PRACTICAL REFERENCES

1. At children about 1-1,5 years are elderly at tuberculosis development rekomenduyoetsja instead of a stage in the HIV-infection diagnosis specify initial kolichestyovo Cd4-limfotsitov as their depression can have transitional character and after clinical treatment of a tuberculosis it will be possible vystayovit subclinical (3), instead of late (4Б, 4В) a HIV-infection stage.

2. In the absence of an immunodeficiency the algorithm of revealing and diagnostics of a tuberculosis at children with a HIV-infection should be standard, at immuyonodefitsite, in force tuberkulinovoj anergies, tactics diagnostic meroyoprijaty will depend on clinical, laboratory, radiological implications of disease.

3. Obligatory profound inspection on a tuberculosis, including carrying out of a computer tomography of organs of a thorax, at polozhiyotelnoj reactions to allergen tubercular rekombinantnyj and at podozyorenii on a tuberculosis at negative reactions to the immunologic dermal tests bound to an immunodeficiency.

4. A dispensary observation the phthisiatrician not less than 2th years from the moment of becoming infected MBT in the absence of disease and quantity CD4 - lymphocytes more than 350 kl/mkl (more than 20 %). Constant observation to pereyovoda in an adult network at revealing of a tuberculosis and at depression CD4 - lymphocytes less 350kl/mkl (less than 20 %) as the risk of development disseminirovannyh processes is enlarged.

5. Children born from women with a HIV-infection, but not infitsiroyovannyh a HIV, it is necessary to inoculate BTSZH as it is possible in early terms. Children, sick HIV-infections is inexpedient to vaccinate BTSZH a vaccine. Early begun VAART can be an alternative method of preventive maintenance of development disseminirovannyh processes.

6. At an exception of the scheme of chemotherapy of rifampicin and rifabutiyona (except MLU MBT) appointment of 2 preparations reserve rjayoda (Km/Am, Fq/Pto) is necessary.

Restrictions for appointment rifabutina:

- Chronic virus hepatitis In, With;

- The initial maintenance of leucocytes less than 5 thousand in 1 мм³ bloods;

- The initial maintenance of thrombocytes less than 200 thousand in 1 мм³ bloods;

Duration of chemotherapy sick of a tuberculosis in a combination to a HIV-infection should make not less than 9 months at small and not less than 12 months at the widespread and complicated forms of tubercular process. Duration of treatment at a tuberculosis with MLU/SHLU MBT not less than 18-24 months according to IV and V regimens of chemotherapy.

7. Preventive antituberculous treatment should provoyoditsja under the control of the medical worker taking into account all risk factors and degree of depression of CD4-lymphocytes in peripheric blood. Profilakyotichesky treatment is necessary for prescribing in cases:

- Primary tubercular infection ("bend") irrespective of rezulyotata assays with allergen tubercular rekombinantnym (a preparation DIA - ^SKINTESTj;

- Becomings infected MBT with doubtful and positive reaction on ^DIASKINTESTj;

- Contact to a sick tuberculosis;

- Initial maintenance CD4 ⁺-limfotsitov in peripheric blood less 350kl/mkl ( 20 %), but not less than 6 months.