People living with HIV in Russia and visiting AIDS centers do not differ in main social and demographic indicators from the Russian Federation citizens of the same age who do not have HIV. They represent an economically and socially active population and participate in demographic processes so one of the public health priorities is to maintain and improve their quality of life.

Aim. The article addresses the progress in elimination of mother-to-child transmission of HIV in the Russian Federation. The authors reviewed the available data on the current situation and identified opportunities to reduce the risk of mother-to-child transmission of HIV. Materials and methods. The basic HIV statistics for 2017 from the federal public health watchdog Rospotrebnadzor and the Russia's ministry of health were analysed. The findings included several important aspects. Results. In 2017, women constituted a substantial proportion of population living with HIV, both among all cases and among new HIV infections (37%-38%). The number of new HIV cases among women was growing every year and by 2017 increased 62% compared to 2010. In 28 regions of the Russian Federation, more than 1% of pregnant women were HIV positive. Across the whole monitoring period (from 1987), 177,663 pregnancies complicated by HIV infection and ended in delivery were registered in Russia by the end of 2017, including 14,969 such pregnancies in 2017 alone. In 2017, 91.0% of pregnant women living with HIV took ART during pregnancy, 94.7% received it in labour. 98.7% of new-borns were given antiretroviral therapy as prevention. However, a three-stage chemoprophylaxis was provided to only 89.1% of mother-child pairs. It was revealed that 1,635 motherchild pairs (10.9%) missed at least one of prevention stages. The main reason for incomplete prevention was the late diagnosis of HIV infection in mothers. The viral load before delivery was not suppressed in 25.8% of HIV-positive pregnant women whose pregnancies were completed in 2017 (2,527 women were tested for viral load and 1,342 did not take antiretroviral drugs during pregnancy). 708 children born to HIV-positive mothers were diagnosed HIV positive in 2017 of whom, however, only 235 were born that year. Calculations showed that in 2017 the risk of vertical HIV transmission amounted to 2.3%, which were 348 new-born babies. A significant number of children (35,579 born in different years) did not undergo a final HIV test. 3.9% of all HIV-infected children born to HIV-positive women had contracted HIV through breastfeeding. There was also a trend towards increasing the number of HIV transmissions this way. The article reveals that in the cohort of children born women, the death rate is higher. So in 2017 mortality among infants born to HIV-positive mothers was 1.5 times higher, while perinatal mortality was twice as high as in the general population. Conclusion. The study showed that in order to improve the situation concerning vertical transmission of HIV, it is necessary to solve a number of tasks related to low threshold programmes aimed at access to surveillance, treatment and retention in care for women, especially those of at-risk of HIV. The ways to achieve the goal are early infant HIV diagnosis in first two months of new-borns' life, urgent final laboratory examination of older children exposed to HIV at birth, determination and elimination of factors leading to increased infant mortality, breast-feeding counselling, as well as improvements in statistical methods.

The goal of the study was to evaluate the impact of antiretroviral therapy (ART) on the semen characteristics in HIV-infected men.Materials and methods. A prospective case-control study enrolled 66 HIV-infected male patients who presented for fertility assessment. Group 1 included 51 male patients treated with ART; Group 2 included 15 males who were not receiving ART. 97 and 25 semen samples were analyzed, respectively. HIV status was assessed based on the data regarding the stage and phase of the disease, viral load, CD3+, CD4+, CD8+ counts and the ART duration.Study results. At enrollment in the study, the duration of HIV infection in Group 1 was longer than that in Group 2 (the difference being statistically significant): 5 years (2–9 years) versus 2,5 years (0,4–4,5), respectively (р=0,0004). Median duration of treatment in Group 1 was 1,5 years. The most common type of abnormal semen morphology in ART-treated patients was teratozoospermia (40%), and the percentage of abnormally shaped spermatozoa in this group was higher compared to Group 2 (the difference being statistically significant): 97 (96–98) versus 96 (94,5–96,5); р=0,006). Group 1 demonstrated a negative relationship between the count of abnormally shaped spermatozoa and CD4+ cell count (r=–0,362; р=0,026), disease duration (r=0,173; р=0,173) and sperm count (r=–0,242; р=0,020), progressively motile (category B) sperm count (r=–0,241; р=0,024). The ART duration showed an inverse correlation with the progressively motile sperm count (category B) (r=–0,224; р=0,036). Group 2 demonstrated a statistically significant positive relationship between the CD4+ cell count, the semen volume (r=0,778; p=0,014), and the count of progressively motile (category B) spermatozoa (r=0,667; р=0,05). We also revealed a statistically significant inverse relationship between the viral load and the semen volume (r=–0,669; р=0,035). Sperm DNA fragmentation was found to be higher in HIV-infected patients treated with ART compared to HIV-infected men not receiving ART (15,8% (12,4–23,0) and 14% (10,9–20,5); р=0,533), respectively. Thus, HIV-infected patients treated with ART demonstrated abnormal sperm morphology (increased abnormal sperm count), decreased sperm motility and increased sperm DNA fragmentation level. The percentage of abnormally shaped sperm was higher in patients with lower CD4+ cell counts. In patients with a long history of HIV infection, the sperm count decreases and the count of immotile spermatozoa increases. HIV-infected individuals who are not receiving ART and have high viral loads show decreased semen volume. This value increases upon an increase in the CD4+ cell count.

2ФГАОУ ВО «Р оссийский университет друж бы народов», М осква 3ГБОУ ВПО «К расноярский государственный медицинский университет им. проф. В. Ф. Войно-Я сенецкого», г. К расноярск 4СНИО ЭП СП И Д Ф Б У Н «Центральный Н И И эпидемиологии» Р осп отр ебн адзора, М осква Представлен клинический случай коинфекции (В И Ч-и /Т Б) у беременной и новорожденного. В обсуждение врачебной тактики рассмотрены основные вопросы, от которых зависит успех терапии: правильность выбранного режима химиотерапии; правильность принятия решения о проведении родоразреш ения по жизненным показаниям со стороны матери; возможность своевременной диагностики туберкулеза у ребенка. Необходимо создание меж дисциплинарных рекомендаций от профессиональных сообществ по тактике ведения беременных с сочетанной патологией (В И Ч-и /Т Б), что позволит повысить качество оказания медицинской помощи беременным и новорожденным на всех этапах наблюдения.