The population of HIV-infected reproductive age women and the incidences of pregnancies and deliveries in this population are increasing in Saint Petersburg. To develop and optimise programs aimed to reduce the rates of perinatal HIV transmission, a retrospective examination of the clinical and epidemiological characteristics of HIV-infected pregnant women included reproductive history anamnesis, the time of HIV detection and registering at maternity dispensaries and AIDS Center, the time of the onset of a chemoprevention therapy, and the characteristics of gestation and labor able to influence mother-to-child HIV transmission.

HIV-associated neurocognitive disorders of different degrees of severity are found, in spite of HAART administration, in 60% of HIV patients having undetectable HIV loads. The most common pathology upon brain involvement is HIV-associated encephalitis, although other types of damage to the CNS are encountered. The present review of published data on HIV-associated neurocognitive disorders addresses risk factors and etiology of neurological and cognitive disorders, as well as current approaches to their classification and early diagnostics.

HIV infection is often accompanied by disorders in the hypothalamus-pituitary-adrenal system. Its dysfunctions at the early stages of the disease are manifested as increased blood cortisol, which is believed to be caused by increased cytokines able to enhance glucocorticoids production. With the further progression of HIV infection, the risk of adrenal failure increases because of opportunistic infections (most commonly cytomegaloviral) or neoplastic infiltration of adrenals and/or pituitary. Drugs used to treat HIV can also promote adrenal failure. For the differential diagnostics of the overt adrenal failure and conditions reminiscent of adrenal failure and for assessing the reserve capacity of adrenals, diagnostic test are expedient because unjustified therapy with glucocorticoids is unsafe.

The presence of the alleles UGT1A1*28 and HLA B*5701 was checked up in 47 and 366 adult HIV patients, respectively. The rate and severity of the adverse effects of using Atazanavir or Abacavir in ART during 2003-2013 were compared with the genetic findings. The prevalences of grade 3 or 4 increases in unconjugated bilirubin and of overt jaundice upon ART were 36,2% and 10.6%, respectively. The highest risk of profound hyperbilirubinemia was featured by patients homozygotic for UGT1A1*28. This allele was found in 57,4% of patients, including 14,9% homozygotes. HLA B*5701 was found in 13 patients (3,7%). Taking account of testing results decreased the rate of ART discontinuation to 4,7%. The specificity of the test was 100% and its sensitivity and informativeness was 99,2%.

A retrospective examination of 1133 case histories was carried out to define the clinical features and immunological manifestations of HIV infection in patients registered as HIV-infected at different stages of HIV epidemic in Saint Petersburg (Russia). The three time periods by the years of registering at dispensaries were: 1) 2000-2002, 2) 2006, and 3) 2010-2013. It has been found that by now significant changes occurred not only in the age- and sex-related and social conditions of patients, but also in their clinical and immunological characteristics. Among HIV patients registered at Saint-Petersburg AIDS Center, 53,3% have secondary manifestations of HIV infection, 58,4% have CD4+ cell counts below 350 μL^-1, and one third have viremia above 105 RNA copies/mL. Thus, about 60% of patients registered and AIDS Center are in need for HAART by clinical indications and some 6% more are because of high viral loads.

Blood CD4+ cell counts data were reviewed for HIV patients registered in a major town Samara from the onset of HIV epidemic in 2000 through the year 2011. Decreases in CD4+ cell counts were found to occur over the study period. Female compared with male patients were registered having lesser decrements in their CD4+ cell counts. Older compared with younger patients were registered having significantly (p<0,006) lower CD4+ cell counts.

The primary medical documents of 338 HIV-infected children registered at the Maternity Department of Saint-Petersburg AIDS Center were examined. The data comprised the results of clinical and laboratory examination of the children, including 278 cases (82,2%) treated with HAART. In 2013, secondary infections were found in 32 children (9,5%), thrombocytopenia in 14 (4,1%), and significant increases of blood aminotransferases in 64 (18,9%). HAART was associated with a significant amelioration of clinical symptoms, decreases in viral loads to undetectable levels, and the normalization of immune conditions.

Systemic lupus erythematosus is an autoimmune disease, which in 70-75% of cases leads to psychoneurological manifestations and in 7-13% is the principal cause of patient’s death. In the present case report, lesions to the central nervous system (thalamus) and lungs (necrotizing vasculitis and pneumonia) are described.

A pilot longitudinal study of the feasibility and effectiveness of individualized case management of HIV-infected injection drug users (IDUs) in need for highly active antiretroviral therapy (HAART) is being carried out at present. By 8 months of following-up of 60 patients with combined HIV-infection and drug-dependence, the program shows effectiveness with regard to developing of commitment to therapy and adherence to HAART and the efficacy of HAART. Recruiting of nonprofessional help provides, such as family members and friends, is a promising approach to increasing the effectiveness of medical, social and psychological following-up of HIV-infected IDUs.

Men having sex with men are traditionally referred to high HIV risk populations. We have carried out an anonymous cross-sectional study to assess HIV prevalence among MSM attending gay clubs. HIV prevalence was found to be high, amounting to 13,6% of tested subjects. Interviews with 161 MSM were conducted. The data suggest that this population is epidemiologically important for HIV spread.

In December 2012 through February 2013, the Intersectoral Social Partnership Foundation conducted a study aimed at the assessment of prospects for implementing express HIV testing and early HIV treatment in the Russian health care system.

To estimate the incidence of tuberculosis among HIV patients in Omsk Oblast, epidemiological data for the period 2000-2012 were analysed. It was found that combined forms of TB and HIV infections are being registered increasingly often, although TB prevalence in the general population is decreasing. TB is often found among confirmed HIV patients. The incidence generalized TB forms, predominantly with CNS involvement, is increasing among HIV patients. The main cause of death in patients having combined TB/HIV pathology in Omsk Oblast is TB progression.

Study group included 235 patients with active tuberculosis confirmed by culture tests, who in 2005-2009 were hospitalized at F.G.Gaaz Regional Hospital of the Federal Correctional Department of the Russian Federation in Saint Petersburg and Leningradskaya Oblast. More than a half of the patients (n=144, 61,3%) were HIV-positive. No TB was found in HIV-negative patients. The data suggest that there is no direct association between HIV infection and the prevalence of drug resistant mycobacteria in penitentiary facilities.

Specific features of HIV epidemic in Tajikistan are reviewed with special attention to population groups at risk. Factors of HIV transmission and spread and conditions that promote them are described. The causes of increasing HIV prevalence in 1991-2013 are determined. Uneven territorial HIV distribution in Tadjikistan is revealed.