Vol 31, No 2 (2026)

This article provides an up-to-date review of current approaches to the treatment of opportunistic mycoses in patients with HIV infection. This issue is of particular importance in the context of the increasing prevalence of resistant fungal strains and the complexity of antifungal therapy. Moreover, the problem is further exacerbated by the growing number of secondary immunodeficiencies, particularly HIV infection. The authors emphasize the importance of timely diagnosis and individualized selection of antifungal agents, taking into account their efficacy, resistance patterns, and adverse effects. A total of 38 studies published between 2014 and 2025 were analyzed, allowing identification of key trends and advances in the treatment of mycoses such as candidiasis, cryptococcosis, pneumocystis pneumonia, histoplasmosis, and dermatomycoses in patients with HIV infection. A major finding is the demonstrated effectiveness of combination and adaptive treatment regimens, as well as the importance of regular antifungal susceptibility testing to prevent the development of resistance. Particular attention is given to the role of antiretroviral therapy in improving clinical outcomes and reducing the incidence of mycotic complications. It was also observed that, despite the periodic use of alternative therapeutic approaches, standard treatment regimens recommended for patients with HIV infection remain effective. However, achieving therapeutic success may take time and largely depends on multiple factors, including viral load, CD4+ T-lymphocyte count, treatment adherence, and the occurrence of adverse events, which may necessitate regimen modification or dose adjustment. In conclusion, individualized therapy selection, monitoring of adverse effects, and continuous improvement of treatment regimens remarkably improve survival and quality of life in patients with HIV-associated mycoses. This review provides a comprehensive overview of current advances and future perspectives in antifungal therapy for this patient population, which is of important practical significance for the implementation of effective strategies to combat opportunistic infections.

BACKGROUND: Maintaining the normal status of natural colonization barriers in humans in an artificial habitat is one of the most important areas in physiology. It is particularly important for preserving the microbiota of the intestines and other organs under extreme conditions (such as space flights, model isolation experiments, etc.), as the negative impact of space flight factors on the human microbiota has been experimentally proven, manifesting primarily as a decrease in the colonization resistance of almost all biotopes. Accumulated experience shows that probiotics, namely autoprobiotics, serve as a highly effective means of managing the human-microorganism system in an artificial habitat such as a space flight.

AIM: To evaluate the efficacy and safety of a postbiotic incorporated into bread, containing an inactivated culture of the probiotic strain Enterococcus faecium L-3, based on its effect on the quantitative and qualitative indicators of the intestinal, nasal, and pharyngeal microbiomes of the study participants during a 60-day isolation.

METHODS: The study employed microbiological methods. Six men of reproductive age underwent a 60-day isolation in the Ground Experimental Complex of the State Scientific Center of the Russian Federation—Institute of Biomedical Problems of the Russian Academy of Sciences (Moscow, Russia). Fecal samples were collected in sterile airtight containers; serial tenfold dilutions were prepared and plated onto Petri dishes with selective media. The dishes were incubated at 37°C for 48 hours; dishes with Sabouraud medium were additionally kept at room temperature for another 48 hours. Anaerobes were cultured in an anaerobic jar. After incubation, colonies of each species were counted taking the dilution factor into account. The eubiotic index was calculated, and data were processed using Statistica 6 and Statistica 10 software packages. Parametric and nonparametric methods were applied, and the significance of differences was determined using Student t-test.

RESULTS: Consumption of the product containing a postbiotic based on enterococci inactivated during bread baking resulted in positive changes in the intestinal microbiota composition of the study participants: the number of protective microorganisms (bifidobacteria, lactobacilli, and, in some cases, enterococci) increased, while the counts of enterobacteria, staphylococci, and yeasts decreased.

CONCLUSION: For the first time, a bread containing a postbiotic based on enterococci inactivated during the baking process was developed and tested. Its consumption stabilizes the intestinal microbiota composition primarily by increasing the counts of lactobacilli and bifidobacteria and reducing the count of enterobacteria.

BACKGROUND: The digital transformation of higher education is accompanied by the active implementation of artificial intelligence (AI) technologies, which are viewed as tools for increasing the accessibility and personalization of learning. The potential of generative models (such as GPT-4 and others) is of particular interest in terms of creating educational content, including speech synthesis and animated avatars. This raises the question of whether traditional lecturers can be partially or completely replaced. However, there is a lack of empirical research evaluating the effectiveness of fully AI-generated lectures compared to expert lecturers in real-world medical education settings.

AIM: To conduct a comparative assessment of learning effectiveness among medical students attending a traditional lecture delivered by a human lecturer versus a lecture fully generated using AI technologies (including text generation, voice synthesis, and an animated avatar).

METHODS: Within a single lecture on infectious diseases for 5th-year medical students of the General Medicine Department at Tver State Medical University (Tver, Russia), a lecture on “Leptospirosis” was delivered by an expert lecturer. A lecture on “Hemorrhagic fever with renal syndrome” was presented via an AI-generated video. The lecture text was generated by GPT-4, GPT-3.5 Turbo, GPT-4o, and Perplexity models based on clinical guidelines, and was subsequently verified for accuracy by an expert. The lecture was voiced using synthesized speech (ElevenLabs) cloned from the lecturer’s voice, and visualized by an animated avatar (D-ID) based on the lecturer’s photograph. Following the lecture, 99 students completed a test on both topics (using a 10-point scale) and filled out an online survey (Yandex Forms) to compare the delivery methods and assess AI’s potential. Data were processed using Microsoft Excel.

RESULTS: The average test score for the lecturer-delivered topic was 8.9/10, compared to 5.9/10 for the AI-delivered topic. According to the survey, 94.9% of the students found the human lecturer’s information delivery clearer and more understandable. The lecturer’s delivery was rated 4.76/5, while the AI’s delivery was rated 3.01/5. However, 89% of the respondents acknowledged the potential for developing AI technologies for education.

CONCLUSION: Despite a satisfactory score (5.9/10) and having its potential recognized by the students, the AI-generated lecture demonstrated statistically and subjectively lower effectiveness in knowledge transfer compared to the traditional expert lecturer. The results confirm the current superiority of the human factor (experience, adaptability) in the lecture-based learning format, but also highlight the progress of AI and its prospects as a supportive educational tool.

BACKGROUND: The treatment of chronic hepatitis C virus (HCV) infection remains a major public health priority within the World Health Organization Global Health Sector Strategy on Viral Hepatitis, which aims to eliminate viral hepatitis by 2030.

AIM: This work aimed to analyze accumulated experience in epidemiological modeling and real-world clinical practice data on the treatment of patients with chronic hepatitis C in order to accurately assess the prospects for elimination of this infection in the Perm Territory.

METHODS: A Markov model of chronic HCV progression was developed to assess the evolution of the epidemic situation in the Perm Territory. In addition, a single-center retrospective cohort descriptive study was conducted, analyzing data from 1041 patients with confirmed chronic HCV who received direct-acting antiviral therapy between 2020 and 2024 in healthcare institutions of the Perm Territory.

RESULTS: According to the modeling results, the most realistic scenario for hepatitis C elimination in the Perm Territory—consistent with the current organization of medical care—requires increasing the number of treated patients to 2500 annually. This scenario also involves gradual removal of restrictions based on liver fibrosis stage. Real-world data analysis demonstrated high effectiveness of pan-genotypic antiviral regimens, with an overall sustained virologic response rate of 97.98%. This finding supports the expansion of patient coverage with such treatment. The overall effectiveness of regimens based on velpatasvir+sofosbuvir, glecaprevir+pibrentasvir, or sofosbuvir+daclatasvir without ribavirin at standard treatment duration reached 98%. Antiviral regimens demonstrated high effectiveness regardless of virus genotype (>96%) or liver fibrosis stage (>97%). In patients with cirrhosis and genotype 3 infection, treatment effectiveness was 100% for glecaprevir+pibrentasvir and sofosbuvir+daclatasvir, without ribavirin, and 98.11% for velpatasvir+sofosbuvir. Among patients with advanced fibrosis and genotype 3 infection, pan-genotypic antiviral regimens also maintained high effectiveness (≥95%).

CONCLUSION: The modeling of the epidemic situation and analysis of real-world treatment data indicate that elimination of this infection in the Perm Territory is achievable. Achieving this goal is directly associated with the use of highly effective direct-acting antiviral regimens in healthcare institutions of the Perm Territory.

Brucellosis is a pressing public health problem in endemic regions. Musculoskeletal involvement is the most common manifestation of this infection, while brucellar spondylitis and spondylodiscitis often mimic degenerative diseases of the spine, which frequently complicates timely diagnosis.

This article demonstrates the management approach for a patient with acute brucellosis complicated by spondylodiscitis and epiduritis, based on a clinical case of a 36-year-old patient. The patient lived in an endemic region and had occupational contact with cattle on a brucellosis-affected farm. Clinical manifestations at disease onset included high fever, nocturnal hyperhidrosis, and severe lumbosacral pain with radiculopathy.

During the prehospital and initial inpatient stages, the patient received treatment for a spinal lesion presumably of degenerative-dystrophic origin (ICD-10 codes: M47.8, M51.1) without significant effect. Based on comprehensive clinical data, the diagnosis of Acute brucellosis complicated by brucellar spondylodiscitis of the lumbar spine (L5–S1) and epiduritis was verified at the regional infectious diseases hospital. It was confirmed by serological testing: ELISA for IgM and IgG antibodies to Brucella spp., as well as Wright and Huddleson tests. Combined etiotropic therapy (doxycycline and rifampicin) partially relieved the toxic symptoms; however, severe pain persisted. A month later, due to a deteriorating condition and increasing neurological symptoms, the patient was readmitted to the neurosurgical department. The comprehensive examination and MRI data confirmed L5–S1 spondylodiscitis with epiduritis and secondary spinal stenosis. Total laminectomy at the L5–S1 level with decompression of the nerve structures was performed, and antibiotic therapy was continued, which significantly reduced the pain syndrome and improved the patient’s functional status.

This clinical case highlights the need to rule out brucellosis early in patients presenting with fever of unknown origin and back pain in endemic regions. It also emphasizes the importance of a multidisciplinary approach involving an infectious disease specialist and a neurosurgeon in cases of spondylodiscitis with a neurological deficit. A notable feature of this case was initial misdiagnosis of osteochondrosis and intervertebral disc herniation, which led to the patient being referred to surgical and neurosurgical departments without etiotropic therapy. Combined with targeted antimicrobial and surgical treatment, timely diagnosis allows for a favorable outcome and prevents patient disability.