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

Zinc deficiency and advanced liver fibrosis among HIV and hepatitis C co-infected anti-retroviral naïve persons with alcohol use in Russia

Background and aims Liver disease in people living with HIV co-infected with hepatitis C virus is a source of morbidity and mortality in Russia. HIV accelerates liver fibrosis in the setting of HCV co-infection and alcohol use. Zinc deficiency is common among people living with HIV and may be a factor that facilitates the underlying mechanisms of liver fibrosis. We investigated the association between zinc deficiency and advanced liver fibrosis in a cohort of HIV/HCV co-infected persons reporting heavy drinking in Russia. Methods This is a secondary data analysis of baseline data from 204 anti-retroviral treatment naïve HIV/HCV co-infected Russians with heavy drinking that were recruited into a clinical trial of zinc supplementation. The primary outcome of interest in this cross-sectional study was advanced liver fibrosis. Zinc deficiency, the main independent variable, was defined as plasma zinc \u3c0.75 mg/L. Exploratory analyses were performed examining continuous zinc levels and fibrosis scores. Analyses were conducted using multivariable regression models adjusted for potential confounders. Results The prevalence of advanced liver fibrosis was similar for those with zinc deficiency compared to those with normal zinc levels, (27.7% vs. 23.0%, respectively). We did not detect an association between zinc deficiency and advanced liver fibrosis in the adjusted regression model (aOR: 1.28, 95% CI: 0.62–2.61, p = 0.51) nor in exploratory analyses. Conclusions In this cohort of Russians with HIV/HCV co-infection, who are anti-retroviral treatment naïve and have heavy alcohol use, we did not detect an association between zinc deficiency or zinc levels and advanced liver fibrosis

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

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

Prognostic factors in patients with hematological malignancies and concomitant chronic hepatitis C

The study evaluated the impact of HCV infection on the prognosis in patients with hematological malignancies. A total of 96 patients with anti-HCV antibodies were enrolled, with the age of 37.8 (3.0–81.0) years old, 39.6% had non-Hodgkin’s lymphoma. Chronic hepatitis C (CHC) was diagnosed in 46.9% patients prior to malignancy development, in 38.5% patients simultaneously with malignancy, and in 14.6% patients during malignancy treatment. Clinical and biochemical signs of HCH were mild in most of the patients, minimal liver fibrosis (F0–1 by METAVIR system) was discovered in 47.3% patients, severe fibrosis or cirrhosis (F3–4) was diagnosed in 40% of participants. Only 20 (20.8%) of patients received antiviral therapy against HCV prior to enrollment. Regression analysis demonstrated that age 55 years old, late onset of antiviral therapy, and poor nutritional status were significant predictors of death from hematological malignancy. Survey conducted among physicians of hematological oncology hospitals in Saint-Petersburg revealed gaps in knowledge on presentation and risks of HCV infection, as well as on opportunities of modern antiviral therapy

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

Причины смерти больных ВИЧ-инфекцией в Ломоносовском районе Ленинградской области в 1999–2011 гг.

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. Цель – анализ причин смерти больных ВИЧинфекцией, умерших в Ломоносовском районе Ленинградской области в 1999–2011 гг. Материалы и методы. Проведен ретроспективный анализ 118 результатов протоколов вскрытий всех больных ВИЧ-инфекцией, умерших в Центральной районной больнице (ЦРБ) и участковых больницах Ломоносовского района Ленинградской области, а также лиц, доставленных в патолого-анатомическое отделение ЦРБ Ломоносовского района для аутопсии из дома или найденных на улице в 1999–2011 гг. Результаты. Из 118 пациентов мужчины составили 76% (90 человек). Средний возраст больных – 32,1±4,3 года. Умерли вследствие ВИЧ-инфекции 53 человека (49%), основным посмертным диагнозом был туберкулез (45 чел., 85%), преимущественно протекавший в генерализованной форме. Вследствие соматических причин или насильственной смерти умерли 29 (27%) и 27 человек (24%) соответственно. Из 62 больных, умерших в стационарах Ломоносовского района, у 11 человек (18%) смерть наступила в первые сутки после госпитализации и более трети (42%) погибли в первые 3-е суток нахождения в стационаре. Антиретровирусную терапию получали 9 больных, все были не привержены терапии и нарушали режим лечения. Остальные больные не состояли на диспансерном наблюдении или нерегулярно наблюдались у врача-инфекциониста. Заключение. Почти у половины больных смерть была обусловлена прогрессированием ВИЧ-инфекции. Для всех умерших была характерна недостаточная приверженность диспансерному наблюдению и лечению ВИЧ-инфекции. Полученные результаты подтверждают важность своевременного и раннего выявления лиц, инфицированных ВИЧ, проведение их регулярного диспансерного наблюдения и повышение приверженности наблюдению и антиретровирусной терапии.

Содержание лептина и адипонектина в крови у больных хроническим гепатитом С с наруш ениями уг леводно-жирового обмена

Aim: to analyze leptin and adiponectin serum levels in patients with chronic hepatitis C in comparison with metabolic syndrome components, biochemical features and stage of hepatitis.Materials and methods: In 93 patients with chronic HCV in age 20-55 with a few symptomatic HCV-infection and minimal liver fibrosis stage serum leptin and adiponectin was measured. Associations between leptin, adiponectin and metabolic abnormalities, biochemical features, and hepatic fibrosis were determined.Results: Abdominal obesity was revealed at 40% patients, overweight – at 41%, insulin resistance – at 36,6% cases. The leptin and adiponectin levels were within normal limits range at most patients. Patients with minimal liver fibrosis had higher index of leptin by comparison to patients with moderate and severe fibrosis (r= – 0,402, р= 0,018). In patients with HCV genotype 3a the adiponectin level was below, than in HCV genotype 1b. Patients with abdominal obesity and overweight had higher leptin and lower adiponectin indexes by comparison to patients without these metabolic abnormalities. Direct cross-correlation between the leptin level and body mass index (r=0,358, p=0,001), waist circumference (r=0,292, p=0,01); negative cross-correlation between the adiponectin level and body mass index (r=- 0,435, р <0,021), waist circumference (r=- 0,386, р =0,001) were displayed.Conclusion: Leptin and adiponectin blood levels in HCVpatientis associated with abdominal obesity and overweight. The connection of leptin level and liver fibrosis stage was revealed. Difference of adiponectin level in HCV-patients with 3a and 1b genotypes of virus was found.Цель: оценить содержание лептина и адипонектина в крови больных хроническим гепатитом С в сопоставлении с компонентами метаболического синдрома, биохимическими характеристиками и стадией фиброза печени. Материалы и методы. Содержание лептина и адипонектина в крови определили у 93 больных хроническим гепатитом С в возрасте от 20 до 55 лет с малосимптомным течением заболевания и минимально выраженным фиброзом печени в большинстве случаев. Оценивали связь между содержанием лептина и адипонектина в крови и метаболическими нарушениями, биохимической активностью гепатита, стадией фиброза печени.Результаты. Абдоминальное ожирение выявлено в 40% случаев, избыточная масса тела – в 41%, инсулинорезистентность – в 36,6%. У большинства больных уровень лептина и адипонектина был в пределах нормальных колебаний. Средний показатель лептина был достоверно выше у пациентов с минимальным фиброзом печени в сравнении с выраженным и тяжелым фиброзом (r= – 0,402, р= 0,018).У больных гепатитом, вызванным HCV генотипа 3a, средний уровень адипонектина был ниже, чем у пациентов, инфицированных HCV генотипа 1b. Достоверно более высокие показатели лептина и низкие адипонектина были у больных хроническим гепатитом С с абдоминальным ожирением, повышенной массой тела в сравнении с пациентами без этих нарушений обмена. Выявлена прямая корреляционная связь между уровнем лептина и индексом массы тела (r=0,358, p=0,001), окружностью талии (r=0,292, p=0,01); отрицательная корреляционная связь между уровнем адипонектина и индексом массы тела (r=-0,435, р <0,021), окружностью талии (r=- 0,386, р =0,001).Заключение. У больных хроническим гепатитом С уровень лептина и адипонектина в крови ассоциирован с абдоминальным ожирением, избытком массы тела. Выявлена связь уровня лептина со стадией фиброза печени, найдены различия уровня адипонектина в крови у больных, инфицированных HCV генотипа 3a и 1b