Vol 26, No 3 (2021)

BACKGROUND: The number of infertile couples and women seeking in vitro fertilization is on the rise worldwide. At the same time, the probability of pregnancy after one in vitro fertilization attempt is 25–40%. Among the various causes of in vitro fertilization failure, the impact of opportunistic infections remains underestimated.

AIMS: retrospective assessment of the dependence of the number of successful in vitro fertilization attempts on the intensity of immunity to opportunistic infections.

MATERIALS AND METHODS: On the basis of the Clinic of the Kuban State Medical University, from January 2020 to March 2021, 865 women aged 26 to 48 years with infertility, included in the assisted reproductive technology program, were observed. Before the in vitro fertilization procedure, all patients were examined by enzyme immunoassay (ELISA) and polymerase chain reaction for the presence of herpesvirus infections (herpes infection, cytomegalovirus infection) and toxoplasmosis. The study included 79 people with unexplained infertility with a history of one to four in vitro fertilization cycles and positive antibody titers [IgG (+), IgM (–)] to herpes simplex virus, cytomegalovirus, and toxoplasmosis. During the study, groups were formed depending on the presence of opportunistic infections and the number of unsuccessful in vitro fertilization attempts.

RESULTS: During the study, a dependense was established between the number of in vitro fertilization attempts and the level of the initial (before pregnancy) IgG to toxoplasma. A negative prognosis for the effectiveness of in vitro fertilization is most likely in the presence of high titers of IgG to toxoplasma (370.0±57.0 U/ml). In the case of herpes infection, there was a tendency to increase the number of necessary in vitro fertilization attempts to 3–4 in the group with higher herpes simplex virus IgG levels. The baseline IgG cytomegalovirus level was not directly related to the effectiveness of the in vitro fertilization procedure.

CONCLUSION: The study demonstrates the importance of determining the intensity of immunity to toxoplasma and herpes infection in preparation for in vitro fertilization, especially if there is a history of unsuccessful in vitro fertilization attempts or spontaneous abortion.

The article presents an analysis of a special clinical case: a male patient with perinatal HIV infection and the development of HIV multi-resistance to antiretroviral drugs. Multiple corrections of treatment regimens were carried out based on the results of determining HIV resistance to the antiretroviral drugs used. The treatment regimen included antiretroviral drugs with fundamentally new mechanisms of action for HIV, not registered in the Russian Federation. However, to date, in the patient with more than twenty years of experience in antiretroviral therapy, it has not been possible to achieve immunological and virological efficacy of treatment. There continues to be a persistent decrease in the indicators of the immune status and an increase in the viral load of HIV in the blood, the appearance of clinical symptoms of opportunistic diseases indicating the progression of HIV infection and an unfavorable vital prognosis, despite the use of various combinations of antiretroviral drugs. This observation demonstrates the difficulties in choosing an effective antiretroviral therapy, taking into account the established sensitivity of HIV to antiretroviral drugs and the possibility of their progredient administration. It is certainly necessary to analyze all ART regimens with the results of HIV resistance to antiretroviral drugs using to improve the effectiveness of therapy is in each case.

Currently, there are indications of an increase in the incidence of cardiovascular pathology in patients with HIV infection in comparison with population data and a higher mortality rate from cardiovascular diseases. The problem of detecting the pathology of the cardiovascular system in patients infected with the human immunodeficiency virus (HIV) is relevant due to the increase in the number of HIV-positive individuals and the established effect of HIV infection on the circulatory organs. In order to identify cardiovascular pathology, two patients with stages III and IV of HIV infection were extensively examined. The examination was carried out using electrocardiography, echocardiography and ultrasound dopplerography. Both clinical cases are presented below, in which pronounced cardiovascular pathology was detected in both cases. As factors influencing the development of pathology of the cardiovascular system, based on the presented clinical examples, drug addiction (long-term intravenous use of surfactants) and pathologies of other internal organs in the development of HIV-mediated opportunistic diseases are considered. Analysis of the course of the disease showed that the lesion can develop in various stages of HIV infection, more often infectious endocarditis is the main diagnosis in patients in stage 3 of HIV infection (the first clinical example), and dilated cardiomyopathy — in the late stages of HIV infection and is considered as a concomitant pathology due to lung and kidney damage (the second clinical example).