Лейшманиоз и ВИЧ-инфекция – актуальная проблема?

The aim of the work is the clinical characteristics of all known cases of combined visceral leishmaniasis (VL) and HIV infection in the Russian Federation.Results. The article contains information on the problem of the combined course of HIV infection and leishmaniasis: a number of statistical and overview data in the world. A brief description of known cases of high blood pressure in patients with HIV infection in the Russian Federation, as well as a detailed description of the last patient diagnosed with VL in 2019 in Moscow. In all cases, the diagnosis of VL was difficult, which was due to clinical features and the lack of alertness of physicians in relation to VL. All but one of the patients contracted VL during their stay in Crimea.Conclusion. The authors point to the need for the formation of diagnostic alertness among doctors on this pathology, especially since with the expansion of tourist routes abroad in endemic countries, as well as in the Crimea, the relevance of this problem increases.Цель: клиническая характеристика всех известных случаев сочетанного течения висцерального лейшманиоза и ВИЧ-инфекции в Российской Федерации.Результаты. Статья содержит сведения по проблеме сочетанного течения ВИЧ-инфекции и лейшманиоза: ряд статистических и обзорных данных в мире. Представлена краткая характеристика известных случаев висцерального лейшманиоза у больных ВИЧ-инфекцией в РФ, а также подробное описание последнего больного с установленным диагнозом висцерального лейшманиоза в 2019 г. в Москве. Во всех случаях установление диагноза висцерального лейшманиоза было затруднительно, что было обусловлено клиническими особенностями и отсутствием настороженности медиков в отношении висцерального лейшманиоза. Все больные, кроме одного, заразились висцеральным лейшманиозом во время пребывания в Крыму.Заключение. Авторы указывают на необходимость формирования у врачей диагностической настороженности по данной патологии, тем более что с расширением туристических маршрутов за рубеж, особенно в эндемичные страны, а также в Крым актуальность этой проблемы возрастает.

Leishmaniasis and HIV-infection – an actual problem?

The aim of the work is the clinical characteristics of all known cases of combined visceral leishmaniasis (VL) and HIV infection in the Russian Federation.Results. The article contains information on the problem of the combined course of HIV infection and leishmaniasis: a number of statistical and overview data in the world. A brief description of known cases of high blood pressure in patients with HIV infection in the Russian Federation, as well as a detailed description of the last patient diagnosed with VL in 2019 in Moscow. In all cases, the diagnosis of VL was difficult, which was due to clinical features and the lack of alertness of physicians in relation to VL. All but one of the patients contracted VL during their stay in Crimea.Conclusion. The authors point to the need for the formation of diagnostic alertness among doctors on this pathology, especially since with the expansion of tourist routes abroad in endemic countries, as well as in the Crimea, the relevance of this problem increases

Dolutegravir plus lamivudine versus dolutegravir plus tenofovir disoproxil fumarate and emtricitabine in antiretroviral-naive adults with HIV-1 infection (GEMINI-1 and GEMINI-2): week 48 results from two multicentre, double-blind, randomised, non-inferiority, phase 3 trials

Background: Effective two-drug regimens could decrease long-term drug exposure and toxicity with HIV-1 antiretroviral therapy (ART). We therefore aimed to evaluate the efficacy and safety of a two-drug regimen compared with a three-drug regimen for the treatment of HIV-1 infection in ART-naive adults. Methods: We conducted two identically designed, multicentre, double-blind, randomised, non-inferiority, phase 3 trials: GEMINI-1 and GEMINI-2. Both studies were done at 192 centres in 21 countries. We included participants ( 6518 years) with HIV-1 infection and a screening HIV-1 RNA of 500 000 copies per mL or less, and who were naive to ART. We randomly assigned participants (1:1) to receive a once-daily two-drug regimen of dolutegravir (50 mg) plus lamivudine (300 mg) or a once-daily three-drug regimen of dolutegravir (50 mg) plus tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg). Both drug regimens were administered orally. We masked participants and investigators to treatment assignment: dolutegravir was administered as single-entity tablets (similar to its commercial formulation, except with a different film colour), and lamivudine tablets and tenofovir disoproxil fumarate and emtricitabine tablets were over-encapsulated to visually match each other. Primary endpoint was the proportion of participants with HIV-1 RNA of less than 50 copies per mL at week 48 in the intention-to-treat-exposed population, using the Snapshot algorithm and a non-inferiority margin of 1210%. Safety analyses were done on the safety population. GEMINI-1 and GEMINI-2 are registered with ClinicalTrials.gov, numbers NCT02831673 and NCT02831764, respectively. Findings: Between July 18, 2016, and March 31, 2017, 1441 participants across both studies were randomly assigned to receive either the two-drug regimen (n=719) or three-drug regimen (n=722). At week 48 in the GEMINI-1 intention-to-treat-exposed population, 320 (90%) of 356 participants receiving the two-drug regimen and 332 (93%) of 358 receiving the three-drug regimen achieved plasma HIV-1 RNA of less than 50 copies per mL (adjusted treatment difference 122\ub76%, 95% CI 126\ub77 to 1\ub75); in GEMINI-2, 335 (93%) of 360 in the two-drug regimen and 337 (94%) of 359 in the three-drug regimen achieved HIV-1 RNA of less than 50 copies per mL (adjusted treatment difference 120\ub77%, 95% CI 124\ub73 to 2\ub79), showing non-inferiority at a 1210% margin in both studies (pooled analysis: 655 [91%] of 716 in the two-drug regimen vs 669 [93%] of 717 in the three-drug regimen; adjusted treatment difference 121\ub77%, 95% CI 124\ub74 to 1\ub71). Numerically, more drug-related adverse events occurred with the three-drug regimen than with the two-drug regimen (169 [24%] of 717 vs 126 [18%] of 716); few participants discontinued because of adverse events (16 [2%] in the three-drug regimen and 15 [2%] in the two-drug regimen). Two deaths were reported in the two-drug regimen group of GEMINI-2, but neither was considered to be related to the study medication. Interpretation: The non-inferior efficacy and similar tolerability profile of dolutegravir plus lamivudine to a guideline-recommended three-drug regimen at 48 weeks in ART-naive adults supports its use as initial therapy for patients with HIV-1 infection. Funding: ViiV Healthcare