MECHANISMS OF CENTRAL NERVOUS SYSTEM DAMAGE IN COVID-19

The issues of diagnosis and treatment of nervous system damage in the new coronavirus infection (COVID-19) remain relevant, regardless of information and experience in treating such patients, accumulated nowadays. The review contains updated data on the ways of SARS-CoV-2 invasion, examines mechanisms of central nervous system damage: direct virus-induced damage, immune dysfunction, excessive thrombo-inflammation, coagulation disorder, cytokine and metabolic imbalance, hypoxia, etc.;it presents clinical examples with one variant of damage — the development of Guillain-Barre syndrome that, to some extent, allows to confirm the virus neurotropism. Doctors' knowledge about this infection is constantly expanding, new information appears on its various neuropsychiatric effects during an acute period and post-COVID syndrome, on symptoms, treatment and prevention strategy. These data enables to understand better the reasons for developing the main clinical manifestations, from a headache or myalgia to more severe symptoms, such as a stroke, psychosis and anosmia, severity and reversibility of their course. Although several hypothesis of CNS damage pathogenesis in COVID-19 are being discussed, the unified pathophysiological mechanism of many dysfunctions remains unclear, and, probably, additional factors, such as social isolation during a pandemic, presence and treatment in the intensive care unit, premorbid somatic status of a patient, contribute to the development of some registered nervous system disorders. © 2023, HIV Infection and Immunosuppressive Disorders.All Rights Reserved.

T-cell immune response to SARS-CoV-2 in HIV patients.

Objective. To assess the T-cell immune status against SARS-CoV-2 in HIV patients with or without antiretroviral therapy. Patients and methods. The study included 21 HIV patients who had laboratory-confirmed COVID-19 between September and December 2021 without previous immunization against SARS-CoV-2. The characteristics of HIV infection (CD4-lymphocytes count, HIV viral load in blood plasma, the presence of antiretroviral therapy) and COVID-19 (the severity degree and duration of the disease) were analyzed, the T-cell immune response to SARS-CoV-2 was assessed using the ELISPOT method 1 month after COVID-19. Statistical analysis was carried out by non-parametric methods (Mann-Whitney U test, Spearman's rank correlation coefficient) using the IBM SPSS Statistics 22 software package. Results. The study showed a more favorable course of COVID-19 in HIV-infected persons who achieved HIV suppression in the blood: a mild form of the disease was significantly more common, and the virus was eliminated faster. T-cell immune response to SARS-CoV-2 was recorded more frequently in these patients. Significant correlation of T-cell immune status with the CD4-lymphocytes count and HIV suppression in the blood was revealed. Conclusion. Thus, T-cell immune response to SARS-CoV-2 as assessed using the ELISPOT method was registered significantl.Copyright © 2023, Dynasty Publishing House. All rights reserved.

Clinical and Epidemiological Characteristics of COVID-19 in Persons Living with HIV Complicated by Tuberculosis

Relevance. At present, three infections – HIV infection, tuberculosis, and COVID-19-are spreading simultaneously in the world. Of great practical importance is the assessment of clinical and epidemiological features of COVID-19 in HIV-infected patients with tuberculosis, COVID-19. Aim. To study the risk of COVID-19 disease and identify clinical and epidemiological features in and population of patients with HIV infection complicated by tuberculosis in comparison with patients with HIV infection and the population without these diseases. Materials and methods. Since 13.03.2020 by 31.12.2021 in the Kemerovo Region-Kuzbass, a continuous prospective analytical epidemiological study of the case-control type was performed. Of those with COVID-19, two observation groups were formed: group I (HIV +), group II (HIV/TB) and comparison group III (persons without either HIV or tuberculosis). All patients underwent: determination of SARS-CoV-2 RNA, standard examination methods in accordance with the temporary methodological recommendations «Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19)», relevant at the time of treatment. Results. The incidence of COVID-19 among patients with HIV infection complicated by tuberculosis exceeded the incidence of COVID-19 among HIV-infected by 14%. There were no gender differences between patients I (HIV +) and II (HIV/TB) groups. In the comparison group, the incidence of COVID-19 was 1.26 times higher in women compared to men. COVID-19 disease in patients with co-infection (HIV/TB) was predominantly mild. Viral pneumonia developed 1.86 times less often, oxygenotherapy was required only in 18.75% of cases, which is 2.5 times lower than in group I (HIV +) and 2.47 times less than in the comparison group (III). In labeled pairs, clinical symptoms of COVID-19 in all groups occurred with the same frequency. Metabolic disorders were evident in all groups. Co-infected patients (HIV/TB) had higher levels of D-dimer, ESR, total bilirubin. Conclusion. Active tuberculosis in HIV-infected people is a factor that increases the risk of COVID-19 disease without affecting the severity of the infectious process. © 2023, Numikom. All rights reserved.

Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome

Human immunodeficiency virus (HIV)-1, the virus that causes HIV infection and acquired immunodeficiency syndrome (AIDS), has caused cases of infection recognized in the United States since the late 1970s. As scientists seek a cure for HIV, much has been learned about the interaction of the virus and the immune system. Recent advances in therapies used as tools for HIV treatment and prevention have resulted in a worldwide decrease in new infections, and public health campaigns are aimed at reducing new cases to a level signaling the end of the HIV epidemic. While organs and tissue systems may be damaged not only by HIV but also by the treatment of HIV with antiretroviral medications, people living with HIV can live a normal life span with appropriate medical management. The new epidemic affecting humankind, the novel coronavirus disease that emerged in 2019 (COVID-19) caused by the severe acute respiratory syndrome (SARS) coronavirus-2 (CoV-2), is disrupting HIV treatment and prevention programs worldwide and has laid bare health and healthcare disparities and inequalities existing in rich and poor countries alike. The effects of the COVID-19 pandemic on the HIV epidemic have yet to be realized. © 2023 Elsevier Ltd. All rights reserved.

Single-centre review of rapid antiretroviral therapy initiation during the COVID-19 pandemic

Background: BHIVA released interim guidance on first line anti-retroviral therapy (ART) initiation during the COVID-19 pandemic, when investigations/follow-up was restricted. Our HIV service didn't restrict follow-up but suspended in-house resistance testing (RT) due to laboratory capacity. Having prescribed 'rapid ART' based on the Northern Algorithm 01/08/2020-01/01/2022 we wanted to evaluate our prescribing during the pandemic. Method(s): All new HIV diagnoses 01/08/2020-31/12/2021 were identified via our HARS dataset. Retrospective casenote review identified ART prescribed, and switches that occurred upon baseline RT availability, to more suitable and/or cost-effective regimes. Result(s): 32 new diagnoses: 11 female, 21 male, median age 41 years (17-81), 10 MSM, 22 Heterosexuals, White British 14, African 9, other 7. Median time to ART initiation 10 days (0-210). Median CD4 count 359 (2-1251), 8 had CD4<200. 7/32 had Primary HIV infection, 5 initiating ART at 1st visit. 30/32 started ART within our service, 1 relocated, 1 initiated abroad. 28/30 started algorithm compliant rapid ART. Of the 2 that delayed, 1 had significant resistance, the other patient choice. 8/30 (27%) 'rapid ART' initiations switched post RT availability. Conclusion(s): All patients initiating ART in our service during the pandemic were algorithm compliant and fulfilled BHIVA recommendations. 7/10 starting Darunavir/ r-based therapy switched to Delstrigo post RT, a more cost-effective STR. Zero patients on Biktarvy switched post RT;implying it's difficult to switch patients from small INSTI-based-STRs. Future work includes comparing our results with other centres and reviewing ART switches post HIV National Prescribing Guide implementation. (Table Presented).

Some clinical and epidemiological aspects of the course of COVID-19 in people living with HIV

Objective. To describe the clinical and epidemical characteristics of a new coronavirus disease 2019 (COVID-19) in people living with HIV, for HIV infection implies the development of an immunosuppressive condition that may exacerbate the course of COVID-19. Material and methods. The research is based on retrospective and current epidemiological situation of HIV and SARS-CoV-2 infections in the Southern Russia regions during 2020 and survey of the patients with the co-infections concerning epidemiological, clinical, and laboratory diagnostic information. We collected all data from 15 regional centers for AIDS prevention and control in the Southern and North Caucasus Federal Districts. The survey sample consists of 121 patients. Statistical computation is done with Microsoft Office Excel 2010. Results and discussion. HIV patients of various age and social characteristics are involved in the COVID-19 epidemic process. Within registered HIV and SARS-CoV-2 co-infections all patients have apparent clinical symptoms. Asymptomatic cases are not presented. Mild cases prevail in the sample (48.8%). The frequency of severe and extremely severe was significantly higher in people living with HIV/AIDS on ART more than 2 months against naive PLHIV or using ART up two one month (p<0.05).Copyright © 2022 by the authors.

Ultrasound examination of the lungs in pneumonia in HIV-infected patients

The aim - to study was to assess the condition of the lungs and pleural cavities in HIV-infected patients with community-acquired pneumonia by ultrasound examination. Material and methods. During the period from May 2020 to February 2021, 7 HIV-infected patients with community-acquired pneumonia were observed, who underwent ultrasound of the lungs and pleural cavities. Results and discussion. Ultrasound of the lungs is the most affordable method of diagnosis in outpatient settings, at the pre-hospital stage to solve the issue of patient routing. Ultrasound is mandatory for quick triage of patients with suspected pneumonia in the emergency department. Given that ultrasound is not associated with radiation exposure to the patient, the examination of pregnant women, newborns and children with suspected pneumonia of any etiology should begin with ultrasound of the lungs, pleural cavities and mediastinum. Ultrasound of the lungs can be performed after pneumonia in order to monitor rehabilitation to assess the nature of changes in the chest cavity and determine the prognosis of the disease. The article presents a clinical example of lung ultrasound in an HIV-infected patient with pneumonia of unknown etiology.Copyright © 2021 Infectious Diseases: News, Opinions, Training. All rights reserved.

Infectious Lesions of the Central Nervous System

This book discusses all aspects infectious CNS pathology, including different bacterial, viral, fungal, mycoplasma and protozoan pathogens, accompanied by illustrations that show macro-and histopathological changes. It also presents microbiological, epidemiological and clinical data, with a particular focus on meningitis and encephalitis of different bacterial and viral aetiologies, influenza, COVID-19 and other viral and bacterial generalized infections. Further, the book explores the importance of mixed infections, including those in the late stages of HIV infection, as well as pathological changes in different age groups including newborns. A special chapter is devoted to the probable role of biological pathogens in noninfectious brain pathology. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Features of the diagnosis and course of COVID-19 in HIV-infected patients hospitalized in a hospital

The global pandemic of coronavirus infection (COVID-19) has set complex diagnostic tasks for doctors of polyclinics and hospitals. Considering the simultaneous pandemic spread of two infectious diseases - COVID-19 and HIV infection, the problem of studying the clinical features of combined COVID-19/HIV infection becomes urgent. The aim of the study was to determine the features of the diagnosis and course of COVID-19 against the background of HIV infection in patients undergoing inpatient treatment. Material and methods. The study was conducted on the basis of the temporary Clinical Medical Center COVID-19 of the A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation in Moscow from October 2020 to January 2022. The study included 31 233 patients with COVID-19 complicated by pneumonia. To analyze the features of the course of combined COVID-19/HIV infection, a group of 51 HIV-infected patients was identified. The diagnosis of COVID-19 was determined based on the detection of SARS-CoV-2 RNA by PCR in nasal/oropharyngeal smears and/or according to computed tomography of the lungs (CT). During the study, age, gender, anamnesis, objective examination data were analyzed, taking into account the results of CT scans of the chest organs, data from routine laboratory blood tests, oxygen support regimens, treatment outcomes and duration of detection of SARS-CoV-2 RNA. All patients were treated according to the Temporary Clinical Guidelines for the Diagnosis and Treatment of COVID-19, 14 version dated 12/27/2021. Results. The number of patients with combined HIV infection and SARS-CoV-2 out of the total number of hospitalized COVID-19 patients (n=31 233) was 0.16%. Upon admission, 30 (59%) patients reported having HIV infection and receiving antiretroviral therapy (ART). HIV infection was first diagnosed in 21 patients at 2-3 weeks of inpatient treatment. The average age of patients with SARS-Cov-2/HIV co-infection was 1.5 times less than in patients without HIV (41.1+/-5.3 and 64.4+/-10.1, respectively) (p<=0.05). Concomitant pathology (hypertension, type 2 diabetes mellitus, chronic kidney disease and chronic lung diseases) was less common (51%) in the group of combined infection than in the group without HIV (83%). However, in 41% of patients with coinfection, chronic viral hepatitis B, C was detected, in contrast to 0.3% of cases of COVID-19 patients without HIV. 26 (51%) patients were discharged with improvement, while the average bed-day did not differ from patients without HIV infection (13.4+/-4.5 days and 11.7+/-5.2, respectively) (p>=0.05). 7 (24%) patients at the time of discharge (16.8+/-4.2 days) with clinical and laboratory improvement maintained a positive result of PCR RNA on SARS-Cov-2. In 22 (43%) patients with coinfection, hospitalization was fatal for 3 to 21 days of treatment, with ARDS with respiratory and multiple organ failure, which is 3.6 times higher than in patients without HIV infection. The analysis showed that, regardless of the result of PCR on SARS-CoV-2 RNA, in non-specialized hospitals, HIV testing is indicated for young patients with fever for more than 14 days, with lung damage in the form of bilateral interstitial changes according to CT, a history of chronic hepatitis C, B, with progressive severity of the condition on against the background of COVID-19 therapy. Early consultation of an infectious disease specialist, examination of sputum/lavage by PCR for pathogens of opportunistic infections and the appointment of ART and drugs for the treatment of opportunistic diseases will improve the quality of medical care for patients in a non-core HIV hospital will improve the prognosis of COVID-19.Copyright © Eco-Vector, 2022.

Epidemiology and Course of Infectious Diseases during the Covid-19 Pandemic. Report 1. Hiv Infection, Hepatitis C and Tuberculosis

Pathological conditions of various natures are capable of mutual aggravation, significantly affecting the overall burden of the disease, its manifestations and severity. This analytical review is devoted to the interaction between pathogens of socially significant infections - human immunodeficiency viruses (HIV), hepatitis C, Mycobacterium tuberculosis and SARS-CoV-2. Foreign and own data covering the issues of syndemia and interference of pathogens are presented. The results of epidemiological analysis in the North-Western Federal District (NWFD) are presented, which demonstrated the absence of a significant impact of the pandemic caused by a new coronavirus infection (COVID-19) on the epidemic incidence of HIV, viral hepatitis C or tuberculosis at the population level, which may be due to various mechanisms of transmission of infections and the required infectious dose of the pathogen. The absence of a negative effect of COVID-19 on mortality rates in HIV infection, viral hepatitis C and tuberculosis in the territories of the NWFD was noted. Special attention is paid to the clinical picture of the combined course of HIV infection, tuberculosis and COVID-19. The data are demonstrated, which allow us to conclude that the worst prognosis and risk of death are patients in the progressive stage of the disease, which is characterized by the presence of opportunistic infections, especially AIDS-indicator conditions, with disseminated tuberculosis and in the cirrhotic stage of viral hepatitis. The significance of severe manifestations of infectious pathology in cases of deterioration of the prognosis of COVID-19 is shown. Based on the experience of two years of the pandemic, the problems contributing to the syndrome of new coronavirus infection and other conditions, as well as the causes of high mortality from COVID-19, which include: limited resources for non-infectious areas of medical care;insufficient funding for planned and high-tech care;a decrease in the volume of primary diagnosis and detection of infectious and non-infectious pathology;delayed and limited research in areas;distraction of specialists from preventive and dispensary work outside of infectious pathology;shortage of medicines and consumables;social instability and deterioration of the well-being of the population, characteristic of pandemics. The role of a personalized approach to patients with concomitant somatic and infectious diseases as a preventive measure for the severe course and complications of COVID-19 is determined.

Difficulties of differential diagnosis of polyneuropathy developed after Gam-COVID-Vac vaccination on the background of combined infectious pathology (clinical case).

The clinical case describes the difficulties of differential diagnosis of polyneuropathy that developed, after Gam-Covid-Vac vaccination on the background, of combined, infectious pathology (HIV infection, tick-borne borreliosis, COVID-19) in a young woman. It is shown that various infectious and noninfectious diseases with similar clinical symptoms (peripheral nervous system, affliction.) occurring simultaneously in one patient can significantly affect each other's course and. complicate the establishment of the true cause of polyneuropathy. It should, be noted, that in this example, the establishment of a final diagnosis was carried out collectively, by consensus, and. was based, on the effectiveness of etiotropic (antibacterial) treatment, which in fact was an exjuvantibus therapy option, which made it possible to establish the most probable etiology of polyneuropathy -tick-borne borreliosis. In turn, HIV infection and. possibly vaccination, according to the authors, could, cause immunosuppression, which, affected, the degree of dissemination, of Borrelia burgdorferi. It is also likely that the insufficient immune response in combination. with the cascade plasma filtration session affected the initial dubious results of the serological tests, which further complicated. the diagnosis.Copyright © 2022 Authors. All rights reserved.

HIV treatment strategies across Central, Eastern and Southeastern Europe: New times, old problems.

INTRODUCTION: In the last decade, substantial differences in the epidemiology of, antiretroviral therapy (ART) for, cascade of care in and support to people with HIV in vulnerable populations have been observed between countries in Western Europe, Central Europe (CE) and Eastern Europe (EE). The aim of this study was to use a survey to explore whether ART availability and therapies have evolved in CE and EE according to European guidelines. METHODS: The Euroguidelines in Central and Eastern Europe (ECEE) Network Group conducted two identical multicentre cross-sectional online surveys in 2019 and 2021 concerning the availability and use of antiretroviral drugs (boosted protease inhibitors [bPIs], integrase inhibitors [INSTIs] and nucleoside reverse transcriptase inhibitors [NRTIs]), the introduction of a rapid ART start strategy and the use of two-drug regimens (2DRs) for starting or switching ART. We also investigated barriers to the implementation of these strategies in each region. RESULTS: In total, 18 centres participated in the study: four from CE, six from EE and eight from Southeastern Europe (SEE). Between those 2 years, older PIs were less frequently used and darunavir-based regimens were the main PIs (83%); bictegravir-based and tenofovir alafenamide-based regimens were introduced in CE and SEE but not in EE. The COVID-19 pandemic did not significantly interrupt delivery of ART in most centres. Two-thirds of centres adopted a rapid ART start strategy, mainly in pregnant women and to improve linkage of care in vulnerable populations. The main obstacle to rapid ART start was that national guidelines in several countries from all three regions did not support such as strategy or required laboratory tests first; an INSTI/NRTI combination was the most commonly prescribed regimen (75%) and was exclusively prescribed in SEE. 2DRs are increasingly used for starting or switching ART (58%), and an INSTI/NRTI was the preferred regimen (75%) in all regions and exclusively prescribed in SEE, whereas the use of bPIs declined. Metabolic disorders and adverse drug reactions were the main reasons for starting a 2DR; in the second survey, HIV RNA <500 000 c/ml and high cluster of differentiation (CD)-4 count emerged as additional important reasons. CONCLUSIONS: In just 2 years and in spite of the emergence of the COVID-19 pandemic, significant achievements concerning ART availability and strategies have occurred in CE, EE and SEE that facilitate the harmonization of those strategies with the European AIDS Clinical Society guidelines. Few exceptions exist, especially in EE. Continuous effort is needed to overcome various obstacles (administrative, financial, national guideline restrictions) in some countries.

TIME-RELATED CHANGES IN THE TITER OF VIRUS NEUTRALIZING ANTIBODIES AGAINST SARS-COV-2 AFTER COVID-19 IN PATIENTS WITH HIV INFECTION

Objective. Тo assess the time-related changes in the titer of virus neutralizing antibodies to SARS-CoV-2 in patients with HIV infection within 6 months after experienced COVID-19, and to identify factors associated with the intensity and duration of the natural humoral immune response Materials and Methods. А prospective study was performed in 102 HIV-infected patients who had COVID-19 without previous vaccination, the titer of virus neutralizing antibodies to SARS-CoV-2 was identified by microneutralization assay using the standard method, the follow-up period was 6 months. Patients were enrolled in St. Petersburg from October 2020 to January 2022. The possible impact of clinical and laboratory characteristics of HIV infection and the severity of COVID-19 on antibody titer was assessed. Results and discussion. А high antibody titer (>1:160) was detected at 1 month in 15 patients (14.7%), at 3 months — in 5 of 44 patients;at 6 months — in 3 of 26 patients. There was a statistically significant positive correlation of the titer at 1 month with an undetectable HIV viral load and the Cd4+lymphocytes count in the blood. Cases of a late increase in antibody titer (after 3 and 6 months) were registered without COVID-19 re-infection along with improvement of the immune status on antiretroviral therapy. Conclusion. А low incidence of effective humoral immune response 1 month after COVID-19 infection was demonstrated in HIV-infected patients without vaccination against SARS-CoV-2. Single cases of delay in antibody titer increase with an immune status improvement were observed. © 2022,HIV Infection and Immunosuppressive Disorders. All Rights Reserved.

Immunological aspects of the lethal HIV/COVID-19 coinfected cohort.

SARS-CoV-2 pandemic is now a global medical and social problem. Little is known about its impact on some vulnerable subgroups, such as immunocompromised patients. Therefore, there is still a strong interest in exploring the impact of SARS- CoV-2 infection among HIV-positive individuals worldwide. Aim of the study: to analyze immunological aspects of the deceased, patients with HIV/COVID-19 coinfection. Materials and. methods. We provided retrospective analysis of 258 patient's electronic medical records. All patients were admitted, to the Infectious diseases hospital N2 with HIV/COVID-19 coinfection and died in May 2020 - February 2022. Standard, immunological parameters were analyzed, like CD4+, CD8+ counts and. immunoregulatory index for different patient's subgroups. Statistical data processing was provided by SPSS 17 version (allowable error E=5%). Results and. discussion. The study demonstrated. CD4+ and CD8+ reduction in HIV-infected with COVID-19. Late HIV-presenters didn't display such phenomenon probably because of immune system, exhaustion. COVID-19 itself in some cases could, lead, to immunodeficiency worsening due to depletion of T cell populations in HIV-patients on effective antiretroviral therapy. Conclusion. Comprehension, of different immunological characteristics in HIV/COVID-19 coinfected patients could, improve therapeutic approaches for this challenging cohort.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.

Immunological aspects of the lethal HIV/COVID-19 coinfected cohort

SARS-CoV-2 pandemic is now a global medical and social problem. Little is known about its impact on some vulnerable subgroups, such as immunocompromised patients. Therefore, there is still a strong interest in exploring the impact of SARS- CoV-2 infection among HIV-positive individuals worldwide. Aim of the study: to analyze immunological aspects of the deceased, patients with HIV/COVID-19 coinfection. Materials and. methods. We provided retrospective analysis of 258 patient's electronic medical records. All patients were admitted, to the Infectious diseases hospital N2 with HIV/COVID-19 coinfection and died in May 2020 — February 2022. Standard, immunological parameters were analyzed, like CD4+, CD8+ counts and. immunoregulatory index for different patient's subgroups. Statistical data processing was provided by SPSS 17 version (allowable error E=5%). Results and. discussion. The study demonstrated. CD4+ and CD8+ reduction in HIV-infected with COVID-19. Late HIV-presenters didn't display such phenomenon probably because of immune system, exhaustion. COVID-19 itself in some cases could, lead, to immunodeficiency worsening due to depletion of T cell populations in HIV-patients on effective antiretroviral therapy. Conclusion. Comprehension, of different immunological characteristics in HIV/COVID-19 coinfected patients could, improve therapeutic approaches for this challenging cohort. © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.

Immunological aspects of the lethal HIV/COVID-19 coinfected cohort.

SARS-CoV-2 pandemic is now a global medical and social problem. Little is known about its impact on some vulnerable subgroups, such as immunocompromised patients. Therefore, there is still a strong interest in exploring the impact of SARS- CoV-2 infection among HIV-positive individuals worldwide. Aim of the study: to analyze immunological aspects of the deceased, patients with HIV/COVID-19 coinfection. Materials and. methods. We provided retrospective analysis of 258 patient's electronic medical records. All patients were admitted, to the Infectious diseases hospital N2 with HIV/COVID-19 coinfection and died in May 2020 - February 2022. Standard, immunological parameters were analyzed, like CD4+, CD8+ counts and. immunoregulatory index for different patient's subgroups. Statistical data processing was provided by SPSS 17 version (allowable error E=5%). Results and. discussion. The study demonstrated. CD4+ and CD8+ reduction in HIV-infected with COVID-19. Late HIV-presenters didn't display such phenomenon probably because of immune system, exhaustion. COVID-19 itself in some cases could, lead, to immunodeficiency worsening due to depletion of T cell populations in HIV-patients on effective antiretroviral therapy. Conclusion. Comprehension, of different immunological characteristics in HIV/COVID-19 coinfected patients could, improve therapeutic approaches for this challenging cohort.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.

The Problem of Comorbid Socially Significant Infections Under The Conditions of The COVID-19 Pandemic.

The aim of the study. To analyze formation features of the epidemic situation for tuberculosis (TB) in the context of the COVID-19 pandemic in order to predict the further actions of medical organizations. Materials and methods. The data for the region for the last 5 years (2017-2021) were analyzed, including 1,762 newly diagnosed cases of patients with TB and comorbidities (according to the data of the Regional Public Health Organization <<Regional Clinical Anti-Tuberculosis Dispensary>>). All cases were verified using standard diagnostic methods, including molecular genetic methods, to determine the resistance of pathogens to antibacterial drugs. Results. It was revealed that the epidemiological situation in the region was multidirectional: thus, during the COVID-19 epidemic, the most pronounced incidence decrease was observed among cases of chronic course hepatitis (by 16.4 times), while among patients with tuberculosis the incidence decreased by 2.75 times, and among patients with acute hepatitis - only by 1.5 times (P<0.05). Among the cases of comorbid infection, the most severe course was observed in patients with combined (TB + HIV) infection: there was both a more severe general condition, and the development of adverse (undesirable) reactions to anti-TB drugs, which required an extension of maintenance therapy. Conclusions. The results of the study showed that against the background of the COVID-19 pandemic in the region, there was no tendency towards a worsening of the epidemic situation, primarily for the more socially significant infection - tuberculosis. At the same time, there was an increase in the number of cases of comorbid pathology, including HIV + TB. In the treatment of patients with comorbid forms of infection, it is necessary to take into account the possibility of developing hepatotoxic reactions and, as a result, the appointment of accompanying drugs with hepatoprotective and detoxification effects in therapy.Copyright © Team of Authors, 2022.

Difficulties of differential diagnosis of polyneuropathy developed after Gam-COVID-Vac vaccination on the background of combined infectious pathology (clinical case).

The clinical case describes the difficulties of differential diagnosis of polyneuropathy that developed, after Gam-Covid-Vac vaccination on the background, of combined, infectious pathology (HIV infection, tick-borne borreliosis, COVID-19) in a young woman. It is shown that various infectious and noninfectious diseases with similar clinical symptoms (peripheral nervous system, affliction.) occurring simultaneously in one patient can significantly affect each other's course and. complicate the establishment of the true cause of polyneuropathy. It should, be noted, that in this example, the establishment of a final diagnosis was carried out collectively, by consensus, and. was based, on the effectiveness of etiotropic (antibacterial) treatment, which in fact was an exjuvantibus therapy option, which made it possible to establish the most probable etiology of polyneuropathy -tick-borne borreliosis. In turn, HIV infection and. possibly vaccination, according to the authors, could, cause immunosuppression, which, affected, the degree of dissemination, of Borrelia burgdorferi. It is also likely that the insufficient immune response in combination. with the cascade plasma filtration session affected the initial dubious results of the serological tests, which further complicated. the diagnosis.Copyright © 2022 Authors. All rights reserved.

Difficulties of differential diagnosis of polyneuropathy developed after Gam-COVID-Vac vaccination on the background of combined infectious pathology (clinical case).

The clinical case describes the difficulties of differential diagnosis of polyneuropathy that developed, after Gam-Covid-Vac vaccination on the background, of combined, infectious pathology (HIV infection, tick-borne borreliosis, COVID-19) in a young woman. It is shown that various infectious and noninfectious diseases with similar clinical symptoms (peripheral nervous system, affliction.) occurring simultaneously in one patient can significantly affect each other's course and. complicate the establishment of the true cause of polyneuropathy. It should, be noted, that in this example, the establishment of a final diagnosis was carried out collectively, by consensus, and. was based, on the effectiveness of etiotropic (antibacterial) treatment, which in fact was an exjuvantibus therapy option, which made it possible to establish the most probable etiology of polyneuropathy -tick-borne borreliosis. In turn, HIV infection and. possibly vaccination, according to the authors, could, cause immunosuppression, which, affected, the degree of dissemination, of Borrelia burgdorferi. It is also likely that the insufficient immune response in combination. with the cascade plasma filtration session affected the initial dubious results of the serological tests, which further complicated. the diagnosis.Copyright © 2022 Authors. All rights reserved.

TUBERCULOSIS COMBINED WITH HIV INFECTION IN RUSSIA IN THE PERIOD BEFORE - AND DURING THE COVID-19 PANDEMIC

Objective. Analysis of the main epidemiological indicators characterizing the situation of tuberculosis combined with HIV infection in Russia during the period before and during the COVID-19 pandemic. Materials and methods. Information from Federal Statistical Observation Forms No. 8, No. 33 and No. 61 for 2012–2021. Rosstat data on the number of patients who died from tuberculosis and HIV infection, and the average annual population of Russia, for 2011–2021. Information from the Federal statistical Observation form No. 30 on the population of Russia covered by screening aimed at early detection of tuberculosis for the period from 2018 to 2021. Results and discussion. The COVID-19 pandemic has had a noticeable impact on the implementation of the Tuberculosis Eradication Program in Russia in less than two years, breaking the 10-year stable rate of decline in tuberculosis morbidity and mortality. The reduction in screening time during the pandemic led to an increase in the number of people with common forms of tuberculosis, which could have been sources of tuberculosis infection among the population for a long time, and especially among people infected with HIV infection. During the COVID-19 pandemic, the proportion of patients with tuberculosis combined with HIV infection increased in the structure of the incidence of tuberculosis and HIV infection. Treatment of patients with HIV infection combined with tuberculosis with multiple and broad resistance of the pathogen is of considerable complexity and creates a high risk of death and an increase in mortality among patients of this group © 2022, HIV Infection and Immunosuppressive Disorders.All Rights Reserved.