IDENTIFICATON OF AN AIDS CASE AND THE CAUSES OF DEATH IN PATIENTS WITH HIV INFECTION

Objective. To investigate approaches to identifying and recording an AIDS case and the causes of death in HIV-infected patients in the Russian Federation. Materials and methods. The authors compared the approaches of the WHO, the Centers for Disease Control and Prevention (CDC, USA), the European Center for Disease Prevention and Control (ECDC), and the Russian Ministry of Health to determining a case of AIDS and the cause of death in HIV-infected patients. The Instruction Manual for ICD-10, the guidelines of the Ministry of Health of Russia, and instructions for filling out federal state statistical observation No. 61 «Information on infectious and parasitic diseases» were studied. Personalized data on AIDS cases and on death cases among HIV-infected patients in Russia in 2018, which had been submitted to the Federal Research and Guidance Center for AIDS Prevention and Control, were analyzed. The case histories of 3333 HIV-infected patients with Stages 4B-4C (AIDS), who had been treated in Infectious Disease Clinical Hospital Two (IDCH-2), Moscow Healthcare Department, in 2014-2015, and data on 4145 HIV-infected patients with Stages 4B-4C (AIDS) from the specialized units of IDCH-2 in 2016-2017. Autopsies were performed in the morbid anatomy unit, IDCH-2; their results were used to estimate the incidence of secondary diseases in 892 HIV-infected patients who died in 2016-2017. Results. The investigation revealed that territorial AIDS centers had a significant frequency of a generalized HIV infection diagnosis formulated at the stage of secondary diseases, without specifying the cause, which determined the stage of AIDS; in case of a fatal outcome, the final diagnosis was formulated, without reasonably determining the leading secondary disease and the immediate cause of death in the patient, which is partly due to the imperfection of ICD-10 and often to the lack of a reliable definition of the etiological cause of secondary disease and death. There was a substantial difference in the incidence of secondary diseases in patients with AIDS diagnosed in the territorial AIDS centers and in those who had undergone inpatient treatment and examined using modern diagnostic methods in IDCH-2 for late-stage HIV infection. There was a considerable difference in the incidence of a number of secondary diseases as causes of death in HIV-infected patients according to the reports from the territorial AIDS centers and to the reliably established causes of death in patients from the data obtained from the morbid anatomy unit, IDCH-2. Conclusion. The clear logic of the diagnosis, the definition of the underlying and concomitant diseases, the correct coding of diseases and their corresponding registration are a prerequisite for the clinical process, a guarantee to successful medical efforts, as well as the correct planning of further organizational actions to improve the quality of medical care for HIV-infected patients.

HIV infection, AIDS, reporting, coding