The stages of optimization of the operation of Saint-Petersburg AIDS Center in the course of development of HIV epidemic are described. The main organizational and scientific achievements of the Center over 25 years of its activity are outlined.

The present retrospective study of the causes of death among HIV patients taking HAART in 2010-2013 and of the significant factors of the lethal outcomes is based on a digital database comprising case histories of 647 patients including men (72,3%) and women (27,7%). The causes of death were categorized according ICD-10. The profiles of the causes of death and survival were determined. Odds ratios were calculated using fourfold contingency tables. Kaplan-Meyer curves were built to determine patients’ survival time (months). Results. Tentative infection routes are: parenteral, associated with intravenous drug use (IDU, 73%), heterosexual (17%) and homosexual (MSM, 1%). Among IDUs, death rate is 3,1 times higher in men than in women. IDUs discontinued therapy twice as often as patients who contracted HIV by the heterosexual route. In those who discontinued HAART the risk of death attributed to HIV is by 33% higher than in those who adhered to therapy. The total annual death rate in the period under study was 2,5% to 3,0%. Among those who started therapy in 2010-2013, 83% died in the first two years of treatment. The meant age at death was 36,5 years in men (95% CI: 35,8 to 37,2 years) and 34.8 years in women (95% CI: 33,7 to 35,9 years). The main cause of death in 72,0% of cases (n=466) was progression of HIV infection to AIDS. TB was found in 49% of these cases. Other causes included cardiovascular diseases (7,4%), liver pathology unrelated to HIV (5,4%), external causes (6,3%) including social circumstances, cancer unrelated to HIV (4%), other somatic conditions (2,8%), and iatrogenic causes (0,5%). No data were available in 4%. An association between CD4 cell counts at the onset of HAART and the causes of death was found. At baseline CD4 cell counts above 200 μL^-1, causes unrelated to HIV predominated. At baseline CD4 cell counts <200 μL^-1, patients died of HIV 2,31 times more often than at ≥200 μL^-1. AIDS as the cause of death was regularly associated with low CD4 cell counts (<50 μL^-1). No association between the causes of death and the times of survival was found (p>0,005) among patients treated with HAART. The mean time of survival after HIV diagnosis was 8,3 years.

The nucleotide sequences of 236 the pol gene fragments of HIV-1 variants circulating in the territory of the Volga Federal District (Perm, Kazan, Nizhny Novgorod) were analyzed. It was shown that HIV subtype A1 variants dominate (95,2%) in this region. In addition, HIV variants of subtype B (2%), CRF03_AB (1,2%), and in rare cases - subtypes C, G, CRF02_AG were also revealed. Phylogenetic analysis found that the HIV subtype A1 variants relates to the IDU-A variant, and other viruses form a common branch with the related strains. Only in 47,5% of patients receiving ART, with virological failure drug resistance mutations were identified. The absence of drug resistance mutations at 52,5% patients on ART with high viral load may indicate poor adherence to treatment of these persons.

Objective: To search for organizational risk management technologies, which cause poor adherence of patients with ARV therapy, including psychological and medico-biological risks in the consumption of psychoactive substances. Materials and methods. 239 HIV - positive patients were divided into groups depending on the leading psychological and medico-biological risks nonadher ence to receive antiretroviral (ARV) drugs. Adherence was assessed by the doses of drugs have been released for every 12 months and the frequency of the optimal level as a percentage. The index of anxiety was assessed by the results of the Jntegrative test anxiety, the presence of symptoms of depression was determined by the method of L. Rudloff. For medico-biological risks were considered signs of psychopathology substance abuse consumers surfactant. Comparison of groups using the criterion χ², χ² with Yates' correction, Fisher's exact test, p<0,05. Analysis of relationships studied traits by Spearman rank correlation. Results. Psychological and medico-biological risks are identified before the start of ART in 64,9% and 44,4% of patients in the study group. Fears of ARVs and medico-biological risks prevalent in men (p=0,013; p=0,052), self-stigma manifestations - in women (p=0,011) and were accompanied by a decrease in optimal adherence compared with a group of patients with no identified risk to 12-24^th month. ART (p=0,012; p=0,034). Among consumers surfactant in a cohort psychological risks are significantly more 94,2%, compared with patients without dependence 82,6% (p=0,022), and due to the high frequency of manifestations of fears associated with taking HAART (p = 0,003). The group of patients with the lack of support from the inner circle of 12-36 months. ART showed a tendency to decrease commitment. In groups with medico-biological risks and lack of support for the inner circle of the 60^th month of the observation frequency of unauthorized interruption was the highest (35,8% and 31,3%). Conclusion. Reduced commitment often showed the group of patients with medico-biological risks before consumers surfactant (12-48 months). Treatment with psychological risks associated with fears receiving ART predominantly male (12 months) and self-stigma mostly women (12 , 24, 48 months). Between 12 and 36 months, and receive ARV therapy is uncertain commitment to patients and requires the active support of the multi-professional teams. to maintain it.

HIV-infection affects psychosocial aspects of the lives of patients infected with HIV. Comprehensive rehabilitation programs designed to fit the most important factors affecting patient potential for rehabilitation is needed to cope with these psychosocial problems. In order to assess the attitude towards HIV as a predictor of HIV-infected patient potential for rehabilitation, we studied the findings from the anonymous interviewing with 67 HIV-infected patients (of different age ranges and at the different stages of the disease) living in Volgograd and the Volgograd region. The research was conducted in 2013-2014. We used «Attitude Towards Disease Questionnaire» developed by the St. Petersburg Bekhterev Research Psychoneurology Institute to identify the main types of attitude towards HIV in HIV-infected patients. The results demonstrate that more than half of HIV-infected patients have problems with psychological and social adaptation. We also assessed the type of attitude towards disease as a predictor of patient potential for rehabilitation. We recommend using «Attitude Towards Disease Questionnaire» to measure HIV-infected patient potential for rehabilitation and rehabilitation therapy prognosis. We justify the development and implementation of patient-tailored comprehensive rehabilitation programs for all HIV-infected patients using a differentiated psychosocial treatment approach.

The article presents epidemiological analysis of the parameters of the epidemic and the main manifestations of the epidemic process of HIV-infection in the 12 administrative territories of the Siberian region at the beginning of 2015. Used these forms of Federal statistical observation of HIV-infection. The HIV epidemic in the Siberian region has continued to develop with a tendency to increase the incidence of the population with growth rate of +7,7 percent. The incidence rate was of 135,7 per 100 thousand population in the medium to long-term indicator 75,4. The most affected are the territory of the Irkutsk, Kemerovo and Novosibirsk regions, where there is a high incidence and prevalence of HIV-infection. In the cohort of HIV-infected patients was dominated by those who were in the subclinical stage of the disease (74,2%), late stage had more than 10% of patients. Secondary diseases, such as infectious and parasitic diseases were detected in more than 20% of patients with HIV-infection. Short-term forecast of the incidence of HIV-infection remains poor with a tendency to increase the number of cases to 31 thousand new cases by 2017.

A retrospective review of the incidence of malignant lymphomas in Irkutsk Region (Russia) during the period when the rate of accumulation of HIV cases in population was high (2001-2004) and a cohort study comparing the incidences of lymphomas among HIV patients and the general population are presented. After HIV epidemic started in 1999, HIV prevalence reached 1,4% in 2014. Starting from 2005, an increase in mortality attributed to non-Hodgkin lymphomas was registered, especially among men, which was associated with a decrease in mortality attributed to Hodgkin lymphomas. These changes correlated with HIV prevalence (r=0,96 and r=-0,90, respectively). The relative risk of NHL in HIV patient cohort increased from 2,1 to 25,1 in 2007-2012. A randomized case-control study suggests a higher risk of Burkitt’s lymphoma among HIV patients compared with the rest of population (OR=5,8).

This survey contains the data analysis of literature, that is devoted to the urgent problem of development of the most commonly registered nonbacterial opportunistic infections (viral, fungal, protozoal) and their resulting deaths of the HIV/AIDS patients. The first part contains information about opportunistic nature of cytomegalovirus infection and toxoplasmosis, while the development and course of the mentioned infections of patients with HIV/AIDS, their immunopathogenesis and the most frequent clinical manifestations are given too. There are also mentioned the reasons and risk factors of deaths, the ability to influence them of accompanying infectious processes. Moreover, there is possible to see the methods of laboratory diagnostics. At the conclusion of the first part of the article, the lack of knowledge about the problems of forecasting deaths with сytomegalovirus infection and toxoplasmosis, as well as the need for further action are being highlighted.

The article describes a high therapeutic efficacy of the approved in July 2015 in Russian Federation of new direct acting antiviral agents - asunaprevir and daclatasvir as well as beclabuvir which currently on the registration stage in Russian Federation. Results of administration of these drugs in the treatment of naïve patients, and patients, who failed in treatment by combined therapy with interferon and ribavirin were reported. The high sustained virological response was observed in 90-98% of patients. A special attention was paid on the possible use of daclatasvir having high therapeutic effect in combination with the other drugs for treatment of all genotypes of hepatitis C virus, as well as patients with hepatitis C and HIV co-infection.

We describe a case of visceral leishmaniasis in HIV-infected patient

A unique clinical case of successful prevention of HIV infection after transfusion of erythrocyte suspension contaminated with HIV to a 1-year child is described. Importantly, the condition of the child being transfused was severely bad after abdominal operation complicated with intoxication, severe anemia, postoperative bowel syndrome, and sepsis. All this in combination with the high level of HIV RNA in donated blood (more than 40 000 copies per 1 mL) made the risk of HIV transmission very high. The absence of an established procedure for preventive interventions under such conditions and a limited published experience of dealing with such cases made the management of this case still more complicated. The clinical tactics discussed in the present paper resulted in the positive dynamics of laboratory tests and thus may be useful for scholars and clinicians.

In the Russian Federation, the increasing prevalence of HIV is associated with a perpetually high prevalence of syphilis. The problem of the combined HIV/syphilis infection is addressed in sporadic publications in Russia; therefore, further studies are warranted. Study objective: To examine the clinical manifestations of syphilis in HIV patients. Materials and methods: 634 cases of syphilis, including 312 cases combined with syphilis and 322 cases of HIV monoinfection, were followed-up from Jan. 2006 through Dec. 2012 at the Stationary Hospital of Saint-Petersburg Municipal Dermatovenereologic Dispensary. Results: Among patients with the combine HIV/syphilis infection, the early clinical forms, including primary and secondary syphilis of the skin and mucosa and neurosyphilis, are predominant, whereas cryptic forms dominate among syphilis cases in general. HIV infection influences the clinical forms of early syphilis by promoting an earlier and more prevalent involvement of the central nervous system in the pathological process.

The review sums up the results of using the antiretroviral drug phosphazide (Nikavir) as a component of HAART delivered to HIV patients infected with hepatitis C virus. Phosphazide is shown to be advantageous compared with Abakavir in regimens of antiretroviral therapy combined with specific therapy for chronic viral hepatitis C in HIV/HCV patients. The results of using phosphazide in treating HIV patients having TB are also considered. Phosphazide is shown to be advantageous compared with Combivir in regimens of antiretroviral therapy combined with anti-TB drugs delivered to HIV patients having tuberculosis.