The analysis of the epidemic process associated with COVID-19 is carried out, possible scenarios of the development of events are presented. The most common anamnestic data, symptoms of infection, clinical picture and possible complications are described in detail. The features of the COVID-19 course in risk groups and the algorithms of administrative and medical actions that should underlie the provision of medical care to patients with cardiovascular, oncological, rheumatological diseases, pregnant women, etc. The section of diagnostics and examination features is of particular importance, since it includes not only the definition of the causative agent of the disease, but also the main indicators that determine the severity of the clinical picture, prognosis, the nature and extent of medical care. Considerable experience is presented in the clinical practice of computed tomography of the lungs, the method, the primary and early method for identifying not only lung lesions, but also the underlying disease — COVID-19. Information is presented from literary sources based on the experience of overcoming this formidable disease and its consequences by our colleagues, as well as the experience of domestic clinicians and scientists.

The main directions and approaches to the implementation of measures for the prevention and treatment of the disease caused by the novel coronavirus SARS-CoV-2 against the backdrop of the further spread of the COVID-19 epidemic are presented. Experience shows that in infection of many thousands of people, some of them are asymptomatic and pauci-symptomatic, severe or critical cases are observed in up to 1/3 of the patients that may need intensive care. The quality, effectiveness and final result of medical care depend on the level of professional, organizational, material, technical, psychological preparation of the healthcare system, the entire community of specialists, including infectious disease specialists, resuscitators, general practitioners, etc., middle and junior medical workers.

To evaluate the molecular-epidemiological structure and pharmacoresistant HIV variants in HIV-infected individuals in Ho Chi Minh City (Socialist Republic of Vietnam), nucleotide sequences of the polymerase gene fragment (pol) HIV were analyzed in 42 patients (4 people with newly diagnosed HIV infection and 38 with virologic failure of antiretroviral therapy).

Results. In the examined group, HIV circulating recombinant form CRF01_AE (92,2%) prevailed compared to genotype B (5,3%), CRF08_BC was detected in one patient (2,6%). Among people with newly diagnosed HIV infection, 75% were genotype CRF01_AE and 25% were genotype B. The drug resistance mutations to any drugs in 76,2% of patients were detected. Among isolates with identified pharmacoresistance, 43.75% had single mutations. Mutations to IR were more common (84,8%) than mutations to PI (15,2%). The most common mutations were NNRTIs — 47,8%, followed by NRTIs (37%) and PI (15,2%). Isolates with pharmacoresistance only to NRTIs amounted to 9,4% (7,1% of the general group), only to NNRTIs 28,1% (21,4% of the general group), only to PI 12,5% (9,5% from the general group), simultaneously to PI and NRTI 6,25% (4,8% of the general group), to PI and NNRTI 3,1% (2,4% of the general group), to NRTI and NNRTI 37,5% (28,6% of the general group), isolates with drugs resistance mutations to all three groups simultaneously were not detected. The drug resistance mutations occurrence and the occurring number naturally polymorphic variants in patients with two / three ARV regimens were significantly higher than those in patients with one regimen, regardless of the treatment duration. A pharmacoresistance mutation was detected in an ART-naive patient. Based on the foregoing, it seems necessary to monitor the HIV drug resistance in Vietnam to both those receiving ART and those who are ART-naive. K

Methadone is a potent synthetic opioid used in several countries both for substitution therapy in people with opioid dependence and to prevent HIV infection spreading. In Russia methadone trafficking is prohibited. Despite the current ban, cases of hospitalization with methadone poisoning are regularly recorded in an intensive care units and toxicological departments of emergency hospitals (TD EH). Frequently polydrug consumption detected in a laboratory study. People who use psychoactive substances (PS) are vulnerable to HIV-infection as well as hard-to-reach group for HIV testing. Often HIV-infection and drug abuse pathology are revealed only when drug users hospitalized to an emergency hospital after overdose with one or several PS. During the period 2015–2018 to the toxicological department of Sklifosovsky Research Institute for Emergency Medicine hospitalized 732 patients with acute methadone poisoning. In 76,8–83,9% of cases, methadone was detected in combination with other PS, predominantly with opiates/opioids, psychostimulants, psychodysleptics, as well as pharmaceutical medicaments. In addition to methadone, we recorded the presence of ethanol in biological samples (blood and urine) in a concentration from 0,3 to 3,6‰ in 19,2–33,3% of cases. The prevalence of HIV infection in patients with acute methadone poisoning ranged from 15,7 to 31,8%, increasing by 1,5 times during the analyzed period. The reasons for the increase of prevalence HIV infection in hospitalized patients could be linked to a change in the structure of the taken PS and virus transmission pathways. Patients of TD EH are a high-risk group for the spread of HIV and can be considered as a focus group reflecting general trends in the consumption of drugs in Moscow.

The work was carried out molecular-epidemiological analysis of HIV-1 in the cities of the North-West Federal District — Vologda and Cherepovets. The study used a collection of peripheral blood mononuclear cells (PBMC) obtained from 80 HIVinfected patients: 52 samples were obtained from patients living in Cherepovets, and 28 samples — from Vologda. The distribution of the HIV-1 genetic variants in the studied cities was as follows: sub-subtype A6 — 51,25%; subtype B — 6,25%; the recombinant form of CRF_03AB — 32,5%; unique recombinant forms (URFs) — 6,25%, and 3,75% were represented by other subtypes: G and CRF63_02A1. A phylogenetic analysis confirmed the relationship of the sub-subtype A6 viruses with the A6 (IDU-A) variant predominating in Ukraine, Russia and other former Soviet Union (FSU) countries; the sequences of subtype B formed a common branch on the phylogram with reference strains characteristic of men who have sex with men; 32,5% of the nucleotide sequences formed a single cluster with the reference strain CRF03_AB. In addition to these subtypes, the presence of unique recombinant forms of HIV-1 containing segments of the sub-subtype A6 and IDU-B viruses were also found. The results of the molecular epidemiological analysis in the Vologda Oblast also showed significant differences in the genetic profile of HIV-1 in two nearby cities — Vologda and Cherepovets. Thus, the evolution of HIV-1 in the Vologda Oblast continues, with the main source of variability being the mutual penetration of viruses between risk groups and recombination processes.

Purpose: identification of patients with manifest forms of CMVI among PLHIV with neurological manifestations and eye lesions.

Materials and methods: 85 patients with CD4 less than 330 cells were examined who quantified CMV DNA in blood leukocytes. Patients depending on CD4 were divided into 2 groups: group 1 — patients with values of CD4<00 cells (n=42) and group 2 — patients with values of CD4 from 101 to 330 cells (n=43). According to indications, the patient underwent lumbar puncture followed by determination of CMV DNA in the cerebrospinal fluid.

Results and discussion: There were 20 patients in the III clinical stage (23,5%) and 65 (76,5%) in the IV clinical stage. VL CMV among patients with CD4 less than 100 cells was positive in 52,4%, and with CD4 more than 101 cells in 18,6%. VL CMV of less than 1000 copies was detected in 23,8% in patients with CD4 less than 100 cells and in 16,3% in patients with CD4 101–330 cells. The diagnosis of CMV retinitis was made in 6 out of 21 patients (28,6%) with CMV DNA in the blood. CMV DNA in CSF was determined in 3 patients. Half of 42 patients (52,4%) with severe and final stages of cognitive and motor impairment showed a generalized form of CMVI. Physical, clinical and biochemical parameters are not highly informative for determining the generalization of CMVI.

Aim. The analysis of ophthalmopathology in HIV patients with a lethal outcome. Materials and methods. 371 HIV patients with lethal outcome were treated in Perm Regional Clinical Infectious Diseases Hospital within 13 years; 143 (38,5%) were examined by an ophthalmologist; ophthalmopathology was identified in 44,1% of individuals. The medical histories of these patients have been analyzed retrospectively, the remaining patients are excluded from the studies due to no changes of the organ of vision. Examination of patients included conventional eye care methods, immunological (determination of CD4+ cells), molecular-genetic (determination of viral load), serological (detection of antibodies against the infectious agents), common clinical methods and consultations by allied specialists. Statistical analysis of data was performed with the program «Microsoft Excel 2007, 2010». Results. 59,4% were men and 40,6% — women; the mean age was 33,1±6,3 years. The total of cases had the late stages (4A–B, 5th) of HIV infection; the level of CD4+ cells/μl of blood was reduced in 98,1% of patients from 410 to 1. The average duration of the established HIV infection before death ranged from 1 week to 15 years. There were 15,6% of patients with ART. HIV co-infection occurred in all cases, most often with viral hepatitis C (85,9%) and tuberculosis (43,7%). Ophthalmopathology revealed in 124 eyes was vascular in 93,5%, inflammatory — in 4,1%, dystrophic — in 2,4%. The leading cause of death was a generalized course of opportunistic infectious diseases. Conclusion. The entire complex of disorders developed against the background of a low level of indicators of the immune status, as well as the patients’ addiction to drugs and alcohol. Ophthalmopathology was mainly of vascular nature. All HIV-infected people need timely consultation and regular examinations by an ophthalmologist.