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Realization of early congenital latent syphilis in a newborn from an HIV-infected mother HIV感染母亲对新生儿早期先天性潜伏梅毒的认识
Q4 Medicine Pub Date : 2023-07-21 DOI: 10.22328/2077-9828-2023-15-2-114-118
T. M. Cherkasova, A. B. Kazanina, N. Gurevich, E. Kravtsova, V. M. Moskvina
In the modern world, the problem of simultaneous infection with syphilis and HIV infection is of particular relevance. The same conditions and transmission routes, identical contingents at risk of infection, make it possible to assume the presence of coinfection with a high degree of probability. It should be noted that in an HIV-infected pregnant woman, against the background of receiving antiretroviral therapy, the clinical picture of syphilis changes, its diagnosis becomes difficult, and the risk of infection of the newborn increases.
在现代世界,同时感染梅毒和艾滋病毒的问题特别重要。同样的条件和传播途径,同样有感染风险的特遣队,使得很有可能假设存在共同感染。应该注意的是,在感染艾滋病毒的孕妇中,在接受抗逆转录病毒治疗的背景下,梅毒的临床情况发生了变化,诊断变得困难,新生儿感染的风险增加。
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引用次数: 0
Generalized HIV-associated kaposi's sarcoma with multiorgan lesion in a comorbid patient 一名合并症患者的全身性HIV相关卡波西肉瘤伴多器官病变
Q4 Medicine Pub Date : 2023-07-21 DOI: 10.22328/2077-9828-2023-15-2-100-105
A. Khryanin, D. V. Kapustin, A. P. Nadeev, V. Sturov, E. V. Pushkarev
An important role in a number of different clinical manifestations of HIV infection is played by the pathology of the skin and mucous membranes. Kaposi sarcoma (KS) is a multifocal malignant tumor of vascular origin with a predominant lesion of the skin and involvement of internal organs. Prior to the development of the HIV epidemic, KS was considered a rare tumor. Under conditions of increasing immunosuppression, HIV-associated KS tends to have a more severe course, generalization, and is accompanied by damage to visceral organs, leading to the death of patients. The authors demonstrate a clinical case of generalized KS with lesions of the skin, mucous membranes and internal organs (lungs) in a patient with HIV infection. The pulmonary form of KS is rare, but often leads to death.
皮肤和粘膜的病理学在HIV感染的许多不同临床表现中发挥着重要作用。卡波西肉瘤(KS)是一种血管源性多灶性恶性肿瘤,主要累及皮肤和内脏。在艾滋病流行之前,KS被认为是一种罕见的肿瘤。在免疫抑制增强的条件下,HIV相关的KS往往有更严重的病程、更普遍,并伴有内脏器官损伤,导致患者死亡。作者证明了一例HIV感染患者的皮肤、粘膜和内脏(肺)病变的全身性KS临床病例。肺型KS是罕见的,但经常导致死亡。
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引用次数: 0
The global burden of HIV/AIDS in Russia in terms of public health. Part 1 俄罗斯艾滋病毒/艾滋病在公共卫生方面的全球负担。第1部分
Q4 Medicine Pub Date : 2023-07-21 DOI: 10.22328/2077-9828-2023-15-2-69-80
Z. Zagdyn, N. V. Kobesov, E. V. Verbitskaya, V. L. Denuyshenkov
Objective. Evaluation of the global HIV burden in Russia, identification of progress made and outstanding problems for 1987–2021.Materials and methods. The analysis of national and foreign publications, data obtained from Rosstat, from forms of federal statistical observation and the FNM of the AIDS Center of Rospotrebnadzor was carried out. The study used information-analytical, epidemiological and statistical methods. Mathematical calculations were performed using the SPSS-26 program.Results and discussion. In Russia, the target indicators of the state program of HIV/AIDS response strategy is being provided in different directions: the greatest success has been achieved in conducting chemoprevention of mother to child HIV transmission, somewhat less in the coverage of the population with HIV testing, which amounted to 26.1% versus the target indicator of 30.0% in 2021, the number of newly detected cases of HIV infection is decreasing (from 73.7 to 71.0 thousand people in 2020–2021, versus the target indicators of 76.1 and 72.3 thousand people, respectively), there is decreasing the HIV incidence (40.4 per 100 thousand. in 2021 versus 68.5 in 2015). Antiretroviral therapy (ART) coverage of patients registered in AIDS Centers went up from 12.4% to 78.9% in 2007–2021. Meanwhile, the determining factor in the HIV/AIDS epidemic progress in Russia is a heterosexual route (F=75.1, p<0.0001) leading to the penetration of infection into all population segments. In addition, despite the increase in the coverage of ART for people living with HIV (PLWH), the HIV mortality rate is remaining high (11.6 per 100 thousand population in 2021, versus 7.9 in 2007).Conclusion. In recent years, there has been a positive trend in the coverage of three-stage HIV chemoprophylaxis in pregnant women, women in labor and newborns. The number of HIV population based screening tests is increasing annually. There is an increase in the ART coverage of patients and a decrease in the number of newly diagnosed cases of the disease. However, along with the observed increase in the HIV spread through heterosexual contacts, it is necessary to strengthen information and preventive measures, especially among the reproductive age group. The high HIV mortality rate is continuing to remain, despite the increase in ART coverage of PLWH. The identified problems need to be solved comprehensively based on the results of large-scale sociological research conducted in various regions of Russia.
客观的俄罗斯全球艾滋病毒负担评估,确定1987-20021年取得的进展和悬而未决的问题。材料和方法。对国内外出版物、从Rosstat获得的数据、联邦统计观察表和Rospotrebnadzor艾滋病中心的FNM进行了分析。该研究采用了信息分析、流行病学和统计方法。使用SPSS-26程序进行数学计算。结果和讨论。在俄罗斯,国家艾滋病毒/艾滋病应对战略计划的目标指标正朝着不同的方向提供:在对母婴艾滋病毒传播进行化学预防方面取得了最大成功,但在艾滋病毒检测人群的覆盖率方面有所下降,从2021年30.0%的目标指标下降到26.1%,新发现的艾滋病毒感染病例数量正在下降(2020-2021年从73.7万人下降到71.0万人,而目标指标分别为76.1万人和7230万人),艾滋病毒发病率正在下降(2021年为40.4/10万,而2015年为68.5)。2007-2021年,在艾滋病中心登记的患者的抗逆转录病毒治疗覆盖率从12.4%上升到78.9%。同时,俄罗斯艾滋病毒/艾滋病流行进展的决定因素是异性恋途径(F=75.1,p<0.0001),导致感染渗透到所有人群中。此外,尽管抗逆转录病毒疗法在艾滋病毒感染者中的覆盖率有所提高,但艾滋病毒死亡率仍然很高(2021年为11.6‰,而2007年为7.9‰)。基于艾滋病毒人群的筛查检测数量每年都在增加。抗逆转录病毒疗法患者的覆盖率有所增加,新诊断的该疾病病例数量有所减少。然而,随着观察到艾滋病毒通过异性接触传播的增加,有必要加强信息和预防措施,特别是在生殖年龄组中。尽管PLWH的ART覆盖率有所提高,但艾滋病毒的高死亡率仍在继续。需要根据在俄罗斯各地区进行的大规模社会学研究的结果,全面解决已发现的问题。
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引用次数: 1
Adherence to treatment in young people with perinatal HIV infection in the first years after transition from pediatric to the adult medical service 从儿科向成人医疗服务过渡后的头几年对围产期艾滋病毒感染青年的治疗依从性
Q4 Medicine Pub Date : 2023-07-21 DOI: 10.22328/2077-9828-2023-15-2-59-68
P. Safonova, O. Koltsova
Objective. To assess ART adherence and treatment continuity in young adults living with HIV since birth or childhood in the first years after transition from paediatric to adult service of the AIDS Center, as well as to analyse factors associated with treatment adherence interruption after transition to adult care.Materials and methods. In our study, 86 cases of young people living with HIV since birth or childhood were obtained by chart audit and analyzed, among whom 53.5% were girls and 64.0% lived at home at the time of their 18th birthday, who have been transferred from paediatric to adult care of the AIDS Center for more than one year.Results and discussion. The majority (92%) of young adults living with HIV since birth or childhood retained in the health care system in the first year after the transition, but only 53–62% were highly adherent to treatment and monitoring for HIV infection in the first years after the transition. Episodes of non-adherence to treatment during childhood and adolescence, «more complex» ART scheme and the lack of adult’s social support at the time of 18th birthday increase the likelihood of interruption in treatment adherence in the first year after transition to adult care, while the combination of these factors has negative consequences for adherence and continuity of treatment for a longer period of time.Conclusion. Successful transition from paediatric to adult care for patients living with HIV since birth or childhood requires special additional attention of the health care system, contributes to the health protection of each patient, aims to stop HIV in the second generation.
客观的评估艾滋病中心从儿科服务过渡到成人服务后的头几年,感染艾滋病毒的年轻人自出生或儿童时期起的抗逆转录病毒疗法依从性和治疗连续性,并分析过渡到成人护理后与治疗依从性中断相关的因素。材料和方法。在我们的研究中,通过图表审计获得并分析了86例自出生或童年以来感染艾滋病毒的年轻人,其中53.5%是女孩,64.0%在18岁生日时住在家中,他们从儿科转到艾滋病中心的成人护理已经超过一年。结果和讨论。大多数(92%)自出生或儿童时期感染艾滋病毒的年轻人在过渡后的第一年仍留在医疗保健系统,但只有53-62%的人在过渡前几年高度坚持治疗和监测艾滋病毒感染。儿童和青少年时期不坚持治疗的情况、“更复杂”的抗逆转录病毒疗法计划以及18岁生日时缺乏成年人的社会支持,增加了向成人护理过渡后第一年治疗坚持中断的可能性,而这些因素的组合对长期治疗的依从性和连续性具有负面影响。结论为出生或儿童期感染艾滋病毒的患者从儿科护理成功过渡到成人护理,需要卫生保健系统给予特别的额外关注,有助于保护每个患者的健康,旨在阻止第二代感染艾滋病毒。
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引用次数: 0
HIV-mortality trends in the regions of Russian Federation 俄罗斯联邦各地区艾滋病毒死亡率趋势
Q4 Medicine Pub Date : 2023-07-21 DOI: 10.22328/2077-9828-2023-15-2-81-89
A. A. Savina, A. S. Lukmanov, E. Zemlyanova
Background. In the beginning of 2000s infectious mortality in Russian regions was predominantly determined by socially significant diseases i.e. TB, hepatitis and HIV. Over 20-year period contribution of HIV to mortality within the class «Certain infectious and parasitic diseases» increased multi-fold and it moved to the top of ranking. According to experts’ opinion, accelerated increase of mortality from HIV in the second decade of XXI century was partly conditioned by peculiarities of registration of death causes as well as insufficient antiretroviral coverage in Russian regions.Objective. Identification of trends and features of the dynamics of mortality from HIV/AIDS in certain age groups in the subjects of the Russian Federation.Materials and methods. Analysis of mortality indicators in Russian regions was conducted using official statistics of Rosstat and Federal Service for Surveillance in Healthcare for 2000–2021. Method of direct ranking was applied to analyze mortality from HIV-associated causes.Results and discussion. According to official statistics, mortality from HIV-associated causes has reached its peak values in 2018. Analysis of gender differences shows that mortality in males is twice higher than in females. There are substantial differences in regional levels of mortality from HIV-associated causes. The highest mortality levels from those causes were registered in several regions of Siberia and Urals.Conclusion. The study results show that Kemerovo region is the most unfavourable in terms of HIV-mortality. In 2021, the indicator estimated 50.4 per 100,000 that is nearly 5-fold higher than the country’s average. The number of HIV deaths in Kemerovo region was higher than cumulative number of deaths from external causes (alcohol poisonings, suicides, homicides, drownings and transport injuries). High levels of mortality from HIV were also registered in Perm territory (32.3), Irkutsk (32.2), Novosibirsk (27.5) and Sverdlovsk (26.4) regions.
背景。21世纪初,俄罗斯各地区的传染性死亡率主要由结核病、肝炎和艾滋病毒等具有社会意义的疾病决定。20年来,艾滋病毒对"某些传染病和寄生虫病"类别中死亡率的贡献增加了数倍,并上升到排名的首位。专家认为,21世纪第二个十年艾滋病毒死亡率加速上升的部分原因是死亡原因登记的特殊性以及俄罗斯各地区抗逆转录病毒覆盖率不足。查明俄罗斯联邦境内某些年龄组艾滋病毒/艾滋病死亡率动态的趋势和特点。材料和方法。利用2000-2021年俄罗斯国家统计局和联邦卫生保健监督局的官方统计数据,对俄罗斯各地区的死亡率指标进行了分析。采用直接排序法分析hiv相关原因的死亡率。结果和讨论。根据官方统计数据,与艾滋病毒相关的死亡率在2018年达到峰值。对性别差异的分析表明,男性死亡率是女性的两倍。艾滋病毒相关原因造成的死亡率在区域水平上存在很大差异。在西伯利亚和乌拉尔的几个地区,这些原因造成的死亡率最高。研究结果表明,克麦罗沃地区在艾滋病毒死亡率方面最不利。2021年,该指标估计为每10万人50.4人,比全国平均水平高出近5倍。克麦罗沃地区的艾滋病毒死亡人数高于外部原因(酒精中毒、自杀、杀人、溺水和交通伤害)造成的累计死亡人数。彼尔姆地区(32.3例)、伊尔库茨克(32.2例)、新西伯利亚(27.5例)和斯维尔德洛夫斯克(26.4例)地区的艾滋病毒死亡率也很高。
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引用次数: 0
Combination of primary CNS lymphoma and mycobacteriosis of the brain in the background of HIV infection HIV感染背景下原发性中枢神经系统淋巴瘤合并脑分枝杆菌病
Q4 Medicine Pub Date : 2023-07-21 DOI: 10.22328/2077-9828-2023-15-2-106-113
M. A. Savchenko, N. Voinov, D. Sitovskaya, O. M. Vorobieva, Y. Zabrodskaya, R. Grozov, A. Panteleev
Aim of the study. To present a clinical observation of a combined brain tissue lesion in a patient with HIV infection, which emphasizes the complexity of the differential diagnosis process when making a final diagnosis, the need for interdisciplinary interaction of trained specialists.Materials and methods. The description of clinical observation, results of instrumental diagnostic methods is performed. The data of histological and immunohistochemical examination of the biopsy of the patient’s brain tissue are presented.Results and conclusion. Damage to the central nervous system in patients with HIV infection is characterized by a wide range of etiological factors. Diagnosis, in this case, is a complex task and requires a comprehensive examination of the patient, including performing computed tomography, magnetic resonance imaging of the brain, as well as cultural and molecular genetic methods of studying cerebrospinal fluid. Pathognomonic clinical manifestations and neuroradiological syndromes do not exist, and several pathogens can be released simultaneously in the biological fluids of the patient. In addition to determining the etiology of the infectious process, it is necessary to exclude a brain tumor lesion with possible biopsy, histological and immunohistochemical verification of the neoplasm.
研究目的。对一名艾滋病毒感染患者的合并脑组织损伤进行临床观察,强调在做出最终诊断时鉴别诊断过程的复杂性,需要训练有素的专家进行跨学科互动。材料和方法。对临床观察、仪器诊断方法的结果进行了描述。提供了患者脑组织活检的组织学和免疫组织化学检查数据。结果和结论。HIV感染患者的中枢神经系统损伤具有广泛的病因特征。在这种情况下,诊断是一项复杂的任务,需要对患者进行全面检查,包括进行计算机断层扫描、大脑磁共振成像,以及研究脑脊液的文化和分子遗传学方法。不存在病理性临床表现和神经放射学综合征,患者的体液中可以同时释放几种病原体。除了确定感染过程的病因外,还需要排除脑肿瘤病变,并对肿瘤进行可能的活检、组织学和免疫组织化学验证。
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引用次数: 0
Mortality from tuberculosis and HIV infection in Russia in the period before and during the COVID-19 pandemic 新冠肺炎大流行前和期间俄罗斯结核病和艾滋病毒感染死亡率
Q4 Medicine Pub Date : 2023-07-21 DOI: 10.22328/2077-9828-2023-15-2-90-99
E. Tsybikova, I. Lapshina
Objective: to study the dynamics of mortality from tuberculosis and HIV infection, as well as the causes of death of contingents with tuberculosis and HIV infection, in Russia and the subjects of the Russian Federation, in the period before and during the COVID-19 pandemic.Materials and methods. Rosstat data for 2002–2021 were used to analyze mortality from tuberculosis, HIV infection, infectious diseases and COVID-19 in Russia. Information on the number and causes of death of contingents with tuberculosis and HIV infection was obtained from Federal statistical observation Forms No. 61, No. 8 and No. 33 for 2012–2021. Information on the causes of death of contingents with tuberculosis, including from COVID-19, was received upon request from 16 subjects of the Russian Federation. Statistical analysis was carried out using the program Stat Tech v.2.8.8 (developed by Stattech LLC, Russia).Results and discussion. In Russia, during the pandemic (2020–2021), there was a synchronous decrease in mortality from infectious diseases, tuberculosis and HIV infection. At the same time, a «reverse transition» was registered in the dynamics of these indicators, as a result of which the rates of reduction in mortality from HIV infection exceeded those from tuberculosis for the first time in the last 20 years.The main factor that had a positive impact on the dynamics of mortality from HIV infection was an increase in the coverage of HIV-infected patients with antiretroviral therapy, the share of which increased to 82.2% and 83.3% in 2020–2021 (2019 — 71%). The deterioration of the epidemic situation of tuberculosis during the pandemic was due to the introduction of restrictive measures (lockdown), which led to a decrease in the proportion of the population covered by screening aimed at early detection of tuberculosis among the population. As a result, in the structure of the deceased contingents with tuberculosis, the proportion of those whose cause of death was tuberculosis increased to 30% (ICD-10 A15–A19).Such dynamics was due to an increase to 7.6% in the proportion of patients diagnosed with tuberculosis posthumously (in 2019 — 4.8%). In addition, among the deceased contingents with tuberculosis, every 3rd was a patient with tuberculosis combined with HIV infection. During the pandemic, in 16 regions of the Russian Federation, the proportion of deaths from COVID-19 was low and amounted to only 2.3% in the structure of deceased contingents with tuberculosis.Conclusion. During the pandemic (2020–2021) in Russia, there was a slowdown in the rate of decline in mortality from tuberculosis, due to an increase in the proportion of patients in whom tuberculosis was detected late as a result of post-mortem diagnosis. Maintaining a high proportion of patients with tuberculosis combined with HIV infection in the structure of deceased populations with tuberculosis slows down the rate of reduction in mortality from HIV infection.
目的:研究新冠肺炎大流行前和大流行期间俄罗斯和俄罗斯联邦受试者因结核病和艾滋病毒感染而死亡的动态,以及感染结核病和艾滋病毒的特遣队的死亡原因。材料和方法。俄罗斯统计局2002-2021年的数据用于分析俄罗斯结核病、艾滋病毒感染、传染病和新冠肺炎的死亡率。关于感染结核病和艾滋病毒的特遣队人数和死亡原因的信息,可从2012-2011年第61号、第8号和第33号联邦统计观察表中获得。应俄罗斯联邦16名受试者的请求,收到了关于特遣队肺结核(包括新冠肺炎)死亡原因的资料。使用Stat-Tech v.2.8.8程序(由俄罗斯Stattech LLC开发)进行统计分析。结果和讨论。在俄罗斯,在疫情期间(2020-2021年),传染病、结核病和艾滋病毒感染的死亡率同步下降。与此同时,这些指标的动态出现了“反向转变”,因此,艾滋病毒感染死亡率的下降率在过去20年中首次超过结核病。对艾滋病毒感染死亡率动态产生积极影响的主要因素是接受抗逆转录病毒治疗的艾滋病毒感染患者的覆盖率增加,其中的比例在2020-2021年分别增加到82.2%和83.3%(2019-71%)。在大流行期间,结核病疫情的恶化是由于采取了限制性措施(封锁),导致人口中接受旨在早期发现结核病的筛查的人口比例下降。因此,在结核病死亡队伍的结构中,死亡原因为结核病的人数比例增加到30%(ICD-10 A15–A19)。这种动态是由于死后诊断为结核病的患者比例增加到7.6%(2019年为4.8%)。此外,在肺结核死亡队伍中,每三分之一是肺结核合并艾滋病毒感染的患者。在大流行期间,在俄罗斯联邦16个地区,新冠肺炎死亡人数比例较低,在死于结核病的特遣队结构中仅占2.3%。结论在俄罗斯的疫情期间(2020-2021年),结核病死亡率下降的速度有所放缓,原因是尸检后发现结核病的患者比例增加。在肺结核死亡人口结构中,保持较高比例的肺结核合并艾滋病毒感染患者可以减缓艾滋病毒感染死亡率的下降速度。
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引用次数: 0
Cognitive training as a technology for protecting and restoring the functions of the central nervous system in patients with infectious pathology 认知训练作为一种保护和恢复感染性病理患者中枢神经系统功能的技术
Q4 Medicine Pub Date : 2023-07-20 DOI: 10.22328/2077-9828-2023-15-2-19-36
G. N. Khokhlova, O. Koltsova, E. Isaeva, E. Boeva, V. Rassokhin
Many infectious diseases still have medical and social significance, the late detection and untimely treatment of which causes persistent health disorders, leading to early disability. Drug therapy has significantly reduced mortality among people on the background or after infections, increasing the duration and quality of life. However, lesions of the nervous system in human immunodeficiency virus (HIV), viral hepatitis, new coronavirus and other infections, and related neurocognitive disorders cause great concern, are accompanied by complex and clinically important problems.The authors conducted an analytical review of publications and their own research based on the experience of implementing cognitive training in neurocognitive rehabilitation programs that have proven their effectiveness for patients with cognitive disorders against the background of socially significant infections and comorbid conditions.
许多传染病仍然具有医学和社会意义,这些疾病的晚发现和不及时治疗造成持续的健康障碍,导致早期残疾。药物治疗大大降低了感染背景或感染后人群的死亡率,延长了生活时间和质量。然而,人类免疫缺陷病毒(HIV)、病毒性肝炎、新型冠状病毒等感染的神经系统病变及其相关的神经认知障碍引起了人们的高度关注,并伴有复杂的临床重要问题。作者根据在神经认知康复项目中实施认知训练的经验,对出版物和他们自己的研究进行了分析回顾,这些研究已经证明了它们对具有社会重大感染和合并症背景的认知障碍患者的有效性。
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引用次数: 0
Prevalence of HIV-1 drug resistance among early diagnosed HIV-infected children enrolled through the national program for prevention of mother-to-child transmission in Southern and Central Highland provinces — Vietnam within 2017–2021 通过2017-2021年越南南部和中部高原省份预防母婴传播国家方案登记的早期诊断的艾滋病毒感染儿童中艾滋病毒-1耐药性的流行情况
Q4 Medicine Pub Date : 2023-07-20 DOI: 10.22328/2077-9828-2023-15-2-37-47
H. Huynh, D. Valutite, A. N. Schemelev, V. S. Davydenko, Y. Ostankova, T. Truong, T. Tran, T. Nguyen, A. Semenov
Background. In Vietnam, there has been an increase in efforts to monitor and prevent mother-to-child transmission of HIV since 2013. However, data on HIV drug resistance among HIV-1 infected children younger than 18 months of age remain limited. The study fills a critical knowledge gap by providing important insights into the prevalence of resistance among this population in the Southern and Central Highland provinces of Vietnam.Objective. This study aimed to determine the prevalence of HIV drug resistance and patterns of mutation among treatment-naïve children under the age of 18 months who had been recently diagnosed with HIV.Material and methods. Between May 2017 and May 2021, stored remnant DBS samples were collected from children under the age of 18 months who had been diagnosed with HIV through routine Early Infant Diagnosis testing in Central Highland and Southern Vietnam. HIV drug resistance tests were performed, and interpretation was done using the Stanford algorithm.Results and discussion. Overall, 111 samples with eligible viremia for sequencing (ct value <31) were collected for genotyping, in which 110 protease sequences and 106 complete reverse transcriptase regions were generated. Males were 61.3%, 52.3% were aged from 6 weeks to <9 months and 37.0% were breastfed. Access to mother-to-child intervention was reported in 60.3%. The accumulation of major drug resistance mutations was found in 43.8% of infants and most of them were resistant to Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI) (37.7%). High-level resistance to Nevirapine was present in 40% of cases. The risk factors associated with NNRTI resistance were antiretroviral prophylaxis (aOR: 3.68, 95% CI: 1.83–7.45) and breast-feeding history (aOR: 2.16, 95% CI: 1.03–4.53). CRF01-AE was the predominant subtype.Conclusion. The study identified a high prevalence of resistance to NNRTIs among HIV-1 infected infants less than 18 months of age in the Southern and Central Highland provinces of Vietnam. This highlights the need for further investigation and a potentially larger national survey to confirm the extent of this issue in Vietnam. Our findings support the current actions of the Vietnam Ministry of Health, which prioritize integrase inhibitor-based regimens as the preferred first line of ART for children to achieve durable viral suppression and minimize treatment failure. This approach aligns with the recommendations of the World Health Organization.
背景。自2013年以来,越南加大了监测和预防艾滋病毒母婴传播的力度。然而,关于18个月以下感染艾滋病毒1型儿童中艾滋病毒耐药性的数据仍然有限。该研究填补了一个关键的知识空白,为越南南部和中部高地省份这一人群的耐药性流行提供了重要的见解。本研究旨在确定最近被诊断患有艾滋病毒的年龄在18个月以下的treatment-naïve儿童中艾滋病毒耐药性的流行情况和突变模式。材料和方法。在2017年5月至2021年5月期间,从越南中部高地和南部通过常规早期婴儿诊断检测被诊断为艾滋病毒的18个月以下儿童中收集了储存的残余DBS样本。进行艾滋病毒耐药性测试,并使用斯坦福算法进行解释。结果和讨论。总的来说,收集了111个符合测序条件的病毒血症样本(ct值<31)进行基因分型,其中产生了110个蛋白酶序列和106个完整的逆转录酶区域。男性占61.3%,6周龄~ <9月龄的占52.3%,母乳喂养的占37.0%。60.3%的人报告可获得母婴干预。43.8%的婴儿出现主要耐药突变的积累,其中以非核苷类逆转录酶抑制剂(NNRTI)耐药最多(37.7%)。40%的病例对奈韦拉平有高度耐药性。与NNRTI耐药相关的危险因素是抗逆转录病毒预防(aOR: 3.68, 95% CI: 1.83-7.45)和母乳喂养史(aOR: 2.16, 95% CI: 1.03-4.53)。CRF01-AE为优势亚型。该研究发现,在越南南部和中部高地省份的18个月以下的HIV-1感染婴儿中,NNRTIs的耐药性很高。这表明需要进一步调查,并可能进行更大规模的全国调查,以确认这一问题在越南的严重程度。我们的研究结果支持越南卫生部目前的行动,即优先考虑基于整合酶抑制剂的方案作为儿童抗逆转录病毒治疗的首选一线,以实现持久的病毒抑制并最大限度地减少治疗失败。这一做法符合世界卫生组织的建议。
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引用次数: 1
HIV in pregnant women group in the Republic of Guinea: frequency and genetic characteristics 几内亚共和国孕妇群体中的艾滋病毒:频率和遗传特征
Q4 Medicine Pub Date : 2023-07-20 DOI: 10.22328/2077-9828-2023-15-2-48-58
T. Balde, A. Shchemelev, Y. Ostankova, S. Boumbaly, D. Valutite, V. S. Davydenko, E. Serikova, E. B. Zueva, E. Anufrieva, V. V. Skvoroda, D. A. Vasileva, E. Esaulenko, A. Semenov, A. Totolian
The aim of this study was to assess the prevalence and study of the molecular genetic characteristics of the human immunodeficiency virus in pregnant women of the Republic of Guinea.Materials and methods. The material for the study was blood plasma samples of 972 pregnant women from the Republic of Guinea. The patients were examined for the presence of HIV infection serological (Ag+Ab) and molecular markers (RNA). For patients with a positive PCR result and a sufficient viral load (>500 c/ml), the genetic sequences of the pol gene fragment responsible for the synthesis of pro and rev proteins were obtained by Sanger sequencing. These sequences were used for phylogenetic analysis and examined for drug resistance mutations.Results and discussion. 12.96% of patients was positive in ELISA. Among women who were positive in ELISA, RNA was detected in 76.98% of cases, however, in 11 cases, RNA was detected in patients without serological markers of HIV infection, so the incidence of HIV RNA in the entire surveyed population was 11.11%. In the vast majority of cases, the circulating recombinant form 02_AG is found. Based on the analysis, we assume a significant contribution of recombinant forms of HIV to the genetic diversity of the virus in the region under study.The incidence of DR mutations was quite high (26.80%). The most frequent substitutions were in position 20 of the protease (70.10%, 95% CI 59.96–78.98%), of which the K20I mutation was dominant. In addition, the L10I/V mutation was relatively common, increasing the replication of viruses with other PI resistance mutations. Among the mutations associated with HIV resistance to NNRTIs, a non-polymorphic mutation V179T was found.Conclusion. An important factor influencing the effectiveness of Prevention of Mother to Child Transmission identified in this study was the high prevalence of PDR among pregnant women in Guinea. The high prevalence of drug resistance mutations found in this study in pregnant women, as well as in ART-naive women, indicates that current regimens in Guinea are insufficient to prevent vertical HIV infection.
本研究的目的是评估几内亚共和国孕妇人体免疫缺陷病毒的流行率和分子遗传特征研究。材料和方法。这项研究的材料是来自几内亚共和国的972名孕妇的血浆样本。检查患者是否存在HIV感染血清学(Ag+Ab)和分子标记物(RNA)。对于PCR结果呈阳性且病毒载量充足(>500c/ml)的患者,通过Sanger测序获得负责合成pro和rev蛋白的pol基因片段的遗传序列。这些序列用于系统发育分析,并检测耐药性突变。结果和讨论。ELISA阳性率为12.96%。在ELISA阳性的女性中,76.98%的病例检测到RNA,但在11例病例中,在没有HIV感染血清学标志物的患者中检测到RNA。因此,在整个调查人群中,HIV RNA的发生率为11.11%。在绝大多数病例中,发现了循环重组形式02_AG。根据分析,我们认为重组形式的艾滋病毒对研究区域病毒的遗传多样性有重大贡献。DR突变的发生率很高(26.80%)。最常见的取代发生在蛋白酶的20位(70.10%,95%CI 59.96–78.98%),其中K20I突变占主导地位。此外,L10I/V突变相对常见,增加了具有其他PI抗性突变的病毒的复制。在与HIV对NNRTI的耐药性相关的突变中,发现了一个非多态性突变V179T。结论本研究中确定的影响预防母婴传播有效性的一个重要因素是几内亚孕妇PDR的高患病率。这项研究在孕妇和未接受抗逆转录病毒疗法的妇女中发现的耐药性突变的高流行率表明,几内亚目前的治疗方案不足以预防艾滋病毒的垂直感染。
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HIV Infection and Immunosuppressive Disorders
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