Analysis of the epidemiological and demographic characteristics of HIV-infected pregnant women is important for organizing effective care for this group of patients and further reducing the frequency of mother-to-child transmission. Between 2014 and 2017 in Saint-Petersburg, there were 2524 deliveries in HIV-infected women who were observed during pregnancy, mainly in the Saint-Petersburg AIDS Center (AIDS Center). The average frequency of perinatal HIV transmission over the study period in the city was 1,3%, which is lower than the average for Russia. Out of 2524 women recently confined, 1858 HIV-infected women, who were observed during pregnancy at the AIDS Center in 2014–2017, were enrolled. Risk groups for perinatal HIV transmission in Saint-Petersburg are HIV-infected pregnant women: external or internal migrants, women with late registration at the dispensary registration for pregnancy in the antenatal clinic and the AIDS Center and, accordingly, late initiation of perinatal HIV transmission, active consumers of surfactants, pregnant women with low adherence to observation in medical institutions and to getting antiretroviral agents. The increase in coverage of the city’s population with HIV testing reveals new infections, including among women of reproductive age, as well as their partners. The timely use of ARV at the planning stage of pregnancy reduces perinatal HIV transmission and the risks of opportunistic diseases. The availability of medical care and free distribution of ARV drugs to all pregnant women who applied to the AIDS Center helps to reduce perinatal HIV transmission, including among internal and external migrants who do not have a permanent registration in Saint-Petersburg. Counseling women at the planning stage and during pregnancy by various specialists of the AIDS Center (gynecologists, infectious disease specialists, psychologists, narcologists) allows one to form a commitment to monitoring, to receiving ARV, giving up bad habits, to reduce the incidence of HIV-dissidence.

The objective of the present study is to reveal characteristics of the course of gestation and perinatal outcomes of preterm, labor associated with human immunodeficiency viral infection. Materials and methods. Retrospective case control study with the participation of 76 pregnant HIV-positive women with preterm labor (main group) and their 76 newborns was held. Comparison group consisted of 198 pregnant women without HIV-infection and their 198 newborns. HIV-infection verification was conducted in accordance with the standard procedure regulated by the Order of the Ministry of Health of the Russian Federation. Results. Antenatal chemoprophylaxis with antiretroviral drugs was used in 92,1% of infected patients. In the vast majority of cases (89,4%) the therapy was conducted with the combination of drugs: Combivir (zidovudine 300 mg + lamivudine 150 mg) taken 1 tablet twice daily combined with Kaletra (lopinavir 200 mg + ritonavir 25 mg) taken 2 tablets twice daily. Initiation of ART vary depending on the HIV infection date: in the first trimester of pregnancy, 48,9% of pregnant were intended to treat, in the second trimester — 36,2%, in the third — 6,4%. 7,9 patients did not receive treatment. Intranatal chemoprophylaxis of prevention of mother-to-child transmission was held in 69 (90,8%) HIV-infected patients. HIV-infection was detected in 2 (2,6%) newborns from mothers who did not receive etiotropic treatment. Common complications of gestation under HIV-infection include anemia (61,8%) and intrauterine growth retardation (34,2%), during labor — meconium in the amniotic fluid (31,6%). Respiratory distress syndrome occurred in 6 (7,6%) newborns, cerebral ischemia was diagnosed in 86,8% of newborns, respiratory distress — in 7,9%. Respiratory distress prophylaxis was conducted in 46% cases only. Conclusion. The course of gestation in women living with HIV with preterm labor was complicated by iron-deficiency anemia, intrauterine growth retardation, meconium in the amniotic fluid; cerebral ischaemia and respiratory distress syndrome most commonly occurred in newborns.

Objective: to study the features of the course of pregnancy and childbirth in HIV-infected women in the Saratov region according to a retrospective analysis of case histories for 2013–2018. Materials and methods. A retrospective clinical and statistical analysis of the course of pregnancy, childbirth and the postnatal period was carried out according to medical records of 282 HIV-infected pregnant women who were treated at the State Agrarian Medical Center (Engels, Saratov Region, Russia) in 2013–2018. (main group). The comparison group consisted of patients who were not infected with HIV who were treated at the SAUS EOC in 2013–2018. To assess the statistical significance of differences, the standard statistical analysis software package STATISTICA 10,0 was used. Results. Compared to 2013, in 2018, the age of HIV-infected pregnant women has decreased (p<0,05). HIV-infected people are less likely to go to a maternity clinic before the 12th week of pregnancy (p<0,05). A high frequency of co-infection of HIV-infected women with urinary infection (p<0,05) and genital tract (p<0,05), hepatitis C viruses (p<0,05) and B (p<0,05), and syphilis was found anamnesis (p<0,05). A high susceptibility of these women to viral infections was noted: acute respiratory viral infection (p<0,05), genital herpes virus (p<0,05), cytomegalovirus infection (p<0,05). The incidence of sexually transmitted infections is high: urogenital chlamydia (p <0,05), trichomonas colpitis (p<0,05). HIV-infected pregnant women have an increased incidence of anemia (p<0,05), chronic pyelonephritis (p<0,05), and skin diseases (p<0,05), and body mass deficiency is more common (p<0,05). In case of HIV infection, the frequency of operative delivery (p<0,05), premature birth (p<0,05), the frequency of formation of a low-weight fetus at a time of gestation (p<0,05), as well as perinatal mortality (p<0,05). The reserve for reducing perinatal mortality for newborns from HIV-infected mothers is in the pregravid period, testing for HIV, hepatitis C virus, correction of the patient’s weight, elimination of the iron deficiency condition, detection and rehabilitation of urogenital foci. When taking to a dispensary account, control and correction of anemia, chronic infectious diseases, monitoring of the state of the vaginal biocenosis are necessary, in the second half of pregnancy — control of fetal growth.

Genital TB is the cause of tubal-peritoneal infertility in 60–95% of clinical observations. The aim of the study was to reveal the peculiarities of reproductive disorders and combinations of sexually transmitted infections and conditionally pathogenic microflora in women with genital tuberculosis in Russian and Buryat ethnic groups. Materials and methods. The main group consisted of 92 women 32,7±4,8 years with tuberculosis of genital organs, 56 (61%) Russians and 36 (39%) Buryat. 115 women without genital tuberculosis 31,4±7,1 years, respectively, Russian and Buryat women made a comparison group. Results. The frequency of tubal peritoneal infertility among Russians and Buryats was 67,9% and 63,9%, (Pc2>0,05) in the main group. The duration of infertility for more than 5 years was 55,6% Russian and 37,5% Buryat (Pc2<0,05) in the main group. The combination of trichomoniasis, gonorrhea, chlamydia and viral infection was more often detected in women with reproductive disorders and genital tuberculosis 60,9% versus 45,2% (Pc2>0,05) without statistical difference in ethnic groups. Viral infection (cytomegalovirus and herpes of type 1, 2) was significantly more often detected in women with genital tuberculosis than in  28,3% versus 14,8%, (Pc2<0,05). Conclusion. A high incidence of genital infections and opportunistic microflora was detected in women at risk of genital tuberculosis with reproductive disorders irrespective of the presence of genital tuberculosis — 81,6%, indicating that clinical manifestations of genital tuberculosis and its combination with sexual infections in women with infertility are not specific. Experts detect Urogenital TB already in irreversible anatomical changes when the prospects of recovery of reproductive function are unsatisfied even using modern IVF.

A feature of the HIV epidemic is currently a large number of comorbid and severe forms of the disease, with frequent involvement in the pathological process of the brain. Methods of in vivo verification of brain damage in clinical practice is sufficient, but in some cases they are limited by financial availability and time factor. Correct and timely deciphering of the nature of brain damage is necessary for the choice of treatment tactics, and as a consequence, reducing mortality. Objective: to study the epidemiology, clinic and pathomorphology of brain damage in HIV infection in conditions of urgent and planned admission of patients to a specialized hospital. Materials and methods. Clinical and pathomorphological studies of HIV-infected patients (n=85) receiving specialized medical care were carried out. The final diagnosis was made taking into account clinical, laboratory and morphological data on the classification of ICD-10 in accordance with the domestic requirements of the formulation of comorbid diagnosis. Conclusion. Brain lesions are clinically and morphologically detected in most HIV-infected patients. Opportunistic and secondary diseases with brain damage have their clinical picture, but it is not specific. From the timely decoding of the nature of brain damage depends on the choice of treatment tactics and, as a consequence, reducing the risk of death. Therefore for verification of the etiological agent, you need to conduct a comprehensive examination: clinical (neurological, psychological distress) and laboratory (cellular composition of CSF protein level and glucose) and bacteriological (seeding of CSF on the flora, on Wednesday Saburo to identify mushrooms on medium Bactec and Lowenstein-Jensen medium for detection of M.tuberculesis); immunological (number of CD4-lymphocytes, at.gondii IgM, at.gondii IgG antibodies), molecular genetic (HIV RNA; DNA HSV1, 2; VZV DNA; DNA EBV; CMV DNA; DNA ВГЧ6; T.gondii DNA; DNA of M.tuberculesis; DNA Cr.neoformans; JC virus DNA) and radiological (MRI brain) research methods. The structure of brain damage in deceased patients was dominated by toxoplasmosis in 28,8% of cases; neuroinfection of unspecified etiology in 28,8% and herpesvirus lesion in 11,9%. Rarely met: tuberculosis 8,47%; candidiasis 8,47%; PML 3,39%; cryptococcosis 3,39%; b-cell lymphoma with brain metastases 3,39%. 

The course of a chronic HCV infection in 50% of cases is followed by affection of the brain. Its most frequent manifestations are various cognitive and psychogenic and neurological disorders. It is considered they are based on the activation of HCV infected microglial cells and related to this exitotoxic injury of neurons. According to the data of literature similar changes of microglia in white matter play an important role in a pathogenesis of HIV-associated subcortical dementia. Despite active studying the role of microglia in HCV infection, structural changes and tissue reactions of these cells in nervous tissue remain unexplored. In this regard the purpose of this research was comprehensive immunomorphological research of microglia cells in white matter of different departments of brain in HCV infection. Object of a research was autopsy samples of white brain matter from 40 patients died in the outcome of a chronic HCV infection. 20 people deceased without infectious and mental pathology made up the control group. After histological processing by standard methodic microscopic sections of white matter samples were prepared and stained with review and elective stainings. The immunohistochemical research was conducted using antibodies to virus protein NS3 and antibodies to CD68 microglia cells. The evaluation of microglia cells reactive changes in nervous tissue was performed with submitted earlier methodic. Statistical processing of results was carried out by dispersive Kruskal-Wallis analysis using the SSPS application programs. Level of significance p was accepted equal 0,05. It was established that during chronic HCV infection in white matter of the brain occurs productive changes of microglia cells. They are presented with diffuse and focal anizomorphic microgliosis which expressiveness differs depending on departments of the brain develop (p=0,000). The highest rates of a microgliosis are defined in white matter of brain hemispheres and a brainstem (р=0,05). Morphological features of microgliosis during HCV infection include glial knots formation, phagocytic transformation of microglia with prevalence of amoeboid cells, granular globes appearance, rod microglia congestions in a hippocampus and also degenerative changes in perifocal white matter. These changes of a microglia can be considered as a morphological equivalent of infected with HCV microglia cells activation. The revealed changes indicate that the microgliosis is typical morphological feature of brain injury during chronic HCV infection, and it plays an important role in the pathogenesis of the HCV-associated damage of central nervous system.

The aim of the study was to evaluate the levels of blood of cytokines and their correlations with indices of liver injury in patients coinfected with HIV and hepatitis C virus. Materials and methods. 61 persons were enrolled in the study: HIV/VHC coinfected patients (n=20), HIV monoinfected patients (n=21) and non-infected volunteers (n=20). Serum levels of IL-6, IL-10, IL-5, TNF-a, VEGF, FGF basic and biomarkers of liver injury (AST, SGPT, APRI) were measured. The significant increase in serum levels of proinflammatory and anti-inflammatory cytokines in HIV/VHC co-infected patients compared to the same indices in HIV mono-infected patients was detected. Positive correlation between biomarkers of liver injury and concentrations of observed cytokines and growth factors was found. Conclusion. In chronic inflammation, increased level of peripheral proinflammatory and anti-inflammatory cytokines and their associations with biomarkers of liver injury may explain accelerated liver fibrosis in HIV/HCV coinfected patients.

The aim: the effectiveness of the treatment tuberculosis combined with HIV infection in TB facilities of the Federal Penitentiary Service (FSIN), depending on the type of drug resistance. Materials and methods. 239 prisoners sick TB with HIV co-infection. Age: from 19 to 56 years. Results. At 50% Patients with tuberculosis, co-infected with HIV infection at Anti-tuberculosis Institution Federal Penitentiary Service will be discontinued as a result of bacterial excretion microscopy within 2 months with drug-sensitive Mycobacterium tuberculosis (Mb) 3 months from the mono-and poly-resistant and 4 months multidrug resistant (MDR). By results of seeding for 3 months drug-sensitive Mb, mono-and poly-resistant; and 4 months MDR. Will be closed cavity disintegration within 3 months from the mono-resistant, 4 months for drug-sensitive Mb, 5 months with poly- and MDR Mb.

The study of the manifestations of the epidemic process of facial phlegmons was carried out on the basis of a detailed retrospective analysis of the incidence rate of the inhabitants of the Perm region for the period from 2011 to 2016. Separately, the incidence of phlegmons among HIV-infected patients was taken into account. As a result of the research, it has been shown that there is a tendency of an increase in the incidence of phlegmons of the face in the general population and a slight decrease among HIV-infected people. The bulk of the cases are people of young and middle age. In HIV-infected patients, facial phlegmons is 8,9 times more common than in the general population, which must be taken into account when providing medical care, especially surgical.

Objective: to characterize the structure and dynamics of the incidence of herpes virus infections (recorded in statistical forms) in a region with a high prevalence of HIV infection. Materials and methods. The state medical statistics for the Irkutsk region for the first 20 years after the start of the spread of HIV infection (2002–2017) was used as the material for the study. At the first stage, a retrospective analysis of the incidence of herpes virus infections was performed. The long-term incidence of herpes virus infections among children, adolescents and adults was compared with the prevalence of HIV infection in the population with the calculation of the Spearman correlation. At the second stage, a cohort study was conducted. The incidence rates of cytomegalovirus infection were compared in a cohort of patients with HIV infection and among the rest of the population. Relative risks of cytomegalovirus infection detection were assessed over the years 2008 and 2015. Conclusion. By 2017, the prevalence of HIV infection in the general population reached 1,7%. There was a direct strong correlation (0,7–0,8) between the prevalence of HIV infection and the incidence of chickenpox, infectious mononucleosis and cytomegalovirus infection. Starting in 2007, incidence of herpes virus infections was increased among children as well as among adults. In 2008–2015 the relative risk of cytomegalovirus infection in a cohort of HIV patients increased from 70,1 to 130,3. The incidence of herpes simplex among HIV patients was also increased.

Objective: to study the knowledge of general practitioners and general practitioners (family medicine) on the identification and early diagnosis of tuberculosis in conditions of high HIV prevalence. Materials and methods. The source of information was the results of an anonymous one-step survey by questioning 140 general practitioners and general practitioners (family medicine) on issues that determine the level of knowledge and readiness to apply them in practice according to the requirements of the order of the Ministry of Health of Russia № 951 of December 29, 2014 «On Approval of Methodological recommendations for improving the diagnosis and treatment of respiratory tuberculosis». Questionnaires included 13 questions of a closed type. Statistical analysis was performed using the SPSS-17 computer application package. Results and its discussion. The obtained data demonstrated an insufficient level of knowledge of the interviewed specialists in the field of early diagnosis of tuberculosis infection, especially in patients with HIV infection, which justifies the need for training of physicians providing medical care in the framework of primary health care in the early detection of tuberculosis, including patients with HIV infection.

Western Siberia is one of the main regions with a large number of HIV-infected individuals. District therapists are the main link that makes the first contact with HIV infected people. However, it is not yet clear how general practitioners agree with the communication with HIV infected people. In turn, effective communication between the doctor and the patient can be crucial in the formation of a positive attitude of the patient to treatment and significantly affect the effectiveness of future treatment activities. The study was conducted in 2017 by anonymous questionnaires. The study involved 334 medical students of the 4th year of the therapeutic and pediatric faculties of the NSMU. For the survey, an adapted questionnaire was developed, based on the UNAIDS model questionnaire. It was found that medical students do not condemn HIV infected people. They do not believe that people with a positive HIV status necessarily behave immorally and therefore deserve this disease. They are ready to help these patients, although they themselves feel the fear of infection during medical manipulations. A lack of knowledge of a number of legal issues concerning HIV infected patients has been established.