Epidemiological data about HIV infection among migrants in Saint Petersburg are reviewed. In 2010-2013, the numbers of newly diagnosed HIV cases per year among foreign citizens increased from 330 to 515, and in 2014 amounted to 1/6 of total newly diagnosed HIV cases. More than 160 migrants have passed an in-depth examination for HIV infection, which included assessing of immunological parameters, viral activity and clinical stages. About 43% of HIV-infected migrants are in need for HAART, yet cannot receive it because they are not citizens of the Russian Federation. The main countries of origin of the migrants are Uzbekistan, Ukrain, and Tadjikistan.

Benefits of the wide use of antiretroviral therapy achieved in the last decades are associated with positive affects on life span and quality of people living with HIV. However, the benefits are significantly compromised by the high prevalence of tuberculosis in this population. According to WHO estimates, among 8,6 million TB patients newly diagnosed in 2012 worldwide, 1,1 million were HIV-infected, of whom 320 000 patients died of tuberculosis. In the Russian Federation, the prevalence of combined HIV/TB infection in 2013 reached 33 894 cases, 7345 of the patients died, and 5841 lethal cases were ascribed to TB. Patients with seropositivity for HIV acquire TB 20 to 30 times more often than HIV-negative people do. Therefore, preventive interventions are of priority for reducing the burden of tuberculosis among people living with HIV, especially in countries where the prevalences of the two infections are high. The present publication reviews current recommendations and studies in different countries, including Russia, related to the use of anti-TB therapy for preventive purposes in the pursuit of the final goal of reducing TB prevalence and TB-related mortality among HIV patients.

Substance use, especially among HIV-infected women, can threaten their health and affect the likelihood of engaging in behaviors that may facilitate the transmission of HIV infection. However, few studies have examined the impact of substance use history on sexual risk behaviors and HAART adherence among HIV-infected women. HIV has become a chronic infectious dis ease that requires not only compliance with treatment for health conservation, but also the elemination of certain behaviors, such as risky sexual behaviors to prevent the spread of HIV infection. The aim of our study was to examine the effect of lifetime past substance use history on sexual risk behaviors, adherence to treatment, and alcohol use among HIV-infected women receiving HAART. Analysis of computerized survey and clinical parameters of 250 HIV-infected women receiving HAART identified women’s substance use history as associated with current risky behavior: opioid use indicates significant social troubles, women with psychostimulant use demonstrate greater sexual risks, and HIV-infected women with polysubstance drug use in the past are the most vulnerable group to all HIV transmission risks such as sexual behavior, HAART non-adherence, current risky injecting behavior. Screening for drug use history among women at outpatient visits will facilitate identifying women’s risk behaviors and provide an opportunity to refer women to services designed to provide individually-oriented medical and psychological intervention to reduce their risky behaviors. The reported study was partially supported by RFBR-NIH, research project № 12-06-91440.

The prevalence of patients having advanced immunodeficiency, Stages 4B and 4V, has increased in the last years. One of the causes of this increase is delayed addressing of patients to health care services. Low commitment of patients to dispensarization significantly contributes to the emergence of drug-resistant forms of HIV. Increasing use of ART is also a factor of increase in the number of patients having drug-resistant forms of HIV Because of the development of resistance to antiretroviral therapy in HIV patients, and with account of the increasing number of patients having low CD4 cell counts, there is the need for changes therapy and for using of novel classes of drugs, including Enfuvirtide.

As much as 102 new TB cases with pleurisy were studied. Average age was 31,5 years, 88 (86,3%) patients had TB/HIV coinfection. In 57 (55,9%) cases pleura was the only site of active TB, in the remaining cases other locations of active TB were also detected. TB origin of pleurisy was approved with exudates culture for Mycobacterium TB positive in each third case and with exudates positive for Mycobacterium TB complex DNA in 68,6% cases. Sensitivity of polymerase chain reaction (PCR) in pleural fluid was higher in TB/HIV patients. Direct TB affection of the pleura is the leading reason of tuberculous pleural effusion in HIV infected patients. All possible diagnostic tools should be used simultaneously to approve the origin of TB pleurisy. Regarding diagnostics of pleurisy, PCR of pleural fluid should be considered as the priority method, especially in patients with HIV-infection. Thoracoscopy with pleural biopsy increases the diagnostic potential of etiological verification of TB pleurisy.

Timely diagnosis of tuberculosis (TB) among HIV-infected patients is a very important task of health care. The objective is to evaluate the cost- effectiveness of different scenarios of detecting TB among HIV-infected people, Material and methods. It was carried out through modelling, based on simulation-based Russian Federation epidemiological data. Costs estimated taking into account average wholesale prices of medicines and St. Petersburg regulatory documents 2013. The analytic horizon is 2 years. Analyse was conducted from the health care system perspective with an analytical horizon of 2 years. The results and discussion. Additional use of Gene Xpert MTB/Rif together the standard diagnostic scenario detecting of TB among HIV+ patients with CD4+ <200 cells/ml allows additionally identifying 8 patients and preventing 2 deaths per 1000 HIV+. Additional costs are 314 thousand roubles per 1 additionally identified patient with TB and 2,97 million roubles per 1 additionally prevented death. For cohorts with CD4+ more than 200 cells/ml, additional use of Gene Xpert MTB/Rif not only has minimal impact to diagnostic accuracy and prognosis, but is not cost effective. Conclusions. Additional use of Gene Xpert MTB/Rif together the standard diagnostic scenario detecting TB among HIV+ patients with CD4+<200 cells/ml allows increasing number of diagnostic findings by 9.4% and has acceptable level of cost - effectiveness.

The increasing prevalence of syphilis as a coinfection, in particular with HIV, poses a significant threat being a factor that promotes the spread of both infections in the world. With account of the increasing rate of their advanced forms, including neurosyphilis, it is important to evaluate the effects of social risk factors able to promote the dissemination of the combination of syphilis and HIV infection. To study the epidemiological characteristics and the degree and nature of the effects of medicosocial factors on the development of the combined HIV/syphilis infection, 634 syphilis cases were examined. HIV was found in 5,22% of patients hospitalized for syphilis, and 63,1% of them have viral hepatites. In 49,4% of the patients, HIV infection was newly found upon hospitalization for syphilis. Among patients with the combination of syphilis and HIV infection, people aged 20 to 29 years predominate (43,1%). More than one third of patients with the mixed infection are injection drug users. This condition is associated with a 8,5-fold increase in the risk of having the combination of syphilis and HIV infection.

Data about the rates of HIV marker detection in donated blood and its components in the Russian Federation in 2009-2013 are presented. The use of in-procedure methods of ensuring blood and blood products safety, which are executable upon blood transfusion to exclude HIV transmission, is discussed. The rate of detecting of HIV markers in blood donors varied within 0,09-0,12% over the observation period. In 2009-2013, the amount of quarantined plasma delivered by Russian Blood Service increased 1,4-fold, the amount of stored plasma treated to deactivate viruses increased 3-fold, and the proportion of platelet concentrate treated to inactivate viruses increased 3,8-fold. The degrees of implementing modern technologies of ensuring donated blood safety show high interregional variability.

The current HIV epidemic in Russia represents a serious public health concern. However, associations between structure of health care delivery and psychosocial, behavioral and other characteristics of people living with HIV/AIDS have not been sufficiently studied. The purpose of the research is to examine the effect of decentralization of HIV care on patients’ satisfaction with care in clinics of St. Petersburg, Russia. We conducted a cross-sectional study with 418 HIV-positive patients receiving care at the St. Petersburg AIDS Center or at District Infectious Disease Departments (centralized and decentralized models, respectively). Face-to-face interviews included questions about psychosocial characteristics, patient’s satisfaction with care, and clinic-related patient experience. Our finding showed that patients of District Infectious Disease Departments spent significantly less time in lines and traveling to reach the clinic, and they had stronger relationships with their doctor. The overall satisfaction with care was high, with 86% of the sample reporting high level of satisfaction. Nevertheless, satisfaction with care was strongly and positively associated with the decentralized model of care and Patient-Doctor Relationship Score. Patient experience elements such as waiting time, travel time, and number of services used were not significant factors related to satisfaction. Given the positive association of satisfaction with decentralized service delivery, it is worth exploring decentralization as one way of improving health care services for people living with HIV/AIDS.

In one of two groups of HIV patients having tuberculosis, Enfuvitrid (Fuseon) was included in HAART regimen for 6 months. The use of Fuseon was associated with a more rapid and pronounced increase in CD4 cell counts and decrease in HIV load. The incidence of the was not increased in Fuseon-treated group. The results of TB treatment in patients who received HAART including Fuseon were more favorable, first of all, in that mortality rate decreased. The long-term results of follow-up show a decrease in the incidence of TB relapse in patients treated with Fuseon.

HIV infection and HAART can reduce the minetal density of bones resulting in osteopenia and osteoporosis. We compared bone density in healthy people and HIV patients. In patients, bone ensity was reduced in all sites including forearm, femoraql neck, and lumbar spine. Osteoporosis and osteopenia was found more often in HIV patients than in healthy subjects.

In primary HCV patints, Simeprevir as a component of combined antiviral therapy provides for stavle virological responces in 80,4% of cases vs. 50% in control (QUEST-1+QUEST-2).