[Spectrum, clinical features, diagnosis of opportunistic and comorbid pathology in HIV-infected patients admitted to infection hospital of Moscow].

AIM: To analyse structure, clinical features, diagnosis of opportunistic and concomitant diseases in patients with HIV infection admitted to infection hospital of Moscow. MATERIAL AND METHODS: A total of 4155 patients with HIV infection (1518 of them with AIDS) most of them (89%) at the age of 20-39 years were treated in Moscow AIDS hospital in 2006-2007. The examination included standard blood and urine tests, device diagnosis, immunological, bacteriological and molecular investigations of biological materials for detection of opportunistic infections. Cell-mediated immunity was also studied. HIV infection resulted in a lethal outcome in 255 (6.1%) inpatients. RESULTS: Leading causes of hospitalization of patients at early stages of HIV infection were bacterial bronchitis or pneumonia, hepatic pathology (chronic viral hepatitides, alcohol-associated diseases), sepsis. One-third of the inpatients were at AIDS stage characterized by tuberculosis (66.3%), visceral candidosis (12%), manifest cytomegalovirus infection (10.1%), cerebral toxoplasmosis (9.2%), pneumocystic pneumonia (5.5%). The number of HIV-infected persons with atypical mycobacteriosis, lymphoproliferative diseases, brain tumors increased. Chronic hepatitis C prevailed among liver damage cause in HIV infection, it also often caused hospitalization and death of patients. 60.3% patients having HIV infection who died without AIDS stage had hepatic cirrhosis. Tuberculosis was a leading cause of severe pulmonary pathology, most frequent opportunistic disease, main cause of death in patients with HIV infection. One-third of patients had generalized tuberculosis. Tuberculosis was diagnosed in more than 40% HIV-infected patients with pulmonary lesion, in 65% AIDS patients, 36% dead AIDS patients. CONCLUSION: To render effective anti-HIV treatment, infection hospital must be equipped with facilities providing device tests, molecular diagnosis, modern etiotropic and pathogenetic medication.

[Pulmonary diseases in patients with HIV infection].

AIM: To characterize the spectrum, incidence rate and features of pulmonary pathology in HIV-infected inpatients with reference to a fall in the count of CD4-lymphocytes. MATERIAL AND METHODS: A total of 2370 patients with HIV infection admitted to Moscow infectious hospital N 2 were examined. The protocol of examination included: standard diagnostic tests, bronchoscopy with examination of bronchoalveolar lavage and bronchial biopsies for genetic markers of basic pulmonary disease pathogens, assessment of external respiration function by spirometry. By the count of CD4-lymphocytes in the blood (> 500 cells/mcl; 500-200 cells/mcl and < 200 cells/mcl) the patients with pulmonary pathology were divided into groups 1, 2 and 3. RESULTS: Affection of the lower respiratory tract (LRT) was detected in 1209 (51%) patients. Incidence, etiological spectrum and severity of LRT lesions increased significantly with aggravation of immunological disorders. The patients of group 1 were affected more frequently with bacterial bronchitis, pneumonia (88.2%), group 2 patients - with bacterial pneumonia (67.1%) and pulmonary tuberculosis (28.1%), group 3 - with tuberculosis including generalized forms (53.9%), cytomegalovirus infection (11.2%), pneumocystosis (7.2%). Combined pulmonary pathology was diagnosed in 25% cases. CONCLUSION: Changes in external respiration function were most evident in pneumocystosis and tuberculosis, but they were most persistent in cytomegaloviral lesion of the lungs. Some tuberculosis and CMV infection patients exhibited ventilatory disorders prior to clinical and x-ray symptoms, this suggests prognostic significance of spirometry.