[Treatment of infection caused by human immunodeficiency virus in the Russian Federation].

AIM: To study efficacy and safety of highly active antiretrovirus treatment (HAAT) used in the Russian Federation for development of recommendations for HIV infection treatment. MATERIAL AND METHODS: A total of 285 patients with chronic HIV infection and 42 patients with acute HIV infection participated in investigation of efficacy and safety of different HAAT schemes in 1997-2008. Efficacy of the treatment was assessed by percentage of the patients who had HIV RNA undetectable by the test system (< 400 copy/ml) after 24-48 treatment weeks, by a mean reduction of HIV RNA in blood plasma and an increase in the number of CD4-lymphocytes in 1 mcl of blood. RESULTS: A 12-year experience in antiretrovirus therapy administration for management of HIV infection is reviewed. Efficacy and safety of Russian antiretrovirus drug Phosphaside in HAAT schemes are shown in patients with both chronic and acute HIV infection. The model of HIV patients consulting before the treatment, psychological support during the treatment, methods of individual and group consulting, conception of the school for patients on HAAT are presented. Recommendations are proposed for administration of antiretroviral therapy and a model of calculation of the number of HIV-infected patients in need of antiretroviral therapy in Russia. Basing on the results of investigations on efficacy and safety of HAAT schemes, the physicians of the National Anti-AIDS Center have developed clinical recommendations, guidelines on the treatment of HIV infection, standards of medical care for HIV-infected patients.

[Antiretroviral therapy of acute HIV-infection]. / Antiretrovirusnaia terapiia ostroi VICh-infektsii.

AIM: To study efficacy of a short course of highly active antiretroviral therapy (HAART). MATERIAL AND METHODS: Acute HIV infection was verified in 16 infected subjected basing either on seroconversion (by immunoblotting) or a documented negative result 6-12 months before registration of a positive result for HIV antibodies. RESULTS: HAART was given to 12 patients (combivir + nevirapin). The number of CD+ lymphocytes (by median) 1 month after the treatment increased by 185 cells/mcl, 3 months after the treatment--by 215 cells/mcl. After 1-month therapy viral load (median) diminished by 2.02 log10 copy/ml, after 3 months--by 2.31 log10 copy/ml. 71% patients had HIV RNA under 400 copy/ml. Untreated patients showed changes neither in CD4+ lymphocytes number nor in viral load. The study continues. CONCLUSION: HAART is used at the stage of acute infection in the presence of psychic trauma provoked by establishment of HIV-infection diagnosis. Therefore, it is necessary to consult the patients for preparing them for treatment and to maintain compliance.

[Development of approaches to enhancing of patient adherence to antivirus therapy in the treatment of human immunodeficiency virus infection]. / Razrabotka podkhodov k povysheniiu priverzhennosti k antiretrovirusnoi terapii u bol'nykh s infektsiei virusa immunodefitsita cheloveka.

AIM: To study approaches to enhancing adherence of HIV-infected patients receiving antiretrovirus therapy. MATERIALS AND METHODS: 25 patients (including 3 females) aged 18 to 45 years receiving VAART (fortovasa + norvir + videx, and viramun) were examined. While treating the patients, group classes were conducted to enhance their adherence to the therapy, followed by individual consultations in order to consolidate the obtained effect. The adherence to the therapy was rated by the patients' self-reports. RESULTS: There was an increase in the activity and openness of those who attended group classes and positive changes in their self-assessment. Approaches to enhancing adherence and a model of school for HIV-infected individuals were developed. CONCLUSION: It has been shown that a combination of patients' awareness of different HIV-infection-associated problems with consulting allows treatment motivation to be increased.

[Dementia as a sequelae of cytomegaloviral encephalitis in patients with AIDS]. / Dementsiia kak sledstvie tsitomegalovirusnogo éntsefalita u bol'nykh SPIDom.

Five cases of irreversible mental disorders (dementia) are reported in patients with immunodeficiency as the consequence of HIV-infection. Such cases comprise 4.3% of the patients infected by HIV at the stage of AIDS. Among the patients with dementia a cytomegaloviral damage to the brain was diagnosed in 83.3% of the cases. Mean life span of the patients was 2 months from the moment of the rise of psychopathologic symptomatology. An early diagnosis of the disorders of mental activity in individuals infected by HIV is necessary for establishing etiology of the pathologic process and for prescribing a specific medicine early.

[Alcohol abuse in HIV infection]. / Zloupotreblenie alkogolem pri infektsii, vyzyvaemoi VICh.

249 cases of HIV infection (170 males, mean age 30.2 +/- 0.8 years; 79 females, mean age 28.7 +/- 0.9 years) have been analyzed for prevalence of alcoholization. 6 months after the establishment of HIV diagnosis the number of alcoholics in the studied group was greater than in this group before the diagnosis. 22% developed further alcohol addiction. Detrimental effects of alcoholization on mentality, memory and social status of HIV-infected subjects are described.

[The anxiety state in HIV-infected persons after the discovery of their seropositivity]. / Sostoianie trevogi u lits, infitsirovannykh VICh, posle obnaruzheniia seropozitivnosti.

The authors analyzed psychoemotional reactions of 225 subjects (151 males and 74 females, mean age 30.2 and 27.8 years, respectively) to detection of HIV in their blood serum. 52% of the examinees responded with nonpathological emotions among which all kinds of anxiety were most common. Psychotherapeutic and pharmacological correction of anxiety is specified.

[Psychoneurologic aspects of infections caused by the human immunodeficiency virus]. / Psikhonevrologicheskie aspekty infektsii, vyzyvaemoi virusom immunodefitsita cheloveka.

The clinical and follow-up analysis of 213 cases (including 144 males and 69 females) with human immunodeficiency virus-induced infection at different stages and 14 autopsies characterizes the factors which have a negative influence on the CNS. These include opportunistic infections, concomitant infections, chronic alcoholism, drug abuse, premorbid altered background, endogenous diseases, psychosexual disorientation concerning the sex of the object, psychogenic reactions. It is concluded that there are difficulties of distinguishing the symptomatology directly associated with human immunodeficiency virus neurotropism. There are positive and negative trends in the lifestyle of the HIV-infected persons and AIDS patients.

[Asthenic disorders in persons infected with HIV at the initial stages of the disease]. / Astenicheskie rasstroistva u lits, infitsirovannykh VICh, na nachal'nykh stadiiakh zabolevaniia.

Clinical psychopathological, follow-up and neuropsychological evaluation was made for 125 HIV-infected patients in stage 2B of the disease (general lymphadenopathy by V. I. Pokrovskii's classification). It is shown that seropositive subjects had asthenic syndrome for the initial 6 months of the disease. According to the manifestations, asthenia was defined as psychogenic-reactive and organic. In the former variant the treatment involved psychotherapy and occasionally drugs, the latter was treated with chemotherapy and psychopharmacological modalities as the first-line and psychotherapy as adjuvant means. The authors expect that a differential approach to HIV-infection-related asthenia at the disease onset may contribute to better life quality and prognosis in AIDS patients.

[Clinico-experimental study of mental processes in men with HIV infection]. / Kliniko-éksperimental'noe issledovanie psikhicheskikh protsessov u muzhchin, infitsirovannykh VICh.

A total of 55 males aged 19.5 to 62 years who were infected with HIV were examined psychopathologically+ and neuropsychologically by A.R. Luria's methods. Twenty-one of these patients were homosexuals. Syphilis was recorded in 34.7% in this group. Lymphadenopathy was the major clinical sign of HIV infection. Symptoms of organic involvements+ of the central nervous system were revealed by a psychopathological method. Neuropsychological studies detected dysfunction of the right cerebral hemisphere, particularly in a group of homosexuals suffering from syphilis.

[Characteristics of mental status of men infected with human immunodeficiency virus]. / Osobennosti psikhicheskogo sostoianiia muzhchin, infitsirovannykh virusom immunodefitsita cheloveka.

A total of 55 men infected with HIV, aged 19 to 42, were examined by clinical and psychopathological methods. Thirty-two of these were heterosexuals, 23 suffered from disturbed psychosocial orientation in respect of the object sex (homosexuals). Lymphadenopathy was the major clinical manifestation of HIV infection. Neurotic disorders characteristic of the acute adaptation period were more frequent among heterosexuals (84.9 percent). Symptoms of organic involvement of the central nervous system of varying severity were more incident among homosexuals (78.2 percent), which fact may be explained by specific premorbid features and by syphilis, a disease frequent in this population.

[Effect of thyrotropin releasing hormone on the verbal forms of mental activity in patients with alcoholism]. / Vliianie tireotropnogo rilizing-gormona na verbal'nye formy psikhicheskoi deiatel'nosti bol'nykh alkogolizmom.

It has been shown that under the influence of thyrotropic releasing hormone the examinees show an improvement in the performance of the procedure of dichotic listening and memorizing 6 words in the preset order. A conclusion is made that the hormone under study produces a beneficial effect on the verbal forms of mental activity of patients suffering from alcoholism.

[Effect of leu-enkephalin on the verbal forms of mental activity in alcoholics and healthy persons]. / Vliianie lei-énkefalina na verbal'nye formy psikhicheskoi deiatel'nosti bol'nykh alkogolizmon i zdorovykh lits.

A neuropsychological method was used to study the effect of a synthetic analog of leu-enkephalin (dalargin) on the verbal forms of psychic processes in 40 examinees (20 healthy volunteers and 20 alcoholic patients). 20 healthy persons receiving placebo, were entered into the control group. The agent was shown to produce a noticeable effect on the condition of the higher psychic functions. It produced a correcting effect with maximum influence on the pathological links of psychic processes. The nature of influence was regulating: administration of the drug resulted in the normalization of the absolute values of experimental indices and their more balanced ratio.