CHRONIC VIRAL HEPATITIS, TUBERCULOSIS, AND HIV AS COMORBIDITY: FROM THEORY TO PRACTICE

With the aim of improving the system of epidemiological surveillance and monitoring of the most significant and socially determined co-infections, carried out the epidemiological analysis of viral hepatitis B and C, tuberculosis and HIV infection who were registered in the Clinical infectious hospital named. S. P. Botkin in the beginning of this century (17-year period). Examined 707 patients. The comparison carried out between the three groups of patients co-infected identified in 1998–2001 year (period I, 128 patients), 2008– 2011 year (period II, 334 patients) and in 2013–2014 (period III, 245 patients). The proportion of patients with acute viral hepatitis in the first period was 24.2%, and the second and third periods, their share declined to 0,6% and 0,4%. Among the chronic viral hepatitis in the first and second periods were dominated by chronic viral hepatitis C (of 28,1 and 39,8%), and in the third period came to dominate the hepatitis caused by combination viruses B and C (58,8 per cent). Symptoms of liver damage and the activity of enzymes in patients co-infected testified to the increase in the number of cases of cirrhosis of this body and served morphological studies, the prevalence of liver cirrhosis increased more than 4 times, from 8,6% (first period) to 26,9% (period III). Changes of tuberculosis, showed a significant increase in the share of common forms of tuberculosis, including disseminated tuberculosis of the lungs from 19,5% to 57,6% (3 times), and lymph system, including tuberculosis of lymphatic nodes of the chest from 3,1% (period I) to 27,8% (period II). The main changes in patients with co-infection was associated with HIV, whose share increased from 10,0% of (period I) to 91,8% (period III). The mortality of patients co-infected increased from 11,7 to 34,7% (3 times).

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