bekhterevОбозрение психиатрии и медицинской психологии имени В.М.БехтереваV.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY2313-70532713-055XV. M. BEKHTEREV NATIONAL RESEARCH MEDICAL CENTER FOR PSYCHIATRY AND NEUROLOGY OF THE RUSSIAN FEDERATION MINISTRY OF HEALTH10.31363/2313-7053-2022-56-1-95-104bekhterev-656Research ArticleИССЛЕДОВАНИЯINVESTIGATIONSСложности формирования приверженности антиретровирусной терапии при остром ретровирусном синдроме — недооцененное значение алкоголяAcute retroviral syndrom — challenges in maintain of adherence, underestimated role of alcoholhttps://orcid.org/0000-0003-4163-5769ЯковлевА. А.YakovlevA A

Яковлев Алексей Авенирович — д.м.н., заведующий кафедрой инфекционных болезней, эпидемиологии и дерматовенерологии

г. Санкт-Петербург

Alexey A. Yakovlev

Saint-Petersburg

aay28@yandex.ruhttps://orcid.org/0000-0003-3590-9145ДьячковА. Г.DiachkovA G

Дьячков Андрей Георгиевич — ассистент кафедры инфекционных болезней и эпидемиологии

г. Санкт-Петербург

Andrey G. Diachkov

Saint-Petersburg

cd4@inbox.ruhttps://orcid.org/0000-0003-2428-3802МусатовВ. Б.MusatovV B

Мусатов Владимир Борисович — к.м.н., доцент кафедры инфекционных болезней, эпидемиологии и дерматовенерологии

г. Санкт-Петербург

Vladimir B. Musatov

Saint-Petersburg

doctormusatov@gmail.comhttps://orcid.org/0000-0002-5613-2809КеллиД.KellyJ

Келли Джеффри — профессор, директор

Милуоки

Kelly A. Jeffrey

Milwaukee

jeffkelly@msu.eduhttps://orcid.org/0000-0003-4542-8353КрамынинЛ. А.KramyninL A

Крамынин Леонид Александрович

г. Санкт-Петербург

Leonid A. Kramynin

Saint-Petersburg

kramleo@yandex.ruСанкт-Петербургский государственный университетРоссияSt. Petersburg State UniversityRussian FederationПервый Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаРоссияFirst Pavlov state medical universityRussian FederationЦентр исследований по ВИЧ-профилактическим вмешательствам, Медицинский колледж ВисконсинаСоединённые Штаты АмерикиCentre for Research on HIV Prevention, Medical College of WisconsinUnited States20223003202256195104Copyright © Яковлев А.А., Дьячков А.Г., Мусатов В.Б., Келли Д., Крамынин Л.А., 20222022Яковлев А.А., Дьячков А.Г., Мусатов В.Б., Келли Д., Крамынин Л.А.Yakovlev A.A., Diachkov A.G., Musatov V.B., Kelly J., Kramynin L.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bekhterevreview.com/jour/article/view/656

Цель исследования: описать клинико-лабораторные параметры и оценить значение алкоголя как барьера для формирования приверженности у больных острым ретровирусным синдромом, а также изучить готовность врачей-инфекционистов к обсуждению с пациентами вопросов употребления алкоголя. Материалы исследования: Проведен ретроспективный анализ медицинской документации 112 больных с установленным диагнозом «ВИЧ-инфекция, стадия первичных проявлений». 22 из 112 больных приняли участие в анонимном анкетировании, посвященном вопросам готовности к началу приема антиретровирусной терапии и особенностях употребления алкоголя. Проведено анонимное анкетирование 82 врачей-инфекционистов по вопросам работы с больными алкогольной зависимостью. Результаты: Из 112 больных острой ВИЧ-инфекцией, госпитализированных в стационар, у 2 больных была диагностирована стадия — 2А, у 96 — 2Б, у 14 — 2В. У всех больных 2В стадией был диагностирован орофарингеальный кандидоз. Средняя продолжительность госпитализации составила не более 10 дней, 2 пациентам потребовалась госпитализация в отделение реанимации и интенсивной терапии. Только 10 больных (8,9%) исследуемой группы начали прием антиретровирусной терапии, находясь в стационаре. Половина больных острым ретровирусным синдромом, прошедших анкетирование, имела опасный уровень употребления алкоголя. Только треть пациентов, участвовавших в анкетировании, были готовы к началу антиретровирусной терапии. Медицинские работники имеют низкие показатели мотивации и удовлетворенности при работе с больными, страдающими алкогольной зависимостью. Заключение: Больные острой ВИЧ-инфекцией имеют широкий спектр клинических проявлений и обладают высоким потенциалом для распространения инфекции в популяции. Недооценка степени употребления алкоголя в сочетании с недостаточной мотивацией медицинских работников по работе с больными, злоупотребляющими алкоголем, может способствовать дальнейшему распространению эпидемии.

Purpose: To describe clinical and laboratory features and define a role of alcohol as a barrier to adherence in patients with acute retroviral syndrome, to study readiness of infectious diseases specialists to discuss alcohol consumption issues with their patients. Research materials: Retrospective analysis of medical records of 112 patients with established diagnosis of acute HIV-infection was performed, 22 of them fulfilled an anonymous questionnaire regarding they readiness for starting antiretroviral treatment and alcohol consumption. 82 infectious diseases doctors answered anonymous questionnaire about their attitude towards patients with alcohol related problems. Results: Among 112 hospitalized patients with acute HIV-infection 2 had stage 2А, 96 — stage 2Б and 14 — stage 2В. All patients at stage 2B had oropharyngeal candidiasis. Mean inpatient stay were 10 days, 2 patients required ICU admission. Only in 10 patients (8,9%) antiretroviral therapy was initiated while in-hospital. Half of a patients who fulfilled anonymous questionnaire had a dangerous level of alcohol consumption. Only one third of patients fulfilled survey were ready to start antiretroviral therapy. Medical workers had a low score on motivation scale and satisfaction scale while asked about their attitude towards patients with hazardous level of alcohol comsumption. Conclusion: Patients with acute HIVinfection presented with variety of clinical syndromes and possessed a high potential for spreading disease across society. Underestimation of alcohol consumption along with lack of motivation to work with alcohol abusers are typical for doctors and might facilitate further spreading of epidemy.

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The authors declare that there are no conflicts of interest present.