Standard regimens of chemotherapy sick of a tuberculosis, reglamenyotirovannye the order of Ministry of Health Russian FederaYOtsii from 21.03.2003г. № 109 About perfection antituberculous meyoroprijaty in the Russian Federation, are not to the full applied to children by the patient tuberkuleyozom, sochetannym with a HIV-infection.

The reason for that is simultaneous treatment of a tuberculosis and a HIV-infection which becomes complicated medicinal interactions, especially between an antituberculous preparation riyofampitsinom and antiretrovirusnymi preparations; besides clinical implications of a HIV-infection in the form of accompanying secondary infections and syndromes.

On our data, the first regimen of chemotherapy with including rifamyopitsina or rifabutina 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. A combination from 3 PTP 1 number without rifampicin and it is frequent without an injection preparation it was prescribed in 35,6 % (3 regimen HT), however not vseyogda was successful - in 7,3 % of cases the exacerbation of tubercular process became perceptible.

Duration of chemotherapy has made 10,62,4 months. It is necessary otmeyotit, that in 2,9 % of cases after end of a basic course of chemotherapy (9 months) within 1-2 years disease relapse is noted.

Hence, at active specific process appointment 3 PTP without rifampicin, and also a basic course of treatment less than 12 months javyoljajutsja insufficiently effective.

It is in most cases more expedient to speak about an individualization of chemotherapy of children sick of a tuberculosis, sochetannym with a HIV-infection, especially against VAART. Restrictions of including of rifampicin in a chemotherapy regimen it is bound by that before appointment of antituberculous therapy already received the overwhelming majority of children (89,3 %) antiretrovirusnoe
Treatment, which scheme included protease inhibitors (lopino - vir/ritonavir) or group NNIOT preparations (nevirapin, evafirenz). RiYOfabutin received only 7,2 % of children. Appointment restrictions rifabutina have been bound not only with the years patients, but also presence of conditions and zayobolevany, concerning contraindications (restrictions) of appointment of a preparation: chronic a hepatitis In, With (6,9 %), changes in a haemogram in the form of an anaemia, a leukopenia and a thrombocytopenia (44,8 %). Besides, at nayoznachenii rifabutina noted adverse collateral reactions (27,6 %) in the form of a leukopenia (less than 3000 in 1 мм3 bloods) and thrombocytopenias (less than 100 million in 1 мм3 bloods), appearing at the initial maintenance of leucocytes 4,5-4тыс. In 1 мм3 bloods; augmentation of enzymes of a liver (ALT, nuclear heating plant) - in 13,8 % of cases.

The important component of treatment sick of a tuberculosis and a HIV - an infection was highly active antiretrovirusnaja therapy which 10,7 % sick sochetannoj a pathology of children (did not receive only refusals roditeyolej and has not been shown art). From all patients receiving VAART, the share of children by which antiviral preparations after the beginning himioyoterapii concerning a tuberculosis are prescribed, has made only 22,3 %. Planned art, early begun, promotes the prevention of development of generalised forms of a tuberculosis: so disseminirovannyj and a generalised tuberculosis vyjavyoljali only at children who were not receiving art before occurrence symptoms zabolevayonija, at the same time at children against planned art tubercular process taped in a phase of an involution more often, than at children who were not receiving art (16,6 % and 8,7 %; ОШ=3,85; Dee 2,4-7,3, p

<< | >>
Scientific source KLEVNO HOPE IVANOVNA. TUBERCULOSIS At CHILDREN, SICK HIV-INFECTIONS (prevalence, features of clinical implications, diagnostics, treatment, preventive maintenance). The dissertation on competition of a scientific degree of the doctor of medical sciences. Moscow - 2015. 2015

Other medical related information THE CONCLUSION:

  2. Conclusions
  5. Chapter 8. The CONCLUSION
  12. the CONCLUSION