The causes of death of HIV-Infected subjects in Lomonosov district of the Leningrad region, Russia, in 1999–2011

Aim – to analyze causes of death of HIV infected subjects died in Lomonosov District of the Leningrad Region, Russia, in 1999-2011. Materials and Methods. A retrospective analysis of 118 autopsy results of all HIV-infected patients who died in hospitals of Lomonosov district of the Leningrad region, as well as those delivered to the autopsy department from homes or streets in 1999–2011. Results. Males were 76%, the middle age – 32,1±4,3 years. The HIV-infection was the cause of death in 53 subjects (49%). Tuberculosis was the major postmortem diagnosis in this group of patients (85%). Due to other diseases or have died a violent death 29 (27%) and 27 (24%) individuals correspondingly. From 62 patients deceased in hospitals 18% subjects died at first day of staying at hospitals, and 42% during first three days. Antiretroviral treatment was prescribed to 9 patients. All of the were nonadherent to treatment and follow-up. Other study subjects were nonadherent to follow-up or never on follow-up. Conclusion. In almost half of subjects the death was due to progression of HIV-disease. All HIV-infected patients had poor adherence to follow-up and/or antiretroviral treatment. The results confirm the critical importance of timely and early detection of HIV-infected persons, regular follow-up and improving adherence to antiretroviral therapy among HIVinfected patients

Случай геморрагической лихорадки, вызванный вирусом денге

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EVALUATION OF EFFECTIVENESS OF ANTIVIRAL THERAPY FOR CHRONIC HEPATITIS C, CAUSED BY HCV GENOTYPE 6

Objectives: Evaluating the effectiveness of 2 therapeutic schemes for chronic hepatitis C (genotype 6) which combined sofosbuvir and ribavirin, one of them also included pegylated interferon. Materials and methods: The study included 110 patients with chronic hepatitis C (genotype 6), who have undergone antiviral therapy (HTP) in Hepatology Clinic inHo Chi Minh City,Vietnamfrom November 2015 to July 2016. 24 patients were treated by Pegylated interferon alfa-2a, ribavirin and sofosbuvir for 12 weeks, 86 patients – by sofosbuvir and ribavirin for 24 weeks. Non-interferon regimen was administered primarily to patients with contraindications to the use of interferon. To monitor the effectiveness of antiviral therapy, quantification of HCV RNA in serum was performed by PCR prior to treatment, at 4th, 12th or 24th week (depending on the observation group) from the starting of treatment and at 12th, 24th week after completion of treatment. Results: All patients, who were treated with pegylated interferon, ribavirin and sofosbuvir, completed the full course of treatment and 100% of them are registered with sustained virological response at 12th and 24th week after the end of antiviral therapy (SVR-12 and SVR-24, respectively). In the group of patients, who treated with ribavirin and sofosbuvir, 97,7% of patients completed full course of treatment (SVR-12 was registered in 93% of patients, and SVR-24 – in 91,9% of patients). Of 75 patients without a history of HCC, SVR24 was registered in 74 people (98,7%), of 11 patients with HCC – in 5 patients (45,5%). SVR-24 was registered in 98% of patients with cirrhosis (F4) without HCC. Conclusion: The results can serve as a justification for the use of these schemes of antiviral therapy for special groups of patients and/or conditions when it is impossible to follow the latest recommendations, which will help to expand the access of patients to effective antiviral therapy for chronic hepatitis C

Быть или не быть: прогноз развития эпидемии COVID-19 в России

Currently, the intensity of COVID-19 epidemic in Russia is declining. Most of the country’s regions are at the first stage of lifting restrictions; some regions have moved to the second and third phases. At the same time, the development of the COVID-19 pandemic in Southern hemisphere indicates the continuous circulation of SARS-CoV-2 in the world. The article provides statements arguing for the development of the «second wave» of the COVID-19 epidemic in Russia, as well as practical recommendations aimed at preparing for the autumn-winter epidemic season 2020–2021.В настоящее время эпидемия COVID-19 в России идет на спад. Большая часть регионов страны находятся на первом этапе снятия ограничений, некоторые регионы перешли ко второй и третьей фазе. Вместе с тем, развитие пандемии COVID-19 в странах Южного полушария свидетельствует о непрекращающейся циркуляции SARS-CoV-2 в мире. В статье приведены аргументы, свидетельствующие в пользу развития «второй волны» эпидемии COVID-19 в России, а также даны практические рекомендации, направленные на подготовку к осенне-зимнему эпидемическому сезону 2020–2021 гг

ЛЕЧЕНИЕ ХРОНИЧЕСКОГО ГЕПАТИТА С (ГЕНОТИПА 6) У БОЛЬНЫХ, ИМЕЮЩИХ ПРОТИВОПОКАЗАНИЯ К ПРИМЕНЕНИЮ ИНТЕРФЕРОНА-α

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Assessment of the humoral immune response in children after immunization with different types of inactivated influenza vaccines in the 2019-2020 season

Causing millions of cases worldwide every year, influenza is one of the most common respiratory infections. The effectiveness of influenza vaccination and the nature of the resulting immune response may vary depending on the vaccine composition and age group. Since children are at the highest risk of disease and act as the main carriers of influenza, the assessment of the immunological efficacy of vaccines in this group is crucial for controlling the epidemic. Therefore, this study aimed to evaluate the characteristics of the humoral immune response in children after immunization with various types of inactivated influenza vaccines. An observational study was conducted in the 2019-2020 season and involved 230 children (< 18 years old) and a comparison group of 87 adults aged 18 to 60 years. The subjects, who provided informed consent to participate, were vaccinated with one of three vaccines (Grippol Plus, Sovigripp, or Ultrix) in an open-label fashion. The humoral immune response was assessed by measuring the hemagglutination inhibition (HI) titer in the paired sera taken before and three weeks after vaccination. The immunogenicity of the vaccines in the age group under 18, met the CPMP criteria for the assessment of inactivated influenza vaccines in terms of the fold increase in antibody titers and the proportion of individuals with seroconversion to all three components (A/H1N1pdm09, A/H3N2, and B/Victoria). Although 6 to 18-year-old participants showed a more robust immune response to the B/Victoria component compared to the adult participants (aged 18 to 60), it was insufficient to ensure that 70% of the participants have a protective antibody titer. A comparative analysis of the vaccines’ immunogenicity was carried out for a subgroup of children aged 6-18 who had initially low antibody levels at the time of vaccination. The analysis showed that the split vaccine Ultrix outperformed the adjuvanted vaccine Grippol Plus in generating an antibody response to the component B/Victoria; however, the antibody responses to the A/H1N1pdm09 and A/H3N2 components did not differ between the two vaccines. The children under 6 years of age demonstrated a less pronounced humoral immune response to vaccination compared with the other age groups, which may be due to the age-related characteristics of the immune system in children of preschool age

Клинико-лабораторная характеристика гемофильной инфекции типа b с поражением центральной нервной системы у детей младшего возраста

Introduction. Invasive Haemophilus influenza type b (Hib) infection often manifests as severe and complicated forms of purulent meningitis in children from birth to 6 years of age. Hib meningitis is the most commonly diagnosed invasive form, with a severe course. There is no generally accepted clinical classification of Hib infection. Along with meningitis, the infection is often manifested with purulent inflammatory foci of different localization.The objective was to characterize the course of purulent Hib meningitis, including in combination with purulent foci, in young children.Methods and materials. We analyzed 45 case histories of children (under the age of 3 years) who had an invasive Haemophilus infection with purulent meningitis. Hib meningitis (Group-1) was diagnosed in 17 patients and meningitis in combination with specific purulent foci was diagnosed in 28 patients (Group-2). The diagnosis in all patients was confirmed bacteriologically or serologically (Latex Agglutination Test).Results. The combination of meningitis with purulent foci of Hib infection was characterized by late hospitalization (36 %), longer recovery of cerebrospinal fluid, longer duration of the disease, and the prevalence of severe and complicated disease, and often required surgical treatment (46.4 %). A burdened premorbid background is traditionally considered a condition for the development of invasive Hib infection. According to our data, only 40 % of children had a burdened premorbid background, which is confirmed by clinical cases.Conclusion. Since Hib infection in young children is often combined with meningitis with purulent foci, is characterized by a severe and complicated course, and often requires surgical treatment, it is advisable to consider this form of infection separately. Введение. Генерализованные формы гемофильной инфекции типа b (Hib) нередко проявляются в виде тяжелых и осложненных форм гнойного менингита у детей от рождения до 6 лет. Hib-менингит является самой часто диагностируемой генерализованной формой, с тяжелым течением. Отсутствует общепринятая клиническая классификация инфекции. Наряду с менингитом, нередко инфекция проявляется гнойными воспалительными очагами разной локализации.Цель – охарактеризовать течение гнойного Hib-менингита, в том числе в сочетании с гнойными очагами, у детей младшего возраста.Методы и материалы. Проанализированы 45 историй болезни детей (в возрасте до 3 лет), перенесших генерализованную Hib-инфекцию с развитием гнойного менингита. У 17 пациентов диагностирован Hib-менингит (группа 1) и у 28– менингит в сочетании с гнойными специфическими очагами (группа 2). Диагноз у всех пациентов подтвержден бактериологически или серологически (метод реакции латекс-агглютинации).Результаты. Вариант сочетания менингита с гнойными очагами Hib-инфекции отличался поздней госпитализацией (36 %), более длительной нормализацией состава спинномозговой жидкости, бóльшей продолжительностью заболевания, преобладанием тяжелых и осложненных форм заболевания, а также нередко требовал хирургического лечения (46,4 %). Отягощенный преморбидный фон традиционно рассматривается как условие развития генерализованных форм Hib-инфекции. По нашим данным, лишь 40 % детей имели отягощенный преморбидный фон, что иллюстрируют клинические случаи.Заключение. В связи с тем, что Hib-инфекция у детей младшего возраста часто протекает в виде менингита с гнойными очагами, характеризуется тяжелым и осложненным течением и нередко требует хирургического лечения, целесообразно выделять эту форму инфекции.

Клинические случаи пневмоцистной пневмонии у больных ВИЧ-инфекцией на фоне COVID-19

During the COVID-19 pandemic, additional difficulties have emerged in the differential diagnosis of interstitial pulmonary abnormalities, especially in patients with HIV infection, in whom this kind of injury can be caused by a wide range of pathogens, including opportunistic diseases. The high probability of an adverse outcome of pulmonary disease in patients with severe immunodeficiency requires an urgent choice of effective therapy.The article describes clinical cases of pneumocystis pneumonia in two COVID-19 patients with newly diagnosed HIV infection, illustrating the difficulties of differential diagnosis in these conditions.В период пандемии новой коронавирусной инфекции COVID-19 появились дополнительные трудности в дифференциальной диагностике интерстициальных изменений в легких, особенно у больных ВИЧ-инфекцией, у которых такое поражение может быть обусловлено широким спектром патогенов, включая оппортунистические заболевания. Высокая вероятность неблагоприятного исхода поражения легких у пациентов с глубоким иммунодефицитом требует неотложного выбора эффективной терапии.В статье приводится описание клинических случаев пневмоцистной пневмонии у 2 больных COVID-19 с впервые выявленной ВИЧ-инфекцией, иллюстрирующих сложности дифференциальной диагностики подобных состояний

Характеристика HCV-инфекции у онкогематологических больных

Objective: clinical and laboratory characteristics of HCV infection in patients with oncohematological malignancies. Materials and Methods: The study included 106 patients with a positive serum HCV antibody (anti-HCV) test result, who were examined or treated in 5 specialized oncohematological units of different hospitals in Saint Petersburg in 2018–2019.Laboratory tests included: ALT and AST activity, qualitative (with sensitivity of 60 IU/ml) and quantitative determination of HCV RNA, as well as HCV genotyping by real-time PCR. The presence and the grade of liver fibrosis according to the METAVIR scale were evaluated by indirect elastography on Fibroscan. Results: Men were predominant (62,2%), and most of patients (67%) were of young and middle age (18-59 years old). HCV infection was confirmed in 68% patients, and in 41.7% of them HCV genotype 3 was detected. HCV RNA was not detected in 32% cases, suggesting the spontaneous clearance of the virus. Severe liver fibrosis (F3) or cirrhosis (F4) were found in 40% patients with confirmed viremia. In most patients, the normal ALT activity level was registered. 86% patients diagnosed with HCV infection were followed up by an infectious disease specialist until the present study. 19% patients received antiviral therapy for HCV infection. Conclusion: A significant proportion of patients with advanced liver fibrosis and HCV 3 genotype, causing the greatest difficulties in antiviral treatment for HCV infection, was revealed. Prescription of direct-acting antiviral agents in the early terms after establishment of the diagnosis is reasonable.Цель: клинико-лабораторная характеристика HCVинфекции у больных онкогематологическими заболеваниями.Материала и методы: в исследование включены 106 больных с положительным результатом обследования на антитела к HCV (anti-HCV) в сыворотке крови, проходивших обследование или лечение в 5 специализированных онкогематологических отделениях стационаров Санкт-Петербурга в 2018–2019 гг.Лабораторное обследование включало: определение активности АлАТ и АсАТ, качественное (чувствительность – 60 МЕ/мл) и количественное определение РНК HCV и генотипирование HCV методом ПЦР в режиме реального времени. Наличие и степень выраженности фиброза печени по шкале METAVIR оценивали методом непрямой эластометрии на аппарате Fibroscan.Результаты исследования: среди пациентов преобладали мужчины (62,2%), большинство больных (67%) молодого и среднего возраста (18-59 лет). ХГС подтвержден у 68% пациентов, из них у 41,7% выявлен HCV генотип 3. В 32% случаев РНК HCV не выявили, что позволяет предположить естественную элиминацию вируса. У 40% пациентов с подтвержденной виремией установлен выраженный цирроз (F3) или фиброз печени (F4). Нормальная активность АлАТ отмечена у большинства больных. На диспансерном наблюдении у врача-инфекциониста состояли 86% от числа больных с установленным диагнозом ХГС до настоящего исследования. Противовирусная терапия ХГС проведена 19% пациентов.Заключение: обнаружение значительной доли пациентов с продвинутыми стадиями фиброза печени и генотипом 3 HCV, обусловливающим наибольшие сложности при проведении противовирусной терапии ХГС, которым целесообразно назначать противовирусные препараты прямого действия в ранние сроки после установления диагноза