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SPECIFICITY OF COMBINED INFECTIONS IN CHILDREN UNDER 14 YEARS OLD
WITH HIV INFECTION Gaffarov Kh.A.1, ^simova R.I.2, Mirzakarimova D.B.3, Kasimov U.M.4
1Gaffarov Khusan Abdumutalipovich - Assistant, DEPARTMENT OF INFECTIOUS DISEASES, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN; 2Kosimova Ra'no Ibrohimovna - Doctor of Medical Sciences, Associate Professor, SCIENTIFIC RESEARCH INSTITUTE OF VIROLOGY, TASHKENT; 3Mirzakarimova Dildora Bahadirovna - PhD, Associate Professor, Head of the Department; 4Kasimov Ulug'bek Marifivich - Assistant, DEPARTMENT OF INFECTIOUS DISEASES, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: HIV infection is a viral disease of the immune system, leading to a sharp decrease in the body's resistance to opportunistic microbes, as well as an increased propensity to oncological diseases, ending in an inevitable fatal outcome.
A child is born with an imperfect immune system. The final formation of immunity occurs only by the age of sixteen. Therefore, HIV, the main target of which is just the immune system, causes serious harm to the child's body. This article highlights the features of the clinical course of concomitant infections in children under the age of 14 infected with HIV.
Keywords: child's age, HIV infection, immune system.
СПЕЦИФИКА СОЧЕТАННЫХ ИНФЕКЦИЙ У ДЕТЕЙ ДО 14 ЛЕТ С ВИЧ-
ИНФЕКЦИЕЙ
Гаффаров Х.А.1, Косимова Р.И.2, Мирзакаримова Д.Б.3, Касимов У.М.4
1Гаффаров Хусан Абдумуталипович - ассистент, кафедра инфекционных болезней, Андижанский государственный медицинский институт, г. Андижан; 2Косимова Раъно Иброхимовна - доктор медицинских наук, доцент, Научно-исследовательский институт вирусологии, г. Ташкент; 3Мирзакаримова Дилдора Бахадировна - кандидат медицинских наук, доцент, заведующий кафедрой;
4Касимов Улугбек Марифивич - ассистент, кафедра инфекционных болезней, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
УДК 616.98-022-053.2(075.8)
Аннотация: ВИЧ-инфекция - вирусное заболевание иммунной системы, ведущее к резкому снижению устойчивости организма к условно-патогенным микробам, а также повышенной склонности к онкологическим заболеваниям, заканчивающееся неизбежным летальным исходом.
Ребенок появляется на свет с несовершенной иммунной системой. Окончательное формирование иммунитета происходит только к шестнадцати годам. Поэтому ВИЧ, основной мишенью которого является как раз иммунная система, наносит детскому организму серьезный вред.
Вданной статье освещаются особенности клинического течения сопутствующих инфекций у детей в возрасте до 14 лет, инфицированных ВИЧ.
Ключевые слова: детский возраст, ВИЧ инфекция, иммунная система.
Relevance. There are more than 50 million people living with HIV in the world, of which 17.6 million are women and 2.7 million are children under the age of 15 [2,6,9]. The percentage of people infected with HIV ranges from 0.3% in Australia to 15% or more in southern Africa. In some African countries, more than 50% of the adult population is infected with HIV. The total number of cases registered in Russia exceeded 280 thousand [1, 4, 10].
For more than 30 years since the description of the epidemic, humanity has been fighting against HIV / AIDS, but this problem has not really been solved yet. As you know, HIV / AIDS is not only a problem of one state, but also a global problem throughout the world, as well as one of the main challenges facing the world community [3, 7, 8].
According to WHO statistics, over 35 million people living with HIV are currently officially registered in the world. But thanks to the fact that international organizations have made efforts to combat HIV / AIDS, already in the XXI century. there is a tendency to a decrease in the number of new cases of HIV infection, and over the past 3 years, mortality from AIDS has decreased by 5 times [2, 5, 6].
Children are the most vulnerable part of the world's population. The vast majority of the child population infected with HIV are infected perinatally [4, 8]. At the same time, competent work on the prevention of the vertical route of infection makes it possible to achieve the minimum probability of HIV transmission from an infected mother to a child (less than 1%).
Purpose of the study. To study the features of the clinical course of concomitant infections in children under 14 years of age with HIV
Materials and research methods. We selected a total of 50 patients out of 50 HIV-infected children under the age of 14 years to fulfill our task and implemented the characteristics of the clinical course of co-infections in them.
Research results. Age periodization was carried out in accordance with the clinical and immunological categories of immunosuppression in children with HIV infection, since the number of CD4 + T-lymphocytes in children under 6 years of age is higher than in adults.
In 55.6% (20) of cases, a congenital form of HIV infection was registered, in 44.4% (16) - an acquired form.
Analysis of the ways of infection in congenital form showed that 47.2% of children were born from HIV-infected mothers, 8.3% became infected during breastfeeding. 5 children with perinatal infection arrived from other regions. It should be noted that with proper antenatal prophylaxis, the frequency of perinatal infection should not exceed 2%.
With the acquired form of HIV infection, 38.9% of adolescents became infected through sexual intercourse, 2.8% through injecting drug use (IDU). In a single case (2.8%), the transmission route was not established, however, it is known that the child suffered from leukemia and received multiple blood preparations.
The age of children was distributed as follows: 25.0% were children 1-5 years old, 30.6% - children 6-12 years old, 44.4% - teenagers 13-18 years old. There were no gender differences in the distribution of HIV-infected children by sex (p> 0.05). Boys were 41.7% (15), girls - 58.3% (2).
At the same time, with congenital infection (20), boys prevailed - 70.0%, p <0.05, compared with girls - 30.0%, p <0.05. With acquired infection (16), the majority of patients - 93.8% - were female. At the same time, in half of the cases (53.3%), HIV infection was detected during the examination of girls in connection with pregnancy.
The overwhelming majority of children - 94.4%, p <0.05% lived in a family, 5.6% - in an orphanage. In 55.5% of patients, the mother was HIV-infected, in 19.4% - the father, in 5.6% - a brother or sister.
In the study of risk factors of mothers of children with congenital infection, it was found that risky behaviors were practiced by 30.0% of women. 10.0% of mothers used injecting drugs, 5.0% were involved in commercial sex, and 15.0% abused alcohol. Bad habits in the form of smoking were found in 20.0% of women.
In children with congenital HIV infection, HIV status was confirmed at 0.3 ± 0.2 years. Adolescents with acquired HIV infection became infected on average at the age of 16.0 ± 0.3 years.
Analysis of the stages of HIV infection showed that at the time of diagnosis of the disease in children with congenital HIV infection, more advanced stages were documented (37.5% - stage 3, 62.5% - stage 4A) than in adolescents with the acquired form (12 , 5% - stage 2B, 81.3% - stage 3, 6.3% - stage 4A), p <0.05. However, the rates of disease progression over a 5-year period did not fundamentally differ: with congenital infection, the stages advanced in 31.3% (5) children, with acquired infection - in 25% (4).
In the clinical picture of children with a congenital form, HIV-associated symptoms were recorded more often than with acquired (p <0.05) - in 85% of cases, including generalized lymphadenopathy (35%), hepato- and splenomegaly (40%), lag in psychomotor (15%) and physical development (5%). 70% of children have frequent ARVI.
Opportunistic infections in children with congenital form were also detected more often than in adolescents with acquired (p <0.05) - in 70% of cases, including in half of children (50%) - infections of the skin and mucous membranes, in 45% - bacterial ENT infections, 15% have recurrent gastrointestinal infections. In a single case (5%), a child developed HIV encephalopathy and cachexia. Concomitant pathology is represented by chronic hepatitis C (10.0%) and B (5%).
In adolescents with the acquired form, HIV-associated symptoms were detected in 25.0% of cases, opportunistic infections - in 18.8%. Concomitant pathology was detected in one third of cases (31.3%), including chronic hepatitis B and C (12.5%), leukemia (6.3%), syphilis (12.5%).
Output. A specific feature of HIV infection in Uzbekistan is a significant proportion of acquired forms (44.4%). A variety of ways of infection of children is characteristic. Gender indicators are distinguished by the predominance of boys with congenital HIV infection, and the predominance of girls with acquired.
The implementation of perinatal contact is 5.6%. Familial foci are formed in 25% of cases. During the period of diagnosis with congenital form of infection, more advanced stages are recorded, however, the rate of progression of HIV infection in children with congenital and acquired forms in the first 5 years is the same. HIV infection is
characterized by a high frequency (22.5%) of concomitant pathology, mainly co-infection of chronic hepatitis (13.9%).
Parents of patients signed informed consent to participate in the research.
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