Vol 13, No 1 (2023)

The paper describes the history of identifying child-to-mother transmission of HIV at breastfeeding during the nosocomial outbreak of HIV infection in the south of Russia in 1988–1989 and discusses the consequences of this outbreak

Objective. To assess the incidence of hepatitis B (HB) and C (HC) and its trend in the Far Eastern Federal District (FEFD).

Materials and methods. The authors used data on the incidence of HB and HС in Federal Statistical Observation Form No. 2 «Information on infectious and parasitic diseases» and state reports «On the state of sanitary and epidemiological well-being of the population in the Russian Federation» over 2014–2020.

Results. The incidence of acute HB and HC (AHB and AHC) in the FEFD in 2020 turned out to be twice less than the average Russian values: 0.15 cases of AHB and 0.39 cases of AHC per 100,000 population, while it in the Russian Federation was an average of 0.35 and 0.66 per 100,000 population, respectively. The trend in the incidence of AHC was shown to be correlated with a decrease in the incidence of drug addiction in the FEFD. The overall incidence of chronic HB in the FEFD was slightly higher than that detected in the Russian Federation (5.06 versus 4.36 per 100,000 population). There were no significant differences between the incidence rates of CHC in the FEFD and in the Russian Federation: the rates were 16.82 and 16.70 per 100,000 population, respectively. A reduction in the incidence of HB and HC in 2020 was noted in both the FEFD and in the whole of the Russian Federation.

Conclusion: It is necessary to continue monitoring the incidence of contact HB and HC, the decline in which in 2020 was likely to be temporary due to the redistribution of the forces of healthcare to combat COVID-19.

Objective. To analyze morbidity and mortality from malignant neoplasms (MNs) of the reproductive system organs in men and women aged 15 to 39 years in the Russian Federation due to the fact that improving demographic indicators is a priority in the development of medical science in Russia.

Subjects and methods. The authors analyzed official cancer statistic data in Russia over 2008–2020. The analysis included individual MNs of the reproductive organs in people aged 15 to 39 years. Morbidity and mortality rates from MNs of the reproductive organs were calculated in this age group; the corresponding confidence intervals are presented.

Results. The investigation revealed an increase in morbidity and no decline in mortality from MNs of the reproductive system organs among young men and women from 2008 to 2019; since 2020 there has been a decrease in morbidity and mortality, which may be associated with the COVID-19 pandemic. The highest indicators were found in the group of 30–39 years. The incidence rates were in aggregate higher in the women than in the men of all age groups.

Conclusion. The study emphasizes the necessity of developing and optimizing measures to prevent reproductively significant cancers in the adolescent and adult populations.

Objective. To study the time course of changes in the coverage of testing for HIV antibodies in the Russian Federation and in the structure of the surveyed contingents.

Materials and methods. The authors analyzed the data of Form No. 4 of the Federal Statistical Observation «Information on the Results of Blood Test for HIV antibodies», which contained the results of testing for HIV antibodies for the period 2011–2021.

Results. In the last 10 years, there has been an annual increase in the coverage of testing for HIV antibodies in the resident population of the Russian Federation from 17.3 to 27.8% of the average annual population of the country. The number of new-onset HIV infection ranged from 332.1 per 100,000 population in 2011 to 427.7 in 2015, and then decreased to 224.5 in 2021. At the same time, the proportion of people belonging to vulnerable population groups (drug users; men who have sex with men; prisoners; patients with sexually transmitted infections) decreased from 6.5% in 2011 to 3.1% in 2021. HIV infection was detected 10-27 times more often in the vulnerable groups than in the general population. The reference study revealed 91,169 positive results in the immune blot or PCR in those tested for HIV, which was 3.4% more in 2021 than in 2020. The population was 14.7% more frequently tested for HIV in 2021 than in 2020, that is, the testing coverage rate in Russia in 2021 returned to that in 2019. The women accounted for 54.6% of those tested in 2021; however, HIV infection was almost 2 times more commonly detected for the first time in men (302.7 HIV-positive ones per 100,000 surveyed) than that in women (157.1).

Conclusion. The HIV testing coverage rate is high in the Russian Federation, since 2016 there has been a trend towards a decrease in the detection rate of new HIV infection cases that are registered much more frequently among the vulnerable groups than in the general population, but the proportion of these groups among all those tested for HIV is insignificant and continues to decline.

Objective. To identify the spectrum of central nervous system (CNS) lesions, by determining the detection rate and quantitative characteristics of the DNA of the causative agents of neuroinfections and RNA of the human immunodeficiency virus (HIV) in the cerebrospinal fluid (CSF) of inpatients with HIV infection.

Subjects and methods. Clinical observations were conducted in 5485 inpatients with HIV infection and their case histories were analyzed. Of these, 3333 patients had Stage 4B AIDS; 1310 patients had CNS lesions. The patients underwent contrast-enhanced brain MRI and diagnostic lumbar puncture. A total of 1667 CSF samples were studied using real time RT-PCR with the qualitative or quantitative determination of secondary disease pathogen DNA and HIV RNA. The reagent kits made by the Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, were used. The authors applied Statistica version 10.0 and SPSS version 20 statistical software packages, R was a programming language. Associations were examined by making a contingency table analysis using Pearson’s χ² test. The significance level for the tested statistical hypotheses was taken equal to 0.05.

Results. The paper presents the quantitative measures of blood and CSF HIV RNA. Statistically significant associations were found between the blood and CSF HIV RNA levels. CNS lesions as encephalitis, meningoencephalitis, or meningitis were diagnosed in 1310 patients with HIV infection (23.8% of the total number of inpatients, 39.3% of those having Stage 4B AIDS, and 62.7% among the deceased). Among the patients with CNS lesions, there was a significant proportion (53.7%) of cases having encephalitis of unclear etiology. The presence of CSF neuroinfection pathogen DNA and HIV RNA were shown to have a high diagnostic sensitivity and the etiological role of the pathogen could be excluded in the absence of CSF. The qualitative detection of the DNAs of T. gondii, M. tuberculosis, C. neoformans, and human polyomavirus 2 (JCPyV) was shown to have a high diagnostic specificity. On the contrary, the fact of detecting the DNAs of cytomegalovirus, Epstein-Barr virus, human herpes virus type 6 (HHV-6 A/B type), fungi of the genus Candida, and HIV RNA was insufficient to confirm the etiological role of these pathogens in brain lesions. A wide CSF concentration range of these pathogens was established.in HIV-infected patients.

Conclusion. The absence of neuroinfection pathogen DNA and HIV RNA in the CSF excludes the corresponding etiology of brain damage. Detection of CSF T. gondii, M. tuberculosis, C. neoformans, or JCPyV DNAs confirms the nature of encephalitis. Quantitative determination should be used when examining CSF for EBV, CMV, HHV-6A/B, and Candida fungi DNAs and HIV RNA,

Objective. To develop a mathematical model for the epidemic process of infection caused by Epstein-Barr virus (EBV), to forecast the effectiveness of potential immunization strategies, and to identify optimal vaccination contingents.

Materials and methods. A compartmental model was developed, which took into account all currently known features of EBV infection. The adequacy of the model was proved by comparing the obtained parameters with statistical indicators.

Results. The spread of EBV was minimal in a group of children under 1 year of age (37,3%) and maximal in that of persons aged 18 years and older (75%). The increased spread was accompanied by a decrease in the proportion of EBV-susceptible individuals from 62,7 to 25%. Potential vaccination will be able to reduce EBV spread among the population in the next 80 years, but not to eliminate the pathogen. The optimal populations for potential vaccination are healthy individuals, children under 1 year of age with chronic latent EBV infection, and women aged 18–39 years. Immunization of these groups selected during the modeling of parameters will be able to increase the proportion of people who were not involved in the epidemic process to 69.4% by the age of 18, with a slight decrease to 54,9% by the age of 80. The spread of EBV in the adult population will decrease by 2,5 times by the age of 18 years and by 1,7 times by that of 80.

Conclusion. The proposed model can be easily adapted to the parameters of any vaccine for the prevention of EBV infection after its design and allows you to choose an effective immunization strategy in a short time. The introduction of revaccination at an interval corresponding to the duration of the protective effect of a particular vaccine can be considered as additional measures.

Objective. To identify the relationship between immunological parameters and the severity of liver fibrosis (LF) in patients with chronic hepatitis C (CHC).

Subjects and methods. Examinations were made in 69 men and 48 women (mean age 45.7 ± 2.1 years) with a confirmed diagnosis of CHC. The number and functional activity of T lymphocyte subpopulations were studied by flow cytofluorometry using an EPICS XL cytometer (Beckman Coulter, USA). The serum concentration of interferons (IFN-α, IFN-γ, and IFN-λ) was estimated by an enzyme-linked immunosorbent assay (ELISA). Liver fibroelastometry was performed using a Fibroscan 502 device (Echosens, France), whereas the stage of fibrosis was determined using the METAVIR scoring system.

Results. An increase in the total number of T lymphocytes and T helper cells was detected in patients with CHC at all stages of LF. A significant decrease was found in B lymphocytes in patients with fibrosis stages F3 and F4. There was a tendency of IFN-α to decrease and IFN-λ to increase with progression of fibrosis stage.

Conclusion. The findings not only confirm the opinion about the pronounced immunosuppressive effect of viral hepatitis C, but also emphasize the importance of T cell immunity and IFN-γ in the prognosis of severe LF.

Objective. To compare DNA detection cases in sexually transmitted infections (STIs) and vaginal microbiota disturbances (VMDs) associated with opportunistic microorganisms in 2019–2021 and to assess their association.

Subjects and methods. The results of the 2019-021 laboratory studies for DNA of STI pathogens and microorganisms associated with bacterial vaginosis, aerobic vaginitis, and vulvovaginal candidiasis were analyzed in 128,512 women.

Results. During the study period, there was an increase in cases of N. gonorrhoeae DNA detection, while no significant differences were found for T. vaginalis and M. genitalium. For C. trachomatis, there was a decline in the number of detected cases in 2020 and a return to the figure of 2019 in 2021. Significantly fewer cases of VMDs were detected in 2020, whereas the number of cases increased in 2021 versus 2019. There was an increase in the chance of infection for a number of STIs in the presence of VMDs.

Conclusion. The 2020 pandemic period did not substantially affect the decline in the number of detected STIs. The increased chance of infection for a number of STIs in VMDs should be taken into account when choosing the scope of laboratory tests and prescribing therapy. Further work is needed to introduce effective STI prevention measures.

The development of tourism, migration processes create favorable conditions for the importation of communicable and parasitic diseases from the endemic and natural foci to the non-endemic areas. The lack of alertness of healthcare workers to tick-borne rickettsioses leads to difficulties in their diagnosis, despite the presence of characteristic clinical manifestations. The paper considers cases of importation of rickettsial diseases and describes a clinical case of tsutsugamushi fever (scrub typhus) that is difficult to verify.

The literature review is devoted to the course of chronic hepatitis C (CHC), describes new treatments with direct-acting antivirals and their efficacy. The outcomes of CHC, such as liver cirrhosis and hepatocellular carcinoma, the timing, duration and frequency of their occurrence, are shown. The review presents the conducted studies on gene polymorphisms that can serve as biomarkers for the development of liver cirrhosis and hepatocellular carcinoma.

Objective. To identify a patient profile and to evaluate the efficacy of different doses and routes of administration of olokizumab in patients with mild to moderate COVID-19.

Subjects and methods. The RESMICA multicenter non-interventional retrospective study was conducted. This study included patients data 1,104 patients with mild to moderate COVID-19 who received therapy with olokizumab at doses of 64 or 128 mg subcutaneously (SC) or intravenously (IV). The investigators used statistical tests and modeling adjustment for demographic characteristics, initial state of the patients, and risk factors.

Results. Olokizumab at a SC dose of 64 mg was primarily prescribed to patients with mild or moderate COVID- 19, a low level of comorbidity, and moderate signs of inflammation. That at a SC dose of 128 mg was given to patients with a similar profile, but a significantly higher level of comorbidity. The drug at IV doses of 64 or 128 mg was prescribed mainly to patients with moderate COVID-19 and more pronounced signs of the disease.

Conclusion. The use of olokizumab at a dose of 128 mg reduces the risk of an adverse COVID-19 outcome.