Sexually-transmitted infections are among the most well-known risk factors for HIV infection. The problem of combined diseases of STIs and HIV in infected people is represented by few works in the domestic scientific literature, therefore further study of this issue is required. Objective: to identify the prevalence of sexually transmitted infections in HIV-infected patients at the time of registration. Materials and methods. 49 clinical histories of patients with HIV infection were analyzed and studied at the Republican Center for the Prevention and Control of AIDS and Infectious Diseases of the Ministry of Health of the Republic of Tatarstan. Results. STIs with the prevalence of urogenital chlamydia, ureaplasmosis and mycoplasmosis in the oligosymptomatic clinical course were registered in 63% of patients (predominantly women — 67% of cases) with HIV infection in the natural infectious process course. Patients with HIV infection and syphilis showed lower level of CD4 lymphocytes and high levels of HIV RNA viral load.

Aim. To assess the structure of opportunistic infections and concomitant diseases, including the stage of infection, in patients hospitalized with HIV-infection. Methods. 40 cases of in-patient treatment of patients diagnosed with HIV aged 25 to 42 (mean age 34.26±1.22), male - 26, female - 14, with mean duration of infection 6,7±0,6 years were analyzed. Results. The patients were admitted to the hospital on 17±3.24 day of the disease, including cases of pulmonary diseases (on 23±3.6 day), cases of chronic hepatitis reactivation and liver cirrhosis decompensation (on 30±10.09 day), cases of acute infections (on 7±1.16 day). Previous psychoactive drug use was confirmed in 28 (70.0%) of patients. 13 (32.5%) patients received treatment with antiretroviral drugs, 3 (7.5%) have abandoned it, the rest had never been offered an antiretroviral treatment. According to the classification by V.I. Pokrovsky, the patient were staged as: stage III - 4 (10.0%) patients, stage IVA - 8 (20.0%), IVB - 11 (27.5)%, IVC - 17 (42.5%) patients. Pulmonary diseases were the most prevalent and were diagnosed in 17 (42,5%) patients, including cases of community-acquired pneumonia (focal, multisegmental, interstitial, lobular) in 8 (47.1%) patients, pulmonary tuberculosis (infiltrative, military, intrathoracic lymph nodes tuberculosis) in 9 (52.9)% patients. Liver diseases (chronic hepatitis B, chronic hepatitis B + C, liver cirrhosis) were the most frequent concomitant diseases and were found in 21 (52.5%) patients. Conclusion. Herpes zoster and liver diseases are the most predominant concomitant diseases at the early stages of HIV-infection, whereas ooportunistic infections, tuberculosis, community-acquired pneumonia and sepsis are typical in patients with late stages of HIV-infection.

Применение антиретровирусной терапии (АРВТ) при ВИЧ-инфекции позволило перевести заболевание в разряд тера-певтически контролируемых. Основная цель АРВТ -увеличение продолжительности жизни пациента и сохранение ее качества. Она достигается снижением вирусной нагрузки (числа копий РНК ВИЧ в плазме крови), что приводит к росту числа CD4 + -Т-лимфоцитов. Но терапия может быть неэффективной. В работе изучена частота случаев иммуно-логической (ИН), вирусологической (ВН) и клинической неэффективности АРВТ. В исследование включили 341 взрос-лого ВИЧ-инфицированного пациента, получавшего АРВТ, начатую на стадиях 3-4 заболевания, с вирусологической эффективностью как минимум в течение первого года лечения. Участников исследования наблюдали на протяжении 1-3 лет. ИН АРВТ определяли как увеличение числа клеток CD4 + менее чем на 50 клеток/мкл в год на фоне полной супрессии ВИЧ, ВН АРВТ -как число копий РНК ВИЧ выше порога определения через 6 мес от начала лечения. Частота случаев ИН АРВТ составила 14,0-15,9 % для одного года лечения и 22 % для трех лет наблюдений. Отмечено, что для последующего адекватного восстановления содержания Т-лимфоцитов CD4 + необходимо увеличение их числа в первый год терапии более чем на 100 клеток/мкл. Вирусологически эффективной АРВТ была для 92,7 % пациентов. Большая часть (80 %) случаев ВН АРВТ была обусловлена низкой приверженностью пациентов к лечению. Клиничес-кая эффективность АРВТ составила 91 % и в значительной степени определялась числом участников исследования с ИН АРВТ. Иммунологическая неэффективность АРВТ является фактором риска прогрессирования заболевания на фоне АРВТ и смерти при ВИЧ-инфекции. Риск клинического прогрессирования ВИЧ-инфекции при ИН АРВТ выше в 6,232 раз (95 % ДИ 3,106-12,51).Ключевые слова: ВИЧ-инфекция, антиретровирусная терапия, клиническая эффективность, вирусологическая эффективность, иммунологическая эффективность, неэффективность терапии CLINICAL, IMMUNOLOGICAL AND VIROLOGICAL INDICATORS OF ANTIRETROVIRAL THERAPY EFFICIENCYAntiretroviral therapy (ART) for HIV-positive patients allowed labeling the disease a therapeutically controlled one. The main goal of ART is to prolong patient's life and preserve its quality. This is accomplished through viral load reduction (decrease of the number of HIV-RNA copies in blood plasma), which leads to the growing numbers of CD4 + -T-lymphocytes. However, ART can be ineffective. In 2010-1014, we conducted an observational cohort retro/prospective study aimed at learning how often ART can be ineffective from immunological (II), virological (VI) and clinical points of view. The study was carried out at the premises of the Republic Center of AIDS and Infectious Diseases (Kazan, Russia). The study included 341 adult HIV-positive patients subjected to ART at 3rd and 4th stages of disease's development, with the treatment virologically efficient at least during the first year. The observation period was 1 to 3 years. ART was considered II (immunologically inefficient) when the number of CD4 + increased for less than 50 cells/mcl...

Aim. To identify the frequency and to perform the comparative analysis of IL-28B genotypes distribution in patients with hepatitis C (HCV) mono-infection and combined HIV/HCV infection. Methods. 101 patients (65% - males, average age 33.85±0.62 years) were included in the study. The first group (n=58) - patients with HCV mono-infection, second (n=43) - patients with combined HIV/HCV infection. Single nucleotides polymorphism at rs8099917 and rs12979860 locuses of IL-28B gene was performed using the «AmpliSens Genoscreen-IL28V-FL» reagent kit in the viral hepatitis laboratory of the molecular diagnostics department, CSRIE, Moscow. The baseline activity of HCV infection was determined by RNA-HCV viral load 400 000 copies/mL and alanine aminotransferase level (ALT). In the first group high RNA-HCV viral load (400 000 copies/mL) was observed in 30 (51.7%) patients, mean ALT level was 72.79±9.85 U/L; in the second group high HCV-RNA viral load was detected in 35 (81.4%) patients, mean ALT level was 85.46±7.73 U/L. In the group with combined infection 26 (60.5%) of patients received antiretroviral therapy (ART); in 14 (53.8%) of them there was no detectable viral load. The median absolute number of CD4+ lymphocytes was 0.400±0.04 cells/μL, median percentage - 25.41%±2.41. In 17 (39.5%) treatment-naïve patients the viral load was low (10 000 copies/mL), in 11 (64.8%) of these patients mean CD4+ count was 0.470±0.04 cells/μL (25.33%±2.15); the term of HIV antibodies detection was 6.89±0.53 years. The sensitivity of the PCR method for the qualitative detection of HCV-RNA was 111.1 copies/mL, quantitative - 275 copies/mL, for HIV-RNA - 150 copies/mL. Results. In patients with HCV mono-infection the rate of unfavorable IL-28B CT and TT rs12979860 genotypes and ТG and GG rs8099917 genotypes was 45 (77.6%) и 26 (44.8%) correspondingly, favorable СС rs12979860 and ТТ rs8099917 genotypes were registered in 13 (22.4%) and 32 (55.1%) patients correspondingly. In patients with HIV/HCV infection (n=43) unfavorable IL-28B CT and TT rs12979860 genotypes and ТG and GG rs8099917 genotypes were detected in 20 (46.5%) и 13 (30.2%) of cases, and favorable СС rs12979860 and ТТ rs8099917 genotypes - in 23 (53.5%) and 30 (69.8%) of cases correspondingly. Conclusion. Results show that favorable CC rs12979860 and TT rs8099917 genotypes of the IL-28B and their combination are found quite frequently in patients with mixed HCV/HIV infection, particularly in patients with HCV genotype 3, these patients also had more significant inflammatory reaction and high HCV RNA viral load compared to HCV mono-infected patients.

An early-stage infection induces the most powerful reactions of immune system. 137 clinical histories of patients with HIV infection, and HCV/HIV-infected at the early stages of HIV infection were subjected to analysis. Patients and methods: a group of 45 patients at early terms of HIV infection included 25 cases of HCV/HIV-infected patients (first group), and 20 cases with HIV mono-infection (second group). Duration of infection was less than 1 year (with positive ELISA test), with mean terms of HIV immunoblot positivity of 5.5±0.6 months. For comparative analysis, the natural course group was examined, i.e., 43 patients with combined HCV/HIV infection (third group), and 49, with HIV monoinfection (fourth group) with a duration of HIV infection for 4.4±0.21 years. The group of healthy controls included 52 persons. We aimed to perform a comparative evaluation of clinical course and immunological features from the early stages of infection in the patients with combined HCV/HIV and HIV infection. Results: at early stages of infection, clinical pattern in HCV/HIV-infected patients was dominated by purulent-inflammatory, fungal infections and secondary diseases, along with more pronounced inhibition of cellular immunity and increased viral load of RNA HIV, as compared to data on HIV-infected patients.