EDITORIAL
COVID-19, having not completed its epidemic development, gradually passes into the stage of prolonged diseases, which at the clinical level is designated as «postcovid syndrome». The symptomatology of these negative phenomena is quite diverse, covers the dysfunction of many organs and systems, and deserves the formulation of polymorphism of secondary and delayed complications. They are based on the consequences of the transferred acute phase of inflammation, systemic prolonged metabolic and structural disorders, including the studied genetic disorders. Possible causes of polymorphism of disorders and their manifestations in the postcovid period are considered.
ANALYTICAL REVIEW
We conducted a systematic analysis of the studies, which utilized the methods of cognitive function assessment in Russianspeaking practice for the identification of cognitive impairments in patients with substance use disorder and HIV infection. We searched the relevant studies in the following electronic database: ELIBRARY, PubMed, Embase, and PsycInfo (searched in April 2020). We included articles published in the past 20 years (from 2000 to 2020). The literature review, data extraction, and presentation were conducted based on the PRISMA statement. The majority of the papers included cross-sectional studies. In the studies, they included patients with substance use disorder, the co-occurrence of HIV infection was not controlled as a potential confounder. Researchers applied qualitative or quantitative methods and their combination, as well as screening instruments. The most popular cognitive assessment methods in research among the Russian-speaking population included the following: Luria memory words test, Schulte table, WAIS subscales, and Mini-Mental State Examination (MMSE). The important future direction is the development of the standardized assessment specifically designed to use in patients with substance use disorder, including those who also live with HIV infection.
ORIGINAL STUDIES
The research aimed to study the frequency of class G antibodies` formation to SARS-CoV-2 in HIV-infected patients in response to immunization with the Gam-COVID-Vac vaccine and the reactogenicity of the vaccine.
Materials and methods. 36 HIV-infected and 38 HIV-negative volunteers were vaccinated. The inclusion criteria for patients were: age 18 years and older; absence of earlier disease COVID-19; negative test of the presence of RNA in a smear from the nasopharyngeal and oropharyngeal mucosa and IgG in blood serum to SARS-CoV-2, absence of contraindications, undetectable viral load. The number of CD4+ lymphocytes in the blood of HIV-infected people before vaccination was 520,0±9,6. It was used the two-dose vaccine Gam-COVID-Vac, developed by National Research Center named after N.F. Gamaliel. The interval between the administration of the vaccine was 24,2±0,5 days. The presence of IgG before vaccination and 44–54±0,6 days after the start of vaccination to SARS-CoV-2 coronavirus was determined by enzyme immunoassay using the SARS-CoV-2-RBD-ELISA-Gamaleya test system. The positivity index (PI) was calculated for each test sample. The sample was considered positive at IP>1.
Results. The presence of antibodies in HIV-infected patients was detected in 75,0% cases, in HIV-negative — in 92,1% cases, the arithmetic average of the positivity index was 10,3±1,9 in the observation group, 15,3±1,9 in the comparison group (c2=3,9; p=0,04). There are no postvaccinal complications registered in patients of both groups. The frequency of general reactions to the introduction of the first and (or) second components of the vaccine in the group of HIV-infected and HIV-negative did not differ and amounted to 8,3 and 13,2%, respectively. Local reactions among HIV-infected (in 19,4% of cases) were less common than among HIV-negative (in 47,4% of cases) (c2=6,4; p=0,01).
Conclusion. Humoral immunity in response to immunization of Gam-COVID-Vac against SARS-CoV-2 in HIV-infected with minor immunosuppression is less pronounced than in HIV-negative. However, the production of postvaccinal class G immunoglobulins in HIV-infected patients in 75,0% of cases and the weak reactogenicity of the vaccine it is recommended for using in people living with HIV on the back of effective antiretroviral therapy.
ORIGINAL STUDIES
Purpose: to characterize the epidemiological features of HIV infection in children in the Primorsky Territory and to analyze the results of vaccination against human papillomavirus in adolescents with HIV infection.
Materials and methods. They instilled against HPV 52 HIV-infected teenagers. Three times 51 patients, two times — 1.
Results. Three-fold monitoring of the level of CD4-lymphocytes and viral load (VL) of HIV was carried out before vaccination, 3 and 6 months after. In all 52 individuals, 6 months before the forthcoming vaccination, the level of CD4-lymphocytes ranged from 350 to 1925 cells in 1 ml (the average value was 857,5), VL was determined from 0 to 300 copies in 1 ml (with an average value of 64,6). During vaccination, the level of CD4-lymphocytes tended to increase and ranged from 350 to 1952 cells in 1 ml (the average value was 884,1), while the VL indices even decreased from 0 to 274 (with an average value of 53,9 copies per 1 ml). 6 months after the completed vaccination, all indicators also practically did not change: the level of CD4-lymphocytes was from 353 to 1955 cells in 1 ml (the average value was 844,5), VL from 0 to 302 (with an average value of 64,4 copies in 1 ml).
Conclusion. Vaccination did not adversely affect the immune status of patients. No serious vaccine-related adverse events were observed.
Study of the peculiarity of HIV spread, first of all in the cities led to the formulation of syndemic concept — mutually enhancing set of social, behavioral and biological characteristics of which most frequently mentioned is a combination of substance abuse, victimization (experience of violence) and presence of HIV-infection or AIDS (SAVA syndrome). The prevalence of this syndemic is not studied in detail in Russian Federation.
The goal of the present study was to evaluate the prevalence of this syndrome and its components among injecting drug users in six cities in the Russian Federation.
Results and discussion. The summary prevalence of the full SAVA was 12,3% (95% CI=10,0–14,.6%), but there were significant differences between cities especially between St. Petersburg and Krasnoyarsk (18,9% vs 6,7%, р=0,031). Prevalence of incomplete SAVA syndrome (without the mandatory presence of HIV/AIDS) was 66,0% (95% CI=62,4–69,6%) the and majority of respondents (96,8%) had up to 4 SAVA components. There were no statistically significant differences in SAVA prevalence depending on gender. SAVA is relatively highly prevalent among IDU in participating cities and does not relate to respondents’ gender.
Purpose. To study the incidence and risk factors for the development of extrahepatic manifestations like arthralgias, cutaneous manifestations of vasculitis, polyneuropathy, xerophthalmia, Raynaud’s syndrome, chronic kidney disease (CKD) in patients with chronic HCV infection, and HCV/HIV co-infection.
Materials and methods. The cohort study included 331 patients: 254 people with HCV, 77 — with HCV/HIV.
Results. Extrahepatic manifestations were detected in 50% of HCV patients and 70% of HCV/HIV patients (p=0,002). Among patients with HCV and HCV/HIV the most common were joint lesions (42% vs 46%, p=0,563), skin rashes (20% vs 25%, p=0,345), polyneuropathy (13% vs 17%, p=0,441), CKD (11% vs 35%, p<0,001), less often Raynaud’s syndrome (3% vs 8%, p=0,076) and xerophthalmia (5% vs 4%, p=0,661). The logistic regression model revealed a significant relationship between the development of one or more extrahepatic manifestations in patients with chronic HCV infection with cryoglobulinemia (p<0,001), the presence of HIV infection (p<0,001), and age (p=0,007). However, logistic regression models tested for each of the studied manifestations revealed a significant effect of HIV infection only on the development of CKD (p<0,001), while cryoglobulinemia possessed significant risk factors for each of the manifestations, except xerophthalmia.
Conclusion. The data obtained indicate a high incidence of extrahepatic manifestations in patients with chronic HCV and HCV/HIV infection, also a significant role of HIV co-infection for the development of CKD, and the role of cryoglobulinemia in the development of extrahepatic manifestations, except xerophthalmia.
Management of patients with an infection caused by the human immunodeficiency virus (HIV), is accompanied by difficulties of early diagnosis, expensive treatment, and the lack of specific prevention. To date, 32,7 million people worldwide have died due to the HIV epidemic from Acquired Immune Deficiency Syndrome (AIDS). One of the most important directions, to enable monitoring of viral load and extend the life expectancy of patients with HIV is to have a sufficient number of HIV treatment options available at each stage of the disease, which increases the effectiveness of treatment and allows to avoid and/or minimize the side effects of medication.
The objective of this work is to review the various directions in the development of new dosage forms antiretroviral agents based nanosystems (NS) as the drugs hahavereater efficacy for the prevention and treatment of HIV infection.
The study aimed to analyze the studies regarding the psychological sexuality features in people living with HIV. These features were considered as a factor contributing to the HIV epidemic growth.
Publication analysis methodology. The analysis included works performed from 2010 to 2020 with a legitimate study design.
The publication analysis included: the definition of the concepts used, the study of the types of psychological sexuality features, risky sexual behavior, and the comorbidity of HIV with drug addiction.
Analysis results. Features of sexual dysfunctions associated with the presence/absence of HIV were revealed in the study. The following negative effects in the sexual sphere of people living with HIV were identified in the study: violation of relationships with a partner and satisfaction of the acceptance and love needs, as well as reduced sexual life. The presence of a certain deficit and fragmentation of modern foreign publications and an insufficient number of domestic publications on the topic of research has been established.
Data describing the effects of ultrasound upon blood serum biological objects are analyzed in the paper. Biophysical as well as medical aspects of tissue reactions caused by ultrasound are considered in fine detail including the immune complexes’ dissociation processes accompanied by releasing of antibodies and antigens that used to be present in bound form and have been inaccessible for revelation using laboratory tests. The prospects of using ultrasonic techniques in laboratory diagnostics are presented using HIV infection as an example.
CLINICAL PRACTICE
Invasive pulmonary aspergillosis (IPA) is a rare disease occurring mainly in immunocompromised patients. Currently, there is a steady increase in the number of patients with oncohematological diseases, autoimmune pathology, requiring new highly effective immunosuppressive therapy, however, HIV infection remains one of the main reasons for the development of immunosuppression. Despite the progress made in studying issues related to HIV infection, many problems, especially in relation to the course of this disease and secondary infections in children, remain unresolved. One of them is invasive mycosis, including PLA. The article presents a clinical observation of IPA in a 7-year-old patient with newly diagnosed HIV infection, demonstrates the difficulties of diagnosing and treating such conditions.
CHRONICLE
On November 18–19, 2021, the XIII Scientific and Practical Conference with national participation «HIV infection and immunosuppression was held in St. Petersburg. Socially significant infections as a cause of medical and social problems».