aidsВИЧ-инфекция и иммуносупрессииHIV Infection and Immunosuppressive Disorders2077-9828Baltic Medical Education Center10.22328/2077-9828-2020-12-3-35-45aids-556Research ArticleОБЗОРREVIEWПроблемные вопросы терапии микобактериозов у пациентов с ВИЧ-инфекциейMycobacteriosis treatment challenges in patients with HIV-infectionСавченкоМ. А.SavchenkoM. A.

Савченко Михаил Андреевич — врач-инфекционист

191167, Санкт-Петербург, ул. Миргородская, д. 3

Michail A. Savchenko

St. Petersburg

inf.ma.savchenko@gmail.comПантелеевА. М.PanteleevA. M.

Пантелеев Александр Михайлович — доктор медицинских наук, профессор кафедры социально-значимых инфекций ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П.Павлова» Министерства здравоохранения Российской Федерации; главный врач Санкт-Петербургского ГБУЗ «Городской противотуберкулезный диспансер»

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8196158, Санкт-Петербург, Звездная ул., д. 12

Aleksandr M. Panteleev

St. Petersburg

alpanteleev@gmail.comСПб ГБУЗ «Клиническая инфекционная больница имени С. П. Боткина»РоссияCity Tuberculous ClinicRussian FederationСПб ГБУЗ «Городской противотуберкулезный диспансер»РоссияClinical Infectious Diseases Hospital named after S. P. BotkinRussian Federation2020121120201233545Copyright © Савченко М.А., Пантелеев А.М., 20202020Савченко М.А., Пантелеев А.М.Savchenko M.A., Panteleev A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hiv.bmoc-spb.ru/jour/article/view/556

В течение последнего десятилетия в Российской Федерации наблюдается неуклонный рост частоты выявления микобактериоза у пациентов с ВИЧ-инфекцией (прирост за последние пять лет в среднем составлял 57% в год). Это определяет интерес к данной проблеме, особенно в свете низкой эффективности терапии данного заболевания, длительных сроков и стоимости лечения. История изучения МАК-инфекции при синдроме приобретенного иммунодефицита (СПИД) берет свое начало в начале 1980-х годов в США, когда смертность в течение года после выявления заболевания достигала 71%. Роль инфекции в танатогенезе пациентов удалось, впрочем, окончательно установить лишь к началу 1990-х годов. Выявление активности макролидов в отношении возбудителя значительно улучшило прогноз для пациентов, особенно в комбинации с высокоактивной антиретровирусной терапией. Широкое введение в практику противовирусных препаратов и возможность достичь иммунной реконституции позволили предотвращать развитие оппортунистических инфекций, но не смогли помочь в решении оставшихся неразрешенными вопросов терапии МАК-инфекции, главным из которых является лечение больных с резистентным к кларитромицину возбудителем. Нет единого мнения и касательно определения чувствительности нетуберкулезных микобактерий к антибактериальным препаратам.

Over the past decade, in Russian Federation there has been a steady increase in the incidence of MAC-infection in patients with HIV (the growth of nosology over the past five years, on average, was 57% per year). This determines the interest in this problem, especially in terms of the high inefficiency of treatment for the disease, the long term and cost of treatment. The history of the study of Mycobacterium Avium Complex-infection (MAC) originates in the early eighties in the United States, when the prognosis for a patient with AIDS and mycobacteriosis was extremely poor: mortality within one year after the detection of pathogen reached 71%. The role of infection in the thanatogenesis of patients was, however, established only by the beginning of the nineties. The detection of macrolide activity against the pathogen significantly improved the prognosis for patients, especially in combination with highly active antiretroviral therapy. The widespread introduction of antiviral drugs into practice and the ability to achieve immune reconstitution prevented the development of opportunistic infections, but did not solve the remaining issues of the treatment of the MAC-infection. The main one is the treatment of patients with a clarithromycin-resistant pathogen. There is no consensus on the sensitivity of non-tuberculous mycobacteria to antibacterials.

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The authors declare that there are no conflicts of interest present.