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Daminova Kh. M., associate professor at the Department of Neurology T. M. A. Tashkent city Zhumaniyozov N. B., master of the Department of Pediatric Infectious Diseases Tashkent Pediatric Medical Institute, Tashkent city
Daminova M. N.., associate professor at the Department of Pediatric Infectious Diseases, Tashkent Pediatric Medical Institute, Tashkent city
Jalilov A. A.,
associate professor at the Department of Ambulatory Medicine Tashkent Pediatric Medical Institute, Tashkent city
THE PREVALENCE OF TUBERCULOSIS IN PATIENTS WITH HIV INFECTION
Abstract: Tuberculosis is a disease that takes a lot of people's lives, and especially if it manifests itself in patients with HIV infection and therefore aspects of this problem are revealed in our work based on a literature review. Keywords: infections, complications, mortality, mycobacterium, children, population.
Tuberculosis remains the most significant infectious disease in the third millennium, taking the first place among the causes of death.
As the statistics show, by 2020, out of 68 million deaths, 11.9 million will be caused by respiratory diseases: 1) 4.7 million for COPD; 2) 2.5 million - pneumonia; 3) 2.4 million -tuberculosis; 4) 2.3 million - lung cancer.
Tuberculosis, which has been a number of controlled infections for several decades, is now becoming a threat on a global scale: more than a third of the world's population is infected with Mycobacterium tuberculosis (MBT), about 9 million people die of tuberculosis every year, and 1.4 million people die of this infection.
The current period is characterized by a worsening situation for tuberculosis in the country with a significant increase in the incidence and mortality rates from tuberculosis, and the weighting of the clinical and social structure of newly diagnosed patients with tuberculosis. One of the factors that require a significant correction of the global tuberculosis control strategy is drug resistance of the causative agent.
According to the WHO, in 2011, 8.7 million cases of tuberculosis were found, equal in the world to 125 cases per 100,000 population.
Of these, 59% in Asia, 26% in Africa.
In 2011, 1.4 million people died from tuberculosis, among them 500,000 were women.
Worldwide, in 2011, 630.000 cases of MDR-TB were detected, in the range of 460.000-790.000. Among them, the number of patients with pulmonary tuberculosis was 310.000.
As the authors of the literature note, tuberculosis remains an important national problem in the world, despite the complex of large-scale anti-tuberculosis measures being carried out, the epidemiological situation oftuberculosis remains tense. The current epidemiological situation in many countries, including Uzbekistan, is characterized by a deterioration in the main indicators for tuberculosis (morbidity, mortality, disability).
An analysis of the literature showed that in the early 1990s, the first reports appeared about the worsening epidemiological situation of tuberculosis in the world, especially in places where the negative impact of environmental and socioeconomic factors was great and the level of anti-tuberculosis measures was reduced.
Clinicians described types ofresistance differ in their prevalence and severity. It is known that the frequency ofprimary drug resistance is lower, the structure is more favorable (resistance is more often to 1-2 drugs), and the minimum inhibitory concentrations of drugs are lower than with secondary resistance.
There is no doubt the relationship of both types of resistance. Thus, the presence of primary drug resistance in some cases is a prerequisite for the emergence of secondary resistance to more anti-tuberculosis drugs.
At the same time, the high prevalence of secondary drug resistance causes the population to become infected with resistant strains with the further development of primary resistant tuberculosis.
In addition, in the study of resection material, so-called latent drug resistance was described, when resistance to a larger number of drugs was found in the cavity than in sputum.
Medical science
The contingent of newly diagnosed patients with tuberculosis is characterized by resistance, comorbidities and adverse factors, which leads to a lack of effectiveness of treatment.
The development of resistance of mycobacterium tuberculosis to anti-tuberculosis drugs is a special case of the development of drug resistance and is observed for all currently known anti-tuberculosis drugs.
Among the reasons explaining this process, the leading role is played by the presence of a significant reservoir of tuberculosis infection, a significant number of patients who secrete multi-resistant forms of mycobacterium tuberculosis.
Domestic authors claim that the weakening of the work of the fluorographic service contributed to the late detection of tuberculosis and the formation of a significant reservoir of tuberculosis infection. Every third patient with tuberculosis secretes mycobacteria and is dangerous for others, every fifth patient with tuberculosis becomes disabled.
Tuberculosis often affects the most efficient age of the population and causes economic damage to society.
According to Danilova I. D. the age from 18 to 34 years old accounts for almost half (47.6%) of all newly infected women and 34.2% of newly infected men, that is, compared with men, women are more likely.
Among the factors contributing to the progression of the process, insufficiently effective treatment, an important role is played by concomitant diseases, i.e. they aggravate the course of tuberculosis and cause its unfavorable dynamics
Currently in the world there are two epidemics that are interconnected with each other. The development of tuberculosis, which has been the main cause of human mortality for a millennium, is fueled by the epidemic of HIV infection, and on a global scale tuberculosis is one of the main causes of death in HIV-infected people and people with AIDS.
As the authors of the literature note, that in the context of the AIDS epidemic, an increase in the incidence of tuberculosis is a global national security problem in most countries. Despite the development of effective methods for treating tuberculosis, this infection remains one of the leading causes of
morbidity and mortality in the world. Approximately 1/3 of the human population is infected with mycobacteria tuberculosis (MBT) and 5-10% of them develop active tuberculosis during life. Every year the frequency of tuberculosis in the world increases by 0.4%.
The main reasons for this situation are the HIV / AIDS pandemic and the rapid increase in the number of antibiotic-resistant strains of the causative agent of tuberculosis. In no country with a severe HIV situation, it is not possible to successfully control the situation with tuberculosis.
It has been established by the authors of the literature that the risk of progression from infection with tuberculosis to the development of a clinically expressed disease increases when combined with HIV infection from 6 to 26 times in different countries with different epidemiological conditions. A direct correlation has been revealed between the increase in the number of cases of tuberculosis and HIV infection, as well as the number of patients with these mixed infections. The situation is exacerbated by the fact that both infections are characterized by the proximity of risk groups: these are young people under 30 years old who are not working, use intravenous drugs, who often served time in prison (MJIC) and were in contact with tuberculosis patients.
HIV-infected individuals are at increased risk of acquiring primary tuberculosis and reactivating their latent tuberculosis infection that previously existed.
The authors noted that the low life expectancy of HIV -infected patients suffering from tuberculosis is due to the late diagnosis of the pathological process. The difficulties that arise in detecting tuberculosis are due to the great similarity of the clinical manifestations of AIDS and tuberculosis. The issues of chemoprophylaxis of tuberculosis in HIV-infected people, including primarily the indications for it, evaluation of its effectiveness, remain unresolved.
Summing up the literary analysis, it can be noted that it is necessary to look for ways to improve the efficiency of early diagnosis and prevention of tuberculosis in HIV-infected patients.
References:
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