The article is devoted to the topical issue of the status of HIV genotyping methodology in clinical practice in Russia. The data about the history of the introduction of this type of laboratory studies, as well as the current state of the laboratory and advisory basis for the detection of HIV drug resistance mutations. The article presents the results of a sample survey conducted in 9 AIDS centers in Russia on the issues of compliance of the appointment and interpretation of HIV genotyping to the recommended algorithm in practice. The conclusion about the need to restructure the existing system of HIV drug resistance laboratory analysis toward the centralization of research, the implementation of quality control and evidence-based results systematization, as well as the raise of education level of medical specialists.

Objective: to study the readiness of health workers to provide medical and psychological care for HIV infected patients who require special attention due to problems of psychological and social adaptation in connection with the disease. Materials and methods a comparison of opinions, attitudes, and preferences of the professional staff of the Center for AIDS and other infectious diseases and specialists of multidisciplinary clinics in St. Petersburg. The results showed that tolerance and knowledgeable about HIV positive people to help medical staff help better to treat people living with HIV. The development of productive relations with HIV infected patients in recent years has undergone significant changes: those who constantly work with people living with HIV, often abandoning the moral evaluation of the patient’s behavior (8,3%) less than empathize (17,5%) and better use rational approach (56,7%) in the provision of professional assistance. Conclusion: psychological setting, tolerance and different manifestations of stigmatization from the AIDS Center staff and multidisciplinary hospitals. The evolution of attitudes towards HIV-infected patients is characterized by the gradual abandonment of moral evaluation of the patient’s behavior, empathy and the formation of a rational approach to aid. The development of specialist knowledge on HIV medicine should be accompanied by the formation of skills in counseling, including the use of psychological interventions.

The injection route of HIV transmission for many years has been playing the leading role in HIV spread in the Russian Federation in general and in Saint Petersburg in particular. Because of the lack of information about the exact number of injection drug users (IDU) it is hard to estimate HIV incidence in this population. We have carried out anonymous cross-sectional study, including interviewing and subsequent HIV testing, to assess HIV prevalence in a group of 501 IDUs. The first part of our report presents the gender and social characterization of the group. It consists mainly of men and women whose mean age is 32 years. The age of the onset of drug use is mostly 15 to 20 years, i.e., relates chronologically to 1996-2003. According to a five-score scale used to assess the factors of transmission of blood-borne infections, scores 2 to 3 suggest that shared needles, syringes and drug containers use are the factors in 75% of cases. In 56%, the sex partners of respondents are also IDUs.

A retrospective comparative analysis of antiretroviral drugs identity was carried out in the groups of patients who died and in the general group of patients treated with HAART in 2010-2013. Assessed were the rates and durations of using specific HAART regimens and their combinations from the onset of therapy to its discontinuation because of non-adherence or death and the associations of ARD with the immediate causes of death. Results: In the group of patients who died compared with all patients treated with HAART, Lamivudin and Efavirenz were prescribed 1,5-2,0 times more often and the fusion inhibitor Enfuvitride was prescribed 4 times more often (р<0,0001). The medians of durations of taking different ARD suggest that the need to change drugs occurred up to 4-5 times over a short period, and the prescription of specific drugs was associated with the severity of HIV infection. No significant relationships were found between ARD and the immediate causes of death. At the same time, a multivariate analysis of 22 ARD showed that the rates of intake of five of them were associated with certain immediate causes of death. The regimens comprising Abacavir and Lopinavir/Ritonavir were associated with cardiovascular causes of death, whereas EFV, Stavudin and 3TC were associated with tuberculosis. HAART failure in some patients was associated with the development of HIV resistance to ARD, which promoted HIV disease. Among 47 patients examined, mutations causing the genotypic HIV resistance to ARD were found in 62% of cases, including resistance to NRTI in 36%, to NNTRI in 51%, to protease inhibitors in 2%, and to both NRTI and NNRTI in 44,8%. The discontinuation of HAART increased the rate of deaths because of AIDS by 12,4% and because of tuberculosis by 50%. Liver pathology as the cause of death was found 3 times more often among patients who did not interrupt HAART. Cardiovascular diseases caused death significantly less often among patients who discontinued HIV treatment. However, myocardial infarction, acute disturbances of cerebral circulation, and sudden heart arrest were found more often among patients who did not interrupt HAART, whereas different cardiomyopathies (toxic, alcoholic, mixed-type etc.) were found in most patients who discontinued HAART. Conclusions: Each of factors analyzed contributed independently to the risk of lethal outcome, irrespective of HAART received by patients. The degree of immunosuppression at the onset of HAART, the discontinuation of therapy, and the acquired HIV resistance to drugs were of key importance for progression of HIV infection. The presence of social risk factors at work before the onset of HAART was another predictor of therapeutic failure in most patients. The finding that cardiovascular and liver diseases are the immediate causes of lethal outcomes associated with HAART warrants further studies to define the categories of patients at the risk of such complications and to develop approaches to HAART correction and therapy optimization by supplementing it with other groups of drugs.

The safety, tolerance and potential therapeutic benefits of 6HP were assessed upon its use in treatment courses provided to ART-naïve adult HIV patients within the framework of Phase I randomized single-blinded trial 6HP-1-2013. Study group included 75 HIV patients referred to the third subclinical stage of HIV infection. The patients were randomized into five groups, each comprising 15 subjects. 6HP was administered per os twice daily at the dose 600 mg in Group 1 and 800 mg in Group 2 and once daily at the dose 1200 mg in Group 3, 1600 mg in Group 4, and 2000 mg in Group 5. Treatment courses lasted for 35 days. After they were completed, significant decreases in HIV RNA (log10 copies/mL) were found in all groups (p<0,05). The decreases were significantly more pronounced in Groups 2, 4, and 5 than in Group 1 (p<0,05). In all groups, CD4 cell counts medians were found to increase. Drug tolerance under the conditions of the above therapeutic regimen was estimated as good. No associations were found between the rates and severities of adverse events and the doses and administration regimens of 6HP. The adverse events were detected in 53,3% of patients. In 90% of the cases, the events were mild and did not necessitate an additional therapy. 6HP administration once daily combined with other ART drugs was recommended for further clinical studies.

Despite the efforts to stop the epidemic, HIV is considered one of the major socially significant threats in the field of public health all around the world. HIV/AIDS prevention objectives have gone beyond medical approach and need a comprehensive solution. The development and testing the efficacy of the secondary HIV prevention programs, which aim to stop the spread of HIV from those already infected and to improve the quality of life of people living with HIV, is urgently needed. Innovative programs with the use of internet-technologies have high preventive potential. Distant HIV prevention has been widely developing in the West, while in Russia, as far as we know, such programs have not been implemented yet. The present article represents an overview of the modern state of secondary HIV prevention with the aim to define effective technologies to become the basis of distant preventive program for PLWH in Saint-Petersburg. The research is implemented with the support of the RHSF grant «Comprehensive distant prevention program for socially significant diseases: psychological and medical basis for development and efficacy evaluation» (№ 15-06-10506).

The number of HIV positive patients admitted to the department for the gravity of their condition continually increased. In work the analysis of hospitalizations and deaths of HIV infected patients. The main cause of death of patients death was: generalized tuberculosis, chronic viral hepatitis in cirrhotic stage.

The second part of the literature review, on the analysis of the causes of deaths arising from nonbakterial opportunistic infections of the HIV/AIDS patients, includes the information about the role in this urgent problem of pathogenic fungi genera Pneumocystis, Cryptococcus, Candida. In the point of view of the modern approach the importance of expanding the range of conditionally pathogenic species implicated in the development of generalized mycotic pathology, as well as finding the entrance gate of pathogens and conditions of their dissemination primarily associated with immune mechanisms are noted. There is also summarized the value of the accompanying infectious processes and a combination of mycosis themselves. There are showed some of the recent years achievements in laboratory diagnosis of mycosis. The analysis focuses on finding the best ways for researchers to predict the possible deaths of opportunistic mycoses of the HIV/AIDS patients.