Modeling of forecasting the development of the HIV epidemic process in a region with a high level of HIV infection as a determinant of the direction of anti-epidemic measure

Aim. Identification of opportunities to influence the development of the epidemic process of HIV infection.Materials and methods. Mathematical modeling and statistical analysis methods were used to assess the epidemiological situation forecast. In addition, the work uses methods of epidemiological research: analytical, descriptive and evaluative, statistical observation method with the calculation of intensive and extensive indicators, a continuous observational retrospective epidemiological study in the volume of the General population over a long period.Results. A retrospective analysis of the development of the epidemic process of HIV infection in a region with a high level of HIV infection over a 26-year period since the first case was registered in 1993 showed that a concentrated stage of the epidemic has formed in the region at the present stage with an average annual rate of HIV growth of +259,9% against the national rate of +31,4%. By the end of 2018 a characteristic trend in the age structure of HIV is to reduce the proportion of persons aged up to 24 years, the prevalence of persons 35–44 years of age, a notable increase of the age group 55–64 years with a predominance of women infected by heterosexual sex (55,8 per cent). Predicting the epidemiological situation in relation to the age structure of HIV-infected people until 2023 showed a steady trend towards an increase in the HIV-positive age group up to 14 years, 40– 49 years, 50 years and older. There is a fairly high rate of HIV transmission among women.Conclusions. At the present stage of development of the epidemic process of HIV infection, the main share of HIV-infected people is 35–44 years old (72,4%). The results obtained during the study of predicting the development of the epidemic situation with regard to HIV infection until 2023 allow us to focus the anti-epidemic work of epidemiologically significant age groups.

The experience of a medical psychologist in a center for treatment of patients with new coronavirus infection (COVID-19)

Objective. To assess the cognitive and emotional-affective spheres of functioning of patients with a new coronavirus infection who were treated in an infectious COVID hospital and to develop strategies for emergency psychological assistance.Materials and methods. The study sample consisted of patients admitted to the Center for the treatment of patients with new coronavirus infection (COVID-19) of I.P.Pavlov First St.-Petersburg State Medical University, who were assigned a consultation with a medical psychologist.Results. The predictors of more pronounced cognitive decline were determined: older age and severity of the disease, as well as predictors of a higher level of anxiety and depressive symptoms: younger age, previous traumatic situation and more severe course of the disease. Three main problem areas have been identified that require psychological intervention in the treatment of patients with COVID-19: cognitive impairment, high anxiety and depressive symptoms associated with psychological trauma of patients, conflicting or non-adherent patients.

Еffectiveness and safety of the in vitro fertilization program for HIV infection in men

Purpose of the study: to evaluate the effectiveness and safety of IVF/ICSI program for couples with HIV infected men.Research and methods. Prospective clinical study was applied to 169 infertile married couples. The main group of subjects was 94 couples with HIV infected men. The control group included 75 couples with HIV negative status for both partners. In the main group there were carried out 60 treatment IVF/ICSI cycles and 31 frozen protocols, in the control group 86 and 39 cycles respectively. Before the Assisted Reproductive Technology (ART) was applied to the HIV infected men they were tested for DNA HIV in purified spermatozoa by PCR method. To evaluate the seroconversion in 21 days following the embryo transfer the women were tested for the presence of an antigen/antibodies to the HIV virus.Results. Clinical pregnancy rate [6 (19,4%) and 17 (27%); p=0,41] as well as birth rate [5 (16,1%) and 11 (17,5%); p=0,87] in couples with HIV infected male was comparable to the control group. The testing of semen samples showed no RNA HIV in 100% cases. Evaluation of seroconversion showed absolutely no antibodies to HIV in the women’s blood in 100% cases.Conclusion. Implementation of the IVF/ICSI program for discordant married couples with HIV infected male showed the rate of pregnancy onset which is comparable to the HIV seronegative control. Ejaculate processing of HIV infected male using «double» gradient and swim up is turns to be the measure to prevent horizontal transmission of the virus. This method can be recommended when implementing ART for couples with HIV infected male, both in the case of infertility and according to epidemiological indications.

Сlinical and morphological case of cervical cancer due to HIV-associated infection

Cervical cancer ranks second in the structure of mortality of malignant tumors of the female reproductive system. Of particular interest is cervical cancer in patients with HIV infection, which develops more rapidly than in HIV-negative women. In this regard, the purpose of our study was to analyze the clinical and morphological case of the development of cervical cancer with HIV infection and to describe the features of metastasis in a young patient.Materials and methods. A postmortem examination was carried out, the material of the accompanying documentation (case history, outpatient card) was studied, a histological examination of the material was carried out (staining with hematoxylin and eosin, immunohistochemical examination for CK5/14, p16, p63).Research results. In a young patient (41 years old), HIV-infected, the cervix is revealed with destructive changes, ulceration, with signs of infiltrative growth, with the growth of the tumor structure into the surrounding tissues. Squamous cell non-keratinizing cancer of the cervix of a moderate degree of differentiation was histologically exposed. In the analyzes — CD4+ lymphocytes 18 cells/ml. The peculiarity and rarity of the presented clinical and morphological case is that against the background of the aggressive course of cervical cancer, there is an absence of characteristic metastases, there is a pronounced infiltrating growth and germination of atypical cells into the surrounding tissues, with the development of severe complications.

Radiology of the central nervous system of patients in the acute phase of СOVID-19

This article, being based on the analysis of literature and the author’s own materials, outlines the features of the lesion of the central nervous system in a new coronavirus infection. The main idea is that despite the primary damage to the respiratory tract, SARS-CoV-2 can be attributed to a number of signs as neurotropic viruses, which is ultimately realized by the transport of the pathogen COVID-19 from the place of primary localization — the respiratory tract to the human brain. The virus is capable of hitting all possible pathways of being transferred through tissues and within a short time appears in the brain, interacting with ACE2 receptors and co-receptors, which are expressed in almost all brain cells, neurons, astrocytes, oligodendrocytes, microgliocytes, which carry out the main functional tasks of the brain. The clinical part is devoted to radiation diagnosis of lesions of the nervous system caused by the SARS-CoV-2 coronavirus. Analysis of the literature has made it possible to identify radiation variants of CNS lesions in COVID-19, illustrating the main clinical manifestations of the disease. There are several main clinical and morphological variants of CNS damage in COVID-19 1: acute ischemic stroke, acute encephalopathy, due to massive diffuse damage to the endothelium against the background of vasculitis / endotheliitis, occurring both with and without signs of cerebral artery thrombosis, hemorrhages, primarily of the type of small petechiae, polyetiologic in nature (endothelial damage, acute hypoxia, microembolism). In addition, hemorrhages can be a consequence of venous infarction against the background of sinus thrombosis. Radiological methods can diagnose multi-step lesions of the supra- and subtentorial white matter, vasculitis, in particular Susak’s syndrome, posterior reversible leukoencephalopathy — PRES, leukoencephalopathy, delayed post-hypoxic leukoencephalopathy, Miller–Fischer’s polyneuropathy (Guillain-Barre syndrome), syndrome.

Рsychosexual needs and sexual behavior of adolescents living with HIV since infancy

The first generation of children living with HIV since their infancy are growing up and create a new unique group of patients at AIDS Center. Young adults living all their life with chronicle disease that is stigmatized by the society especially in connection with sexuality, have same sexual and reproductive needs and rights as their HIV-negative peers. Aim of this study was to investigate attitudes, needs and social norms toward reproductive and sexual health among adolescents and young adults living with HIV since infancy, as well as their sexual behavior. Among 27 young males and females of 16–20 years old who have lived with HIV since infancy and who took part in anonymous on-line questionnaire, 50% are sexually active. Most of them didn’t experience restrictions in their sexual and reproductive rights, nevertheless they often feel fear of transmitting HIV sexually to the other person. Adolescents and young adults perinataly infected with HIV are willing to use condom during sex and disclose their HIV status to their partner, however they have difficulties in more «complicated» social situations. They have a need in talking about sexual and reproductive health.

Сomparative epidemiological and demographic characteristics of TB and HIV infections among military personnel of the Russian Federation and USA armed forces and armed forces of National liberation army of people’s Republic of Сhina

More than 1,7 million people, 770 thousand people from HIV infection, died from tuberculosis worldwide in 2018. In accordance with the United Nations Sustainable Development Goals and the World Health Organization’s strategy to fight tuberculosis, all countries need to reduce the incidence of tuberculosis by 80% and reduce the death rate from tuberculosis by 90% by 2030. According to the Joint United Nations programme on HIV/AIDS (UNAIDS) goals of «90–90–90», countries should achieve the following indicators by 2020: «90% of people living with HIV infection should know their HIV status; 90% of those who know about their HIV infection should receive treatment, and 90% of those who are being treated should not have their viral load determined». Socially significant diseases are a serious problem for the Russian Federation (RF). The RF is one of 30 countries with a high incidence of tuberculosis and ranks 3rd place in multidrug-resistant tuberculosis and 6th place in the prevalence of HIV infection. Socially significant diseases present a serious problem for the Armed Forces of the RF. 150 new cases of tuberculosis, over 50 cases of HIV infection are diagnosed every year among military personnel of the RF Armed Forces.The purpose of the study is to analyze the current epidemiological situation of tuberculosis and HIV infection in the armed forces of the Russian Federation and foreign armies, to generalize domestic and foreign experience in the organization of medical care for military personnel with these diseases.Data from reports of the medical service and a review of domestic Russian and foreign medical literature allowed us to assess TB and HIV sickness rate among military personnel in the RF and foreign states, as well as to characterize the current system of medical care for this category of patients.

The dynamics of the COVID-19 pandemic and formation of the postcovid period in Russia

The pandemic of the newly coronavirus infection COVID-19 was the test primarily for scientists, experts in epidemiology, infectiology and other fields of medicine participating in addressing the issues of organization and delivery of care, forming up the whole ideology of public health in new conditions. The lecture presents the complex analysis of development of the epidemiologic process, concerning a review of last epidemics, regional features, forecast and modelling approaches, the observers will be able to evaluate demographic, social and medical aspects of evolution. The emphasis is made on the consequences of the transferred infection that directly affect human health, a brief analysis of the clinical manifestations of post-covid syndrome and its expected impact on people, the functioning of all levels of health care, including rehabilitation. The key role of vaccination as the main method of population immunity, prevention of SARS-CoV-2 infection, the development of severe and complicated forms of the disease, as well as domestic manufacturers and manufacturers of several safe and highly effective vaccines has been determined. The article is intended for a wide range of medical professionals, healthcare organizers, government officials and other interested parties.

X-RAY-morphological features of the current COVID-19 and HIV infection

Infection of HIV-infected with a new coronavirus infection, due to its high contagiousness, is inevitably growing all over the world. According to estimates of Chinese scientists, their number is currently more than 500 thousand people. Considering that COVID-19 leads to suppression of immunity and the emergence of opportunistic infections in HIV-negative patients, the activation of secondary diseases in patients with HIV is natural. In view of this, the study of the features of the X-ray morphological picture of inflammatory changes in the lungs according to MSCT data in patients with COVID-19/HIV became the goal of this study. 13 patients who underwent treatment at the Surgut Regional Clinical Hospital during the period from March to July 2020 underwent MSCT of the chest organs upon admission, before discharge, as well as in case of deterioration or lack of effect from the therapy — every 3 days. The detection of pathognomonic CT signs of COVID-19 in the lungs in patients with HIV (the nature of the lesion, the stage of the disease, the severity of the inflammatory process) was carried out in parallel with the diagnosis of opportunistic infections. During the examination, atypical clinical and X-ray morphological signs of the course of COVID-19/HIV coinfection were identified. In HIV-infected people, COVID-19 proceeds more easily and in disguise, while opportunistic infections both in clinical and radiological manifestations have priority signs. They are the reasons for the aggravation of the course of the disease, as well as the development of complications in these patients.

Social network strategies in HIV medicine

The article contains a review of domestic and foreign literature on the use of social networking technologies — analysis of social networks and network interventions — in HIV medicine as promising, cost-effective and sustainable measures to improve HIV prevention and treatment outcomes in the framework of UNAIDS 90–90–90 program. The article described practical experience of using social network analysis to explain differences in the prevalence of HIV infection, including evaluation the behavioral risk levels among persons injecting drugs and the frequency of use of barrier contraceptives. The review reflects examples of the use of the most popular network interventions such as peer education and the Popular Opinion Leader for HIV prevention and for engaging people living with HIV into the medical monitoring and care. In addition, the experience of using innovative social network technologies in St. Petersburg in Russia is described.