[Unspecified encephalitis in HIV-infected patients: clinical and postmortem evaluation].

BACKGROUND: The search for an aetiology of central nervous system (CNS) lesions In HIV patients can be extremely challenging. AIM: To establish the nature and character of CNS lesion according to the data of pathological examination of deceased HIV-patients who had an antemortem clinical diagnosis of unspecified encephalitis. MATERIALS AND METHODS: We analysed clinical and laboratory data of 225 HIV-patients admitted to the ICU at the Infectious Clinical Hospital №2 (Moscow, 2018). The principal diagnosis was unspecified encephalitis characterized by cerebral oedema. Had died 183 (67.9%) patients. We conducted pathological examination in 43 (23.5%). RESULTS: CNS lesions occurred in 331 patients (58.8% of 563 ICU). The antemortem diagnosis established were as follows: 12.1% toxoplasmosis; 6.6% HIV-encephalitis; 5.1% CNS lymphoma; 3.6% cryptococcal meningoencephalitis; 3.0% cytomegaloviral diseases; 2.1% progressive multifocal leukoencephalopathy. The cause of the pathology remained unidentified in 225 patients (68% with CNS lesions). Majority of patients were ART-naive. Post-mortem verification was conducted in 29 (67.4%) deceased patients, of which HIV-encephalitis 34.5%, toxoplasmosis 10.3%, progressive multifocal leukoencephalopathy 3.4%. The nature of brain damage in the remaining 20.7% cases was not established even after post-mortem investigation. Productive lepto-meningitis 8 (27.6%), indicating a prolonged duration of the inflammatory process. In the brain 48.1% patients with subacute and productive changes, had a pre-hospital time of more than 30 days, in contrast to 11.1% of patients who had acute pathological processes in the CNS (p0.05). Autopsy didnt reveal any inflammatory changes in the brain in 14 (32.6%) patients, though cerebral oedema 93.3%, haemorrhagic syndrome 60% cases. CONCLUSION: Accurate retrospective identification of the aetiology of CNS lesions combined with assessing in vivo characterisation of the pathological process plays an essential role in subsequent formation of diagnostic approaches in pathologies of the CNS in HIV-patients.

[Clinical, Virusological and Immunological characteristics of hospitalised HIV-infected patients].

AIM: The primary objective of this study was to describe clinical, virusological and immunological characteristics of hospitalised HIV-infected patients, who had different stages of the disease. MATERIALS AND METHODS: This study was conducted at Moscow Infectious Diseases Hospital №2 in 2012-2015. We have clinically observed 5485 HIV-infected patientsand studied their clinical histories [age: 25-45 (87%), men - 3998 (72.9%), women - 1487 (27.1%)]. 593 (10.8%) have died. We have tested plasma and liquor HIV RNA viral load, immune status, number of viral DNA copies in blood, liquor, lavage, pleural fluid, large intestinal and esophagus biopsies and other materials. Statistica v. 10.0 and SPSS v. 20 were used for statistical analysis. RESULTS AND CONCLUSION: Clinical state of HIV-infected hospitalised patients has been described and the results of quantitive determination of HIV RNA in blood and liquor, absolute and relative CD4+ and CD8+ T-lymphocytes concentrations and immunoregulatory index in patients in various disease stages, including patients on antiretroviral therapy (ART) have been presented. Statistically significant correlation between blood and liquor HIV RNA load as well as between viral load and cellular immune markers in hospitalised HIV-infected patients has been found.

Development of opportunistic lesions in patients with HIV infection in the absence of pronounced immunodeficiency.

AIM: Statistical data concerning patients with opportunistic infections depending on parameters of immunity and the description of a number of clinical cases of development of opportunistic lesions in patients with HIV infection in the absence of the expressed immunodeficiency. MATERIALS AND METHODS: Medical records of the patients with HIV infection hospitalized in 2012-2015 in the Infectious Diseases Clinical Hospital No. 2 of Moscow, and the clinical cases of patients with development of opportunistic lesions with satisfactory indicators of the immune status. RESULTS: The distribution of patients with HIV infection who had opportunistic infections, depending on the number of CD4+ lymphocytes at the time of development of the disease revealed a significant group of patients with a sufficiently large number of CD4+ cells. Statistical data on the development of various opportunistic lesions with different parameters of the immune status are presented. The authors describe a number of relevant clinical cases. The possible causes of the development of opportunistic diseases and their recurrence in patients with HIV infection with a satisfactory amount of CD4+ lymphocytes are discussed. In the pathogenesis of this phenomenon are important not only quantitative but also qualitative parameters of immunity, as well as the characteristics of the causative agents of opportunistic lesions.

Clinical, Virusological and Immunological characteristics of hospitalised HIV-infected patients.

AIM: The primary objective of this study was to describe clinical, virusological and immunological characteristics of hospitalised HIV--infected patients, who had different stages of the disease. MATERIALS AND METHODS: This study was conducted at Moscow Infectious Diseases Hospital №2 in 2012-2015. We have clinically observed 5485 HIV-infected patientsand studied their clinical histories [age: 25-45 (87%), men - 3998 (72.9%), women - 1487 (27.1%)]. 593 (10.8%) have died. We have tested plasma and liquor HIV RNA viral load, immune status, number of viral DNA copies in blood, liquor, lavage, pleural fluid, large intestinal and esophagus biopsies and other materials. Statistica v. 10.0 and SPSS v. 20 were used for statistical analysis. RESULTS: Сlinical state of HIV-infected hospitalised patients has been described and the results of quantitive determination of HIV RNA in blood and liquor, absolute and relative CD4+ and CD8+ T-lymphocytes concentrations and immunoregulatory index in patients in various disease stages, including patients on antiretroviral therapy (ART) have been presented. Statistically significant correlation between blood and liquor HIV RNA load as well as between viral load and cellular immune markers in hospitalised HIV-infected patients has been found.

[Approaches to antiretroviral therapy in HIV-infected patients with low CD4 lymphocyte counts].

There are increasing numbers of patients with late-stage HIV infection in the Russian Federation. To choose optimal antiretroviral therapy regimens for patients with severe immunosuppression is a relevant problem. According the data obtained in the ECHO and THRIVE, ARTEMIS, CASTLE, SPRING-2 and other trials, the efficacy and/or safety of efavirenz are higher than those of rilpivirine, comparable with those of raltegravir and dolutegravir; darunavir and atazanavir are more effective than lopinavir, but dolutegravir is more effective than raltegravir (in numerical terms) in patients with low CD4 lymphocyte counts (less than 50 cells/µl or 200 cells/µl depending on a trial. To choose therapy for patients with late-stage HIV infection is an intricate problem and requires an individual approach that will take into account not only the efficiency of therapy, but also its possible side effects, as well as potential drug interactions for the treatment of opportunistic infections.