[The pattern of central nervous system lesions in HIV-infected patients of the specialized unit in infectious disease hospital].

AIM: To define the incidence and features of brain lesion (BL) in HIV-infected inpatients. SUBJECTS AND METHODS: Four hundred and fifty-eight patients with Stage 4B HIV infection (AIDS) and central nervous system (CNS) lesion admitted to Infectious Diseases Hospital Two, Moscow, were followed up in 2003-2009. The authors used cerebrospinal fluid (CSF) microscopic and bacteriological assays for DNA of T. gondii, M. tuberculosis, herpes simplex virus (HSV) types 1 and 2, cytomegalovirus (CMV), HSV type 6, and varicella-zoster virus, Cr. neoformans, C. albicans, C. glabrata, and C. krusei. Blood and CSF were tested for IgM and IgG T. gondii antibodies; brain magnetic resonance imaging was carried out. RESULTS: In patients with late-stage HIV infection, the principal cause of neurological diseases was cerebral toxoplasmosis (34.7% of BL cases) and a generalized process involving the brain, lung, heart, liver, and eyes in 11.5%. There was commonly cerebral toxoplasmosis concurrent with CMV infection with clinical manifestations. 16-32% of the inpatients developed tuberculosis meningoencephalitis that was a manifestation of hematogenous disseminated tuberculosis involving the lung. There was a rise in the incidence of cancers (brain lymphomas, astrocytomas) running with CNS lesion. Mental disorders progressing to dementia were a distinctive property of CMV ventriculoencephalitis, one of the leading factors in the development of AIDS dementia complex. Molecular diagnostic techniques are needed to ascertain the etiology of BL in HIV infection. CONCLUSION: The CSF test for DNA of causative agents is a specific and most sensitive method for diagnosing a relevant CNS lesion.

[Spectrum, clinical features, diagnosis of opportunistic and comorbid pathology in HIV-infected patients admitted to infection hospital of Moscow].

AIM: To analyse structure, clinical features, diagnosis of opportunistic and concomitant diseases in patients with HIV infection admitted to infection hospital of Moscow. MATERIAL AND METHODS: A total of 4155 patients with HIV infection (1518 of them with AIDS) most of them (89%) at the age of 20-39 years were treated in Moscow AIDS hospital in 2006-2007. The examination included standard blood and urine tests, device diagnosis, immunological, bacteriological and molecular investigations of biological materials for detection of opportunistic infections. Cell-mediated immunity was also studied. HIV infection resulted in a lethal outcome in 255 (6.1%) inpatients. RESULTS: Leading causes of hospitalization of patients at early stages of HIV infection were bacterial bronchitis or pneumonia, hepatic pathology (chronic viral hepatitides, alcohol-associated diseases), sepsis. One-third of the inpatients were at AIDS stage characterized by tuberculosis (66.3%), visceral candidosis (12%), manifest cytomegalovirus infection (10.1%), cerebral toxoplasmosis (9.2%), pneumocystic pneumonia (5.5%). The number of HIV-infected persons with atypical mycobacteriosis, lymphoproliferative diseases, brain tumors increased. Chronic hepatitis C prevailed among liver damage cause in HIV infection, it also often caused hospitalization and death of patients. 60.3% patients having HIV infection who died without AIDS stage had hepatic cirrhosis. Tuberculosis was a leading cause of severe pulmonary pathology, most frequent opportunistic disease, main cause of death in patients with HIV infection. One-third of patients had generalized tuberculosis. Tuberculosis was diagnosed in more than 40% HIV-infected patients with pulmonary lesion, in 65% AIDS patients, 36% dead AIDS patients. CONCLUSION: To render effective anti-HIV treatment, infection hospital must be equipped with facilities providing device tests, molecular diagnosis, modern etiotropic and pathogenetic medication.

[Pulmonary diseases in patients with HIV infection].

AIM: To characterize the spectrum, incidence rate and features of pulmonary pathology in HIV-infected inpatients with reference to a fall in the count of CD4-lymphocytes. MATERIAL AND METHODS: A total of 2370 patients with HIV infection admitted to Moscow infectious hospital N 2 were examined. The protocol of examination included: standard diagnostic tests, bronchoscopy with examination of bronchoalveolar lavage and bronchial biopsies for genetic markers of basic pulmonary disease pathogens, assessment of external respiration function by spirometry. By the count of CD4-lymphocytes in the blood (> 500 cells/mcl; 500-200 cells/mcl and < 200 cells/mcl) the patients with pulmonary pathology were divided into groups 1, 2 and 3. RESULTS: Affection of the lower respiratory tract (LRT) was detected in 1209 (51%) patients. Incidence, etiological spectrum and severity of LRT lesions increased significantly with aggravation of immunological disorders. The patients of group 1 were affected more frequently with bacterial bronchitis, pneumonia (88.2%), group 2 patients - with bacterial pneumonia (67.1%) and pulmonary tuberculosis (28.1%), group 3 - with tuberculosis including generalized forms (53.9%), cytomegalovirus infection (11.2%), pneumocystosis (7.2%). Combined pulmonary pathology was diagnosed in 25% cases. CONCLUSION: Changes in external respiration function were most evident in pneumocystosis and tuberculosis, but they were most persistent in cytomegaloviral lesion of the lungs. Some tuberculosis and CMV infection patients exhibited ventilatory disorders prior to clinical and x-ray symptoms, this suggests prognostic significance of spirometry.

[Cerebral toxoplasmosis in HIV-infected patients].

AIM: To detect clinical characteristics of cerebral toxoplasmosis in HIV-infected patients, to clarify diagnostic role of detection of DNA and antibodies to Toxoplasma gondii in the cerebrospinal fluid (CSF) and blood. MATERIAL AND METHODS: Diagnostic procedures were performed in 156 patients with HIV infection at the stage IVB (AIDS) in 2003-2006. All the patients suffered from diseases of the central nervous system (CNS). Toxoplasmosis was diagnosed in 57 (36%) cases. Lumbar puncture, MR imaging of the brain, reaction of indirect immunofluorescence, polymerase chain reaction and enzyme immunoassay were made to identify IgM and IgG to T. gondii. RESULTS: Typical for HIV-infected patients with cerebral toxoplasmosis were focal symptoms of CNS affection, hemipareses, adynamia, mental disorders, intoxication symptoms. CONCLUSION: MR imaging data are very important. Toxoplastosis is characterized by multiple destructive foci in the hemispheres and cerebellum with great amount of the parasites along the periphery of brain tissue necrosis. Detection of the infective agent DNA and specific IgG antibodies in cerebrospinal fluid confirms the presence of toxoplasmosis but sensitivity of the markers is low. IgG antibodies to T. gondii have diagnostic implications if they occur in high and moderate titers.

[Differential diagnosis of lymphadenopathy in HIV/AIDS].

AIM: To determine the role of histological diagnosis of lymphadenopathy (LAP) associated with clinico-laboratory picture in patients with HIV infection/AIDS. MATERIAL AND METHODS: Target biopsy of the peripheral lymph node was made in 80 HIV-infected patients from 2002 to 2005. Histological diagnosis was made in all the patients with light microscopy, in some patients at immunohistological examination. RESULTS: Most of the patients had peripheral blood CD4 lymphocytes under 200 cell/mcl. Viral load was hundred thousands copies in mcl. Tuberculosis was diagnosed in 33 (41%) patients, lymphomas--in 23(29%), lymphogranulomatosis--in 5 (6%), reactive lymphadenopathy--in 15 (19%), germinogenic tumors--in 3 (4%), sarcoidosis--in 1 (1%). Histologically, LAP was represented by follicular hyperplasia (n = 9), involution (n = 2), bacterial lymphadenitis with necrosis (n = 4). CONCLUSION: Biopsy of peripheral lymph nodes is an early, safe, reliable and cost-effective method of LAP diagnosis in patients with AIDS.

[Cytomegalovirus infection of the gastrointestinal tract in patients with HIV-infection].

AIM: To study clinical and morphological characteristics of gastrointestinal cytomegalovirus (CMV) infection in HIV-infected subjects. MATERIAL AND METHODS: The examination of 70 HIV-infected subjects (all of them had secondary diseases, AIDS, CMV infection in the gastrointestinal tract; mean age 31.2 +/- 1.4 years) observed from 1993-2005 included conduction of flow cytofluorimetry (to assess immunity), esophagogastroduodenoscopy, colonoscopy, PCR (to assay CMV DNA in blood leukocytes), examination of biopsy and autopsy samples for CMV DNA and other pathogens of opportunistic diseases). There were 55 lethal outcomes. In autopsy, a total macroscopic and microscopic examination of the gastrointestinal tract was made. Serial histotopographic sections were studied with a wide spectrum of histological stains. RESULTS: CMV gastrointestinal lesion was diagnosed in 38.9% of 180 HIV-infected subjects who had stomatitis, pharyngitis, esophagitis, gastritis, enteritis, enterocolitis or colitis. Diagnostic criteria of viral lesion were high blood concentrations of CMV DNA, the presence of cytomegalocells, CMV DNA in biopsy or autopsy material. CONCLUSION: CMV infection manifested with severe pain, loss of weight, weakness, remitting fever. Gastrointestinal lesions were erosive-ulcerous or ulceronecrotic. The following pathogenetic chain of CMV infection course in the gastrointestinal tract was established: vasculitis--microcirculatory disorders--segmental ischemia--necrosis with inflammatory infiltration and CMV transformation of the cells--fibrosing--cicatricial transformation of the organ wall. Developing sclerosis due to CMV involvement of the intestine may promote cancer, but this should be proved in further studies. CMV gastrointestinal infection was successfully treated by cimeven (ganciclovir) and valcit (valganciclovir). The effect was achieved in 91% cases.

[Search for HHV-8 associated diseases reservoir and spread paths of HHV-8 in Russia]. / Poiski HHV-8-assotsiirovannykh zabolevanii, rezervuara i putei rasprostraneniia HHV-8 v Rossii.

Summarized in the paper are study results of human herpesvirus type 8 (HHV-8) and of its association with Kaposi's sarcoma (KS). The data obtained denotes that the share of individuals producing the antibodies to HHV-8 in a majority of studied patients was low and ranged form 0 to 5.5%, which is indicative of a low degree of the virus spread in population. At the same time, a high share of persons with antibodies to HHV-8 was detected among HIV-infected homosexuals (71.4%), kidney recipients (26.0%) and among AIDS-KS patients (78.6%). It was also unexpectedly high among patients with T- and B-cell lymphomas (50%), encephalopathy (27.3%) and with stomach cancer (41.8%): the appropriate parameters were 7-12-fold higher versus healthy subjects. The HHV-8 markers, i.e. virus specific antibodies and/or nucleotide sequences of the virus, were detected in blood serum and ejaculate of a significant number of patients with different pathologies of the prostate. Such detection of viral markers in the above categories of patients is suggestive of that sexual contacts with such patients are decisive for the HHV-8 spread in population.

[Secondary diseases in patients with HIV infection: 15-year follow-up]. / Vtorichnye zabolevaniia u bol'nykh c VICh-infektsiei - 15-letnee nabliudenie.

AIM: To analyse the results of a 15-year study of opportunistic diseases in AIDS patients. MATERIAL AND METHODS: The spectrum of opportunistic diseases were made in AIDS patients in respect to clinical, laboratory and autopsy data for the periods: 1987-1992 (n = 27, 25 deaths--92.6%), 1993-1997 (n = 95, 58 deaths--61.8%), 1998-1999 (n = 70, 28 deaths--40%), 2000-2001 (n = 126, 31 deaths--24.6%), 2002 (n = 80, 32 deaths--40%). RESULTS: The spectrum of opportunistic diseases in AIDS patients was determined for the above time periods and causes underlying these diseases have been determined. CONCLUSION: Among opportunistic diseases associated with HIV infections most prevalent were the following: tuberculosis, cytomegaloviral infections, cerebral toxoplasmosis. Leading modern trends were identified: increasing morbidity of AIDS, tuberculosis, new AIDS cases at late stages with severe opportunistic diseases (2/3 of deaths).

[Liver involvement in secondary infections in HIV-infected patients]. / Porazheniia pecheni pri vtorichnykh zabolevaniiakh u bol'nykh s VICh-infektsiei.

AIM: To determine spectrum and frequency of hepatic lesions, clinical, laboratory and morphological characteristics of hepatic pathology in secondary diseases in HIV-infected patients. MATERIAL AND METHODS: In 1991 to 2002 the authors observed 59 HIV-infected patients with hepatic affection caused by opportunistic infections and tumors. The examination included biochemical tests of blood, immunological tests, biopsies and tests of the autopsy material for CMVDNA, T. Gondii, M. Tuberculosis. Polymerase chain reaction, puncture biopsy of the liver, ultrasound investigation of the abdominal organs. 57 lethal outcomes were registered. RESULTS: Hepatic lesion was of tuberculous origin in 42.4%, CMV--in 16.9%, toxoplasmic--in 6.8%. 3 patients had fungal infection. Cancer of the liver was diagnosed in 18.6%. Clinical picture in most of the examinees was not clear and did not correspond to morphological severity of the condition. Ultrasound detected hepatic lesions if they were caused by CMV infection, toxoplasmosis and malignant tumors. Biochemical parameters were changed moderately. Patients with CMV hepatitis showed significant rise in the activity of GGT and AP. CONCLUSION: Apart from virus hepatitis B, C and D, the liver of HIV-infected patients got affected with tuberculosis, CMV-infection, toxoplasmosis, cancer. Hepatitis in HIV-infected subjects unrelated to viruses or medicines indicates a generalized disease, late stage of HIV-infection with a fall of the number of CD4-lymphocytes under 100 cells/microl.

[Anabolic therapy in patients with HIV infections]. / Primenenie anabolicheskoi terapii u bol'nykh s VICh-infektsiei.

AIM: To assess effectiveness of Deka-Duraboline--preparation of anabolic steroid hormone (nandrolone decanoate)--in the treatment of weight loss in AIDS patients. MATERIALS AND METHODS: 13 AIDS patients with weight loss < 10% admitted to Moscow Center of AIDS Prevention and Treatment were given Deka-Durabolin 1 time a week 50 mg intramuscularly for 12 weeks after failure of attempts to arrest weight loss. Body mass, diarrhea, appetite and general condition (visual analogue scale) were studied. RESULTS: Deka-Duraboline treatment arrested weight loss in 12 of 13 cases, improved well-being. All the patients displayed better appetite, reduced diarrhea. CONCLUSION: Deka-Duraboline is effective in improving body weight, appetite, diarrhea and well-being in AIDS patients. It is advisable to further study Deka-Duraboline in a controlled randomized trial.

[The etiological structure and characteristics of liver involvement in patients with HIV infection]. / Etiologicheskaia struktura i osobennosti porazhenii pecheni u bol'nykh s VICh-infektsiei.

Hepatic lesions were analyzed in 33 patients with HIV-infection. The patients were divided into two groups by the disease stage: early (stage IIB, IIIA, n = 12) and late (stage IIIB and IIIC, n = 21). Markers of hepatitis A, B and C were found in 42.4% of patients. Patients of group 1 had acute and chronic viral hepatitides (75%), hepatic alcoholic damage. Patients of group 2 developed combined hepatic lesions resultant from generalized bacterial, fungal and parasitic infections (66.7%), chronic hepatitides and viral cirrhoses (33.3%), alcohol abuse (33.3%). Elevated levels of the enzymes (AsAT, AlAT, LDG) at early stages of HIV-infection were brought about by hepatic involvement while at late stages by polyorganic abnormalities.

[The first case of visceral leishmaniasis in a patient with HIV infection in Russia]. / Pervyi sluchai vistseral'nogo leishmanioza u bol'nogo s VICh-infektsiei v Rossii.

A case history of a 39-year-old male is reported. The patient was diagnosed to have visceral leishmaniasis and HIV infection in January 1997. HIV-infection manifested with advanced Kaposi's sarcoma, recurrent Candida and Herpes infection, a decrease of body mass by more than 10%. The diagnosis of visceral leishmaniasis was confirmed by detection of Leishmania in biopsy from the bone marrow. Glucantim treatment produced a good clinical effect.

[The diagnosis and clinical characteristics of cytomegalovirus infection in HIV-infected subjects]. / Diagnostika i klinicheskaia kharakteristika tsitomegalovirusnoi infektsii u VICh-infitsirovannykh lits.

Out of 180 HIV carriers active cytomegalovirus (CMV) infection was found in 30 patients, in 16 cases the infection manifested clinically. Most of the latter were patients with HIV infection IIIb or IIIc stage against persistent lowering of CD4-lymphocyte count under 100/mm3. Active CMV infection may be determined most significantly by the following criteria: high or moderate concentrations of CMV DNA in the blood, low concentrations of blood CMV DNA in the presence of long-term (at least 3 months) persistence of anti-CMV IgM and isolation of urinary CMV. CMV infection manifested usually as a generalized disease with typical signs of retinitis, myelitis, erosive-ulcerative colitis. Most patients had thrombocytopenia, functionally defective platelets. CNS involvement predicts poor prognosis in CMV-infected HIV carriers.

[Tuberculosis in patients with HIV infection]. / Tuberkulez u bol'nykh s VICh-infektsiei.

Within 1987-1995 the authors observed 16 cases of tuberculosis in HIV-infected patients which accounted for 26.7% of AIDS patients treated by them. 14 cases were diagnosed intravitally, 2 postmortem. Infiltrative, generalized, cavernous, intrathoracic lymph node, intraabdominal lymph node tuberculosis and tuberculous pleurisy were identified in 5, 6, 2, 1, 1 and 1 patients, respectively. 6 patients from the above are still alive and are receiving treatment (5 of them with infiltrative tuberculosis), 10 died. Tuberculosis course and outcomes in HIV-infected subjects depended on the stage of their immunodeficiency. In moderate immunodeficiency (CD4-lymphocyte > 200/mm3) tuberculosis ran, as a rule, as local and infiltrative, sensitive to specific therapy. In severe damage to immune system (CD4 < 100/mm3) tuberculosis acquired a generalized course, sometimes fulminant, resistant to treatment. It is inferred that HIV-infected subjects with immunodeficiency need tuberculosis prophylaxis with isoniazide or rifampicin.