Vol 13, No 3 (2023)

The human immunodeficiency virus (HIV) pandemic, which has claimed more than 40 million lives, continues, although the use of antiretroviral therapy (ART) as the main tool in the fight against HIV is constantly expanding. Despite a significant increase in the proportion of people living with HIV (PLHIV) receiving ART, the number of new HIV infections and premature deaths of PLHIV is reducing not rapidly. This is primarily attributed to insufficient funding, but there are accumulated data indicating that strategy for the fight against HIV based on ART alone is effective enough to eliminate HIV. In Russia, despite the fact that 0.8% of the population lives with a diagnosis of HIV infection, about 60,000 new PLHIV are detected annually, more than 30,000 deaths of HIV-positive citizens are recorded, and the economic damage caused by HIV is increasing, there is a tendency to deny the epidemic the HIV spread, exaggerate the effectiveness of mass screening of the population for HIV infection and the results of mass use of ART. This leads to the fact that other HIV control measures are rarely used, and the level of knowledge of the population about HIV infection remains low and does not increase. An analysis of the available data shows that mass screening for HIV antibodies does not yet lead to a decrease in the number of detected cases of HIV infection in Russia, since it does not affect vulnerable groups of the population. An insufficiently large part of Russian PLHIV is covered by effective ART, since many of the PLHIV found during testing do not register in dispensaries, are lost from follow-up, or stop ART, and not all PLHIV receiving ART become non-contagious. Therefore, the antiepidemic effect of ART on the circulation of HIV in Russia is not yet sufficiently pronounced, but drug-resistant strains are already being transmitted. Although the number of PLHIV who die from diseases traditionally associated with HIV infection is reducing, the number of PLHIV who allegedly die from other causes is increasing. However, their premature death in most cases is also associated with HIV infection, and lethal outcomes can be observed against the background of effective ART. Further efforts to reduce the incidence of HIV infection and mortality among PLHIV should be aimed at expanding the range of preventive measures for both HIV infection and concomitant diseases and improving the quality of medical care for PLHIV.

Objective. Analysis of the epidemic situation of HIV infection in the Russian Federation by the end of 2022 to monitor the epidemic process and the influence of ongoing activities.

Materials and methods. The data of long-term dynamic monitoring of the characteristics of the epidemic process of HIV infection in Russia, carried out in 1987–2022, were summarized at the Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being on the basis of reporting and accounting forms of statistical observation.

Results. By the end of 2022, 1,168,076 people lived in the country with a laboratory-confirmed diagnosis of HIV infection, excluding 461,879 patients who died during the entire follow-up period. In 2022, 45,037,376 blood samples from Russian citizens were tested for HIV, which was 10.9% more than in 2021. The incidence rate of HIV infection in the Russian Federation increased by 3.8% compared to 2021 and 2020 and amounted to 43.29 cases per 100 thousand population. In 2022, 63,150 new cases of HIV infection and death of 34,410 HIV-infected Russians were reported. The total number of people living with HIV continues to grow, the prevalence of HIV infection as of December 31, 2022 was 794.7 cases per 100,000 population. Active transmission of HIV infection was observed both among the general population of reproductive age through heterosexual sexual intercourse, and in traditional risk groups.

Conclusion. The effectiveness of antiretroviral therapy in the context of HIV prevention remains insufficient, mainly due to the significant number of HIV-infected people who are not covered by medical care and a significant proportion of patients with an unsuppressed viral load.

Objective. Genetic characterization of HIV variants circulating among the citizens of Republic of Armenia and assessment of the connectivity of HIV epidemics between Republic of Armenia and the Russian Federation.

Materials and methods. 1009 HIV nucleotide sequences of the pol region and accompanying depersonalized information about patients obtained under the orders of the Government of the Russian Federation carried out in 2016–2021 were studied. To assess the connectivity of the HIV epidemic, sequences from the Los Alamos database and the collection of Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being were also analyzed. The BLAST tool, phylogenetic and cluster analysis were applied to the resulting pool of sequences.

Results. Among the analyzed HIV sequences of Armenian citizens, 87.2% belonged to subsubtype A6, 5.6% - to subtype B, 2.7% – to CRF63_02A6, and 1.9% – to CRF02_AG. Other genetic variants were less common (1%). The largest number of genetically related HIV sequences were of Russian origin (44.52%), followed by the origin from Republic of Belarus (10.59%) and the USA (8.04%). Using cluster analysis, it was found that significantly more often mixed AM-RU clusters consisted of male patients with homosexual transmission, living in the suburbs of Yerevan, whose infection presumably occurred in Russia.

Conclusion. Bioinformatic analysis of HIV nucleotide sequences obtained from citizens of the Republic of Armenia, in combination with HIV genetic variants available today, has shown a high genetic similarity between the HIV sequences in Armenia and the Russian Federation.

Objective. To define the dominant behavioral strategy for HIV-infected patients during their visit to a physician and to study the influence of sociodemographic factors on its formation.

Materials and methods. The investigation was conducted via a questionnaire survey that involved 1083 HIV-infected patients who were followed up in the AIDS control centers of eight regions.

Results. Sociodemographic factors, such as education, marital status, gender, and age, have been found to have a statistically significant influence on the choice of the preferred behavioral strategy during the patient visit to a doctor in 6 of the 8 regions. Regional differences in the influence of sociodemographic factors are shown. Those are found in the choice of the preferred behavioral strategy when visiting a physician. By and large, in all the regions, only 40.2% of patients go to see their physician immediately after the onset of symptoms and 17.6% do this only when they realize that the situation is serious.

Conclusion. In the regions participating in the study, various sociodemographic factors have been found to influence the behavioral strategies during a visit to the physician, which must be taken into account when developing recommendations to improve adherence to treatment in each region.

Objective. Analysis of the role of a group of drug users in the development of the HIV infection epidemic on the example of the Moscow Region.

Materials and methods. The data of personalized records of patients with HIV infection in the Moscow region, presented in the primary medical records of the AIDS Center, in the AIDS Info System computer database of the AIDS Center and medical information systems, as well as data from forms of federal statistical monitoring, were analyzed.

Results. A decrease in the significance of HIV transmission through intravenous drug use has been identified, but the true prevalence of the disease among drug users remains an open question. The arguments for the low level of HIV case detection were the decrease in the proportion of drug users among those tested for HIV infection, as well as the high proportion of people who became infected through intravenous drug use among cases of posthumously confirmed HIV diagnosis by the forensic medical examination service. An annual decrease in the proportion of drug users with severe immunodeficiency among those enrolled in care has been registered.

Conclusion. There is evidence to support a reduction in the importance of HIV transmission through intravenous drug use, but the issue of a «hidden» HIV infection epidemic among drug users requires further study.

Objective. Assessment of the causes of lethal outcomes associated with and not associated with HIV in patients with HIV infection in the Russian Federation for the period from 2008 to 2021.

Materials and methods. The results of a multi-year special study of the causes of deaths among those infected with HIV, conducted in 2007–2022, were summarized in all regions of the country.

Results. The most common etiological cause of death associated with HIV in 2019–2021, as in previous years, was mycobacterial infection. In 2018 and 2021, the number of patients who died from pneumocystis pneumonia, lymphoproliferative diseases and multiple infections increased. Cardiovascular and gastrointestinal diseases (primarily liver cirrhosis of viral etiology), as well as external causes and oncological diseases remain the main causes of deaths not associated with HIV infection. In 2021, 6.4% of people with HIV infection died from COVID-19 infection. Among the deceased, the proportion of patients receiving antiretroviral therapy was significantly less than in the population of patients with HIV infection who were under follow-up.

Conclusion. Reducing premature deaths from HIV infection and comorbidities can be achieved by increasing the coverage of people living with HIV with antiretroviral therapy and improving the diagnosis and treatment of comorbidities.

Objective. Identification of the leading etiologically significant healthcare-associated pathogens (HAI) in puerperal women and newborns and intrauterine infections (IUI) in newborns and assessment of their antimicrobial resistance.

Materials and methods. A retrospective epidemiological analysis of data on the etiology and resistance of HAI pathogens in puerperas and newborns and IUI to antibacterial drugs and disinfectants for 2018–2021 was carried out.

Results. Gram-positive microorganisms (Staphylococcus and Enterococcus) were identified as the leading etiological agents of HAIs in puerperas and newborns and IUI, but an increase in the proportion of E. coli was noted. In general, HAI and IUI pathogens were characterized by high sensitivity to antimicrobial drugs. Resistant microorganisms were isolated in less than 5% of cases.

Conclusion. It is necessary to improve microbiological monitoring in the system of epidemiological surveillance for HAI and IUI.

Objective. Evaluation of the effectiveness of using an individual set of consumables for self-collection of vaginal mucosa during testing for the detection of human papillomavirus (HPV) at the first stage of screening for cervical and vaginal precancerous diseases in HIV-infected women in the Moscow Region.

Materials and methods. The study involved 100 HIV-infected women. The results of testing of samples of vaginal mucosa, taken by the patient herself, and scraping of the cervical canal, taken by a gynecologist, were analyzed. The ease of use of the set of consumables was assessed using a questionnaire. Real-time PCR was used to determine HPV DNA. Cytological examination was performed using the technique of liquid cytology with Papanicolaou staining of cervical micropreparations.

Results. The frequency of detection of 13 high-risk oncogenic HPV types in samples of vaginal discharge and scraping of epithelial cells from the mucous membrane of the cervical canal was 42 and 30% (p > 0.05). According to the results of the survey (assessment was carried out on a 10-point scale, where difficult/very uncomfortable = 0, easy/very comfortable = 10), the ease of taking biological material was rated by study participants at an average of 9.4 points, the availability of understanding and ease of following the instructions – at 9.5 points, comfort of using the set – 8.9 points. An assessment of personal preferences in choosing a method for taking a biomaterial showed that only 15% of respondents would prefer a traditional visit to a gynecologist in the future.

Conclusion. There was no significant difference between the compared methods of taking biological material at the first stage of screening for cervical and vaginal precancerous diseases (p > 0.05). The use of an individual set of consumables for HPV testing will significantly increase the coverage of the population of HIV-infected women, as well as identify a risk group among them.

A variety of sexual practices, low awareness of the population about the risks of contracting sexually transmitted infections lead to the spread of pathogens, including outside typical localizations, which complicates the detection of diseases. A clinical case of extragenital chlamydial infection in a pair of homosexual men is presented.

Combination triple antiretroviral therapy (ART) is the mainstay of treatment for people living with HIV (PLHIV). It allows patients to achieve viral load suppression and increase life expectancy to the general population level. However, these schemes in the long term can lead to the risk of developing adverse events from various organs and systems. The aging of the PLHIV population and the need to treat comorbidities lead to polypharmacy and an increased risk of drug interactions. For these reasons, two-drug ART regimens currently look promising. The article presents literature data on studies on the dual therapy of HIV infection. The combination dolutegravir + lamivudine is one of such regimen which has proven to be safe and effective in switching to it for previously treated patients. However, long-term safety and efficacy as a first-line regimen has not yet been adequately studied. Further research is required, including among people living with HIV in Russia.

The advantages and disadvantages of domestic, foreign and international clinical and immunological classifications of HIV infection and AIDS criteria are discussed. Suggestions for improving the domestic classification of HIV infection are given. The authors invite readers to take part in the discussion.