Recently, management of patients co-infected with syphilis and HIV infection is becoming an increasingly important problem. Similarity of circumstances and ways of HIV and syphilis transmission as well as populations at risk of infection suggests that in the coming years the number of cases of co-infection will increase. The .negative synergy. of HIV infection and syphilis has been proven. This means a mutual reinforcement of the negative effect, when each of the diseases in their combination is more unfavorable than the separately existing disease. Syphilis increases the likelihood of HIV acquisition and transmission during unprotected sexual intercourse and contributes to the progression of HIV infection. On the other hand, it is traditionally believed that concomitant HIV infection can significantly change clinical features and course of syphilis and make its diagnosis and treatment more complicated. However, the widespread use of antiretroviral therapy has allowed to significantly reduce this negative effect. The review article is devoted to the problem of the biological and epidemiological .synergy. of these two infections, as well as to the analysis of modern data on the clinical features of syphilis developing against the background of HIV infection.

The objective of the study was to analyze clinical, immunological and morphological features of malignant non-Hodgkin lymphpomas (MNHL) in HIV-infected patients, evaluate the options and the results of the treatment for the patients in oncohematological hospital environment. Materials and methods. The study evaluated the data from Original Medical Records of 185 HIVinfected patients (mean age 36–40 years) with MNHL that was detected during the period from 1994 to 2017. The results of clinical, laboratory, morphological and immunohistochemical methods used for the study in HIV-infected patients with MNHL were represented. Results. During the period from 1994 to 2017, increasing in the number of HIV-infected patients with MNL, mean age of which was less than 40 years, had been marked. Duration of HIV-infection up to the time of detection the MNHL was 7 years but in 23% of cases the HIV-infection and tumor disease were diagnosed at the same time. Low number of CD4 lymphocyte cells (132 cells/μL) and high number of RNA HIV (more than 550 000 copies/μL) were detected in the blood of the patients. The following distribution was among morphological types of MNHL: diffuse large B-cell lymphoma (DLBCL) — 42%, Burkitt's lymphomas — 32%, plasmablastic lymphomas — 26%. Clinical lymphomas with the extranodal manifestations accompanied with large quantity of complications and opportunistic infections directly resulted from immunosuppression severity (p<0,05) were predominant (76%). Evaluation of combined chemoimmunotherapy effectiveness in HIV-infected patients and in the patients with MNHL showed comparable results in contrast with the population of seronegative HIV-infected patients under using standard polychemotherapy regimens with rituximab, antiretroviral therapy, prevention of infectious complications and immune reconstitution syndrome. Conclusion. Malignant non-Hodgkin lymphpomas represent the group of oncological diseases, which is predominant in HIV-infected patients. These diseases require team approach in early detection, current treatment, prevention of complications in the multidisciplinary team that will significantly improve disease outcome.

The objective of the present study was the analysis of medical and social status of women co-infected with HIV and VHC with the following assessment of their readiness to antiviral therapy of chronic hepatitis C virus infection (CHC) taking into account the mental health and living conditions and sustaining the adherence to antiviral therapy thereafter. Materials and methods. To clarify the social and psychological status, 100 outpatient cards of women co-infected with HIV/HCV were analyzed. The in-depth study with the assessment of the psychosocial and detoxification status and the adherence to antiretroviral therapy (ART) was held in fifty patients. Results. Most of the women had a long-standing history of HIV infection and HCV. Of these, 78% underwent ART and 84,6% had a high adherence to treatment. The main social problems of the women were connected with their work (34,2%) and family circumstances (26,3%). An increase in the concentration of carbohydrate-deficient transferrin (CDT), the marker of chronic alcohol abuse, was detected in three of 50 patients, and other three of the 50 had this parameter in the zone of unstable values. 72% of the patients showed mental disorders, while more than half of them (60%) had actively used psychoactive substances, and organic symptomatic mental disorder effects were observed in 20% of the patients. Most of the women were in remission on the use of psychoactive substances. Evaluation of the depression and anxiety levels has showed scattered results but in the meantime 54% of the women expressed complaints of asthenic nature, anxious mood was marked in 38% of the patients, 40% of them earlier had been suicidally inclined. Conclusion. Taking into account the social problems in one-third of patients that may negatively affect the treatment of HCV and HIV infection, it is essential to lend complimentary psychological support and assist with solving difficulties before the treatment assignment in order to increase the adherence to treatment. Due to mental health reasons, the patients need continuous observation and periodic condition correction. The majority of surveyed agree ART of CHC at this moment and in the short term but carefully relate to offered treatment regimens and its duration. Given the mental state of the patients, it can be assumed that virus C in women with HIV/HCV co-infection should be treated with direct-acting antiviral agents that do not exacerbate existing disorders. The next issue of the journal .HIV infection and immunosuppression disorders. (2018. Vol. 10, No. 4) will present the results of the study of clinical status features and the prospects for the therapy.

Purpose: еstablishment of the frequency of infection and clinical forms of cytomegalovirus infection in pregnant women with HIV infection. Materials and methods. A retrospective analysis of medical records of 254 HIV-infected pregnant women of the Krasnodar Territory was conducted, which were observed in the framework of the current regulations on HIV infection and the management of pregnant women. Verification of cytomegalovirus infection and distribution of clinical forms was carried out by serological tests. The comparison group is a prospective analysis of 29 pregnant women with HIV infection who were additionally examined for cytomegalovirus infection by polymerase chain reaction. Results. Latent form of CMV infection was diagnosed in 220 (90,5%) of HIV-infected pregnant women, primary — in 5 (2,1%) and reactivated (late primary, reinfection)— in 18 (7,4%). Cytomegalovirus infection frequency increase with growing pregnant, increasing stages of HIV infection, more frequent multiplicity pregnancy, reducing CD4+ T-lymphocytes and increase in HIV RNA. The well-being of obstetric history had no effect on the incidence of infection with cytomegalovirus and various forms of CMV infection. Reactivated forms of cytomegalovirus infection were significantly more frequent in pregnant women with HIV infection at the lowest CD4 + T-lymphocyte counts, maximal HIV viremia, later onset of perinatal antiretroviral prophylaxis, but did not depend on the well-being of the obstetric anamnesis. A comparison group study demonstrated the presence of latent cytomegalovirus infection in all pregnant women, confirmed by the detection of only specific IgG. From the whole blood, the DNA of CMV in low concentration was isolated by PCR method in 1 (3,4%) of the patient, from the cervix — in 8 (27,6%). The amount of detected CMV DNA in the cervix was different, had a direct correlation with the level of HIV RNA of pregnant women and did not depend on the number of CD4-lymphocytes. The calculation of the relative risk in our observations demonstrated that the presence of cytomegalovirus in the cervix did not increase the risk of premature termination of pregnancy.

The purpose of the work: development and generalization of the algorithm of radiation examination of HIV-infected patients with acute abdominal syndrome. Materials and methods. The work is based on the results of examination of 92 patients who were on treatment in the surgical department for the period from 2010 to 2017. The specificity and sensitivity of ultrasound diagnostics, radiography, contrast methods and magneto-contrast methods were evaluated. Results. To improve the methods of rendering specialized medical care to HIV-infected patients entering the clinic of an acute abdomen, it is advisable to use the syndromic approach, which provides for the allocation of syndromes of acute intestinal obstruction, a widespread inflammatory process of the abdominal cavity, a limited inflammatory process of the abdominal cavity and perforation syndrome of the hollow organ. Diagnostic possibilities of the survey radiography and ultrasound of the abdominal organs in these patients are limited due to hyperpneumatization of the intestine and the presence of free fluid in the abdominal cavity. Contrast study of the gastrointestinal tract (passage of barium) is contraindicated in case of suspected perforation of the hollow organ, which often occurs in this category of patients. Multispiral computed tomography is the method of choice for examining HIV-infected pati ents with acute abdominal syndrome, because it allows, and quickly, to answer many tactical questions, provides the possibility of performing therapeutic manipulations under CT control (percutaneous aspiration of pathological fluid accumulations, drainage of abscesses, establishment nephro-, cholecysto-, cholangiostom). The use of the method of magnetic resonance imaging is limited because of the severe condition of patients and is applicable for assessing the effectiveness of the therapy for liver abscesses, diagnosis of heart attacks and abscesses of the spleen, development and description of the survey algorithm.

Objective: to study the immunohistochemical expression of proand anti-apoptotic factors — FasL(CD95), TNF-a, p65 NFkB, and granzyme B in the endometrium of patients with adenomyosis. Material and Methods. The endometrial samples, taken during the proliferative phase of the cycle, while carrying out paypel biopsy and hysteroscopy in 41 women aged 37 to 48 years with adenomyosis. The comparison group consisted of 25 women with infertility. The study of TNF-a, Granzym B, NFkB immunohistochemical expression in the development and progression of adenomyosis was performed using monoclonal antibodies. The results of reaction were evaluated by semiquantitative method. Statistical analysis was performed using the software package Biostat Apps MicrosoftR Excel full-featured office Microsoft Office 2010 package. Results. In the comparison group, the expression of TNF-a and NFkB in endometrium was not evident. In the group of patients with adenomyosis, a marked expression of these markers in epithelial and stromal cells was observed. Granzym B expression was detected in the cytoplasm of leucocytes of the stroma of the endometrial functional layer with no statistically significant differences between the groups. Conclusion. Presumably, given the expression peaks of both TNF-a, p65 NFkB, the observed in adenomyosis increase (compared to normal) in expression of these molecules does not mean readiness of epithelial cells of the endometrial functional layer to apoptosis, as is the norm, upon the occurrence of menstruation, but it means readiness of these cells to proliferate. The absence of statistically significant differences in the number of CD56-positive endometrial stromal granulocytes and endometrial NK-cells, determined by Granzym B expression in these cells, is also an indirect evidence of a low level of readiness to apoptosis. And statistically significantly less expression of FasL(CD95) in women with adenomyosis. That is, TNF-a and NFkB at adenomyosis, probably, play the role of cell survival factors.

Aim of research: to detect a diagnostic value of cumulative clinical assessment of systemic inflammation markers in monitoring a course of HIV infection. Materials and methods. The research is implemented in a sample of 162 HIV patients. The sample is divided into two groups: 1 — receiving HAART (n=88), 2 — not receiving HAART (n=74). The content of lipopolysaccharidebinding protein (LBP), procalcitonin and cytokines (TNF-a, IL-1b, IL-6, IL-8, IL-10, IFN-g, IFN-a) are detected in serum by solid-phase enzyme-linked immunosorbent assay. The number of CD4+-lymphocytes was determined by flow cytometric techniques. Results. Significantly high LBP concentration, in comparison with healthy persons’ indices, is found in both groups of the sample. The content IFN-g and IFN-a is significantly high in majority of HIV patients of the sample regardless of the therapy received. HIV patients with low content of CD4+ lymphocytes, have the indications of more severe systemic inflammation accompanied by enhanced production of anti-endotoxin proteins, and their cytokine profile is characterized by more expressed proinflammatory orientation than in HIV patients with high CD4+ lymphocytes indices. The LBP level may be treated as an indirect criterion of immune suppression intensity in HIV infection.

The purpose of this study was to study the clinical and radiological forms of TB in patients with HIV and the possibilities of etiologic diagnosis-the detection of MBT using various methods for determining and the effect of immunosuppression on the results of etiologic diagnosis. Materials and methods. The materials for the study were the analysis of clinical x-ray examination data and the results of etiological diagnosis of the Office in the Republic of Karelia for the period from 2001 to 2016 among 159 patients with a co-infection of HIV+TB in the bacteriological laboratory of the Republican TB Dispensary of the Karelia. Results of the research. The peculiarities of clinical and radiological forms of tuberculosis (TB) and infomativity of various methods of etiologic diagnosis of TB among 159 patients with combined HIV+TB infection for the period 2001–2016 in the Republic of Karelia were studied. It was revealed that the PCR diagnostics significantly reduced the likelihood of a lethal outcome of patients with a co-infection, as it allowed us to quickly identify not only the presence of the MBT, but also to identify MDR and appoint adequate chemotherapy on the first day of detection, which significantly reduced the risk of death. The frequency of bacterial excretion most often (69%) occurred in the group of patients with the most severe immunosuppression with an amount of CD4 cells less than 100 in 1 ml. It was found that among the patients with co-infection with HIV + pulmonary TB, cavities of disintegration in the lung tissue (38,5%) are significantly less likely to be detected, but bacteriovirus (68,5%) is detected more frequently than among patients with pulmonary TB in the territory of the Republic of Karelia (form 33). It has been established that improving the organization of sputum collection can significantly increase (at least 20%) the incidence of MBT in patients with pulmonary TB and HIV, which is important in the rapid diagnosis of TB and the appointment of adequate therapy, especially considering that among patients with co-infection 1⁄2 (52,8%) had MDR. The conclusion. For the timely diagnosis of pulmonary TB in HIV-infected patients, with frequent atypical clinical and radiological picture of TB and the possibility of rapid progression with lethal outcome, and also taking into account the results obtained (in 56% of patients with TB+HIV-MBT+), etiologic diagnosis of TB has priority value. The most affordable, cheap and epidemiologically significant method for detecting TB is sputum smear microscopy. The epidemiological danger was aggravated by the detection in 52,8% of patients with HIV+TB strains of multidrug-resistant and extensively drug-resistant MBT.

We have presented the data from a two-year dispensary follow-up carried out by a TB dispensary. We observed a cohort of 178 new TB patients co-infected with HIV. Out of them 79,8% were injecting drug users and suffered from viral hepatitis B and C; 86,5% did not receive antiretroviral therapy (ART); and 34,3% had CD4+ cell count less than 50 cells/μL of blood. Most common forms of TB were disseminated (28,8%) and infiltrative (30,5%) pulmonary TB; in 41,6% it was accompanied by extrapulmonary TB and in 29,2% — by other secondary diseases. Complex therapy resulted in clinical cure in 9% of patients in significant improvement in 53,9% of patients in 6,7% the disease was progressing and 30,3% of patients died during the follow-up. Disease progressing and lethal outcome were associated with low antiretroviral therapy adherence, drug addiction, severe and advanced pulmonary tuberculosis with extra pulmonary tuberculosis and other HIV-associated diseases.

The goal is to consider the lethality as an indicator of the adequacy and success of timely detection, clinical examination and treatment of patients with HIV infection. Materials and methods. A retrospective analysis of 913 deaths of HIV-infected patients in the Novgorod Region was carried out for the period from 2001 to 2017. The study included patients with previously known HIV status and patients with newly diagnosed HIV infection. Age, time (from the time of detection of HIV infection to death), clinical (causes of deaths) and other characteristics were taken into account. The conclusion. Every year, the number of deaths of HIV-infected patients increases, while the number of deaths diagnosed with AIDS is increasing yearly. The structure of deaths is dominated by cases caused by severe immunosuppression, which is a characteristic feature of this stage of the epidemic. The most likely cause of increased mortality is the late onset of treatment, low coverage of therapy and a large number of late-identified patients. The age structure of the deceased is dominated by persons 30–39 years old. The main cause of death is tuberculosis. The increase in deaths from tuberculosis depends on the number of patients with unstable social status. Other common causes of death are bacterial infections (pneumonia, sepsis, etc.), malignant neoplasms, toxoplasmosis, pneumocystis pneumonia. A similar structure of deaths is associated with late diagnosis and atypical course (rapid progression) of tuberculosis. Among the causes of death not related to HIV, a significant proportion is occupied by viral hepatitis in the cirrhotic stage, cardiovascular diseases, malignant neoplasms, drug overdoses, alcohol poisoning. The annual increase in lethal outcomes in the region is due to inadequate coverage and late onset of ARVT, a low percentage of prevention of opportunistic diseases at a critically low level of CD4 cells, weak adherence to medical examination and treatment. To increase the life expectancy of HIV-infected people, it is necessary to improve and expand programs for the prevention and treatment of HIV infection.

This research was carried out within the framework of joint research work between the Siberian Federal District Center for the Prevention and Control of AIDS of the Omsk Research Institute of Natural Focal Infections and the multifunctional medical center for migrants .NISO.. The work involves several stages from the beginning of 2016. A questionnaire method was used to collect primary data and laboratory results of testing for HIV and syphilis were used. During the period under study, there was a tendency to reduce the number of examined and identified foreign citizens in the Omsk region and the low prevalence of HIV infection in this category of citizens. However, the revealed cases of syphilis, irresponsible attitude to the passage of medical examinations, failure to use protective equipment during sexual intercourse, insufficient knowledge or lack of them for the prevention of dangerous infectious diseases, low level of education can contribute to worsening of the epidemic situation both in the region of stay and in the country of exodus.

Objectives. To describe the clinical and laboratory characteristics of chronic hepatitis C patients with hepatocellular carcinoma (HCC) and to evaluate the effectiveness of antiviral therapy in these patients. Materials and methods. This is a prospective and retrospective study. Data from 1870 patients with CHC observed in the hepatology clinic in Ho Chi Minh City (Vietnam) for the years 2010–2015 were analyzed. Results. The average age of detection of HCV infection in patients with hepatocellular carcinoma was 63,1±10,0 years, men — 62,3%. HCC was detected in 9% of patients with chronic hepatitis C (159 people). In 58% of cases, HCC and HCV infection were diagnosed at the same time. In 91,8% patients with HCC, HCV infection was first detected at the age of over 50 years. However, in 46,1% of patients, HCC was diagnosed at stages of the disease, when the possibilities of therapy were limited. Analyzing the effectiveness of antiviral therapy, including sofosbuvir and ribavirin (in 24 weeks), showed that of 75 patients with chronic hepatitis C (genotype 6) without a history of HCC, SVR-24 was registered in 98,7% people; of 11 patients with HCC, only 5 patients (45,5%) achieved SVR-24. Conclusion. Presence of HCC, including after chemotherapy or surgical treatment, is a negative predictor of response to therapy, including sofosbuvir and ribavirin. It is necessary to introduce in Vietnam screening programs for HCV infection to identify patients in the early stages of the disease and to expand access to antiviral drugs for HCV therapy.