An analysis of medical panel reports, standard reporting forms No 16-vn, ambulatory charts, and case histories of patients registered at Saint-Petersburg AIDS Center in 2088-2013 has shown that the annual increases in the proportion of HIV patients at the advanced stages of their disease and in the rates of detection of HIV in advanced-age groups, where concomitant diseases are found, are the causes of prolonged temporary incapacity and earlier debilitation of HIV patients. The prevalences of concomitant diseases and risk factors of cardiovascular and renal diseases and osteoporosis in HIV patients whose age is above 40 years were determined.

Objectives. The cost effectiveness of first-line antiretroviral therapy (ART) was evaluated. Materials and methods. Retrospective analysis of the results of treatment of 260 HIV patients who received ART for 5 years at Saint-Petersburg AIDS Center. Modelling was carried out for the three most commonly prescribed first-line regimens: nucleoside reverse transcriptase inhibitors+protease inhibitors (NRTI+PI), namely Zidovudine/Lamivudine+Lopinavir/Ritonavir (3TC/AZT+LPV/r), and NRTI+non-nucleoside reverse transcriptase inhibitor (NNRTI), namely Zidovudine/Lamivudine+Efavirenz (3TC\AZT+EFV) and Zidovudine/Lamivudine+Nevirapine (3TC\AZT+NVP). Direct medical costs estimates included expenses for HIV treatment according to the main regimens and for alternative therapies in case the main ones fail, for correction of adverse effects and for laboratory diagnostics, in-patient accomodation, and examinations and follow-up by medical personnel. Results and discussion. Direct therapeutic costs increased in the resent 5 years by 14% on average and by 69% for 3TC/AZT+LPV/r and by 61% for 3TC/AZT+EFV and 3TC/AZT+NVP because of more frequent replacement of NNRTI with more costly second-line drugs or alternative regimens necessitated by adverse by-effects and their treatment. Cost/effectiveness ratio (CER), that is expenses per one patient treated for five years, was the lowest for 3TC/AZT+EFV at 200-1 and for 3TC/AZT+NVP at CD4<200 pL^-1. The 3TC/AZT+EFV regimen recommended as the main one for the onset of HIV treatment at 200-1 provides for a decrease in budget load compared with that associated with the regimens that include IP and is preferable in the pharmacoeconomic sense. However, higher rates of by-effects and complications cause turning to more costly drugs in shorter times. The first-line HAART regimen including IP (Lopinavir/Ritonavir), although it is more costly, is characterised by a similar CER for patients having 200-1 at baseline. In patients having CD4<200 pL^-1, the IP-containing regimen 3TC/AZT+LPV/r is more efficient clinically and allows to keep more patients being treated with HAART; however, CER is lower in this case compared with NNRTI regimens.

The use of HIV-1 genotyping for tropism prediction before Maraviroc (MVC, Pfizer) prescription in Russia will produce a large number of env gene sequences. These data may be useful for both therapy and epidemiological surveillance. But HIV-1 subtyping tools performance on Russian strains is still undetermined. In this work we have investigated the accuracy of genotypic subtype prediction by Geno2pheno algorithm on env gene region. Concordant results between pol and env regions were for 84,7% samples. Agreement between phylogenetic analysis and automatic prediction by Geno2Pheno of env gene region was found in 90,6% that means quite high accuracy of the algorithm. Discordant results were associated with low sensitivity for recombinants and inaccurate algorithm performance.

In connection with the existing problems in developing a vaccine, which causes time between antibodies against various strains of HIV-1, there is need to develop methods to assess virus neutralization, as well as search for broadly neutralizing antibodies capable of blocking various HIV-1 strains. We investigated the serum of HIV-infected people with non-progressive form of the disease. In our work we used serum subtype A and CRF63_02A1, and the panel of infectious HIV-1 isolates isolated from recently infected patients different genetic and biological characteristics. Reactions were carried out neutralization between homo- and heterologous pairs serum HIV-1 isolate. Analysis showed weaker suppression isolates CRF63_02A1 recombinant form of HIV-1, while sera from individuals infected CRF63_02A1, the vast majority of the studied isolates us, including the homologous HIV-1 isolates.

Analysis of clinical, immunological and epidemiological features of HIV infection in 57 patients infected by subtype A HIV-1 in 98,2% cases has been done in dependence on viral tropism. Detection of HIV tropism was performed by sequencing of V3 loop of gp120 gene. It was revealed that patients infected by R5-tropic HIV had more expressed immunity activation markers on blood lymphocytes in comparison with ones infected by non-R5-tropic HIV The different profile of CCR5 and CXCR4 expression on blood lymphocytes were detected in patients with AIDS in dependence on tropism that seem to associate with existing of different mechanism of immunosuppression formation in different viral tropism. Correlation between clinical symptoms including presence of AIDS and viral tropism has not been revealed in studied group.

Long-term follow-up of HIV patients reveals a high incidence of candidiasis in the initial as well as advanced and even lethal forms of HIV infection. The retrospective analysis of follow-up data provides for assessing the forms and the incidences of the severe forms of candidiasis, their significance for the adverse outcomes of HIV infection and suggests the expediency of early diagnostics and etiotropic therapy.

A retrospective study of 381 case histories of patients with combined infections was carried out to identify which characteristics of HIV infection influence the results of TB treatment. The following factors were found to be associated with unfavorable courses of TB in HIV patients: Epstein-Barr virus infection, immunoregulatory index below 0,2, viral load above 10⁵ mL^-1, and no antiretroviral therapy.

For today a chronic viral hepatitis are widely distributed throughout the world and they have a high medical and social significance, due to both the contingent features of affected individuals and the difficulties of diagnosis, treatment, and serious complications. This review of the literature devoted to the psycho-neurological status’ characteristics of patients with chronic viral hepatitis, including, on a background of antiviral therapy, knowledge of which is important in terms of developing the optimal strategy and tactics of medical and psychological support to patients, which implies, in particular, an optimal patient compliance to the ongoing drug therapy.

Surveillance for changes in epidemic pattern is one of the main functions of public health. To get early warning sentinel surveillance in risk groups is employed. To separate random and systematic variability in case numbers it was proposed to use control charts. Control charts created with data on registration of new cases of HIV infection and syphilis among detainee at the point of entry to jail shows that in last year situation with HIV infection became worse, especially in 2011 whereas syphilis morbidity does not changed much. The most helpful for tracking down changes in morbidity are CUSUM charts.

The analysis of 52 clinical histories of HIV-infected patients who died in patients receiving antiretroviral therapy in 2013 was done. The ratio of men to women is 2.1:1. The median age was 37 years with a range from 25 to 63 years. Duration of HIV infection ranged from a few weeks to 17 years, contamination due to the use of injection drugs was noted in 31 cases, sexually - 21 case. In 51 of the 52 patients with established 4B stage of HIV infection (AIDS stage). Among lethal cases - 28 patients started ARVT in the present hospitalization and 24 patients in the ambulance period. In almost all cases the patient’s death occurred as a result of the progression of AIDS-associated conditions, including 7 patients who had at the time of death undetectable viral load. The most frequent HIV-associated conditions that led to death were: mycobacterial infection (19 cases and 3 cases of atypical mycobacteriosis) and the group of oncohematological diseases (10 cases). Among patients with newly appointed ARVT 23 of 28 patients (82,1 per cent) died within the first 4 weeks of therapy, including 17 patients died within the first 14 days from start of ARVT.

The effectiveness of medical service provision by a multiprofessional team (MPT) to antiretroviral (ART) therapy-treated patients addicted to psychoactive substances (PAS) was assessed. The group of 239 patients was subdivided into subgroups depending on addiction to PAS. Commitment to therapy was assessed by ART drug doses provided over 12 months. HIV load was monitored. MPT effectiveness was estimated by the percents of patients whose commitment to therapy was ≥95%, of patients having undetectable viral load, of patients who continued therapy, lethal outcomes, and of patients who voluntarily discontinued therapy. Significant positive correlation was found between commitment level and the frequency of cases of suppressed HIV replication. The indices of continuation of ART (%) and the mean commitment to therapy were significantly higher in comparison with similar reference studies. Under management by MTP, HIV patients addicted to PAS can reach the degrees of commitment to therapy required for a stable therapeutic response.

Epidemiological prerequisites of HIV infection in 273 children born to HIV-positive mothers and 70 cases of clinical follow-up of such children in Osh Oblast are described.

Early attracting of HIV patients to health care services allows commencing HIV treatment at earlier stages, facilitates adherence to therapy, increases ART effectiveness, improves life quality of patients, and prevents HIV spread. To study factors that facilitate or hamper the involvement and retention of people living with HIV (PLH) in health care services, in-depth interviews were conducted in 2013-2014 with 30 providers of medico-social services to PLH at state institutions (SI) and non-state organizations (NO). Differences in the opinions of these two groups of professionals were found. SI representatives talked more about HIV detection resulting from examinations of clinical or epidemiological indications, pregnant women examinations, and planned testing for HIV. An NO representative spoke more about the effectiveness of targeted educational interventions. The main factors that facilitate HIV patients involvement and retention in HIV health care services are the presence of multidisciplinary teams, effective case management, and effective pre- and posttest counseling. Three of four informants pointed out positive roles of communities of people who live with HIV Two groups of barriers against HIV patients involvement and retention in health care services were identified. One group relates to health care services (infrastructure, quality, and privacy). The other group relates to attitudes frequently held in families and communities (persistent myths about HIV and stigmatization of people living with HIV).

We performed evaluation of questioning method for study of risky behavior of HIV infection in migrant workers seeking for medical examination in the Unified Medical Center of St. Petersburg. Using a questionnaire containing a structured interview and a 201 points formalized card for data logging, we subsequently assumed to study risk factors in the home country, Russia and the other countries of residence. Previously the validity of interviews with 40 migrant workers selected by case-control method was being assessed. The case was a person of migrant workers with confirmed HIV infection. The control group without HIV infection had similar characteristics in particular identical ethnic and age characteristics. The ratio of cases and controls was 1:3. It has shown that diagnosis and objectification of risk-related behavior in migrant workers when carrying out a medical examination causes certain difficulties, as they are afraid to get under regulated by the legislation of the Russian Federation limitations on the right to work. The study revealed that the questioning method, a basic tool of identifying risky behavior, has the lack of effectiveness. Nevertheless, a survey has revealed extremely low awareness of participants about HIV infection in general, ways of transmission and ways to prevent it - 85% of the interviewees found low awareness of these issues, or complete lack of relevant knowledge. Differences between groups of HIV-infected and intact migrants were insignificant.