Vol 15, No 3 (2010)

The paper gives the results of surveys among men having sex with men in Kazan. The surveys were made by a structured deep interview (16 respondents) in May 2005 and by a questionnaire (188 respondents) in 2006-2007. The community has been found to include wide age range subjects who have a high educational level and show a responsible attitude towards their health, are well informed about HIV infection, and use protective agents during sexual contacts. Most of them have no constant sexual partner, but lead a rather active sexual life, assess the risk of HIV infection as low, although every three men have a history of sexually transmitted infections.

The causes of death are analyzed among HIV-infected patients in the Russian Federation in the past years. There has been a rise in fatal outcomes among the entire population of patients and those with late-stage (4B, 4C, 5) HIV infection, in whom the main causes of death are severe lesions, primarily tuberculosis (66.5%). There has been an increase in the number of patients with new-onset HIV infection with the development of severe secondary diseases; in these cases their treatment is frequently late. The regions of the Russian Federation show a low regular medical check-up and treatment coverage (43.2% patients are given antiretroviral therapy late - when the CD4 lymphocyte count is less than 200 per μl) and a low treatment coverage in patients with chronic hepatitis B and C, who constitute a considerable (13.5-14.5%) proportion in the pattern of fatal outcomes.

The paper analyzes the sociodemographic characteristics of a group of patients suffering with HIV and tuberculosis and shows how to increase the quality of care delivered to these patients. At present the concept of health and disease should be interpreted in the context of a biopsychosocial approach. It is wrong to consider disease apart from a human being having this disease. Of importance are both the objective evaluation of his/her condition and the subjective appraisal of life satisfaction, namely the quality of life. The main sociodemographic characteristics of a group of patients with HIV infection and tuberculosis are described. Knowledge about this contingent of patients makes it possible to give a better insight into their main needs, to assess possible behavioral risks, and to anticipate some problems during treatment.

The paper presents the comparative results of treatment for chronic hepatitis C in HIV-infected patients in two groups: those who receive and do not receive highly active antiretroviral therapy (HAART). The findings indicated that the efficiency of therapy for hepatitis was comparable in both groups: the proportions of patients with a steady-state virological response who received and did not receive HAART were 34.1 and 40.9%, respectively. Some adverse reactions significantly differed in their frequency in both groups. Nevertheless, their severity was that which did not require hepatitis therapy discontinuance.

The rates of development of virologic and biochemical responses and the incidence and degree of hematological disorders within the first 12 weeks of treatment for chronic hepatitis C (CHC) were determined in patients with HIV infection depending on the used agents from a group of nucleotide reverse transcriptase inhibitors as part of an antiretroviral therapy (ART) regimen. Seventy-eight patients with HIV infection and CHC who received ARVT for at least 3 months were followed up. According to the ARVT regimen, the patients were divided into 2 groups: 1) 46 took phosphaside incorporated into an ARVT regimen; 2) 32 received stavudine or abacavir. Among all the patients, rapid and complete early virologic responses (rEVR and cEVR) were obtained in 52 and 79% of cases, respectively. When phosphaside was used in the ART regimens, the rates of rEVR and cEVR development were significantly higher (95.8 and 53.3% of cases, respectively). The phosphaside-treated patients with hepatitis C virus (HCV) genotype 1 also had a high cEVR rate. The absolute majority of patients with HCV genotype 3 showed cEVR irrespective of the ART regimen. Following 12-week treatment for CHC, 83.3-95.5% had a reduction in alanine aminotransferase levels to the values observed in healthy individuals, which was also indicative of the efficiency of treatment. In the HIV infected patients treated for CHC, the use of phosphaside, stavudine, or abacavir was safe in terms of hematological complications. In the patients receiving phosphaside, the reduction in hemoglobin levels was more considerable. Evolving hematological disorders required no changes in the ART regimen or reductions in the dose of pegylated interferon or ribavirin.

The investigation was undertaken to specify the readiness of physicians taking part in the treatment of HIV infection for the use current technologies to form adherence to regular medical check-up in this disease. The investigation was performed using an anonymous questionnaire and a focused interview in a group of 190 physicians of various specialties who were involved in the delivery of specialized medical care in HIV infection. The analysis showed the readiness of the physicians taking part in the treatment of HIV infection for the use current complex and interdisciplinary technologies to form adherence to regular check-up in this disease. The problems of attracting and holding HIV-infected patients in the regular medical check-up regimen are realized as urgent by health workers; the solution of the problems is embodied in their practical activity.

A central nervous system (CNS) lesion in a HIV-infected patient presents particular difficulty in an infectiologist's work. No pathognomonic symptoms, a need for expensive instrumental and laboratory studies to interpret the nature of neurologic disease frequently lead to its late diagnosis, the inefficiency of etiotropic therapy, and severe consequences of organic brain lesion. A CNS lesion occurred in 16.3% of 957 patients with Stage 4B HIV infection (AIDS) treated at Moscow Infectious Diseases Hospital Two. Cytomegalovirus encephalitis accounts for 4-12% of cases of infectious CNS lesion in HIV infection and 15-18% of the cases with manifest cytomegalovirus (CMV) infection. CMV encephalitis develops in not only HIV-infected patients, but also in neonates and babies of the first months of life, less frequently in organ recipients; the pattern and pathogenesis of disease, its clinical features and early diagnosis remain inadequately studied. The paper describes a clinical case of CMV ventriculoencephalitis with the morphological characteristics of brain lesion in an adult patient with HIV infection.