Title : Combined Tuberculosis/HIV infection in Russia: Current status and perspectives
Objective: Epidemiology of combined TB/HIV infection in the Russian Federation over the past 10 years (2009-2018).
Materials and methods: retrospective analysis of statistical data received from the reporting forms of the ROSSTAT and MoH of Russia for the period (2009-2018). For the analysis, cartographic and correlation analyses were used.
Results: over the past 10 years, in Russia, against background of a steady decline in the incidence of tuberculosis (TB), there has been a radical change in the structure of TB patients due to increase in proportion of TB/HIV patients, which in 2018 was 23.1% among newly diagnosed patients and 20.7 % among TB contingents. The incidence of TB/HIV for the same period increased by 1,2 times and in 2018 amounted to 7,6 per 100000 of population, while the total rates of growth were 16,9%. The spread of TB/HIV was mainly observed in the age groups of 25-44 years, the proportion of which throughout the entire observation period was 76% among newly diagnosed patients and 77% among TB/HIV contingents. In the structure of TB/HIV patients there was a high proportion of patients with severe HIV infection with manifestations of multiple infections and diseases (ICD-10 B20.7, B22.7), accounting in 2018 for 39% among newly diagnosed patients and 40% among contingents, that evidenced of late diagnosis of HIV. The proportion of TB/HIV patients who were diagnosed Hepatitis (ICD-10 B20.7) was high and in 2018 accounted for 38% among newly diagnosed patients and 44% - among contingents, prevailing Hepatitis C in their structure, whose proportion was 93%.
The spread of TB/HIV in 85 constituent entities of Russia was characterized by apparent irregularity: if in 35 constituent entities of Russia (41% of their total number) the incidence of TB/HIV was high and exceeded that in Russia, then in 50 constituent entities of Russia (59% of their total number), on the contrary, it was low and did not reach that in Russia. The most severe group was MDR-TB/HIV patients, whose proportion in 2018 was 18% among newly diagnosed patients and 17% among contingents. In 48 constituent entities of Russia, where the proportion of TB/HIV patients was >7% of newly diagnosed TB patients, a direct correlation was revealed (r = 0.33, p <0.05, t-statistics = 1.4) between the proportion of patients with MDR-TB and the proportion of TB/HIV patients as well as the proportion of TB/HIV patients who died during the first year of observation (r = 0.45, p <0.01, t-statistics = 3.5).
Among patients with TB/HIV, a consistently high level of immunosuppression was observed (CD4 lymphocyte count of <350 cells/μl), and, for example, in 2018 it was observed in 68% of newly diagnosed patients, which had a negative impact on the results of their treatment.
In Russia over the past 10 years, the effectiveness of TB/HIV patients’ treatment has been low and averaged 47%. Proportion of deaths, on the contrary, was high and in 2018 amounted to 22%. In 22 constituent entities of Russia, it was even higher and ranged from 25% to 88%. In structure of the deceased patients, 81% were people aged 25-44 years.
Conclusions: High prevalence of TB/HIV, currently registered in 35 out of 85 constituent entities of the Russian Federation, facilitates to slowing down the rates of decrease in the incidence of TB, which may not be enough to achieve the WHO targets in the program to eliminate tuberculosis in Russia.