Organization of day care centers at TB dispensaries has become a promising trend of directly observed treatment of tuberculosis patients.The objective of the study: to analyze the activities of a day center by TB dispensary for the period of 12 years.Subjects and methods. Two groups of people were compared: patients with TB/HIV co-infection (n = 232) and HIV negative tuberculosis patients (n = 665).Results. HV positive patients had tuberculosis of chest lymph nodes 3.8 times more often. Destructive changes in the lungs were found equally often in both groups in about a quarter of patients. In patients with TB/HIV co-infection, viral hepatitis was diagnosed statistically significantly more often than among HIV negative tuberculosis patients (82.3% versus 11.3%; p < 0.01). Tuberculosis treatment efficacy in HIV positive patients was identical in the day center and in-patient units. Treatment of patients in a dayhospital of TB dispensary has allowed increasing the duration of directly observed treatment of tuberculosis.

Tuberculosis is common in all regions of the World. According to WHO, in 2016, 476 774 people with tuberculosis had a positive HIV status, which was 7,5% of all cases. About 374 thousand of them died from tuberculosis infection (WHO, 2017). In recent years, there has been a steady increase in the incidence of tuberculosis in patients with HIV infection in the Russian Federation. According to the Federal Monitoring Center for Tuberculosis, number of people with HIV infection has doubled. The article presents an overview of the epidemic indicators of tuberculosis and HIV infection in Russia and the world, difficulties of diagnosis of tuberculosis in combination with co-infection, as well as new laboratory and immunological methods that are currently used in the world and national practice to detect tuberculosis infection.

Organization of day care centers at TB dispensaries has become a promising trend of directly observed treatment of tuberculosis patients. The objective of the study: to analyze the activities of a day center by TB dispensary for the period of 12 years. Subjects and methods . Two groups of people were compared: patients with TB/HIV co-infection (n = 232) and HIV negative tuberculosis patients (n = 665). Results.  HV positive patients had tuberculosis of chest lymph nodes 3.8 times more often. Destructive changes in the lungs were found equally often in both groups in about a quarter of patients. In patients with TB/HIV co-infection, viral hepatitis was diagnosed statistically significantly more often than among HIV negative tuberculosis patients (82.3% versus 11.3%; p < 0.01). Tuberculosis treatment efficacy in HIV positive patients was identical in the day center and in-patient units. Treatment of patients in a dayhospital of TB dispensary has allowed increasing the duration of directly observed treatment of tuberculosis.

Co-infection of tuberculosis and HIV-infection continues to be the current crucial issue not only due to the persistent growth of HIV-infection but also due difficulties in diagnostics of tuberculosis. Often X-ray changes in the lungs are atypical, clinical signs are manifested only in case of the severe and disseminated disease. At present the IGRA-tests are widely used worldwide while in Russia TRA tests are used. The trial provided the data on the use and comparative efficiency of the above immunological tests against Mantoux test with 2 TU when examining 239 persons from 2014 to 2015. The comparativeness of diagnostic sensitivity of all immunological tests had been proved. The specificity of IGRA-tests and TRA tests is twice higher compared to Mantoux test with 2 TU. Also it was proved that when diagnosing tuberculosis in HIV patients the skin tests (Mantoux test with 2 TU and TRA test) had low diagnostic informativeness compared to IGRA tests, among which ELISPOT was the most sensitive.

Co-infection of tuberculosis and HIV-infection continues to be the current crucial issue not only due to the persistent growth of HIV-infection but also due difficulties in diagnostics of tuberculosis. Often X-ray changes in the lungs are atypical, clinical signs are manifested only in case of the severe and disseminated disease. At present the IGRA-tests are widely used worldwide while in Russia TRA tests are used. The trial provided the data on the use and comparative efficiency of the above immunological tests against Mantoux test with 2 TU when examining 239 persons from 2014 to 2015. The comparativeness of diagnostic sensitivity of all immunological tests had been proved. The specificity of IGRA-tests and TRA tests is twice higher compared to Mantoux test with 2 TU. Also it was proved that when diagnosing tuberculosis in HIV patients the skin tests (Mantoux test with 2 TU and TRA test) had low diagnostic informativeness compared to IGRA tests, among which ELISPOT was the most sensitive.

Combination of TB and HIV-infection is still the most nowadays important problem, and it connects not only with steady growth of HIV infection, but with difficulties in TB diagnosis. X-ray lung studies often have unusual nature, clinical symptomatology appears when process are hard and spread. At the same time in global practice IGRAtests applying, to which they belong to SPOT.TB test and QuantiFERON®-TB Gold test, they pay great attention to it, particularly among patients with HIV- infection. In study there were data when 41 patients with lung TB were examined, 56 HIV-positive patients with lung TB and 58 healthy donors. When active TB IGRA-test and test with Diaskin test show comparable same results. Against the backdrop of HIV skin tests (Mantoux test with 2 TE and tests with Diaskin test) it was demonstrated direct dependence of level immunosuppression in contrast to IGRA – tests, that allows to carry out these researches in conditions when standard skin tests do not work.