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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">aids</journal-id><journal-title-group><journal-title xml:lang="ru">ВИЧ-инфекция и иммуносупрессии</journal-title><trans-title-group xml:lang="en"><trans-title>HIV Infection and Immunosuppressive Disorders</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2077-9828</issn><publisher><publisher-name>Baltic Medical Education Center</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.22328/2077-9828-2024-16-1-7-22</article-id><article-id custom-type="elpub" pub-id-type="custom">aids-877</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>РЕДАКЦИОННАЯ СТАТЬЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>EDITORIAL</subject></subj-group></article-categories><title-group><article-title>Патогенетические параллели и клинические взаимосвязи ВИЧ-инфекции и лимфомы  Ходжкина</article-title><trans-title-group xml:lang="en"><trans-title>Pathogenetic parallels and clinical relationships of HIV infection and Hodgkin’s lymphoma</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1159-0101</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Рассохин</surname><given-names>В. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Rassokhin</surname><given-names>V. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Рассохин Вадим Владимирович — доктор медицинских наук, профессор  «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова»; заведующий лабораторией хронических вирусных инфекций отдела экологической физиологии  «Института экспериментальной медицины»; ведущий научный сотрудник  «Санкт-Петербургский научно-исследовательский институт эпидемиологии и  микробиологии имени Пастера»</p><p>  «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова» ,197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8</p><p>  «Санкт-Петербургский научно-исследовательский институт эпидемиологии и  микробиологии имени Пастера», 197101, Санкт-Петербург, ул. Мира, д. 14</p></bio><bio xml:lang="en"><p>V. V. Rassokhin </p><p>Saint Petersburg</p></bio><email xlink:type="simple">ras-doc@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0016-2531</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Некрасова</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Nekrasova</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Некрасова Анастасия Викторовна — кандидат медицинских наук, врач онколог </p><p>142770, Москва, п. Коммунарка, ул. Сосенский Стан, д. 8, с. 3</p></bio><bio xml:lang="en"><p>A. V. Nekrasova </p><p>Moscow</p></bio><email xlink:type="simple">9095842005onco@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова; Институт экспериментальной медицины; «Санкт-Петербургский научно-исследовательский институт эпидемиологии и  микробиологии имени</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Pavlov First Saint Petersburg State Medical University; Saint Petersburg Pasteur Institute; Institute of Experimental Medicine</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Московский многопрофильный клинический центр «Коммунарка»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Moscow Multidisciplinary Clinical Center «Kommunarka»</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>15</day><month>04</month><year>2024</year></pub-date><volume>16</volume><issue>1</issue><fpage>7</fpage><lpage>22</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Рассохин В.В., Некрасова А.В., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Рассохин В.В., Некрасова А.В.</copyright-holder><copyright-holder xml:lang="en">Rassokhin V.V., Nekrasova A.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://hiv.bmoc-spb.ru/jour/article/view/877">https://hiv.bmoc-spb.ru/jour/article/view/877</self-uri><abstract><sec><title>Цель</title><p>Цель: показать значение особенностей развития лимфомы Ходжкина (ЛХ) на фоне ВИЧ-инфекции, возможных клинических взаимосвязей и последствий одновременно протекающих у пациентов заболеваний, а также проводимой комплексной терапии.</p></sec><sec><title> Материалы и методы</title><p> Материалы и методы. В статье представлен аналитический обзор по проблеме и ретроспективные данные о 63 пациентах с ВИЧ-ассоциированной ЛХ (ВИЧ-ЛХ), у которых в период 2000–2017 гг. в стационарах Санкт-Петербурга был выставлен диагноз ЛХ. Для диагностики ВИЧ-ЛХ были использованы регламентированные морфологические, иммуногистохимические, инструментальные и лабораторные методы исследования, стадия опухоли определялась на основании классификации Ann-Arbor (модификация Cotswold). Диагноз ВИЧ-инфекции был подтвержден выявлением специфических антител к ВИЧ (и антигена р24) при серологическом и иммуноферментном исследовании крови, методом иммунного блоттинга. Количество копий РНК ВИЧ и количество CD4-лимфоцитов в крови пациентам определяли с помощью коммерческих тест-систем, разрешенных к применению на территории РФ. Анализ общей выживаемости выполняли с использованием метода Каплана–Мейера. Статистическая обработка результатов исследования производилась с помощью статистических программ MS Excel 2010, GraphPad Prism 8 (GraphPad Software, Inc., США), SPSS версии 22.</p></sec><sec><title> Результаты</title><p> Результаты. В группе исследования преобладали мужчины (73%), медиана возраста составила 32 года, у 16 (25,4%) пациентов ВИЧ и ЛХ были выявлены одномоментно. Количество CD4-лимфоцитов &gt;500 кл/мкл в дебюте ЛХ отмечалось у 33,3% пациентов, преобладали пациенты с выраженной иммуносупрессией: 50–250 кл/мкл у 20 (31,7%), 250–500 кл/мкл — у 11 (17,5%), менее 50 кл/мкл — у 11 (17,5%). Количество РНК ВИЧ &gt;400 коп/мл отмечено в 82,5%, ВИЧ-инфекция на стадиях 4В-5 определена в 89% случаев, на момент выявления ЛХ АРТ проводилась у 16 пациентов. Отмечены коинфицирование ВЭБ (77,8%), цитомегаловирусом (60%), вирусными гепатитами (55,6%) с преобладанием вирусного гепатита С, распространенные оппортунистические инфекции (туберкулез, пневмоцистная пневмония, токсоплазмоз головного мозга, распространенный кандидоз), одновременно протекающие от 1 до 3 инфекции наблюдались в 77,8%. Стадия IV ЛХ установлена у 54%, III — у 22%, II — у 24% пациентов, наличие В-симптомов подтверждено в 73% случаев. Преобладающим гистологическим вариантом ВИЧ-ЛХ был нодулярный склероз (58 больных), смешанно-клеточный — у 4 пациентов, с лимфоидным преобладанием — в 1 случае. Экстранодальные поражения наблюдались у 34 (54%), осложнения опухолевого процесса — у 33 (37,5%) пациентов. Противоопухолевое лечение по поводу ЛХ получили 42 (66,7%) пациента: 1-й линии по схеме АBVD — 85,7% (у 80% достигнута ПЭТ-негативная полная ремиссия (ПР), по  схемам ВЕАСОРР esc или ВЕАСОРР  — 33,3%; 2-й линии  — по  схемам ICE или DHAP (n=10). Объективный ответ отмечен у 4 пациентов, ПЭТ-негативная ПР — у 2 из них, частичный ПЭТ-позитивный регресс — у 2 пациентов. Прогрессирование наблюдалось у 2 человек. Аутологичная трансплантация костного мозга (аутоТКМ) выполнена у 2 пациентов (в частичном ПЭТ-позитивном регрессе); 3-й линии (n=3) — химиоиммунотерапия с включением бендамустина, гемцитабина (2 пациентам выполнена аутоТКМ). Кумулятивный показатель сроков жизни пациентов на 1 год и 2 года составил 44% и 37% соответственно, 1-летняя общая выживаемость — 75%, 2-летняя — 60%. Факторами, отрицательно влияющими на  выживаемость и  продолжительность жизни, оказались прогрессирование и осложнения опухоли, ECOG ≥2 (р=0,0001), кандидоз, пневмония (р=0,001), вирусные гепатиты В и С (р=0,045),  отсутствие противоопухолевого лечения и АРТ (р=0,0001), возраст моложе 40 лет, поражение ЦНС, наличие 1 и более сопутствующих инфекций (р=0,024).</p></sec><sec><title>Заключение</title><p>Заключение. ВИЧ-ЛХ является одним из частых гематологических злокачественных новообразований, характеризуется неоднородностью по своим проявлениям, полиморфизмом патогенетических и клинических особенностей и взаимосвязей. При диспансерном наблюдении ЛЖВ особое внимание необходимо уделять факторам неблагоприятного прогноза заболевания, своевременности назначения АРТ и оценке рисков развития лимфопролиферативных заболеваний в рамках синдрома восстановления иммунной системы (СВИС) для увеличения продолжительности их выживания и качества жизни. Необходимы дальнейшие исследования относительно патогенеза, ранней диагностики и эффективного лечения лимфом, ассоциированных с вирусом иммунодефицита человека.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Aim</title><p>Aim: to show the importance of the features of the development of Hodgkin’s lymphoma (HL) against the background of HIV infection, possible clinical relationships and consequences of simultaneous diseases in patients, as well as complex therapy.</p></sec><sec><title> Material and methods</title><p> Material and methods. The article presents an analytical review of the problem and retrospective data on 63 patients with HIV[<xref ref-type="bibr" rid="cit1">1</xref>]associated HL (HIV-HL) who were diagnosed with HL in St. Petersburg hospitals in the period 2000–2017. For the diagnosis of HIV-HL, regulated morphological, immunohistochemical, instrumental and laboratory research methods were used, the tumor stage was determined based on the Cotswolds-modified Ann Arbor classification. The diagnosis of HIV infection was confirmed by the detection of specific antibodies to HIV (and the p24 antigen) during serological and enzyme immunoassay of blood, by immune blotting. The number of copies of HIV RNA and the number of CD4 lymphocytes in the blood of patients were determined using commercial test systems approved for use in the territory of the Russian Federation. The analysis of overall survival was performed using the Kaplan–Meyer method. Statistical processing of the research results was performed using statistical programs MS Excel 2010, GraphPad Prism 8 (GraphPad Software, Inc., USA), SPSS version 22.</p></sec><sec><title>Results</title><p>Results. The study group was dominated by men (73%), the median age was 32 years, in 16 (25.4%) patients HIV and HL were detected simultaneously. The number of CD4 lymphocytes &gt; 500 cl/μl at the HL debut was noted in 33.3% of patients, patients with severe immunosuppression prevailed (50–250 cl/μl in 20 (31.7%), 250–500 cl/μl in 11 (17.5%), less than 50 cl/μl in 11 (17.5%). The amount of HIV RNA&gt;400 kop/ml was noted in 82.5%, HIV infection at stages 4B-5 was detected in 89% of cases, at the time of detection of HL ART was performed in 16 patients. EBV coinfection (77.8%), cytomegalovirus (60%), viral hepatitis (55.6%) with a predominance of viral hepatitis C, common opportunistic infections (tuberculosis, pneumocystis pneumonia, toxoplasmosis of the brain, common candidiasis), simultaneously occurring from 1 to 3 infections were observed in 77.8%. Stage IV HL was established in 54%, III — in 22%, II — in 24% of patients, the presence of B-symptoms was confirmed in 73% of cases. The predominant histological variant of HIV-HL was nodular sclerosis (58 patients), mixed[<xref ref-type="bibr" rid="cit1">1</xref>]cell sclerosis in 4 patients, with lymphoid predominance in 1 case. Extranodal lesions were observed in 34 (54%), complications of the tumor process in 33 (37.5%) patients. 42 (66.7%) patients received antitumor treatment for HL: line 1 according to the ABVD scheme — 85.7% (80% achieved PET-negative complete remission (CR), according to the VEASORR esc or VEASORR schemes — 33.3%; line 2 — according to the ICE or DHAP schemes (n=10). An objective response was noted in 4 patients, PET-negative response in 2 of them, partial PET-positive regression in 2 patients. Progression was observed in 2 people. Autologous bone marrow transplantation was performed in 2 patients (in partial PET-positive regression); line 3 (n=3) — chemoimmunotherapy with bendamustine, gemcitabine (2 patients underwent autologous bone marrow transplantation). The cumulative life expectancy of patients for 1 year and 2 years was 44% and 37%, respectively, 1-year overall survival was 75%, 2-year — 60%. The factors negatively affecting survival and life expectancy were tumor progression and complications, ECOG≥2 (p=0.0001), candidiasis, pneumonia (p=0.001), viral hepatitis B and C (p=0.045), lack of antitumor treatment and ART (p=0.0001), age younger than 40 years, central nervous system damage, the presence of 1 or more concomitant infections (p=0.024).</p></sec><sec><title> Conclusion</title><p> Conclusion. HIV-HL is one of the most common hematological malignancies, characterized by heterogeneity in its manifestations, polymorphism of pathogenetic and clinical features and relationships. During the dispensary supervision of PLHIV, special attention should be paid to the factors of an unfavorable prognosis of the disease, the timeliness of the appointment of ART and the assessment of the risks of developing lymphoproliferative diseases within the framework of the immune system restoration syndrome (IRIS) in order to increase their survival and quality of life. Further research is needed on the pathogenesis, early diagnosis and effective treatment of lymphomas associated with the human immunodeficiency virus</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>ВИЧ-инфекция</kwd><kwd>лимфома Ходжкина</kwd><kwd>ВИЧ-ЛХ</kwd><kwd>патогенез</kwd><kwd>клинические особенности</kwd><kwd>антиретровирусная терапия</kwd><kwd>CD4-лимфоциты</kwd><kwd>оппортунистические инфекции</kwd><kwd>синдром восстановления иммунной системы</kwd></kwd-group><kwd-group xml:lang="en"><kwd>HIV infection</kwd><kwd>Hodgkin’s lymphoma</kwd><kwd>HIV-HL</kwd><kwd>pathogenesis</kwd><kwd>clinical features</kwd><kwd>antiretroviral therapy</kwd><kwd>CD4 lymphocytes</kwd><kwd>opportunistic infections</kwd><kwd>immune reconstitution inflammatory syndrome (IRIS)</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Ладная Н.Н., Покровский В.В., Соколова Е.В. 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