N 1 (186) 2024 р. P. 54–61

PROBLEMATIC ISSUES OF PRESCRIBING ANTIRETROVIRAL THERAPY FOR HIV/TUBERCULOSIS CO-INFECTED PATIENTS IN UKRAINE

O. V. Bachynska, I. T. Doan, V. V. Kozlov, L. I. Hetman, V. I. Romanchuk, O. A. Gerasymenko, O. S. Sovirda

Odesa National Medical University, Odesa, Ukraine
International European University, Kyiv, Ukraine
Bogomolets National Medical University, Kyiv, Ukraine
State Institution “Public Health Center of the Ministry of Health of Ukraine”, Kyiv, Ukraine

DOI 10.32782/2226-2008-2024-1-9

Introduction. Thanks to antiretroviral therapy (ART), humanity has made progress in overcoming HIV infection. With adherence to treatment, ART suppresses HIV multiplication, promotes immune system maintenance and recovery, provides people living with HIV (PLHIV) with a familiar, quality-adjusted and long life, and prevents further HIV transmission. Although the recommendation to start ART in such patients as soon as possible, regardless of CD4 cell count, has been implemented since 2010, there is still a delay in prescribing ART in Ukraine.

Materials and methods. We conducted a desk study to identify problematic issues of delaying and/or not prescribing ART to patients with HIV/TB coinfection in Ukraine based on original observations, and analysis of scientific publications, regulations, and national and international standards of HIV/TB coinfection treatment.

Research findings and their discussion. It has been established that the regulatory documents governing the detection, registration, medical surveillance, and treatment of HIV infection and tuberculosis in Ukraine are in line with international recommendations. The prescription of ART for HIV/TB co-infected patients in Ukraine is related to anti-tuberculosis treatment. The timeframes for ART initiation after antituberculosis therapy (ATT) administration are up to 8 weeks (early initiation), after 8 weeks (delayed initiation) and up to 2 weeks (early initiation). According to new scientific evidence, ART should not be associated with ATT, and ART initiation after prescription of antimycobacterial therapy should be reduced to 2 weeks. ART initiation before 8 weeks should be delayed only in PLHIV receiving treatment for CNS localized TB.

Conclusion. The reasons for not prescribing and/or delaying the prescription of ART to patients with HIV/TB co-infection include the lengthy algorithm of TB diagnosis by a TB physician alone, and in some cases by a consilium of physicians; the refusal of medical institutions to conduct HIV testing using rapid tests, and the transfer of this HIV testing service to specialized laboratories using enzyme-linked immunosorbent assays (ELISA); the low level of HIV and TB screening among key populations at risk and education on HIV and TB prevention methods; and the low level of HIV and TB testing among key populations at risk.

Key words: HIV infection, tuberculosis, antiretroviral therapy, co-infection.

REFERENCES

  1. Public Health Center. HIV infection in Ukraine. Information bulletin. No. 53. Kyiv 2022. Available from: https://phc.org.ua/kontrol-zakhvoryuvan/vilsnid/monitoring-i-ocinyuvannya/informaciyni-byuleteni-pro-vilsnid.
  2. UNAIDS Global AIDS Strategy 2021–2026. Available from: https://www. unaids.org.ua Available from: https://www.unaids.org.ua/ua/.
  3. Ford N, Meintjes G, Vitoria M, Greene G, Chiller T. Evolution of the role of CD4 cell counts in HIV treatment. CurrOpin HIV/AIDS. 2017; 12 (2):123–128.
  4. Clinical protocol of antiretroviral therapy for HIV infection in adults and adolescents approved by the Order of the Ministry of Health of Ukraine No. 658 dated October 4, 2006.
  5. Clinical protocol of antiretroviral therapy in adults and adolescents approved by the Order of the Ministry of Health of Ukraine No. 551 dated July 12, 2010.
  6. Summarized key principles of HIV prevention, testing, treatment, services, and monitoring: recommendations for a public health approach: July 2021, WHO.
  7. Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy, July 2017. Geneva: World Health Organization; 2017. Available from: https://apps.who.int/iris/handle/10665/255884 (Last accessed: 01 June 2021).
  8. Guidelines for treatment of drug-susceptible tuberculosis and patient care. 2017.
  9. Order of the Ministry of Health of Ukraine No. 1292 dated June 5, 2019, “On approval of a new Clinical protocol of the use of antiretroviral drugs for treatment and prevention of HIV infection”. Available from: https://moz.gov.ua/article/ministry-mandates/nakaz-moz-ukraini-vid-05062019–1292-pro-zatverdzhennja-novogo-klinichnogo-protokolu-iz-zastosuvannja-antiretrovirusnih-preparativ-dlja-likuvannja-ta-profilaktiki-vil-infekcii.
  10. Rajasekaran S. Benefits of early anti-retroviral therapy in patients with HIV-TB co-infection. Indian J Tuberc. 2009 Jul; 56(3):113–6.
  11. Bruchfeld Judith, Correia-Neves Margarida, Kallenius Gunilla. Tuberculosis and HIV Coinfection. Cold Spring Harb Perspect Med. 2015 Feb 26;5(7):а017871.
  12. Unified Clinical Protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care for co-infection (tuberculosis/HIV/AIDS) approved by the Order of the Ministry of Health of Ukraine No. 1039 dated December 31, 2014 Available from: https://ips.ligazakon.net/document/MOZ24197.
  13. Charbonnier Florian, Calmy Alexandra, Janssens Jean-Paul. Tuberculosis and HIV co-infection: a therapeutic challenge. Rev Med Suisse. 2011 Nov 23; 7(318):2295–6, 2298–3000.
  14. Narendran G, Swaminathan S. TB-HIV co-infection: a catastrophic comradeship. Oral Dis. 2016 Apr; 22 Suppl 1:46–52. doi: 10.1111/odi.12389.
  15. Order of the Ministry of Health of Ukraine No. 585 dated July 10, 2013 “On approval of regulatory legal acts to improve the organization of medical care for people living with HIV”. Available from: https://zakon.rada.gov.ua/laws/show/ z1254-13#Text.
  16. State strategy for the development of tuberculosis medical care for the population: Decree of the Cabinet of Ministers No. 1414-r dated November 27, 2019. Available from: https://zakon.rada.gov.ua/rada/show/1414-2019-%D1%80#n8.
  17. Procedure for HIV testing and quality of research approved by the Order of the Ministry of Health of Ukraine No. 794 dated April 5, 2019 “On improvement of the quality management system of laboratory tests in the fight against HIV/AIDS”. Available from: https://zakon.rada.gov.ua/laws/show/z0698-19#Text.
  18. Order of the Ministry of Health of Ukraine No. 585 dated July 10, 2013 “The procedure for establishing a diagnosis of HIV infection”.
  19. Unified Clinical Protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care for co-infection (tuberculosis/HIV/AIDS) approved by the Order of the Ministry of Health of Ukraine No. 1039 dated December 31, 2014 Available from: https://ips.ligazakon.net/document/MOZ24197.
  20. Order of the Ministry of Health of Ukraine No. 585 dated July 10, 2013 “The order of record keeping and medical monitoring of people living with HIV”.
  21. Tuberculosis Health Care Standard approved by the Order of the Ministry of Health of Ukraine No. 530 dated February 25, 2020 (as amended by the Order of the Ministry of Health of Ukraine No. 2161 dated October 6, 2021). Available from: https://moz.gov.ua/uploads/6/33449-dn_2161_06_10_2021_dod.pdf.
  22. Procedure for organizing the detection of tuberculosis and latent tuberculosis infection approved by the Order of the Ministry of Health of Ukraine No. 302 dated February 16, 2022. Available from: https://zakon.rada.gov.ua/rada/show/z0366-22#Text.
  23. Procedure for maintaining the Patient Registry in the electronic healthcare system approved by the Order of the Ministry of Health of Ukraine No. 2755 dated November 30, 2020. Available from: https://zakon.rada.gov.ua/laws/show/z0044-21#Text.
  24. Matsegora N, Kaprosh A, Antonenko P. The impact of IgG administration on the cellular immunity status in the patients with multidrugresistant tuberculosis/ HIV with CD4 + lymphocyte cells below 50 cells/μl. International Journal of Mycobacteriology. 2019; 8(4):374–380. doi: 10.4103/ijmy.ijmy_122_19.
  25. Matsegora NA, Kaprosh AV, Vasylyeva TI, Antonenko PB, Antonenko K. The Effect of Immunoglobulin G on the Humoral Immunity in Patients with Tuberculosis/HIV Coinfection. AIDS Res Hum Retroviruses. 2024 Jan 31. doi: 10.1089/ AID.2023.0074. Epub ahead of print.
  26. Order of the Ministry of Health of Ukraine No. 415 dated August 19, 2005 “On improvement of voluntary counseling and testing for HIV infection”.
View article PDF