Five-year trends in epidemiology and prevention of mother-to-child HIV transmission, St. Petersburg, Russia: results from perinatal HIV surveillance

<p>Abstract</p> <p>Background</p> <p>The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission.</p> <p>Methods</p> <p>Standard HIV case-reporting and enhanced perinatal HIV surveillance systems were used for prospective assessment of HIV-infected women giving birth in St. Petersburg, Russia, during 2004-2008. Trends in social, perinatal, and clinical factors influencing mother-to-child HIV transmission stratified by history of injection drug use, and rates of perinatal HIV transmission were assessed using two-sided χ²or Cochran-Armitage tests.</p> <p>Results</p> <p>Among HIV-infected women who gave birth, the proportion of women who self-reported ever using injection drugs (IDUs) decreased from 62% in 2004 to 41% in 2008 (<it>P </it>< 0.0001). Programmatic improvements led to increased uptake of the following clinical services from 2004 to 2008 (all <it>P </it>< 0.01): initiation of antiretroviral prophylaxis at ≤28 weeks gestation (IDUs 44%-54%, non-IDUs 45%-72%), monitoring of immunologic (IDUs 48%-64%, non-IDUs 58%-80%) and virologic status (IDUs 8%-58%, non-IDUs 10%-75%), dual/triple antiretroviral prophylaxis (IDUs 9%-44%, non-IDUs 14%-59%). After initial increase from 5.3% (95% confidence interval [CI] 3.5%-7.8%) in 2004 to 8.5% (CI 6.1%-11.7%) in 2005 (<it>P </it>< 0.05), perinatal HIV transmission decreased to 5.3% (CI 3.4%-8.3%) in 2006, and 3.2% (CI 1.7%-5.8%) in 2007 (<it>P </it>for trend <0.05). However, the proportion of women without prenatal care and without HIV testing before labor and delivery remained unchanged.</p> <p>Conclusions</p> <p>Reduced proportion of IDUs and improved clinical services among HIV-infected women giving birth were accompanied by decreased perinatal HIV transmission, which can be further reduced by increasing outreach and HIV testing of women before and during pregnancy.</p

ВИЧ-ИНФЕКЦИЯ, МИГРАЦИОННЫЕ ПРОЦЕССЫ И ПРИМОРСКИЕ РЕГИОНЫ РОССИИ

The present lecture provides evidence on the spread of HIV infection in the Russian Federation. Epidemiological situation in maritime regions is described. Some of regions are leaders by HIV spread. To treat and prevent HIV in this group of people, a special branch represented by territorial HIV centers that organize all necessary measures to carry out voluntary examination in different groups of people was created. Common factors of HIV progression and ways of suppression of viral replication are presented. HIV is considered as chronic medicamentally manageable disease with long course. Antiretroviral therapy (ART) is used to treat HIV infection at the present time. HIV medications are designed to affect HIV at the molecular biological level. Current medications are incapable to eliminate genetic material of virus integrated in DNA of human target cells, so, active viral replication in human body and disease progression will go back up again as soon as a patient stops taking ART medications. In the Armed Forces of the Russian Federation, HIV ranks fourth out of the other diseases. At the same time, there is a growing number of primary disease incidence in 2018 in comparison with earlier periods.В лекции представлены сведения о распространении ВИЧ-инфекции в Российской Федерации. Рассмотрена эпидемиологическая ситуация в приморских регионах. Некоторые из них входят в лидеры по распространению ВИЧ-инфекции. Для лечения и профилактики данной категории больных создана специальная служба ВИЧ-инфекции в виде территориальных Центров СПИД, которые организуют все необходимые мероприятия по добровольному обследованию различных категорий людей. Представлены закономерности развития ВИЧ-инфекции и пути подавления репликации вируса. ВИЧ-инфекция рассматривается как хроническое медикаментозно регулируемое заболевание с длительным течением. Для лечения ВИЧ в настоящее время применяется антиретровирусная терапия. Препараты для лечения ВИЧ-инфекции предназначены для воздействия на ВИЧ в организме на молекулярно-биологическом уровне. Современные препараты не способны уничтожить генетический материал вируса, интегрированный в ДНК клетки-мишени человека, поэтому активная репликация вируса в организме человека и прогрессирование болезни возобновляются, как только пациент прекращает прием антиретровирусных препаратов. В Вооруженных Силах Российской Федерации ВИЧ-инфекция занимает четвертое место среди других заболеваний, но отмечается рост первичной заболеваемости в 2018 г. по сравнению с предыдущими периодами.</p