Aim. To evaluate the diagnostic approaches to viral hepatitis B and immune response on hepatitis B vaccination among clinical dispensary of dermatology and sexually transmitted diseases medical staff. Methods. The study included 92 serum samples of healthcare facility staff who underwent hepatitis B vaccination more than 7 years before. To assess the post-vaccination immunity, levels of antibodies to surface antigen of hepatitis B (anti-HBS) were determined by ELISA. Published data on the duration of post-vaccination immunity and annual reporting forms of clinical dispensary of dermatology and sexually transmitted diseases of Kazan in 2013 were analyzed. Results. Patients with human immunodeficiency virus, viral hepatitis B and C are often seeking for medical aid, retaining the risk for medical staff and other patients to be infected. Diagnosis of hepatitis B virus in medical settings is based on the detection of hepatitis B surface antigen (HBSAg), while revealing hepatitis B core antigen (HBCAg), anti-HBC (summary levels), extra-Dane particle antigen (HBEAg) and other markers of viral hepatitis B would allow to diagnose a latent form of hepatitis B. In 56.5% (n=92) of cases, anti-HBs levels were below the protective titer, suggesting higher risk for infection and requiring an additional revaccination. In the remaining 43.5% of cases, protective antibodies titers were revealed, confirming the effectiveness of specific prevention measures. Conclusion. Despite the mass vaccination for hepatitis B, owing to post-vaccination immunity weakening over time, revaccination of medical staff remains important.

Aim. To study clinical epidemiological and laboratory features of chronic brucellosis in the Republic of Tatarstan in ten-year aspect. Methods. 59 patients infected with various forms of brucellosis in 2007-2017 were examined. Clinical laboratory and instrumental diagnosis of brucellosis was confirmed by the immunoassay (EIA) with determination of IgM and IgG antibodies, passive hemagglutination test with a brucellar diagnosticum, Coombs test, Wright and Hedelson agglutination test. Results. Clinically 91 % of patients had asthenic-vegetative syndrome, 55 % - mild intoxication symptoms, 89 % - articular syndrome, 49 % - fibrositis. EIA revealed in 91 % of patients IgG (38 %) and IgM (53 %) antibodies to causative agents of brucellosis, 25 % of patients had positive Wright agglutination test, and 30 % - positive Hedelson agglutination test. In 9 % of cases the diagnosis was confirmed by Coombs test and in 26 % by passive hemagglutination test with brucellar diagnosticum. The retrospective analysis with clinical cases of patients with chronic brucellosis indicates introduced cases in 19 % (from the republics of Central Asia and Transcaucasia), local cases in 81 % (from the Republic of Tatarstan), their occupational character (57 %), the mixed (contact and alimentary) route of infection (21 %), and 64 % with clinically primary involvement of the musculoskeletal system and peripheral nervous system, i.e. prevalence of the mixed form of chronic brucellosis. Conclusion. Chronic brucellosis in the Republic of Tatarstan is characterized by high risk of introduced cases, occupational history, prevalence of the mixed route of infection in females and working-age patients; with the features of systemic disease involving the musculoskeletal and peripheral nervous system against the background of mild syndrome of intoxication and moderate asthenic-vegetative syndrome. Divergence of the results of serological diagnostics requires careful studying of duration of infection, features of the immune response in each case on follow-up.

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.

The main component of the treatment of patients with HIV infection is highly active antiretroviral therapy (HAART), which can help to control the disease. The main goal of HAART is to increase the life duration and to maintain the quality of patients’ life. Improved survival among HIV-infected patients receiving highly active antiretroviral therapy is achieved mainly by a decrease of HIV RNA viral load, which increases CD4 lymphocytes count. However, some patients may present with discordant response to treatment, when there is no CD4 lymphocyte count elevation associated with the virus disappearing from the blood. Such patients retain immunodeficiency, despite long-term treatment. The risk of opportunistic infections on the background of insufficient immunological response, despite viral replication suppression, is higher than in patients with good immunological response to treatment. Consistently low CD4 cell counts are associated with an increased risk of AIDS diagnosis. Furthermore, this group of patients shows a slight increase in mortality not associated with AIDS-defining illnesses. The reasons for the low CD4 lymphocytes count increase in some patients achieving virologic response to HAART remain unclear. The immunological efficacy of treatment depends on many factors: baseline CD4 count, duration of HIV infection prior to HAART initiation, age, co-infection with HCV, presence of secondary diseases and comorbidities, HAART regimens, IL-2 use and others. Literature review covers the phenomenon of immunological «non-response» to HAART, factors leading to its development, and possible methods of correction. Currently, there are more questions than answers in the area of immunological non-effectiveness of HAART in HIV-infected patients.