LETAL OUTCOMES IN PATIENTS WITH HIV INFECTION, PARALLELS WITH ADEQUACY OF DIAGNOSTICS, DISPENSER AND TREATMENT

The goal is to consider the lethality as an indicator of the adequacy and success of timely detection, clinical examination and treatment of patients with HIV infection. Materials and methods. A retrospective analysis of 913 deaths of HIV-infected patients in the Novgorod Region was carried out for the period from 2001 to 2017. The study included patients with previously known HIV status and patients with newly diagnosed HIV infection. Age, time (from the time of detection of HIV infection to death), clinical (causes of deaths) and other characteristics were taken into account. The conclusion. Every year, the number of deaths of HIV-infected patients increases, while the number of deaths diagnosed with AIDS is increasing yearly. The structure of deaths is dominated by cases caused by severe immunosuppression, which is a characteristic feature of this stage of the epidemic. The most likely cause of increased mortality is the late onset of treatment, low coverage of therapy and a large number of late-identified patients. The age structure of the deceased is dominated by persons 30–39 years old. The main cause of death is tuberculosis. The increase in deaths from tuberculosis depends on the number of patients with unstable social status. Other common causes of death are bacterial infections (pneumonia, sepsis, etc.), malignant neoplasms, toxoplasmosis, pneumocystis pneumonia. A similar structure of deaths is associated with late diagnosis and atypical course (rapid progression) of tuberculosis. Among the causes of death not related to HIV, a significant proportion is occupied by viral hepatitis in the cirrhotic stage, cardiovascular diseases, malignant neoplasms, drug overdoses, alcohol poisoning. The annual increase in lethal outcomes in the region is due to inadequate coverage and late onset of ARVT, a low percentage of prevention of opportunistic diseases at a critically low level of CD4 cells, weak adherence to medical examination and treatment. To increase the life expectancy of HIV-infected people, it is necessary to improve and expand programs for the prevention and treatment of HIV infection.

Download Full-text

Opportunistic diseases in patients with HIV infection in the intensive care unit

Terapevticheskii arkhiv ◽

10.26442/terarkh201890114-17 ◽

2018 ◽

Vol 90 (11) ◽

pp. 13-17

Author(s):

G M Kozhevnikova ◽

S L Voznesenskiy ◽

T N Ermak ◽

E V Petrova ◽

V P Golub ◽

...

Keyword(s):

Intensive Care Unit ◽

Chronic Hepatitis ◽

Intensive Care ◽

Hiv Infection ◽

Comparative Study ◽

Opportunistic Infections ◽

Pneumocystis Pneumonia ◽

Hiv Patients ◽

Number Of Patients ◽

Secondary Diseases

The aim of the study was to analyze the incidence and prevalence of opportunistic diseases and comorbidities in patients admitted in the intensive care unit. Materials and methods. A specialized intensive care unit (ICU) for patients with severe HIV infection was set up in 2014 at the infectious diseases 2nd state hospital Moscow. It provides intensive care and treatments for HIV patients with severe co-morbidities and opportunistic infections. Retrospective analysis of medical records from 2014-2016 was carried out. Also carried out was a comparative study of the most common presentation of secondary diseases with available data of HIV patients in Russia from 1993-1997. Results. The number of patients treated increased from 455 to 852, and the death rate in the department decreased from 64.8 to 50.2% since it began operating. The opportunistic infections noted were cytomegalovirus, pneumocystis pneumonia, esophageal candidiasis, tuberculosis and toxoplasmosis of the brain. The most common comorbidities were chronic hepatitis C and mixed form of chronic hepatitis with cirrhosis complications. Despite the vast diagnostic possibilities, bacterial pneumonia and encephalitis of unknown origin significantly occurred. Comparative study of secondary disease since the early 1990s revealed a significant increase in cerebral toxoplasmosis (from 1.7 to 10.4%), pneumocystis pneumonia (from 5.2 to 16.0%) and encephalitis of unspecified etiology (from 13.8 to 39.4%) Conclusion. Disease severity among HIV patients is increasing. CMV and pneumocystis pneumonia were predominant opportunistic diseases. There were significant changes in the presentation of secondary diseases compared to data from 1993-1997.

Download Full-text

Analysis of the causes of death in HIV-infected individuals in 2008-2010 according to the data of the clinical infectious diseases hospital named after S.P. Botkin, St. Petersburg

Kazan medical journal ◽

10.17816/kmj1884 ◽

2012 ◽

Vol 93 (3) ◽

pp. 522-526 ◽

Cited By ~ 5

Author(s):

A G Rakhmanova ◽

A A Yakovlev ◽

M I Dmitrieva ◽

T N Vinogradova ◽

A A Kozlov

Keyword(s):

Infectious Diseases ◽

Hiv Infection ◽

Viral Hepatitis ◽

Causes Of Death ◽

Mortality Rates ◽

Chronic Viral Hepatitis ◽

Concomitant Disease ◽

Short Term ◽

Number Of Patients ◽

Short Term Mortality

Aim. To analyse the causes of death of individuals infected with the human immunodeficiency virus (HIV)/patients with acquired immunodeficiency syndrome (AIDS) in the Clinical Infectious Diseases Hospital named after S.P. Botkin in 2008-2010 taking into account the timing of disease, comorbidities, and clinical and laboratory data. Methods. The study included 439 HIV-infected individuals, who died in the Clinical Infectious Diseases Hospital named after S.P. Botkin in 2008-2010. Two groups of patients were identified: deaths from HIV/AIDS (n=306) and from other diseases (n=133, HIV infection was considered to be a concomitant disease). In both groups, analyzed were the short-term mortality rates, the presence of drugs and/or alcohol dependency, and the main causes of death (according to autopsy results). Results. In the group of patients who died of HIV-infection/AIDS and who did not receive antiretroviral therapy, generalized tuberculosis was diagnosed most often (65.7% of cases). Other rare diseases were pneumocystis pneumonia, cryptococcosis, cerebral toxoplasmosis, generalized fungal infection, cerebral lymphoma, and cytomegalovirus infection. The most frequent causes of death in the group of patients whose HIV-infection was considered to be a concomitant diseases were chronic viral hepatitis in the cirrhotic stage (42.9%) and septic thromboendocarditis, which were mainly diagnosed in social maladjusted patients: patients with alcoholism or intravenous drugs users. During evaluation of the short-term mortality rates it was established that 21 to 29% of patients in different years died on the 1st-3rd day after admission, which was related to extremely severe conditions of the patients. In Russia, including St. Petersburg, an annual increase in the number of new cases of HIV infection and increased mortality are registered, which indicates the severity of the epidemic and makes it possible to predict the increase in the number of patients requiring hospital treatment. Conclusion. The main causes of death among HIV-infected individuals in 2008-2010 were generalized tuberculosis and chronic viral hepatitis in the stage of cirrhosis; the high index of short-term mortality among HIV-infected patients suggests the need for measures for early detection of HIV-positive individuals and their medical examination, as well as an increase in the number of beds in order to provide specialized care to HIV-infected individuals in St. Petersburg.

Download Full-text

SOCIETAL DETERMINANTS AS RISK FACTORS OF HIV-INFECTION SPREAD IN REGIONS IN THE RUSSIAN FEDERATION

Health Risk Analysis ◽

10.21668/health.risk/2021.3.11.eng ◽

2021 ◽

pp. 118-128

Author(s):

S.I. Boyarkina ◽

◽

D.K. Khotimchenko ◽

Keyword(s):

Hiv Infection ◽

Public Healthcare ◽

Behavioral Strategies ◽

Potential Health ◽

Infected People ◽

Number Of Patients ◽

Structure Of Population ◽

The Russian Federation ◽

Social Environmental ◽

Infection Spread

The paper dwells on the results obtained via examining dependence between HIV-infection spread and factors related to social environmental and social structure of population in RF regions. These factors are considered to be potential health risk ones. The authors tested a hypothesis about influence exerted by demographic, economic, cultural and behavioral de- terminants and public healthcare availability on differences in territorial spread of the disease within social-epidemiologic approach. To solve the set task, data that characterized 85 RF regions were taken from official statistical reports. Descriptive statistic analysis was performed and regression models were built up; it allowed testing whether the analyzed factors had their influence in RF regions and selecting the most significant ones to be included into the overall regression model. The research revealed significant contextual differences in HIV-infection spread. Regression analysis showed that 22.0 % differences in a number of HIV-infected people detected in RF regions occurred due to differences in urban popu- lation numbers, provision with ambulatories and polyclinics, and unemployment rate. Moreover, a number of registered crimes committed by minors determined 32.5 % difference in a number of patients with the first diagnosed HIV-infection between the examined regions. These results allow assuming that the greatest influence on spread of the disease in RF regions is exerted by conse- quences of urbanization; this process is usually accompanied with a growth in a share of urban population in a given region, instability on the labor market there as well as related migration processes within the country and wider opportunities to pursue individual behavioral strategies including those that involve law violations and/or are destructive for people’s health.

Download Full-text

DIAGNOSTIC MARKERS IN NEONATAL SEPSIS

Fetal and Maternal Medicine Review ◽

10.1017/s0965539507001866 ◽

2007 ◽

Vol 18 (1) ◽

pp. 53-65

Author(s):

HUGH S. LAM ◽

PAK C NG

Keyword(s):

Bronchopulmonary Dysplasia ◽

Bacterial Infections ◽

Bacterial Resistance ◽

Antimicrobial Agents ◽

Very Low Birth Weight ◽

Late Onset ◽

Significant Proportion ◽

Control Measures ◽

Exogenous Surfactant ◽

Vlbw Infants

Breakthroughs in the management of sick newborns, including exogenous surfactant therapy, advance ventilation techniques, inhaled nitric oxide, and use of antenatal corticosteroids have led to substantial improvements in the survival of vulnerable preterm infants. Neonatal clinicians now have access to an ever increasing armament of antimicrobial agents to help combat infections. However, even with the support of such advanced therapeutic modalities, strict infection control measures and low thresholds for use of broad-spectrum antibiotics, the threat of bacterial infections especially in the most susceptible group of preterm, very low birth weight (VLBW) infants have persisted. A recent survey suggests that a significant proportion of VLBW infants (21%) have at least one episode of late-onset culture proven sepsis during their stay in the neonatal unit. Infected infants require longer hospital stay and have higher risk of developing complications, such as bronchopulmonary dysplasia and adverse long-term neurodevelopment. Neonates with infection often present with subtle and non-specific signs of sepsis. Some may be asymptomatic at the initial stages of infection. Even those infants with signs may not be clinically distinguishable from patients suffering from transient tachypnoea of the newborn, respiratory distress syndrome, apnoea of prematurity or acute exacerbation of bronchopulmonary dysplasia, during early phases of the disease. Such presentations can lead to both delayed treatment of genuinely infected infants and indiscriminate use of antibiotics in non-infected cases, resulting in acceleration of emergence of bacterial resistance, alteration of patterns of bacterial infection, and inefficient treatment of septicaemia. Both early and late-onset infections are important causes of neonatal morbidity and mortality. Methods to assist neonatal clinicians diagnose infants in the early stages of infection are, therefore, highly desirable.

Download Full-text

Analysis of the level and structure of the incidence of the population of the KHMAO

Medical Science And Education Of Ural ◽

10.36361/1814-8999-2021-22-3-82-89 ◽

2021 ◽

Vol 22 (3) ◽

pp. 82-89

Author(s):

T. V. Razumova ◽

◽

T. V. Zuyevskaya ◽

P. I. Pavlov ◽

E. V. Sadrieva ◽

...

Keyword(s):

Hiv Infection ◽

Russian Federation ◽

Age Groups ◽

Circulatory System ◽

Federal District ◽

Malignant Neoplasms ◽

Number Of Patients ◽

Working Age ◽

The Russian Federation ◽

Khanty Mansi Autonomous

Purpose of the study: assessment of the level and structure of the incidence of the population to determine the main categories of diseases most common in the Khanty-Mansi Autonomous Okrug-Yugra, as well as making a territorial comparison of the incidence of the population. Materials and research methods: statistical materials from the annual collection “Health of the population of the Khanty-Mansi Autonomous Okrug-Yugra and the activities of medical organizations” and data of statistical reporting on the incidence of the population from the Medstat program were used, in particular, the primary morbidity of the population of the Khanty-Mansi Autonomous Okrug-Yugra in different age groups, the general incidence the population of different age groups of the Khanty-Mansi Autonomous Okrug-Yugra. The analysis used indicators such as primary morbidity, general morbidity, one-year mortality (died within the first year from the date of diagnosis) in malignant neoplasms. Results. The primary morbidity of the population in the Khanty-Mansi Autonomous Okrug-Yugra tends to grow in all age groups. The indicators of primary morbidity of the population of the Khanty-Mansi Autonomous Okrug-Yugra in 2018 are 17.1% higher than in the Russian Federation and 12.2% higher than in the Ural Federal District. In the structure of primary morbidity, the first place is taken by diseases of the respiratory system, the second place in the structure of the primary morbidity of people over working age is taken by diseases of the circulatory system, and the third place is by diseases of the genitourinary system. The overall incidence rate of the entire population is 1896 per 1000 population. In 2018, 41.2 cases of tuberculosis per 100 thousand of the population were detected for the first time in the Khanty-Mansi Autonomous Okrug-Yugra (in the Ural Federal District – 61.6, in the Russian Federation – 44.4 per 100 thousand of the population). This pathology tends to decrease and compared with 2017 decreased by 10.2% (the Russian Federation decreased by 8.1%, the Ural Federal District – 2.1%). The number of patients with newly diagnosed HIV infection in 2018 decreased by 1.5% compared to 2017 and amounted to 82.3 per 100 thousand population, which is higher than in the Russian Federation (58.5), but lower. than in the Ural Federal District (108.2) per 100 thousand population. Since 2012, there has been a tendency towards an increase in the incidence of malignant neoplasms, but the detection rate of malignant neoplasms at stages III-IV has not changed since 2015 and is 39.5%, which is higher than in the Russian Federation (38.5%). Conclusion: the primary morbidity in the Khanty-Mansi Autonomous Okrug-Yugra in 2018 is 17.1% higher than in the Russian Federation. In the first place are diseases of the respiratory system (48.4%, of which in children – 66.4, and in persons of older working age – 22.2%). In second place in children is infectious pathology, and in people of working age – diseases of the genitourinary system. The second place in morbidity in older people of working age is diseases of the circulatory system. The district has a high level of infectious and parasitic diseases. The number of patients with newly diagnosed tuberculosis is lower than in the Ural Federal District and the Russian Federation. The number of patients with HIV infection is higher than in the Russian Federation, but lower than in the Ural Federal District. There is a tendency towards an increase in the number of malignant neoplasms. The number of neoplasms is lower than in the Ural Federal District and the Russian Federation. In the Khanty-Mansi Autonomous Okrug-Yugra, there is a positive trend in the reduction of socially significant diseases, such as tuberculosis, HIV infection, STIs, alcoholism, drug addiction, injuries and an increase in overall morbidity, including malignant neoplasms, which indicates the availability of medical care, health literacy of the population and carrying out appropriate preventive work.

Download Full-text

Mortality Analysis of the Pulmonary Department of the Emergency Hospital

MediAl ◽

10.21145/2225-0026-2020-1-16-21 ◽

2020 ◽

pp. 16-21

Author(s):

I. I. Dubrovskaya ◽

L. V. Puzyreva ◽

O. A. Yanina ◽

N. E. Didenko ◽

A. V. Druzenko ◽

...

Keyword(s):

Hiv Infection ◽

Preventive Measures ◽

Pneumocystis Pneumonia ◽

Malignant Neoplasms ◽

Statistical Research ◽

Emergency Hospital ◽

Medical Institutions ◽

Late Stages ◽

Reporting Data ◽

Mortality Analysis

The assessment of mortality in medical institutions is a reflection of the health status of the majority of the population and the assessment of preventive measures aimed at reducing the incidence of certain nosologies.Purpose of the study: to assess mortality in the pulmonology department of the emergency hospital on-duty.Materials and methods. The reporting data of the pulmonology department for the period from 2017 to 2019 were used. using statistical research methods.Results. Pneumonia led to death in 35,2% of patients, which was associated with hospitalization of elderly and senile patients with a severe comorbid background, as well as the admission of patients leading an asocial lifestyle, late seeking medical help. Mortality from HIV infection caused death in 11,5% of patients, all in the late stages of infection 4B with the development of secondary diseases (bacterial pneumonia, pulmonary tuberculosis, pneumocystis pneumonia). Mortality from malignant neoplasms remains high during the study period, which indicates a late diagnosis. During the study period, oncology caused death in 13,2% of patients.Conclusion. High mortality in the pulmonology department is due to late verification of pneumonia, HIV infection and malignant neoplasms.

Download Full-text

Case report of partial response on second line with Ramucirumab and FOLFIRI in treatment of 74 year old male with metastatic HER2-negative gastric adenocarcinoma

Medical Council ◽

10.21518/2079-701x-2021-9-130-136 ◽

2021 ◽

pp. 130-136

Author(s):

N. S. Besova ◽

T. A. Titova ◽

A. E. Kalinin ◽

V. A. Shalenkov ◽

I. S. Stilidi

Keyword(s):

Drug Therapy ◽

Gastric Adenocarcinoma ◽

Significant Proportion ◽

The Elderly ◽

Malignant Neoplasms ◽

Rapid Progression ◽

Second Line ◽

First Line ◽

Second Line Therapy ◽

Line Therapy

According to the data of the world statistics, gastric cancer (GC) occupies the 5th place by morbidity and the 3rd one by mortality among malignant neoplasms. A significant proportion of patients are elderly patients, the proportion of which in real clinical practice can reach up to 60%. Ramucirumab is among the standards of second-line drug therapy both in monotherapy and in combination with paclitaxel. The feasibility of prescribing ramucirumab to patients with disseminated cancer of the elderly and its satisfactory tolerability is shown in a subgroup analysis of the REGARD and RAINBOW studies. The use of paclitaxel, included in the standard first-line regimens, may be limited by persistent neurotoxicity, a side effect of platinum derivatives. In this regard, the effectiveness of the combination of ramucirumab with the FOLFIRI regimen as a second-line therapy began to be studied. The article presents a clinical case of achieving a partial effect on the second-line therapy with ramucirumab with FOLFIRI regimen in a 74-year-old patient with HER2-negative gastric adenocarcinoma while registering rapid progression after 4 courses of first-line chemotherapy in XELOX regimen. Tolerability of the second line was acceptable: asthenia grade 1, stomatitis grade 1-2, neutropenia grade 3 were observed, so the irinotecan dose was reduced to 165 mg/m2. By June 2021, there were 10 28-day cycles of treatment, which is ongoing. The duration of disease control in the second line therapy was 11+ months, of which 9+ months – on the background of FOLFIRI regimen drug therapy with ramucirumab.

Download Full-text

SOCIETAL DETERMINANTS AS RISK FACTORS OF HIV-INFECTION SPREAD IN REGIONS IN THE RUSSIAN FEDERATION

Health Risk Analysis ◽

10.21668/health.risk/2021.3.11 ◽

2021 ◽

pp. 118-128

Author(s):

S.I. Boyarkina ◽

◽

D.K. Khodorenko ◽

Keyword(s):

Hiv Infection ◽

Public Healthcare ◽

Behavioral Strategies ◽

Potential Health ◽

Infected People ◽

Number Of Patients ◽

Structure Of Population ◽

The Russian Federation ◽

Social Environmental ◽

Infection Spread

Download Full-text

Epidemiology of HIV Infection and Molecular and Genetic Features of the Virus at the Infected Persons in Siberian Federal District

Epidemiology and Vaccinal Prevention ◽

10.31631/2073-3046-2016-15-5-46-51 ◽

2016 ◽

Vol 15 (5) ◽

pp. 46-51

Author(s):

A. N. Kolomeets ◽

G. A. Kalacheva ◽

L. I. Levakhina ◽

V. K. Yastrebov ◽

A. Kh. Nurpeysova ◽

...

Keyword(s):

Hiv Infection ◽

Significant Proportion ◽

Federal District ◽

Risk Groups ◽

Age Group ◽

Siberian Federal District ◽

Nonnucleoside Reverse Transcriptase Inhibitors ◽

Number Of Patients ◽

Immunodeficiency Virus ◽

Genetic Features

Relevance. HIV infection epidemic in the Siberian Federal District (SFD) continues to develop with a tendency to incidence growth. The prevalence indicator in the district on 1/1/2015 made 948,4 on 100 thousand of the population. Since 1996 within 20 years in Siberian federal district the group which is the most affected with HIV infection were the consumers of injecting drugs (CID). The greatest number of patients with HIV is registered among males from risk groups in age group of 30 - 39 years (25.8%). And the combined infections lead risky behavior in respect of HIV infection to increase in number of the dead. Goal. Studied the frequency distribution of mutations associated with resistance of human immunodeficiency virus to three main classes of antiretrovirals in patients on therapy, as well as «naive» patients Materials and methods. The study is supposed to monitor the epidemic process of HIV infection in the Siberian Federal District in 2001 - 2015. Results. Patients on therapy, noted the prevalence of mutations of HIV to nucleoside and nonnucleoside reverse transcriptase inhibitors. The "naive" patients in the majority of cases revealed no mutations associated with resistance. Conclusions. Established the dominance of HIV subtype A1, along with a significant proportion of circulating recombinant form 02_AG and 63_02А1.

Download Full-text

Dispanserization monitoring for HIV-infected patients in the Siberian Federal District in 2013–2017

Medical almanac ◽

10.21145/2499-9954-2019-3-44-48 ◽

2019 ◽

pp. 44-48

Author(s):

E. S. Dovgopolyuk ◽

L. I. Levakhina ◽

A. T. Tyumentsev ◽

O. A. Pasechnik

Keyword(s):

Hiv Infection ◽

Federal District ◽

Siberian Federal District ◽

Infected People ◽

Number Of Patients ◽

Target Values ◽

The Russian Federation ◽

Living With Hiv

According to UNAIDS, 1.4 million people are living with HIV in Eastern Europe and Central Asia, 75% of them in Russia. International guidelines recommend regular clinical evaluation of HIV-infected patients, which is achieved through follow-up. Purpose of the study: to characterize the quality of follow-up observation of HIV patients in the Siberian Federal District for the five-year period from 2013 to 2017. Materials and methods. A retrospective descriptive-assessment epidemiological study for the period 2013–2017 was conducted in the Siberian Federal District, in which dispensary observation indicators were most affected by improving the epidemiological situation associated with the spread of HIV infection. Results. The HIV infection in the Siberian Federal District increased during the period under review by 62,4% and reached 1328,5 per 100 thousand population. The prevalence of HIV infection at the beginning of 2018 was 679.0 per 100 thousand population (with an average Russian indicator of 430,2). The SFO accounted for 20,7% of all HIV cases (n = 130 595), which were registered at specialized medical organizations in the Russian Federation. The coverage of HIVinfected patients with clinical observation reached the target value and amounted to 88,2%. The number of patients who were examined to determine the immune status and viral load increased almost 2 times. At the same time, the proportion of HIV-infected people receiving antiretroviral therapy was at the level of 39,8%, which is 4,2% lower than the target values. The proportion of patients surveyed for tuberculosis among those who underwent medical examination in 2017 remains at the level of 87,8%, which does not stabilize the incidence of tuberculosis infection. The number of HIV-infected patients with a diagnosis of active tuberculosis increased 1,4 times to 17 610 in 2017 (10,9% of the number of patients). Conclusion. In the context of the continuing increase in the incidence of HIV infection in the population and an increase in the number of patients in need of various types of medical care, additional measures are needed to improve the quality and effectiveness of follow-up observation of patients with HIV infection.

Download Full-text