Epidemiology and Infectious Diseases. Current Items

Objective. Evaluation of the causes of death of patients with HIV infection in the Russian Federation (RF) in 2022–2023.

Materials and methods. An analysis of responses received from 89 regions of the Russian Federation to a special request from the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing on the causes of death of HIV-positive citizens in 2022–2023 was conducted.

Results. In 2022 and 2023, 32,425 and 32,321 deaths were registered among HIV-infected individuals, respectively; of which 1,362 and 1,498 were in the 4 reunited territories, respectively. The proportion of deaths coded by the B20–B24 (HIV infection) code remained unchanged: 41.5% in 2022 and 41.7% in 2023. Mycobacterial infection (B20.0) remained the most common cause of death in the Russian Federation, with a tendency for its proportion to decrease to 27.7% in 2023. Secondary diseases of viral etiology (B20.2 + B20.3), mycoses (B20.4 + B20.5), pneumocystis pneumonia (B20.6), other infectious and parasitic diseases, including cerebral toxoplasmosis (B20.8), led to death in 1.6-4.3% of cases. In 2022 and 2023, the Russian Federation recorded the same proportion of HIV-infected patients (52.2–52.9%), in whom death was caused by diseases not traditionally associated with HIV infection. The most common causes of death were cardiovascular diseases, gastroenterological diseases, injuries, poisoning and some other consequences of exposure to external causes. According to the data received from the 4 territories reunited with the Russian Federation, the etiological cause of death was established only in one third of patients, which is probably due to late detection of HIV infection, late hospitalization in a specialized hospital and initiation of treatment, as well as insufficient diagnostic capabilities of medical institutions and a small proportion of pathomorphological studies. In these territories, the proportion of PLHIV who died due to HIV infection was higher – 56.7 and 56.4%.

Conclusion. In 2022–2023, no significant decrease in the number of HIV-positive citizens who died per year and the proportion of patients among them who died from HIV-related diseases was detected in the territory of the Russian Federation, despite an increase in treatment coverage for patients undergoing follow-up care.

Objective. Assessment of the current epidemic situation of HIV infection in the Russian Federation (RF).

Materials and methods. The data of federal statistical observation forms № 4 «Information on the results of blood tests for HIV antibodies», № 2 «Information on infectious and parasitic diseases»; departmental monitoring form of Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being «Information on measures to prevent HIV infection, hepatitis B and C, detection and treatment of HIV patients» and personalized accounting forms on cases of HIV infection identified in 1987－2024 in Russia (form № 266 y-88) were analyzed.

Results. In the Russian Federation, a decrease in the number of people living with HIV (PLHIV) registered for the first time in 2024 was noted, against the background of an increase in the total number of the population of the Russian Federation tested for HIV and a decrease in the number of tested individuals belonging to the most vulnerable for HIV groups of the population. An increase in the number of newly identified PLHIV in remote areas and among the rural population, an increase in the prevalence of HIV infection in general was noted. The number of PLHIV in the Russian Federation increased by 2.3 times by the end of 2024 compared to 2010. There was no significant increase in the coverage of PLHIV with effective antiretroviral therapy and a decrease in the number of deaths among the HIV-positive population.

Conclusion. The epidemic process of HIV infection in the Russian Federation retains a high potential for development, it is necessary to intensify anti-epidemic measures and expand their range.

Objective. Assessment of the state of immunity against hepatitis B virus among HIV-infected individuals.

Materials and methods. The study included HIV-infected patients undergoing follow-up care at the Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being. The study was conducted from October 2022 to September 2023. Laboratory examination of patients included: determination of the CD4⁺ lymphocyte number, the blood HIV RNA level, and serological markers of hepatitis B.

Results. 417 patients , including 274 (65.7%) men, were examined. The age of the patients ranged from 20 to 73 years, the mean age was 43 years. Current hepatitis B virus (HBV) infection was recorded in 10 (2.4%) patients. Previous hepatitis B was detected in 74 (18.2%) patients, latent or hidden HBV infection – in 38 (9.3%). 116 (28.5%) people were vaccinated against HBV. The number of participants not immune to HBV infection was 179 (44%).

Conclusion. The obtained results showed low coverage of vaccination against HBV among HIV-infected patients. Measures to increase the effectiveness and availability of vaccination are required.

Objective. Determination of the prevalence of transmissible drug resistance (DR) and resistance to antiretroviral therapy (ART) drugs among recently infected HIV patients with no experience of receiving ART in the Irkutsk region.

Materials and methods. In 2019 and 2023, 2 threshold studies of transmissible HIV DR were conducted in patient samples of the Irkutsk Regional Center for the Prevention and Control of AIDS and Infectious Diseases. Both studies used blood plasma from 50 HIV-infected individuals with no experience of ART, with an estimated infection duration of no more than 1 year and a CD4⁺ level of more than 500 cells/μl at the time of the study.

Results. Mutations of the transmitted DR were detected in samples from 3 patients in 2019 and 6 in 2023 (6% (90% CI 0.5–11.5%) and 12% (90% CI 4.4–19.6%), respectively). In the 2019 sample, 2 patients (4%) had mutations of DR to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and 1 patient (2%) had mutations of DR to protease inhibitors (PIs). In 2023, the following DR variants were detected: 2 patients (4%) with DR to PIs, 2 patients (4%) with DR to NNRTIs, 1 patient (2%) with DR to NRTIs+NNRTIs (2%), and 1 patient (2%) with DR to PIs+NNRTIs. According to the phylogenetic analysis, in the 2019 sample, 1 (2%) sample clustered with subtype B, 5 (10%) – with the recombinant CRF63 02_A6, the remaining 44 (88%) samples were typed as A6. In 2023, the following distribution was revealed: A6 – 90%, CRF63 02_A6 – 8%, B –2%.

Conclusion. Transmissible HIV DR in the Irkutsk region has currently settled at 12%, which does not exceed the threshold of 15%, after which it is necessary to test each patient before prescribing ART. It is advisable to conduct a repeat study for transmissible DR after 2 years to assess the dynamics of the spread of resistant HIV strains.

Objective. Evaluation of the role of follow-up care conducted in a medical organization specializing in providing assistance to people living with HIV (PLHIV), in identifying cardiovascular diseases (CVD) and stratifying CV risks.

Materials and methods. The age profile of CVDs detected by a general practitioner and a cardiologist was analyzed using the medical records of 400 PLHIV receiving foloow-up care at the Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being. The age discrimination ability for the detected nosologies was determined. The lipid profile of PLHIV adherent to modern antiretroviral therapy (ART) regimens was characterized, CV risks were calculated using the SCORE2 and SCORE2-OP scales, and the obtained data were compared with the general population data. The effect of a cardiologist consultation on adherence to antihypertensive and lipid-lowering therapy was studied.

Results. It was determined that the age profile of CVDs in PLHIV adherent to ART does not differ from that in the general population. At the same time, the addition of a cardiologist consultation to follow-up care increases the detection of CVD compared to a protocol that includes only examinations by a general practitioner. The lipid profile in PLHIV differs from the general population by higher concentrations of low-density lipoproteins and lower triglyceride levels. Taking a number of ART regimens is associated with abnormal concentrations of individual plasma lipid fractions. Patients who were consulted by a cardiologist had significantly higher adherence to antihypertensive and lipid-lowering therapy; such a relationship was not determined for consultations with a general practitioner.

Conclusion. The use of estimated cardiovascular risk scales by attending physician provides timely identification of indications for consultation with a cardiologist among PLHIV over 40 years of age. An infectious disease specialist can correct these risks taking into account the proatherogenic potential of ART. Individualization of screening for concomitant pathology of PLHIV allows for improving their quality of life and reducing treatment costs.

Objective. Evaluation of the incidence of depressive symptoms and determination of the relationship between depression and socio-demographic factors in groups of HIV-infected patients in 6 countries of Eastern Europe, Caucasus and Central Asia ЕЕССА and 3 regions of the Russian Federation.

Materials and methods. The study was conducted in 2022–2023 in 6 EECCA republics and 3 regions of the Russian Federation. A total of 1,148 patients with HIV infection who were receiving antiretroviral therapy (ART) were interviewed. A direct questionnaire survey was conducted with a continuous sample. A.Beck’s depression questionnaire was used to identify depressive symptoms. The questionnaires included socio-demographic indicators, as well as data on life expectancy with HIV and the duration of ART.

Results. Most respondents in all groups were aged 35 to 44 years. In seven groups, the median total depression score was within 4–5 points. In groups 1 (Republic of Azerbaijan) and 5 (Republic of Tajikistan), this indicator was 13 and 8 points, respectively. The total incidence rate of various depressive symptoms in group 1 was 61.5%, in group 5 – 45%. In the other groups, this indicator ranged from 28.2 to 35.6%. In some groups, it was possible to identify a correlation between socio-demographic factors and the level of depression.

Conclusion. The questionnaire is a convenient tool for screening depressive symptoms and making subsequent decisions on the prevention of adherence disorders risks.

Objective. Assessment of the impact of late diagnosis of HIV infection on patient survival and factors associated with deaths from causes related to the progression of HIV infection.

Materials and methods. The data of 1072 patients over 18 years old who were diagnosed with HIV infection for the first time in 2019 were analyzed. Socio-demographic and clinical data of patients, as well as death data were collected and analyzed. The follow-up period was from the moment of detection to November 2023. The criteria for late diagnosis were a CD4 cell count below 200 cells/mm³ and/or HIV infection stage 4, established within 3 months after detection of HIV infection. Extensive indicators (proportions, %), adjusted odds ratios (AORs) and their 95% CIs were calculated.

Results. During the follow-up period, 235 (21.9%) people died, including 95 people from causes associated with the progression of HIV infection. Using Cox regression, it was found that the risk of death from causes associated with the progression of HIV infection was increased by factors such as late diagnosis (adjusted odds ratio (aOR) 8.424; 95% CI 4.805–14.768), living in rural areas (aOR 2.210; 95% CI 1.294–3.774), and age (AOR 1.041; 95% CI 1.019–1.063). However, this risk was reduced when patients used antiretroviral therapy (aOR 0.159; 95% CI 0.097–0.261). The risks of death decreased among workers by 2.123 times (aOR 0.471; 95% CI 0.283–0.783), among pensioners by 3.554 times (aOR 0.281; 95% CI 0.089–0.891), compared with the unemployed.

Conclusion. Late diagnosis of HIV infection increases the risk of death from HIV/AIDS-related causes. In this regard, it is important to maximally improve access to counseling and screening testing for HIV infection for all population groups.

A case of development of secondary diseases 17 years after detection of HIV infection in a patient leading an asocial lifestyle and neglecting prescribed therapy is presented.

When prescribing an antiretroviral therapy (ART) regimen, preference is given to fixed combinations of drugs, especially drugs in which the entire ART regimen is presented in one tablet, which is an advantage due to the reduction in the number of tablets, the frequency of drug administration and the guaranteed adherence to prescribed doses and drug combinations.

The review presents data on the efficacy, safety and tolerability of drugs registered in Russia, Biktarvy, Delstrigo, Elpida^® Combi and Dovato. They include combinations of active substances of the latest generations, which differ from previously used ones by better tolerability and safety, a high barrier of resistance and a narrower spectrum of drug-drug interactions, which allows them to be used even in patients with combined pathology and in elderly patients. Currently, these drugs are included in the preferred regimens for the initiation of ART in most patients with HIV infection in domestic and foreign recommendations.