Vol 8, No 3 (2022)

Favipiravir is one of the modern medicinal agents able to suppress RNA viruses, which include various pathogens of ARVI. The aim of the research is to assess the safety and tolerability of Areplivir (favipiravir) use in adult patients with mild to moderate ARVI clinical course, who have chronic diseases of organs and systems and who was becoming outpatient treatment during the COVID-19 pandemic, based on the dynamics of their clinical picture and subjective state. Material and methods. A prospective open initiative study of the safety and tolerability of Areplivir medicine was carried out on the basis of 7 outpatient medical institutions in 3 regions of the Russian Federation from December 2021 to March 2022. The study included 137 adult comorbid patients with symptoms of ARVI and a high risk of COVID-19 (based on the epidemiological history), having chronic diseases. Safety and tolerability of favipiravir in the observation group was assessed by identified adverse events in accordance with the scale of degrees of reliability of the cause-and-effect relationship «medicine - adverse reaction». The life quality and its dynamics before and after treatment were determined according to the results of the «COV19-QoL» questionnaire. Results. According to the results of the study in patients, therapy with Areplivir was characterized by a favorable safety profile. According to the doctors, the patients showed good tolerability of the medicine. Only a third of patients (n=46; 33,58%) experienced short-term adverse events (AEs) typical of favipiravir. Such changes were not accompanied by complaints of patients or other clinical manifestations. According to the evaluation of the doctors-researches, there was no causal relationship between the occurrence of AEs and the therapy with the study medicine in 34 (40,96%) of 83 cases. In 25 (30,12%) cases, this connection was possible, in 10 (12,04%) - probable, in 3 (3,61%) - conditional, in 3 (3,61%) - doubtful, in 8 (9,63%) - unclassified. All patients treated with study medicine did not experience significant deterioration of the condition requiring drug withdrawal or hospitalization. Conclusion. Therapy with Areplivir (favipiravir) was characterized by a favorable safety profile and good tolerability in comorbid patients with ARVI. Timely and mandatory prescription of etiotropic targeted antiviral therapy allows, in a pandemic, to reduce the risk of a aggravated course of COVID-19 in case of late diagnosis and, accordingly, reduce the pharmacoeconomic burden on the healthcare system, preventively influencing the possible consequences of RNA-associated respiratory diseases, as well as improve the quality of life of patients.

Timely detection of HIV variations resistant to antiretroviral medicines (ARM) and correction of the therapeutic direction can prevent the formation of mutations. The aim of the research is to study the prevalence of primary HIV-1 resistance to ARM in patients with HIV infection in Novosibirsk region in 2021. Material and methods. We examined 119 patients with newly diagnosed HIV infection aged 22 to 66 years old, who were observed in city clinical hospital No.1 in Novosibirsk in 2021. The nucleotide sequence of HIV-1 genome fragments encoding the protease and reverse transcriptase of the virus was studied, the HIV-1 genotype was determined, and the analysis for the presence of mutations associated with the development of virus resistance to ARM was made. Results. Among the 119 examined patients with HIV infection, males predominated - 68,1%. Among the ways of HIV infection transmission heterosexual transmission dominated - 61,3%. HIV-1 genotyping revealed 6 HIV genetic variants in 110 patients: subtype A6 (12,7%), subtype B (1,8%), CRF63_02A6 (80,9%), CRF01_AE (1,8%), CRF02_AGFSU (0,9%) and two variants of unique recombinant HIV (URF) formed with the participation of subtype A6 and CRF63_02A6 (0,9% each). According to the main list of mutations subject to surveillance for primary HIV-1 resistance, 16 resistant variants of HIV-1 were found - in 13,4% of the study group of patients. Based on the totality of all identified mutations (including those subject to surveillance), primary resistant variants of HIV-1 were detected in 19,3% of cases (n=23 from 119). More often than others, isolated mutations to drugs from the NNRTI group were registered -in 61,0% (n=14 from 23); isolated mutations to NRTIs were fixed in 21,8% (n=5 of 23), combination of mutations to NRTIs + nNrTIs in 12,9% (n=3 of 23), mutations to PIs + NnRTIs in 4,3% of patients (n=1 from 23). In patients with HIV resistance mutations (n=23), K103N was most common - alone (30,6%) and in combination with P225H or K70T (4,3% each). Most often, a high level of resistance was detected to ARPs of the NNRTI group - efavirenz (7,5%) and nevirapine (8,4%). The average level of resistance in isolated cases was registered to etravirine, rilpivirine and efavirenz (0,8% each). Conclusion. Among the naive HIV-infected, the prevalence of primary HIV-1 resistance to ART corresponds to the average level for the territories of Russia - 13,4%. Among HIV resistance mutations (n=23), K103N was the most common one (30,6%) and also in combination with P225H and K70T (4,3% each).

The existence of occult hepatitis C virus (HCV) infection in the general population and in selected clinical groups is covered in the literature, but its consequences in various clinical situations require further study. The aim of the study was to evaluate the long-term outcomes of chronic hepatitis C after successful antiviral therapy. Material and methods. In patients with chronic hepatitis C (n=182), clinical and laboratory parameters and liver density were compared at the start of therapy and at the end point of follow-up (median follow-up of 99 weeks), were tested for occult HCV infection (n=109). Results. The proportion of patients with liver cirrhosis and severe fibrosis decreased from 47% to 36%. A regression of cirrhosis occurred in 12 (24%) patients with Child-Pugh class A. A significant decrease in the FIB4 and APRI indices was recorded (p<0,05). In 27 (14%) patients, negative dynamics was observed (progression of fibrosis, n=17; decompensation of the cirrhosis, n=3; portal vein thrombosis, n=2; development of hepatocellular carcinoma, n=5) associated with higher AFP, FIB4, comorbidity index level. Occult HCV infection was detected in 5,5%. Conclusion. In patients with severe fibrosis and liver cirrhosis, the risk of fibrosis progression, decompensation of the cirrhosis and the development of HCC after the eradication of hepatitis C virus remains. Further studies on risk stratification are required to optimize dispensary follow-up after antiviral therapy.

The study and analysis of the use of the updated SCORE scale in patients with arterial hypertension (AH) is of interest for practical medicine. The aim: conducting a screening assessment of cardiovascular risk (CVR) in patients with AH on the SCORE-2 and SCORE2-OP scales using digital software tools. Material and methods. A team of authors created an Internet resource HeartCare, which allows you to automatically calculate the CVR according to the input data («Sex», «The fact of smoking», «Age», «SBP», « non-HDL cholesterol»). 80 people (38 women and 42 men) with AH aged from 45 to 70 years were included. The clinical status was assessed: complaints, anamnesis morbi and vitae, SBP and non-HDL cholesterol levels. The vascular age (VA) of patients was calculated - the program included the initial data of the subjects without taking into account risk factors (FR): smoking status, elevated levels of SBP, non-HDL cholesterol, after which a comparison was made of the «ideal» and actual CVR, which made it possible to calculate the difference between the chronological and VA patients. Results. There were 14% smokers among the surveyed. Positive smoking status increased CVR up to 50%. The mean value of SBP was 157,6±14.2 mm Hg. Non-HDL cholesterol values repeated from 3,00 to 6,71 mmol/l. The average value was 4,5±1,0 mmol/l. The maximum value of the degree of risk of developing CVD in the study group was 41%, the minimum - 5%. The average value of the CVR was 21,6%. In the context of the group, only 5 people had moderate CV risk, 75 people had high CV risk. The average value of the qualitative indicator of CVR was 1,9±0,2, where 0 - «Low risk», 1 - «Moderate risk», 2 - «High risk». The VA of the sample is, on average, 13,2±2,8 years higher than the biological one. This indicates the identification of the contribution of indicators «The fact of smoking» and «Non-HDL cholesterol» on the CVR in the target group. Conclusion. The SCORE-2 and SCORE2-OP software model can be used to estimate the rate of increase or decrease in CVR; to analyze of the effectiveness of prevention and treatment of AH in dynamics in individual patients. Automating the calculation of scale values and uploading them to an Internet resource allows them to be used not only by doctors, but also by patients themselves in order to control CVR at home.

It is proposed to designate the cardiological manifestations of a new coronavirus infection with the term «acute COVID-19-associated cardiovascular syndrome». The syndrome is characterized by acute myocardial damage with decreased left ventricular ejection fraction in the absence of obstructive coronary arteries failure. The main manifestations of acute myocardial injury in this case are myocarditis and cytokine dysregulation, less often stress-induced cardiomyopathy. Still there are no clear explanations for the variability of manifestations, and there remains considerable uncertainty regarding the cause of acute myocardial injury during coronavirus infection in patients without coronary artery obstruction. Literature data on the diagnosis of myocardial damage against COVID-19 background are collected in the current article. The literature was searched and analyzed for articles published up to November 2021 in MEDLINE databases. Inclusion criteria to this review were reports of myocardial injury diagnosis in patients with laboratory-confirmed infection who underwent comprehensive diagnostic studies, including cardiac MRI.

The article presents an overview of the significance of endothelial dysfunction in the pathogenesis of coronavirus infection and long-term COVID-19 syndrome. The mechanisms of endothelial damage are considered, data on the significance of glycocalyx damage in the formation of endotheliopathy in COVID-19 are presented. The analysis of modern therapeutic strategies for restoring endothelial function and preventing hypercoagulation after coronavirus infection is presented.

SARS-CoV-2 infection often leads to thrombotic complications, including complications in the coronary arteries. Thrombosis of the coronary arteries can be observed both in intact vessels and in vessels with atherosclerotic lesions of the walls. The article presents 2 clinical observations of the development of acute coronary syndrome with different course and outcomes of the disease in patients with COVID-19-associated pneumonia.

COVID-19 is a viral disease characterized by damage to the respiratory and other systems of the body, among which a frequent violation of brain functions. The interest is attracted by postcovid syndrome (PCS), characterized by long-existing subjective and objective signs of violation of various functions of the body. The review examines current information about the main causes of the development of PCS and its clinical manifestations. Information on the prevalence of this pathological condition is provided. The issues of treatment of patients with PCS are considered.