Том 10, № 3 (2020)

The author compares pandemics caused by human immunodeficiency virus (HIV) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) using the previously proposed classification of infections, which is based on their different impact on main demographic indicators, such as mortality, fertility, life expectancy, and working capacity of the population. The HIV pandemic leads to deteriorating all of the above indicators, whereas the spread of SARS- CoV-2 only results in temporary disability and a slight reduction in the average life expectancy due to premature deaths in elderly people with chronic diseases. Although public attention is focused on the coronavirus, HIV infection poses a more serious demographic and economic threat to the population of Russia, since over the past 5 years it has been first diagnosed in more than 400,000 Russian citizens, whereas the total number of Russians living with HIV has exceeded 1,000,000. According to the Russian Federal State Statistics Service, HIV infection was named the main cause of death for more than 4% of able-bodied Russians who died in 2018. The HIV-positive residents of Russia who died in 2018 accounted for more than 8% of all the Russians who died at working age. In this connection, the paper discusses the problem of postmortem diagnosis, taking into account a variety of diseases associated with HIV infection. The author analyzes the contents of articles in this issue of the journal, which are devoted to HIV infection surveillance and treatment, and urges to activate preventive measures and to make health care better for Russians living with HIV.

Objective. To investigate the prevalence of HIV infection among people with no fixed abode (homeless persons) in Moscow and to assess the behavioral risks of infection and the possibility of their receiving medical care if they are HIV-infected. Materials and methods. An anonymous survey was conducted using a specially designed questionnaire and HIV antibody assays, by applying a rapid test for the qualitative detection of HIV antibodies in the paragingival fluid samples of 370 homeless people. Results. Most of the respondents were men (74.3%); the mean age was 45.7 years. The prevalence of HIV infection among the homeless people was 3.8%. Among HIV- infected respondents, 62.5% reported having a history of injecting drug use. Almost half(44.8%) of the respondents had sexual intercourses, but did not use a condom. Only 5 out of 14 people with previously diagnosed HIV infection received full medical care. Conclusion. The prevalence of HIV infection among the study homeless people exceeded the rate among the general population of the Russian Federation, but it was lower than that in other key groups at risk for HIV infection. It is necessary to introduce prevention programs for safe sexual behavior and condom distribution among homeless people. It is advisable to develop measures to ensure that the patients of this group have access to medical care for HIV infection.

Objective. To investigate male and female sociodemographic characteristics and their impact on access to medical services for HIV infection in 7 countries of Eastern Europe and Central Asia (EECA). Subjects and methods. The multicenter cross-sectional study with a retrospective model covered 12,500patients over 18 years of age in 7 EECA countries. The total study period was from 2014 to 2018. Results. In the population of people living with HIV, EECA showed a preponderance of males who experienced intravenous drug use. Females were more often infected sexually and were diagnosed at a younger age and in the early stages of the disease; in them the virus could be more frequently suppressed during treatment. The lower male adherence to follow-up and treatment is probably due to the prevalence of drug dependence and to their more active participation in the migration processes characteristic of the region. Most of the study participants were employed (63%), married (62%), and had dependent minor children (52%). Conclusion. In general, the people living with HIV represent an economically and socially active part of the population and participate in demographic processes. To maintain and improve their quality of life is one of the priorities of healthcare.

The number of deaths from HIV/AIDS in the world has decreased by 56% versus 2004. This is due to an increase in antiretroviral therapy (ART) coverage and to a decline in the incidence of HIV infection. Objective. To study trends in HIV -related mortality in the Russian Federation in 1987-2018. Materials and methods. The paper analyzes personalized data on the number of deaths among HIV-infected patients in the Russian Federation in the period from 1987 to 2018; data of federal state statistical observation forms Nos. 4, 2 and 61; those from the departmental monitoring form of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, and the results of a special study of the causes of death among HIV-infected patients. Results. In Russia, the HIV infection mortality rate per 100,000population increased from 0.1 in 2000 to 14.0 in 2018. It was highest among urban male residents (22.8 per 100,000population in 2018). HIV infection is responsible for premature deaths (the patients die at an average age of 38.9 years); therefore, it has a perceptible impact on demographic processes in the Russian Federation. In this country, 318,870 HIV-infected people (24.0% of the registered patients) died during the entire follow-up period by the end of 2018. In 2018, HIV-related disease is a cause of death in 20,597Russians, which accounted for more than half of all deaths from infectious diseases. Among the HIV-infected individuals, the total number of deaths from all causes is almost twice as many deaths due to HIV infection; a total of 36,868patients died in 2018. HIV infection was one of the main causes of premature death in young people, especially in women: in 2018, the HIV-infected people accounted for 21.7% of the women who died at the age of 30-34years. Among those who died at working age in 2018, HIV infection was a cause of death in 4.9% of the Russians whereas all dead HIV-infected people accounted for even 8.8%. In 2018, the coverage of HIV-infected Russians with ART was low (58.9% of those registered at the dispensary, 42.3% of those living with HIV). Conclusion. The reasons why HIV mortality rates are higher in the population of the Russian Federation are, with the increasing prevalence of the disease, which is insufficiently limited by preventive measures, a set of factors associated with the shortcomings of the organization of healthcare for HIV-positive citizens, which lead to the incomplete coverage of effective ART among people living with HIV. If the further spread of HIV is not halted and if ART is widely and effectively used, the contribution of HIV infection to premature deaths will constantly increase.

Objective. To investigate approaches to identifying and recording an AIDS case and the causes of death in HIV-infected patients in the Russian Federation. Materials and methods. The authors compared the approaches of the WHO, the Centers for Disease Control and Prevention (CDC, USA), the European Center for Disease Prevention and Control (ECDC), and the Russian Ministry of Health to determining a case of AIDS and the cause of death in HIV-infected patients. The Instruction Manual for ICD-10, the guidelines of the Ministry of Health of Russia, and instructions for filling out federal state statistical observation No. 61 «Information on infectious and parasitic diseases» were studied. Personalized data on AIDS cases and on death cases among HIV-infected patients in Russia in 2018, which had been submitted to the Federal Research and Guidance Center for AIDS Prevention and Control, were analyzed. The case histories of 3333 HIV-infected patients with Stages 4B-4C (AIDS), who had been treated in Infectious Disease Clinical Hospital Two (IDCH-2), Moscow Healthcare Department, in 2014-2015, and data on 4145 HIV-infected patients with Stages 4B-4C (AIDS) from the specialized units of IDCH-2 in 2016-2017. Autopsies were performed in the morbid anatomy unit, IDCH-2; their results were used to estimate the incidence of secondary diseases in 892 HIV-infected patients who died in 2016-2017. Results. The investigation revealed that territorial AIDS centers had a significant frequency of a generalized HIV infection diagnosis formulated at the stage of secondary diseases, without specifying the cause, which determined the stage of AIDS; in case of a fatal outcome, the final diagnosis was formulated, without reasonably determining the leading secondary disease and the immediate cause of death in the patient, which is partly due to the imperfection of ICD-10 and often to the lack of a reliable definition of the etiological cause of secondary disease and death. There was a substantial difference in the incidence of secondary diseases in patients with AIDS diagnosed in the territorial AIDS centers and in those who had undergone inpatient treatment and examined using modern diagnostic methods in IDCH-2 for late-stage HIV infection. There was a considerable difference in the incidence of a number of secondary diseases as causes of death in HIV-infected patients according to the reports from the territorial AIDS centers and to the reliably established causes of death in patients from the data obtained from the morbid anatomy unit, IDCH-2. Conclusion. The clear logic of the diagnosis, the definition of the underlying and concomitant diseases, the correct coding of diseases and their corresponding registration are a prerequisite for the clinical process, a guarantee to successful medical efforts, as well as the correct planning of further organizational actions to improve the quality of medical care for HIV-infected patients.

Objective. To investigate the quality of antiretroviral therapy (ART) among patients in the Russian Federation. Materials and methods. The paper analyzes the data on ART, which were obtained from all subjects of Russia in the period of2008-2018 during a special study and from the reporting forms of the Ministry of Health of Russia and the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being. Results. In the period of2008-2018, ART coverage for people living with HIV increased from 10.9 to 38.4%. By the end of 2018, the viral load was below the detection threshold in 73.2% of those receiving ART, which was less than its target value (90%). The proportion of patients starting ART with a CD4+ lymphocyte count of <200cells/pl decreased from 43.6% in 2008 to 16.6% in 2018. That of patients receiving ART regimens including non-nucleoside reverse transcriptase inhibitors rose from 40.1% in 2013 to 68.1% in 2018. Among the patients who initiated ART in 2018, by the end of the year 17.5% stopped it (of them 46.4% did due to death). Of the remaining on ART, its regimen was changed by 20.7% (of them, 40.8 and 19.8% did because of side effects and its inefficiency, respectively). Conclusion. The problem of insufficient ART coverage and late initiation remains relevant. The frequency of ART discontinuation and treatment interruptions remains high. It is expedient to use drugs with a high resistance barrier and good tolerance when starting ART.

Objective. To study the awareness of Russian HIV-infected patients about a pre-exposure prophylaxis (PrEP) procedure and the assessments of prospects for its application and to clarify their attitude to the latter. Materials and methods. The study enrolled 96 patients infected with HIV. The investigators used a semistructured interview that included indicators as open and closed questions, the answers to which could clarify the sociodemographic characteristics of the study participants and their awareness about prevention of HIV transmission. Results. At the time of the interview, 61% of the respondents were unaware of the existence of the PrEP method. 16% ofthe respondents having discordant partners noted that they did not use HIV prevention methods. Most (77%) of the respondents expressed a positive attitude to the PrEP procedure; 10% reported that they did not think about this. 47, 29, and 24% assessed PrEP positively, doubtfully, and negatively respectively. The Internet was a primary source of information on PrEP for respondents; only 8% learned about the method from health workers. Conclusion. It is advisable to monitor the risk of HIV transmission, by assessing the time course of changes in the characteristics of the risk behavior of patients who are followed up and receive ART. Emphasizing the cause-and-effect relationship between adherence to physician recommendations and a lower risk of HIV transmission during adherence counseling enhances the ability to shape a desirable behavior in patients. To promote this prevention method, it is necessary to elaborate a PtEP algorithm, in the structure of which a significant place should be given to information and advice on reducing the risk of HIV transmission.

The paper reviews the results of recent studies that establish a relationship between body weight gain in patients and use of drugs from the HIV integrase inhibitor (II) group. Over 60 years of age, female sex, African or Hispanic ethnicity, use of dolutegravir (mostly when combined with tenofovir alafenamide (TAF) versus other IIs/protease inhibitors (PIs)/nonnucleoside reverse transcriptase inhibitors (NNRTIs), as well as antipsychotic medication intake, low baseline CD4+ lymphocyte counts, and a high viral load were associated with large body weight gains or body mass index (BMI) changes. Body weight gain in patients during antiretroviral therapy (ART) increased the risk of developing type 2 diabetes mellitus and cardiovascular diseases. The impact of using a second-generation NNRTI (such as doravirine) as part of a first-line ART regimen was comparable to that of the ART regimens including PI or efavirenz (EFV). Further investigations are needed to clarify the influence of individual factors and their combination on BMI and a risk for somatic diseases.

The paper presents materials on the features of a number of opportunistic diseases that still occur rarely in Russia, which are registered in the country or can be imported from endemic regions. The findings will assist physicians caring for HIV- infected patients in diagnosing and treating difficult cases.