National Mycobacterium Reference Laboratory, Center for Infectious Diseases, Institute of Cell and Molecular Sciences, Queen Mary College, Barts and the London School of Medicine, University of London, 2 Newark Street, E1 2AT, London, UK.
BMC Infect Dis. 2011 Oct 18;11:276. doi: 10.1186/1471-2334-11-276.
Tuberculosis remains a serious public health threat and economic burden in Russia with escalating rates of drug resistance against a background of growing HIV-epidemic. Samara Oblast is one of the regions of the Russian Federation where more than 1% of the population is affected by the HIV-epidemic; almost half of the cases are concentrated in the largely-industrial city of Togliatti with a population of 800 000.
We conducted a retrospective analysis of errors leading to death of HIV-positive patients in general health care hospitals in Togliatti, Russia, in 2008. All (n = 29) cases when tuberculosis was established at autopsy as a cause of death were included.
Median length of hospital stay was 20 days; in 11 cases the death occurred within the first 24 hours of admission. All cases were known to be HIV-positive prior to admission, however HAART was not initiated for any case, and no relevant tests to assess severity of immunosupression were performed despite their availability. No appropriate diagnostic algorithms were applied to confirm tuberculosis. Major gaps were identified in the work of hospital and consulting physicians including insufficient records keeping. In almost all patients earlier regular HIV-relevant tests were not performed due to poor compliance of patients, many of whom abused alcohol and drugs.
We conclude that introduction of prompt and accurate diagnostics tests, adequate treatment protocols and intensive training of physicians in management of AIDS and TB is vital. This should include reviewing standards of care for HIV-positive individuals with accompanying social problems.
结核病仍然是俄罗斯严重的公共卫生威胁和经济负担，其耐药率不断上升，HIV 疫情也在不断加剧。萨马拉州是俄罗斯联邦受 HIV 疫情影响超过 1%的地区之一；几乎一半的病例集中在拥有 80 万人口的大型工业城市陶里亚蒂。
我们对 2008 年俄罗斯陶里亚蒂普通医疗保健医院导致 HIV 阳性患者死亡的错误进行了回顾性分析。所有（n=29）经尸检证实结核病是死亡原因的病例均被纳入研究。
中位住院时间为 20 天；11 例患者在入院后 24 小时内死亡。所有病例在入院前均已知为 HIV 阳性，但均未启动高效抗逆转录病毒治疗（HAART），尽管有相关检测但未对免疫抑制的严重程度进行任何相关检测。未应用适当的诊断算法来确认结核病。医院和会诊医生的工作存在重大漏洞，包括记录保存不足。几乎所有患者都因患者依从性差而未进行早期定期 HIV 相关检测，许多患者滥用酒精和药物。
我们的结论是，及时准确地进行诊断检测、采用适当的治疗方案以及对医生进行艾滋病和结核病管理的强化培训至关重要。这应包括审查针对伴有伴随社会问题的 HIV 阳性个体的护理标准。
