ОПЫТ РАННЕЙ ЩАДЯЩЕЙ ИММУНИЗАЦИИ ВАКЦИНОЙ БЦЖ-М ДЕТЕЙ С ПЕРИНАТАЛЬНЫМ КОНТАКТОМ ПО ВИЧ

A practice of an early reduced-antigenic-load BCG-M vaccination of HIV-exposed infants inIrkutskdistrict, a district with the high HIV and tuberculosis (TB) prevalence, had been evaluated. It had been establish that the vaccination within the conventional time frame leads to the development of an anti-tuberculous immune response which, usually, is verified by the post-immunization reactions and the tuberculosis skin test results. A high safety of the reduced-antigenic-load BCG-M vaccination had been confirmed in cases with perinatally HIV-infected infants. The clinical development of the TB infection in non-vaccinated children, especially of the youngest age, had been characterized by a development of the hazardous complications which tend to be persistent. С позиций эффективности и безопасности оценен опыт ранней щадящей иммунизации вакциной БЦЖ-М детей с перинатальным контактом по ВИЧ на территории Иркутской области — регионе с высокой превалентностью и инцидентностью ВИЧ-инфекции и туберкулеза. Ранняя щадящая иммунизация на основе традиционных сроков проведения и показаний к вакцинации формирует адекватный, умеренно выраженный противотуберкулезный иммунитет, подтверждаемый местными постпрививочными реакциями и кожными туберкулиновыми тестами. Подтверждена высокая безопасность ранней щадящей вакцинации БЦЖ у детей при реализации перинатальной ВИЧ-инфекции. Клиническое течение туберкулеза у не вакцинированных детей, особенно раннего возраста, отличается тяжелым осложненным течением, склонным к прогрессированию.

Features of Epidemic Process of Tuberculosis in the Territory with High Prevalence of HIV Infection

Scales of epidemic process of HIV-associated of tuberculosis are especially noticeable in regions with high prevalence of HIV infection and tuberculosis. A striking example of this situation is the Irkutsk region – the territory with the highest prevalence of HIV infection in the Russian Federation and one of the most unsuccessful one on tuberculosis – in 2010 became Russian “leader” and in prevalence of the HIV-associated tuberculosis, keeping a position “in the first five” so far. It is clear, that all this cannot but imply negative manifestations of two considered epidemic processes at their simultaneous development in one territory. The above-said facts predetermined carrying out the retrospective epidemiological analysis of spread of tuberculosis among the cumulative population in the Irkutsk region, a territory of high risk of HIV infection.The purpose of the work was to assess features of spread of tuberculosis in the territory of the large center of HIV infection (Irkutsk region).Results. The expressed negative impact of HIV infection on epidemic process of tuberculosis in the studied region, shown in divergence of trends and higher levels of epidemiological indicators in comparison to the all-Russian data is established.Conclusion. As a result of a research the trend of regional incidence of tuberculosis, multidirectional with the all-Russian indicators, is established from the moment of epidemic spread of HIV infection that demonstrates integration of epidemic processes of the studied infections. Even on condition of regress of epidemic process of tuberculosis at the end of the analyzed period which is followed by decrease in incidence of all population, HIV infection has a significant impact on his tension that, certainly, demands the strengthened measures of epidemiological control of these socially important infections

Viability of causative pathogen in patients with drug-sensitive and drug-resistant forms of respiratory tuberculosis

To predict outcomes of tuberculosis we investigated the viability of Mycobacterium tuberculosis (MTB) in relation to drug resistance of strains and clinical manifestations of tuberculosis. During the study on solid Löwenstein - Jensen medium, we determined the speed, growth rate and drug resistance of MBT in 5945 cultures, isolated from the sputum of patients with pulmonary tuberculosis - residents of the Irkutsk region (2193 -from newly diagnosed patients, 3752 - from previously treated patients). The criterion of high viability of MBT was the growth rate of >100 colonies over 20 days; and low viability corresponded with the growth rate of 30 days. 2171 cultures (36.5 %) had high viability of MBT strains, 3021 (50.8 %) - low, and 753 (12.7 %) cultures had average degree of viability. A high degree of pathogen viability was more often determined in newly diagnosed patients with tuberculosis of intrathoracic lymph nodes (all patients with HIV-infection without antiretroviral therapy), fibrotic-cavernous and infiltrative tuberculosis. Among previously treated patients with tuberculosis the high viability of MBT was often determined in patients with fibrous-cavernous and infiltrative tuberculosis, and caseous pneumonia. Cultures from previously treated patients with tuberculosis of intrathoracic lymph nodes had low degree of viability. The number of drug-sensitive strains was 1992, drug-resistant ones - 3953, including 1430 strains with multidrug resistance. We have found that 37.5 % drug-resistant strains associated with a high degree of viability (multidrug resistance - 38.5 %), it's was more often than the drug-sensitive (35.4 %; p < 0.01)

PRACTICE OF EARLY REDUCED-ANTIGENIC-LOAD BCG-M VACCINATION OF HIV-EXPOSED INFANTS

A practice of an early reduced-antigenic-load BCG-M vaccination of HIV-exposed infants inIrkutskdistrict, a district with the high HIV and tuberculosis (TB) prevalence, had been evaluated. It had been establish that the vaccination within the conventional time frame leads to the development of an anti-tuberculous immune response which, usually, is verified by the post-immunization reactions and the tuberculosis skin test results. A high safety of the reduced-antigenic-load BCG-M vaccination had been confirmed in cases with perinatally HIV-infected infants. The clinical development of the TB infection in non-vaccinated children, especially of the youngest age, had been characterized by a development of the hazardous complications which tend to be persistent

THE CLINICAL PICTURE AND COURSE OF TUBERCULOSIS IN CHILDREN WITH PERINATAL HIV INFECTION

Examinations were made in 125 children, including 65 with tuberculosis and perinatal HIV infection (a continuous sample) and 60 with tuberculosis (a paired sample). The tuberculous process developing in the presence of perinatal HIV infection was manifested by a more marked progression with the registration of the disseminated and complicated forms of tuberculosis, the high frequency of pathogenic dissemination. Adherence to and timely start of antiretroviral therapy contributed to the predominant formation of tuberculous processes within the lymphatic system in most children and to the adequate time of regression of tuberculous changes. The natural course of HIV infection aggravates the tuberculous process, favors the development of disseminated, including generalized, forms, substantially decreases the efficiency of antituberculosis therapy, and is an important predictor of mortality

The Socio-Epidemiological Environment and the Health of Infants without Having Been Impacted by Maternal HIV Infection

The results of a cohort study of 177 newborns, from birth until they were 18 months old, are presented. The 87 of those children had lacked impact of maternal HIV infection, and 90 children were not exposed to HIV prenatally. Antisocial factors were observed among the newborns exposed to a prenatal HIV infection which had a negative impact upon them throughout infancy. The social deviance of their family members with a HIV infection was 10.5 times higher than the standard risk of a neonatal abstinence syndrome, 4 times higher than a standard risk of growth retardation during fetal development, and 3.8 times higher than a standard risk of postnatal development disorders. Undiagnosed infants who were exposed to a HIV-infection constitute a medico-social risk group requiring scrupulous and extended medical assistance

Risk Factors of a Progradient TB Course in Children with Perinatal HIV-infection: the Results of a Cohort Study

Cohort study of 130 children with monoinfection TB and co-infection of HIV was carried out. For the first time, both a progradient and a regradient TB course were identified. The progradient diseases pattern in a group of patients with HIV co-infection appears to be 5.3 times higher than in a group of patients with monoinfection. High frequency linkage of epidemiological, social, and medicobiological risk factors were recognized. Predictive significance of the progradient TB course in children with HIV-infection was observed in the following: a contact with TB infected individuals, imperfections in the pediatric observations and the evasion of fluorographic testing by adults interacting with the children and the social deviations of adult members of the family

КЛИНИКА И ТЕЧЕНИЕ ТУБЕРКУЛЕЗА У ДЕТЕЙ С ПЕРИНАТАЛЬНОЙ ВИЧ-ИНФЕКЦИЕЙ

Examinations were made in 125 children, including 65 with tuberculosis and perinatal HIV infection (a continuous sample) and 60 with tuberculosis (a paired sample). The tuberculous process developing in the presence of perinatal HIV infection was manifested by a more marked progression with the registration of the disseminated and complicated forms of tuberculosis, the high frequency of pathogenic dissemination. Adherence to and timely start of antiretroviral therapy contributed to the predominant formation of tuberculous processes within the lymphatic system in most children and to the adequate time of regression of tuberculous changes. The natural course of HIV infection aggravates the tuberculous process, favors the development of disseminated, including generalized, forms, substantially decreases the efficiency of antituberculosis therapy, and is an important predictor of mortality.Обследовано 125 детей: 65 детей, больных тубер­ку­лезом и перинатальной ВИЧ-инфек­цией (сплошная выборка); 60 детей, больных тубер­ку­лезом (попарная выборка). Развитие тубер­ку­лезного процесса на фоне перинатального инфицирования ВИЧ проявлялось более выраженной прогрессией с регистрацией распространенных и осложненных форм тубер­ку­леза, высокой встречаемостью диссеминации возбудителя. Приверженность и своевременный старт антиретровирусной терапии способствовали преимущественному формированию тубер­ку­лезных процессов в пределах лимфатической системы у большинства детей и адекватному времени регрессии тубер­ку­лезных изменений. Естественное течение ВИЧ-инфек­ции усугубляет тубер­ку­лезный процесс, способствует развитию диссеминированных, в том числе генерализованных форм, существенно снижает эффективность противотубер­ку­лезной терапии и является значимым предиктором летальности

Lipid profile stability and prognostic value in adolescents: 22-year prospective study

Aim. To prospectively assess dynamics, stability, and prognostic value of blood lipid profile (LP) in adolescents, for identifying early coronary heart disease prevention approaches. Material and methods. This prospective study included 347 boys and 332 girls. During 22-year follow-up, six clinical examinations were performed (at the age of 13-14, 15-16, 19-20, 21-22, 26 and 34-35 years). Examination program included measuring levels of total cholesterol (TCH), high-density lipoprotein CH (HDL-CH), and triglycerides (TG), body weight (BW) and height (BH), subscapular, abdominal, and triceps skin fold thickness (SST, AST, and TST), pubescence assessment. Results. Gender differences in LP, especially in pubescence, could not be completely explained. Increased LP atherogenity and dyslipidemia (DLP) rates in young males were associated with increased BW and fat tissue percentage. Mildly increased and normal TCH, HDL-CH, low-density lipoprotein CH (LDL-CH) in pubescent boys and girls were equally stable and not associated with increased risk of atherogenic DLP in adult age. In pubescent adolescents, TCH predicted its level in 34-35 year-olds only in combination with physical development parameters. Overweight in pubescent boys was an independent predictor of future hypercholesterolemia in adult age. Conclusion.The observed age LP dynamics points to the need for early preventive measures in risk groups and general population, starting in pre-pubertal or early pubertal periods