[Treatment of infection caused by human immunodeficiency virus in the Russian Federation].

AIM: To study efficacy and safety of highly active antiretrovirus treatment (HAAT) used in the Russian Federation for development of recommendations for HIV infection treatment. MATERIAL AND METHODS: A total of 285 patients with chronic HIV infection and 42 patients with acute HIV infection participated in investigation of efficacy and safety of different HAAT schemes in 1997-2008. Efficacy of the treatment was assessed by percentage of the patients who had HIV RNA undetectable by the test system (< 400 copy/ml) after 24-48 treatment weeks, by a mean reduction of HIV RNA in blood plasma and an increase in the number of CD4-lymphocytes in 1 mcl of blood. RESULTS: A 12-year experience in antiretrovirus therapy administration for management of HIV infection is reviewed. Efficacy and safety of Russian antiretrovirus drug Phosphaside in HAAT schemes are shown in patients with both chronic and acute HIV infection. The model of HIV patients consulting before the treatment, psychological support during the treatment, methods of individual and group consulting, conception of the school for patients on HAAT are presented. Recommendations are proposed for administration of antiretroviral therapy and a model of calculation of the number of HIV-infected patients in need of antiretroviral therapy in Russia. Basing on the results of investigations on efficacy and safety of HAAT schemes, the physicians of the National Anti-AIDS Center have developed clinical recommendations, guidelines on the treatment of HIV infection, standards of medical care for HIV-infected patients.

[The structure of the secondary diseases in HIV-infected patients in Russia]. / Struktura vtorichnykh zabolevanii u bol'nykh VICh-infektsiei v Rossii.

In 95 patients with HIV infection (76 males and 19 females), observed in 1993-1997, the structure of secondary diseases was studied. During this period 58 patients (61.1%) died. In the structure of secondary diseases represented by 14 nosoforms prevailed cytomegalovirus and candidal infections, tuberculosis, Kaposi's sarcoma, rarely--pneumocystis pneumonia, cryptococcal meningitis and toxoplasmosis.

[Genetic characteristics of variants of human immunodeficiency virus type 1, causing an epidemic among substance abusers in Commonwealth of Independent States countries]. / Geneticheskaia kharakteristika variantov virusa immunodefitsita cheloveka 1-go tipa, vyzvavshikh épidemiiu sredi narkomanov v stranakh SNG.

Gag/env nucleotide sequences of human immunodeficiency virus type 1 (HIV-1) variants detected in drug users in Russia, Ukraine, and Belarus are analyzed. Two HIV-1 subtypes A and B circulate in this risk group. Genetic variability within one subtype is no higher than 3.1 and 3.9% for gag and env genes, respectively, suggesting the same source of infection in populations of drug users infected with the same subtype. Recombinant viruses with gagAenvB genotype, genetically related to parental strains of subtypes A and B, circulate in this risk group. This is the first report about HIV-1 recombinant of the two subtypes, for which both parental strains are known, directly confirming the in vivo recombination between different subtypes.

[Replicative properties of HIV-1 strains, resistant to 3'-azido-2'3'-dideoxythymidine]. / Replikativnye svoistva shtammov VICh-1, rezistentnykh k 3'-azido-2',3'-didezoksitimidinu.

The replicative activity of two strains of human immunodeficiency virus type I, 1974 and 1978, resistant to 3'-azido-2',3'-dideoxythymidine (AZT), was investigated. Assessment of AZT sensitivity by the standard method showed the 50% effective dose (ED50) for strain 1974 to be 0.1 mumole and for strain 1978, 1 mumole. Both strains had the slow/low. 3 phenotype. The level of virus-specific antigens in these strains was 3-7 times lower than in AZT-sensitive strain IIIB. In order to study the effects of AZT on virus replication, the strains were passaged in Jurkat-tat cells in the presence of 3.5 mumole of AZT. Virus activity was assessed from the level of intracellular (S-12) and extracellular (P-100) antigens, cell viability, and syncytium formation. Cell viability increased by 10%, syncytium formation dropped 5 times, and antigen accumulation increased 1.5-2 times in the culture with strain 1974. For strain 1978 these parameters were as follows: 17% decrease of cell viability, increase of syncytium formation by 1.7 times, and no changes in the level of viral antigen. After four serial passages in the presence of AZT ED50 for strain 1974 was 0.5 mumole and at least 1 mumole for strain 1978.

[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.

[The effect of immunoglobulin on hemostatic function in patients with HIV infection]. / Vliianie immunoglobulina na sostoianie gemostaza u bol'nykh VICh-infektsiei.

The influence of immunoglobulin for intravenous injection on the state of cell- and plasma-mediated elements of hemostasis in patients with HIV infection, treated with immunoglobulin (Ig) in connection with the presence of secondary diseases of bacterial nature and having thrombocytopenia, was analyzed. After two injections of 50.0 ml of Ig to patients with HIV infection and thrombocytopenia a rise in the count of blood platelets in 80% of cases; this rise reached its maximum on day 7-10 after the beginning of treatment and was retained 1-3 months later in most patients on the level of healthy persons. Under the influence of Ig the aggregation capacity of thrombocytes increased mainly in persons with the initially low function of blood platelets. The introduction of Ig did not perceptibly influence the capacity of thrombocytes for endo-exocytosis, the aggregation activity of red blood cells, as well as the plasma-mediated element of hemostasis.

[The thrombocytic link in hemostasis and the immunity system of patients with HIV infection]. / Sostoianie trombotsitarnogo zvena gemostaza i sistemy immuniteta u bol'nykh VICh-infektsiei.

To find out possible relationships between disturbances in the thrombocytic element of hemostasis and in the immune system (the count of lymphocytes CD4, the concentration of IgG, the content of circulating immune complexes), 18 adult patients with HIV infection were examined, and in 8 of them thrombocytopenia was diagnosed. 10 patients without thrombocytopenia formed the control group. The study revealed that with the development of thrombocytopenia in patients with HIV infection the aggregation capacity of their blood platelets decreased, which correlated (p < 0.01) with a decrease in the count of lymphocytes CD4; this was indicative of the progress of immunodeficiency.