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HIV Infection and Immunosuppressive Disorders

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Vol 6, No 1 (2014)
https://doi.org/10.22328/2077-9828-2014-6-1

EDITORIAL

7-18 2697
Abstract
Steady increases, which depend on the progression of immunodeficiency, in the incidences of development and diagnosis of secondary, somatic, and psychoneurological diseases in HIV patients are found. The most important for unfavorable prognoses concerning outcomes for patients are increases in the incidences of cardiovascular diseases, cancer, gastrointestinal and liver diseases, and disorders of the CNS, and electrolyte balance and renal functions. Forecasting of secondary and somatic diseases is necessary for estimating of the capacities of specialized medical facilities and possibilities to treat diseases associated with or developing upon HIV infection.

ANALYTICAL REVIEW

19-27 1570
Abstract
Illicit drug users, which constitute but a minor part of a total population, make a significant proportion of people living with HIV However, being an active drug user is not a criterion for the refusal to provide health care. The present review addresses the issues arising from interactions of illicit narcotic drugs and therapies for HIV infection. At present, the policy of intolerance to illicit drug use and associated ethical and legal issues prevent pharmaceutical companies from conducting trials of interactions between illicit psychoactive drugs and antiretroviral medications. Possible interactions may be inferred only from isolated serendipitous reports, which are usually clinical. At present, there are no models of adherence of drug users to therapy. This may make generally valid recommendations impracticable in specific cases. However, patient’s awareness of drug interactions and their manifestations makes it possible to inform health care providers about them in order to correct dosages, which is important for patient’s state and adherence to treatment and to treatment efficiency.

LECTURE

28-39 1678
Abstract
The main mechanisms of cognitive impairments associated with HIV infection are reviewed. The reversal of such impairments depends on differences in the ability of antiretroviral drugs (ARVD) to penetrate the hematoencephalic barrier (HEB). The mechanisms of HEB penetration by ARV and the conditions that determine the effects of ARVD on the CNS are discussed. Increasing need for HAART at mental hospitals in Saint Petersburg warrants developing therapeutic regimens with account of interactions between ARVD and psychotropic drugs. The pharmacodynamic characteristics of metabolism of such drugs are described and their adverse effects are considered.

ORIGINAL STUDIES

40-45 3075
Abstract
Lesions of central nervous system in HIV infection have serious clinical importance, but certain questions, including histopathology, stay not sufficiently described. In the present study were analysed the results of 122 autopsies of deceased from HIV infection in AIDS stage in 2012 in S.PBotkin clinical infectious hospital. CNS lesions were diagnosed by pathologists in 46,2% of cases, the objective difficulties of diagnostics at life time are evaluated. Detailed morphological characteristics of lesions due to HIV, mycobacteria tuberculosis, toxoplasma, herpes viruses and cryptococci is presented. The questions for further studies are outlined as well.
46-51 640
Abstract
Immunological tests were performed upon admission and 2 and 3 weeks postoperation in seventy HIV-positive and HIV-negative patients with TB-associated spondylitis. TB was confirmed with histological and bacteriological tests. All HIV-positive patients received HAART before operation. According to CD4+ cell counts, the patients were subdivided into three groups: 1) <200; 2) 201 to 499 mL-1; and 3) ≤500 mL-1. In the first group, TB was most severe and involved three or more organs. High levels of apoptotic (CD95+) cells characteristic of progressing proliferative and destructive processes were found in these patients. The most significant markers of the severity of TB-associated spondylitis were the levels of IgE, IL-2-PPD and IL-2-FGA.
52-58 655
Abstract
To assess the efficiency of therapy for combined TB/HIV infection, 424 clinical cases were reviewed, including 97 mixed TB/HIV cases and 327 pure TB cases. Mixed-infection patients hospitalization to day-time clinic was caused not as much by the need for primary therapy for TB (42,3%) as by the continuation of treatment after discharge from a TB hospital and by waiting in queue for admittance to a TB hospital. The prevalence of intrathoracic lymph node TB was 4 times higher in mixed TB/HIV (18,6 vs. 4,9%), and chronic viral hepatitis marker were found in these patients more often (82,5% vs. 4,9%). Mixed patients were the most socially handicapped, and the efficacy of treatment of such cases proved to be by one third lower compared with pure TB patients. The day-time inpatient clinic make it possible to increase the duration of controlled therapy even compared with a stationary hospital (137,7±9,07 days vs. 88,6±12,4 days, p<0,001).

EPIDEMIOLOGY AND ORGANIZATION OF THE SERVICE

59-65 1184
Abstract
The high prevalence of HIV infection and substantial rates of unprotected sexual intercourse reported among injection drug users in St. Petersburg has led to speculation that sexual transmission of HIV from IDUs to their non-injecting heterosexual partners (PIDUs) may generate a self-sustaining, heterosexual epidemic. We constructed a mathematical model that incorporated behavioral data from a survey of St. Petersburg IDUs and their sexual partners into an epidemic model that combines a network model of sexual partnerships of IDUs and non-IDUs to represent sexual transmission of HIV and a deterministic model for parenteral transmission among IDUs. We compared the model to surveillance data obtained from testing conducted throughout St. Petersburg and from targeted testing of IDUs. The model closely follows both forms of surveillance. The model outputs reveal a constant HIV prevalence of approximately 50% among IDUs, increasing prevalence among PIDUs and the general population reaching 14% and 2%, respectively, by 2025. These high HIV prevalences outside of IDUs occur because parenteral transmission drives the epidemic and the PIDU bridge population plays a crucial role transferring infection into the general population. This implies that sexual transmission could sustain a non-IDU HIV epidemic but only if parenteral trans mission remains unchecked. Thus, the key to epidemic control is reducing transmission among IDUs by a combination of prevention programs and antiretroviral treatment to reduce viral load.

ОБМЕН ОПЫТОМ И ИДЕЯМИ

66-73 630
Abstract
Despite broad access to antiretroviral therapy for HIV patients in the Russian Federation, the proportion of patients registered at dispensaries and being treated adequately is still low. Commitment to therapy is a pivotal component of any system for health care provision to people living with HIV. Many of them are alcohol-dependent, have contracted HIV by illicit drug use, have HIV-associated tuberculosis, and are generally referred to the disadvantageous part of population. Standard approaches to involving such patients in health care and to clinical and laboratory monitoring of such patients proved to be very inefficient. The present paper discusses innovative models of recruiting people who live with HIV to health care. The models are based on within-group mutual social support. The methodological foundations, theoretical background and potential difficulties in implementing of such programs are reviewed in detail. The stages of preparing and carrying-out of a pilot program in Saint Petersburg are presented.
74-77 714
Abstract
HIV-discordant couples in most medical institutions of Russia are turned to the use of assisted reproductive technologies. In this paper is described by the organization of work with HIV-discordant couples based MAHCF «Center of family planning and reproduction», the city of Chelyabinsk. Indicate the relative safety of assisted reproduction techniques using semen of HIV-infected husband. We have developed are also presented samples of the application and informed consent to the procedure of IVF or artificial insemination with sperm of HIV-infected-consistent husband.

ДОКЛАДЫ

78-83 574
Abstract
Discussed are the main medical, financial, and organizational problems related to HIV infection, a serious socially important condition, which causes severe losses to all nations affected. The experience gained in Saint Petersburg in integrated approaches to making decisions and to developing a consolidated budget for purchasing of antiretroviral drugs and diagnostic means is reviewed. Measures for further cutting down of treatment costs and for optimizing of medicosocial care provided to HIV patients under limited funding are proposed.
84-89 597
Abstract
The aspects of laboratory diagnostics of HIV related to diagnosis making, HIV infection follow-up and therapeutic monitoring are discussed. Costs of laboratory tests for primary HIV diagnosis and of outpatient follow-up and inpatient treatment are calculated according to authorised standards for health case in HIV cases.
90-96 825
Abstract
One of the modern approaches to a rational allocation of resources available to health care implies assessing of medical technologies. The methodology of such assessments are presented with emphasis on pharmacoeconomic experts assessment and on evaluation of therapeutic effects, both positive and negative. The recent trend of efficacy comparing is discussed. Examples of assessing of health care technologies usable infection are presented. Inferences and recommendations are proposed.
97-100 1044
Abstract
Ensuring adherence to HIV therapy - one of necessary conditions of increase of its efficiency. Treatment with once-daily regimens is preferable. Further it is possible to predict increase in a share of the fixed combinations in structure of consumption of antiretroviral agents in the Russian Federation. Thus it is necessary to consider that the fixed combinations of antiretrovirals in the first-line therapy permit to delay switching to expensive second-line regimens and reduce costs of hospitalization.
101-105 502
Abstract
Two groups of ART-naive patients of Sverdlovsk region were compared for determining the therapeutic efficiency and safety of generic drug «Virokomb» (Ranbaxy Laboratories Ltd) against the original fixed-combination drug Zidovudine/Lamivudine - Kombivr (GLAXO OPERATIONS UK). The study found no statistically significant differences of therapeutic efficiency both drugs. The only one exception was a large proportion of patients with a marked reduction in the level of blood platelets when applying Virokomb. This is expedient to continue the comparison of the both drugs.

CHRONICLE



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ISSN 2077-9828 (Print)