Significant changes in the development of HIV epidemic have been taking place in Saint Petersburg over the last five years. The essence of the changes is defined by a trend to a decrease in HIV incidence in the general population associated with more advanced forms of HIV infection in newly registered cases. The epidemic mainly involves people born in late 1970s - early 1980s, who at their time formed HIV risk groups. In this generation, injection drug use was the prevailing route of HIV spread, and about ten thousand people died of HIV infection. HIV is still most often acquired by people of the same age group. The cryptic population of people with HIV produces patients with the most advanced forms of HIV infection, because they have acquired HIV several years ago. Gradually, HIV risk group is being replenished with a younger generation having other attitudes and being more informed in HIV issues. The task of all services involved in HIV medicine and case management is to prevent the massive transfer of HIV from the older to the younger generation.

To determine opportunities for prevention of postnatal mother-to-child HIV transmission, 350 case histories of HIV-infected children followed-up in Saint Petersburg were examined. In 15% of cases, breastfeeding of children by their HIV-infected mothers is a possible infecting route. This risk group falls outside the system of HIV prevention adopted by AIDS Center and obstetrical facilities. An in-depth questionnaire was used in 36 of 53 cases to investigate family histories for situations associated with infecting children, their parents and the sex partners of the parents with HIV Based on risk factors suggested by this investigation, recommendation for psychosocial counselling of potential parents tested for HIV at AIDS Centers, Maternity Welfare Centers, gynecological departments, and lying-in hospitals have been worked-out.

Objective. To study the safety of ribavirin and PEG-interferon at maximum doses over the full course of therapy for chronic viral hepatitis C in HIV patients. Patients and methods. This open non-randomized prospective study included 242 HCV/HIV patients. Group 1 patients (n=115) were not treated with HAART. Group 2 patients (n = 127) received HAART. Administered for 48 weeks were either PEG-interferon α2a at 180 mg per week or PEG-interferon α2b at 1,5 mg/kg per week, both combined with ribavirin at 15 mg/kg daily. Results. SVR rates among all patients were 67% in Group 1 and 63% in Group 2 and, among patients who completed their therapeutic courses, 78,6% in Group 1 and 70,8% in Group 2. PEG-interferon course was not completed in 37 patients (15,2%). Hemoglobin levels and leukocyte, granulocyte, platelet and CD4+T-lymphocyte counts decreased in both groups in the course of therapy. The maximal decreases were observed during the first 4 to 12 weeks. After the 24^th week, all parameters increased, and, in 6 months, they completely normalized. Zidovudine included in HAART did not increase the rate of anemia. The cases where hemoglobin did not decrease below 100 g/L were associated with higher initial hemoglobin levels and with the male gender of patients. The cases where platelet counts did not decrease below 50x10⁹/L were associated with higher initial counts. The cases were granulocyte counts did not decrease below 0,75x10⁹/L were associated with higher initial counts and with no HAART. Conclusion. The use of PEG-interferon and ribavirin dosed per unit body mass all over therapy for HCV in HCV/HIV patients, both treated and untreated with HAART, is safe and makes it possible to reach SVR in most cases. HAART does not significantly influence anemia and thrombocytopenia; however, it promotes decreases in granulocyte counts during therapy for HCV

Introduction: The aim of the study was to determine the influence of psychopathology symptoms and substance use on the level of viral load suppression in HIV-infected patients taking antiretroviral therapy (ART). Methods: We analyzed measures included a socio-demographic characteristics, clinical data (CD4+ cell count and viral loads) the Symptom Check List 90 Revised (SOL-90-R) and the Addiction Severity Index (ASI) of 75 HIV-infected patients who had taken ART for at least 6 month. Results: Participants were almost equally distributed by gender - 49% of males and 51% of females. The mean age was 35,9±9,94 years. Using viral load data as the marker of ART adherence, we divided our sample into two groups: 29 participants who had detectable HIV viral load (Detectable VL) and 46 patients who had suppressed HIV viral load (Suppressed VL). The average viral load in the patients with Detectable VL was determined to be 85,813±226,798 copies/ml. The group of patients with Suppressed VL contained significantly more females (67% and 24%, respectively, p<0,001). A higher proportion of the officially married respondents was identified in this group (40% and 14%, respectively, p<0,03). Education level was significantly higher than in the Detectable VL group (34% and 7%, respectively; p=0,03). The analysis of the SCL-90-R answers demonstrated no statistically significant differences between the investigated groups of patients. The differences in substance use between Detectable and Suppressed VL groups with respect to ASI scores were not identified. Discussion: We have found that high education level, official marriage and female gender are predictors of optimal adherence resulting in better HIV viral load suppression. Overall results failed to demonstrate substance use and psychopathology symptoms as predictors of ART adherence. However, for the sample as a whole the full range of substance use and symptoms of psychopathology were higher than in the general Russian population.

Because of drug resistant HIV-1 variants have become widely spread, HIV isolate genotyping is important in order to find out mutations associated with HIV resistance. We performed HIV sequencing in 53 blood plasma samples of patients. Almost half of the cases diagnosed subtype B. Genotyping of the samples revealed recombinant forms CRF01_AE/A, CRF02_AG and form В/А. Resistance to protease inhibitors not detected in most cases. Most of the results were consistent with resistance to nucleoside inhibitors of reverse transcriptase and non-nucleoside inhibitors of reverse transcriptase.

Antiretroviral therapy can increase lifetime and quality of life HIV-positive patient. But the use such a therapy leads to the development of HIV drug resistance, it is expressed increasing viral load. HIV drug resistance profile needs to know for prescription or change therapy regimen. Drug resistance testing significantly improves choice antiretroviral therapy regimen. The review briefly describes modern assays for determining HIV drug resistance and proposed approach next-generation-based HIV drug resistance genotyping technique.

A high performance liquid chromatography method for the determination of the active metabolite of 3’-azido-3’-deoxythymi-dine in blood plasma is developed. Its performance characteristics, including validity, specificity, precision and reproducibility, are presented. The method is validated and used in clinical trials of the novel drug 6HP Upon taking the drug once or twice daily at daily doses ranging from 1,2 to 2,0.g by 75 patients, individual variations of the analyte were 2,5 to 15,0 ng/mL, and the mean concentrations were, irrespective of drug dosage, 6,5±1,4 (n=750); 5,34±0,6 (n=450)upon a single daily intake and 8,36±1,30 (n=300) upon two daily intakes. The method may be used for the adjustment and individualization of antiviral therapy using Zidovudine or phosphazide and for the further clinical appraisal of 6HP

We studied 948 new cases of respiratory tuberculosis in convicts. As much as 692 cases (73%) were detected with X-ray (fluorography) screening campaigns. The rest were detected upon patient’s application for medical care with symptoms typical for TB. In 427 cases (45%), TB was associated with HIV-infection. TB was detected with X-ray screening in 90,6% of HIV-negative and only in 51,5% of HIV-positive patients (p<0,001). Among the cases detected with X-ray screening, 93,9% had TB foci or infiltrative TB. The prevalence of cavitary lesions was similar in HIV positive and HIV negative patients. In the cases detected upon patient’s application, each second patient had extended forms of TB. Cavitary lesions prevailed in HIV-negative patients (p<0,01). X-ray screening campaigns remain to be an effective way of screening for TB in convicts; however, value of X-ray screening is decreased in HIV-positive patients.

The urgency of the problem of HIV and viral parenteral hepatitis is determined by common epidemiological, social and economic indicators. In this paper, as a method of study, analyzed the autopsy, at City Hospital for Infectious Diseases named after Botkin. Statistical processing was performed using the software package MS Excel. Determined by the arithmetic mean indicators, standard deviation, standard error of the mean. The paper analyzes the mutual influence of HIV and viral hepatitis, given the obtained statistical data on the composition of deceased HIV-positive in 2011 and 2012. Data on causes of death in HIV-infected patients with AIDS, the percentage of HIV/CVH coinfected, special emphasis was placed HIV-infected patients who died for reasons related to chronic viral hepatitis. The main findings of this study were as follows: 92% of deaths with AIDS were infected with viral hepatitis, and only 11% of the deaths were caused by the aggravation of chronic viral hepatitis, the greater part died because of tuberculosis 41%.

An analysis of opportunities for funding of the main programs in the field of HIV prevention and treatment shows an increase in funding through federal and regional avenues, which however lags behind the current demands. Expenses are increasing because of the needs to support preventive programs, expand and improve laboratory diagnostics, and meet the increasing number of patients requiring HAART and rising prices of ART drugs, including domestically produced generics. With funding declared for 2015, crisis in HAART provision is possible. The crisis will aggravate in the first half of 2016. Measures for the minimization of funding deficit in HIV medicine are suggested.

Background. The dynamical progress of the Northwest Region of Russia, including its demographic, socioeconomic and other parameters, influences the epidemiological characteristics of HIV spread and the availability, scope, and quality of health services for HIV patients. Objective. To characterize the epidemiological situation related to HIV infection in the Northwest Region of the Russian Federation (NWRF) and compare statistical data as of 2013 and 2005. Materials and methods. Official statistical data on HIV cases registered in 2013 in 11 administrative units of NWRF were used to compare situations in 2005 and 2013. Results. Statistics suggest a decrease in HIV incidence in NWRF. At the same time, novel trends in the development of HIV epidemic become apparent. Firstly, this related to the main risk factors and routes of HIV transmission and to the age and gender composition of populations infected with HIV [1-3]. In particular, increases in the role of the sexual route of HIV transmission and in the proportion of women among HIV patients are noteworthy because they result in the increased perinatal exposure of children to HIV [4, 5]. In the recent years, an increase in HIV prevalence in elder age groups is noticeable. The traditional HIV risk groups, i.e. IDUs and MSMs, retain their importance. Migrants from other places and countries contribute to HIV epidemic significantly. Conclusion: Current epidemiological situation necessities further improvement of measures for control of HIV epidemic in NWRF. The measures should include increasing the involvement of middle- and old-age people and of labor migrants in HIV preventive interventions, and consolidation of the material and technical and human resources of AIDS Centers.