Volume 14, Nº 3 (2024)

The article describes the presentation of HIV infection in the current edition of the International Classification of Diseases and Related Health Problems (ICD-10) and its new version, ICD-11, which is being considered for adoption in Russia. The advantages and disadvantages of presenting HIV infection in ICD-10 and ICD-11 and possible problems for practical healthcare associated with the adoption of the new version of ICD are discussed.

Objective. Assessment of the epidemic situation of HIV infection in the Russian Federation in 2023.

Materials and methods. The data of federal statistical surveillance forms No. 2, No. 4, Rospotrebnadzor monitoring form «Information on measures to prevent HIV infection, hepatitis B and C, detection and treatment of HIV patients» and personalized information on identified cases of HIV infection in Russia (form No. 266 u~88) were analyzed.

Results. In 2023, 58,740 new HIV cases were registered, 7% less than in 2022. A significant number of new HIV cases were detected among the rural population and residents of remote regions. The number of tests conducted increased to 48,914,663, mainly due to testing of population groups without a specific risk of HIV infection, while testing of HIV-vulnerable population groups decreased, which could lead to a decrease in the number of new cases. At the same time, mass screening of the population made it possible to identify many HIV-positive people, which ensured their access to timely treatment. 77.6% of newly diagnosed HIV-positive respondents named heterosexual contacts as the only risk factor for infection, 17.7% also mentioned drug use, and 3.7% reported homosexual contacts. One of the reasons for the persistent level of HIV transmission was the insufficient coverage of patients with effective antiretroviral therapy.

Conclusion. In 2023, the spread of HIV infection in Russia continued with the same intensity as in the previous 3 years, which leads to a gradual increase in the prevalence of HIV among the population.

Objective. Assesment of the dynamics of HIV reservoirs during the use of a two-component antiretroviral therapy (ART) regimen with dolutegravir and lamivudine (DTG + 3TC) in previously untreated patients.

Materials and methods. The study included 30 HIV-positive patients over 18 years of age, monitored in the AIDS Consultation and Diagnostic Department of the Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, who first started treatment with the DTG + 3TC regimen in 2021–2022. A standard clinical and laboratory examination, determination of the immunoregulatory index and HIV DNA in blood cells were performed.

Results. During 48 weeks of ART, no adverse events associated with the study drugs that required changes in the treatment regimen were registered. All patients achieved the virological efficacy criterion by 24 weeks of treatment. The mean CD4⁺-lymphocyte level before treatment was 526 cells/μl, 24%; after 48 weeks of ART – 747 cells/μl, 34% (p < 0.05), the mean CD4⁺/CD8⁺ ratio was 0.55 and 1.06, respectively (p < 0.05). The correlation index (r) of the HIV DNA level in blood cells before the start of ART with HIV RNA in blood plasma was 0.8; with CD4⁺-lymphocytes – -0.4, with the duration of HIV infection – –0.2. The mean HIV DNA level in blood cells before treatment was 480 copies per 1 million cells, after 48 weeks of ART – 220 copies per 1 million cells (p < 0.05).

Conclusion. The use of the DTG + 3TC regimen in patients who had not previously received ART showed clinical, immunological and virological efficacy for 48 weeks. The HIV reservoir volume before treatment was higher in patients with high viral load and lower CD4⁺-lymphocyte level. The volume of viral reservoirs decreased with the use of DTG + 3TC.

Objective. Assessment of cardiovascular risk in HIV-positive individuals with latent tuberculosis infection (LTBI).

Materials and methods. Screening for tuberculosis infection was performed in 395 patients with HIV infection followed-up in the AIDS Consultation and Diagnostic Department of the Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being. A positive result was obtained in 75 (19%) people. From these patients, the study group of 39 people with HIV and LTBI was formed. Control group included HIV-infected patients without LTBI, matching in gender, age, smoking status and antiretroviral therapy regimen with study group. Lipid profile parameters, ten-year risk of fatal and non-fatal cardiovascular events according to the SCORE2 scale, comorbidities, relative number of classical (CD14⁺⁺CD16^-), inflammatory (CD14⁺⁺CD16⁺) and non-classical (CD14⁺CD16⁺⁺) monocytes were analyzed in the groups.

Results. High risk according to the SCORE2 scale was found in 68% of the study group and 57% of the control group, very high risk – 28 and 32%, respectively. Arterial hypertension was found in 31% of the study group and 24% of the control group, metabolic syndrome – 17 and 5%. The CD14⁺⁺CD16- monocytes level was higher than normal in 67% of patients in the sudy group and in 82% in the control group, and CD14⁺CD16⁺⁺ were lower than normal in 97 and 100% of patients, respectively.

Conclusion. No statistically significant differences were found between the groups, however, it cannot be ruled out that LTBI is an additional factor contributing to atherogenesis in patients with HIV infection.

Background. Anogenital herpes has a negative impact on the quality of life, but in vulnerable groups it often remains undiagnosed, which leads to its spread and an increased risk of transmission of sexually transmitted infections, including HIV. This situation requires the implementation of different diagnostic and preventive approaches.

Objective. Assessment of the prevalence of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) in men with risky sexual behavior with investigation of various anatomical loci (oropharynx, anal canal, urogenital tract) outside medical institutions in two large regions of Russia (Moscow region and St. Petersburg).

Materials and methods. The study involved 564 representatives of vulnerable groups. Three types of biological material from three anatomical loci were examined: secretions from the mucous membrane of the oropharynx, anal canal, and the first portion of urine (urogenital tract). RT-PCR was used to determine HSV-1 and -2 DNA.

Results. HSV-1 and -2 DNA was detected in at least one studied locus in 58 (10.3%) of the examined subjects, including HSV-1 in 36 (62.0%) and HSV-2 in 22 (38.0%). The frequency of detection of HSV-1 and -2 in the anatomical loci was as follows: oropharynx in 35 (6.2%) of the examined subjects, anal canal - in 21 (3.7%), and the urogenital tract - in 6 (1.1%).

Conclusion. The frequency of HSV DNA detection among individuals with risky sexual behavior in two regions of the Russian Federation was 10.3% (95% CI 8.04–13.07). The prevalence of HSV-1 and HSV-2 among men who have sex with men, when examined outside medical institutions, was higher in the Moscow Region than in St. Petersburg (p = 0.03).

A case of solitary plasmacytoma with extensive lesions of the maxillofacial region in combination with a tuberculous process in a patient with HIV infection is presented. Antitumor therapy led to aggravation of immunodeficiency, which contributed to the development of tuberculosis with extensive drug resistance, a long course of the disease with an unfavorable prognosis.

The review is based on literature data and analysis of previous studies. Current indications for vaccination against pneumococcal infection in HIV-infected adults, the efficacy and safety of modern vaccines are considered and systematized; strategies for improving vaccination results are discussed.

Objective. Evaluation of the efficacy and safety of antiretroviral therapy (ART) regimens based on elsulfavirine (ESV) in patients with HIV infection who have not previously received treatment (PASS-1).

Materials and methods. The PASS-1 study was conducted at 22 research centers in the Russian Federation and included 518 patients. All participants were prescribed ESV and 2 HIV nucleoside reverse transcriptase inhibitors (NRTIs). Follow-up period lasted lasted for 96 weeks. Efficacy was assessed in patients receiving first-line ART regimens (n = 241): ESV + TDF + 3TC (or FTC) and ESV + ABC + 3TC (or FTC), and safety – in all study participants.

Results. The virological and immunological efficacy of these first-line ART regimens were demonstrated. After 48 weeks of therapy, undetectable HIV RNA levels were achieved in 93.9–100% of patients, and after 96 weeks, in 85.0–97.0%. The median increase in CD4⁺ lymphocyte level after 48 weeks was 173.0– 222.0 cells/μl, after 96 weeks – 236.0–247.5 cells/μl. A favorable safety profile of ESV-based ART regimens has been demonstrated. ESV-associated adverse reactions (ARs) were reported in 21.6% of cases, 99.0% of which were mild or moderate. All reported ADRs were classified as uncommon or rare in frequency. ADRs of special interest accounted for only 26.1% of the total ADRs. No life-threatening or fatal adverse reactions were reported.

Conclusion. An ART regimen including ESV and 2 NRTIs can be recommended for most HIV-infected patients with starting treatment for the first time and, depending on the nucleoside backbone (TDF or ABC), is quite reasonably considered a preferred and alternative first-line ART regimen.