PROBLEMATIC ISSUES OF PRESCRIBING ANTIRETROVIRAL THERAPY FOR HIV/TUBERCULOSIS CO-INFECTED PATIENTS IN UKRAINE

Abstract

Introduction. Thanks to antiretroviral therapy (ART), humanity has made progress in overcoming HIV infection. With adherence to treatment, ART suppresses HIV multiplication, promotes immune system maintenance and recovery, provides people living with HIV (PLHIV) with a familiar, quality-adjusted and long life, and prevents further HIV transmission. Although the recommendation to start ART in such patients as soon as possible, regardless of CD4 cell count, has been implemented since 2010, there is still a delay in prescribing ART in Ukraine. Materials and methods. We conducted a desk study to identify problematic issues of delaying and/or not prescribing ART to patients with HIV/TB coinfection in Ukraine based on original observations, and analysis of scientific publications, regulations, and national and international standards of HIV/TB coinfection treatment. Research findings and their discussion. It has been established that the regulatory documents governing the detection, registration, medical surveillance, and treatment of HIV infection and tuberculosis in Ukraine are in line with international recommendations. The prescription of ART for HIV/TB co-infected patients in Ukraine is related to anti-tuberculosis treatment. The timeframes for ART initiation after antituberculosis therapy (ATT) administration are up to 8 weeks (early initiation), after 8 weeks (delayed initiation) and up to 2 weeks (early initiation). According to new scientific evidence, ART should not be associated with ATT, and ART initiation after prescription of antimycobacterial therapy should be reduced to 2 weeks. ART initiation before 8 weeks should be delayed only in PLHIV receiving treatment for CNS localized TB. Conclusion. The reasons for not prescribing and/or delaying the prescription of ART to patients with HIV/TB co-infection include the lengthy algorithm of TB diagnosis by a TB physician alone, and in some cases by a consilium of physicians; the refusal of medical institutions to conduct HIV testing using rapid tests, and the transfer of this HIV testing service to specialized laboratories using enzymelinked immunosorbent assays (ELISA); the low level of HIV and TB screening among key populations at risk and education on HIV and TB prevention methods; and the low level of HIV and TB testing among key populations at risk.