The general picture of HIV epidemic in Russia, Eastern Europe, and Central Asia is presented, and the factors that influenced the development of AIDS-related services in the Russian Federation and determined the main directions of clinical, scientific and educational projects development are analyzed. The main trends of basic HIV-related research in Russia include HAART studies, such as estimating the effectiveness of drugs, determining the adverse effects of drugs, testing novel therapeutic regimens, and developing domestic drugs. Epidemiological studies are still topical in the Russian Federation because of persistent differences in HIV prevalence between regions. So far, only general notions about the territorial differences in the dynamics of HIV epidemic, the routes of HIV transmission, and the roles of defined population groups in HIV spread are available. HIV studies in the field of maternity and childhood are important in Russia as far as they help preventing the perinatal HIV transmission. These studies relate to family planning, HAART, and HIV prevention in women before they have children. Of unfading interest for researchers are projects related to concomitant HIV, hepatitis virus and M. tuberculosis infections because the problem is large-scale, patients are numerous, and their death rate is high. Starting from 1990s, studies of HIV patient behavior and psychology go on, and educational interdisciplinary programs are being developed with the aimed to work out comprehensive approaches to HIV treatment. One of the major themes of current and prospective HIV research are cormobid conditions, i.e., combinations of HIV infection with CNS lesions, somatic and oncological diseases, severe liver damage, mental disorders etc., because the prevalence of severe and cormobid HIV cases increases. This increase is promoted by pronounced immunosuppression and somatic and systemic pathologies resulting, despite of HAART, in high death rates among such cases.

Study objectives: To assess the effectiveness of antiretroviral therapy in HIV patients living in Sverdlovsk Region, to examine the impact of operation of a multiprofessional team on the successfulness of antiretroviral therapy, and to study the 2-year dynamics of cases having undetectable HIV loads. Materials and methods: Based on digital database information, the virological effectiveness of ART in Sverdlovsk Region in 2013-2015 was assesses and the proportion of HIV patients having undetectable HIV loads was determined. The virological success was assumed to be a case where HIV load was found to below 50 copies per 1 mL of blood two times successively. Changed in the proportion of HIV patients having undetectable HIV loads were traced for two years. Results: In Sverdlovsk Region, the proportion of HIV patients having undetectable HIV load upon two successive tests was 63,9% and 70,6% in 2013 and 2015, respectively. The proportion of virological success cases varied in different territories from 80,1% (in Kamensk-Uralskiy) to 27,1% (in Degtiask) in 2013 and from 89,2% to 31,7% in 2015 in the same places. The operation of a multiprofessional team in a territory was associated with a higher proportion of HIV patients with suppressed viremia (68,6% and 76% where a multiprofessional team was present in 2013 and 2015, respectively, vs. 52,3% and 58,1% where no such team was organized). Conclusion: HIV load monitoring based on data included in a unified informa- tional system may be used to assess the quality of health care provided to HIV patients. The presence of a multiprofessional team correlated with higher rates of virological success. From 2013 to 2015, the proportion of HIV patients having undetectable HIV loads increased in Sverdlovsk Region.

Study objective: Interviewing and testing of 500 IDUs in Saint-Petersburg using saliva express tests for HIV 1/2. Results. In the course of anonymous cross-sectional study for assessing HIV prevalence among IDUs, HIV diagnosis was established in 501 subjects aged above 18 years. The gender and social characterization of the patients was given in the first part of this report. The second part is concerned with estimating the familiarity of the respondents about HIV infection and the regularity of their addressing for medical attention. Currently, HIV prevalence among IDUs is as high as 65,7%. Interviewing suggests a high level of familiarity with HIV transmission risks and routes and enough objectivity in self-estimating concerning these issues. Almost all respondents but a few exceptions are well informed about the results of their tests. The rate of detection of new HIV cases in the course of this study was 4,7%. All newly found HIV cases among IDUs were tested for HIV antibodies less than one year earlier on average. An association is found between the rates of injection drug use and of HIV detection. Two groups of IDUs are the most vulnerable to HIV infection: one with an extremely high and the other with a low rate of drug injection

The characteristics of pregnancy and parturition, the perinatal outcomes, and the results of therapy for tuberculosis were analyzed based on findings related to 24 women coinfected with HIV and TB who were followed up at Krasnoyarsk Regional TB Dispensary № 1 in 2010-2014. Eight women continued psychoactive drug abuse during pregnancy. Abortions were made upon patient’s agreement with medical panel advice in four cases of seven associated with the progression of coinfection during the second trimester. Pregnancy ended with parturition in 13 cases. One infant died within the antenatal period. Among twelve mother-and-child pairs, eight passed through three-stage preventive interventions against perinatal HIV transmission. One infant still contracted the coinfection and died of it at six months of age. Three women died, including two cases that occurred in the early postpartum period and one case that occurred in 20 months, its causes being unrelated to TB or HIV Radiological examinations revealed TB progression during the early and late postpartum period in seven and four women, respectively. With account of forced combined therapy and resulting multiple drug interactions and of high risks of adverse outcomes for both, women and fetuses, HIV-infected women coinfected with TB should be strongly advised to use contraception.

Socio-epidemiological characteristics, somatic anamneses, and immunological parameters were analyzed in a group of reproductive-age female HIV patients having or having no HCV coinfection. Half of the subjects received secondary education and were married. Two thirds of them were employed, 34,4% had children, and 41% had secondary somatic health problems, mainly involving the urinary system. No significant differences in socio-epidemiological characteristics between the two groups were found, except for among HIV/HCV-coinfected women there were more IDUs (96,7% vs. 93,3%) and more registered criminal cases (16,7% vs. 13,3%). In the coinfected women, blood CD4 cell counts were below 350 ml^-1 before HAART and remained low over 12 months of HAART suggesting that in this group the recovery of immunity is slowed probably because of indirect effects of HCV on CD4 lymphocytes.

To assess the roles of pre- and posttest counselling as an approach to HIV prevention, the experience of Anonymous Counselling Office of Vladivostok in 2014-2015 was reviewed. Materials and methods: Examined were 796 questionnaires obtained from persons who wished to pass anonymous testing for HIV. Of them, 63 persons were found to be HIV-positive. Most of the HIV cases were working-class men aged 31-40 years and showing risky behavioral patterns, including injection drug use and unprotected heterosexual contacts. Results: The data suggest that at the stage of pretest counselling it is necessary to develop trustful and easy relationships with patients in order to foster their commitment to health care and motivation for changing behavioral patterns and to enhance preventive interventions in the general population.

Errors in forecasting the expected number of HIV patients lead to organizational and economic problems. In particular, the budgetary funding of the purchases of drugs and diagnostic means may turn out to be inadequate to a real epidemiological situation. Study objective: To ascertain the accuracy of modeling of HIV infection based on standard epidemiological data supplemented with the incidence of early HIV cases. The expediency of this task is determined by the necessity to find approaches to making more accurate prognoses. Materials and methods: Retrospective modeling of the dynamics of HIV epidemic was carried out for the period of 2010 to 2014 with account of the incidence of new HIV cases and HIV-related mortality rate. The coef- ficient of HIV increment in the study population was used. This parameter is determined from empirical data by calculating the incidence of the early HIV cases are assumed to be those that have negative or uncertain results of immunoblotting for p24 antigen and some p24-positive cases selected based on additional criteria. The use of parameters accounting of the time elapsed from HIV contraction made it possible to calculate the probable number of the cases of newly acquired HIV based on the incidence of early HIV cases in the population. On average, one «missed» HIV case may result in infecting 0,64 + 0,09 (p<0,05) persons annually. The difference between this estimate and HIV-related mortality rate provides for calculating the increment coefficient, which characterizes the rate of HIV spread and determines the short-time trend of HIV epidemic. The mean error of this prognosis relative to the actual number of HIV cases found was 4% vs. 26% found in the case of using the least squares method. The incidence of the early HIV cases may be used as a criterion of the effectiveness of preventive interventions and for calculating the minimal scope of screening that can make the trend of HIV epidemic be declining.

Study objective: To determine the current epidemiological characteristics of HIV infection among women of reproductive ages for developing measures for timely prevention of perinatal HIV transmission in Osh Region, one of major territories of Kirghizstan. Materials and methods: Monthly reports about testing of different populations for HIV (Form 4), official statistical reports about HIV registering in 2000-2014 (Form 4a), charts of the epidemiological studies in the foci of HIV outbreaks, and charts of dispensary follow-up of HIV-infected women were used. Results: An increase in HIV prevalence among pregnant women and their infants was revealed. Novel approaches to preventive intervention with account of the state policy in gender issues must be priority trends in HIV/AIDS prevention.

Background. In 2014, the first experiment of drug inclusion into or exclusion from restrictive inventories based on a score system and independent expert assessments has been carried out. Based on data obtained in 2014, the present authors have developed and tested linear mathematical models for making decisions concerning drug inclusion into restrictive inventories. The objective of the present work was to develop a model for the year 2016 with account of novel and supplementary data derived from the analysis of such inventories. Materials and methods. The linear models that have been developed and adopted earlier were used. The analysis included 141 records of medicinal drugs. Analyzed were verdicts provided by expert institutions and by chief non-stuff experts and the final decisions made by Interdisciplinary Panel. Results. In 2016, the Restrictive Inventory of VEID included 43 drugs. It was shown that the model for making decisions by expert organizations was associated with a 7,09% error (12,4% in 2014). The model for chief on-stuff experts was associated with a 7% error (10% in 2014). The above positive changes suggest that persons involved are able to become trained in using the formal approaches. The model for making the final decision by interdisciplinary panel was associated with a 42% error vs. 35% found earlier. Conclusion. Linear models are effective instruments for making prognoses concerning the inclusion of medicinal drugs into restrictive inventories. However, the currently adopted system should be formalized further.

An analysis of the regimens of antiviral therapy licensed in Russia for treating chronic viral hepatitis C at staged preceding liver cirrhosis has been carried out from clinical, pharmacoeconomic, and epidemiological viewpoints accounting of the effectiveness, safety, and cost of treatment and its potential to prevent the progression of the disease at a stage before liver cirrhosis develops. The results of the analysis suggest that clinical benefits (i.e., high antiviral potency and, hence, prevention of the progression of the disease at a pre-cirrhotic stage) determine cost-effectiveness in the strategic perspective because they reduce the enormous expenses for the treatment of liver cirrhosis, which eventually results from chronic HCV infection.

The main objective of the title document is to support the efforts of the authorities of the Russian Federation being undertaken to combat HIV epidemic. With account of dire epidemiological conditions and of ART drug deficit in Russia, the Coalition for Commitment to Therapy continuously monitors ART drugs purchasing and provision to HIV patients with the aims to analyze the situation and to work out recommendation for improving it. The report includes, among other things, answers to the following questions: What drugs for treating HIV were purchased in 2015 and at what amounts? What are the prices for specific ART drugs and is there a trend to their reduction? What is the estimated number of patients treatable with drugs purchased? What possible interventions can improve ART drugs provision to HIV patients?