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Pathological conditions of various natures are capable of mutual aggravation, significantly affecting the overall burden of the disease, its manifestations and severity. This analytical review is devoted to the interaction between pathogens of socially significant infections human immunodeficiency viruses (HIV), hepatitis C, Mycobacterium tuberculosis and SARS-CoV-2. Foreign and own data covering the issues of syndemia and interference of pathogens are presented. The results of epidemiological analysis in the North-Western Federal District (NWFD) are presented, which demonstrated the absence of a significant impact of the pandemic caused by a new coronavirus infection (COVID-19) on the epidemic incidence of HIV, viral hepatitis C or tuberculosis at the population level, which may be due to various mechanisms of transmission of infections and the required infectious dose of the pathogen. The absence of a negative effect of COVID-19 on mortality rates in HIV infection, viral hepatitis C and tuberculosis in the territories of the NWFD was noted. Special attention is paid to the clinical picture of the combined course of HIV infection, tuberculosis and COVID-19. The data are demonstrated, which allow us to conclude that the worst prognosis and risk of death are patients in the progressive stage of the disease, which is characterized by the presence of opportunistic infections, especially AIDS-indicator conditions, with disseminated tuberculosis and in the cirrhotic stage of viral hepatitis. The significance of severe manifestations of infectious pathology in cases of deterioration of the prognosis of COVID-19 is shown. Based on the experience of two years of the pandemic, the problems contributing to the syndrome of new coronavirus infection and other conditions, as well as the causes of high mortality from COVID-19, which include: limited resources for non-infectious areas of medical care; insufficient funding for planned and high-tech care; a decrease in the volume of primary diagnosis and detection of infectious and non-infectious pathology; delayed and limited research in areas; distraction of specialists from preventive and dispensary work outside of infectious pathology; shortage of medicines and consumables; social instability and deterioration of the well-being of the population, characteristic of pandemics. The role of a personalized approach to patients with concomitant somatic and infectious diseases as a preventive measure for the severe course and complications of COVID-19 is determined.
Pathological conditions of various natures are capable of mutual aggravation, significantly affecting the overall burden of the disease, its manifestations and severity. This analytical review is devoted to the interaction between pathogens of socially significant infections human immunodeficiency viruses (HIV), hepatitis C, Mycobacterium tuberculosis and SARS-CoV-2. Foreign and own data covering the issues of syndemia and interference of pathogens are presented. The results of epidemiological analysis in the North-Western Federal District (NWFD) are presented, which demonstrated the absence of a significant impact of the pandemic caused by a new coronavirus infection (COVID-19) on the epidemic incidence of HIV, viral hepatitis C or tuberculosis at the population level, which may be due to various mechanisms of transmission of infections and the required infectious dose of the pathogen. The absence of a negative effect of COVID-19 on mortality rates in HIV infection, viral hepatitis C and tuberculosis in the territories of the NWFD was noted. Special attention is paid to the clinical picture of the combined course of HIV infection, tuberculosis and COVID-19. The data are demonstrated, which allow us to conclude that the worst prognosis and risk of death are patients in the progressive stage of the disease, which is characterized by the presence of opportunistic infections, especially AIDS-indicator conditions, with disseminated tuberculosis and in the cirrhotic stage of viral hepatitis. The significance of severe manifestations of infectious pathology in cases of deterioration of the prognosis of COVID-19 is shown. Based on the experience of two years of the pandemic, the problems contributing to the syndrome of new coronavirus infection and other conditions, as well as the causes of high mortality from COVID-19, which include: limited resources for non-infectious areas of medical care; insufficient funding for planned and high-tech care; a decrease in the volume of primary diagnosis and detection of infectious and non-infectious pathology; delayed and limited research in areas; distraction of specialists from preventive and dispensary work outside of infectious pathology; shortage of medicines and consumables; social instability and deterioration of the well-being of the population, characteristic of pandemics. The role of a personalized approach to patients with concomitant somatic and infectious diseases as a preventive measure for the severe course and complications of COVID-19 is determined.
Numerous studies have shown that COVID-19 is more severe and is accompanied by high mortality in older people and in the presence of comorbid pathology. An important role belongs to diseases accompanied by suppression of cellular immunity, which lead to frequent complications and longer viremia, which can be observed with HIV infection. The similarity of clinical, laboratory and radiological data does not allow to differentiate COVID-19 and HIV-opportunistic diseases with lung damage in an early period, especially in patients without an established HIV status. Identification of the features of the course of the disease, alertness towards HIV infection in patients admitted to the hospital with COVID-19 at a young age, the peculiarities of the epidemiological history will allow early diagnosis and improve management tactics.
The problem of non-smooth course of COVID-19 in people with severe comorbidities is topical. The greatest number of deaths from a new coronavirus infection was noted in the presence of such diseases as: obesity, chronic bronchopulmonary, cardiovascular diseases, HIV infection, diabetes mellitus, oncohematology, etc. Due to the focus of the healthcare system on the COVID-19 pandemic, less attention is paid to the fight against the immunodeficiency virus, despite the fact that the epidemiological situation with HIV infection in the Russian Federation continues to be tense. Individuals with HIV infection may be at increased risk of complications and death associated with COVID-19. The stage of HIV infection, indicators of the immune status, viremia, and taking antiretroviral therapy correlate with the severity of the course of COVID-19/HIV and have prognostic value. A clinical observation of the course of a new coronavirus infection in a 15-year-old teenager born to an HIV infected mother (who hid her HIV status at the time of hospitalization of a child) who was not at a dispensary observation at the AIDS Center was presented. The child was hospitalized with a new coronavirus infection (COVID-19), complicated: acute community-acquired (interstitial) bilateral pneumonia. The low index body mass of the child, the presence of concomitant pathology, the non-smooth course of the disease made it possible to suspect the patient of an immunodeficiency condition and identify concomitant HIV infection in the secondary disease stage (4B), the progression phase with the absence of antiretroviral therapy. Conclusion: the non-smooth course and severity of the disease were mainly due to secondary infections pathology. Severe immunosuppression detected in a child due to HIV infection contributed to the long-term persistence of the SARS-CoV-2 virus. In this case, it was not established that HIV infection in the patient was a factor predisposing to the severe course of COVID-19 and contributing to a prognostically unfavorable outcome. Complex therapy including antiretroviral therapy prevented further progression of immunosuppression and led to recovery from new coronavirus infection and management of comorbidity. The increase in the number of HIV-infected persons in the late stages of infection, often detected by chance, only during hospitalization, presents difficulties for therapy due to late diagnosis, the presence of a combined secondary pathology and the severity of its course against the background of low immune status parameters.
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