First experience of liver transplantation for HIV-positive patients in Russia

The article presents the results of liver transplantation in five HIV-infected recipients with irreversible liver damage. It is shown that four of them survived in the long-term period and are observed in a stable condition, and the only death in the recipient was not related to the HIV infection. The experience in the treatment of these patients was summarized. Analysis of the first results of liver transplantation in HIV-infection in Russia shows its validity and clinical efficacy. The only lethal case is connected with the initial extremely grave condition of the recipient and his age. Two cases of surgical traumatism, lack of consistent vaccination in the preoperative period, as well as lack of patients with hepatocellular cancer, small number of observations are obvious drawbacks of our first experience and should be corrected in the future. The success of a complex and multidisciplinary program of organ transplantation in HIV infection is impossible without participation of HIV-infectionists in the transplantation team

Листериозный менингоэнцефалит как оппортунистическое заболевание при ВИЧ-инфекции

Aim: To identify the signs and reasons why listeriosis can be classified as opportunistic infections in HIV infection, requiring timely diagnosis and treatment to prevent the development of a severe course of the disease and minimize the risks of death.  Materials and methods: 38 hospitalized patients with listeriosis meningitis/ meningoencephalitis were examined. All patients were hospitalized in the boxed departments of neuroinfections (the diagnosis of HIV infection was not known) with a directional diagnosis of meningitis of unclear etiology, where, according to the Meningitis program, a PCR examination for L. monocytogenes was included. The comparison group consisted of patients with other most common bacterial pyogenic meningitis (BPM) – meningococcal, pneumococcal and patients with listeriosis meningitis/meningoencephalitis without HIV infection.  Results: Studies have shown that patients with HIV infection accounted for the majority – 26% (out of 38 hospitalized). Men predominated among the patients – 60 %, the average age was 34.9 ± 2.2 years (29 – 41), which differs from the well–known age status, where the risk group is primarily male patients over 70 years of age.  Conclusion: Polymorphism of clinical manifestations of neuro listeriosis in some cases presents diagnostic difficulties for primary care physicians. CNS listeriosis in patients with HIV infection belongs to the category of opportunistic infections, which clinically and in the study of cerebrospinal fluid presents difficulties for early diagnosis, which directly affects the timing of the initiation of etiotropic therapy and the further outcome of the disease. Цель: выявить признаки и причины, по которым листериоз можно отнести в разряд оппортунистических инфекций при ВИЧ-инфекции, требующих своевременной диагностики и лечения для предотвращения развития тяжелого течения заболевания, и минимизировать риски летального исхода.  Материалы и методы. Обследовано 38 госпитализированных с установленным в стационаре листериозным менингитом/менингоэнцефалитом. Все больные госпитализировались в боксированные отделения нейроинфекций (о диагнозе ВИЧ-инфекция не было известно) с направительным диагнозом «Менингит неясной этиологии», где по программе «Менингиты» в ПЦР включено обследование на L. monocytogenes. Группу сравнения составили больные другими наиболее распространенными бактериальными гнойными менингитами – менингококковым, пневмококковым и больные листериозным менингитом/менингоэнцефалитом без ВИЧ-инфекции.  Результаты. Проведенные исследования показали, что больные ВИЧ-инфекцией составили большинство – 26% (из 38 госпитализированных). Среди больных преобладали мужчины – 60 %, средний возраст 34,9±2,2 лет (29–41), что отличается от общеизвестного возрастного статуса, где группой риска, прежде всего, являются пациенты старше 70 лет мужского пола.  Заключение. Полиморфизм клинических проявлений нейролистериоза в ряде случаев представляет диагностические трудности для врачей первичного звена. Листериоз центральной нервной системы у больных ВИЧ-инфекцией относится к категории оппортунистических инфекций, которая клинически и при исследовании спинномозговой жидкости представляет трудности для ранней диагностики, что напрямую влияет на сроки начала этиотропной терапии и дальнейшего исхода заболевания.

First experience of liver transplantation for HIV-positive patients in Russia

The article presents the results of liver transplantation in five HIV-infected recipients with irreversible liver damage. It is shown that four of them survived in the long-term period and are observed in a stable condition, and the only death in the recipient was not related to the HIV infection. The experience in the treatment of these patients was summarized. Analysis of the first results of liver transplantation in HIV-infection in Russia shows its validity and clinical efficacy. The only lethal case is connected with the initial extremely grave condition of the recipient and his age. Two cases of surgical traumatism, lack of consistent vaccination in the preoperative period, as well as lack of patients with hepatocellular cancer, small number of observations are obvious drawbacks of our first experience and should be corrected in the future. The success of a complex and multidisciplinary program of organ transplantation in HIV infection is impossible without participation of HIV-infectionists in the transplantation team.</jats:p

The Preparation of Convencent Plasma and Recruiting of Donors during the COVID-19 Pandemic

Background. The pandemic of the new coronavirus infection has challenged the medical community for quickly finding and implementing effective methods of treatment. In the absence of a vaccine or specific therapy with proven effectiveness, the usage of convalescent plasma can be the one of perspective methods. An important aspect of this technology is the efficient and safe preparation of convalescent plasma. To date, in the world literature there are practically no publications about donor recruitment and the specifics of the preparation of convalescent plasma.&#x0D; Purpose of the research. Presentation of the experience of organizing a workflow for recruiting donors and stockpiling of convalescent plasma with a high titer of virus-neutralizing antibodies to SARS-CoV-2.&#x0D; Methods. The analysis of the work of the Blood Service of the Moscow Department of Health for stockpiling of COVID-19 convalescent plasma has been executed. In total it has been stockpiled 1240 doses. The normative documentation has been developed by a working group on the basis of the current federal legislation of Russian federation and been approved by the Moscow Department of Health. The titer of neutralizing antibodies (VNA) has been determined as the basic method for assessing the immunological viability of convalescent plasma. The main characteristics of donors, the characteristics of the disease course, the results of preliminary testing for the presence of specific antibodies by ELISA and CLIA methods has been compared with VNA titers in the stockpiled convalescent plasma.&#x0D; Results. Due to a Moscow Health Departments order No. 325 dated 01.04.2020 (a basic local regulatory document) it has been developed a regulation for the stockpiling, examination, storage, safety and transfering of fresh frozen pathogen-reduced plasma of COVID-19 convalescent donors to medical organizations of the Moscow Health Department. For arranging an interaction with donors it has been created a call-center. For effective preliminary selection, it has been formed a donor characteristics list, which has been combined with screening of specific antibodies by ELISA and CLIA methods.&#x0D; Conclusions. Developed a system of recruiting donors and procurement process of convalescent plasma for treatment СOVID-19, which includes the necessary regulations, algorithms for the selection and recruitment of donors, the registry of donors and recipients, algorithms, efficiency and safety of convalescent plasma.</jats:p