In recent years, the number of newly detected cases of HIV infection in Russia has been increasing every year. Risky behaviour and mental disorders (not only disorders caused by HIV infection, but also premorbid mental disorders leading to HIV infection are well-known risk factors for HIV infection. One of the mental disorders associated with risky sexual behaviour is compulsive sexual behaviour, which was recommended for inclusion in the International Classification of Diseases of the 11-th revision under the diagnosis of Compulsive sexual behaviour disorder. This review article is devoted to the problem of compulsive sexual behaviour and its connection with the HIV infection. Current data on epidemiology and clinical characteristics of compulsive sexual behaviour are presented. Special attention is paid to the theoretical substantiation of the impact of compulsive sexual behaviour on the implementation of risky sexual behaviour in the aspect of increasing the risk of HIV infection.

Antiretroviral therapy (ART) in HIV infected patients generally results in the suppression of viral replication and reconstitution of CD4+ T lymphocytes cell counts. In some patients (about 20%), however, a disturbance in regeneration of immune competent cells with a background of low viral load occurs. The term «immunological nonresponders» has been used to describe this phenomenon. Discordant immune response to antiviral therapy may be caused by increasing of depletion and reducing of production of CD4+ T cells. However, mechanisms for low immune reconstitution are not currently well understood. «Immunological nonresponders» exhibit booster lymphocyte proliferation, increased immune activation and reducing of CD4+ T lymphocytes survival time in comparison with patients with concordant response to the therapy. Their immune system is characterized by more pronounced aging and exhaustion. This leads to early and frequent manifestation of AIDSrelated diseases. Besides, immunological nonresponders have an increased risk of non-AIDS-related diseases due to pronounced systemic inflammation. The objective of the present review was to highlight the important problem that is rather common on аntiretroviral therapy and to enlist the specialists to the solving of this issue.

Survey objective: analysis of transmission routes of HIV infection, its course and treatment in children with the aim of determining the common problems and solutions. Materials and methods. Observation of 388 HIV-infected children at the age from month to 17 years was held for the purpose of analysis of common problems on the basis of Motherhood and Childhood Department of State Budgetary Healthcare Institution «St. Petersburg Center on Prevention and Control of AIDS and Infectious Diseases». Statistical processing of data was carried out using Statistica for Windows software (v. 8.0). Survey results. It was found that 363 of children were infected with HIV during perinatal period (93,6%), 23% (5,9%) were infected during childbirth and 2 children — through injected drugs (0,5%). Of the 16 children with perinatally acquired AIDS diagnosed in 2017, breastfeeding was reported in 6 (37,5%) cases that evaluates HIV-screening of sexual partners of pregnant women. 378 (97,4%) of children take ART when clinically, immunologically and virologically indicate. Of this number, first line ART regimen is used in 130 children (34,4%). 199 (80,2%) switched to second-line ART regimen due to adverse effects, 49 (19,8%) after virological failure. Prevailing adverse effects such as dyslipidemia (40,8%), polyneuropathy (22,6%) and anemia (12,6%) were a reason for switching to alternative regimen with combined medications. Presently, it is a great problem that parents or foster parents of a child — HIV-dissidents refuse of children care and treatment that led to lethal outcome in 18 cases. In light of this, pediatricians of Centers on Prevention and Control of AIDS have to protect children’s rights for health by making request and applications to the guardianship authorities, courts, prosecutors, law enforcement agencies. 57 appeals to these authorities have been made in total.

Work objective: justification and development of algorithm for observation of HIV-serodiscordant couples at the stage of planning parenthood, including using Assisted Reproductive Technologies (ART) in Sverdlovsk region territory. Materials and methods. Statistical data were obtained from the materials of personal registration of people living with AIDS in State Budgetary Healthcare Institution of Sverdlovsk region «Sverdlovsk Regional Center on Prevention and Control of AIDS». 27 thousands of women of reproductive age and 31 thousands of men diagnosed with HIV infection were revealed in the region as of the end of 2018. On the basis of infectious disease department of State Budgetary Healthcare Institution of Sverdlovsk region «Sverdlovsk Regional Center on Prevention and Control of AIDS» a retrospective chart review for HIV-serodiscordant couples planning parenthood was held with using ART or the natural way. Statistical processing of data was carried out using Statistica 6 software. Results and discussion. The results of the survey showed the necessity of observation of HIV-serodiscordant couples from the stage of planning parenthood. Characteristics of partners were described with account for age, epidemiological anamnesis, laboratory parameters and final outcomes of conception with using ART or the natural way. Conclusion. Necessity of development of algorithms for observation of HIV-serodiscordant couples at the stage of planning parenthood was shown as these algorithms allow to determine case follow-up approach with the involvement of infectious disease physician and obstetrician-gynaecologist.

The problem of HIV infection has not lost its relevance, despite the progress and deepening of our knowledge about the disease over the years of study. The paper reflects the detailed structure of lethal outcomes and secondary diseases in HIV infection, taking into account in-depth histological studies in three time periods (1996/97, 2006, 2016) on the basis of these protocols of pathoanatomical autopsies in S.P.Botkin. Some of the data obtained confirms the facts known from the literature, while others are new and need further in-depth study. An important aspect of the work was the assessment of the significance of individual diseases in the tanatogenesis of each case, taking into account all clinical, laboratory and morphological data. The range of HIV-associated diseases varied in different time periods, although in many cases it was insignificant. In general, during the 20-year period of time HIV infection has undergone significant pathomorphosis.

The aim was to study the characteristics of community-acquired pneumonia in patients with HIV infection, depending on the outcome of the disease and to identify significant predictors of death. Materials and methods. The study included 80 patients with community-acquired pneumonia and HIV-infection. Two groups were formed in accordance with the outcome of community-acquired pneumonia. 1 group (study group) — 40 deceased patients, 2 group (comparison group) — 40 patients discharged from the hospital with improvement. Inclusion criteria: patients over 18 years of age, diagnosis of community-acquired pneumonia, diagnosis of HIV infection, informed consent of the patient. Patients with diagnosed pulmonary tuberculosis were excluded at the stage of examination and treatment. Results. Patients with HIV infection entered the hospital with community-acquired pneumonia of severe degree in 65% of cases, 71,25% of cases with respiratory insufficiency of II and III degrees, in 16,25% of cases with critically low oxygen saturation (less than 85%). The majority of patients had bilateral pneumonia (78,75%), in 28,75% of cases complicated by pleural effusion. Patients needed respiratory support at different levels-the chambers of the pulmonology ward in 3625% of cases, indications for noninvasive ventilation (NIV) in the intensive care unit (ICU) were noted in 80% of cases, ventilation in the ICU in 56,25% of cases. Deceased patients were significantly more likely to be injecting drug users, reported weight loss of more than 10% in six months, CD4+ cells did not exceed 50/μl, bilateral lung damage, pleural effusion, oxygen saturation less than 90%. The conclusion. Treatment and diagnosis of comorbid patients with community-acquired pneumonia and HIV infection is complex, in the stage of pronounced immunosuppression can lead to death. Early onset of NIV in the presence of severe respiratory failure may improve the survival prognosis.

Aim: to estimate the prevalence of the occult hepatitis B virus among HIV-infected patients with the virological ineffectiveness of antiretroviral therapy in Veliky Novgorod. Materials and methods. Blood plasma samples from 76 HBsAg-negative HIVinfected patients with virological inefficiency of antiretroviral therapy from Veliky Novgorod were used in the work. For the detection of the hepatitis B virus, nucleic acids were isolated using the commercial kit AmplePrime Ribo-prep. For amplification and sequencing, overlapping pairs of specific primers were used, jointly flanking a 1475 base pair fragment including the 1169 base pair Pre-S1/Pre-S2/S region recommended for genotyping the hepatitis B virus. Results. Among 76 samples of hepatitis B virus DNA, 44 samples were found, which was 57,89%. None of the patients had HBsAg, and 6 patients (13,63%) had HBcor IgG and HBe IgG antibodies. On the basis of phylogenetic analysis, it was shown that only genotype D, which is the most common genotype of the hepatitis B virus in the Russian Federation, was detected in the examined group. The subgenotype D2 (47,72%) prevailed in comparison with the subgenotype D1 (34,09%) and the subgenotype D3 (18,18%). The distribution possible ways of the subgenotype D1 hepatitis B virus, which is uncharacteristic for the region, are discussed. Only one isolate of hepatitis B virus with mutations of drug resistance to nucleotide / nucleoside analogue therapy has been identified — amino acid substitution in the polymerase gene of the virus (L180M, M204V) associated with the development of resistance to lamivudine, entecavir, telbivudine and tenofovir. Conclusion. The high prevalence of occult hepatitis B among HIVinfected patients indicates a lack current tests for the diagnosis of chronic HBV infections. The identification of occult hepatitis B in HIV-infected individuals seems appropriate for timely treatment of patients and requires the use more sensitive methods.

Sexually-transmitted infections are among the most well-known risk factors for HIV infection. The problem of combined diseases of STIs and HIV in infected people is represented by few works in the domestic scientific literature, therefore further study of this issue is required. Objective: to identify the prevalence of sexually transmitted infections in HIV-infected patients at the time of registration. Materials and methods. 49 clinical histories of patients with HIV infection were analyzed and studied at the Republican Center for the Prevention and Control of AIDS and Infectious Diseases of the Ministry of Health of the Republic of Tatarstan. Results. STIs with the prevalence of urogenital chlamydia, ureaplasmosis and mycoplasmosis in the oligosymptomatic clinical course were registered in 63% of patients (predominantly women — 67% of cases) with HIV infection in the natural infectious process course. Patients with HIV infection and syphilis showed lower level of CD4 lymphocytes and high levels of HIV RNA viral load.

Single cases of autochthonous visceral leishmaniasis are registered in the Crimea and Dagestan. The article presents the first case of autochthonous cutaneous leishmaniasis in an HIV infected resident of the Republic of Dagestan, where this disease had not previously been registered. The diagnosis was made on the basis of a parasitological study of material taken from an ulcer on the border between the upper lip and the right nostril. Examination of the patient revealed a high burden of HIV (4 473 014 copies/ml) and a low level of CD4+ (76×10⁶/l; 9%), which indicated an advanced stage of HIV infection. The patient underwent antiretroviral therapy (treatment with amphotericin B), against which a good result was obtained. A decrease in viral load and an increase in the content of CD4 lymphocytes in the blood were noted. A scar has formed on the site of a leishmaniasis ulcer.

There are presented clinical observations of scabies in HIV-infected men 40 and 25 years old. Scabies was atypical. Parasitic disease in both cases was very widespread and involving face and hairy part of the head. And the typical itching trails were not found. Efflorescences were manifestated by strongly expressed exudative elements-vesicles, papules, urticariform exanthems. One of the patients, who has been suffering for more then two months from the disease,was misdiagnosed common eczema. Desensitizing therapy was ineffective. In the same time antiscabial therapy caused strengthening of infiltration in the base of elements and puffiness. Nevertheless,exanthems gradually regressed after the course of external therapy. The itch disappeared. The second patient’s exanthems also regressed during a week after the local therapy. But the itch episodically appeared onetwo times a day on some days. In this way, practicing dermatologists have to make differential diagnostics of HIV-infected patients with itching dermatoses (eczema, urticaria, pruritus) and scabies.

The attendance of patients with HIV infection, combined with tuberculosis, of different medical organizations was studied before and after limiting service of patients with co-infection in the AIDS center polyclinic. 163 flushes from the hospital environment of the AIDS centre polyclinic were studied by polymerase chain reaction for the presence of tuberculosis mycobacteria DNA. It was established that a decrease in the number of visits to a specialized polyclinic by the patients with HIV infection combined with tuberculosis was accompanied by a decrease in the degree of hospital facility environment contamination by tuberculosis mycobacteria.

The HIV infection prevalence rate suggests that in the Russian Federation the number of new cases of infection continues to grow. The retrospective epidemiological analysis of HIV infection in the Amur region was performed during a 5-year period from 2013 to 2017. The study included evaluation of incidence and prevalence rates, morbidity and mortality patterns. A positive HIV status has 0,14% of the region population. In 2017, the HIV-incidence rate equaled to 10,97‰₀₀. Similar incidence rates were registered during 2015 and 2016. During 2013–2017 annual growth of HIV-prevalence that reached its peak in 2017 and exceeded the previous year’s rate at 18,3±0,65% (p=0,001) was registered. The highest HIV prevalence was detected at age from 30 to 39 years (45%). Among the HIV-positive people, sexual transmission route was dominant and during 2017 and totaled to 87%. Among people living with HIV registered for outpatient treatment, the most frequent stages of the disease (representing 97,7% of all clinical forms) were subclinical stage diagnosed in 251,3‰ [95% CI 232,2–270,3] and second stage (of secondary manifestations) totaled to 216,1‰ [95% CI 191,5–240,5]. This indicates on the development of the concentrated stage of HIV infection in the Amur region. Epidemiologic features of infection spread in the Amur region derives not only from active cross-border movements of citizens, but also from the specifics of demography processes.

According to the order of the Government of the Russian Federation of 01.12.2004 № 715 the disease caused by the virus of immunodeficiency of the person enter the list of socially significant diseases and the list of the diseases presenting danger to people around. Therefore, the aim of the research was to study the dynamics of the volume of procurement of medicines for the treatment of HIV-infected patients and the assortment availability of antiretroviral medicines in the Republic of Bashkortostan. The studies were conducted during the period of 2010–2016 years. The objects were the materials of reporting of the State Budget Health Agency Republican Center for Prevention and Control of AIDS and infectious diseases, electronic cards of government contracts. Methods of research: statistical, marketing, logic-economic, ATC/DDDs. The average growth rate in procurement of antiretroviral medicines is relatively the basic 2010 in monetary terms amounted to 168,52%. The largest share (1⁄2 part) were domestic medicines with one active substance. In value terms, there is a significant reduction of 26,74% in the volume of purchases of imported medicines with one active substance. At the same time, the import antiretroviral medicines were more in demand among combined antiretroviral medicines: their share increased by 28,56%. In natural terms, the share of domestic medicines with one active substance increased by 49,37%, in general, the share of the volume of antiretroviral medicines purchases of domestic production increased by 2,64 times. An analysis was conducted of the levels of management of assortment based on the calculation of the coefficients of the latitude of ARVs, regional mesocontours of domestic and imported ARVs of the six of the analyzed ATCgroups 4-th level were formed. The number of average daily doses of DDDs/1000 people/day for ARVs was calculated. It is established that the dominating in 2010–2016 there were ARVs of two ATC-subgroups: non-nucleoside — reverse transcriptase inhibitors (NNRTIs) and Nucleoside — reverse transcriptase inhibitors (NRTIs), which corresponds to the preferred first-line regimen for patients who had not previously taken antiretroviral therapy.

Objective: to study the medical and social aspects, behavioral risks, the level of awareness of HIV infection and pre-contact HIV prevention among men who have sex with men. Materials and methods. The sources of information were official statistics and the results of rapid testing for HIV infection among 2,295 individuals classified as MSM. The study of the level of awareness and attitudes towards pre-contact prophylaxis of HIV infection among MSM was carried out through voluntary anonymous questionnaires. The questionnaires included 12 open and closed type questions developed by the authors. Results and its discussion. The obtained data demonstrated a high level of HIV infection detection rate among the MSM group, which, according to rapid testing, averaged 2.8% for 2016–2018, which is 7 times higher than the detection rate among the general population. Anonymous questionnaire data revealed a high level of MSM awareness regarding HIV infection. Conclusion The result of the study showed that MSM use barrier contraceptives to a greater extent and are not ready to use pre-exposure prophylaxis. But the results of rapid testing indicate high risks of HIV infection in this group and, therefore, the need to find approaches to solving these issues, including using pre-contact prophylaxis.

The aim was to study the characteristics of community-acquired pneumonia in patients with HIV infection, depending on the outcome of the disease and to identify significant predictors of death.

Materials and methods. The study included 80 patients with community-acquired pneumonia and HIV-infection. Two groups were formed in accordance with the outcome of community-acquired pneumonia. 1 group (study group) - 40 deceased patients, 2 group (comparison group) - 40 patients discharged from the hospital with improvement. Inclusion criteria: patients over 18 years of age, diagnosis of community-acquired pneumonia, diagnosis of HIV infection, informed consent of the patient. Patients with diagnosed pulmonary tuberculosis were excluded at the stage of examination and treatment.

Results. Patients with HIV-infection entered the hospital with community-acquired pneumonia of severe degree in 65% of cases, 71.25% of cases with respiratory insufficiency of II and III degrees, in 16.25% of cases with critically low oxygen saturation (less than 85%). The majority of patients had bilateral pneumonia (78.75%), in 28.75% of cases complicated by pleural effusion. Patients needed respiratory support at different levels-the chambers of the pulmonology ward in 36.25% of cases, indications for noninvasive ventilation (NIV) in the intensive care unit (ICU) were noted in 80% of cases, ventilation in the ICU in 56.25% of cases. Deceased patients were significantly more likely to be injecting drug users, reported weight loss of more than 10% in six months, CD4 + cells did not exceed 50/μl, bilateral lung damage, pleural effusion, oxygen saturation less than 90%.

The conclusion. Treatment and diagnosis of comorbid patients with community-acquired pneumonia and HIV-infection is complex, in the stage of pronounced immunosuppression can lead to death. Early onset of NIV in the presence of severe respiratory failure may improve the survival prognosis.