[Cerebral toxoplasmosis in the pattern of secondary CNS involvements in HIV-infected patients in the Russian federation: clinical and diagnostic features].

The incidence of cerebral toxoplasmosis (CT) among all brain involvements was determined in patients with Stage 4B HIV infection (AIDS) in 2003-2009. Clinical and laboratory parameters were estimated in 156 patients to reveal diagnostic criteria. As a result, CT was shown to be a leading cause of neurologic diseases in patients with late-stage HIV infection (34.7% of cases of brain involvement). In 11.5%, it took place as a generalized process. CT concurrent with cytomegalovirus infection, tuberculosis, or other secondary lesions was frequently diagnosed. Of importance in the diagnosis of CT are magnetic resonance imaging results in addition to basic, clinical data that can assume this diagnosis. The high and moderate serum concentrations of T.gondii IgG are of diagnostic value, which may be used as an auxiliary method to verify the diagnosis.

[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.

[Morphological fibroblastic changes in cytomegalovirus infection].

Cytomegalovirus (CMV) infection is widely spread among population. While immunocompetent patients suffer rarely from this virus, it can lead to a lethal outcome in immunocompromised patients. An electron microscopic study has detected fibroblastic morphological changes of a definite cytodestructive character. The nuclei of some fibroblasts have chromatine condensation. A clear zone arising due to vacuolization near this inclusion may reflect nuclear rearrangement leading to further CMV metamorphosis of the cell. This metamorphosis is characteristic of the changes developing in the cells of different parenchymatous organs.

[Analysis of autopsies in HIV infection]. / Analiz autopsii pri VICh-infektsii.

The analysis of 321 necropsies made in Clinical Infections Hospital N 2 from 1991 to 2001 showed a significant increase in the number of deaths of HIV-infection beginning from 1996. The highest mortality (40%) was registered among males aged 25-34 years. The deceased had a wide spectrum of opportunistic diseases (infections and tumors). The deceased with AIDS most frequently had cytomegaloviral infections (19%), tuberculosis (14%), Kaposi's sarcoma (10%), bacterial pneumonias (8%), toxoplasmosis (7%). A late stage of AIDS was characterized by generalized opportunistic diseases, the presence of several severe infectious diseases and more frequent neoplasms.

[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.

[PCR diagnosis of sequences of a novel human herpes virus type 8 in patients with Kaposi sarcoma in Russia]. / PTsR-diagnostika posledovatel'nostei novogo gerpesvirusa cheloveka 8-go tipa u bol'nykh sarkomoi Kaposhi v Rossii.

Associations of a new human herpesvirus type 8 (HHV-8) with different forms of Kaposi's sarcoma (KS) in Russia have been studied. Search for this virus genetic information has been carried out in biopsy specimens of benign and malignant tumors other than KS, and probable sites of HHV-8 latency in human body have been checked. HHV-8 sequences were detected by polymerase chain reaction (PCR). HHV-8 sequences were most often detected in idiopathic (80.6%), AIDS-associated (80%), and immunosuppressive (100%) KS. The results indicate a selective association of HHV-8 with KS. No probable sites of the virus latency were detected in peripheral blood cells of patients with KS and in the prostate of patients with chronic prostatitis. The only exception was the husband of a patient with KS: HHV-8 sequences were detected in his prostatic secretion by nested PCR.

[Sensitivity and specificity of the PCR-test-system for diagnosing HIV infections]. / Chuvstvitel'nost' i spetsifichnost' PTsR-test-sistemy dlia diagnostiki VICh-infektsii.

Sensitivity and specificity of the Russian PCR test system (experimental lot) were assessed with materials from 107 Russian patients with HIV infection and 100 donors without specific antibodies to HIV-1. The electrophoretic and hybridization-enzymatic methods for amplicon detection were compared. The sensitivity of electrophoresis was 89.9%, specificity 91%; for hybridization-enzymatic detection these values were 96.1 and 100%, respectively. Samples which yielded false-negative results were repeatedly tested by two-staged amplification (nested PCR) with external and internal primers. The main cause of false-negative results was a low concentration of proviral HIV-1 DNA in some blood samples.

[Polymerase chain reaction in diagnosing cytomegalovirus infection in HIV-infected patients]. / Polimeraznaia tsepnaia reaktsiia v diagnostike tsitomegalovirusnoi infektsii u VICh-infitsirovannykh patsientov.

The authors propose a simple and standard approach to semi-quantitative detection of cytomegalovirus (CMV) DNA in blood leukocytes by the polymerase chain reaction. The method was used in early diagnosis and treatment of manifest CMV infection in HIV-infected patients. High titers of CMV DNA correlated with the manifestation of CMV disease and progressive loss of host immune function. Clinical significance of difference in DNA titers was revealed. The proposed method can be used to assess the efficacy of specific anti-CMV therapy.

[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 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.