The problem of autoimmune diseases in HIV-infected patients is interdisciplinary, and differential diagnosis issues often come to the fore. The interaction between HIV and the human immune system is characterized by an imbalance in lymphocyte populations with selective depletion of certain subtypes of CD4 lymphocytes and preservation of immune activation. This imbalance, which persists for a long time, provokes the early appearance of the immune aging phenotype, which is associated with an increase in the frequency of autoimmune reactions. The incidence of rheumatic diseases in people living with HIV (PLHIV) is increasing, while timely diagnosis, justification, selection and early initiation of complex therapy for comorbid pathology are extremely urgent tasks. The incidence of autoimmune diseases in PLHIV varies: systemic lupus erythematosus — 6.25%, reactive arthritis (often HLA-B27-associated) — 2.67%, psoriatic arthritis — 1–3%, rheumatoid arthritis — 0.29%, Sjogren’s syndrome — 0.03%, systemic vasculitis — 1%, also several pathological processes can develop simultaneously. It is not uncommon to detect a number of autoantibodies without developing an autoimmune disease symptoms. It is necessary to take into account the features of prescribing antirheumatic therapy in the context of mandatory and continuous antiretroviral therapy (ART), constant monitoring of the number of CD4 lymphocytes and HIV RNA in the blood, the risk of developing immune reconstitution inflammatory syndrome and reactivation of opportunistic infections with severe immunosuppression. Management of patients with complex comorbidity, such as HIV infection and rheumatic diseases, should be carried out as part of an interdisciplinary team with the mandatory participation of an infectious disease specialist, constant monitoring of the number of CD4 lymphocytes and the level of HIV viral load in the blood.

The aim was to describe the clinical and epidemiological features of sexually transmitted infections (STIs) combined with other infections included in the list of socially significant diseases (SSIDs).
Materials and methods. The research material was data published in scientific articles of domestic and foreign publications for the period from 2011 to 2023 on STI/SSID coinfection.
Results and discussion. Based on the analyzed research results, the following aspects characterizing the features of STI/SSID coinfection were considered. Epidemiology features: 1) the predominance of the population from the risk groups is more represented in comparison with monoinfection; 2) a significant proportion of cases of their combination with STIs in the structure of various SSIDs. Clinical features (in comparison with monoinfection): 1) a more severe course of the infectious process due to the synergistic effect of two or more pathogens acting on the body simultaneously; 2) the presence of atypical clinical manifestations; 3) the predominance of rare localizations. Immunological features: 1) difficulties in conducting immunological diagnostics; 2) significant differences in immunological parameters when combined with various STIs. Prevention and treatment features: 1) high recurrence rate after treatment; 2) more complex routing of patients associated with the need for timely and coordinated work of physicians: infectiologists, dermatovenerologists, phthisiatricians.
Conclusion. The clinical and epidemiological features of STIs combined with other infections included in the list of socially significant diseases necessitate the improvement of diagnosis, treatment, prevention, and monitoring of patients with this pathology

Chronic hepatitis C is a global problem for public health and society. There are more than 71 million patients with chronic hepatitis C in the world, approximately 400 thousand people die annually from causes associated with liver damage in viral hepatitis C. Against the background of an annual increase in the number of HIV-infected patients, the number of co-infected persons infected with 2 viruses at the same time increases annually. Both viruses have a synergistic interaction with each other, which makes the problem of combined infection super-urgent.
The aim of the study is to study the effectiveness of the applied treatment regimens for chronic hepatitis C in coinfected patients in the Novgorod region.
Materials and methods. The total number of patients was 104 people. The patients were monitored throughout the entire period of taking the drugs and 12 weeks after the end of therapy.
Results and discussion. Among the observed patients, men 60.6% were more often registered, these were patients of young reproductively active age. Pangenotypic therapy regimens were received by 33.7% of coinfected patients, 66.3% received genotype- specific therapy regimens. The virological response at the end of therapy in the general cohort of patients was achieved in 96.2% of patients. In the group of patients receiving pangenotype schemes, a virological response was registered in 100% of patients, and in the group of patients receiving genotype-specific schemes, in 94.2% of patients. Against the background of therapy, virological efficacy could not be achieved in 4 patients, and the exact causes of failure could not be established. These patients belonged to the group of patients receiving genotype-specific treatment regimens, therefore, the frequency of achieving SVR in this group of patients was 94.2%. SVR was registered in all patients (100%) in the following groups: patients receiving pangenotypic therapy regimens (n=35); patients with 1a, 2 and 3 virus genotype (n=42); patients with high degree of liver fibrosis (F3) or cirrhosis of the liver (n=43); patients with HCV/HCV (n=10); patients over 60 years of age (n=4). There were no clinically significant deviations of the main specific laboratory parameters during the study. On the contrary, there were improvements in the average values of liver enzymes after treatment after 12 weeks of follow-up. Also, no adverse events were reported during therapy.
Conclusion. Thus, the results of this study showed the high effectiveness of antiviral therapy and a good safety profile, both when using pan-genotype therapy regimens and genotype-specific regimens

The aim: to evaluate the effectiveness of implementing elements of the antimicrobial therapy control strategy in the hospital of the AIDS Center using epidemiological criteria.
Materials and methods. The results of identification of 2025 isolates isolated in 2013–2019 were analyzed. from samples of clinical material from 1103 inpatients at the AIDS Center. A Protocol for initial antibacterial therapy has been developed, including the results of data analysis on local microflora resistance to antibiotics and stratification of patients according to the risk of the presence of antibiotic-resistant pathogens. Using epidemiological criteria, an assessment was made of two time periods before and after the implementation of the Protocol with an interval of 12 months between them: the first quarter of 2018 and the first quarter of 2019. Statistical analysis of the results included calculations of exact 95% Clopper-Pearson confidence intervals for qualitative indicators. If two intervals did not have common values, differences between groups were considered significant at a level of less than 0.05. Analyzes were performed using SAS statistical system version 9.0 (SAS Institutes Inc., Cary, NC).
Results and discussion. It was established that during the study period, 10 microorganisms predominated in the spectrum of pathogens of non-AIDS-indicative bacterial infections in patients with HIV infection, the share of which ranged from 82.1% in 2014. up to 74.7% in 2019 Among them, the leaders were K. pneumoniae (18.4%), E. coli (12.6%) and S. aureus (14.9%). The use of the Initial Antibacterial Therapy Protocol made it possible to reduce the proportion of gram-negative bacteria from 65.5.5% to 50.9% (p=0,0286), reduce the detection rate of K. pneumoniae from 31.8% to 16.0% (p=0,0067), reduce the frequency of isolation of carbapenem-resistant strains of K. pneumoniae and cephalosporin-resistant isolates of enterobacteria from 44.8% to 36.4%. The proportion of methicillin-resistant staphylococcus decreased from 8.3% to 4,8%.
Conclusion. The introduction of elements of the antimicrobial therapy control strategy made it possible to change the spectrum and properties of pathogens causing infectious complications in HIV-infected patients in a specialized hospital

The key to success in HIV treatment is compliance with antiretroviral therapy (ART). This is because continuous AR therapy can suppress HIV to undetectable levels, reduce the risk of drug resistance, improve quality of life and survival, improve overall health, and reduce the risk of HIV transmission. On the other hand, non-compliance with treatment can be a major cause of therapy failure.
The aim: to identify factors influencing compliance with ART therapy in patients with HIV/AIDS
Material and Methods. This study used a cross-sectional method. It involved 289 respondents as samples. The sample size was based on HSIEH formula (1989). Univariate analysis used frequency distribution to describe the percentage. Bivariate Logistic regression analysis (Adjusted OR and 95% confident interval) and multivariate analysis used Multiple logistic regression with Adjusted OR, 95% Confident Interval (CI), and a significant value of <0.05.
Results and discussion. Some factors had a significant relationship to the outcome, namely age with a p-value of <0.001 (95% CI 4.15–134.09), Occupation with a p-value of 0.002 (95% CI 2.7–32.7), Knowledge with a p-value <0.001 (95% CI 6.15– 43.8), attitude with a p-value of <0.001 (95% CI 3.37–43.8), accessibility of health services with a p-value of 0.004 (95% CI 1.5–9.4), and health worker’s attitudes with a p-value <0.001 (95% CI 1.88–9.21).
Conclusion. Another factor is also important, namely a good patient-provider relationship. Increasing patient trust through non-judgmental and supportive care and using positive motivational strategies can affect treatment compliance. Considering each measure taken is important to achieve optimal clinical outcomes and realize public health with preventive treatment

Despite the organizational and preventive measures, the prevalence of HIV infection continues to increase in Russian Ferderation. The course of the disease is exacerbated by comorbidities such as tuberculosis and chronic hepatitis. This requires a special approach to treatment. The increase in the number of comorbid cases, insufficient screening coverage in risk groups have an impact on the progression of HIV and cause an increase in mortality both in the Russian Federation and Voronezh region over the past decade. Researchers note that many patients died from mycobacterial infections, pneumonia, lymphomas, and other somatic diseases during the first year after diagnosis.
The aim of the study. Conduct a comparative analysis of the social, demographic, and medical characteristics, as well as the causes of death, of patients with HIV infection between 2013 and 2023. Materials and methods. A complete sample was selected from medical records of 120 patients who were admitted to the Voronezh Regional AIDS Prevention and Control Center clinic and died during that time period. Statistical analysis was performed using Excel 2019 and included calculation of the Student’s t-test (p<0.05) and Spearman’s rank correlation coefficient.
Results and discussion. For the period under study 2013 and 2023 the highest percentage of deaths were observed in the age group from 31 to 40 years old in 2013 and 2023 — 41,7% and 43,3%, respectively, as well as in the age group of 41 to 50 years, which was 23,3% and 43,3%. Both groups were predominantly male, but by 2023 the proportion of young women had increased from 31,7% to 40%, increasing the demographic significance of the problem. Although in the Voronezh region, as well as in the Russian Federation as a whole, HIV infection is mainly transmitted through the sexual contact, our study revealed a high prevalence of patients with experience in places of deprivation of liberty who use drugs and alcohol, highlighting the need for in-depth monitoring and interdisciplinary study of these issues. In the mortality structure, it is necessary to note first of all a significant increase in HIV infection rate, as main cause of death from 11,7 to 25%, an increase in mortality due to external causes from 20% to 25%, and also a decrease in mortality from tuberculosis (TB): from 28,3% to 15%, bacterial infections (extra-hospital bilateral pneumonia and its complications): 11,7% to 8,3%; somatic diseases: 20% to 15%, chronic viral hepatitis C (HCV) in the stage of liver cirrhosis: 8,3% to 6,6%. The negative trend in HIV mortality is due to a number of reasons: improved approaches to clarifying and detailing causes of death have allowed us to better define the role of HIV infection and opportunistic infections (OI). New diagnostic techniques, including telemedicine consultations, could also be introduced. The increase in HIV and AIDS is thought to be related to improved awareness of symptoms and signs of these diseases, leading to earlier diagnosis and lower mortality. However, more research is needed to better understand the causes. Among the somatic diseases that have been the cause of death, an increase in mortality from oncological diseases has been noted (doubling from 3,3% to 6,6%). There were no changes in the mortality rate from cardiovascular disease, but a decrease in mortality from gastrointestinal diseases from 5% to 1,7%. In the group of diseases registered as background pathology, hepatitis C were frequently observed in liver cirrhosis (increase by 11,7% in 2023), gastrointestinal trac diseases (increase by 5% in 2023), nervous system (NS) (increase by 7,3% in 2023) and etc. In contrast to the main group, people living with HIV (PLHIV) between 31 and 50 years of age showed an increase in somatic diseases as a major cause of death (by 2,5%), while the main group decreased by 5%. The increase in mortality from HIV infection and OI from 2013 to 2023 was significantly lower: by 14,3% in the main group and by 2,9% in the age group 31–50 years. The number of deaths from bacterial infections doubled in this group, while the main group showed a decrease. In contrast to the main group, PLHIV at age 31–50 years was observed an increase of somatic diseases (by 2,5%) as the main cause of death while in the main group the same figure decreased by 5%.
Conclusion. Thus, this study provides information on the characteristics of PLHIV deaths, which is useful for understanding the mortality structure and designing measures to improve health. Further studies taking into account regional specificities will help to identify trends in the mortality structure and develop effective measures to improve health for people living with HIV

The aim. Analysis of the features of the development trend of the HIV epidemic process during the COVID-19 pandemic in the Republic of Tajikistan.
Materials and methods. The data on the prevalence and incidence of HIV infection among the general population during the COVID-19 pandemic were retrospectively analyzed based on data from the Republican Center for the Prevention and Control of AIDS of the Ministry of Health and Social Protection of the Republic of Tajikistan.
Results and discussion. An analysis of the epidemic process during the development of HIV infection in the Republic of Tajikistan shows that the country still has a high risk of infection both among the most vulnerable cohorts of people and among the general population. During the period 2018–2019 (before the development of the COVID-19 pandemic), the largest number of new cases of HIV infection among the general population was detected. The epidemic process, starting in 2018, has tended to gradually decrease the incidence and mortality rates of HIV infection among the general population. In 2018, 1,421 new cases of HIV infection were detected. By the end of 2023, this figure was 1,100 cases, that is, it decreased by 1.3 times. In 2020, 1,095 HIV cases were identified, which is 20.5% lower than in 2019 (n=1,320), i.e. before the pandemic. In addition, the coverage of the population with HIV testing was 805,120 people, which is 1.3 times less (n=1,062,509) in 2019. During the COVID-19 pandemic, the prevalence of coronavirus among HIV-infected people was 0.31% of the total number of this cohort of patients.
Conclusion. The COVID-19 pandemic, despite a slight decrease in the incidence of HIV infection, did not have a significant impact on the development of the HIV epidemic in the country. This trend is, in particular, associated with a decrease in the volume of HIV testing and with restrictive measures introduced in the country due to the worsening epidemiological situation with COVID-19.