Purpose. To assess epidemiological situation of three co-infections: HIV, CVH and tuberculosis in Vologda region in comparison with neighboring territories of Northwest region.

Materials and methods. The data of epidemiological study of the area of HIV infection, reports on «Causes of mortality of HIVinfected », data of statistic surveys: form No. 61 «Data on HIV-infected», form No. 33 «Data on infected with tuberculosis», form No. 8 «Data on infected with active tuberculosis», form No. 1 «Personal record of patient suffered from tuberculosis coinfected with HIV-infection» in Vologda region and some of its districts as well as materials of Northwestern Federal District within the Regional HIV were studied.

Results and discussion. Within the territory of Vologda region, earlier marked out tendency to increasing and spread of HIVinfection as well as tendency to reducing the disease burden of tuberculosis and hepatitis C virus still persist. This tendency is typical for northwest Russia and some of its territories. Co-morbidity is common for pair combination of infections and is less common for three infections in one person. Severe forms of HIV-infection in the course of clinical manifestations in combination with tuberculosis and hepatitis define a high rate of morbidity and mortality. Revealed epidemic regularities of the last years are concurrent with cross-border regions in the East and South from the Northwest.

Purpose of the study. Determination of the level and structure of population immunity to SARS-CoV-2 among the population of the Murmansk region against the background of the incidence of COVID-19.

Materials and methods. The study was carried out according to a unified method for determining the seroprevalence of the population, developed by Rospotrebnadzor with the participation of the St. Petersburg Pasteur Institute. A total of 3117 volunteers were examined, distributed into 7 age groups. The content of antibodies to SARS-CoV-2 was determined by ELISA using a set of reagents for analyzing human serum or plasma for the presence of specific immunoglobulins of class G to the nucleocapsid of the SARS-CoV-2 virus produced by the FBUN GNCPMiB Rospotrebnadzor (Obolensk) in accordance with the instructions for application.

Results. The level of population immunity in the Murmansk region as a whole was 31,2%. The highest seroprevalence was found among children aged 1–6 and 7–13 years (35.6% and 44,1%, respectively), the lowest among the elderly population aged 60–69, as well as 70 and more years (20,4% and 20,9%, respectively). In the cities of the Murmansk region. the herd level of immunity varied from 19,6% (Kola city) to 46,1% (Kandalaksha city). It was not possible to find a reliable relationship between the incidence of the population of the cities of the Murmansk region and seroprevalence. The highest level of seroprevalence was noted among office workers (38,0%), the lowest among transport workers (19,5%). In the presence of contacts with patients with COVID-19, seropositivity increased 1,4 times compared to the average population value. The level of specific humoral immunity in convalescents after COVID-19 is 64,1%, which is 2,2 times higher than the average for half-day. The proportion of asymptomatic forms among seroprevalence volunteers was 89%.

Objective of the study: identification of HPV and identification of the most common types in urethral swabs taken from HIV-1- infected men, as well as determination of the dependence of the presence of HPV in patients with HIV viral load (VL) and CD4 + T-lymphocyte count.

Materials and methods. The study included 34 HIV-1-infected men being monitored at the Center for the Prevention and Control of AIDS and Infectious Diseases (Vladivostok). They were asked to undergo a urological examination, including the collection of urethral swabs, as well as a face-to-face interview to collect socio-demographic, behavioral and clinical-anamnestic data.

Results. HIV-1-infected patients (34 people) included in the study were 25–60 (37,8±7,1) years old. HPV was detected in 23 (67,6%) patients aged 25–45 (37,8±5,5) years. The vast majority of patients with multiple HPV infection reported having had sex with three or more sexual partners and did not always use a condom, and 17.4% of the men surveyed said they never used one. In the past, 47.8% of HPV-positive patients used narcotic substances, and 30.4% of the respondents, at the time of the survey, were active users of psychoactive substances. In 23 HIV 1-infected men, 9 genotypes were identified — 6 (HPV-HP), 16, 18, 33, 35, 52, 53, 58, 73 (HPV-VR) — belonging to 5 types of HPV: AlphaPV-6, AlphaPV-7, AlphaPV-9, AlphaPV-10, AlphaPV-11. In 5 patients, coinfection of two genotypes was revealed, in 3 — two types of HPV. The most common genotype was HPV-16 (30,4%) and HPV-18 (26,1%), the least HPV-{6, 58, 73} (1/23≈4,3%). The presented results indicate the need to create diagnostic programs focused on early detection of cancer of the anogenital region in persons of both sexes in patients with immunodeficiency states, primarily in HIV 1-positive patients with HPV-HR.

Objective: to determine the prevalence and severity of clinical and cytological manifestations of papillomavirus infection in HIV-infected women of childbearing age in relation to immunological and virological parameters.

Materials and methods. Statistical data were obtained through direct randomised inclusion of 182 HIV-infected women of fertile age who were being followed up at the AIDS Centre during their initial gynaecological examinations. Statistical processing of the findings was carried out using IBM SPSS Statistics software.

Results and discussion. The results of the study showed a high detection rate of chronic papillomavirus infection of high carcinogenic risk (HPV HRS) among HIV-infected women, which is a prognostically unfavorable factor for the development of pathological changes in the cervix and was confirmed in a study by extended colposcopy. It was found that the concentration of HPV VKR increases against the background of a decrease in the immune status, and there is an indirect relationship between the level of HIV viral load and the concentration of HPV VKR.

Conclusion. The feasibility of HPV vaccination among HIV-infected girls and women aged 9–45 has been demonstrated.

Aim: catamnestic analysis of the effectiveness of antiviral therapy for chronic hepatitis C in combination with HIV infection.

Materials and methods. A retrospective study included 145 patients with combined HCV/HIV infection for 8±0,43 years.

Results. 55% of patients received antiviral therapy for chronic hepatitis with pegylated interferons and ribavirin. The frequency of achieving a stable virological response is 73%. Persistent virological response with favorable Il-28B genotypes was detected in 85% of cases, with unfavorable genotypes less frequently — in 63% (p=0,028); the relapse rate is 27%. The level of HIV RNA viral load and the frequency of patients with secondary diseases was higher in patients with natural HCV/HIV infection with favorable interleukin-28B genotypes compared to other comparison groups (р<0,05).

Conclusion. The course of chronic hepatitis C after therapy was more positive with favorable Il-28B genotypes. HIV infection was more severe in the absence of antiviral therapy for chronic hepatitis C.

Purpose. To carry out an analysis of characteristics and to reveal the peculiarities of laboratory changes of cerebrospinal fluid (CSF) in patients with tuberculosis of central nervous system associated with HIV-infection.

Materials and methods. Analysis of 206 patients with CNS tuberculosis associated with HIV-infection who were treated in State Budgetary Healthcare Institution «City tuberculosis hospital No. 2» of Saint Petersburg during the period from 2006 to 2018 was conducted.

Results and discussion. It was concluded that a mean protein level in CSF was 1,6±0,1 g/l and was significantly increased in patients with tubercular meningoencephalomyelitis. When decreasing the amount of CD4-lymphocytes, increasing of protein level in cerebrospinal fluid is observed. As cytosis increases, the amount of neutrophils increases too. Patients with tuberculous meningitis showed remarkable pleocytosis in comparison with patients with meningocephalitis. In 47% of cases, neutrophilic cell composition of CSF was registered. Therewith, the rate of neutrophils in CSF increased as the rate of lymphocytes decreased. Reducing of glucose in CSF was observed in the majority of patients with CNS tuberculosis independently of severity of immunosuppression and extent of brain injury.

For the first time in Russia, a description of a case of full application in clinical practice of a completely interferon-free mode of the 3D-mode GLE/PIB + SOF for the treatment of recurrence of HCV 1b RNA viremia after a primary course of interferonfree therapy in the PTV/r/OBV + DSV mode, which included inhibitors of NS3/4A PI, NS5Ai and NS5Bi, in a patient with combined HCV syndrome is presented. The target result of the repeated course of interferon-free therapy — SVR12 — was achieved despite the presence of significant RAS R117H in the NS3 region of the HCV genome and multiple RASs in the NS3 and NS5A regions, the nature of resistance of which to the corresponding inhibitors of GLE and PIB was unknown. Along with a complete virological response, the treatment also achieved a complete immunological response, which lasted for 12 weeks after the end of the repeated course of interferon-free therapy.

There is concern that the widespread use of antiretroviral drugs (ARV) to treat human immunodeficiency virus 1 (HIV-1) infection may result in the emergence of transmission of drug-resistant virus among persons newly infected with HIV-1. Russia is one of a growing number of countries in the world where drug-resistant HIV is becoming a serious health problem because it has the potential to compromise the efficacy of antiretroviral therapy (ART) at the population level.

Materials and methods. We performed a genetic analysis of the HIV-1 plasma derived pol gene among the newly diagnosed ART-naïve HIV-1 infected patients during the period from November 2018 to October 2019 in the St. Petersburg Clinical Infectious Diseases Hospital named after S.P. Botkin. We used reverse transcriptase polymerase chain reaction (RT-PCR) followed by direct sequencing of PCR products to determine the prevalence of primary drug resistance (PDR) conferring mutations. HIV-1 genotypes were determined by phylogenetic analysis.

Results. The predominant HIV-1 subtype was A1 (87.2%), followed by B (11.8%) and CRF06_cpx (1%). The overall prevalence of PDR was 11%. Virus with known resistance-conferring mutations to any nucleoside reverse transcriptase inhibitors (NRTIs) was found in 8 individuals, to any non NRTIs in 5 subjects, and to any protease inhibitors in 1 case. Multidrug-resistant virus was identified in 2 individuals (2%).

Conclusion. The distribution of HIV-1 genotypes in St. Petersburg, Russia is diverse. The emerging prevalence of PDR in ART-naïve patients demonstrates the significance of constant monitoring due to the challenges it presents towards treatment.

The study materials of 23 patients with COVID-19, combined with newly diagnosed tuberculosis at the late stages of HIV infection with an average CD4+ cells count not exceeding 30 cells/μl of blood and in the absence of antiretroviral therapy (the main group) and 23 patients with no COVID-19 (the comparison group) and the similar parameters are presented. The presence or absence of COVID-19 is characterized by social maladjustment, drug addiction, concomitant viral hepatitis B or C and COPD, generalized tuberculosis with extrapulmonary damage of various organs and the development of other opportunistic pulmonary infections, similar clinical and radiological manifestations, which can only be differentiated by microbiological and molecular genetic research methods. To prevent exogenous infection of the healthy population with COVID-19, it is imperative to organize an active regular examination of all patients with tuberculosis and HIV infection for COVID-19, especially at the later stages, in the TB care office for HIV-infected people at TB dispensaries.

Hepatitis C is a major public health problem and measures against it require the development of a national strategy and concept of a prognostic model. This is relevant for Yakutia, as a tremendous region with extremely specific and severe climatic and social conditions that cause a high incidence of hepatitis C.

Objective: to evaluate the effectiveness of various scenarios for the development of the epidemiological situation of hepatitis C in RS (Y) depending on the strategy for providing medical care to people with chronic hepatitis C.

Material and Methods. The work uses the materials of official statistics of the Federal State Institution of Rospotrebnadzor for RS (Y) and information from the register «Chronic viral hepatitis in RS (Y). To assess the burden of disease, the main scenarios were analyzed using the dynamic Excel model.

Results and discussion. RS (Y) is a disadvantaged territory of the Russian Federation for parenteral viral hepatitis, including hepatitis C. According to the register «Chronic viral hepatitis in RS (Y)», 14643 people are registered, of which with chronic hepatitis C — 7395, which amounted to 50,5%. The proportion of HCV infection in the group of people with cirrhosis is 44.1%, with hepatocellular carcinoma 59,3%, and 76% in the total structure of the dead. Implementation of the WHO scenario for hepatitis C will reduce mortality by 65%, the number of people with hepatocellular carcinoma by 66%, decompensated cirrhosis by 66% and reduce the overall incidence by 34% by 2030.

Conclusion. Achieving the WHO goals by 2030 seems realistic when creating a regional strategy to eliminate HCV in RS (Y), which includes increasing access to therapy with modern drugs with direct antiviral effects, an interdisciplinary approach to the diagnosis and management of patients with chronic hepatitis C, specialties about the problem of chronic hepatitis C and the possibility of curing it.

The objective: to study the state of intestinal microflora in patients with cirrhosis of the liver of viral etiology and pathogenetic substantiate therapeutic measures taking into account the severity of the disease, the period of therapy.

Materials and research methods. This study was conducted on the basis of the clinic RIEMID MH RUz in the department of chronic viral hepatitis. To achieve this goal and solve problems, we examined 35 patients with a diagnosis of CP of viral etiology (all patients were with a delta agent), the average age of the patients was 38±9,7 years. Men 20 (57%), women 15 (43%). Groups of patients were selected by random sampling as they were admitted to the hospital.

Results and discussion. Summarizing the data obtained, it should be emphasized that in patients with CP of viral etiology, the progression of the disease is accompanied by the parallel progression of a violation of microbiocenosis. The formation of dysbiosis and aggravation of the degree of dysbiosis is directly dependent on the amount of concomitant pathology. That is, the more concomitant pathology, the higher the likelihood of the formation of intestinal dysbiosis. During a clinical examination, intestinal dysbiosis was found in all 35 (100%) patients.

Conclusions. Cirrhosis of the liver is accompanied by functional changes in the colon, which increase as the class of cirrhosis increases. The use of the probiotic Bactrimsubtil normalized the intestinal microflora in patients with LC, helping to reduce the manifestation of a number of clinical symptoms.

The aim of the study is to study the main pathways and risk factors for HIV infection in a child, to establish a probable source of infection for a child, as well as to exclude the possibility of criminal or nosocomial infection.

Materials and methods. At the first stage, an epidemiological investigation was conducted. Next, a molecular genetic analysis of two blood plasma samples studied (child and mother) and a comparison group were used, in which 18 nucleotide sequences of HIV-1 variants were used, obtained from patients living in the Primorsky Region, and 8 characterized nucleotide sequences additionally taken from GenBank international database. Distance calculation and phylogenetic analysis were performed by constructing phylogenetic trees using the Maximum Likelihood method using the GTR evolution model.

Research results. The data obtained indicate that the nucleotide sequence from the child is most similar to the nucleotide sequence from the mother (potential source) and reliably grouped on the phylogenetic tree, forming a common cluster that is different from the samples of the comparison group. This indicates the likelihood of an epidemiological link between HIV infections in the mother and her child.

Conclusion. According to the results of this study, we can conclude that the child is infected from an HIV-infected mother, approximately at the age of a child older than 4 years old, when he received the last negative test result for HIV markers.

The antiretroviral therapy is a lifelong use of a combination of three or more antiretroviral drugs (ARVDs). One of the factors contributing to a significant decrease in patients’ adherence to treatment is the high toxicity of ARVs.

The aim of the study is to study the safety of antiretroviral drugs retrospectively and based on spontaneous reports about adverse drug reactions (ADRs) inputted in the ARCADe database.

Materials and method. The objects of our research were the 649 spontaneous messages about ARVDs recorded in the regional electronic database (register) of spontaneous messages for period 01 January 2009 — 31 December 2018.

Results. Most often, ADR were registered with the use of combined ARVD and non-nucleoside reverse transcriptase inhibitors. Zidovudine and Efavirenz were the leaders in terms of the incidence of ARV ADR. Among the combined anti-HIV drugs, the most frequently ADR were associated with the use of a Lamivudine and Zidovudine combination.

Conclusion. Long-term use of ARVs requires regular monitoring of adverse reactions, which will improve the quality of life of patients with HIV infection and significantly increase their compliance with antiretroviral pharmacotherapy.

The aim: to conduct a constitutional and legal analysis of the legal regulation of medical secrecy protection for HIV-infected Russian citizens.

Materials and methods. The analysis was carried out on the basis of Russian and foreign legislation and scientific literature published on this topic over the past 7 years, including in Pubmed. The study used dialectical and logical methods, which created the basis for a comprehensive and complete study of the limits of admissibility of protecting medical secrets of HIV-infected; the use of the systemicstructural method allowed to study it in conjunction with constitutional guarantees of human rights.

Results. Some problems in the legal regulation of medical secrecy protection of HIV-infected Russian citizens have been identified. It is noted that in Russia there are specific circumstances and reasons requiring disclosure of the positive status of HIV-infected citizens. They hide their diagnosis when entering into intimate relationships with healthy people and even in marriage. The current criminal liability for contracting another person’s HIV infection does not ensure the suppression of infringements on the health of others. Based on the analysis of judicial practice, the excessive protection of medical secrets of HIV-infected is noted. 

Conclusion. It is concluded that in order to effectively protect the health of Russian citizens, it is necessary to limit in some aspects the protection of personal secrets of HIV-infected persons to ensure the safety of all people in contact with them.