The lecture intended for general practitioners represents collated information on the most important mechanisms of brain damage under HIV infection, the rate of neurocognitive disorders and their role in disability of patients, classification of these disorders. The capabilities and importance of diagnosis and an in-depth work-up of patients for establishing complete clinical diagnosis and order of effective treatment are presented in the lecture. Much attention is given to immunosuppression influence, brain cell elements involvement and forming of reservoir of HIV infection in pathogenesis of neurocognitive diseases. The lecture describes special aspects of radiology examinations including magnetic resonance imaging, magnetic resonance spectroscopy for assessment of metabolism and tissue perfusion using some chemical markers. Approaches to prevention, diagnosis and treatment are provided taking into account the stage of a disease. An algorithm of detection of causes and diagnosis of cognitive disorders is stated in the lecture and the role of different diagnostic approaches at different stages of HIV infection including HIV-associated diseases is shown.

The most common co-infection associated with HIV infection is viral hepatitis C. More than half of HIV-infected patients is coinfected with HCV in Russia. Both infections can have a reciprocal negative effect, what is reflected in an increase in the morbidity and mortality of co-infected patients compared with mono-infected patients. The negative role of HIV infection in the development of hepatitis C is manifested by the acceleration of the process of fibrosis and the formation of cirrhosis of the liver, as well as the frequent occurrence of hepatocellular carcinoma. The effects of HCV infection on the course of HIV infection have been less studied. It is known that hepatitis can slow down the immune reconstitution while receiving antiretroviral therapy. In addition, a violation of the hepatic barrier for products supplying from the intestine, apparently, can lead to additional activation of the immune system, aggravatted immunodeficiency, increased systemic inflammation and the development of AIDS-non-associated diseases, primarily cardiovascular diseases. Most researchers see the solution of the problem in the early start of antiretroviral therapy, as well as in the transition from interferon therapy to the appointment of drugs of direct action in the treatment of HCV infection.

The review of literature on strategies of improvement and maintaining of the treatment compliance aimed at increasing the treatment efficacy for patients with chronic diseases is presented. Emphasis is placed on the need for increasing compliance rate in people living with HIV. Practical recommendations for achievement of high compliance rate in antiviral treatment for «difficult» patients were discussed. Publications mainly for the last 10 years in peer-reviewed medical journals and on current Internet resources including elibrary and Pub-Med were used.

The materials on psychological and psychosocial status of women with HIV and HCV co-infection [1] with the following assessment of their readiness and ability to undergo treatment of chronic hepatitis C virus and maintenance of treatment compliance to antiretroviral therapy of HIV. The objective of the survey: analysis of the clinical and somatic status of women with HIV and HCV co-infection with the following assessment of their ability to antiviral therapy of CHC and maintenance of treatment compliance to ART taking into account their health status. Materials and methods: the check-up of 100 surveyed women with HIV and HCV co-infection taking into account epidemiologic evidence, laboratory parameters: immunologic (CD4 lymphocyte count), virological (HIV and VHC RNA, VHC genotype) and complete and biochemical blood count was made. Medical prescriptions and response to treatment of CHC were analyzed taking into account the drugs used. Results. Mean age of patients was 36±6 years. Most women had a long-standing co-infection. 1% of women were in the subclinical stage of HIV infection, 64% had stage 4A, 4B — 14% and 4B — 11%. The number of CD4 lymphocytes was 494±29 cells/μl. 78% received ART, and 85% of women showed a high rate of treatment compliance. Among the prevalent HIV-associated diseases were candidiasis (62%), viral (7%) and bacterial diseases (3%); a high percentage (15%) of past tuberculosis of various localization was noted. In 45 cases (53%), HCV RNA was detected in the blood. According to the results of liver elastometry, 74,4% had minimal and moderate fibrosis (METAVIR ≤F2), and a quarter of patients had marked fibrosis (METAVIR F3-F4). Antiviral therapy of chronic hepatitis C was performed in 24% of 100 surveyed women. 62,5% received the combination of pegylated interferon and ribavirin, in 86,6% of cases a sustained virological response was achieved. Treatment with direct antiviral agents was performed in 5 patients, in all cases a sustained virological response was achieved. 85% of patients showed total bilirubin level within the normal range, alanine aminotransferase and aspartate aminotransferase were moderately increased in 41% of women. Most (67,7%) revealed diffuse changes in the structure of the liver, and 36% had pancreatic diffuse changes. Hepatomegaly was found in 24% of cases and splenomegaly was found in 13,3% of women. Comorbid infectious and non-infectious diseases were diagnosed in 59% of women: 32,2% — diseases of the digestive system, 20,3% — diseases of the urogenital system and 18,6% — diseases of the respiratory system. Diseases of the nervous system were diagnosed in 70% of women. Conclusion. The somatic state of women with HIV/HCV co-infection in almost all cases was quite stable, the comorbid pathology was in remission, which gives grounds for expanding indications for prescribing antiviral therapy for CHC. However, many patients are not inclined to undergo treatment with interferon-containing regimens due to the duration of the course and poor tolerance, some of them are focused on treatment with direct-acting antiviral agents and are looking for such a possibility outside the hospital. Therapy with direct-acting antiviral agents with a small number of side effects and high efficacy is a priority for women with HIV/HCV co-infection.

The article describes the first limited experience of early warning indicators (EWIs) of HIV drug resistance recommended by WHO; information on their content and order of use is given. The results of EWIs survey performed in 2016 in nine Russian cities: Blagoveshchensk, Vladivostok, Yekaterinburg, Izhevsk, Krasnodar, Perm, Saint-Petersburg, Khanty-Mansiysk, and the Moscow Region — are presented. The on-time pill pick up indicators were optimal, >90% in four centers (44,4%), all others showed intermediate resulеs (80–90%). The retention rate was over 85% in six of the nine regions (66,6%). Two of the nine regions (22,2%) reported the existence of stock-outs in the supply of antiretroviral drugs. Bi-and monotherapy with antiretroviral drugs was administered to patients in three regions (33,3%). Suppression of viral load to values less than 1000 copies RNA/ml in more than 85% of patients was achieved only in three regions (33,3%). The conclusion was made concerning the necessity to implement the monitoring of HIV drug resistance in Russia as soon as possible, including an analysis of the EWIs and other types of monitoring studies.

Early diagnosis and effective treatment, including operative, in patients with comorbide conditions of pulmonary involvement affected by HIV infection with various infection ways is relevant. Materials and methods. Two clinical cases with pulmonary involvement in comorbidity conditions with the late detection of HIV infection and without antiretroviral therapy are presented. Results. It has been shown that a reduction in the high incidence of adverse outcomes of severe comorbid forms of the disease (in particular, a combination of HIV infection and tuberculosis) can be achieved by conducting an adequate monitoring of these patients, including secondary chemoprophylaxis of tuberculosis as well as, detection, treatment and prevention of co-infections and timely elimination of other possible risk factors (both social and medical). Conclusion. It is necessary to develop optimal algorithms and approaches of medical and psychosocial impact, focused on the initial period of treatment of patients with HIV infection (antiretroviral therapy, anti-tuberculosis therapy, prevention of opportunistic infections, etc.), since it is during this period that the greatest number of severe cases of the disease and adverse outcomes are observed.

To determine the possible causes of an increase in the of HIV infection rate in the Vologda Region. HIV cases within the Vologda Region, 169 maps of epidemiological survey of the HIV nidus, state federal statistical monitoring forms № 4 «Data on the results of test on antibodies to HIV», annual reports of Budgetary Institution of Health Care «Center for Prevention of Infectious Diseases», Vologda were used as a data for study. The most probable cause of the increase of HIV infection rate in the Vologda Region is activation of narcotic channels of HIV infection the share of which increased from 30,2% to 48,2% for the period of 2015 through 2017. The highest HIV infection detection rates were observed in people surveyed by the code «102» which in 2017was 5,0 per 100 surveyed, exceeding the rates for 2014 and 2015 in 2,7 and 3,6 times, correspondingly. The data of laboratory examination of patients for immune status at registration indicated a recent HIV infection of a part of patients, probably, in the last 2 years (CD4 was over 500 c/ml in 22% of examined). At the same time, there is a factor of accumulation of sources of HIV infection among IDUs who have long-standing infection and have been living with HIV for many years (CD4 is less than 500 c/ml in 22% of examined) without knowing about it. The authors regard the activation of injection channels of HIV infection as a dangerous relapse in the evolution of epidemic previously observed in the NWFD.

Objective: to perform a molecular-epidemiological analysis of HIV-1 variants circulating in the Jewish autonomous region territory. Materials and methods. The research included 58 patients with HIV-infection. Amplified pol-gene fragments were used as a template to detect drug resistance mutations by Sanger sequencing (AmpliSens® HIV-Resist-Seq). Pol-gene is coding protease and a part of reverse transcriptase of HIV-1. Phylogenetic analysis was performed using MEGA version 6.0 program. Results: the research revealed an insignificant prevalence of HIV-1 СRF63_02A1 recombinant form. It was registered in 25 patients (44,6%). Sub-subtype A6 was identified in 23 HIV-positive people (41,1%). Subtype B was revealed in 6 cases (10,7%), subtype С — in two cases (3,6%). Primary drug resistance mutations were identified in 9 patients that were undergoing antiretroviral treatment. This dictates the necessity to change the treatment regimen in the specified patients. The prevalence index of drug resistance mutations in naïve patients equaled to 3,8%.

Until recently in Russia the general methodology for the prevention of sexually transmitted infections (STIs) including HIV-infection and blood-borne infections (BBI) has not been developed and targeted preventive interventions aimed at vulnerable populations have not been applied. As a rule, domestic researchers have been confined to detailed analysis of epidemiological data on the prevalence of STIs and other socially significant diseases in general population and their clinical features without offering social prevention technologies. Meanwhile, a large number of scientific researches aimed at improving the prevention strategies for STI/BBI and comprehensive preventive programs combining biomedical and behavioral components are being carried out all over the world. Unfortunately, preventive programs developed abroad cannot be mechanically introduced into the practice of Russian health care system. The programs should be adapted and implemented in the context of the socioeconomic and cultural uniqueness of Russia. The current epidemic situation necessitates switching from secondary and tertiary STI/BBI prevention and traditional biomedical approach to primary prevention and multidisciplinary approach. The multidisciplinary approach to healthy life style promotion and prevention of self-destructive behaviors including alcohol and drug use and risky sexual practices is a new branch of medicine. The presented article is aimed to analyze theoretical, methodological and practical aspects of the development, implementation and effectiveness evaluation of behavioral preventive interventions focused on socially significant infections.