Химиотерапия туберкулеза в России – история продолжается

The article presents a review of 70 publications. It describes relevant data on drugs, timing, indications, efficacy, and safety of short-term treatment regimens for multiple drug resistant tuberculosis.

The article presents the review of 59 publications describing the aspects of etiology, pathogenesis, diagnostics, and treatment of COVID-19 caused by SARS-CoV-2 coronavirus.The authors state that they have no conflict of interests.

The review presents up-to-date data from 88 publications devoted to the short-course regimens of multiple drug resistant tuberculosis treatment and describes characteristics of the most effective drugs – bedaquiline, linezolid, delamanid, and clofazimine. Information is also provided on the additional properties of the drugs, i.e. modulation of the key immune response and immunometabolic processes that underlie a new approach to improvement of tuberculosis treatment, the so-called host therapy.

Treatment outcomes for Multidrug/Rifampicin-Resistant Tuberculosis (MDR/RR-TB) and Extensively Drug-Resistant Tuberculosis (XDR-TB) remain poor across the globe and in the Russian Federation. Treatment of XDR-TB is challenging for programmes and patients often resulting in low success rates and onward transmission of drug-resistant strains. Analysis of factors affecting culture conversion rate among XDR-TB patients may serve as a basis for optimization of treatment regimens. We conducted a retrospective cohort study using health records from 54 patients with pulmonary XDR-TB treated at a tertiary level facility in the Russian Federation. The study population included adult patients with culture-positive pulmonary XDR-TB who started treatment between 1 January 2018-30 June 2019. Culture conversion was defined as two consecutive negative cultures, collected at least 30 days apart. The date of sputum culture conversion was taken from the first of two consecutive negative sputum cultures fulfilling these criteria. We measured time to culture conversion using cumulative incidence functions accounting for competing risks and applied binary cause-specific Cox regressions to assess associated factors. Sputum culture conversion was recorded for 43 (79.6%) patients. Median time to culture conversion adjusted for competing risk of loss to follow up was 4 months [95% confidence interval (CI): 2–5]. The number of patients who had culture converted by treatment months 2, 4, and 6 were 12 (22%), 29 (54%) and 38 (70%) respectively. In unadjusted analysis, positive baseline sputum smear microscopy [hazard ratio (HR): 0.34, 95% CI: 0.18-0.66; p=0.001), hepatitis C (HR: 0.35, 95% CI: 0.14-0.89; p=0.023], and human immunodeficiency virus (HR: 0.30 95%, CI: 0.09-0.97; p=0.045), and receipt of fewer than 4 effective drugs in the treatment regimen (HR: 0.13, 95% CI: 0.03-0.60; p=0.009) were associated with delayed culture conversion. When compared to their combined use, patients receiving regimens with bedaquiline only (HR: 0.12, 95% CI: 0.03-0.49; p=0.003) or linezolid only (HR: 0.21, 95% CI: 0.06-0.69; p=0.010) were less likely to achieve timely culture conversion. Factors delaying sputum culture conversion should be considered in the management of patients with XDR-TB and considered by clinicians for regimen design and treatment strategies. Our study outlines the importance of simultaneous inclusion of bedaquiline and linezolid in treatment regimens for patients with XDR-TB to reduce time to sputum conversion and increase treatment success.

The objective of the study: to analyze the potential use of video observed therapy (VOT) as one of the fields of mobile health care for treatment of patients with tuberculosis, to substantiate prospects of using VOT as an alternative to directly observed therapy including settings with limited health care resources.Subjects and Methods. The relevant studies were searched for in the following bibliographic databases: MEDLINE/PubMed, EMBASE, LILACS, IMEMR and IMSEAR, and clinicaltrials.gov. 40 publications devoted to video observed treatment of tuberculosis abroad and in Russia were selected. The recommendations of the World Health Organization on the use of digital technology in tuberculosis treatment, in particular video observed treatment have been studied.Results. The article highlights the advantages of video observed treatment of tuberculosis, the possibility of implementing this approach in different groups of patients taking into account the inclusion and exclusion criteria, assessing effectiveness of its use (improved treatment adherence, higher number of completed observations, better responsibility of patients for the disease and therapy, economic benefits for the health system and the patient). The study speculates on the potential implementation of video observed therapy of tuberculosis in the Russian Federation.