Vol 11, No 4 (2021)

Objective. To analyze the prevalence and incidence of HIV infection among injecting drug users (IDUs) in the regions of the Siberian Federal District (SFD). Materials and methods. The authors analyzed the data available in Federal State Statistical Monitoring Forms No. 2, No. 4, and No. 61; the data of the Departmental Monitoring Form of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being; personalized data on all HIV infection cases detected in 1987-2019 in the regions of the SFD; and data from publications on the prevalence of HIV infection and parenteral hepatitis among IDUs who were followed up in narcological facilities. Results. As of December 31, 2020, a total of304,092people were diagnosed with HIV infection in the SFD; 76,568of them died. In 2018-2020, the highest rates of HIV infection and mortality in the Russian Federation were registered in the SFD: in 2020, the incidence rate was 78.0 per 100,000 population, which was almost twice the national average. Seven out of10 regions in the SFD had the highest rates of HIV infection in Russia. The proportion of IDUs among those tested for HIV remains low, but testing for HIV among drug users in the SFD revealed that HIV infection was detected 6 times more often than the average among the Russians. The narcological service data showed that in 2019 there were 41.3% of IDUs who were infected with HIV and 58% with hepatitis C. The risky sexual behavior of IDUs contributed to the active spread of sexually transmitted HIV infection. Conclusion. In 2020, the most difficult HIV epidemic situation developed in both the country and the SFD. In the whole SFD and in its 6 regions, there was a generalized HIV epidemic according to the WHO classification. In the SFD, the IDUs involved in the transmission of the infection both asexually and sexually have made their main contribution to the development of the epidemic in the last decade. The primary task of counteracting the HIV epidemic in the SFD is to ensure effective work in preventing, diagnosing, and treating this disease among IDUs and the general population.

Objective. To investigate the course of COVID-19 and approaches to its therapy in patients with HIV infection. Patients. Eighty-five HIV-infected patients with coronavirus infection were examined. Their median age was 39 years. Seventy-six patients received ART. All had HIV RNA < 50 copies/ml; the median number of CD4+ lymphocytes was 602.5 cells/pl. Nine patients did not receive ART; the median number of CD4+ lymphocytes was 342 cells/pl; the median HIV RNA was 69 915.5 copies/pl. Concomitant diseases were present in 22.4% of the patients. Results. The diagnosis of the disease was confirmed by the detection of SARS-CoV-2 RNA in the nasopharyngeal swabs (PCR) of 45patients and by the presence of anti-SARS-CoV-2 IgG in the blood samples of 45patients. The disease was moderate and mild in 25.9 % and 74.1%, respectively. The clinical symptoms were absent or were less noticeable in 20% of the patients. The patients had fever (82.9%), weakness (75%), anosmia (53.9%), dry cough (35.5%), and dyspnea (5.3%). Lung CT changes were recorded in 28 out of 38 patients (CT3 in 1). No therapy for coronavirus infection was performed in 24.7% of the patients. 6.25% of patients received antiviral therapy; 15.6% took hydroxychloroquine in combination with antibacterial therapy (ABT); 75% had ABT; 21.9 and 4.9% used anticoagulants and corticosteroids, respectively. Conclusion. Coronavirus infection was mild in 3/4 of the patients with HIV infection, asymptomatic or subtle in 20%, which was probably due to the regular follow-up of this patient category, to effective ART in 89.4%, to the young age of patients, and to the absence of concomitant diseases in most patients.

Objective. To compare different methods for detection of point nucleotide mutations in the study of SARS-CoV-2 genetic diversity. Materials and methods. The study was conducted on a batch of samples from patients, which contained SARS-CoV-2 genetic material. The investigators used three methods (Sanger sequencing/fragment analysis, real-time PCR, and loop-mediated isothermal amplification) as the gold standard. Results. Genotyping-by-sequencing analysis was carried out to examine 372 samples from patients; 54, 7, and 25 samples were found to belong to the Alpha, Beta, and B.1.1.523 genetic variants, respectively. It was shown that both the real-time PCR method and loop-mediated isothermal amplification could be employed to detect SARS-CoV-2 N501Y mutation, by using various samples, including those for various (Alpha, Beta) genetic variants. Conclusion. The use of PCR-based screening methods makes it possible not only to reduce the economic and time costs of genotyping SARS-CoV-2 samples, but also to increase study coverage, by obtaining results for the samples unsuitable for sequencing.

Objective. To evaluate the efficacy and safety of switching HIV-infected patients who have previously received the standard triple ART regimen to a dual (DTG and 3TC) regimen during 96 weeks. Subjects and methods. The study enrolled 231 HIV-infected patients with their experience in treatment. The patients were randomized into 2 groups: 1) those, who were switched to the DTG + 3TC regimen and 2) those, who continued to receive the standard triple ART regimen. The groups were equal in terms of sex, age, routes of transmission, stages of HIV infection, baseline immune status, duration of previous ART, and the proportion of patients with concomitant diseases. All the patients had an undetectable baseline viral load (VL). Results. The DTG + 3TC regimen in patients with their previous stable treatment experience showed a comparable high efficacy of both the standard 3-drug therapy. At week 96, 100% of the patients had an undetectable VL (< 50 copies/ml). During the treatment, there was no virological failure. All the patients who reached the 96-week point showed a high adherence to therapy (> 95%). At the endpoint of the study, clinical adverse events associated with ARVagents were recorded in 2.8% of patients in Group 1 and in 15% in Group 2. In all cases, the side effects were mild and required no drug correction; however, they were the reason for modifying the standard triple therapy regimen in 6.9% of patients. Minor laboratory deviations of the main biochemical parameters were observed in both groups with the same frequency. When switching to the dual ART regimen without TDF, there was no substantial effect on the lipid profile, a significant double decrease in the proportion of patients with a GFR of < 90 ml/min, and alkaline phosphatase normalization in all the patients. During 96-week treatment, the patients’ median weight increased by only 0.9 kg, which was 5 times less than with standard ART. Conclusion. In the patients with their therapy experience, the simplified DTG + 3TC regimen is as effective as the standard ART regimens, but significantly exceeds them in tolerance and safety.

Objective. To carry out correlation analysis of the results of a questionnaire survey of people living with HIV and to define indicators for predicting the risks of non-adherence to follow-up and treatment of HIV infection. Subjects and methods. In 2019-2020, a study, one of its stages was a direct written questionnaire survey, was conducted in 2 regions of the Russian Federation (the Republic of Tatarstan and the Leningrad Region). Group 1 consisted of161 patients interviewed in the Republican Center for Prevention and Control of AIDS and Communicable Diseases, Ministry of Health of the Republic of Tatarstan; Group 2 included 166 patients asked in the Leningrad Regional AIDS Center (Saint Petersburg). The respondents were offered a 10-point scale to rate their health status, the ability and willingness to take care of their health, as well as the readiness to visit a physician and to receive ART. Results. Group 1 respondents rated their health status as 3 to 10points (Me, 9.0 [8.0; 10.0] points), the ability to take care of their health as 1 to 10points (Me, 9.0 [8.0; 10.0] points), the readiness to take care of their health as 0.5 to 10points (Me, 9.0 [9.0; 10.0] points). 88.1% of the respondents defined their readiness to take care of their health as 8 or more points. Group 1 rated the readiness to visit a physician and receive ART as 5 to 10points (Me, 10.0 [9.0; 10.0] points). 91.9% of the respondents reported a high readiness. Group 2 respondents rated their health status as 3 to 10points (Me, 7.5 [5.5; 9.0]points). 42.4% gave a point of 8 or more; 24.2% had 5 or less points. The ability to take care of their health was defined as 1 to 10points (Me, 5.5 [3.5; 9.1] points), the readiness to take care of their health was as 0.5 to 10points (Me, 9.5 [8.4; 9.5]points), the readiness to visit a physician and to receive ART as 5 to 10 points (Me, 9.5 [9.0; 10.0)] points). Both groups showed a statistically significant regularity: the higher the self-assessment of their health, the higher the readiness and ability to take care of the latter on their own. The same pattern was observed for the willingness to visit a physician and to receive ART. Self-assessment of health status in both groups did not depend on gender, age, education, marital status, and length of life with HIV. Conclusion. Self-assessment of the health status can be a simple tool that will optimize the tactics of managing a patient in terms of attracting and retaining him at follow-up and effective therapy, and saving the resources of healthcare professionals.

Objective. To study the prevalence of N. gonorrhoeae, C. trachomatis, M. genitalium, T. vaginalis, and T. pallidum in three anatomical loci during out-of-hospital examination of at-risk men and women [males who have sex with males (MSM); commercial sex workers (sex workers (SW)]. Subjects and methods. The investigation enrolled 202 at-risk representatives who lived in Moscow and the Moscow Region. Real-time PCR was used to determine the causative agents of sexually transmitted infections (STIs) in the biomaterial of females (scrape/swab from the cervical canal, oropharynx, and anus) and males (primary urine sample, scrape/swab from the oropharynx and anus). Results. The out-of-hospital examination showed that the incidence of STIs in at-risk patients was 43.6%. The highest prevalence of STIs was observed in the HIV-infected and non-HIV infected MSM (HIV/MSM and non- HIV/MSM) (54 and 44%, respectively) and the less frequent prevalence was seen in female SWs (29.2%). Regardless of the anatomical locus, the detected STI pathogens included C. trachomatis (19.3%), N. gonorrhoeae (14.9%), M. genitalium (13.9%), T. pallidum (4%), and T. vaginalis (1%). Extragenital (rectal and/or oropharyngeal) STIs were more common (70%); genital STIs were noted in 7.1%; genital concurrent with extragenital STIs were recorded in 22.9%. Extragenital STIs were more often detected among HIV/MSM(79.4%) and non-HIV/MSM (75.0%). The SW group exhibited a concurrence of genital and extragenital STIs more frequently (50%). Conclusion. The high prevalence of STIs in at-risk patients necessitates the introduction of new algorithms for their examination, in particular, biomaterial collection from three anatomical loci for PCR.

The paper presents the successful experience with a dual (lopinavir/ritonavir + lamivudine) ART regimen in a 60-year-old patient with newly diagnosed HIV infection in the presence of polyvalent allergy and multiple comorbidities. This 4-year regimen has shown good tolerance, therapeutic remission of HIV infection, and HIV suppression. Immune system functions were restored. Taking into account the increase in the number of patients receiving ART, including the elderly with various comorbidities, it has been justified to incorporate simplified dual ART regimens in the protocols and to introduce them into clinical practice for certain groups of HIV-infected patients.

The Italian Republic was one of the most affected countries with the novel coronavirus infection in March 2020. As a demonstration of solidarity in the fight against the novel infectious disease, the Russian Federation sent its specialists to the Lombardy Region at the center of the epidemic. Objective. To analyze the use of forces and means of the medical service of the Russian Federation’s Armed Forces together with the specialists of the Min istry of Health of Russia and the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being on the territory of the foreign state in the context of the global spread of the novel coronavirus infection. Subjects and methods. The experience with sanitary-anti-epidemic (preventive) and treatment-and-prophylactic measures was analyzed in the Field Hospital of the Association of Alpine Shooters at the FIERA DI BERGAMO’s Exhibition Center in Italy in the context of the COVID-19 pandemic. The work was done by 8 doctor-nurse teams, each of which included an epidemiologist, an anesthesiologist/resuscitation specialist, a general practitioner, and an intensive care nurse (a total of 32 specialists). Results. During their work in the field hospital, the Russian healthcare professionals treated 115 local residents with severe SARS- CoV-2; 76 of them were discharged after recovery, before returning to their homeland, the Russian specialists referred the remaining patients to Italian colleagues to continue their treatment. Conclusion. The work of physicians and nurses as part of the joint detachment of the Russian Federation’s Armed Forces in Italy made it possible to exchange experience with anti-epidemic measures in the localization and elimination of the consequences of the COVID-19 pandemic and the management of patients with this disease.

The paper deals with the anniversary of the Department of Epidemiology and Evidence-Based Medicine, F.F. Erisman Institute of Public Health. I.M. Sechenov First Moscow State Medical University. It presents modern achievements of the Department and the fragments of memoirs of Academician of the Russian Academy of Sciences, Professor Valentin Ivanovich Pokrovsky, who headed the department for many years.