[IMPROVEMENT OF ETIOLOGICAL DIAGNOSIS OF THE CEREBRAL TOXOPLASMOSIS IN HIV-INFECTED PERSONS].

The objective of the study was to determine the diagnostic value of the parallel detection of the avidity index of the IgG to Toxoplasma gondii in the blood and cerebrospinal fluid by a three-step solid-phase enzyme immunoassay using T. gondii antigen, protein dissociating agent and monoclonal antibodies against human IgG at HIV-infected individuals with a focal damage of the brain. The results of the study showed that conducting of the enzyme-linked immunosorbent assay by a direct and dissociated method makes it possible to detect specific intrathecal and serum immunoglobulins, which is proposed in terms of improving diagnosis of cerebral toxoplasmosis in HIV-infected individuals. The high informative ability of the test system for detecting the avidity index of IgG antibodies to T. gondii allows the possibility to apply it in the algorithm for diagnosing an etiological factor of neuroinfection in HIV-infected individuals.

FACTORS AFFECTING THE FATAL OUTCOME IN HIV-INFECTED PATIENTS WITH ENCEPHALITIS.

Despite the successful use of ART up to 40-70% of HIV(+) individuals have neurologic complications caused both by the HIV itself and by the reactivation of OIs on the background of severe immunodeficiency. Nowadays, there are no universally recognized criteria that allow predicting the outcome of encephalitis caused by OIs in this category of patients. The aim of our study was to assess factors affecting the fatal outcome in HIV(+) patients with CNS involvement. Retrospectively we selected 53 HIV(+) patients with confirmed encephalitis due to OIs. Depending on the outcome of the disease, patients were divided into groups: non-survivors (n=22) and survivors (n=31), after compared their clinical manifestation, history of the disease and life, CSF results in the first days of admission. It has been established that the factors affecting the fatal outcome in HIV(+) patients with encephalitis are: the severity of the patient's condition upon admission, acuteness of the onset of the disease, the severity of neurologic symptoms, the degree of co-morbidity, the level of immunosuppression and viral load, absence of ART.

THE ROLE OF POLYMORPHISM ASP299GLY OF THE GENE TLR 4 IN PATIENTS CO-INFECTED WITH HIV/HCV.

For the first time it was conducted complex research of metabolic disorders in patients co-infected with HIV/HCV and was shown that they are characterized by disturbances of mineral, lipid and carbohydrate metabolism types. It was established significantly higher values of indicators of mineral, lipid and carbohydrate metabolism types in patients co-infected with HIV/HCV compared with patients with chronic hepatitis C and HIV-infected persons. In patients co-infected HIV/HCV appears significantly more frequent the polymorphism Asp299Gly of the gene TLR4 (χ2 = 4,5; p<0,05) when compared with healthy donors, which plays a significant role in the development of metabolic disorders, such correlation is confirmed by those relationships: a strong direct relationship between the polymorphism Asp299Gly of TLR4 gene and the content of insulin (r = 0,66; p<0,001), insulin resistance (r=0,66; p<0,001), the absolute number of CD45+ of T-lymphocytes (r=0 45; p<0,001); a moderate direct relationship with the content of TNF-α (r=0,32; p<0,05), CRP (r=0,34; p<0,05), the absolute number of CD3+ of T-lymphocytes (r=0,34; p<0,05), the content of triglyceride (r=0,39; p<0,02), moderate inverse relationship with the zinc content (r = -0,34; p<0,05 ), the relative number of CD4 +,% (r = -0,32; p<0,05). The system of monitoring of metabolic disorders in patients co-infected with HIV/HCV based on the definition of polymorphism Asp299Gly gene TLR4, the presence of which indicates a high risk of metabolic disturbances (OR=23,3; p<0,05) and requires further investigation, namely the definition of an index of insulin resistance, insulin levels, TNF-α, C-reactive protein, zinc and triglyceride levels in dynamics at intervals of 6 months that allow for timely diagnosis and correction of metabolic disorders.

LEVELS OF NEUROSPECIFIC MARKERS IN CEREBROSPINAL FLUID OF ADULT PATIENTS WITH BACTERIAL MENINGITIS.

At present, the great attention is given to the neurospecific markers as their elevated level in the cerebrospinal fluid corresponds to the degree of destruction of relevant CNS cells. Therefore, actual direction of the studies of the pathogenesis and diagnosis of CNS diseases is to determine levels of neurospecific markers in the cerebrospinal fluid (CSF). The purpose of the study was to evaluate the diagnostic and prognostic role of NSE, S-100 protein, GFAP and MBP levels in CSF of patients with acute bacterial meningitis. S-100 protein, NSE, GFAP and MBP levels in CSF of patients with acute pneumococcal and meningococcal meningitis were determined during admission and after 10-12 days of treatment. Patients were divided into groups depending on the etiology and severity of the disease. 60 cases of acute bacterial meningitis, as a study group, and 12 cases with acute respiratory infection and meningism, as a control group, were analyzed. It is shown that CSF levels of NSE, S-100 protein, GFAP and MBP on the first day of admission were significantly increased (P<0,05), depending on the severity of the disease. The highest levels of neurospecific markers have been identified in non-survivors (P<0,001). The concentration changes of CSF neurospecific markers are found to be helpful as a diagnostic and prognostic marker in acute bacterial meningitis.