The thesis is devoted to improvement of the effectiveness of early diagnosis and tactics of integrated HIV-infected patients management by doctors of general practice-family medicine by clarifying the characteristics of the HIV infection course in the presence of comorbid pathology of the digestive system organs and creating an algorithm for providing medical care to such patients.
The study found that the frequency of detection of digestive system (DS) pathology increased as HIV infection were progressing: in patients with II, III and IV clinical stages, it was observed significantly more often than in patients with clinical stage I – digestive system pathology was detected in 43 (45.7 %) patients with clinical stage I, p>0.05, in 30 (83.3%) patients with clinical stage II, p <0.05, in 69 (90.8%) patients with III (p<0.05) and in 115 (81.0%) with IV clinical stage, p <0.05. The DS pathology was reliably more often combined with tuberculosis, candidiasis, kidney diseases and HIV encephalopathy and had a combined character with two or more organs involved in the pathological process. Clinical and laboratory signs of DS pathology in HIV-infected patients included asthenovegetative and dyspeptic syndromes, weight loss, low levels of CD4+lymphocytes and detected viral load in the background of antiretroviral therapy (ART). In addition, the comorbid course of HIV infection and pathology of the DS organs were characterized by deeper changes in general clinical and biochemical blood indices, in particular, more pronounced anemia and leukopenia, a more pronounced increase in the activity of liver enzymes (ALT and GGTP). Patients with DS pathology were significantly more likely to experience side effects of ART, i.e., hematotoxicity, lack of immunological response, lipodystrophy, dyspeptic syndrome, circuit replacements, and interruption in ART.
The results of physician’s survey (general practitioners-family medicine and doctors of narrow specialties, including the infectious disease specialists) revealed insufficient feedback between primary health-care facilities and specialized AIDS services, their low level of professionalism in providing comprehensive medical care for HIV-infected patients with comorbid DS diseases. An algorithm for integrated management of HIV-infected patients with comorbid DS pathology has been developed and proposed for implementation in order to provide comprehensive, continued, coordinated, and patient-oriented medical care to prevent patients from being excluded from the system of continuous antiretroviral treatment due to DS pathology by the primary health-care facilities in cooperation with specialized secondary medical care facilities.
