SELECTION OF AN ANTIRETROVIRAL REGIMEN BASED ON THE RESISTANCE DATA

As part of the global strategy against HIV, UNAIDS formulated the 90-90--90 targets. The targets mean that 90% of people living with HIV and receiving treatment should have achieved viral suppression. One of the main obstacles to achieving the goal is HIV resistance to antiretroviral therapy. It occurs when the virus mutates and affinity of active ingredients of drugs for the corresponding viral proteins is reduced. Drugs differ by the genetic barrier. Non-nucleoside reverse-transcriptase inhibitors lose their ability to inhibit the replication after a single mutation, and ritonavir- boosted protease inhibitors - after 5--8th mutation. The key factor for adequate viral suppression and reduction of risks is good adherence to treatment. Medication non-adherence creates a favorable environment in the body for the evolution of the virus. In the Russian Federation, the prevalence of primary resistance reaches 6.02%, and poor adherence equals 26%. The data and the results of examinations for mutations should be considered when selecting an antiretroviral regimen and approach to patient to improve adherence

WAYS TO ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION OF HIV

Aim. The article addresses the progress in elimination of mother-to-child transmission of HIV in the Russian Federation. The authors reviewed the available data on the current situation and identified opportunities to reduce the risk of mother-to-child transmission of HIV. Materials and methods. The basic HIV statistics for 2017 from the federal public health watchdog Rospotrebnadzor and the Russia's ministry of health were analysed. The findings included several important aspects. Results. In 2017, women constituted a substantial proportion of population living with HIV, both among all cases and among new HIV infections (37%-38%). The number of new HIV cases among women was growing every year and by 2017 increased 62% compared to 2010. In 28 regions of the Russian Federation, more than 1% of pregnant women were HIV positive. Across the whole monitoring period (from 1987), 177,663 pregnancies complicated by HIV infection and ended in delivery were registered in Russia by the end of 2017, including 14,969 such pregnancies in 2017 alone. In 2017, 91.0% of pregnant women living with HIV took ART during pregnancy, 94.7% received it in labour. 98.7% of new-borns were given antiretroviral therapy as prevention. However, a three-stage chemoprophylaxis was provided to only 89.1% of mother-child pairs. It was revealed that 1,635 motherchild pairs (10.9%) missed at least one of prevention stages. The main reason for incomplete prevention was the late diagnosis of HIV infection in mothers. The viral load before delivery was not suppressed in 25.8% of HIV-positive pregnant women whose pregnancies were completed in 2017 (2,527 women were tested for viral load and 1,342 did not take antiretroviral drugs during pregnancy). 708 children born to HIV-positive mothers were diagnosed HIV positive in 2017 of whom, however, only 235 were born that year. Calculations showed that in 2017 the risk of vertical HIV transmission amounted to 2.3%, which were 348 new-born babies. A significant number of children (35,579 born in different years) did not undergo a final HIV test. 3.9% of all HIV-infected children born to HIV-positive women had contracted HIV through breastfeeding. There was also a trend towards increasing the number of HIV transmissions this way. The article reveals that in the cohort of children born women, the death rate is higher. So in 2017 mortality among infants born to HIV-positive mothers was 1.5 times higher, while perinatal mortality was twice as high as in the general population. Conclusion. The study showed that in order to improve the situation concerning vertical transmission of HIV, it is necessary to solve a number of tasks related to low threshold programmes aimed at access to surveillance, treatment and retention in care for women, especially those of at-risk of HIV. The ways to achieve the goal are early infant HIV diagnosis in first two months of new-borns' life, urgent final laboratory examination of older children exposed to HIV at birth, determination and elimination of factors leading to increased infant mortality, breast-feeding counselling, as well as improvements in statistical methods

HIV PREVALENCE AMONG VULNERABLE GROUPS IN RUSSIA - RESULTS OF AN INTEGRATED BIO-BEHAVIORAL SURVEY

Aim. Of the study is to assess HIV prevalence in the vulnerable groups namely injecting drug users (IDU), sex workers (SW), and men who have sex with men (MSM) in some of the largest Russian regiоnal capitals mostly affected by HIV infection. Materials and methods. The study involved 3744 persons from vulnerable groups enrolled by respondent-driven sampling (RDS) or time-location sampling (TLS). The study was undertaken in seven regions of the Russian Federation: Moscow, St.-Petersburg, Yekaterinburg, Krasnoyarsk, Kemerovo, Tomsk and Perm. All participants were interviewed using specially designed questionnaire and then tested for HIV. The retrospective cohort method was applied to evaluate the number of new HIV cases among respondents. Results. HIV prevalence in IDUs ranged from 48.10% [95% confidence interval (CI)=42.20.54.10%] in Krasnoyarsk and 75.20% [95%CI=69.90.80.60%] in Kemerovo. HIV prevalence among sex workers varied from 2.32% [95%CI=0.49.4.17%] in St. Petersburg to 15.01% [95%CI=11.46.18.56%] in Perm. HIV prevalence among MSM ranged from 7.10% [95%CI=4.10.10.10%] in Moscow to 22.80% [95%CI=17.90.27.70%] in St.-Petersburg. Conclusion. The number of new HIV infections estimated by the retrospective cohort method indicated rapid spread of HIV infection among IDUs in all cities except St.-Petersburg, relatively high HIV growth rates among MSM ranging from 1.6% per year [95%CI=0.1... 3.1%] to 4.6% per year [95%CI=0.0... 11%] and 12.3% annual HIV growth rate [95%CI=0.0... 28.3%] among sex workers. Generally, the situation in the studied groups remained adverse and called for more intensive prevention activities in vulnerable populations

УРОВЕНЬ И СТРУКТУРА ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТИ ВИЧ-1 СРЕДИ ПАЦИЕНТОВ БЕЗ ОПЫТА ПРИЕМА АНТИРЕТРОВИРУСНЫХ ПРЕПАРАТОВ С МОМЕНТА НАЧАЛА ПРИМЕНЕНИЯ АНТИРЕТРОВИРУСНОЙ ТЕРАПИИ В РОССИЙСКОЙ ФЕДЕРАЦИИ

Aim: to analyze the prevalence, structure of drug resistance and drug resistance mutations in the protease and reverse transcriptase genes of HIV-1 among treatment naïve patients.Materials and methods. We analyzed protease and reverse transcriptase sequences from 1560 treatment naïve HIV-infected patients from all Federal Districts of the Russian Federation with the first positive immune blot during 1998–2017. Sequences were analyzed for the presence of drug resistance mutations and predicted drug resistance to antiretroviral drugs using two algorithms — Stanford HIVDR Database (HIVdb) and the 2009 SDRM list (CPR).Results. The prevalence of drug resistance mutations was 11,1%. More often the prevalence of drug resistance was found for non-nucleoside reverse transcriptase inhibitor drugs (rilpivirine, nevirapine, efavirenz). The prevalence of transmitted drug resistance associated with mutations from the SDRM list was 5,3%, which is classified by the WHO as a moderate level. However, it should be noted that since the large-scale use of antiretroviral drugs in the Russian Federation, there has been a trend towards a gradual increase in the level of the transmitted drug resistance, and in 2016 it has already reached 6,1%.Conclusion. The results demonstrate the need for regular surveillance of the prevalence of HIV drug resistance to antiretroviral drugs among treatment naïve patients in the Russian Federation.Цель исследования: проанализировать уровень, структуру лекарственной устойчивости и мутаций резистентности во фрагментах гена pol ВИЧ-1, кодирующих протеазу и обратную транскриптазу, к антиретровирусным препаратам среди ВИЧ-инфицированных пациентов, не имеющих опыта антиретровирусной терапии.Материалы и методы. Выполнено исследование 1560 нуклеотидных последовательностей фрагментов гена pol, кодирующих протеазу и часть обратной транскриптазы ВИЧ-1, выделенных от ВИЧ-инфицированных пациентов без опыта антиретровирусной терапии из всех Федеральных округов Российской Федерации с первым положительным результатом иммунного блоттинга в 1998–2017 гг. Нуклеотидные последовательности участков генома ВИЧ-1 анализировали на наличие мутаций резистентности и уровня прогностической лекарственной устойчивости к антиретровирусным препаратам двумя алгоритмами –согласно алгоритму Стэндфордского университета, оценивали основные мутации лекарственной устойчивости (MDRM) и, используя инструмент CPR, оценивали мутации из листа SDRM 2009 г.Результаты. Уровень распространения мутаций, ассоциированных с прогностической лекарственной устойчивостью низкого, среднего и высокого уровня, составил 11,1%. Наиболее высокая распространенность лекарственной устойчивости обнаружена к препаратам класса ненуклеозидных ингибиторов обратной транскриптазы (рилпивирин, невирапин, эфавиренз). Уровень распространенности передаваемой лекарственной устойчивости, связанной с мутациями из списка SDRM, составил 5,3%, что классифицируется ВОЗ как умеренный. Однако следует отметить, что с момента широкомасштабного применения антиретровирусных препаратов в России наблюдается тенденция к постепенному росту уровня передаваемой лекарственной устойчивости, и в 2016 году он уже достиг 6,1%.Заключение. Полученные данные демонстрируют необходимость осуществления регулярного надзора за  уровнем распространения лекарственной устойчивости ВИЧ к  антиретровирусным препаратам среди наивных пациентов в Российской Федерации.</p

Euroguidelines in Central and Eastern Europe (ECEE) conference and the Warsaw Declaration – a comprehensive meeting report

PubMed ID: 27553526Objectives: The objective of this paper is to summarize the outcomes of the Euroguidelines in Central and Eastern Europe (ECEE) conference held in Warsaw in February 2016. The main aim of this conference was to facilitate a discussion on European AIDS Clinical Society (EACS) guidelines implementation across the region and neighbouring countries and to present the current obstacles in benchmarking HIV care in Europe. Methods: During a 2-day meeting, there were country-based presentations using a predefined template so as to make the data comparable and focus the discussion. Areas covered were country epidemiology, surveillance, national strategy for treatment and prevention, standards of care, access to care and treatment availability. Each participant filled in a questionnaire investigating HIV guidelines usage per country. Results: In total, 16 Central and Eastern Europe (CEE) and neighbouring countries were represented at the conference: Albania, Armenia, Belarus, Croatia, Czech Republic, Estonia, Georgia, Hungary, Lithuania, Moldova, Poland, Romania, Russia, Serbia, Slovakia and Turkey. EACS guidelines version 7.1 were used in 14 (87%) countries. In 11 (69%) countries, national guidelines were available, of which eight had been recently updated. Half of the countries declared that they use World Health Organization (WHO) and Department of Health and Human Services (DHHS) guidelines, over one-third the European Centre for Disease Prevention and Control (ECDC) HIV testing guidelines and one in five the International Antiviral Society-USA (IAS-USA) Panel guidelines from 2012. Conclusions: Participants declared their will to promote the widespread use of EACS guidelines for HIV infection in the CEE region and neighbouring countries by signing the Warsaw Declaration. They also emphasized the need to increase publishing of data from national cohorts in that region. © 2016 British HIV Associatio

HIV health care providers are ready to introduce pre-exposure prophylaxis in Central and Eastern Europe and neighbouring countries: data from the Euroguidelines in Central and Eastern Europe (ECEE) Network Group

WOS: 000443397400006PubMed ID: 29989332ObjectivesPre-exposure prophylaxis (PrEP) for HIV infection has been introduced in only a few European countries. We investigated the potential to provide PrEP in the Central and Eastern European region, and in neighbouring countries. MethodsThe Euroguidelines in Central and Eastern Europe (ECEE) Network Group was formed in February 2016 to review standards of care for HIV infection in the region. Information related to PrEP was collected through on-line surveys. Respondents were recruited by ECEE members based on their involvement in HIV care. ResultsSeventy-six respondents from 23 countries participated in the survey. Twenty-six (34.2%) respondents reported that PrEP [tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)] was registered by the drug registration authority in their country. Fifty-three (70.7%) respondents reported being aware of informal' PrEP use in their country. If they had access to PrEP, 56 (74.7%) would advise its use in their practice. Forty-five (59.2%) respondents had concerns regarding PrEP use, and 10 (13.3%) expressed the need for more training. Most of the respondents (88.2%) would provide PrEP to people with high-risk behaviours. ConclusionsPrEP is already used informally in some countries in the region. Physicians are keen to use PrEP if and when it is accessible. Obstacles towards implementing PrEP in those countries were mostly related to lack of national guidelines, drug registration and governmental strategy