During a 2-year period in 2005-2007, we conducted surveillance of group A rotaviruses and other enteric agents among patients hospitalized with acute gastroenteritis in 8 different cities of the Russian Federation. Fecal specimens were gathered from 3208 children (including 2848 children aged <5 years) and 1354 adults who were admitted to hospitals in Moscow, St. Petersburg, Chelyabinsk, Nizhnii Novgorod, Tyumen, Khabarovsk, Makhachkala, and Yakutsk. Polymerase chain reaction was performed to detect rotaviruses of groups A and C, noroviruses of genogroups I and II, astrovirus, sapovirus, and enteric adenoviruses (group F). Group A rotavirus was the most common viral pathogen detected among children aged <5 years (43.6%), followed by norovirus (12.5%), whereas norovirus was the pathogen most commonly detected in adults (11.9%). P and G genotypes were determined for 515 rotavirus specimens, and the most prevalent genotypes were G1P[8] (44.9%), G4P[8] (40.0%), G2P[4] (8.5%), and G3P[8] (6.6%). This study is the first multicenter study of rotaviruses in the Russian Federation and documents the important burden of disease caused by this pathogen, which soon may be preventable by vaccination.

Tuberculosis (TB) and HIV have profound effects on the immune system, which can lead to the activation of viral replication and negatively regulate the activation of T cells. Dysregulation in the production of cytokines necessary to fight HIV and M. tuberculosis may ultimately affect the results of the treatment and be important in the pathogenesis of HIV infection and TB. This work presents the results of a study of the expression of pro- and anti-inflammatory cytokines (IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-10, IL-1RA) in drug-naïve patients with dual infection of HIV/TB at the late stages of HIV-infection, with newly diagnosed HIV and TB, and previously untreated HIV in the process of receiving antiretroviral (ART) and TB treatment vs. a cohort of patients with HIV monoinfection and TB monoinfection. The study revealed that during a double HIV/TB infection, both Th1 and Th2 immune responses are suppressed, and a prolonged dysregulation of the immune response and an increased severity of the disease in pulmonary/extrapulmonary tuberculosis is observed in HIV/TB co-infection. Moreover, it was revealed that a double HIV/TB infection is characterized by delayed and incomplete recovery of immune activity. High levels of IL-6 were detected in patients with HIV/TB co-infection before initiation of dual therapy (2.1-fold increase vs. HIV), which persisted even after 6 months of treatment (8.96-fold increase vs. HIV), unlike other cytokines. The persistent enhanced expression of IL-6 in patients with dual HIV/TB co-infection allows the consideration of it as a potential marker of early detection of M. tuberculosis infection in HIV-infected individuals. The results of multivariate regression analysis showed a statistical trend towards an increase in the incidence of IRIS in patients with high IL-1Ra levels (in the range of 1550–2500 pg/mL): OR = 4.3 (95%CI 3.7–14.12, p = 0.53), which also allows IL-1Ra to be considered as a potential predictive biomarker of the development of TB-IRIS and treatment outcomes.

Once-daily (QD) atazanavir/ritonavir (ATV/r) + 2NRTIs has proven efficacy with favourable lipid and GI profiles in treatment-experienced and -naive HIV patients (pts). Data are needed on effective simplified treatment strategies. MethodsAI424136 (INDUMA) is a randomised, open-label, multicentre study to assess non-inferiority (15% margin) of 48-week maintenance phase (MP) with ATV 400 mg QD vs. ATV/r 300/100 mg QD (1:1), both + 2NRTIs (excl. TDF), in patients with confirmed HIV-1 RNA <50 c/mLafter a 26-30 week induction phase (IP) with ATV/r + 2NRTIs in treatment-naive pts. Primary end-point was proportion of pts with HIV-RNA <50 c/mL through week 48 of MP. Secondary end-points included, percent with HIV RNA <400 c/mL, CD4 cell count change, and safety of MP. Summary of results252 pts entered IP (median CD4 245 cells/mm3; median HIV-RNA 4.95 log10 c/mL), during which 30 pts discontinued (nine for AEs). At the end of IP (EoI), 50 were not suppressed and were continued on ATV/r regimen (not described here), and 172 were randomised to MP. Demographics and EoI subject characteristics for MP were wellbalanced: median CD4 390 cells/mm3; half of pts were on 3TC+ABC. Through week 48 of MP the ATV arm demonstrated similar (non-inferior) efficacy compared to the ATV/r arm. (Table 1.) During MP, mean change in CD4 cell count at week 48 was +92 (SE = 18.1) cells/mm3 for ATV/r and +100 (SE = 14.7) cells/mm3 for ATV; discontinuations prior to week 48 were: ATV/r 14%; ATV 8%. Seven pts on ATV/r and 11 on ATV experienced virological rebound, none had emergence of PI resistance. AEs led to discontinuation in 5% and 1% of pts on ATV/r & ATV, respectively. Lab grade 3-4 total bilirubin was reported in 47% and 14% on ATV/r & ATV, respectively. Mean percent triglyceride change from EoI to week 48 of MP was +9.8 vs. -27.0 for ATV/r & ATV, respectively. The percent of pts who shifted into higher NCEP categories from EoI to week 48 of MP was higher in ATV/r than ATV for total cholesterol (23 vs. 10) and triglycerides (20 vs. 3). ConclusionThese results are consistent with the proven efficacy of atazanavir in naive pts and suggest that for those pts who have achieved undetectability under ATV/r, switching to

This paper evaluates the impact of different medical care strategies for chronic hepatitis C patients in relation to its prevalence, frequency of adverse outcomes and mortality rate.

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