8.1 Chemotherapy

Under references the CART [184, 309] a sick tuberculosis and a HIV - an infection (sochetannoj a pathology) first of all it is necessary to begin a course of antituberculous therapy with subsequent joining art.

87 patients at whom the regimen and-or a combination of received antituberculous preparations have been specified have entered into working out.

Separate specialised units for children with sochetannoj payotologiej in Russia are not present, therefore patients were on treatment in the general children's units of tubercular hospitals.

The chemotherapy regimens, prescribed to children with sochetannoj a pathology, are presented in table 8.1.

Table 8.1

Prescribed regimens HT to children, a sick tuberculosis and a HIV-infection

Regimens of chemotherapy sick of a tuberculosis are regulated priyokazom Ministries of Health of the Russian Federation from 21.03.2003г. № 109 «About perfection of antituberculous actions in the Russian Federation». As follows from table 8.1, to the overwhelming majority of patients (63,3 %) prescribed 1 regimen of chemotherapy. However combination PTP (table 8.2),
Used within the limits of the designated 1 regimen, in the majority not sootvetyostvuet to the given standard regimen provided by the order №109.

Table 8.2

Combination PTP within the limits of prescribed 1 regimen HT

From 55 patients treated on first regimen HT, 27 (49 %) not poyoluchali rifampicin (R) - the basic PTP the first row, prescribed on 1 reyozhimu chemotherapies; rifabutin (Rb) as analogue of rifampicin, received 7,2 % of patients (4 of 55). Often enough (38 %) the combination from three preparations - izoniazad (H) was prescribed, Pyrazinamidum (Z) and an injection preparation Kanamycinum () either Amikacinum (Am), or streptomycin (S) - HZS/K/Am, that corresponds to 3 regimen HT (streptomycin 7 persons from 13 received).

It is necessary to note, at 4 sick (7,3 %), receiving treatment on a regimen of chemotherapy without including in the scheme of rifampicin and injection prepayorata (HZE), in 2 months on fonehimioterapii at next rentgenoloyogicheskom the control are noted advance of tubercular process. Hence, at active specific process appointment 3 PTP without rifampicin is insufficient for effective treatment.

Treatment on 4 regimen of chemotherapy was received by 8 % of patients that it is possible to explain a rare finding of micobacteria of a tuberculosis at children and sootyovetstvenno definition of sensitivity MBT to antituberculous preparations. On 2Б to a regimen 5,7 % of children, preparations 2 numbers more often nayoznachalis in the limited set were treated, and the regimen was designated as individual (18,4 %).

Thus, it is more expedient to speak (in most cases) about an individualization of chemotherapy at children sick of a tuberculosis, sochetanyonym with a HIV-infection, especially against VAART. In half of cases in reyozhim chemotherapies have not been included rifampicin (rifabutin); preparations of a reserve number entered into 47 % sluchayoev (at 41 patients from 87) in the treatment scheme: Amikacinum (Am) or Kanamycinum (), kapreomitsin (Sar), Prothionamidum (Pto), para-aminosalicylic acid-pask (PAS), ftorhinolony (Fq); only 31 % of patients received preparations only the first row (1 and 3 regimen HT).

Restrictions of including of rifampicin in a chemotherapy regimen it is bound by that the overwhelming majority of children (89,3 %) before appointment protivoyotuberkuleznoj therapies VAART, in which scheme at 78 children from 87 protease inhibitors (lopinovir/ritonavir - kaletra) or preyoparaty already received groups NNIOT (nevirapin entered, evafirenz). Appointments rifabutina ogyoranicheny age (the instruction on preparation application), side effects which the preparation can cause: an anaemia, a leukopenia, tromyobotsitopenija, an eosinophilia, hemopoiesis oppression; from organs ZHKT - the dyspeptic phenomena, a nausea, vomiting, a diarrhoeia; a hepatotoxic (povyyoshenie hepatic transaminases, an icterus); a hepatitis; an abdominal pain.

Table 8.3 of Disease and syndromes at children sick of a tuberculosis, sochetannym with a HIV-infection, limiting appointment Rb (n=166)

In table 8.3 at children, voshedyoshih syndromes of a HIV-infection are presented to our research, appointments assuming restriction rifabuyotina at treatment sick of a tuberculosis and a HIV-infection.

At the moment revealing of a tuberculosis at a quarter of patients became perceptible gepa - tosplenomegalija and an anaemia, in 12 % of cases - a leukopenia and a thrombocytopenia, in 21,1 % of cases of disease GASTROINTESTINAL TRACT, including a hepatitis In and With, that limited application rifabutina.

The analysis of specified combinations PTP at patients sochetannoj a pathology has shown, that the most frequent regimen (35,6 %) chemotherapies of patients tuyoberkulezom and the HIV-infection was 3 regimen (fig. 8.1).

Fig. 8.1. Regimens HT (on combination PTP)

1 regimen of chemotherapy received a quarter sick (24,1 %) and a quarter (26,6 %) - individual ("And"). Regimens 4 (5,7 %) and 2Б (8,0 %) received meyonee 14 % of children. Duration of chemotherapy has made 10,6±2,4 months. It is necessary to notice, that at 3 children (2,9 %) after basic course end hiyomioterapii within 1-2 years disease relapse is noted.