Clinical and laboratory findings were nonspecific. There was a trend towards generalization of infection. The proportion of deaths indicates the high importance of mycobacteriosis in the structure of mortality in HIV patients.

Drug utilization research in coinfected patients with tuberculosis and HIV/AIDS

Objectives: This study aims to describe and classify the drugs prescribed for coinfected patients treated at a reference hospital. Methods: A retrospective cross-sectional study with analysis of information contained in a database prepared in an earlier study The Anatomical Therapeutic Chemical (ATC) classification system was used to classify the prescribed drugs. Results: Eighty-one coinfected individuals participated in the study, with a mean age of 40 years old and numerous comorbidities. A total of 147 drugs were found and, when the frequency of prescription was evaluated, the most used therapeutic groups were anti-infectious, considering the large number of opportunistic infections (OIs) presented by coinfected patients, followed by feeding tract drugs used to treat adverse drug reactions. We could observe that 73% of the evaluated population had a CD4+ T lymphocyte count <200 cells/mm3 and a high viral load, indicating advanced immunodeficiency. Conclusion: It is necessary to develop strategies aimed at coinfected patients, such as specialized care, early diagnosis and appropriate treatment of coinfection. It is also important to carry out more studies on the use of drugs among coinfected patients to create actions directed to this population that may contribute to the rational use of drugs.

Outcomes of Universal Access to Antiretroviral Therapy (ART) in Georgia

Since 2004, Georgia achieved universal access to free antiretroviral therapy (ART). A retrospective cohort study was conducted to evaluate the outcomes of Georgia's ART program. The study included adult patients enrolled in the ART program from 2004 through 2009. Of 752 patients, 76% were men, 60% were injection drug users (IDU), 59% had a history of an AIDS-defining illness, and 53% were coinfected with hepatitis C. The median baseline CD4 cell count was 141 cells/mm3. During followup, 152 (20%) patients died, with the majority of deaths occurring within 12 months of ART initiation. Mortality was associated with advanced immunodeficiency or the presence of incurable disease at baseline. Among patients remaining on treatment, the median CD4 gain was 216 cell/mm3and 86% of patients had viral load <400 copies/ml at the last clinical visit. The Georgia ART program has been successful in treating injection drug users infected with HIV.