Abstract
A large number of domestic and foreign studies are devoted to the problem of tuberculosis in combination with HIV infection. Today, chronic viral hepatitis is a new challenge, as the transmission routes of HIV infection and hepatitis B and C are identical, and the likelihood of HIV/CVH co-infection is high, making these patients a high-risk group for tuberculosis. This highlights the importance of TB/HIV/CV comorbidities’ issue. The link between social determinants and poorer health outcomes is evident for many diseases, but it is particularly clear for tuberculosis, HIV infection, and viral hepatitis. The purpose of the study is to examine the adherence to treatment and the medical and social characteristics of in-patients with pulmonary tuberculosis combined with HIV infection and CVH. Materials and methods. A retrospective analysis of medical records was conducted. 248 patients with pulmonary tuberculosis combined with HIV infection and CVH have been studied. The patients’ medical histories and medical status were examined. Research results. The social portrait of the patients (n=248), regardless of adherence to treatment, revealed the prevalence of the following characteristics: male gender, age 22–65 years, homeless, jobless, with a criminal record, family ties lost (more often in the group of non-adherers), substance abuse (significantly higher in the second group than in the first one). The analysis of clinical forms of tuberculosis showed that generalized and cirrhotic tuberculosis was more often recorded in patients of the second group. Multiple-site tuberculosis was not observed in the first group compared to the second group. TB of intrathoracic lymph nodes, tuberculomas and pleuritis were registered only in the first group of patients. In the group of patients who did not adhere to treatment, there were significantly more bacteria shedders, including those with MDR/XDR M. tuberculosis. Mortality rates were significantly higher in the group of patients who did not adhere to treatment. Conclusion. Results of the studies conducted indicate the need to develop special, interdisciplinary medical and social programs for managing patients with pulmonary tuberculosis combined with HIV infection and CVH, which would help to increase the adherence to treatment of these patients and thus reduce the mortality rate and the epidemic danger of a severe category of patients with comorbidity of three infectious diseases — TB, HIV infection and CVH.