TUBERCULOSIS DIAGNOSTICS IN HIV-INFECTED PERSONS BY GEENXPERT MBT/RIF METHOD

Abstract

At present, the problem of multiply drag resistance is becoming more urgent and is widely discussed in all regions of the world. Purpose of the study was to asses the effectiveness of the GeenXpert MTB/Rif method for the diagnosis of tuberculosis in HIV-infected persons
Material and methods. Medical cards of 102 HIV-infected patients with tuberculosis, who was diagnosed for tuberculosis in hospital department. All patients were examined with the GeenXpert method, smear microscopy and culture method on liquid Middlbrook and Levenshtein-Yensen nutrition media. At growth of the tuberculous culture a drug sensitivity test was performed
Results and discussion. Using all methods of bacteriological examination bacterial excretion was revealed in 74 (72.5%) patients. Culture method was the most valuable – 65 (63.7%). The GeenXpert study was informative in 58 (56.9%) cases. Among of 58 patients with a positive GeenXpert result, rifampicin resistance was identified in 23 patients (39.7%)/ It made possible to prescribe patients second-line treatment regimens in a short time (median – 5 doses).
The rifampicin resistance, detected in 23 patients by the GeenXpert method, was confirmed in 18 (78.3%) persons by drag susceptibility test, in other cases there was no MBT culture growth, only the GeenXpert results were used in choosing treatment regimens. Multiply drag resistance was revealed in two patients in the drag susceptibility test , these patients took 32 and 37 doses of 1st-line antituberculous midacations before treatment correction, which significantly exceeded duration of ineffective therapy at comparison with the GeenXpert method.
Conclusions. GeenXpert sputum examination was informative in 56.9% of HIV-infected patients, positive results were confirmed by positive culture MBT in 52 (89,7%) from them. In case of negative microscopy results, the GeenXpert method increased the revealing of bacterial excretion on 23.1%, in case of negative results of smear and culture – on 12.5%, which increased the number of bacteriologically verified tuberculosis
2. Use of the molecular genetic study GeenXpert for test of rifampicin sensitivity to made it possible to perform the necessary correction of antituberculous chemotherapy for a short period of time in 39.7% of tuberculosis/HIV co-infected patients.