Лечение туберкулеза в современных условиях
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Sinitsyn M.V., Kalinina M.V., Belilovskiy E.M., et al. The treatment of tuberculosis under current conditions. Therapeutic Archive. 2020; 92 (8): 86–94. DOI: 10.26442/00403660.2020.08.000762
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Материалы и методы. В Российской Федерации на фоне улучшения основных эпидемиологических показателей по туберкулезу продолжается увеличение числа и доли больных коинфекцией ВИЧ/туберкулез. В 2017 г. среди впервые выявленных больных туберкулезом 20,9% имели ВИЧ-инфекцию. Сочетание двух инфекций существенно затрудняет дальнейшее улучшение ситуации по туберкулезу, а появление устойчивых к лекарственным препаратам штаммов микобактерий туберкулеза (МБТ) иногда полностью нивелирует результаты химиотерапии. В статье описаны схемы современной химиотерапии туберкулеза с учетом коинфекции ВИЧ/туберкулез, а также множественной лекарственной устойчивости (МЛУ) в сочетании с методиками оперативного лечения, а также анализированы данные эпидемиологического мониторинга лечения 1115 впервые выявленных в 2017 г. в Москве больных туберкулезом, 360 больных туберкулезом с МЛУ МБТ (когорта 2013–2014 гг.), результаты лечения с применением новых схем химиотерапии туберкулеза (бедаквилин, линезолид, моксифлоксацин) у 36 больных, эффективность и безопасность хирургических методов у 192 пациентов.
Результаты. Применение новых индивидуализированных схем противотуберкулезной химиотерапии у больных коинфекцией ВИЧ/туберкулез с МЛУ МБТ позволило достоверно увеличить эффективность лечения. Доказано, что хирургическое вмешательство в сочетании с современными схемами химиотерапии у больных коинфекцией ВИЧ/туберкулез с МЛУ МБТ является эффективным и безопасным, способствует улучшению результатов лечения данной категории больных.
Заключение. Слияние двух глобальных проблем коинфекции ВИЧ/туберкулез и МЛУ МБТ значительно препятствует прекращению эпидемии туберкулеза в мире. В то же время успехи в разработке и внедрении новых противотуберкулезных препаратов и методов оперативного лечения создают надежду на существенный прогресс в разрешении этой ситуации.
Ключевые слова: туберкулез, ВИЧ-инфекция, коинфекция ВИЧ/туберкулез, широкая лекарственная устойчивость возбудителя, химиотерапия.
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Aim. Study of the current state of problems of treatment of patients with tuberculosis based on literature data and their own experience.
Materials and methods. In the Russian Federation, the number and proportion of patients with co-infection with HIV/tuberculosis continues to increase against the background of improvement in the main epidemiological indicants for tuberculosis. In 2017, 20.9% of newly diagnosed tuberculosis patients had HIV infection. The combination of the two infections significantly complicates the further improvement of the situation with tuberculosis, and the appearance of drug-resistant strains of Mycobacterium tuberculosis sometimes completely neutralizes the results of chemotherapy. The article describes the schemes of modern tuberculosis chemotherapy taking into account HIV/tuberculosis co-infection, as well as MDR in combination with surgical treatment methods, as well as analyzes the data of epidemiological monitoring of treatment of 1115 tuberculosis patients newly diagnosed in 2017 in Moscow, 360 tuberculosis patients with MDR MBT (cohort 2013–2014), the results of treatment with the use of new chemotherapy regimens for tuberculosis (bedaquiline, linezolid, moxifloxacin) in 36 patients, the effectiveness and safety of surgical methods in 192 patients.
Results. The application of new individualized anti-TB chemotherapy schedules in patients with HIV co-infection/tuberculosis with MDR-MBT has allowed to improve the treatment efficacy. The surgical intervention combined with modern chemotherapy regimens in patients with HIV/tuberculosis co-infection with MDR MBT has been proved to be effective and safe, contributes to the improving the results of treatment for this category of patients.
Conclusion. The confluence of two global problems of co-infection HIV/TB and MDR TB, significantly prevents from the end of the tuberculosis epidemic in the world. At the same time, advances in the development and implementation of new anti-TB drugs and surgical treatment methods give hope for significant progress for resolving this situation.
Keywords: tuberculosis, HIV infection, HIV/tuberculosis co-infection, multidrug-resistant tuberculosis, chemotherapy.
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ГБУЗ «Московский научно-практический центр борьбы с туберкулезом» Департамента здравоохранения г. Москвы, Москва, Россия
________________________________________________
M.V. Sinitsyn, M.V. Kalinina, E.M. Belilovskiy, A.S. Galstyan, M.N. Reshetnikov, D.V. Plotkin
Moscow Research and Clinical Center for Tuberculosis Control, Moscow, Russia