The history of the journal «HIV Infection and Immunosuppressive States» from its launching in 2009 up to now is reviewed. The missions of the journal are to highlight the latest advances in HIV medicine, epidemiology, pharmacy and biology, to foster the interest of researches in Russia to these fields, to help young scientists in data processing and publishing, to expand the scope of HIV research to neighboring research fields, including comorbid conditions, to consolidated research conducted in different regions of Russia, to backup scientific forums, to publish monographs and manuals as supplements to the journal and thus to compile journal library, and to contribute to advanced postgraduate education. The list of monographs, bulletins, manuals and thematic paper compilations included in journal library is presented.

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.

Drug-induces and other iatrogenic lesions of kidney in HIV patients are inevitable upon ART and a therapy for the main opportunistic and concomitant conditions. Besides the direct effects of HIV, the side effects of drugs, such as acute renal lesions, crystal nephropathy, glomerulonephritis, acute and chronic renal failure, and functional renal impairments, are associated with poor ART efficacy and unfavorable prognosis and outcome. In the present paper, the morphological and clinical manifestations of ART-induced renal lesions are described. The main approaches to the early diagnostics of and screening for kidney lesions are suggested. The significance of the most prevalent functional and clinical renal disorders routinely encountered by physicians is evaluated.

A review article is addressed the issue of the diagnosis and treatment of syphilis that is developing against the background of HIV infection. A small number of HIV-infected patients may have false-negative or false-positive serological tests for syphilis. Patients with co-infection are at higher risk of the nervous system involvement as well as ocular and otological syphilis. The cases of treatment failure and neurorelapses are also more frequent in HIV-positive patients with syphilis. The effectiveness of neurosyphilis treatment in co-infected patients is difficult to assess, as the normalization of the CSF in HIV-positives is going slower comparing to HIV-negatives. The inevitable increase in incidence of syphilis and HIV co-infection is anticipated in the coming years. In this regard, a comprehensive study of the co-infection problem and improvement of approaches to managing patients based on the principles of evidence-based medicine is required.

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.

HIV and syphilis have similar epidemiological characteristics which causes a high level of combined infection. Both STDs affect the central nervous system early after infection. Mental disorders occur with a high incidence in HIV-infected patients and patients with syphilis, but data on the effect of combined HIV and syphilis infection on mental disorders are found only in single articles. Objectives. The goal is to study mental disorders and their effect on the commitment to observation in the infectionist in HIV-infected patients with early syphilis. Materials and methods. A comparative study of 148 patients (65 HIV-infected patients with syphilis, 50 patients with syphilis monoinfection, 33 HIV-infected patients, seronegative for syphilis) was carried out. We used clinical, psychopathological, follow-up, psychometric, laboratory and statistical methods of investigation. Results. It was found that mental disorders occur in the majority (83%) of HIV-infected patients with syphilis with the predominance of affective (54%) and addictive (48%) disorders. In HIV-infected patients with early neurosyphilis, psychogenic reactions developed statistically significantly more often than in HIV-infected patients with early syphilis. In contrast, there were no statistically significant differences in the incidence of addictive, affective, personality disorders and mental disorders due to organic brain damage in patients with early neurosyphilis and early syphilis in the case of co-infection with HIV infection. Mental disorders due to organic brain damage had a mixed genesis (including infectious) in all cases and were associated and caused by the already existing HIV infection. HIV-infected patients with syphilis, in general, were characterized by the low commitment to observation in the infectionist which were influenced by the following factors: social maladjustment, drug abuse and criminal activity. Discussion. The frequency of detected mental disorders in the examined HIV-infected patients with syphilis (83,1%) corresponded to the literature on the incidence of mental illness in HIVinfected patients inSt. Petersburg(85,6%), but was higher than the prevalence of mental disorders in patients with syphilis (68%). Given the established influence of neurosyphilis mono-infection on the development of mental disorders due to organic brain damage, it can be concluded that the disease with early neurosyphilis is important in the development of mental disorders of organic genesis. But the weight of this factor is insufficient in case of co-infection with HIV and early neurosyphilis and can only have additional significance in the development of mental disorders and the key factor is HIV-infection action. Mental disorders (addictive disorders and cognitive impairment) adversely affect the commitment to observation in the infectionist of HIV-infected patients with syphilis, therefore timely correction of mental disorders may be one of the factors improving compliance of patients. Conclusions. The study found a minor role of early neurosyphilis (as opposed to HIV infection) on the formation of mental disorders in the case of a combination of these infections. At the same time, it was found that addictive and cognitive symptomatic complexes have a negative impact on the probability of reference to an infectious disease specialist for initiating therapy in HIV-infected patients with syphilis.

The purpose of the study was to study the dynamics of the spread of narcological diseases, opium addiction, including HIV-related co-infection in Primorsky Krai in 2004–2016 in comparison with the indicators ofRussiaand the Far Eastern Federal District. Materials and methods. The official statistics, the data on the registration of narcological diseases of the Regional Clinical Hospital «Regional Narcological Dispensary», the data on the registration of HIV infection in the State Regional Clinical Hospital «Regional Clinical Hospital № 2 — Center for the Prevention and Control of AIDS and Infectious Diseases» were used. Results. Against the background of a decrease in the primary incidence of drug addiction in theRussian Federation, there has been an increase in Primorsky Krai, the main factor of HIV infection in the province remains intravenous drug use, which has an impact on the spread of the incidence of HIV infection. Conclusion: An analysis of the prevalence and prevalence of opiate addiction and HIV infection reflects the direct relationship between injecting drug use and HIV infection. The presented materials reveal the patterns of drug abuse, which is necessary for clarifying the reasons for the broad expansion of drugs, for resolving the issues of organizing narcological care, including those with comorbid pathology.

Interleukin 6 and D-dimer known as chronic systemic inflammation markers shown prognostic significance in course of HIVdisease. Association between opioid use and systemic inflammation response are still elucidate. Objective: аssess plasma levels of IL-6 and D-dimer in HIV-positive patients in groups formed on the base of opiate use activity. Materials and methods. Crosssectional study of 346 HIV-positive ART-naive individuals. Participants were categorized into 3 groups according to their history of opioid use: 1) current opioid use — past 30 day opioid use; 2) «ever» opioid use — no use in past 30 days; 3) «never» opioid use. Results. Рarticipants with current opioid use had higher log-transformed IL-6 (0,4 [ s 1,0]; p<0,0001) and D-dimer (-0,6 [ s 0,9]; p<0,0001) levels than participants who reported «ever» (-0,1 [ s 1,0] and -0,9 [ s 0,8]), or «never» (-0,4 [ s 0,7] and 1,3 [ s 0,7]) opioid use. Conclusion. Оpioid use in HIV-positive participants is associated with higher inflammatory response.

The current epidemiological situation in the world, characterized by a constant increase in the number of HIV-infected. The steady progression of HIV infection, even in the presence of antiretroviral therapy (ART), is accompanied by the development of opportunistic diseases. Tubercolosis most often affects patients with HIV infection, as the risk of their illness is 20–37 times higher. Basically, radiation tests and immunological tests are used for the diagnostic of tuberculosis. The main diagnostic criterion for establishing the diagnosis of tuberculosis is detection of the causative agent (Mycobacterium tuberculosis by bacteriological or molecular genetic method. Other diseases with respiratory organs, pleura, and hilar lymph nodes may also occur In patients with HIV infection, which requires differential diagnostic, including surgical methods. It is often necessary to resort to a biopsy of pulmonary tissue, pleura, and hilar lymph nodes to establish a diagnosis. Among surgical methods, the use of minimally invasive operations using endoscopic techniques is most justified. Purpose of the study. Study of safety and effectiveness of the use of surgical methods in the diagnostic of chest diseases in patients with HIV infection. Materials and methods. The results of 105 diagnostic thoracic surgeries in patients with HIV infection which were performed in Moscow Research andClinicalCenterfor Tuberculosis Control of Moscow city Department in period between 2014–2017 were studied. All patients underwent diagnostic surgical interventions. Minimally invasive methods were predominantly used. The obtained diagnostic material was subjected to morphological, molecular-genetic and bacteriological analysis. Results of the research. After surgical interventions in patients with HIV infection with pathological changes in chest organs, unclear etiology, diagnosis of tuberculosis was established in 74 (70,5%) patients, nontuberculous etiology of the disease was detected in 31 (29,5%). Differential diagnosis of chest diseases in patients with HIV infection is an integral part of the work of phthisiatrician, pulmonologist and infectiologist. Surgical interventions in HIV-infected patients do not create a significant risk of changes in the immune status, respectively, their performance is independent of the level of lymphocytes and produced even with severe immunodeficiency. The use of surgical methods in diagnostic of chest diseases is safe, effective and does not lead to a significant number of complications and mortality in patients with HIV infection, regardless of the initial immune status. In addition, in number of patients, the operation is not only diagnostic, but also therapeutic, allowing significantly shortening the duration of treatment, avoiding the appointment of trial therapy. The conclusion. In case of tuberculosis, morphological verification of pathological changes in combination with bacteriological and molecular genetic research of the operation material makes it possible to assign an adequate regime of antituberculous chemotherapy in accordance with the sensitivity of the pathogen. The establishment of non-tuberculous etiology of the identified changes, changes the routing of an HIV-infected patient from an anti-tuberculosis institution to a specialized medical organization of the appropriate profile.