[Chronic viral hepatitis in St.Petersburg].

Morbidity data on chronic viral hepatitis including cirrhotic stages of disease and lethality indexes in St. Petersburg are provided. The necessity of isolation in ICD- 10 and statistical accounting of chronic viral hepatitis diagnosis with outcome into cirrhosis (cirrhotic stage) is shown. During use of viral etiology liver cirrhosis diagnosis the disease is registered in the structure of liver diseases which does not allow to have data on unfavorable outcomes of chronic viral hepatitis and for complete morbidity accounting.

[The topical problems of morphological diagnosis and the pathomorphism of HIV infection].

The paper analyzes the frequency of admissions to the S. P. Botkin Clinical Infectious Hospital and the City AIDS Center among patients with HIV infection and the structure of fatal outcomes. It is concluded that there is a considerable increase in mortality and the number of patients needing hospitalization. The dead HIV-infected patients autopsied at the Unit of Morbid Anatomy, S. P. Botkin Hospital, in the past years are characterized in detail. The topical problems of HIV infection the solution of which require the participation of pathomorphologists are discussed.

[Comparative clinical and epidemiologic characteristic of HIV infection in women from discordant pairs].

Forty HIV-positive women living with HIV-infected sexual partner as well as 40 HIV-positive women from discordant pairs (HIV-positive wife and HIV-negative husband) were surveyed. Less than half of HIV-infected patients (40%) specified the use of condoms for sexual contacts. In the group of women living with HIV-infected partner more expressed immunosupression (CD4 count 427 cells/mcl versus 528 cells/mcl) was observed. Statistically significant increased viral load in the 1st group compared with the women from discordant pairs was revealed.

Circulation of subtype A and gagA/envB recombinant HIV type 1 strains among injecting drug users in St. Petersburg, Russia, correlates with geographical origin of infections.

Countries of the former Soviet Union are experiencing an emerging HIV-1 epidemic due to a rapid expansion of HIV-1 among injecting drug users (IDUs). To study the molecular epidemiology of HIV-1 among IDUs in St. Petersburg, Russia, virus sequences were obtained from 22 individuals. Phylogenetic analysis of the env and gag regions revealed circulation of two major HIV-1 populations, one belonging to HIV-1 subtype A, and another being a recombinant of subtype A and B viruses (gagA/envB). Both virus populations were highly homogeneous, with a mean pairwise genetic distance of <2%, and similar to viruses obtained earlier from IDUs in other regions of the former Soviet Union. Distribution of the two major HIV-1 genotypes in St. Petersburg correlated with geographical origin of infections. In one individual, a virus type previously unseen among IDUs was found, which demonstrates the possibility that new viruses are entering this risk group.

[Tumor necrosis factor-alpha and interleukin-1beta in the blood plasma of patients with HIV infection]. / Faktor nekroza opukholi-alpha i interleikin-1beta v plazme krovi bol'nykh VICh-infektsiei.

The paper presents examination findings of 67 HIV-infected patients: 32 children aged 2.5 to 16 years and 35 adults aged 21 to 46 years. The proportion of patients with higher alpha-tumor necrosis factor and interleukin-1 beta increased with progression of the disease, the two parameters being higher in the children than in the adults. A correlation was found between the appearance of cytokines in the plasma and some clinical signs, such as fever, weight loss, anemia, neurological disorders. A parallel study of the patients' immunograms indicated significant correlations between the degree of impairments in the composition of lymphocyte subpopulations and the appearance of plasma cytokines.

[The dynamics of the course of HIV infection in patients with concomitant sexually transmitted disease morbidity and viral hepatitides detected in Saint Petersburg in 1997-1998]. / Dinamika techeniia VICh-infektsii u patsientov s soputstvuiushchimi ZPPP i virusnymi gepatitami, vyiavlennye v Sankt-Peterburge v 1997--1998 gg.

During the recent 2 years growth in the number of cases of HIV infection, exceeding 1.2-fold the number of cases detected during the preceding 9 years, was registered in St. Petersburg. In the structure of patients with detected HIV infection injecting drug users prevailed. Among 124 patients with detected HIV infection 28.2% and 46.8% had, respectively, concomitant sexually transmitted diseases (STD) and virus hepatitides (VH). Due to preventive and antiepidemic measures the STD and VH morbidity decreased in all groups of HIV-infected patients under study.

[The clinical course of HIV infection in children who were parenterally infected]. / Klinicheskoe techenie VICh-infektsii u detei s parenteral'nym putem infitsirovaniia.

The data on the study of the clinical course of HIV infection in 127 children, 124 from these infected in nosocomial foci. The overwhelming majority of the children were infected at the period of their stay in hospitals of Elista, Volgograd, Rostov-on-Don, Shakhty (Rostov Province) and Stavropol'. At the end of 9-9.5 years elapsed since the appearance of the first documented cases of parenteral infection 33 children (26%) died. The study revealed that at the age under 1 year the course of HIV infection could rapidly progress into the stage of AIDS in the presence of aggravated premorbid background linked with the unfavorable course of pregnancy in the mother and a severe disease in the child prior to contacting HIV infection.

[The characteristics of the course of tuberculosis in HIV-infected patients and prophylactic measures]. / Osobennosti techeniia tuberkuleza u VICh-infitsirovannykh i mery ego profilaktiki.

Morbidity in HIV infection and tuberculosis in persons having these two infections in association was analyzed. According to the data for the end of the first quarter of 1997 the presence of association of HIV infection with tuberculosis was found in 91 patients. In 70.3% of cases HIV infection was contacted before the appearance of tuberculosis and in 18.7% of cases, after it; in 11% of cases the order of appearance of these two diseases could not be established. The study revealed that the markedness of the clinical picture of tuberculosis was determined by the progress of HIV infection.

[Treatment of Flexner's dysentery with ofloxacin]. / Lechenie dizenterii Fleksnera ofloksatsinom.

Twenty four patients with dysentery due to Shigella flexneri2a and 1 patient with mixed infection (acute dysentery due to Sh.flexneri 2a+group B salmonellosis) were treated with ofloxacin. The patients were divided into 4 groups. In group I ofloxacin was administered intravenously in a dose of 200 mg twice a day followed by its oral use in the form of tablets in a dose of 200 mg twice a day for 5 to 6 days. In group II ofloxacin was used orally in the form of tablets in a dose of 200 mg once a day in the morning for 5 to 7 days. In group III ofloxacin was used in the same dosage but in combination with some other antibiotics. In group IV the patients were treated with antibiotics except for ofloxacin. High efficacy of ofloxacin was observed with all the regimens. In the patients treated with ofloxacin rapid improvement of the patient state (normalization of the body temperature by the 2nd or 3rd day) and complete eradication of the pathogens were recorded. Ofloxacin was superior by the efficacy to the other antibiotics.

[A case of death from AIDS in the USSR]. / Sluchai smerti ot SPID v SSSR.

The authors describe the first case of death from AIDS in the USSR of our countrywoman. The clinical manifestations of AIDS in the young woman were determined by opportunistic infections: disseminated candidiasis of the gastrointestinal tract, respiratory organs as well as Pneumocystis pneumonia which ran an extremely grave course with a progressive increase of acute respiratory and cardiopulmonary failure and sepsis.

[Clinical course of cryptococcosis in HIV infection]. / Klinicheskoe techenie kriptokokkoza pri BICh-infektsii.

Cryptococcosis was detected in 17% of examines with AIDS. The disease was caused by fungus Cryptococcus neoformans. Most frequently cryptococcosis affected CNS (meningitis and encephalitis). The symptoms were scare and nonspecific, e.g. positive meningitis indicators occurred only in 9% of the patients. Cryptococcosis tends to hematogenic spread with severe dissemination. The diagnosis was made primarily basing on the results of mycological investigations of the biosubstrates, i.e. discovery of Cryptococcus neoformans.

[Bacterial complications in acute hepatic failure in patients with hepatitis B]. / O bakterial'nykh oslozhneniiakh pri ostroi pechenochnoi nedostatochnosti u bol'nykh virusnym gepatitom B.

With virus hepatitis B (VHB) associated with acute hepatic insufficiency, precoma and coma, one third of the patients develop bacterial purulent inflammatory complications involving mainly biliary system and intestine. Attendant bacterial complications promoted rapid progression of hepatic coma seen commonly on day 1-10 of the disease. The diagnosis in relevant patients recognizing bacterial complications clinically should be based on alterations in the liver size, the presence of fever, elevated body temperature, relatively low decrease of prothrombin index and fibrinogen against leukocytosis with stab neutrophil shift. These symptoms call for introduction of antibacterial drugs.

[The clinical picture of mycotic complications in HIV-infected patients]. / Klinika mikoticheskikh oslozhnenii u VICh-infitsirovannykh bol'nykh.

Mycotic complications were registered in 21 out of 37 HIV-infected subjects. Oropharyngeal candidiasis was most common. It occurred prior to or concurrently with esophageal and skin candidiasis, fungemia, meningoencephalitis and disseminated lesions. With immunodeficiency progression, the prevalence and severity of mycosis go up. The causing fungi vary in great range: Candida albicans, Candida krusei. Candida tropicalis, Candida pseudotropicalis, Candida parapsilosis. Cryptococcus neoformans, Rhodotorula rubra, Penicillium chrysogenum.

[Liver damage caused by HIV infection]. / Porazhenie pecheni u infitsirovannykh virusom immunodefitsita cheloveka.

Hepatic status was studied in 7 HIV-infected patients at the stage of generalized lymphadenopathy. Intravital needle biopsy obtained from the livers characterizes the latter as enlarged, showing signs of protein-synthesis dysfunction, morphological evidence of mild cytolysis, cholestasis, moderate mesenchymal-inflammatory syndrome. The study of autopsy specimens obtained from hepatic tissue of the woman who had died of AIDS disclosed more advanced lesions: hepatocytes dystrophy, intralobular and periportal infiltration. The conclusion is made on the necessity of liver function examination entailing due therapeutic measures when following up patients with HIV infection and AIDS.

[Tuberculosis in HIV-infected and AIDS patients]. / Tuberkulëz u VICh-infitsirovannykh i bol'nykh SPIDom.

The course of the combined infection (tuberculosis plus HIV-infection) has been analysed in 41 patients. Of them, 24 patients developed tuberculosis in the presence of HIV-infection (group 1) and 17 were infected with HIV when they already had tuberculosis running up to 5 years. HIV-infection in group 1 ran a more severe course, the patients developed generalized, disseminated and complicated forms of tuberculosis with more frequent lethal outcome. 39 patients of both groups received specific antituberculous therapy including 1-5 drugs. A response to treatment was achieved in 23 (60%) patients (52 and 47.8% at early and late HIV-infection stages, respectively). Treatment failure was explained by development of severe opportunistic infections and secondary diseases (generalized cytomegalovirus infection, advanced candidiasis, toxoplasmosis), poor compliance, asocial life style, advanced tuberculosis process, late diagnosis, inadequate treatment. It is shown that in late HIV-infection positive results of treatment can be expected only in early detection of tuberculosis and active long-term treatment.

[Our experience with acycloguanosine treatment of herpes simplex]. / Opyt lecheniia prostogo gerpesa atsikloguanozinom.

A 5% ointment acycloguanosine was tried in the treatment of recurrent herpes simplex of the skin and genitalia in 48 patients. The treatment brought limitation of the process, relief of the symptoms, control of local manifestations and toxicity, accelerated epithelization, complete regression and disappearance of the eruption.