EVALUATION OF CLINICAL CONDITION, IMMUNOSUPRESSION AND VIRAL ACTIVITY IN PATIENTS WITH HIV INFECTION

Materials and methods. The course and the main clinical and laboratory parameters of HIV infection course were studied in 300 HIV patients featuring different clinical symptoms, general conditions and outcomes of their disease. The patients were followed up at Saint-PetersburgCenterfor Prevention and Control of AIDS and Infectious Diseases (AIDSCenter). A modified Karnofsky scale was used to assess the general physical conditions of the patients. The scale defines patient’s condition in 10% steps from 100% (normal conditions) to 0% (death). The patients were examined upon admission and in 6 and 12 months thereafter. They were assigned to two groups, 150 subjects each. Group 1 comprised patients who were hospitalized at advanced stages of HIV infection because of delayed diagnosis when HIV was already manifested clinically, the severity of patients’ conditions was determined by opportunistic or concomitant somatic and neurologic conditions determined, and CD4 cell counts were below 199 ml^–1. This group also included patients who did not receive ART because of different reasons, including delayed HIV diagnosis, refusal to be treated, social and domestic circumstances etc., or either were treated irregularly, i.e., in prolonged non-treatment intervals or discontinued treatment. In this group, 28 patients discontinued ART, and the rest never received ART. Group 2 comprised HIV patients whose conditions were well preserved and CD4 cell counts were 200-350 ml^–1 . The patients were hospitalized for control examinations or for correction of therapy and had no severe clinical symptoms. The study did not involve active drug abusers and patients with endogenous mental disorders. ART was prescribed or renewed under in-hospital conditions according to indications, and the most adequate ART regimens were chosen. Measures to develop adherence to therapy were taken. Statistical treatment was carried out using Vortex ver. 6 and MS Excel 2010 software. Results: Significant negative correlations were found in both groups between the index of patients’ physical wellbeing, which was assessed using the modified Karnofsky Scale, and CD4 cell counts, HIV RNA levels, and the presence of severe opportunistic infections. Negative changes in the index were associated not only with the worsening of patient conditions but also with the need for repeated hospitalizations and prolonged rehabilitation and with unfavorable outcomes. When immunity was improved with ART, Karnofsky index changed positively in both groups, more so in the Group 2. Conclusion: Karnofsky index may be employed as a simple and easily available clinical approach useful in any medical discipline for assessing the general conditions of patients, in particular, for planning individual therapeutic regimens for HIV patients treated under outpatient and inpatient conditions.

1. Novik A.A., Ionova T.I. Guide to the study of quality of life in medicine. 2nd ed. Ed. Akad. RAMS Yu.L.Shevchenko. Moscow: OLMA Media Grupp, 2007, 320 p. (In Russ.).

2. Belyakov N.A. The brain as a target for HIV. Saint-Petersburg: Baltic medical education center, 2011, 48 p. (In Russ.).

3. Gifford A.L., Loridge K., Gonzalez V. HIV/ AIDS. Learning to live. Trans. from English V.N.Mogilny. Moscow: AIDS infoshare, 2005, 264 p. (In Russ.).

4. Belyaeva V.V., Pokrovskiy V.V., Kravchenko A.V. Counselling in HIV infection: A Manual for physicians of different specialties. Moscow: Medicine for you, 2003, 77 p. (In Russ.).

5. Wasserman L.I., Trifonova E.A. Methodology of the study of the quality of life in the context of psychosomatic and somatopsychic relationships. Survey of Psychiatry and Medical Psychology of the name V.M.Bekhterev, 2006, No. 4, pp. 12–15 (In Russ.).

6. Onishchenko G.G. HIV infection is a human problem. HIV Infection and Immunosuppressive Disorders, 2009, Vol. 1, No. 1, pp. 5–9 (In Russ.).

7. Ulyukin I.M., Chikova R.C. Quality of life in patients with HIV infection and its dependence on psychological parameters. Bulletin Saint-Petersburg University, 2006, Series 11, Issue 3, pp. 30–38 (In Russ.).

8. Osoba D. The Quality of Life Committee of the Clinical Trials Group of the National Cancer Institute of Canada: organization and functions. Ibid, 1992, Vol. 1, рр. 211–218.

9. The human immunodeficiency virus — medicine. Eds. N.A.Belyakov and A.G.Rakhmanova. Saint-Petersburg: Baltic medical education center, 2010, 752 p. (In Russ.).

10. Karnofsky D.A., Abelmann W.H., Craver L.F., Burchenal J.H. The Use of the Nitrogen Mustards in the Palliative Treatment of Carcinoma — with Particular Reference to Bronchogenic Carcinoma. Cancer, 1948, Vol. 1, No. 4, рр. 634–656.

11. Oken M.M., Creech R.H., Tormey D.C., Horton J., Davis T.E., McFadden E.T., Carbone P.P. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am. J. Clin. Oncol., 1982, Vol. 5, No. 6, pр. 649–655.

12. Shevchenko Yu.L. Modern Approaches to the Study of the Quality of Life in Health Care. Bulletin of the Interethnic Center for the Study of the Quality of Life, 2003, No. 1–2, pp. 6–15 (In Russ.).

13. Smulevich A.B. Depression in mental and somatic diseases. Moscow: MIA, 2007, 427 p. (In Russ.).

14. Leonova O.N., Stepanova E.V., Belyakov N.A. Severe comorbidВИЧинфекция и иммуносупрессии, 2018 г., Том 10, № 2 67 conditions in patients with HIV infection: analysis of adverse outcomes. HIV Infection and Immunosuppressive Disorders, 2017, Vol. 9, No. 1, pp. 55–64 (In Russ.).

15. Bartlett J.G., Gallant J.E. Medical management of HIV-infection. Baltimore, Merylend: J.Hopkins University School of Medicine, 2001, 372 p.

16. Kaplan R.M., Bush J.W. Health-related quality of life measurement for evaluation research and policy analysis. Health. Psychol., 1982, Vol. 1 (1), рр. 61–80.

17. Salamov G.G., Lapovok G.A., Kazennova E.V., Tumanov A.S., Sotnikov V.P., Aleshina V.P., Bobkova M.R. Evaluation of the effect of the personification on the efficacy and safety of HAART: practical observations. HIV Infection and Immunosuppressive Disorders, 2011, Vol. 3, No. 3, pp. 76–80 (In Russ.).

18. Safonova P.V., Rassokhin V.V., Diclemente R.J., Brown J.L., Sales D.M., Rose I.S., Rybnikov V.Yu. Experience of substance use in the past and risky behavior in the present in HIV infected women. HIV Infection and Immunosuppressive Disorders, 2014, Vol. 6, No. 4, pp. 24–34 (In Russ.).

19. 19Safonova P.V., Rassokhin V.V., Belyakov A.N., Nikitin P.V., Klitsenko O.A., Belyakov N.A. Formation and expansion of the population of socially-adapted people living with HIV. HIV Infection and Immunosuppressive Disorders, 2013, Vol. 5, No. 3, pp. 93–99 (In Russ.).

20. Belyakov N.A., Levina O.S., Rybnikov V.Yu. Formation of adherence to treatment in patients with HIV infection. HIV Infection and Immunosuppressive Disorders, 2013, Vol. 5, No. 1, pp. 7–33 (In Russ.).

21. Zakharova N.G., Sizova N.V., Efimov G.A., Guba Z.V. Ways to improve the safety and effectiveness of highly active antiretroviral therapy (HAART). HIV Infection and Immunosuppressive Disorders, 2013, Vol. 5, No. 2, pp. 7–14 (In Russ.).

22. Zakharova N.G., Dvorak S.I., Plavinskiy S.L., Toropov S.E., Rassokhin V.V., Belyakov N.A. The causes of adverse outcomes in patients with HIV infection taking HAART, and the relationship with determinants of the effectiveness of therapy. Part 1. HIV Infection and Immunosuppressive Disorders, 2015, Vol. 7, No. 3, pp. 48–55 (In Russ.).

23. Zakharova N.G., Dvorak S.I., Plavinskiy S.L., Toropov S.E., Rassokhin V.V., Belyakov N.A. The causes of adverse outcomes in patients with HIV infection taking HAART, and the relationship with determinants of the effectiveness of therapy. Part 2. HIV Infection and Immunosuppressive Disorders, 2015, Vol. 7, No. 4, pp. 52–63 (In Russ.).

24. Berrey M.M, Schacker T., Collier A.C., Shea T., Brodie S.J., Mayers D. Treatment of primary HIV-1 infection with potent antiretroviral therapy reduces frequency of rapid progression to AIDS. J. Infect. Dis., 2001, Vol. 183 (10), рр. 1466–1470.

25. Belyakov N.A., Rassokhin V.V., Leonova O.N., Stepanova E.V., Bobreshova A.S. Integral assessment of the severity of the patient’s condition against the background of comorbidity in HIV infection. HIV Infection and Immunosuppressive Disorders, 2017, Vol. 9, No. 3, pp. 47–53 (In Russ.).

26. Belyakov N.A., Rassokhin V.V., Stepanova E.V., Panteleev A.M., Leonova O.N., Buzunova S.A., Konovalova N.V. Comorbid and severe forms of HIV infection in Russia. HIV Infection and Immunosuppressive Disorders, 2016, Vol. 8, No. 3, pp. 9–25 (In Russ.).

27. Developing adherence to medical surveillance and antiretroviral drugs for HIV infected women: Recommendations for health professionals. Eds. M.V.Demina, V.V.Chirko. Moscow: MMA of the name I.M.Sechenova, 2006, 40 p. (In Russ.).HIV Infection and Immunosuppressive Disorders, 2018, Vol. 10, No. 2 68

28. Zhang L., Ramratnam В., Tenner-Racz К., He Y., Vesanen M., Lewin S., Talal A., Racz P., Perelson A.S., Korber B.T., Markowitz M. Quantifying residual HIV-1 replication in patients receiving combination antiretroviral therapy. N. Engl. J. Med., 1999, Vol. 340 (21), рр. 1605–1613.

29. Kalinina N.M., Ketlinskiy S.A. Immunology of HIV infection. In: Immunodeficiency conditions. Eds. V.S.Smirnov, I.S.Freidlin. Saint-Petersburg: Foliant, 2000, pp. 411–445 (In Russ.).

30. Polyakov A.N., Rassokhin V.V. Resistance of the immunodeficiency virus to antiretroviral drugs. HIV Infection and Immunosuppressive Disorders, 2010, Vol. 2, No. 2, pp. 48–57 (In Russ.).

31. Bartlett J., Gallant J., Pham P. Clinical aspects of HIV infection 2009–2010. Мoscow: R.Valent, 2010, 450 p. (In Russ.).

32. Arribas J.R., Horban A., Gerstoft J., Fatkenheuer G., Nelson M., Clumeck N., Pulido F., Hill A., van Delft Y., Stark T., Moecklinghoff C. The MONET trial: darunavir/ritonavir with or without nucleoside analogues, for patients with HIV RNA below 50 copies/ml. AIDS, 2010, Vol. 24, No. 2, рр. 223–230.