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Chapter 5 Clinico-Immunologichesky indicators of a HIV-infection, sochetannoj with a tuberculosis against antiretrovirusnoj therapies

According to the Russian and international references, antiretrovirusnuju therapy (APT) prescribed the patient with a HIV-infection in the presence of the clinical implications testifying to an immunodeficiency and-or depression of number СЭ4-лимфоцитов more low 0,200-0,350 h 109/l.

In investigated group of 16 patients therapy has been prescribed antiretrovirusnaja. Two patients did not accept therapy (have refused). From 14 patients receiving therapy, 8 patients have independently interrupted therapy on terms from 5 months to the three patients receiving (APT) have died of tuberculosis advance. Three patients continue therapy on present time, from them 2 1 years sick more, 1 patient within 10 years.

Among the patients receiving therapy of 4 patients had an asymptomatic stage of a HIV-infection, antiretrovirusnaja therapy has been prescribed under laboratory indications; 10 patients had a stage of secondary diseases - therapy is prescribed under clinico-laboratory indications. And at 8 of them the tuberculosis has developed against a HIV-infection and was opportunistic disease. At 6 patients the tuberculosis was showed as accompanying disease.

In investigated group all patients, with activity of tubercular process, received 4-5 antituberculous preparations, the scheme of treatment of a tuberculosis at all included rifampicin. In this connection, in scheme APT did not include inhibitors of proteases. 11 patients received antiretrovirusnuju therapy under the scheme: 3 nukleozidnyh an inhibitor of return transkriptazy (kombivir on 1 tablet 150/300 h 2 times a day, ziagen on 1 tablet of 300 mg h 2 times a day), and 3 patients under the scheme: 2 nukleozidnyh an inhibitor of return
transkriptazy and 1 nenukleozidnyj an inhibitor of return transkriptazy (kombivir on 1 tablet 150/300 h 2 times a day, viramun on 1 tablet of 200 mg h 2 times a day).

In control group of 17 patients therapy is prescribed antiretrovirusnaja, 1 patient has refused therapy, 5 patients have independently interrupted therapy on terms from 4 months till 2 years. Two patients have died in connection with HIV-infection advance. 9 patients continue therapy on present time within 2-10 years. Among the patients receiving therapy in control group, 5 patients had an asymptomatic stage of a HIV - of an infection, antiretrovirusnaja therapy has been prescribed under laboratory indications. 11 patients had a stage of secondary implications, therapy is prescribed under clinico-laboratory indications. In control group 1 patient received antiretrovirusnuju therapy under the scheme: 3 nukleozidnyh an inhibitor of return transkriptazy; 10 patients under the scheme: 2 nukleozidnyh an inhibitor of return transkriptazy + 1 nenukleozidnyj an inhibitor

Return transkriptazy; and 5 patients under the scheme 2 nukleozidnyh an inhibitor of return transkriptazy + 1 inhibitor of a protease.

At sick HIV-infections, sochetannoj with a tuberculosis leading syndromes were weight loss (92,8 %), astheno-vegetative (85,7 %) and a bronho-pulmonary syndrome (78,6 %). At 78,6 % of patients the liver augmentation was observed. Against antiretrovirusnoj therapies have decreased implications of all syndromes, the infectious-toxic syndrome, dream disturbance, an arthralgia, an eruption and a skin itch, virus lesions of a skin (fig.

11, table 27) has disappeared. In 2,4 times it became perceptible astenovegetativnyj a syndrome less often, in 1,2 times is more rare bronholegochnyj, in 1,2 times weight loss is more rare. A bacteriemic lesion of a skin against therapy became perceptible less often in 3 times, and a mycotic affection in 1,5 times. Against therapy in 4 times the quantity of patients with an anorexia was enlarged.

? Infectious-toxic ■ Astenovegetativnyj

And Bronholegochnyj

? Weight loss

104

Fig. 11. The basic clinical syndromes of a HIV-infection against antiretrovirusnoj therapies in investigated groups.

In comparison group leading syndromes before appointment antiretrovirusnoj therapies were liver augmentation (62,5 %), limfoadenopatija (56,3 %) and astenovegetativnyj a syndrome (56,3 %). In 2-2,3 times more often, than in investigated group met a lesion of a skin and mucous (a bacteriemic and fungoid aetiology) willows 1,5 times more often gastrointestinalnyj a syndrome. Against antiretrovirusnoj therapies the infectious-toxic syndrome, dream disturbance, a virus lesion of a skin has disappeared, in 3 times it became perceptible astenovegetativnyj a syndrome, in 2,3 times bacteriemic, and in 2,8 times fungoid skin lesions less often. Against spent antiviral therapy among by-effects were more often registered a lesion syndrome GASTROINTESTINAL TRACT, on 6,2 % the liver augmentation has been more often noted. In control group at 1 patient for 5 year of therapy the obliterating atherosclerosis of vessels of the bottom extremities (table 28), at 1 patient for 2 year of therapy - a toxic medicinal hepatitis with augmentation of activity ALT in 12 times, and normalisation of indicators after change of scheme APT has developed.

Table 27

Symptoms Patients
HIV-infection, sochetanyonoj with a tuberculosis (п=14) HIV-infection (п=16)
Before therapy Against therapy Before therapy Against therapy
Temperature, fever 42,8 - 6,3 -
Delicacy 85,7 35,7 56,3 18,8
Headache 14,3 7,1 18,8 6,3
Tussis, dyspnea 78,6 64,2 25 6,3
Pains in a thorax 14,3 14,3 - -
Dream disturbance 7,1 - 6,3 -
Arthralgia, mialgija 7,1 - 6,3 6,3
Eruption and skin itch 21,4 - 25 18,8
Bacteriemic lesion of a skin 21,4 7,1 43,8 18,8
Virus lesion of a skin and mucous 14,3 - 18,8 -
Mycotic affection of a skin and mucous 21,4 14,3 50 18,8
Weight loss 92,8 78,6 25 25
Limfoadenopatija 50 50 56,3 50
Liver augmentation 78,6 78,6 62,5 68,75
Chair disturbance - - 6,3 18,8
Rigid breath 64,2 50 12,5 6,3
Rhonchuses 42,8 35,7 12,5 6,3
Pains in epigastriums 21,4 21,4 31,3 43,8
Appetite loss 7,1 28,5 - 6,3

Clinical implications of the patients receiving antiretrovirusnuju therapy in %

In investigated group, at patients receiving therapy, in a stage of secondary implications of a HIV-infection following opportunistic diseases are taped: Herpes zoster at 1 patient (7,1 %), a mycotic affection of a skin at 3 sick (21,4 %), an encephalopathy of the admixed genesis (a HIV + an alcoholism) - at 3 (21,4 %), a tuberculosis at 8 (57,1 %) patients. In control group, at the patients receiving therapy, opportunistic diseases are taped: widespread mycotic affections of a skin at 6 sick (37,5 %), an encephalopathy (a HIV caused) - at 3 patients

(18,8 %), Sarcoma Kaposhi - at 1 (6,3 %), Sa coli uteri - at 1 patient (6,3 %), a hairy leukoplakia of tongue - at 2 (12,5 %), peaked kandilemy - at 1 patient (6,3 %).

Secondary and accompanying diseases of the patients receiving antiretrovirusnuju therapy in %

Table 28

Symptoms Sick HIV-infekYotsiej, sochetannoj with a tuberculosis (п=Т4) Sick HIV - an infection

(п=16)

Before therapy Against therapy Before therapy Against therapy
Cachexia 42,8 42,8 - -
Oral cavity candidiasis 14,3 7,1 25 -
Mycoses 21,4 14,3 37,5 6,3
Herpes zoster 7,1 - - -
BUT 14,3 - 18,8 -
Furunculosis 21,4 - 37,5 6,3
Encephalopathy (according to KT) 21,4 21,4 18,8 18,8
Anaemia 14,3 - - -
Psoriasis 7,1 7,1 12,5 12,5
Sarcoma Kaposhi - - 6,3 6,3
Sa coli uteri - - 6,3 6,3
Hairy leukoplakia

Tongue

- - 12,5 12,5
Peaked kandilemy - - 6,3 6,3
polinejropatija 14,3 14,3 - 6,3
Depression - - - 18,8
Atherosclerosis of vessels - - - 6,3
Peptic ulcer - - 6,3 6,3
Chronic bronchitis, pneumonia - 43,8 18,8
Adenoid disease - - 18,8 -
Toxic hepatitis 57,1 71,4 - 6,3
Alcoholism 57,1 57,1 12,5 12,5
TB - the opportunist 57,1 57,1 - -
TB - accompanying disease 42,9 42,9 - -
Chronic virus hepatitises 87,5 87,5 56,25 56,25

At research of biochemical indicators of blood it is taped activity of enzymes of cytolysis of a liver in 1,3 time, a thymol turbidity test in 1,2 time and an alkaline phosphatase in 1,2 times against antiretrovirusnoj therapies that has been bound to by-effects of preparations and toxic action on a liver (table 29). In investigated group of 57,1 % of patients 85,7 % the chronic virus hepatitises suffered an alcoholism, and, all patients in connection with activity of tubercular process received 4-5 antituberculous preparations. In group of comparison of 12,5 % of patients suffered an alcoholism and 56,25 %-хроническими virus hepatitises. In connection with low level СО4-лимфоцитов in investigated group of 6 persons received chemoprophylaxis pnevmotsistnoj a pneumonia Biseptolum (960 mg h 3 times a week), and in control group 3 persons. In connection with a mycotic affection of a skin and mucous in investigated group 2 persons received difljukan, in control group 4 persons.

Table 29

Biochemical indicators of blood serum of the patients receiving antiretrovirusnuju therapy

Biochemical indicators of blood serum Sick HIV-infekYotsiej, sochetannoj with a tuberculosis (п=14) Sick HIV - an infection (п=16)
Before therapy Against therapy Before therapy Against therapy
ALT

N=5-22 Ed/l

26,94±6,36 36,09±6,57 36,03±5,34 93,71±18,46
0,05 р0,05 р0,05 0,05
Alkaline phosphatase N=62-176 ed/l 139,67±13,

04

162,11±12,

43

139,93±8,56 205,0±33,22
0,05 r
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More on topic Chapter 5 Clinico-Immunologichesky indicators of a HIV-infection, sochetannoj with a tuberculosis against antiretrovirusnoj therapies:

  1. Chapter 4 the Comparative characteristic clinico-immunologicheskih HIV-infection indicators, sochetannoj with a tuberculosis and a HIV-infection without a tuberculosis
  2. CHAPTER 3 Clinico-Immunologichesky features of a HIV-infection, sochetannoj with a tuberculosis
  3. HAMZINA Ruzalija Vagizovna. CLINICO-IMMUNOLOGICHESKY FEATURES of a HIV-INFECTION, SOCHETANNOJ With the TUBERCULOSIS the DISSERTATION on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg -,
  4. Immunologic features of a HIV-infection, sochetannoj with a tuberculosis, depending on time of revealing of a HIV-infection and an active tuberculosis
  5. Clinical features of a HIV-infection, sochetannoj with a tuberculosis
  6. Clinical aspects of a HIV-infection, sochetannoj with a tuberculosis
  7. modern approaches to HIV-infection treatment, sochetannoj with a tuberculosis
  8. immunologic aspects of a HIV-infection, sochetannoj with a tuberculosis
  9. the Comparative characteristic of a current of tubercular process at patients of the basic group (a tuberculosis in a combination to a HIV-infection) and in control group (a tuberculosis without a HIV-infection)
  10. THE CHAPTER IV MECHANISM OF INFLUENCE MONO - BOTH SOCHETANNOJ THERAPIES EMOKSIPINOM AND DIMEFOSFONOM ON REACTION ­ PEROKSIDATSII, DETOKSIKATSIONNYE ­ CHARACTERISTICS AND CLINICO-BIOCHEMICAL INDICATORS OF BLOOD AT SICK OF THE HYSTEROMYOMA
  11. Chapter 4. Epidemiological and clinico-laboratory harakteristikabolnyh a tuberculosis in a combination to a HIV-infection and virus hepatitises in St.-Petersburg
  12. Chapter 1. A HIV-infection and a tuberculosis
  13. Obshchajaharakteristika sick of a tuberculosis and a HIV-infection
  14. clinical features of the HIV-infection, taped against an active tuberculosis
  15. Immunologic features of a HIV-infection in a combination to a tuberculosis at their simultaneous revealing
  16. sensitivity level to a tuberculin at organs of breathsick of a tuberculosis depending on terms of revealing of a tuberculosis and a HIV-infection
  17. clinical features of a HIV-infection in a combination to a tuberculosis at their simultaneous revealing (P group)
  18. clinical features of a HIV-infection at revealing of an active tuberculosis (SH group)
  19. a HIV-infection Pathogenesis in a combination to a tuberculosis
  20. Features of a combination of a tuberculosis and a HIV-infection in the Kaliningrad area