Среди основных причин неэффективности противовирусной терапии (ПВТ) хронического гепатита С (ХГС), препятствующей проведению адекватного и полного курса лечения иФн-α и рибавирином,-развитие нейтропении (нП) и тромбоцитопении (ТП). В настоящее исследование были включены 63 пациента (59% мужчин и 41% женщин) с ХГС, ранее не получавших ПВТ, все с генотипом 1 вируса гепатита C (ВГС-1), из них с генотипом 1а-15 пациентов, с 1b-42, с генотипами 1a + 1b-6. Возраст пациентов составил 33,8 ± 0,7 года, срок инфицирования-6,1 ± 0,8 года, индекс массы тела (иМТ)-22,4 ± 1,02. Показано, что при назначении Пег-иФн-α в комбинации с рибавирином достоверное снижение числа лейкоцитов, нейтрофилов и тромбоцитов преобладало у пациентов с ВГС-моноинфекцией генотипа 1b в стадиях F0-F2 (2,8-8,6 кПа) по шкале METAVIR. При развитии среднетяжелой ранней (до 12-й недели ПВТ) и для профилактики поздней (после 12-й недели лечения) нП назначение иммунотропного препарата глюкозаминилмурамилдипептида (ГМДП) в дозе 1 мг 2 раза в день в течение 20 дней у пациентов с ХГС (генотип 1b) с фиброзом менее F3 достоверно стимулировало лейкопоэз, повышало число нейтрофилов и тромбоцитов, что позволяло не снижать дозы иФн и повысить эффективность ПВТ. Таким образом, впервые представлены достоверные доказательства эффективности ГМДП в коррекции нП и ТП у больных ХГС (генотип 1b), что свидетельствует о целесообразности включения этого препарата в состав ПВТ. К л ю ч е в ы е с л о в а : хронический гепатит C; генотип 1; мурамилпептид; ликопид; глюкозаминилмурамилдипептид; пегилированный интерферон альфа; рибавирин.

Федеральное государственное бюджетное образовательное учреждение высшего образования «Казанский государственный медицинский университет» Министерства здравоохранения Российской Федерации, 420012, г. Казань, Российская Федерация 2 Государственное автономное учреждение здравоохранения «Республиканский Центр по профилактике и борьбе по СПИД и инфекционными заболеваниями» Министерства здравоохранения Республики Татарстан, 420061, г. Казань, Российская Федерация

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.

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.