Влияние миграционных процессов на ситуацию по ВИЧ-инфекции (аналитический обзор)

Today, the unstable political and economic situation in the world has led to an intensified migration and changes in their directions. The legal norms regarding the status of migrants, including people living with HIV, are also changing. Over the past 10 years laws restricting the entry and residence of HIV-infected foreign citizens have been repealed in many countries, but in Russia the deportation and prohibition of long-term stay of HIV positive international migrants are still in effect. This review presents the main aspects of the impact of migration on the spread of HIV in the world and Russia, as well as the possible positive and negative effects of decriminalization of migrants living with HIV in terms of epidemic situation, socio-demographic and economic processes. The argument for retaining the deportation is due to the potential risk of the spread of the disease by foreigners and the unresolved organization of medical care and treatment of HIV infection for foreign migrants, which are provided for Russian citizens from the state budget. On the other hand, the deportation law touches upon ethical aspects, violating freedom of movement, the right to privacy and freedom from discrimination. Despite the presence or absence of restrictive measures against HIV-positive migrants, HIV has spread throughout all countries and led to a global epidemic. Prevention of HIV infection among general population of the country, regardless of their migration status, is a priority on the way to stop the spread of infection. На сегодняшний день нестабильная политическая и экономическая ситуация в мире ведет к активизации миграционных процессов и изменению их направления. Меняются также и правовые нормы в отношении статуса мигрантов, в том числе живущих с ВИЧ. В течение последних 10 лет во многих странах отменены законы, ограничивающие въезд и проживание ВИЧ-инфицированных иностранных граждан, однако в России продолжает сохраняться норма о запрете на долгосрочное пребывание и депортации иностранцев в случае выявления у них ВИЧ-инфекции. В данном обзоре обсуждаются основные аспекты влияния миграционных процессов на распространение ВИЧ в мире и в России, а также возможные позитивные и негативные последствия декриминализации мигрантов, живущих с ВИЧ, для эпидемической ситуации, социально-демографических и экономических процессов. Аргументами в пользу сохранения закона о депортации является потенциальная угроза распространения ВИЧ-инфекции иностранцами среди граждан страны, а также нерешенный вопрос об организации для иностранных мигрантов медицинской помощи и лечения ВИЧ-инфекции, которые для граждан России предоставляются за счет государственного бюджета. С другой стороны, данный закон затрагивает этические аспекты, нарушая свободу передвижения, право на неприкосновенность частной жизни и свободу от дискриминации. Несмотря на наличие или отсутствие ограничительных мер в отношении ВИЧ-положительных мигрантов, ВИЧ проник во все страны мира, его распространение приняло характер пандемии. Для прекращения развития эпидемии ВИЧ-инфекции основные усилия должны быть направлены на профилактику среди всего населения, что предотвратит возможность распространения ВИЧ независимо от миграционных процессов

Serological diagnosis and prevalence of HIV-1 infection in Russian metropolitan areas

Background: HIV infection is a major health problem in Russia. We aimed to assess HIV prevalence in different population groups and to compare the characteristics of 4th generation immunoassays from Abbott, Bio-Rad, Vector-Best, Diagnostic Systems, and Medical Biological Unit. Methods: The study included 4452 individuals from the general population (GP), 391 subjects at high risk of HIV infection (HR) and 699 with potentially interfering conditions. HIV positivity was confirmed by immunoblot and by HIV RNA, seroconversion and virus diversity panels were also used. HIV avidity was employed to assess recent infections. Results: The prevalence in GP was 0.40%, higher in males (0.62%) and in people aged < 40 years (0.58%). Patients attending dermo-venereal centers and drug users had a high prevalence (34.1 and 58.8%). Recent infections were diagnosed in 20% of GP and in 4.2% of HR. Assay sensitivity was 100% except for one false negative (99,54%, MBU). Specificity was 99.58–99.89% overall, but as low as 93.26% on HR (Vector-Best). Small differences on early seroconversion were recorded. Only the Abbott assay detected all samples on the viral diversity panel. Conclusion: HIV infection rate in the high-risk groups suggests that awareness and screening campaigns should be enhanced. Fourth generation assays are adequate but performance differences must be considered. © 2021, The Author(s)

Comparative evaluation of the 4th generation ELISA/CLIA assays used for the diagnosis of HIV infection in the Russian Federation [СРАВНИТЕЛЬНАЯ ОЦЕНКА ТЕСТ-СИСТЕМ ИФА/ИХЛА 4-го ПОКОЛЕНИЯ, ПРИМЕНЯЕМЫХ В РОССИЙСКОЙ ФЕДЕРАЦИИ ДЛЯ ДИАГНОСТИКИ ВИЧ-ИНФЕКЦИИ]

The aim of the work was to compare the five most widely used ELISA diagnostic kits on the territory of the Russian Federation, which are used for screening for HIV infection. Materials and methods. 5442 samples from visitors of diagnostic centers who came for blood donation for non-infectious analyses, cohorts with a high risk of HIV infection, as well as patients with potentially interfering conditions were used as a material for the study. Additionally, seroconversion panels and a panel of viral diversity were used to evaluate the analytical characteristics. The following test systems were compared: Architect HIV Ag/Ab Combo (Abbott), Genscreen Ultra HIV Ag-Ab (Bio-Rad), CombiBest HIV-1,2 AG/AT (Vector-Best), DS-ELISA-HIVAGAT- SCREEN (Diagnostic Systems), HIV-1,2-AG/AT (Medical-Biological Union). Conclusion. The diagnostic sensitivity of all tests was 100% with the exception of one (Medical-Biological Union), in which it turned out to be 99,54%. Diagnostic specificity ranged from 99,58% to 99,89%, but unexpectedly strongly depended on the test population, decreasing on a group with a high risk of HIV infection to 93,26% (Vector-Best). The convergence between initial and repeat reactive samples ranged from 100% (Abbott) to 89,51% (Vector-Best). The results of the analysis of seroconversion panels showed that the tests differed slightly from each other, receiving positive results from 22,12% (Diagnostic Systems) to 27,88% (Abbott) samples. When testing the panel of viral diversity, diagnostic tests from foreign manufacturers showed better results, revealing 100% (Abbott) and 85,9% (Bio-Rad). The smallest number of panel samples was detected by the kit of the Medical-Biological Union (52,1%). This work is the only study where the 4th generation ELISA kits, widely used in the Russian Federation for screening for HIV infection, were compared in an extensive sampling. The results obtained make it possible to evaluate the effectiveness of the use of the listed kits in routine diagnostic practice. © 2019

The reproducibility of qualitative measurement of RNA HIV-1, RNA hcv and RNA hbv using amplisens reagents' kits

The evaluation of reproducibility of three reagents' kits AmpliSens for quantitative measurement of RNA HIV-1, RNA HCV and RNA HBV using retrospective analysis of protocols of output control of reagents' kits produced by the central research institute of epidemiology of Rospotrebnadzor in 2014-2016. For every reagents' kits more than 100 produced series are analyzed. The total number of tested samples for every reagents' kits was at least 590. For every sample a difference between passport and experimental value of decimal algorithm of concentration of RNA/DNA of virus (dLg) was calculated. The obtained values of dLg were used to determine median and standard deviation (SD). The obtained values of SD were accepted as a reproducibility. The calculations were implemented using Microsoft Excel 2010. The average reproducibility according samples with various concentration of RNA HIV-1 made up to 0,218 Lg, RNA HCV - 0,191 Lg and I'M HBV- 0,174 Lg. The least reproducibility of measurement was observed for concentrations corresponding to lower limit of linear range of qualitative measurement and it made up to for RNA HIV1 0,275 Lg. RNA HCV - 0,206 Lg and RNA HBV- 0,211 Lg. The obtained reproducibility of the given reagents' kits AmpliSens is comparable with reproducibility of reagents' kits of foreign manufacturers. There is no necessity to enhance achieved reproducibility because, taking into account actual recommendations on treatment of patients with HIV and viral hepatitis B and C, according to them a therapy is considered effective when viral load decreases up to 10-100 times and even up to non-detectable levels

The reproducibility of qualitative measurement of RNA HIV-1, RNA hcv and RNA hbv using amplisens reagents' kits

The evaluation of reproducibility of three reagents' kits AmpliSens for quantitative measurement of RNA HIV-1, RNA HCV and RNA HBV using retrospective analysis of protocols of output control of reagents' kits produced by the central research institute of epidemiology of Rospotrebnadzor in 2014-2016. For every reagents' kits more than 100 produced series are analyzed. The total number of tested samples for every reagents' kits was at least 590. For every sample a difference between passport and experimental value of decimal algorithm of concentration of RNA/DNA of virus (dLg) was calculated. The obtained values of dLg were used to determine median and standard deviation (SD). The obtained values of SD were accepted as a reproducibility. The calculations were implemented using Microsoft Excel 2010. The average reproducibility according samples with various concentration of RNA HIV-1 made up to 0,218 Lg, RNA HCV - 0,191 Lg and I'M HBV- 0,174 Lg. The least reproducibility of measurement was observed for concentrations corresponding to lower limit of linear range of qualitative measurement and it made up to for RNA HIV1 0,275 Lg. RNA HCV - 0,206 Lg and RNA HBV- 0,211 Lg. The obtained reproducibility of the given reagents' kits AmpliSens is comparable with reproducibility of reagents' kits of foreign manufacturers. There is no necessity to enhance achieved reproducibility because, taking into account actual recommendations on treatment of patients with HIV and viral hepatitis B and C, according to them a therapy is considered effective when viral load decreases up to 10-100 times and even up to non-detectable levels

Recurrent endometrial hyperplastic processes in a patient with chronic hepatitis C

Background. When describing the etiological factors of the development of endometrial hyperplastic processes (EHP), the authors emphasize the importance of various viral infections. In this regard, the data on EHP in patients with chronic hepatitis C (CHC) are interesting. Description. The paper gives a clinical case of recurrent EHP in a reproductive-aged patient with CHC. The specific feature of the case is the detection of hepatitis C virus genome in endometrial tissue in moderate viremia. Virological study of endometrial tissue was performed by PCR using the Russian reagent kits: AmpliSens HCV/ HBV/HIV-FL, AmpliSens HCV-monitor-FL, and AmpliSens HIV-monitor-FRT. Antiviral therapy (AVT) normalized the endometrial structure. Conclusion. Virological examination of the endometrium and AVT should be performed in reproductive-aged patients with recurrent EHP in the presence of CHC. © Bionika Media Ltd

The impact of migration on HIV infection situation (analytical review)

Today, the unstable political and economic situation in the world has led to an intensified migration and changes in their directions. The legal norms regarding the status of migrants, including people living with HIV, are also changing. Over the past 10 years laws restricting the entry and residence of HIV-infected foreign citizens have been repealed in many countries, but in Russia the deportation and prohibition of long-term stay of HIV positive international migrants are still in effect. This review presents the main aspects of the impact of migration on the spread of HIV in the world and Russia, as well as the possible positive and negative effects of decriminalization of migrants living with HIV in terms of epidemic situation, socio-demographic and economic processes. The argument for retaining the deportation is due to the potential risk of the spread of the disease by foreigners and the unresolved organization of medical care and treatment of HIV infection for foreign migrants, which are provided for Russian citizens from the state budget. On the other hand, the deportation law touches upon ethical aspects, violating freedom of movement, the right to privacy and freedom from discrimination. Despite the presence or absence of restrictive measures against HIV-positive migrants, HIV has spread throughout all countries and led to a global epidemic. Prevention of HIV infection among general population of the country, regardless of their migration status, is a priority on the way to stop the spread of infection. © 2019 Izdatel'stvo Meditsina. All rights reserved

Recurrent endometrial hyperplastic processes in a patient with chronic hepatitis C

Background. When describing the etiological factors of the development of endometrial hyperplastic processes (EHP), the authors emphasize the importance of various viral infections. In this regard, the data on EHP in patients with chronic hepatitis C (CHC) are interesting. Description. The paper gives a clinical case of recurrent EHP in a reproductive-aged patient with CHC. The specific feature of the case is the detection of hepatitis C virus genome in endometrial tissue in moderate viremia. Virological study of endometrial tissue was performed by PCR using the Russian reagent kits: AmpliSens HCV/ HBV/HIV-FL, AmpliSens HCV-monitor-FL, and AmpliSens HIV-monitor-FRT. Antiviral therapy (AVT) normalized the endometrial structure. Conclusion. Virological examination of the endometrium and AVT should be performed in reproductive-aged patients with recurrent EHP in the presence of CHC. © Bionika Media Ltd

Assessment of the effectiveness of determining the duration of HIV infection by analysis of viral genetic variability

The objective. Assessment of the sensitivity and specificity of a method of calculating variable positions in HIV genome for detection of the duration of infection in a cohort of HIV-infected population of Russia. Patients and methods. The effectiveness of the method based on detection of HIV heterogenicity was assessed on 119 plasma specimens of HIV-infected patients with the known date of infection. The average duration of infection was 15 months, and the median - 8 months. In the studied sample, specimens of patients infected less than one year before amounted to 68% (81 of 119). The cohort consisted of 55 women (46%) and 64 men (54%). At the moment of blood testing for studying viral genome the patients' age varied from 0 to 79 years, the mean age was 31 years, median - 31 years. Results. As has been calculated for 119 examined specimens, the linear dependence between the duration of infection and the degree of variability of the sequence can be described by the formula y = 0.0012∗X + 0.0021 (R2 = 0.52). This equation permitted to calculate the variability threshold of 0.33%, which determined the duration of HIV infection as 12 months. Based on the obtained data, we calculated the sensitivity and specificity of the molecular method of detecting recent infection, which were 79.01 and 63.16%, respectively (comparable with previously published data). The duration of infection was calculated for each patient, then it was compared with the duration based on epidemiological data: for 42% of specimens the error in determining the duration of infection was less than 1 years, and for 92% of specimens - less than 3 years. Conclusion. This method might be successfully used in practice to assess the quality of screening programmes of detecting HIV infection performed in various regions and for various risk groups. Also, it might be used to confirm the presence of a recent (less than 1 year) infection

АССОЦИАЦИЯ ПОЛИМОРФИЗМОВ В ГЕНАХ TOLL-ПОДОБНЫХ РЕЦЕПТОРОВ И МАННОЗОСВЯЗЫВАЮЩЕГО ЛЕКТИНА С РИСКОМ РАЗВИТИЯ ТУБЕРКУЛЕЗА У ПАЦИЕНТОВ С ВИЧ-ИНФЕКЦИЕЙ

Objectives: to analyze the association between genetic polymorphisms of Toll-like receptors (TLR) and mannose-binding lectin (MBL) and active tuberculosis in HIV-infected patients to consider the possibility of using genetic markers as a way to personalize the chemoprophylaxis of tuberculosis in this category of patients. Materials and methods: The study enrolled 171 patients (85 HIV-infected, 86 HIV/TB co-infected patients). Single nucleotide polymorphisms (SNP) in the TLR4 (rs4986790), TLR2 (rs5743708) and MBL2 (rs5030737, rs1800450, rs1800451) were genotyped by real-time PCR and pyrosequencing. Data about epidemiological risk factors were obtained from epidemiological anamnesis. Immune status was assessed by the level of CD4+ T-cells count. Results: Statistically significant association with active tuberculosis was identified for the genotype AG of TLR4, rs4986790 (OR=5.2; 95% CI: 1,8-14,6, p=0,002). Multivariate analysis shows that close contact with TB patientand status of ex-prisoner increased the risk of active tuberculosis 5,2 times (OR=5,2; 95% CI: 1,4-18,5, p=0,012 and OR=5,2; 95% CI: 1,5-17,7, p=0,009, respectively); CD4+ T-cell count more than 200 cells/mm3 exerted protective effect and reduced the risk of developing TB 5 times (OR=0,2; 95% CI: 0,1-0,5, p=0,001). The genotype AG of TLR4, rs4986790 increased the risk of active tuberculosis 3,7 times (OR=3,7; 95% CI: 1,1-13,1, p=0,046). Conclusion. The G allele of TLR4, rs4986790 can be considered as an independent risk factor for active tuberculosis in HIV-infected individuals. These results need to be confirmed by further investigations on large samples.Целью исследования явился анализ ассоциации полиморфизма генов Toll-подобных рецепторов и маннозосвязывающего лектина с развитием туберкулеза у пациентов с ВИЧ-инфекцией для рассмотрения возможности применения генетических маркеров как способа оптимизации химиопрофилактики туберкулеза у данной категории больных. Материалы и методы: в исследовании принял участие 171 человек: 85 человек в группе ВИЧ, 86 человек в группе ВИЧ/ТБ. В исследование были включены генетические полиморфизмы rs4986790 гена TLR4, rs5743708 гена TLR2, а также rs5030737, rs1800450 и rs1800451 гена MBL2. Определение аллелей генетических полиморфизмов проводилось методом ПЦР в режиме реального времени и с помощью пиросеквенирования. Выявление эпидемиологических факторов риска проводилось при сборе эпидемиологического анамнеза. Иммунный статус оценивался по уровню CD4+-лимфоцитов, данные о котором были получены при ретроспективном анализе медицинской документации. Результаты: при расчете отношения шансов, статистически значимая ассоциация с развитием туберкулеза выявлена для генотипа AG гена TLR4, rs4986790 (ОШ=5,2; 95% ДИ 1,8-14,6; р=0,002). При многофакторном анализе контакт с бактериовыделителем (ОШ=5,2; 95% ДИ 1,4-18,5; р=0,012) и пребывание в учреждениях ФСИН (ОШ=5,2; 95%ДИ 1,5-17,7; р=0,009) увеличивали риск развития туберкулеза в 5,2 раза, наличие показателя CD4+-лимфоцитов более 200 кл/мкл (ОШ=0,2; 95% ДИ 0,1-0,5; р=0,001) оказывало протективное действие и снижало риск развития туберкулеза в 5 раз. Генотип AG гена TLR4, rs4986790 увеличивал риск развития туберкулеза в 3,7 раза (ОШ=3,7; 95% ДИ 1,1-13,1; р=0,046). Заключение. Полученные данные свидетельствуют, что аллель G гена TLR4 (rs4986790) может рассматриваться как самостоятельный фактор риска развития туберкулеза у пациентов с ВИЧ-инфекцией, необходимо подтверждение полученных результатов в исследованиях на больших выборках пациентов