aidsВИЧ-инфекция и иммуносупрессииHIV Infection and Immunosuppressive Disorders2077-9828Baltic Medical Education Center10.22328/2077-9828-2018-10-2-14-27aids-344Research ArticleЛЕКТОРИЙLECTUREСОВРЕМЕННОЕ ЗВУЧАНИЕ ПРОБЛЕМЫ СИНДРОМА ВОССТАНОВЛЕНИЯ ИММУНИТЕТА НА ФОНЕ АРВТTHE PRESENT DAY PERCEPTION OF THE PROBLEM OF IMMUNE RESTORATION OF UPON ARTБеляковН. А.BelyakovN. A.

Беляков Николай Алексеевич — доктор медицинских наук, профессор, академик РАН, зав. кафедрой социально-значимых инфекций ФГБОУ ВО «Первый СанктПетербургский государственный медицинский университет имени академика И.П.Павлова» МЗ РФ; главный научный сотрудник ФГБНУ «Институт экспериментальной медицины»; руководитель Северо-Западного окружного центра по профилактике и борьбе со СПИДом ФБУН «СанктПетербургский научно-исследовательский институт эпидемиологии и микробиологии имени Пастера» Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека

197101, Санкт-Петербург, ул. Мира, 14

ТрофимоваТ. Н.TrofimovaT. N.БоеваЕ. В.BoevaE. V.

Боева Екатерина Валериевна — клинический ординатор кафедры социально-значимых инфекций ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П.Павлова» МЗ РФ; зав. отделением хронической вирусной инфекции СевероЗападного окружного центра по профилактике и борьбе со СПИДом ФБУН «Санкт-Петербургский научно-исследовательский институт эпидемиологии и микробиологии имени Пастера» Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека

197101, Санкт-Петербург, ул. Мира, 14

kathrine.boeva@gmail.comСеменоваМ. Д.SemenovaM. D.

Семенова Мария Дмитриевна — врач-рентгенолог отделения МРТ, ассистент кафедры радиологии и хирургических технологий 

197758, Санкт-Петербург, пос. Песочный, ул. Ленинградская, 70

maria@sokurenko.nameФГБОУ ВО ПСПбГМУ им. И.П.Павлова Минздрава России; ФБУН НИИ эпидемиологии и микробиологии имени ПастераРоссияFSBEI HE I.P.Pavlov SPbMU MOH Russia; Saint-Petersburg Pasteur InstituteRussian FederationФГБОУ ВО ПСПбГМУ им. И.П.Павлова Минздрава России; ФГУН «Институт мозга человека им. Н.П.Бехтеревой» РАН; ФГБОУ ВО «Санкт-Петербургский государственный университет»РоссияFSBEI HE I.P.Pavlov SPbMU MOH Russia; FSBIS Institute of the human brain. N.P.Bekhtereva RAS; Saint-Petersburg State UniversityRussian FederationФГБУ «Российский научный центр радиологии и хирургических технологий имени академика А.М.Гранова» МЗ РФРоссияFSBI Russian scientific center of radiology and surgical technologies named after academician A.M.GranovRussian Federation2018080720181021427Copyright © Беляков Н.А., Трофимова Т.Н., Боева Е.В., Семенова М.Д., 20182018Беляков Н.А., Трофимова Т.Н., Боева Е.В., Семенова М.Д.Belyakov N.A., Trofimova T.N., Boeva E.V., Semenova M.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hiv.bmoc-spb.ru/jour/article/view/344

Антиретровирусная терапия, направленная на угнетение репликации ВИЧ, способствует частичному восстановлению или активации функции иммунной системы. У ряда пациентов с выраженной иммуносупрессией это может сопровождаться риском развития синдрома восстановления иммунитета с проявлением оппортунистических и вторичных заболеваний, приводящих к ухудшению общего состояния и гибели больного. Рассмотрены вопросы терминологии, факторы риска развития патологического процесса, приведены патогенетические основы, эпидемиологическая статистика синдрома, варианты проявлений клинических и клинико-лабораторных осложнений. Особое внимание уделено вторичным и оппортунистическим заболеваниям, ассоциированным с манифестацией СВИ, возможностям лекарственной профилактики и коррекции осложнений. Приведены характерные радиологические проявления поражений головного мозга при СВИ, ассоциированных с различными патогенами на фоне низких показателей иммунного статуса. Частоту встречаемости СВИ в Российской Федерации трудно оценить — в связи с неоднозначностью клинической картины диагноз выставляется редко. Систематизированы основные клинические и лабораторные проявления синдрома, что позволяет на основании совокупности проявлений формулировать этот диагноз. Профилактика СВИ заключается в благоразумном назначении антиретровирусных препаратов после превентивного курса лечения возможных или клинически проявляющих себя инфекций, а также в раннем начале антиретровирусной терапии при устойчивых показателях CD4-лимфоцитов и низком содержании РНК ВИЧ в крови.

Antiretroviral therapy (ART), which is intended to inhibit HIV replication, promotes partial restoration or activation of immunity. In many patients who have severe immunosuppression, ART may increase the risk of development of immune restoration syndrome (IRS), which is associated with the manifestations of opportunistic and secondary diseases that lead to worsening of the general health of patients and to their death. The present paper addresses IRS-related terminology, the risk factors of IRS development, and IRS pathogenesis, epidemiology, and clinical and laboratory manifestations. Special attention is paid to secondary and opportunistic infections associated with IRS and to the possibilities of pharmacotherapy for IRS and its complications. Characteristic radiological manifestations of brain lesions upon IRS are described as they as associated with different pathogenic factors upon initially poor immunity. It is hard to assess IRS incidence inRussia: IRS is diagnosed seldom becauseВИЧинфекция и иммуносупрессии,2018 г., Том 10, № 2 15 of the ambiguity of its clinical picture. A combination of the main clinical and laboratory manifestations of the syndrome is suggested to help in IRS diagnosis. IRS prevention is based on reasonable regiments of ART following preventing therapy for possible manifested infections and also on early ART onset upon steady CD4 cell counts and low HIV RNA blood levels.

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