Nº 5 (2014)

The spread of human immunodeficiency virus (HIV) in Russia is the most significant social problem and it is not only a medical phenomenon, but also a social and psychological one. Nowadays Russia occupies a leading place in the growth rates of the HIV epidemic in the world. According to the data of the Federal Research Methodology Center for the Prevention and Control of AIDS, 798 866 cases of HIV infection were notified in the country by the end of 2013 and an annual increase is observed in new case detection rates. The current situation with HIV infection has reached a critical point when it may be switched to a generalized stage, on the one hand, and an opportunity to stabilize the situation has not yet missed, on the other.

Objective. Тo evaluate the cost effectiveness of different diagnostic variants of tuberculosis (TB) among the HIV-infected population. Materials and methods. An analytical model constructing a decision tree during a two-year time horizon was elaborated to estimate the cost effectiveness of different diagnostic algorithms for active TB among the people living with HIV(PVH) in the cohorts with a suppression level of <200, 200-499 and >500 cells/μl Three algorithms: Basic (the sequence of standard TB diagnostic stages in the Russian Federation; Addition (The basic one is added by Gene Xpert MBT/Rif; and Replacement (only Gene Xpert MBT/Rif) were analyzed. Results. 1. The Addition algorithm in the cohort of patients with CD4+ lymphocyte counts of <200 cells/μl makes it possible to additionally identify 8 TB patients per 1000 HIP and to significantly increase the number of effectively cured patients, including those with baseline rifampicin resistance; the structure of costs shows a preponderance of treatment charges. In the cohort of patients with CD4 + lymphocyte counts of 200-499 and >500 cells/μl, the Addition algorithm permits one to initiate therapy with consideration for rifampicin resistance in the majority of patients, to effectively cure one more patient in each cohort, and to additionally prevent a 0.5 fatal outcome during an intensive phase. The structure of costs displays a predominance of diagnostic charges. 2. The Replacement algorithm can significantly increase the number of diagnostic omissions at any level of the immune status. 3. The lowest cost effectiveness ratios correspond to the Basic algorithm in all the cohorts. Conclusion. The inclusion of Gene Xpert MBT/Rif in the TB diagnostic algorithm is clinically and cost effective in the cohort of patients with CD4 + lymphocyte counts of <200 cells/μl The use of Gene Xpert MBT/Rif as a standard Replacement TB diagnostic algorithm cannot be considered alternative to the Basic algorithm as this may result in an increase in the number of diagnostic omissions at any level of the immune status. Focusing only on the cost-effectiveness ratio may give rise to the loss of chance of increasing the number of identified and effectively cured patients.

Ebola disease epidemic, which started suddenly in winter 2014 in Guinea, has spread to several Western African countries by September. About 4 thousand people got sick already, more than two thousands of them died, including more than 140 medical professionals. Governments of Guinea, Sierra Leone and, in particular, Liberia recognize the enormous social and economic damage caused by Ebola, and the inability to stop the spread of infection on their own. The World Health Organization has declared the Ebola epidemic «a Public Health Emergency of International Concern» requiring concerted actions by entire world community. The review provides basic information on the epidemiology, pathogenesis, clinical presentation and treatment of Ebola infection. The epidemic progress in 2014 is considered in detail alongside with social, environmental and epidemiological reasons that led to its unprecedented scale. We discuss also ongoing and planned control anti-epidemic measures, as well as forecasts of the epidemiological situation and the possibility of using «experimental» preventive and therapeutic drugs.

The review gives data on the safety, tolerability, and efficacy of abacavir (ABC) and lamivudine (3TC), representatives of a reverse transcriptase nucleoside inhibitor group, and the results of clinical trials of the drugs as a basis for antiretroviral therapy. The trials have indicated that ABC/3TC has a virological efficacy that is comparable to that of ZDV/3TC. Some trials have established that ABC/3TC ranks below TDF/FTC in its virological efficacy in patients with the baseline high (more than 100 000 copies/ml) level of HIVRNA. At the same time, ABC/3TC is characterized by its minimal action on the hematopoietic system. As compared to TDF-including regimens, ABC/3TC presents lower risks for osteoporosis and renal tubular dysfunction.

Objective. To generalize experience in practically using a set of enzyme immunoassay systems (ZAO «ECOlab») to diagnose TORCH infections. Materials and methods. The results of using the enzyme immunoassay systems «EIA-HSV-1+2-IgM», «EIA-HSV-1-IgG», «EIA-HSV-2-IgG», «EIA-CMV-IgM», «EIA-CMV-IgG», «EIA-Toxo-IgM», «EIA-Toxo-IgG», «EIA-Rubella-IgM», «EIA-Rubella-IgG», «EIA-CMV-IgG-avidity», and «EIA-HSV-1+2-IgG-avidity» to examine patients in the healthcare facilities of the Samara, Kaluga, and Lipetsk Regions were analyzed. Results. The real affection of the population in the above regions with TORCH infections was shown to be much higher than the official statistical data. The enzyme immunoassay tests assessing the avidity of IgG antibodies, which are in the above set, may be used without preliminary screening to examine cohorts of patients who are known a priori to have blood antibodies to the respective pathogens. Conclusion. The investigation has shown that there is a need for continuous laboratory monitoring of the respective risk groups: pregnancy-planning women and their sexual partners; pregnant women; neonates and infants less than 1 year old.

For epidemiological analysis, it is desirable to have specialized programs and to train the students of a preventive medicine faculty in their application. With the state-of-the-art capabilities, Internet services are the most convenient variant of applying an approach to these programs. In this connection, the Department of Medical Informatics and Statistics and the Department of Epidemiology and Evidence-Based Medicine of the I.M. Sechenov First Moscow State Medical University with the support of colleagues from other medical universities have developed a project as the websites 1mgmu.com and nasci.ru with information materials and ready programs for the epidemiological analysis of the data accessible to students and specialists. Both universal statistical (calculation of exact confidence limits to frequency) and specialized (analysis of intra-annual morbidity trends and mapping of outbreaks and morbidity rates) programs are available at these websites.