Stopolyanskiy O. Features of diagnosis and clinical course of tuberculosis of the central nervous system in tuberculosis-associated Immune reconstitution inflammatory syndrome in HIV-infected patients

The dissertation is devoted to the study of the features of the clinical course and diagnosis of tuberculosis of the central nervous system in tuberculosisassociated Immune reconstitution inflammatory syndrome in HIV-infected patients. The materials of the dissertation are a fragment of the research work of the National Medical University named after O.O. Bogomolets "Forecasting the development of the incidence of tuberculosis in Ukraine in connection with the COVID-19 pandemic", financed by the Ministry of Health of Ukraine (state registration number 0121U107800). The relevance of the research topic is due to the fact that the problem of Immune reconstitution inflammatory syndrome, in particular central nervous system tuberculosis in tuberculosis-associated immune system restoration syndrome, has been poorly studied in Ukraine. Due to the rapid spread of HIV infection in Ukraine, the number of HIV patients prescribed antiretroviral therapy is increasing. As a result of mostly late diagnosis of HIV infection in our country, antiretroviral therapy is prescribed to such patients who already have a significant immunodeficiency and various opportunistic infections, primarily tuberculosis. The purpose of the study is to study the clinical and diagnostic features and predict the development of Immune reconstitution inflammatory syndrome in HIVinfected patients and predict the occurrence of an adverse effect of treatment/lethal in the case of immune system recovery syndrome in HIV-infected patients, which is manifested by central nervous system tuberculosis. Research methods: clinical, laboratory, molecular genetic, bacteriological, immunological, morphological, statistical. Research objects: Patients who were treated in anti-tuberculosis institutions, their medical documentation: cards of inpatients, cards of outpatients, data of laboratory and instrumental studies. We analyzed more than 180 scientific publications, which were devoted to the problems of etiology, pathogenesis, immunology, diagnosis, treatment, prevention and prognosis of tuberculosis of the central nervous system in tuberculosisassociated Immune reconstitution inflammatory syndrome in HIV-infected patients, and formed a literature review. The essence of the Immune reconstitution inflammatory syndrome is the emergence, exacerbation or recurrence of opportunistic infections, particularly tuberculosis, after a certain time (3 months) after the start of ART. IRIS is mainly characterized by an acute course, general and local inflammatory syndrome. There are two types of SVIS - paradoxical and unmasking. Paradoxical IRIS is an exacerbation of the symptoms of an existing opportunistic infection, and unmasking IRIS is an opportunistic infection that was not previously diagnosed. Due to the clinical features of the course, tuberculosis associated Immune reconstitution inflammatory syndrome with damage to the central nervous system is separately distinguished. The main risk factors for IRIS are pronounced immunosuppression, common opportunistic infections present in the patient before starting ART therapy.