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Research Articles
Published: 2020-05-08

Justification of the integrated approach to management of HIV-infected patients with comorbid pathology of the digestive system

Bogomolets National Medical University
Bogomolets National Medical University
HIV infection pathology of the digestive system family medicine

Abstract

Introduction. Among the main strategic and operational goals of the State Strategy for Combating HIV / AIDS, Tuberculosis and Viral Hepatitis by 2030 in Ukraine is to ensure comprehensive access to HIV treatment, increase the effectiveness of monitoring and support of treatment of both opportunistic infections and other somatic conditions in HIV-infected patients. The key role of family physicians in the detection and treatment of many chronic gastrointestinal complications in HIV-infected patients is recognized.

Purpose of the study. To increase the efficiency of early diagnosis and tactics of integrated management of HIV-infected patients of family physicians (FP) by clarifying the peculiarities of HIV infection in the presence of comorbid pathology of the digestive system (DS) and creating an algorithm for providing medical care to these patients.

Material and methods. The research was conducted on the basis of five regional HIV / AIDS centers of Ukraine during 2017-2019. Randomly selected 342 adult HIV-infected patients were divided into two groups - with concomitant lesions and without concomitant gastrointestinal lesions. The following research methods were used: general clinical and laboratory biochemical, molecular genetic, immunological, enzyme-linked immunosorbent, instrumental (FGDS, chest radiography, abdominal ultrasound, computed tomography of the chest and / or abdominal cavity), analysis of primary medical records, consultations related specialists according to the indications, questionnaires, statistical methods.

Results and discussion. It was found that the incidence of gastrointestinal pathology in patients with II, III and IV clinical stages of HIV infection was significantly higher than in patients with stage I, significantly more often associated with tuberculosis, candidiasis, kidney disease and HIV encephalopathy and was combined. Manifestations of asthenovegetative and dyspeptic syndromes, weight loss, anemia and leukopenia, increased activity of liver enzymes, low levels of CD4 + lymphocytes and preservation of viral load on antiretroviral therapy were significantly more common in HIV-infected patients with gastrointestinal pathology. In the presence of pathology of the digestive system, replacements, breaks and side effects of antiretroviral therapy were significantly more frequent. The results of physicians survey analysis showed the role of family physicians in the current examination and management of HIV-infected people with comorbid pathology of the digestive system.

Conclusions. To detect diseases of the organs of the DS in HIV-infected people, it is necessary to conduct a comprehensive laboratory and instrumental examination, taking into account the possibility of combined pathology. The proposed algorithm of integrated management of HIV-infected patients with comorbid pathology of DS by FPs, taking into account the most informative clinical and laboratory criteria, allows to increase the effectiveness of early diagnosis and tactics of integrated management of HIV-infected by FPs.

Full-text of the article is available for this locale: Українська.

References

  1. Cabinet of Ministers of Ukraine. About Approval of the State Strategy for Counteraction of HIV / AIDS, Tuberculosis and Viral Hepatitis for the Period up to 2030. Published online 2019.
  2. Center for Public Health of the Ministry of Health of Ukraine. HIV infection in Ukraine. Informatsiinyi biuleten. 2020;51.
  3. UNAIDS. Global AIDS Update 2016. Published online 2016.
  4. UNITAID. Hepatitis C Medicines: Technology and Market Landscape. Published online 2015.
  5. Goldschmidt RH, Chu C, Dong BJ. Initial Management of Patients with HIV Infection. American Family Physician. 2016;94(9).
  6. Hepatitis and Primary Care Integration | Official web site of the U.S. Health Resources & Services Administration.
  7. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV infection. Recommendations for a Public Health Approach. WHO Library Cataloguing-in-Publication Data; 2016.
  8. Ministry of Health of Ukraine. Nakaz MOZ Ukrainy vid 05.06.2019 № 1292 Pro zatverdzhennia novoho Klinichnoho protokolu iz zastosuvannia antyretrovirusnykh preparativ dlia likuvannia ta profilaktyky VIL-infektsii. Published online 2019.
  9. Gandzyuk V. The digestive diseases in Ukraine. Dynamics of prevalence rates and mortality 2002–2015. Science of the XXI century: problems and prospects of researches. 2017;3.
  10. Stepanov Y, Skirda I, Petishko O. Digestive system diseases: the actual problem of clinical medicine. GASTROENTEROLOGY. 2009;53(1). doi:https://doi.org/10.22141/2308-2097.53.1.2019.163450
  11. 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. Journal of Gastroenterology and Hepatology. 2019;34(1). doi:https://doi.org/10.1111/jgh.14457
  12. Chu C, Pollock L, Selwyn P. HIV-Associated Complications: A Systems-Based Approach. American Family Physician. 2017;96(3).
  13. Holubovska OA, Vysotska OI, Bezrodna O. Rol pervynnoi medychnoi dopomohy khvorym na hemokontaktni infektsii (VIL-infektsiia ta hepatyty B i C). Infektsiini khvoroby. 2017;(1). doi:https://doi.org/10.11603/1681-2727.2017.1.7764
  14. Chan M. The Rising Importance of Family Medicine. World Congress of the World Organization of Family Doctors. Published online 2013.
  15. Spirit of Astana Declaration - Primary Health Care. Global Conference on Primary Health Care. Published online 2018.
  16. Khalili J, Landovitz RJ. HIV Preexposure Prophylaxis—The Role of Primary Care Clinicians in Ending the HIV Epidemic. JAMA Internal Medicine. 2020;180(1). doi:https://doi.org/10.1001/jamainternmed.2019.5456
  17. Ministry of Health of Ukraine. Nakaz MOZ Ukrainy Pro zatverdzhennia normatyvno-pravovykh aktiv z pytan vdoskonalennia orhanizatsii medychnoi dopomohy liudiam, yaki zhyvut z VIL № 585 vid 10.07.2013. Published online 2013.
  18. Ministry of Health of Ukraine. Nakaz MOZ Ukrainy vid 05.03.2013 № 180 Pro zatverdzhennia form pervynnoi oblikovoi dokumentatsii i zvitnosti z pytan monitorynhu epidemichnoi sytuatsii z VIL-infektsii ta instruktsii shchodo yikh zapovnennia. 2013.