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No 1 (2015)

Articles

Wait-and-see strategy

Pokrovsky V.V.

Abstract

In 2014, over 80,000 new cases of HIV infection were notified in Russia; by the end of the year there were a total of 900,000 registered HIV/AIDS cases in the country. At the same time 175,000 HIV-infected patients have already died. By the end of 2014, only 170,000 HIV-positive patients had continuously received antiretroviral drugs that, suppressing HIV activity, not only prevent the development of AIDS, but also reduce the risk for distributing the virus. The number of new cases of HIV infection and deaths may be theoretically declined if the majority of Russian HIV-infected patients take antiretroviral drugs lifelong; but the mass use of these agents will require not only the increased financing of their purchases, but also the diversion of considerable healthcare resources, including a rise in the staff of trained infectiologists. The treatment coverage of HIV-infected patients, which is sufficient to achieve a preventive effect, is possible only when they are timely and completely detected, but it is unlikely to be feasible since HIV is most actively transmitted in the early phase of the disease when the latter is difficult to diagnose. To keep the HIV-infected on lifelong medication will also require considerable efforts. The HIV/AIDS situation may be fully stabilized, only by developing a national strategy against the epidemic, which involves a package of measures to inform and educate the entire population; special interventions among vulnerable populations; a comprehensive action on the found sources of infection. The implementation of this strategy will be able to require not only the participation of many ministries and departments, but also alterations in the current legislation.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):4-9
pages 4-9 views

Mother-to-child HIV transmission during breastfeeding

Kozyrina N.V., Ladnaya N.N., Sokolova E.V., Tushina O.I., Narsia R.S., Pronina S.I., Pokrovsky V.V.

Abstract

In 2013, a total of 24 babies who got HIV from their infected mothers during breastfeeding were found in Russia. The risk of infection in babies having breastfeeding episodes was about 50%. The main reason for this high risk is maternal infection during late pregnancy or after birth, the absence of chemoprophylaxis and, as a consequence, a high viral load in acute HIV infection developing in a breastfeeding mother. The babies were breastfed in 72% of cases because of the late diagnosis of HIV infection in their mother and in 25% in accordance with a woman’s desire or for inaccessibility of breast milk substitutes (BMSs). Antiepidemic measures that can reduce the risk of HIV transmission through breastfeeding are as follows: to educate and consult pregnant women; to examine their sexual partners; and to provide HIV-infected women with BMSs. The performed analysis of how the babies born to HIV-infected women with BMS were provided with BMSs in 2013 has indicated that 3 out of 82 surveyed subjects of the Russian Federation have no respective programs. BMSs were given out to feed infants in 86% of the regions. However, only low-income women could receive infant formulas free of charge over one-third of the country’s area. In 13.4% of the regions, a monthly allowance ranging from 150 to 2600 rubles was paid out to buy milk formulas. The allowance rate could not ensure wholesome artificial feeding in the majority of the regions.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):10-14
pages 10-14 views

A cascade model in the evaluation of the efficiency of healthcare for HIV-positive people

Pokrovskaya A.V., Ladnaya N.N., Yurin O.G., Dementieva L.A., Pokrovsky V.V.

Abstract

The paper describes a methodology to build a cascade model of healthcare for HIV-positive people in case of Russia on the basis of the World Health Organization (WHO) guidelines. In Russia, 668,032 HIV-positive people had been alive by the end of 2013, which had constituted about half of the estimated number of all HIV-infected persons in Russia. 77% of the notified HIV-positive people had been registered in the AIDS centers; 72% had been followed up. 96% of those requiring antiretroviral therapy (22% of the alive registered HIV-infected patients) had been treated; 81% of them had a viral load of less than 1000 copies/μl. As a result, only 19% of the notified HIV-infected may be regarded as achieving the HIV suppression level that is necessary to prevent the transmission of the virus. The low percentage of these people is probably due to the large number of undiagnosed cases of the infection, the late referral of the HIV-infected to AIDS centers, and the relatively small percentage of patients receiving effective therapy. Analysis of the available data on the HIV/AIDS situation in the Russian Federation, which were collected by the Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, has indicated that they substantially comply with the WHO guidelines and may be used to build a cascade model. This model may be employed as one of the components for assessing the quality of healthcare for HIV-positive people and as an element of epidemiological surveillance.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):15-18
pages 15-18 views

Examination tactics for HBsAg-positive persons

Kozhevnikova G.M., Voznesensky S.L., Efremova O.S., Chulanov V.P., Smetanina S.V.

Abstract

Objective. To estimate the prevalence of active forms of chronic hepatitis B (CHB) to identify those who need specific antiviral therapy and follow-up. Subjects and methods. 252,614 people in whom serum HBsAg levels were determined by an enzyme immunoassay were examined. ALT activity and serological and molecular biological markers were estimated in HBsAg-positive persons. 174 patients with CHB were examined to determine CHB activity and to decide whether they need antiviral therapy and further monitoring. Results. Based on the existing guidelines and the results of this investigation, the authors have proposed the sequence of examining HBsAg-positive persons, by taking into account the grading of blood hepatitis B virus (HBV) DNA levels, ALT activity, the degree of fibrosis, and gender characteristics. HBsAg was found in 4.1% of the examinees. Serum HBV DNA was detectable in 63.3% of the HBsAg persons. Antiviral therapy was required by 34.6% of the examined CHB patients with a high ALT activity. Conclusion. By considering the accessibility and economic constituent of diagnostic tests, the proposed examination algorithm allows the optimization of follow-up of patients with CHB and the selection of candidates for timely initiation of antiviral therapy that can reduce the chance of poor disease outcomes.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):19-23
pages 19-23 views

Pattern of secondary diseases and current approaches to their laboratory diagnosis in patients with HIV infection

Shakhgildyan V.I., Yadrikhinskaya M.S., Safonova A.P., Domonova E.A., Shipulina O.Y., Alvares-Figeroa M.V., Dolgova E.A., Tishkevich O.A.

Abstract

Objective. To determine the pattern of secondary diseases in HIV-infected patients from the Infectious Diseases Hospital and to establish the rate and quantitative characteristics of detection of DNA of opportunistic pathogens in the patients’ biological materials. Subjects and methods. 1333 (85.5%) inpatients with stage 4B-4C HIV infection (AIDS) were examined. CD4+-lymphocyte counts of < 200 cells/μl were found in 70% of the patients. 2456 biological materials (blood, bronchoalveolar lavage (BALF), cerebrospinal (CSF), and pleural fluid samples and biopsy specimens) were investigated for the presence and quantification of M. tuberculosis, C. albicans, С. glabrata, C. cruzei, C. neoformins, T. gondii, cytomegalovirus (CMV), herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), human herpesvirus type 6 (HHV-6), Epstein-Barr virus (EBV), and JC virus DNA and HIV RNA by molecular techniques using the polymerase chain reaction systems made at the Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare. Results. The most common secondary diseases were tuberculosis, esophageal candidiasis, obvious CMV infection, toxoplasmosis, and Pneumocystis pneumonia. There was a rise in the incidence of HIV encephalitis, cryptococcal meningitis, atypical mycobacteriosis, multifocal leukoencephalopathy, and lymphomas. According to the biological material, the sensitivity of Mycobacterium tuberculosis DNA in the patients with tuberculosis was 44.8-93.7% with 100% specificity. The CMV nature of organic diseases was supported by the detection of CMV DNA of 2.0 lg in the leukocytes and > 10,000 copies/ml in the plasma, and cytomegalic cells in the biopsy and autopsy specimens. The presence of CMV DNA of >10,000 copies/ml in BALF or CSF was of diagnostic value. The value of the qualitative and quantitative detection of herpesvirus (HSV-1, HHV-6, varicella zoster virus) DNA in the biological materials in diagnosing herpesvirus-induced visceral involvement calls for further investigations. EBV was the most frequently detected pathogen in any biological material with copy numbers ranging from tens to millions. The virus DNA concentration of > 10,000 copies/ml in CSF may be indicative of primary brain lymphoma. The diagnostic sensitivity of the presence of T. gondii DNA in CSF was equal to 43% with 100% specificity. The detection of the high and moderate concentrations of anti-T gondii IgG antibodies were of diagnostic value. The presence of JC virus in CSF is a determining factor to verify the diagnosis of multifocal leukoencephalopathy. It is necessary to quantify the content of DNA of the pathogen in the sputum and BALF in order to establish the mycotic etiology of lung injury. In cryptococcal meningitis, the detection of C. neoformins DNA in CSF has 100% sensitivity and 100% specificity. In patients with HIV infection, besides CMV encephaloventroculitis and multifocal leukoencephalopathy, neurocognitive impairments may be associated with HIV encephalitis, which necessitates the determination of the presence and concentration of HIV RNA in CSF. Conclusion. Molecular biological techniques for detection of opportunistic pathogens in HIV-infected patients play a central role in making an etiological diagnosis in due time.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):24-30
pages 24-30 views

Hepatotoxicity of antiretroviral therapy in HIV-infected patients

Kanestri V.G., Kravchenko A.V., Gankina N.Y.

Abstract

Objective. To estimate the rate and degree of hepatotoxicity in patients receiving different antiretroviral therapy (ART) regimens for further improvement of therapeutic approaches. Subjects and methods. The rate of hepatotoxicity during the first 48 weeks of ART was analyzed in 720 adult patients with HIV infection. Hepatotoxicity was estimated using the international adverse drug reaction scale on the basis of clinical symptoms and time-course of changes in the ALT and AST levels measured before and 1, 3, 6, and 12 months after ART. Results. The levels of liver enzymes were most frequently elevated after 3-6 months of ART regardless of its regimen. The rate of severe (grade 3) hepatotoxicity increased in proportion to the time antiretroviral drugs were taken. The use of protease inhibitors (PIs) did not virtually affect the rate of an elevation in the level of transaminases while that of nonnucleoside reverse transcriptase inhibitors (NNRTIs) caused hepatotoxicity in more than half of the patients at 6 months of ART. Elevated baseline ALT levels and the presence of chronic viral hepatitis were the most unfavorable factors of hepatotoxicity during ART particularly in patients receiving NNRTIs. Women with a CD4+ lymphocyte count of more than 250 cells/ßl and men with this indicator greater than 400 cells/ßl should be considered as a hepatotoxicity risk group before nevirapine intake. Conclusion. In addition to 2 NNRTIs, a PI should be incorporated in an ART regimen for patients with chronic viral hepatitis or elevated transaminase levels. In so far as each class contains drugs with a higher or lower effect hepatotoxic effect, it is crucially important to choose ART regimens strictly individually with regard to all patient characteristics.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):31-36
pages 31-36 views

Assessment of HIV infection awareness in Moscow dwellers according to the results of the 2014 surveys

Belyaeva V.V., Adigamov M.M., Sokolova E.V., Orlova M.O.

Abstract

Objective. To assess HIV infection awareness in the dwellers of the Central Administrative District of Moscow; to provide valid information to everybody who incorrectly answered indicator questions. Subjects and methods. An anonymous survey using indicator questions was conducted in March-June 2014. A total of 696 persons who were being examined to have a medical certificate at Branch Four, V.A. Gilyarovsky Mental Hospital Three, Moscow Healthcare Department, were questioned. 142 to 232 respondents were asked questions concerning each of the given indicators. Results. As high as 66.5% of those asked gave a correct answer to whether HIV might be transmitted through a mosquito bite. 18.3% answered incorrectly; 15.2% found difficulty in replying. Wrong answers were most common in a group of young people under 20 years of age. 61.3% of the asked agreed with the statement that the condom reliably protected against HIV transmission; 30.1% gave a contrary answer and 8.6% found difficulty in replying. As high as 52.4% of the questioned healthcare workers considered the condom to be a reliable preventive means. Conclusion. The found poor awareness of the transmission routes of HIV and its preventive measures among young people and healthcare workers requires compensation within the framework of adequate preventive and information programs.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):37-41
pages 37-41 views

Manifestation of AIDS in Russia

Pokrovsky V.V.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):42-47
pages 42-47 views

Leishmaniasis and HIV infection

Ermak T.N.

Abstract

The paper reviews the literature on the problem that becomes increasingly relevant due to the pandemic of HIV infection and the high incidence of leishmaniasis worldwide. At the present time leishmaniasis has become one of the opportunistic infections taking the lives of patients with AIDS in the endemic regions and in some of them visceral leishmaniasis is a main cause of death in the HIV-infected. The steady rise in the HIV epidemic in the Russian Federation, expanding tourist routes, including those to visceral leishmaniasis-endemic regions, and the possible contamination with both infections through parenteral drug use can result in the occurrence of cases of this co-infection in our country. As a reminder about this, the authors give a brief description of the first patient with HIV infection concurrent with visceral leishmaniasis.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):48-52
pages 48-52 views

Papillomavirus-induced gynecological cancers in HIV-infected women

Popova A.A., Stepanova A.G., Pokrovskaya A.V.

Abstract

HIV-positive compared to HIV-negative women are more frequently found to have cervical intraepithelial neoplasia and cervical cancer even after adjusting for risk factors, such as age and sexual behavior. Squamous cell dysplasia is also more common in HIV-infected women. High-risk human papillomavirus (HPV) (types 16, 18, 33, 35, 52, and 53) is the major cause of cervical cancer. The HIV-infected women are at risk for chronic HPV infection because of the inability to eliminate HPV. Besides, they have abnormal Pap test results 10 times more often than women in the general population. The absence of clear recommendation for colposcopy and HPV testing in HIV-infected women in Russia and the inadequate gynecological cancer screening coverage of these patients require the elaboration of follow-up algorithms and the introduction of prevention programs.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):53-55
pages 53-55 views

Genetic characteristics of HIV and efficency of its sexual transmission

Kireev D.E., Pokrovskaya A.V.

Abstract

The risk of getting HIV through sexual contact is low; however, the contribution of this mode of transmission versus others to an epidemic outbreak is greatest. An understanding of the characteristics of the virus, which affect the efficiency of its transmission, will promote the elaboration of preventive and therapeutic approaches to declining the number of new cases of the infection. The review describes the results of investigations unveiling a number of important genetic features of HIV, which affect transmission efficiency.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):56-60
pages 56-60 views

A fixed-dose combination of abacavir/lamivudine as a nucleoside basis for first-line antiretroviral therapy regimens

Konnov V.V., Kozyreva N.V., Kanestri V.G., Narsia R.S., Yurin O.G.

Abstract

The review shows the comparative efficacy, safety, and tolerability of an abacavir/lamivudine combination in antiretroviral therapy regimens. Trials have indicated its virological efficiency equal to that of a zidovudine/lamivudine combination, including also that in patients with a high baseline viral load. At the same time, the patients taking abacavir were less frequently observed to have anemia, nausea, vomiting, which were common in those receiving zidovudine. The trials comparing the regimens using the fixed-dose combinations of abacavir/lamivudine and tenofovir/emtricitabine have demonstrated that the virological efficiency of abacavir-containing regimens used in patients with a high baseline viral load may be decreased. However, there are papers that refute this assertion. Abacavir hypersensitivity is a major serious adverse event. HLA В*5701 testing and abacavir use only in the presence of negative test results allow the manifestations of hypersensitivity to be prevented. Abacavir should be used with caution due to the discrepant data regarding the association between its intake and the higher incidence of myocardial infarction and cardiovascular diseases in patients at other risks for diseases of the heart and vessels. Abacavir/lamivudine regimens did not cause any significant metabolic disturbances or have a negative impact on lipid metabolism, renal function, and bone mineral density.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):61-66
pages 61-66 views

Development of the clinical classification of HIV infection

Yurin O.G.

Abstract

The paper considers the current classifications of HIV infection, which have been approved by the Ministry of Health of Russia, such as the Russian classification, the World Health Organization classification, the United States Centers for Disease Control and Prevention classification, and the International Classification of Disease, Tenth Revision. It describes the revisions of these classifications and analyzes their reasons, as well as differences in the classifications, their merits and demerits. The author concludes that there is a needfor another revision of the Russian classification and makes proposals for this revision, which are to be discussed by the National Research Society of Infectiologists.
Epidemiology and Infectious Diseases. Current Items. 2015;(1):67-74
pages 67-74 views

Vadim Valentinovich Pokrovsky

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Epidemiology and Infectious Diseases. Current Items. 2015;(1):75-76
pages 75-76 views

Irina Lvovna Shakhanina

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Epidemiology and Infectious Diseases. Current Items. 2015;(1):77-77
pages 77-77 views
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Meeting of the Public Coordinating Council for Pneumococcal Infection and Vaccination in Russia

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Epidemiology and Infectious Diseases. Current Items. 2015;(1):82-84
pages 82-84 views

On additional professional programs for advanced training in the specialty of disinfectology

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Epidemiology and Infectious Diseases. Current Items. 2015;(1):85-86
pages 85-86 views

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