Kaprosh A. Use of intravenous immunoglobulin G in the complex treatment of patients with the HIV-associated chemoresistant tuberculosis

Object of research: chemoresistant tuberculosis (HRTB) associated with HIV infection; goal - to increase the effectiveness of treatment of patients with HRTB associated with HIV infection through the use of intravenous Ig G; research methods: general clinical, X-ray, examination of sputum for Mycobacterium tuberculosis (MBT), test for drug sensitivity (TDS) to antimycobacterial drugs (AMBD), immunological, HIV testing, research for opportunistic infections, statistical; novelty: it was found that patients with CD4 + from 200 to 50 cells/μl, compared with patients with CD4 + <50 cells/μl, 4 times more likely to develop infiltrative tuberculosis (TB) (p<0,01), almost equally often - disseminated TB, 3.4 times less often - miliary TB (p<0.001), 2.6 times more often - destructive changes in the lungs; for the first time, additional use of Ig G in combination with AMBD and antiretroviral therapy (ARVT) in patients with HRTB/HIV has been shown to improve clinical, hematological, biochemical and immunological parameters from the first 2 weeks of treatment onwards; in patients receiving AMBD and ARVT, there was a two-phase nature of the dynamics of inflammation in the form of deterioration of hematological, biochemical, immunological parameters from the 2nd week to 3 months of treatment, and a tendency to recovery from the 4th month (in patients with CD4 + <50 cells/μl for 4 months); new scientific data were obtained to increase the effectiveness of treatment of patients with HRTB/HIV in the state of deep immunosuppression by 27 % (p<0.05) with the additional inclusion of intravenous Ig G to standard AMBD and ARVT; for the first time, it is scientifically substantiated that the additional use of intravenous Ig G makes it possible to prescribe ARVT to patients with HRTB/HIV at an earlier date, prevent the development of systemic inflammation, reduce the risk of multiple organ failure, increase survival; the expediency and algorithm of application of intravenous Ig G in complex therapy of patients with HRTB / HIV have been proved. Field of application - medicine.