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Tuberculosis and HIV-infections in Prisons

#KR-1590


Early Diagnostics of Tuberculosis in Combination with HIV- Infection /AIDS/ in the Penitentiary System of the Kyrgyz Republic

Tech Area / Field

  • MED-DID/Diagnostics & Devices/Medicine

Status
3 Approved without Funding

Registration date
14.11.2007

Leading Institute
National Center of Phthisiology, Kyrgyzstan, Bishkek

Supporting institutes

  • Public Fund “ LUARA”, Kyrgyzstan, Bishkek\nNational Center of Cardiology and Internal Medicine, Kyrgyzstan, Bishkek

Collaborators

  • University of Arkansas at Little Rock, USA, AR, Little Rock

Project summary

The purpose of the project is studying of approaches to the early biomicrochip genetric diagnostics of the HIV infection /AIDS/ in addition to tuberculosis in the penitentiary system of the Kyrgyz Republic and estimation of efficiency the timely adequate treatment of the patients with this pathology.

The urgency of the project is connected with some reasons. At first, the Kyrgyz Republic, with 5 million population, recently has take place the outbreak of disease (more 1000 cases) HIV-infection and AIDS. This outbreak of disease is exceed the "background" in some times and created a critical situation in the country. At second, more than 80 % infected peoples was drug addict. In this connection is important to note, that the HIV – infected and addicts peoples are group of the increased risk for the tuberculosis disease, and consumptive patients are especially subject for the HIV – infection and AIDS (Thener Ch. P., 1989).

On the threshold of third millennium the global medical -social problems in the world are epidemic AIDS, tuberculosis and, at last years, narcotism of the youth. As a result is explosive growth of the HIV-infection in 1996-1997 (Rahmanova A.G). Therefore in XXI century there are unresolved problems of epidemic AIDS, tuberculosis and narcotics which are interconnected and mutually conditioned (Volkova K.M., Kokosov A.N., 1999).

Acquired Immune Deficiency Syndrome (AIDS) is connected to the final stage of disease and caused by a Human Immunodeficiency Virus (HIV). The tuberculosis is infection which is necessary to differentiate from AIDS. It is connected with the similar clinical symptoms as the fever, the sweaty, decrease of the bodies weight, loss of the appetite, the lymphadenopathy, the cough. This symptoms are observed both the tuberculosis and the AIDS (Kovaleva S.I., Tuganova V.E., 1991). Also, the AIDS can proceed under the mask of the tuberculosis and the mix-infection.

According to summary information of the WHO statistics, the materials of the international committees and publications in the literature, the sickness rate of tuberculosis in 2000 year is equal on average the 144 on the 100 000 populations. In the countries of Africa this number is varied from the 130 up to 392 on 100 000 population. The annually parameter of tuberculosis sickness rate is increased by 9 %.

Among adult patients with primary detected tuberculosis the number of HIV-infected is changed from 7 up to 12 %. In Africa this number is 31 %, and in USA is 26 %. According to the various source of information, from 1,7 up to 2,3 million persons was died from the tuberculosis in 2000 year. About 18% from them was died as result of AIDS development. In conditions of AIDS epidemics the growth of tuberculosis sickness rate is a global problem. Therefore, the epidemic of HIV-infection is posed before programs of struggle against a tuberculosis in the world the complicated problems. This problems are need the immediate decision.

The principal condition in pathogenesis of tuberculosis for AIDS patients is the more serious, the double violation of cellular immunity (i.e. double immune deficiency). It is the result of mix pathologies and activation of the cryptogenic or recently acquired tubercular infection.

It is known, that AIDS and tuberculosis can be combined in two variants:

  1. AIDS and HIV – infected sick in combine to tuberculosis;
  2. Tuberculosis sick of any stage of illness (at recovered, at an aggravation of

process or in an active phase of a tuberculosis) in combine to AIDS and HIV-infection.

In process of studying the interaction of tuberculosis and AIDS is noted, that tuberculosis of HIV – infected patients is developed more seldom than HIV-infection of the tuberculosis patients. Hence, the HIV – infected patients are group of the tuberculosis raised risk and tubercular patients are especially subject of AIDS and HIV-infection. It is corresponded with data of Ch. P. Thener (Volkova K.I., et al., 1998).

Now, on CIS territory, for identification of microorganisms including Mycobacterium Tuberculosis (MBT), frequently use the molecular-biological method of the Polymerase Chain Reaction (PCR). This method is included in the nomenclature of the clinical laboratory researches and effectively is combined and supplemented the traditional diagnostics. The PCR method is connected with greater hopes, it is improved constantly. However, the lacks of PCR method is existed, for example, the absence the typification of MBT populations or only the 45 % reliability of this methods for MBT.

The more highly effective method is microchips method. This method is conformed to modern requirements of molecular-biological diagnostics and based by using the oligonucleotide microchips. This technology allows to identify the mutations in the different strains of MBT.

It is known, this mutations are responsible for development of the resistance and this mutations are located in the different genes or different sites of the one gene. For example, the genes mutations pnsA, rpoB, rpsL, embB, katG, ndh, are ensured the resistance to Pyrazinamide, Rifampicine, Streptomycin, Ethambutolum, Izoniazidum. At present these mutations are well studied, and the observed results are used for diagnostic of the sickness widely.

For definition the MBT sensitivity to the antibacterial agents is used the standard method of diagnostics. This method based on cultivation MBT on nutrient mediums and required time from 3 till 12 weeks. The using of biochips method for the identification and definition of MBT drug resistance allows to reduce this time up to 2 -3 days. It is possible due to the fact that analyzer probes in biochips cells are capable to cooperate directly with DNA of MBT.

Since the beginning of 90th years the epidemiological situation on a tuberculosis in Kyrgyz Republic has become worse and now the negative dynamics in epidemiological situation is continued. According to data of the World Health Organization (WHO) the sickness rate of tuberculosis in Kyrgyz Republic is acquired scale of epidemic. The sickness rate epidemic level is equal 50 cases of disease on 100 thousand person. Now this parameter in Kyrgyz Republic is equal 110.9 (2006г.).

Since 1991 year the all epidemiological parameters (sickness rate, morbidity and death rate) is increased. The epidemiological situation on a tuberculosis at last 10 years is remained intense. The annual stable growth of sickness rate is testified it. For this period the parameter of sickness rate is increased from 56,1 up to 123,2 for 100 thousand population, in other words in 2,1 times. The highest rate was marked in 1995 and 1996 years (21,7 % and 20,0 % accordingly).

The especially hard situation is developed in the penitentiary system of the Kyrgyz Republic. According to the official data of the Ministry of Justice of the Kyrgyz Republic, the every fourth prisoner has the tuberculosis and the most part from them has the tuberculosis chronic form. Accordingly, it is the most probably, they are the “tank” of drug resistance strains of MBT. It is marked, that during the period of big amnesties in republic, the level of drug resistance forms of tuberculosis is raised.

The parameter of sickness rate of tuberculosis in penitentiary system is exceeded the similar parameters in republic. For example, if in the 2006 year the average sickness rate of tuberculosis in republic was equal 110,9, then the average sickness rate with taking into account the penitentiary system was equal 121,2 for 100 thousand population. This data is point to the big sickness rate of tuberculosis in penitentiary system. The difference at 10,3 between the two parameters of sickness rate was calculated for 100 thousand population, but is know, that the penitentiary system has only 17,5 thousand prisoners. Thus, in 2006 year more 900 prisoners in penitentiary system was sick a tuberculosis and the sickness rate in penitentiary system was high number – more than 5000 for 100 thousand population.

The death rate in republic in 2006 year was equal 10,2 for 100 thousand population. In view of the tuberculosis deceased contingent of patients was revealed the prevalence of patients with chronic forms of a tuberculosis and patients from such groups, as a homeless, a drug addicts, a alcoholics, the former prisoners.

The parameter of the prisoners death rate in penitentiary system is exceeded similar parameters in republic greatly. For example, if in 2006 year the death rate of tuberculosis in republic with taking into account the penitentiary system was equal 12,8 for 100 thousand population. Also, the death rate in the penitentiary system was higher – more than 2500 for 100 thousand populations.

The primary detected patients which accounted for the during course of treatment was made 16,3% from total death rate.

In view of the aforesaid, in the present project, the studying of biological microchips method for early diagnostics of drug resistance forms of the tuberculosis with HIV-infection /AIDS/ in the penitentiary system of the Kyrghyz Republic is offered. Also, the estimation of the efficiency of the timely treatment of patients with this pathology is offered.

This developed project will be to promote the early diagnostics of the tuberculosis patients with HIV infection /AIDS/, will be to promote the patients pision into patients with drug resistance and drug sensitive forms of the tuberculosis and will be to promote the efficiency of the treatment of patients with this pathology

It is offered to receive the following results:

  1. to reveal the early drug resistance forms of the tuberculosis in addition to HIV infection /AIDS/ in the penitentiary system of the Kyrghyz Republic;
  2. to accelerate the pision of patients into patients with drug resistance and drug sensitive forms of the tuberculosis;
  3. to increase the efficiency of the treatment of patients with drug resistance forms of the tuberculosis in addition to HIV infection /AIDS/ by means of timely adequate therapeutics;
  4. to increase the epidemic indices of the tuberculosis in addition to HIV infection /AIDS/ in the penitentiary system of the Kyrghyz Republic;

The work for revealing the patients with drug resistance forms of the HIV infection /AIDS/ in addition to tuberculosis in the penitentiary system of the Kyrghyz Republic will be performed by scientists – in past working in military research.


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