Vol 11, No 3 (2021)

The author discusses the current situation and the problems associated with the spread of human immunodeficiency virus (HIV), as well as modern strategies to counter its epidemic. Different agencies are shown to apply different approaches to estimating the number of people living with HIV(PLHIV) in the Russian Federation. If 1,104,768 PLHIV were detected at the end of2020 to have anti-HIV antibodies conf irmed by a specif ic immune blotting test, 7,889,382 or 799.7thousand PLHIV were under regular medical check-up, as evidenced by various official sources. Can both the indicators themselves and the difference between them be used to assess the situation? Thus, reports on the registered cases of anti-HIV antibody identification made it possible to establish that the HIV infections cases detected in 2020 were associated with heterosexual contacts (64.9%), intravenous drug abuse (31.1%), and sexual contacts among men (2.8%); and this indicates that HIV is spreading in all population groups. The difference between the number of people who are found to have anti-HIV antibodies and those who are followed up are about 30%, and only 75% of those who are followed up receive treatment, which hinders the achievement of the indicators of the examine-and-treat strategy, which requires 99.3% of all the funds spent in Russia for HIV control. This approach to combating HIV infection leads to the fact that the epidemic will continue in the next 10 years, and the number of HIV-infected Russians will grow, and this will result in further demographic and economic losses. The prognosis can be better due to the introduction of proven anti-epidemic measures.

Objective. To investigate the impact of the novel coronavirus infection (COVID-19) epidemic on the provision of health care for HIV infection and the prevalence of COVID-19 among people living with HIV (PLHIV). Materials and methods. The investigation was conducted using an anonymous survey on the Internet from July 08 to 31, 2020. The responses of590 HIV-positive respondents and 262 HIV-negative ones were an investigation object. Results. The COVID-19 pandemic demonstrated a negative impact on the provision of health care for HIV infection in the Russian Federation; however, the size of this problem was not as large as expected. Among PLHIV on antiretroviral therapy (ART), 70.5% reported that they had no problems in receiving antiretroviral drugs (ARVDs). 4.1% missed ARVDs due to the inability to get them at the AIDS center. Symptoms characteristic of COVID-19 were present in the majority of PLHIV (55.3%); while 52.7% of the HIV-negative respondents were examined for COVID-19, as were only 28.1% among PLHIV. Among PLHIV, 23.5% were found to have markers for COVID-19 (95% CI, 17.5-30.7). Among the HIV-negative respondents, 6.5% were positive for COVID-19(95% CI, 2.9-10.9). 41.4% of PLHIV reported COVID-19 to the AIDS center. The majority of PLHIV respondents who had experienced coronavirus infection were men (51.3%), those who were aged 35-44years (71.8%), and had a long life experience with HIV. The respondents predominantly reported that their condition was moderate during COVID-19. Conclusion. The investigation showed the negative impact of the COVID-19 pandemic on the provision of health care for HIV infection in the Russian Federation, but the majority of respondents who identified themselves as PLHIV reported that they had no problems in receiving ARVDs. Among the study participants, those who identified themselves as HIV-infected were probably more susceptible to COVID-19 than respondents who identified themselves as HIV-negative. In the presence of symptoms characteristic of COVID-19, PLHIV were 2 times less likely than HIV-negative respondents to be examined for coronavirus infection and less likely to seek medical advice.

Objective. To study the level of awareness about HIV infection and attitudes regarding behavior in the context of preventing HIV infection in persons with no fixed abode (homeless). Subjects and methods. An anonymous survey of 370 homeless people was conducted using a specially designed questionnaire. Results. 79.5% of the respondents obtained information about HIV infection from the mass media (radio, television, newspapers). The information got from the mass media, as well as from physicians and friends, did not affect the level of knowledge about HIV infection in homeless people. The correct answer was given by 33.0% of the respondents on the routes of infection. The level of knowledge about HIV infection in the homeless people is lower than that in the representatives of other risk groups. The number of correct answers was established to depend on the respondents’ age. The level of knowledge about HIV infection was shown to be higher among the homeless people who had been previously examined for anti-HIV antibodies. Conclusion. Actual pre- and post-test counseling in medical practice and assessment of its quality require additional study and elaboration of new approaches to improving its effectiveness.

Objective. To evaluate antiretroviral therapy (ART) in Russia and the measures necessary for its performance to follow up patients. Materials and methods. Data on ART in Russia, which had been obtained from literary sources, 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, were analyzed. Results. ART has been performed in Russia since 1987, first according to monotherapy regimens; since 1996, individual patients have begun receiving treatment according to highly active ART regimens. Since 2006, this regimen has become widely available. During the period 2008-2020, the number of people living with HIV increased by 2.5 times, so did the number of patients who were under regular medical check-up, while the number of people receiving ART increased by 17.2 times. As a result, the follow-up coverage of patients practically did not change, amounting to an average of 75%. At the same time, the ART coverage of HIV-infectedpatients increased from 8% in 2008 to 53% in 2020. Whereas 30.6% of the patients with detected HIV infection did not regularly go through medical check-up, and taking into account the patients who did not show up to examination that year, as well as those who did not undergo a CD4+ lymphocyte count test, the healthcare system has no data on the health status of 36.7% of the alive registered HIV-infected patients or 11.4% of the patients followed up. 47% of the people living with HIV did not receive ART; and the same is true for 16.6% of those regularly going through medical check-up. Conclusion. Despite a substantial increase in the number of patients receiving ART, the problem of insufficient coverage of HIV-infected patients by follow-up, laboratory examination for immune status, and viral load, as well as ART remains relevant.

Objective. To analyze factors that can lead to non-adherence to follow-up and treatment, as well as the readiness ofpatients to visit specialists and to be treated for HIV infection. Subjects and methods. The investigation was conducted using the questionnaire method. Group 1 included 166 HIV-infected patients (91 men and 75 women) who were followed up in the Leningrad Regional Center for Prevention and Control of AIDS and Communicable Diseases. Group 2 consisted of 161 patients (84 men and 77 women) living with HIV who were followed up in the Republican Center for Prevention and Control of AIDS and Communicable Diseases, Ministry of Health of the Republic of Tatarstan. The median age in both groups was 39.0 [34; 45]years. Results. The risks of non-adherence were reported by 54.8% and 55.8% of the respondents in Groups 1 and 2, respectively. The risks associated with work were most significant in both groups (36.2 and 34.5% of the responses). The risks caused by the organizational features of providing care for HIV infection were more often called in Group 1 (p = 0.005); forgetfulness was in Group 2 (p = 0.006). An analysis of the self-assessment of readiness to regularly visit a physician and to take antiretroviral therapy (AR T) indicated that in Group 1, the median score was 9.5; 81.3% of the respondents stated their high readiness (more than 8 scores). In Group 2, the median score was 9.0; 91.9% of the respondents showed their high readiness. Conclusion. The risks usually associated directly with the convenience of taking ART and its tolerability seem to manifest themselves indirectly through the compliance of the follow-up and disease treatment regimens with lifestyle and labor activity. Each case of detecting the low indicators ofpatients’ readiness to visit a doctor and to take ART requires additional counseling, and the low readiness indicators themselves can be an indicator of risk in terms of maintaining adherence to follow-up and treatment for HIV infection.

Objective. To study changes in the indicators of test coverage, prevalence, and successful treatment of multidrug-resistant tuberculosis (MDR-TB) among HIV-infected patients in the CIS countries in the period of2010-2018. Materials and methods. Epidemiological data were analyzed in the Republic of Azerbaijan, the Republic of Armenia, the Republic of Belarus, the Kyrgyz Republic, the Republic of Tajikistan, and the Vladimir Region of the Russian Federation. The data sources were national cases databases, state data registers, departmental statistical reports, the data of phthisiological services and state statistical services, as well as regular reports submitted by the countries to the WHO and UNAIDS. Results. The cumulative assessment of changes in the number of all registered cases in the countries over the period of 2010-2018 suggests that there may be an increase in the number of patients with MDR-TB. During the study period, the coverage of the population by drug susceptibility testing (DST) for the pathogen gradually increased; however, the rate of coverage growth did not always correspond to the increase in the absolute number of incident MDR-TB cases. As this took place, DST was carried out for all incident TB cases in the Republic of Belarus and in the Vladimir Region. A comparison of HIV/TB cases and all TB cases showed that the pathogen resistance as a minimum to rifampicin (RR-TB) was more common in patients with HIV/TB co-infection. The success rates of MDR-TB treatment in HIV-infected patients still significantly lag behind those in drug-susceptible TB (DS-TB) and show no considerable changes during the follow-up period. Conclusion. The detailed analysis of the prevalence of MDR-TB among the people living with HIV is of great prognostic importance for assessing the epidemic situation as a whole, calculating the funding of TB control programs, and improving the control over the disease and the eff iciency of treatment.

Objective. To evaluate the effectiveness and safety of a 96-week Russian ART regimen, including phosphaside (P-AZT), lamivudine (3TS), and elsulfavirine (ESV), used in HIV-infected patients who have not previously received therapy. Subjects and methods. The investigation enrolled 98 HIV-infected patients who had not previously received ART. As of April 1, 2021, 90, 80, and 72patients completed 24-, 48- and 60- week treatment, respectively. The investigation is being continued. 73.5% of the patients were men. The patients’ age ranged from 22 to 70 years (the median age was 35years). Before starting therapy, the median CD4+ lymphocyte count was 449 cells/pl; the immunoregulatory index (CD4/CD8 lymphocyte ratio) was equal to 0.458. The median HIVRNA was 15,286 copies/ml. Results. At 4 and 12 weeks after starting ART, the patients with a HIV RNA level of < 50 copies/ml were 45.9% and 80%, respectively. At 24, 48, and 60 weeks, the patients achieved undetectable HIV RNA levels in 95.4%, 100%, and 95.3%, respectively. After 24, 48, and 60 weeks of the investigation, the increase in the median CD4+ lymphocyte count was 62, 173, and 190 cells/pl, respectively. The median immunoregulatory index was recorded to increase up to 0.828 at 60 weeks of ART. The tolerability of the ART regimen was good: 92.5-95% of the patients noticed no therapy-related adverse events (AEs). At the beginning of therapy, most of the AEs were generally found to be mild and to require no correction of the treatment regimen or the use of additional therapy. Conclusion. The Russian combination of drugs, including P-AZT + 3TS + ESV, was highly effective and safe during 60-weeks treatment in HIV-infected of patients who had not previously received ART. The use of ESV in combination not only with TDF and FTC, but also with P-AZT and 3TS can be recommended in the first-line ART regimens.