Introduction. In the current situation of the HIV-infection epidemic, every 100-th citizen of Ukraine aged between 15 and 49 is infected with HIV. It is one of the highest rates among countries in the European Region. The issue of retaining HIV-positive patients in the medical surveillance system and support for adherence to ART treatment are becoming particularly relevant. At the same time, the comorbidity of HIV-infection with digestive system lesion is one of the main elements of pathological changes, both in the progression of HIV infection and in the occurrence of various complications leading to interruptions or failure to receive continuous antiretroviral therapy (ART).
The purpose of the study is to examine the features of the digestive system lesions of HIV-infected patients and their impact on the effectiveness of antiretroviral therapy.
Materials and methods. The study was conducted on randomly selected 215 HIV-infected patients in compliance with the bioethical and scientific standards, in accordance with industry standards and clinical guidelines approved by the Ministry of Health of Ukraine.
Results and Discussion. Patients were divided into two comparison groups: the main group (MG) had 158 (73.5%) of HIV-infected persons with pathology of the digestive system, the controlled group (СG) had 57 (26.5%) of HIV-infected patients with no signs of gastric lesions of the gastrointestinal tract. Among the lesions of the digestive system in HIV-infected patients, hepatitis of viral and/or toxic genesis, chronic inflammatory diseases of the esophagus and gastroduodenal zone, chronic pancreatitis and cholecystitis were most often observed. In 61.4%, the pathology of the digestive tract was combined. When evaluating the efficacy of ART, no statistical difference was found between MG and CG in the frequency of the virologic response and the level of viral load at the beginning of the study and at 6 months of follow-up. However, MG patients had a worse immunologic response compared to CG, they were significantly more likely to switch the initial ART regimen, have breaks in treatment and development of adverse reactions. Patients treated for comorbid digestive system disorders had ART replacements less frequently and after 6 months of treatment they had an average level of CD4 + lymphocytes, which corresponded to the normal value.
Conclusions. A significant majority of the examined patients with HIV-infection had digestive system lesions (73.5%). HIV-infected patients with digestive system pathology had more treatment interruptions, switch of ART regimens, and a worse immunological response, compared with the controlled group. Untreated diseases of the digestive system could be predictors of an increased break rate of ART, switch of treatment regimens, and decreased treatment efficacy. The introduction of an integrated, patient-oriented approach to the management of these nosologies in family medicine practice is proposed.
2. Statistika z VIL/SNID. Centr Gromadskogo zdorovia Ministerstva ohoronu zdorovay Ukrainy [HIV/AIDS statistics. Center for Public Health of the Ministry of Health of Ukraine]. Режим доступу: https://phc.org.ua/kontrol-zakhvoryuvan/vilsnid/statistika-z-vilsnidu
3. Kolpakova NV, Kurmangulov AA, Mel’nikov AA, Uvarova NA, Petrova UA. [Clinical, amnestic and immunological parameters in HIV-infected patients with gastroenterological diseases. HIV]. Infection and Immunosuppressive Disorders. 2018;10(1):78-83. https://doi.org/10.22328/2077-9828-2018-10-1-78-83
4. Khasanova GM, Urunova DM, Akhmedzhanova ZI, Giyasova GM, Chernikova AA, Khasanova AN. [Defeat of the gastrointestinal tract in HIV infection]. Pacific Medical Journal. 2019;(3):24-28. https://doi.org/10.17238/PmJ1609-1175.2019.3.24-28
5. Crakes KR, Jiang G. Gut Microbiome Alterations During HIV/SIV Infection: Implications for HIV Cure. Front. Microbiol. 2019; (10):1-10. Retrieved from: https://doi.org/ 10.3389/fmicb.2019.01104
6. Tincati C, Douek DC, Marchetti G. Gut barrier structure, mucosal immunity and intestinal microbiota in the pathogenesis and treatment of HIV infection. AIDS Res Ther. 2016;(19). https://doi.org/10.1186/s12981-016-0103-1
7. Gandzyuk VA. [The digestive diseases in Ukraine. Dynamics of prevalence rates and mortality 2002–2015]. Science of the XXI century: problems and prospects of researches. 2017;Vol.3, August:11-15. Retrieved from: http://archive.ws-conference.com/xvorobi-organiv-travlennya-v-ukra%D1%97ni-dinamika-poshirenosti-ta-smertnosti-2002-2015-rr/
8. Stepanov YM, Skirda IY, Petishko OP. [Digestive system diseases: the actual problem of clinical medicine]. Gastroenterologìa. 2019;53(1):1-6. doi: 10.22141/2308-2097.53.1.2019.163450.
9. Zakon Ukraini. Zagalnoderzhavna ciliova socialna programa protudii HIV-infekstsii/ SNID na 2014–2018 roky. [Law of Ukraine. On approval of the National Targeted Social Program for Combating HIV/AIDS for 2014-2018]. Режим доступу: https://zakon.rada.gov.ua/laws/show/1708–18
10. Kuzin I, Martsinovska V, Antonenko G, za redaktsiieiy Kurpita V. HIV-infektsiia v Ukraini. Informatiinii biuleten # 50 [HIV- infection in Ukraine. Newsletter # 50]. Kyiv: Center for Public Health of the Ministry of Health of Ukraine, 2019. 112 p. Режим доступу: https://phc.org.ua/sites/default/files/users/user90/HIV_in_UA_50_2019.pdf
11. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. Second edition. Geneva: WHO Library Cataloguing-in-Publication Data. 2016. 432 p. Retrieved from: http://apps.who.int/iris/bitstream/10665/208825/1/9789241549684_eng.pdf
12. Dr. Margaret Chan, Director-General of the World Health Organization. The Rising Importance of Family Medicine. Keynote address at the 2013 World Congress of the World Organization of Family Doctors. Czech Republic, Prague: 26 June 2013. Retrieved from: https://www.who.int/dg/speeches/2013/family_medicine_20130626/en/
13. Global Conference on Primary Health Care. Kazakhstan, Astana: 25-26 October 2018. Retrieved from: https://www.who.int/primary-health/conference-phc
14. Hepatitis and Primary Care Integration. The Health Resources and Services Administration (HRSA). 2019. Retrieved from: https://www.hrsa.gov/library/hepatitis-and-primary-care-integration
15. Richmond J, Smith E, Wallace J, Duncan D, Lucke J. Hepatitis B testing and diagnosis experiences of patients and primary care professionals in Australia. AFP. 2017; 46(7):513-519. Retrieved from: https://www.racgp.org.au/afp/2017/july/hepatitis-b-testing-and-diagnosis-experiences-of-patients-and-primary-care-professionals-in-australia/
16. Goldschmidt RH, Chu C, Dong BJ. Initial Management of Patients with HIV Infection. Am Fam Physician. 2016;94(9):708-716. Retrieved from: https://www.aafp.org/afp/2016/1101/p708.html#
17. Howell J, Pedrana A, Cowie BC, Doyle J, Getahun A, Ward J, Gane E, Cunningham C, Wallace J, Lee A, Malani J, Thompson A, Hellard ME. Aiming for the elimination of viral hepatitis in Australia, New Zealand, and the Pacific Islands and Territories: Where are we now and barriers to meeting World Health Organization targets by 2030. J Gastroenterol Hepatol. 2019 Jan;34(1):40-48. doi: 10.1111/jgh.14457. Retrieved from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.14457
18. Chu C, Pollock LC, Selwyn PA. HIV-Associated Complications: A Systems-Based Approach. Am Fam Physician. 2017;96(3):161-169. Retrieved from: https://www.aafp.org/afp/2017/0801/p161.pdf
19. Romanelli F, Matheny SC. HIV Infection: The Role of Primary Care. Am Fam Physician. 2009;80(9):946-952. Retrieved from: https://www.aafp.org/afp/2009/1101/p946.html
20. Cheng QJ, Engelage EM, Grogan TR, Currier JS, Hoffman RM. Who Provides Primary Care? An Assessment of HIV Patient and Provider Practices and Preferences. J AIDS Clin Res. 2014 Nov;5(11). PubMed PMID: 25914854; PubMed Central PMCID: PMC4409003. doi: 10.4172/2155-6113.1000366
21. The World Medical Association (WMA) Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. Retrievedfrom: https://web.archive.org/web/20140101202246/http://www.wma.net/en/30publications/10policies/b/
22. Reiester medico-technologichnikh documentiv. Derzhavne pidpruiemstvo “Derzhavniy expertniy centr Ministerstva ohoronu zdorovay Ukrainy”. [ Registry of medical technological documents. The State Expert Centre of the Ministry of Health of Ukraine]. Retrieved from: https://dec.gov.ua/mtd/home/
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