Pub Date : 2023-07-20DOI: 10.22328/2077-9828-2023-15-2-7-18
T. V. Balykchinova, V. V. Zhukov, S. V. Volkova, E. Ryamova
Widespread introduction and early initiation of antiretroviral therapy significantly improves the prognosis in people living with HIV — with an increase in the number of CD4+ T-lymphocytes, the incidence of HIV-related diseases and the mortality rate decreases. Despite suppression of HIV replication, a fraction of ART-treated patients fails to achieve normalization of CD4+ T-cell counts. These patients have an increased risk of clinical progression to AIDS and non-AIDS events. Currently, there are no clear criteria for determining the case of immunological inefficiency of ART. To date, mechanisms of incomplete immune reconstitution in HIV-infected patients have not been fully elucidated. Therefore, in this review, we aim to attract the attention of specialists to this problem — we summarized the results of recent studies and current literature data, described possible mechanisms and risk factors for the development of immunological inefficiency of ART; presented the studied therapeutic strategies aimed at recovering the immunity in HIV-infected patients.
{"title":"Immunological inefficiency of art in HIV-infected patients","authors":"T. V. Balykchinova, V. V. Zhukov, S. V. Volkova, E. Ryamova","doi":"10.22328/2077-9828-2023-15-2-7-18","DOIUrl":"https://doi.org/10.22328/2077-9828-2023-15-2-7-18","url":null,"abstract":"Widespread introduction and early initiation of antiretroviral therapy significantly improves the prognosis in people living with HIV — with an increase in the number of CD4+ T-lymphocytes, the incidence of HIV-related diseases and the mortality rate decreases. Despite suppression of HIV replication, a fraction of ART-treated patients fails to achieve normalization of CD4+ T-cell counts. These patients have an increased risk of clinical progression to AIDS and non-AIDS events. Currently, there are no clear criteria for determining the case of immunological inefficiency of ART. To date, mechanisms of incomplete immune reconstitution in HIV-infected patients have not been fully elucidated. Therefore, in this review, we aim to attract the attention of specialists to this problem — we summarized the results of recent studies and current literature data, described possible mechanisms and risk factors for the development of immunological inefficiency of ART; presented the studied therapeutic strategies aimed at recovering the immunity in HIV-infected patients.","PeriodicalId":37381,"journal":{"name":"HIV Infection and Immunosuppressive Disorders","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43038616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-02DOI: 10.22328/2077-9828-2023-15-1-71-94
A. Editorial
.
{"title":"Materials of the conference of young scientists and specialists of «Infectology News, Microbiology and Biotechnology-2022»","authors":"A. Editorial","doi":"10.22328/2077-9828-2023-15-1-71-94","DOIUrl":"https://doi.org/10.22328/2077-9828-2023-15-1-71-94","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":37381,"journal":{"name":"HIV Infection and Immunosuppressive Disorders","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45303467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-02DOI: 10.22328/2077-9828-2023-15-1-71-95
Article Editorial
.
．
{"title":"Materials of the conference of young scientists and specialists of «Infectology News, Microbiology and Biotechnology-2022»","authors":"Article Editorial","doi":"10.22328/2077-9828-2023-15-1-71-95","DOIUrl":"https://doi.org/10.22328/2077-9828-2023-15-1-71-95","url":null,"abstract":".","PeriodicalId":37381,"journal":{"name":"HIV Infection and Immunosuppressive Disorders","volume":"234 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135270255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.22328/2077-9828-2023-15-1-41-49
Y. Gomon, V. V. Strizheletsky, I. G. Ivanov, A. Kolbin, A. Kalyapin, A. M. Fakhrutdinova, T. A. Usmanova
The objective of this study was to assess the volume of consumption of anti-interleukins and janus kinase inhibitors in the period 2018–2021, used as well as preventive pathogenetic therapy of COVID-19.Materials and methods. Based on actual sales data in the segments of public procurement (including regional and federal preferential drug provision) and retail sales segment in the period 2018–2021, obtained from the IQVIA database. All data was recalculated into the number of established daily doses (DDDs), with the calculation of pharmacoepidemiological indicators «Incidence of prescribing drugs», «Cumulative risk of prescribing drugs», as well as «Prescribing prevalence per year» for tocilizumab, olokizumab, levilimab, sarilumab, kanakinumab, anakinra, baricitinib, tofacitinib and upadacitinib.Results and discussion. The growth of total sales volumes was demonstrated in all market segments, but mostly in the segment of regional purchases, primarily related to the purchase of these groups of medicines for COVID-19 therapy in the period 2020–2021. It was demonstrated that the increase in the number of cases, accompanied by the expansion of prescribing preventive pathogenetic therapy, led to a twofold increase in the number of new cases of prescribing of janus kinase inhibitors and an increase in this indicator for anti-interleukins by 1.5 times, taking into account the estimated number of patients with moderate and severe COVID-19. The cumulative risk of prescribing these classes of drugs increased proportionally: for JAK inhibitors from 14 to 32%, and for anti-IL drugs from 38 to 69%. Calculations showed that the proportion of people over 18 years of age in the Russian Federation who received at least one dose of janus kinase inhibitors and anti-interleukins increased many times, in 1000 times and 500 times.Conclusions. Taking into account the expansion of the use of these groups of medicines, careful monitoring of information about their safety is required.
{"title":"The use of janus kinase inhibitors anti-interleukin therapy in the Russian Federation with COVID-19: pharmacoepidemiological study","authors":"Y. Gomon, V. V. Strizheletsky, I. G. Ivanov, A. Kolbin, A. Kalyapin, A. M. Fakhrutdinova, T. A. Usmanova","doi":"10.22328/2077-9828-2023-15-1-41-49","DOIUrl":"https://doi.org/10.22328/2077-9828-2023-15-1-41-49","url":null,"abstract":"The objective of this study was to assess the volume of consumption of anti-interleukins and janus kinase inhibitors in the period 2018–2021, used as well as preventive pathogenetic therapy of COVID-19.Materials and methods. Based on actual sales data in the segments of public procurement (including regional and federal preferential drug provision) and retail sales segment in the period 2018–2021, obtained from the IQVIA database. All data was recalculated into the number of established daily doses (DDDs), with the calculation of pharmacoepidemiological indicators «Incidence of prescribing drugs», «Cumulative risk of prescribing drugs», as well as «Prescribing prevalence per year» for tocilizumab, olokizumab, levilimab, sarilumab, kanakinumab, anakinra, baricitinib, tofacitinib and upadacitinib.Results and discussion. The growth of total sales volumes was demonstrated in all market segments, but mostly in the segment of regional purchases, primarily related to the purchase of these groups of medicines for COVID-19 therapy in the period 2020–2021. It was demonstrated that the increase in the number of cases, accompanied by the expansion of prescribing preventive pathogenetic therapy, led to a twofold increase in the number of new cases of prescribing of janus kinase inhibitors and an increase in this indicator for anti-interleukins by 1.5 times, taking into account the estimated number of patients with moderate and severe COVID-19. The cumulative risk of prescribing these classes of drugs increased proportionally: for JAK inhibitors from 14 to 32%, and for anti-IL drugs from 38 to 69%. Calculations showed that the proportion of people over 18 years of age in the Russian Federation who received at least one dose of janus kinase inhibitors and anti-interleukins increased many times, in 1000 times and 500 times.Conclusions. Taking into account the expansion of the use of these groups of medicines, careful monitoring of information about their safety is required.","PeriodicalId":37381,"journal":{"name":"HIV Infection and Immunosuppressive Disorders","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43552946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.22328/2077-9828-2023-15-1-60-66
A. H. Lodyagin, E. Rakhmanova, A. Miroshnichenko
Objective. To determine the effectiveness and introduce the Poisoning Severity Score (PSS) scale into the clinical practice of the department for patients with acute poisoning with psychoactive substances.Materials and methods. A single–center retrospective and prospective randomized clinical trial was conducted in 200 patients with acute poisoning with the psychostimulant alpha-pyrrolidinopentiophenone and the synthetic cannabinoid MDMB–FUBINACA. To assess the severity of substance poisoning, the Poisoning Severity Score (PSS) scale developed by the European Association of Clinical Toxicologists IPCS/EC/EAPCCT was used.Results and discussion. This scale allows to objectify clinical and laboratory manifestations of acute poisoning with psychodisleptics, to identify the leading syndromes, to predict the risk of complications and emergency conditions.Conclusion. The PSS scale is easy to use and does not require a wide range of diagnostic capabilities from a medical institution, helps to determine the tactics of patient management and determines the volume of emergency care at the hospital stage.
{"title":"Assessment of the severity of the condition of patients with acute substance poisoning using the PSS scale","authors":"A. H. Lodyagin, E. Rakhmanova, A. Miroshnichenko","doi":"10.22328/2077-9828-2023-15-1-60-66","DOIUrl":"https://doi.org/10.22328/2077-9828-2023-15-1-60-66","url":null,"abstract":"Objective. To determine the effectiveness and introduce the Poisoning Severity Score (PSS) scale into the clinical practice of the department for patients with acute poisoning with psychoactive substances.Materials and methods. A single–center retrospective and prospective randomized clinical trial was conducted in 200 patients with acute poisoning with the psychostimulant alpha-pyrrolidinopentiophenone and the synthetic cannabinoid MDMB–FUBINACA. To assess the severity of substance poisoning, the Poisoning Severity Score (PSS) scale developed by the European Association of Clinical Toxicologists IPCS/EC/EAPCCT was used.Results and discussion. This scale allows to objectify clinical and laboratory manifestations of acute poisoning with psychodisleptics, to identify the leading syndromes, to predict the risk of complications and emergency conditions.Conclusion. The PSS scale is easy to use and does not require a wide range of diagnostic capabilities from a medical institution, helps to determine the tactics of patient management and determines the volume of emergency care at the hospital stage.","PeriodicalId":37381,"journal":{"name":"HIV Infection and Immunosuppressive Disorders","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47266806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.22328/2077-9828-2023-15-1-23-31
A. Khryanin, H. Y. Knorring, V. K. Bocharova
Women are the main population responsible for new HIV infections and the persistence of the HIV pandemic. The article provides a review of the current literature on the factors and mechanisms by which the vaginal microbiome can contribute to HIV infection. A key determinant of susceptibility to HIV infection is the composition of the vaginal microbiome, which can influence the local immune cell population and inflammation status. A low diversity microbial composition dominated by Lactobacillus crispatus does not increase the risk of HIV infection, and a high microbial diversity environment associated with bacterial vaginosis increases the risk of HIV infection. The female reproductive tract has a unique susceptibility to viral infection because tissue-specific immunity must elicit rapid antimicrobial responses to pathogens while maintaining sperm tolerance. It is important to note that the risk of HIV infection during sexual intercourse is multifactorial and is determined not only by the state of the microbiota of a woman’s genital tract, but also by the state of the partner’s microbiota, the viral load of HIV in the blood of the sexual partner, the presence/absence of anti-retroviral therapy in the partner, hormonal background and the phase of the menstrual cycle, which also affect the state of the microbiota.
{"title":"Violation of the vaginal microbiome and the risk of HIV infection in women","authors":"A. Khryanin, H. Y. Knorring, V. K. Bocharova","doi":"10.22328/2077-9828-2023-15-1-23-31","DOIUrl":"https://doi.org/10.22328/2077-9828-2023-15-1-23-31","url":null,"abstract":"Women are the main population responsible for new HIV infections and the persistence of the HIV pandemic. The article provides a review of the current literature on the factors and mechanisms by which the vaginal microbiome can contribute to HIV infection. A key determinant of susceptibility to HIV infection is the composition of the vaginal microbiome, which can influence the local immune cell population and inflammation status. A low diversity microbial composition dominated by Lactobacillus crispatus does not increase the risk of HIV infection, and a high microbial diversity environment associated with bacterial vaginosis increases the risk of HIV infection. The female reproductive tract has a unique susceptibility to viral infection because tissue-specific immunity must elicit rapid antimicrobial responses to pathogens while maintaining sperm tolerance. It is important to note that the risk of HIV infection during sexual intercourse is multifactorial and is determined not only by the state of the microbiota of a woman’s genital tract, but also by the state of the partner’s microbiota, the viral load of HIV in the blood of the sexual partner, the presence/absence of anti-retroviral therapy in the partner, hormonal background and the phase of the menstrual cycle, which also affect the state of the microbiota.","PeriodicalId":37381,"journal":{"name":"HIV Infection and Immunosuppressive Disorders","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44240234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.22328/2077-9828-2023-15-1-67-70
D. Sosnin, V. V. Bazarnyj, A. P. Shhjokotova, N. I. Nasibullina
Sepsis remains relevant especially among people with immunodeficiency. The article presents a case of sepsis with a rapid fatal outcome in an immunodeficient patient. The diagnosis of sepsis was promptly confirmed by detecting bacteremia by microscopy of a stained smear of the patient’s peripheral blood. The publication discusses the problems of lifetime diagnosis of sepsis based on the results of a general blood test. The data on the need for a correct assessment of the results of the 5-diff hematological analyzer in patients using light microscopy data, especially when detecting a large content of erythroblasts, are presented.
{"title":"Intense bacteremia in sepsis in an HIV-infected patient, detected by microscopy of a peripheral blood smear","authors":"D. Sosnin, V. V. Bazarnyj, A. P. Shhjokotova, N. I. Nasibullina","doi":"10.22328/2077-9828-2023-15-1-67-70","DOIUrl":"https://doi.org/10.22328/2077-9828-2023-15-1-67-70","url":null,"abstract":"Sepsis remains relevant especially among people with immunodeficiency. The article presents a case of sepsis with a rapid fatal outcome in an immunodeficient patient. The diagnosis of sepsis was promptly confirmed by detecting bacteremia by microscopy of a stained smear of the patient’s peripheral blood. The publication discusses the problems of lifetime diagnosis of sepsis based on the results of a general blood test. The data on the need for a correct assessment of the results of the 5-diff hematological analyzer in patients using light microscopy data, especially when detecting a large content of erythroblasts, are presented.","PeriodicalId":37381,"journal":{"name":"HIV Infection and Immunosuppressive Disorders","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49480216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.22328/2077-9828-2023-15-1-7-22
V. Rassokhin, E. I. Svetashova, A. Shcherbakov, A. Polushin, M. Kucher, I. V. Kazantsev, O. Goloshchapov, R. V. Klementieva, A. A. Sinyaev, V. Ovechkina, A. A. Lazarev, M. Popova, A. Kulagin
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.
{"title":"Mechanisms of central nervous system damage in COVID-19","authors":"V. Rassokhin, E. I. Svetashova, A. Shcherbakov, A. Polushin, M. Kucher, I. V. Kazantsev, O. Goloshchapov, R. V. Klementieva, A. A. Sinyaev, V. Ovechkina, A. A. Lazarev, M. Popova, A. Kulagin","doi":"10.22328/2077-9828-2023-15-1-7-22","DOIUrl":"https://doi.org/10.22328/2077-9828-2023-15-1-7-22","url":null,"abstract":"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.","PeriodicalId":37381,"journal":{"name":"HIV Infection and Immunosuppressive Disorders","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44453338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.22328/2077-9828-2023-15-1-32-40
M. Dyakova, K. Vladimirov, D. Esmedlyaeva, P. Yablonskiy
The objective of the study was to evaluate the information content of determining the activity of adenosine deaminase and adenosine deaminase-2 in the diagnosis of tuberculous pleurisy in patients with HIV infection.Materials and methods. A total of 378 patients with pleural effusion were retrospectively examined. In 215 cases, tuberculous pleurisy was detected (TP); and 163 patients had non-tuberculous pleural effusion (non-TP). As much as 27 patients in the TP group were HIV co-infected (TP/HIV+), the remaining 188 patients were HIV — negative (TP/HIV–). In all the patients, the activity of total adenosine deaminase (ADA) and its isoenzymes (ADA-1 and ADA-2) in the pleural fluid was determined.Results and discussion. In the TP group, the activity of total ADA (95.5 [67.7; 115.4] versus 82.0 [59.6; 100.0] U/L, p=0.1), ADA-1 (14.2 [5.8; 20.5] versus 12.1 [6.1; 23.7] U/L, p=0.9) and ADA-2 (78,1 [38.1; 93.1] versus 62.4 [35.4; 82.2] U/L, p=0,1) did not depend on HIV status. The activity of these indicators was determined above the threshold level — total ADA in 96.3% and 95.2%, ADA-1 in 25.9% and 30.8% and ADA-2 in 92.6% and 83.3% of cases in the «TP/HIV+» and «TP/HIV–» groups, respectively. A negative correlation between ADA-1 activity and HIV viral load in the group of patients with tuberculous pleurisy and HIV infection (r=–0.45; p=0.008), as well as in the subgroup of TP/HIV+ patients who received (r=–0.9; p=0.008) and in those who didn’t receive ART (r=–0.47; p=0.04) was obtained. Our results show that a total ADA activity increase in the patients with tuberculous pleurisy, regardless of patients’ HIV status, occur due to ADA-2. Thus, the increase in activity of total ADA and ADA-2 in our study was caused by active tuberculosis, not by the presence or absence of HIV co-infection. Also, the ADA-2 activity in HIV-infected patients is likely consistent with ADA-2 important role in cellular immune responses.Conclusion. Our data indicate the participation of purine metabolism enzymes in the pathogenesis of HIV infection. At the same time, adenosine deaminase activity is not a specific biomarker of individual changes characteristic of HIV infection. The study results suggest that the total adenosine deaminase and adenosine deaminase-2 activity increase is a valuable and diagnostically significant marker of tuberculous pleurisy in HIV-infected patients. The value of adenosine deaminase and adenosine deaminase-2 activity remains high even in the patients having severe immunosuppression, which allows them to be actively used for rapid diagnostics and hence, early TB therapy initiation.
{"title":"Enzymes of purine metabolism — biomarkers for the diagnostics of tuberculous pleurisy in patients with HIV infection","authors":"M. Dyakova, K. Vladimirov, D. Esmedlyaeva, P. Yablonskiy","doi":"10.22328/2077-9828-2023-15-1-32-40","DOIUrl":"https://doi.org/10.22328/2077-9828-2023-15-1-32-40","url":null,"abstract":"The objective of the study was to evaluate the information content of determining the activity of adenosine deaminase and adenosine deaminase-2 in the diagnosis of tuberculous pleurisy in patients with HIV infection.Materials and methods. A total of 378 patients with pleural effusion were retrospectively examined. In 215 cases, tuberculous pleurisy was detected (TP); and 163 patients had non-tuberculous pleural effusion (non-TP). As much as 27 patients in the TP group were HIV co-infected (TP/HIV+), the remaining 188 patients were HIV — negative (TP/HIV–). In all the patients, the activity of total adenosine deaminase (ADA) and its isoenzymes (ADA-1 and ADA-2) in the pleural fluid was determined.Results and discussion. In the TP group, the activity of total ADA (95.5 [67.7; 115.4] versus 82.0 [59.6; 100.0] U/L, p=0.1), ADA-1 (14.2 [5.8; 20.5] versus 12.1 [6.1; 23.7] U/L, p=0.9) and ADA-2 (78,1 [38.1; 93.1] versus 62.4 [35.4; 82.2] U/L, p=0,1) did not depend on HIV status. The activity of these indicators was determined above the threshold level — total ADA in 96.3% and 95.2%, ADA-1 in 25.9% and 30.8% and ADA-2 in 92.6% and 83.3% of cases in the «TP/HIV+» and «TP/HIV–» groups, respectively. A negative correlation between ADA-1 activity and HIV viral load in the group of patients with tuberculous pleurisy and HIV infection (r=–0.45; p=0.008), as well as in the subgroup of TP/HIV+ patients who received (r=–0.9; p=0.008) and in those who didn’t receive ART (r=–0.47; p=0.04) was obtained. Our results show that a total ADA activity increase in the patients with tuberculous pleurisy, regardless of patients’ HIV status, occur due to ADA-2. Thus, the increase in activity of total ADA and ADA-2 in our study was caused by active tuberculosis, not by the presence or absence of HIV co-infection. Also, the ADA-2 activity in HIV-infected patients is likely consistent with ADA-2 important role in cellular immune responses.Conclusion. Our data indicate the participation of purine metabolism enzymes in the pathogenesis of HIV infection. At the same time, adenosine deaminase activity is not a specific biomarker of individual changes characteristic of HIV infection. The study results suggest that the total adenosine deaminase and adenosine deaminase-2 activity increase is a valuable and diagnostically significant marker of tuberculous pleurisy in HIV-infected patients. The value of adenosine deaminase and adenosine deaminase-2 activity remains high even in the patients having severe immunosuppression, which allows them to be actively used for rapid diagnostics and hence, early TB therapy initiation.","PeriodicalId":37381,"journal":{"name":"HIV Infection and Immunosuppressive Disorders","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42361189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.22328/2077-9828-2023-15-1-50-59
A. Pokrovskaya, E. A. Samotolkina, S. Matosova, D. Kireev, E. Domonova, S. Voznesenskiy, T. Ermak, E. S. Samotolkina, Y. Parkhomenko, O. A. Tishkevich
Objective: To analyze clinical and laboratory features to predict the outcome of progressive multifocal leukoencephalopathy (PML) in HIV-infected patients.Materials and methods: Retrospective analysis of medical histories of HIV-infected patients with CNS lesions in 2015–2017, and dynamic monitoring of HIV patients with CNS lesions in 2018–2019, who were intensive care unit (ICU) in Infectious Clinical Hospital No. 2 of the Department of Health of Moscow.Results and discussion: A total 196 patients with encephalitis/meningoencephalitis: 124 (63%) patients with detected JCPyV in the cerebrospinal fluid (CSF) — study group (JCPyV+), 72 patients with undetectable JCPyV in CSF — comparison group (JCPyV–). Late terms of hospitalization were noted, mainly in the JCPyV+ group (mean — 58±6 days). The majority of patients had severe immunodeficiency, in the JCPyV+ group the number of patients with CD4<200 cells/μl was significantly higher than in the JCPyV– group (87.8% and 75.8%, p<0.05). Only 22% of patients received antiretroviral therapy (ART) prior to hospitalization. The main clinical manifestations of PML in the study were: paralysis and paresis of the limbs, speech impairment, cognitive disorders in combination with cerebral symptoms in the absence of meningeal signs. In 87.8% patients with positive JCPyV DNA no other pathogens were detected in the CSF; in the patients without PML the detection of infectious agents in the CSF was also rare (14.3%). The disease led to the death for 78% patients in the JCPyV+ group and 72% JCPyV– group, p>0.05. The chance of survival was 2.5 times higher for patients admitted to hospital less than 14 days after deterioration (OR=2.468 [95% CI: 1.244–4.898]). Patients with CD4<200 cells/μL were 5.5 times more chance to die than patients with higher CD4 rates (OR=5.449 [95% CI: 2.388–12.431]). There was no relationship between the concentration of JCPyV DNA and HIV RNA in the CSF and their impact for the disease outcome.Conclusion: Survival prognosis for PML during treatment in ICU was worser for patients hospitalized after 14 days from the onset of symptoms and with CD4<200 cells/μL. Early ART initiation for all HIV-positive individuals significantly reduces the number of opportunistic infections and improve life expectancy.
{"title":"Clinical and laboratory features and prognostic factors for outcome of progressive multifocal leukoencephalopathy in HIV-infected patients","authors":"A. Pokrovskaya, E. A. Samotolkina, S. Matosova, D. Kireev, E. Domonova, S. Voznesenskiy, T. Ermak, E. S. Samotolkina, Y. Parkhomenko, O. A. Tishkevich","doi":"10.22328/2077-9828-2023-15-1-50-59","DOIUrl":"https://doi.org/10.22328/2077-9828-2023-15-1-50-59","url":null,"abstract":"Objective: To analyze clinical and laboratory features to predict the outcome of progressive multifocal leukoencephalopathy (PML) in HIV-infected patients.Materials and methods: Retrospective analysis of medical histories of HIV-infected patients with CNS lesions in 2015–2017, and dynamic monitoring of HIV patients with CNS lesions in 2018–2019, who were intensive care unit (ICU) in Infectious Clinical Hospital No. 2 of the Department of Health of Moscow.Results and discussion: A total 196 patients with encephalitis/meningoencephalitis: 124 (63%) patients with detected JCPyV in the cerebrospinal fluid (CSF) — study group (JCPyV+), 72 patients with undetectable JCPyV in CSF — comparison group (JCPyV–). Late terms of hospitalization were noted, mainly in the JCPyV+ group (mean — 58±6 days). The majority of patients had severe immunodeficiency, in the JCPyV+ group the number of patients with CD4<200 cells/μl was significantly higher than in the JCPyV– group (87.8% and 75.8%, p<0.05). Only 22% of patients received antiretroviral therapy (ART) prior to hospitalization. The main clinical manifestations of PML in the study were: paralysis and paresis of the limbs, speech impairment, cognitive disorders in combination with cerebral symptoms in the absence of meningeal signs. In 87.8% patients with positive JCPyV DNA no other pathogens were detected in the CSF; in the patients without PML the detection of infectious agents in the CSF was also rare (14.3%). The disease led to the death for 78% patients in the JCPyV+ group and 72% JCPyV– group, p>0.05. The chance of survival was 2.5 times higher for patients admitted to hospital less than 14 days after deterioration (OR=2.468 [95% CI: 1.244–4.898]). Patients with CD4<200 cells/μL were 5.5 times more chance to die than patients with higher CD4 rates (OR=5.449 [95% CI: 2.388–12.431]). There was no relationship between the concentration of JCPyV DNA and HIV RNA in the CSF and their impact for the disease outcome.Conclusion: Survival prognosis for PML during treatment in ICU was worser for patients hospitalized after 14 days from the onset of symptoms and with CD4<200 cells/μL. Early ART initiation for all HIV-positive individuals significantly reduces the number of opportunistic infections and improve life expectancy.","PeriodicalId":37381,"journal":{"name":"HIV Infection and Immunosuppressive Disorders","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42134530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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