Highly pathogenic coronavirus SARS-CoV-2 is the cause of COVID-19 in humans sometimes with severe clinical manifestations and death. COVID-19 immunopathogenesis is linked with dysregulated immune response with decreased interferon synthesis at the beginning of infection followed by inflammatory cytokines hyperproduction, resulting in an exuberant lung inflammation and respiratory distress syndrome. Perspective immunotherapy directions for COVID-19 could be: intranasal recombinant interferon application in the initial stage of disease, anticytokine therapy at the stage of severe pneumonia and cytokine storm development, passive immunization with blood plasma of recovered patients or therapeutic monoclonal antibodies, prophylactic vaccination.

The increasing life expectancy of HIV-infected persons due to antiretroviral therapy (ART) is associated with growing frequency of non-opportunistic respiratory diseases. This review of literature is devoted to chronic obstructive pulmonary disease (COPD), which is known to be the most common chronic noninfectious lung condition in HIV-patients. The prevalence of COPD in the global population with HIV is high and is associated with HIV.

The article contains actual data on HIV/COPD comorbidity, presents current information on mechanism of COPD development in HIV-infection, factors contributing to the mutual influence and adverse course of comorbid conditions. The specialties of COPD treatment during ART and clinically significant drug interactions between different COPD medications and some antiretrovirals are highlighted.

The socio-economic significance of both HIV-infection and COPD argues wide informing of pulmonologists, therapists and infectious disease specialists about the course and treatment of COPD in persons with HIV-infection.

Objective: to justify the main directions of optimizing the medical care system for HIV-infected military personnel of the Ministry of Defense of Russia on the basis of studying the clinical, epidemiological and social characteristics of. servicemen.

The materials consisted of 188 case histories of servicemen undergoing examination and treatment in the only specialized department for military medical examination and treatment of the Ministry of Defense of Russia. In the processing and analysis of data we used modern methods of descriptive statistics.

Results of the study. HIV infection rate of the servicemen in Russian Federation is at a consistently low level. HIV-positive servicemen are characterized by: sexual heterosexual way of infection; high social status (income, education, housing conditions), low prevalence of associated pathology. Access of most HIV-positive military personnel to dispensary observation (76,6%) and receiving antiretroviral therapy (66,1%) in the centers for the Prevention and Control of AIDS and Infectious Diseases has already been implemented, despite the lack of a regulatory framework of the Russian Ministry of Defense. A high level of adherence to dispensary observation and receiving antiretroviral therapy (about 95%) was noted in HIV-positive military personnel. Ensuring the legitimate access of HIV-infected military personnel to antiretroviral therapy practically does not require an increase in funding.

Objective. To study the molecular and genetic properties of hepatitis B virus (HBV) and their relationship with clinical and laboratory parameters in patients with chronic HBV infection.

Materials and methods. The study group included 228 patients with chronic HBV-infection. Routine hematological and biochemical tests, serum HBV DNA level, liver fibrosis (F) stage were measured. The determination of HBV genotype, subtype and drug resistance mutations was carried out by sequencing followed by phylogenetic analysis in 131 patients.

Results. HBV DNA level above 2000 IU/ml was found in 68,4% of patients. The majority of the patients were HBeAg-negative (87,3%), they had viral load lower as compared with those HBeAg-positive (p<0,001). The viral load had a positive correlation with aminotransferases activity and severity of liver fibrosis, and negative correlation with the platelets count, albumin and prothrombin levels. HBV DNA level in patients with advanced liver fibrosis (F2-F4) was significantly higher vs. those with liver fibrosis stage F0-F1 (p=0,001). In patients with viral load above 2000 IU/ml hepatic necrosis, hypoalbuminemia and dysproteinemia were more pronounced. Phylogenetic analysis revealed the circulation of HBV genotypes D (74,8%) and A (23,7%), as well as genotype C and recombinant form D/A/D were detected. Patients with genotype D had higher aminotransferases and gammaglutamiltransferase (p<0,05) levels, and higher proportion of advanced liver fibrosis (F2-F4, p=0,04) vs. those with genotype A; no differences in viral load were found. Antiviral treatment is indicated in 59,2% of patients with genotype D, and only in 38,7% with genotype A (p=0,046).

Aim of study: to present the causes of mortality in HIV-infected patients, taking into account age and gender aspects.

Materials and methods. The frequency, causes of mortality in the group of 284 HIV-infected patients are analyzed. Among them were 190 (66,9%) men, 94 (33,1%) women. The average age of patients was 45,3±4,2 years. The medical documentation of patients were retrospectively analyzed.

Results. In the analyzed group of deceased HIV-infected patients, the overwhelming majority were young people under 40 years old (61.6%) compared with people who died between the ages of 41–50 years old — 73 (25,7%) and 51 years old and older 36 (12,7%) (p<0,05). In all age groups, the proportion of deceased men significantly (more than 2 times) exceeded the proportion of women. Among young males, co-infection with viruses of parenteral hepatitis, tuberculosis and alcohol abuse is more common. Over 70% of deceased patients did not receive ART or were on short courses of therapy (less than 1 year). The average life expectancy after HIV-infection diagnosis was 5,8±4,4 years and did not differ depending on the gender and age of the patients. AIDS-related causes of death accounted for 141 (49,6%) cases, nonAIDS-associated — 143 (50,4%). Among AIDSrelated causes, tuberculosis was the most frequent (59/20,8%). Among non AIDS-associated causes, death was associated with the decompensation of liver cirrhosis. A significant influence on the formation of AIDS-associated mortality of a complex of factors — co-infection with viruses of parenteral hepatitis, the presence of «advanced» stages of HIV infection, alcoholism and life expectancy with HIV infection, must be taken into account when monitoring HIV-infected patients.

Objective: to evaluate the results of microbiological examination of sputum of HIV-infected patients with pneumonia clinic.

Materials and methods. The analysis of microbiological results of sputum in 850 patients who were treated with pneumonia at the Infectious Clinical Hospital № 1 from 01.01.2012 to 01.01.2019.

Results and its discussion. Gram-positive cocci were recorded in sputum in patients with HIV infection in 76,7±2,2% of cases. The growth of Staph. aureus noted in 20,1±2,0% of cases and was associated with the presence of sepsis and septic pneumonia. Staphylococcus epidermidis detected in sputum in 0,5±0,4% of HIV-positive patients with angiogenic sepsis. Streptococcus pyogenes was isolated in sputum in 2,3±0,8% of patients with severe community-acquired pneumonia. Str. pneumoniae was detected in 2,6±0,8% of cases. A common finding in the study of sputum in patients with HIV infection were viridans group Streptococci (50,3±2,6%). Gram-negative aerobic non-spore-forming bacterium Pseudomonas aeruginosa was found in 5,2±1,1%, Enterococcus faecalis in 3,1±0,9% of confirmed cases of pneumonia. Klebsiella pneumonia was confirmed in 11,5±1,6% of patients. Microbial association was noted in 24,1±1,7% of isolates; associations in combination with Staph. aureus were more common in 54,5±4,1% of HIV-infected patients with the clinic of community-acquired pneumonia.

Conclusion. In patients with HIV infection with lung damage, it is necessary to collect biological material for microbiological examination, which will affect the further tactics of patient management.

Purpose. To observe clinical course of acute B cell lymphoblastic leukaemia and HIV infection combination from the point of view of current treatment conceptions for thus patients.

Materials and methods. A clinical case of acute B cell lymphoblastic leukaemia in HIV-infected patient is presented.

Results and discussion. 39-year old HIV-infected male with acute B cell lymphoblastic leukaemia received chemotherapy with the ALL-2009 regimen simultaneously with anti-retroviral therapy accompanied by severe leukopenia complicated with pneumonia by the force of strong comorbidity resulting to lethal outcome.

Summary. Nowadays acute B cell lymphoblastic leukaemia and HIV infection combination that predestine poor prognosis in the accordance of special infection and immune status within the comorbidity of the patients, what demands to establish particular guidelines for chemotherapy, target therapy, maintenance treatment and bone marrow stem cell transplantation to improve efficiency of therapeutic influence at the course of heamoblastosis, so as HIV infection.

Objective: to establish a correlation of the main neuroendocrine and metabolic parameters associated with infertility and to provide a prognostic assessment of reproductive disorders in HIV-infected women, stages 4.

Materials and methods. Cross-sectional, cohort, clinical and sociological study of fertility of 83 women of reproductive age with HIV, stages 4.

Results. The most significant indicators of lipid peroxidation and neuroendocrine regulation systems have been established in patients with HIV infection and reproductive disorders, which will make it possible to predict these disorders in the future. Decreased ovarian reserve, ovarian steroid function, increased pituitary prolactinergic function are associated with a deficiency of a number of antioxidants (retinol, tocopherol, superoxide dismutase) and the development of oxidative stress with a predominant accumulation of intermediate lipid peroxidation products in HIV-infected women with infertility.

Conclusion. The pathogenetically substantiated principle of the correction of antioxidant status is the use of a-tocopherol and retinol preparations and the correction of hormonal levels in HIV-infected women with reproductive disorders.

Purpose of research. Study of epidemiological, clinical, diagnostic and therapeutic features of progressive multifocal leukoencephalopathy in HIV-infected patients.

Materials and methods. We analyzed 10 cases of deaths from PML of patients with HIV infection according to the reports of the Magnitogorsk AIDS Center for 2014–2016, and provided our own clinical observation of a patient with PML who was treated in 1 infectious Department of the South Ural State Medical University of the Ministry of Health of Russia in 2018 year.

Results and discussion. In most cases of PML observed with CD4+ less than 50 cells and a viral load of more than 150 000 HIV RNA copies/ml, brain MRI is an informative method of in vivo diagnosis, WARTH slows the progression and improves the prognosis of patients.

Aim. To identify the main clinical signs that make it possible to further detect the development of tuberculosis in patients with HIV infection in a correctional facility of the Federal Penitentiary Service with a high degree of probability.

Materials and methods: 569 patients with tuberculosis, 363 with HIV infection, and 206 prisoners without HIV infection. Age: from 18 to 62 years old.

Results. In this study, we have identified highly probable clinical symptoms in HIV-infected prisoners in the presence of tuberculosis and weakness, cough, clinical manifestations of mycosis, hepatomegaly and lymphadenopathy. The sensitivity of detecting tuberculosis in patients with HIV infection for complaints of weakness — 61,2%, specificity — 57,3%, cough with sputum — 67,8 and 51,0%, clinical manifestation of mycosis — 95,6 and 80,6%, hepatomegaly — 48,8 and 100%, lymphadenopathy — 50,4 and 100,0%, respectively. The combined combination of these clinical manifestations gives a sensitivity of 94,6% with 81,9% specificity. The percentage of correctly classified cases according to this model is 88,93%, with the area under the ROC curve (AUC) — 0,963.

The review article summarizes information about seborrheic dermatitis associated with HIV infection. The article presents current literature data about etiology and pathogenesis of seborrheic dermatitis, as well as the features of the clinical manifestations of seborrheic dermatitis associated with HIV infection. This article contains new hypotheses and concepts about combination of these two diseases. The most important role in pathogenesis of seborrheic dermatitis is belong to the fungus Malassazeia, which uses lipids from the skin surface to produce unsaturated and saturated fatty acids. These fatty acids, being left in the individual’s skin, may induce an inflammatory response. At the same time, the total lipid concentration on the skin surface of HIV-positive and HIV-negative patients with seborrheic dermatitis was similar. However, it was reported about significant alterations in the lipid fractions of HIV-positive patients including a reduction in squalene and an increase in cholesterol and in cholesterol esters, which lead to hypercolonization of the skin with yeast-like fungi and their transition in the pathogenic micellar form. The authors present a clinical case, which is demonstrating a severe course of seborrheic dermatitis associated with HIV infection.

Objective: to study the features of disorders in T and B cell immunity and the synthesis of serum immunoglobulins of classes IgA, IgM, IgG with the aim of predicting severe cytomegalovirus infection (CMVI) in newborns.

Research methods: 133 newborns with cytomegalovirus infection were examined. Lymphocytes were typed to differentiation clusters CD3, CD4, CD8, CD20 using monoclonal antibodies, IMMUNOTECH (France). The expression of membrane markers of immunocompetent cells was determined using a Beckman COULTER EpicsXLII flow laser cytofluorimeter. Depending on the severity of the condition, all children were divided into two groups: 1 — CMVI, severe form — 60 people (45,1%); 2 CMVI, moderate form — 73 people (54,9%).

Results. Using the «classification trees» method, we were able to develop a differentiated approach to the prognosis of a severe form of CMVI in newborn children. Systems of inequalities were obtained, four of which classify a subgroup of newborns with severe CMVI. Conclusion: the proposed diagnostic rules can be considered screening markers for prognosis of a severe form of CMVI in newborns.

The purpose of the article is the analysis of the awareness of the Vologda Oblast population about the ways of spreading HIV infection, its manifestations, methods of prevention and treatment, as well as attitudes towards HIV-positive people.

The study materials was the next stage of monitoring reproductive potential of the Vologda Oblast population conducted by FSBIS VolRC RAS in 2019.

The results of the survey showed that the awareness of the Vologda Oblast population on the problem of HIV infection is differentiated depending on its specific aspects. Residents of the region are most aware of the impact of HIV on the human body and its diagnosis, and the possibility of drug support for the life of patients. However, the population is less aware of the relationship between HIV and AIDS, the ways and biological environments of transmission, and the possibility of having a healthy child with an HIV-positive mother. Women, people aged 20 years and older, and residents from Vologda demonstrated the highest awareness of the main issues of HIV incidence (the nature of the disease, its impact on the body, ways and means of transmission). Men and young people aged 15–19 are less knowledgeable about all aspects, which makes it possible to classify these categories of the population as a «risk group» (i.e. potentially susceptible to HIV infection). In addition, among the residents of the region, social stigmatization of carriers of this disease is widespread, which is expressed in an unjustified fear of contracting HIV infection by household means (sharing dishes, treatment, visiting schools, kindergartens, buying food, etc.).

Conclusion. The problem of insufficient awareness of certain aspects of the disease and discrimination against HIV-positive people can be solved by expanding programs aimed at raising awareness of the region’s population on this issue.