Nº 5 (2017)

Objective. To give the clinical characteristics of patients with HIV infection in the Volgograd Region and to make recommendations for improving the diagnostic and treatment process for this disease. Materials and methods. The paper gives the clinical characteristics of HIV- infected cases in the Volgograd Region on the basis of the 2011-2015 data available in the Volgograd Regional Center for Prevention and Control of AIDS and Infectious Diseases (Annual Report Form No. 61 «Information on HIV-infected patients»). It analyzes the ratio of various stages of progression of the infection among those who are followed up and f irst detected, as well as the dynamics of their changes, the causes of death, and the frequency of deuteropathies. Results. The majority of patients were found to have a subclinical stage of HIV infection and to be identif ied at this stage. Infectious diseases, mainly those of bacterial etiology, prevail among the deuteropathies. The antiretroviral therapy coverage of those in need is consistently high. Tuberculosis is a leading cause of death. Conclusion. Based on the findings, the authors generate recommendations for enhancing the effectiveness of identifying HIV-infected patients, predicting the needs for different types of health and social care, and planning diagnostic and treatment measures. In particular, the authors recommend that amendments be made to a new statistical report form for HIV-infection and that automated data logging systems be introduced into routine practice.

Cardiovascular disorders frequently accompany acute respiratory viral infections (ARVI) and influenza in children. Objective. To estimate the frequency and nature of cardiovascular events in children with ARVI and influenza. Subjects and methods. The results of a follow-up and examination of 1268 children and adolescents aged 1 to 18 years, who had been hospitalized for various ARVIs of specified etiology, were studied. Examination, and laboratory, electrocardiographic and echocardiographic studies were made. Results. 118 (9%) children were noted to have a combination of newly identified clinical changes with enhanced activity of cardiac specific enzymes, and disorders revealed by ECG and EchoCG. Conclusion. Cardiovascular events often develop in children with ARVI and influenza. Their prevention is to use timely adequate etiotropic therapy. Imidazolyl ethanamide pentandiol acid (ingavirin) is a drug with antiviral, antiinflammatory and immunomodulatory effects, which is recommended to treat ARVI and influenza in children aged 7 years or older.

Objective. To carry out a molecular genetic analysis of HIV-1 among prisoners receiving antiretroviral therapy (ART) in the penitentiary facilities. Materials and methods. Viral load was determined in 89 prisoners; out of them 32 individuals with a viral load of >1000 copies/ml were examined for HIV-1 resistance to reverse transcriptase inhibitors and protease inhibitors by a genotypic method. A survey method was used to estimate the degree of compliance with antiretroviral therapy in 138 prisoners. Results. 20 (62.5%) of the 32 examined HIV-1 nucleotide sequences were interpreted as susceptible to 19 antiretroviral drugs. None of the 32 sequences contained mutations of high-level resistance to the prescribed drugs. Genotyping revealed that subtype AFSU was predominant; five genetic variants were CRF03 AB and two variants were CRF63 02A1. Conclusion. The high or multiple resistance of HIV-1 to reverse transcriptase inhibitors and protease inhibitors is not responsible for the virologic failure of ART in prisoners.

Objective. To estimate the diagnostic value of laboratory diagnostic techniques for parasitoses that are relevant to southern Russia. Materials and methods. For verification of parasite infestation in 1500 patients attending the Clinic of Infectious and Parasitic Diseases, Rostov Research Institute of Microbiology and Parasitology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, the investigators used laboratory diagnostic techniques regulated by the Methodological Guidelines (MG) 4.2.3145-13 «Laboratory diagnosis of helminthiasis and protozoan disease» and MG 3.2.1173-02 «Serological tests for laboratory diagnosis of parasitic diseases». Results. Parasitic diseases were found in 58.5% of the patients who had visited the clinic with a referral diagnosis of helminthic invasion. The most frequently recorded diseases were enterobiasis (35.5%), echinococcosis (18.7%), toxocariasis (15.5%), and taeniarhynchosis (5.8%). The most effective method for diagnosing enterobiasis was a triple examination of the material collected from the perianal folds, which could identify pinworm (Enterobius vermicularis) eggs in 91.7% of the patients. The permanent laboratory signs of toxocariasis were peripheral blood eosinophilia and a positive result of ELISA with Toxocara antigen. A one-month follow-up after etiotropic therapy showed that 65.0% of patients had a two-fold or greater increase in antibody titers with a reduction of eosinophilia and normalization of peripheral blood parameters. There were negative results of ELISA with Echinococcus antigen in 9 (42.9%) patients prior to surgery and only in 4 (19.1%) patients a month after surgery. Five patients had a high risk of recurrence due to larval dissemination during surgery. The diagnosis of taeniarhynchosis was based on the results of parasitological examination of helminth segments before and after antihelminthic therapy. Examination of the scrapped perianal material revealed taeniid eggs in 62.5% of the patients. Conclusion. One of the important factors in optimizing the diagnosis of parasitic diseases is the choice of a method and the frequency of examinations, as well as the parallel application of all direct and immunological methods for the laboratory and instrumental verification of a diagnosis.

Mesenteric thrombosis remains a relevant surgical problem because of multietiology, diagnostic difficulties, and high mortality rates. The paper describes a case of mesenteric thrombosis with a fatal outcome, which has developed in an elderly patient with salmonellosis. It discusses the possible causes and clinical manifestations of mesenteric thrombosis, difficulties in differential diagnosis, and the possibilities of timely verification of the diagnosis.

The paper describes current views on the main factors influencing the successful treatment of patients with chronic hepatitis C. The authors give their own data on the key indicators associated with the inefficiency of antiviral therapy. The literature sources containing the results of clinical trials of different treatment regimens are analyzed. The opportunities, problems, and prospects of current retreatment in patients not responding to initial antiviral therapy are discussed.