[Molecular epidemiological analysis of HIV-1 variants circulating in Russia in 1987-2015]. / Molekuliarno-épidemiologicheskii analiz variantov VICh-1, tsirkulirovavshikh v Rossii v 1987-2015 gg.

AIM: To simultaneously analyze HIV-1 samples from all Russian regions to characterize the epidemiology of HIV infection in the country as a whole. SUBJECTS AND METHODS: The most extensive study was conducted to examine nucleotide sequences of the pol gene of HIV-1 samples isolated from HIV-positive persons in different regions of Russia, with the diagnosis date being fixed during 1987-2015. The nucleotide sequences of the HIV-1 genome were analyzed using computer programs and on-line applications to identify a virus subtype and new recombinant forms. RESULTS: The nucleotide sequences of the pol gene were analyzed in 1697 HIV-1 samples and the findings were that the genetic variant subtype A1 (IDU-A) was dominant throughout the entire territory of Russia (in more than 80% of all infection cases). Other virus variants circulating in Russia were analyzed; the phenomenon of the higher distribution of the recombinant form CRF63/02A in Siberia, which had been previously described in the literature, was also confirmed. Four new recombinant forms generated by the virus subtype A1 (IDU-A) and B and two AG recombinant forms were found. There was a larger genetic distance between the viruses of IDU-A variant circulating among the injecting drug users and those infected through heterosexual contact, as well as a change in the viruses of subtype G that caused the outbreak in the south of the country over time in 1988-1989. CONCLUSION: The findings demonstrate continuous HIV-1 genetic variability and recombination over time in Russia, as well as increased genetic diversity with higher HIV infection rates in the population.

[The duration of an HIV infection course and its influencing factors].

AIM: To study the duration of the natural course of HIV infection and to identify its influencing factors. SUBJECTS AND METHODS: 938 outpatient case histories of adult HIV-positive patients registered at the dispensary and the data of 3403 AIDS patients registered in the computer base, including those on 2588 dead people, were retrospectively analyzed. Kaplan-Meier survival analysis and Cox regression model were used. Gender, age, and route of infection were regarded as potential factors influencing the natural course of HIV infection. RESULTS: In Russia before the mass use of antiretroviral therapy (ART), the median survival from infection to death in the HIV-infected was 11.8 years; that from infection to establishment of AIDS was 11.6 years; the life expectancy following its diagnosis was 1.9 months. Patient age was a main factor influencing the course of HIV infection: in persons who had been infected with HIV at an age of over 35 years, lower CD4 lymphocyte counts and clinical progression occurred more rapidly than in those infected at a younger age. Less than 50% of the patients needed ART 5 years after HIV infection. CONCLUSION: An HIV-infected patient without ART survives almost twice less. It is necessary to detect HIV infection as early as possible and to regularly follow up patients regardless of the duration of infection in order to timely initiate its treatment.