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Determining factors of a personalized approach to patients with HIV during the COVID-19 pandemic 新冠肺炎大流行期间HIV患者个性化治疗方法的确定因素
Q4 Medicine Pub Date : 2022-11-09 DOI: 10.22328/2077-9828-2022-14-3-24-34
S. L. Serebryakova, E. Boeva, M. Moisà, S. I. Dyrul, S. Ogurtsova, O. N. Leonov, A. Y. Kovelenov
Objective. To study the epidemiological, medical, social and clinical factors that affect the manifestations and treatment of diseases — infections caused by the immunodeficiency virus (HIV) and the new coronavirus (SARS-CoV-2), which underlie the formation of a personalized approach to the management and treatment of people living with HIV (PLHIV).Materials and methods. Epidemiological analysis of morbidity and mortality from COVID-19 in the Leningrad region for 2021–2022 was carried out. The research team conducted a questionnaire and analysis of medical documentation of 122 HIVpositive patients registered at the Leningrad Regional Center for the Prevention and Control of AIDS and Infectious Diseases who suffered a novel coronavirus infection (COVID-19) in the period from 2020 to 2022. An assessment was made of the psychological and social characteristics of patients affecting adherence to antiretroviral therapy (ART), the clinical picture of the course of HIV infection, including in combination with COVID-19. The fact of SARS-CoV-2 disease was confirmed by polymerase chain reaction (PCR) smears from the mouth and nasopharynx. Additionally, a group of 59 PLHIV hospitalized in hospitals in St. Petersburg and the Leningrad region with a severe form of COVID-19 was isolated for analysis.Results and discussion. Number of COVID-19 cases in 2020–2021 in the Leningrad region amounted to 15.553 people, of which 1.553 had a history of HIV infection (13.5% of patients registered at the dispensary). The mortality rate among PLHIV who underwent COVID-19 was 5.1%. An equal ratio of women and men was observed among 122 surveyed patients, the average age of respondents was 41 years. When assessing the social status of the respondents, it was found that 25.4% had higher education, 56.5% had specialized secondary education. 72.9% had a permanent job. 61.4% of respondents considered themselves to be in the category of material well-being of «average level», 24.6% — to «below average». The sexual route of HIV infection was established in 50.8% of patients, injectable was 29.5%, in other cases it was not unknown. The average level of CD4 lymphocytes in the blood was 544 cl/mcl, most patients (90.2%) had an undetectable indicator of HIV viral load (VL). The average duration of the disease with the new coronavirus in HIV patients was 15.6 days. At the same time, 108 (88.5%) people noted a mild course of COVID-19 and did not need hospitalization. Coverage of COVID-19 vaccination among the surveyed PLHIV was 40.9%. According to data from 59 case histories of PLHIV hospitalized as a result of the severe course of COVID-19, 55 people died, a pathoanatomic autopsy was performed in 26 cases. The autopsy revealed the following complications and concomitant diseases: miliary tuberculosis (7.7%), purulent endocarditis (11.5%), sepsis (19.2%). Improvement in the dynamics was observed only in 4 PLHIV, whose further fate is unknown.Conclusion. The study showed that the incidenc
客观的研究影响免疫缺陷病毒(HIV)和新型冠状病毒(严重急性呼吸系统综合征冠状病毒2型)引起的疾病的表现和治疗的流行病学、医学、社会和临床因素,这些因素是形成个性化HIV感染者管理和治疗方法的基础。材料和方法。对列宁格勒地区2021年至2022年新冠肺炎的发病率和死亡率进行了流行病学分析。研究小组对列宁格勒地区艾滋病和传染病预防控制中心登记的2020年至2022年期间感染新型冠状病毒(新冠肺炎)的122名艾滋病毒阳性患者的医疗文件进行了问卷调查和分析。评估了影响抗逆转录病毒疗法(ART)依从性的患者的心理和社会特征,以及艾滋病毒感染过程的临床情况,包括与新冠肺炎合并感染。口腔和鼻咽的聚合酶链式反应(PCR)涂片证实了严重急性呼吸系统综合征冠状病毒2型疾病的事实。此外,对圣彼得堡和列宁格勒地区医院收治的59名患有严重新冠肺炎的PLHIV患者进行了隔离分析。结果和讨论。2020年至2021年,列宁格勒地区的新冠肺炎病例数为15.553人,其中1.553人有艾滋病毒感染史(13.5%的患者在药房登记)。接受新冠肺炎治疗的PLHIV患者的死亡率为5.1%。在122名接受调查的患者中观察到男女比例相等,受访者的平均年龄为41岁。在评估受访者的社会地位时,发现25.4%的人受过高等教育,56.5%的人受过专门中等教育。72.9%的人有固定工作。61.4%的受访者认为自己属于“平均水平”的物质幸福感类别,24.6%属于“低于平均水平”。50.8%的患者确定了HIV感染的性途径,29.5%的患者是可注射的,在其他情况下也并非未知。血液中CD4淋巴细胞的平均水平为544 cl/mcl,大多数患者(90.2%)具有检测不到的HIV病毒载量(VL)指标。HIV患者感染新型冠状病毒的平均持续时间为15.6天。与此同时,108人(88.5%)表示新冠肺炎病情轻微,不需要住院治疗。接受调查的PLHIV患者中新冠肺炎疫苗接种率为40.9%。根据59例因新冠肺炎严重病程住院的PLHIV病例史数据,55人死亡,对26例病例进行了病理解剖尸检。尸检发现以下并发症和伴随疾病:粟粒性肺结核(7.7%)、化脓性心内膜炎(11.5%)、败血症(19.2%)。仅在4例PLHIV中观察到动力学改善,其进一步命运未知。结论研究表明,列宁格勒地区PLHIV中严重急性呼吸系统综合征冠状病毒2型的发病率与普通人群相当,然而,HIV感染患者的总死亡率高于该地区和全国。根据分析结果,我们得出结论,艾滋病毒感染和新冠肺炎在门诊阶段的共同感染方面是独立的。例外情况是严重和加重的合并症病例,这需要对病情进行更详细的评估,需要更多的专家参与,以及实验室和仪器研究方法。所获得的结果确定了对艾滋病毒感染者采取综合跨学科方法的必要性,同时考虑到他们的个人需求。为PLHIV提供护理的医务人员不仅应考虑疾病的临床情况,还应考虑患者的心理社会状况,以改善新冠肺炎和HIV感染的结果。
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引用次数: 0
Experience in the use of phylogenetic analysis in the investigation of cases of HIV-infected patients 系统发育分析在HIV感染病例调查中的应用经验
Q4 Medicine Pub Date : 2022-11-09 DOI: 10.22328/2077-9828-2022-14-3-43-50
D. Neshumaev, M. Malysheva, S. E. Skudarinov, P. Shesternya, E. Pozhilenkova, V. L. Stasenko
Objective. To establish a probable source of infection using phylogenetic analysis in the investigation of cases of HIV infection. Materials and methods. HIV genome sequencing was carried out using the kit ViroSeq (Celera). The phylogenetic tree was constructed using the maximum likelihood method in the Mega 6 program. As a comparison group, 40 samples of HIV-infected patients from the Krasnoyarsk region were used, as well as 25 nucleotide sequences of various HIV subtypes taken from the international GenBank database. The reliability of the resulting tree was evaluated in bootstrap analysis, a branch rotation test for a thousand random constructions.Results and discussion. The paper presents five cases of epidemiological investigations with a probable nosocomial and occupational mechanism of HIV infection transmission in the Krasnoyarsk region. In 2013, a study was conducted on the infection of three persons treated in the same hospital with an HIV-infected patient. A close genetic relationship of HIV was shown in newly identified individuals, the probable source could not be examined due to death. Second epidemiological investigation in 2013. The association of cases of infection between a newly diagnosed woman with HIV infection and a patient with a previously established HIV status is shown. Both persons were simultaneously in the same medical institution. To determine the direction of transmission of the virus, a test for the duration of infection was used. In 2014, after receiving medical care in four medical organizations, the patient was confirmed to be HIV positive. In all hospitals there were persons with a confirmed diagnosis of HIV infection. Three of them have been examined. The absence of a phylogenetic relationship was confirmed, the fourth died, the material could not be obtained from him. In 2015, a nurse was injured while caring for an HIV-positive patient. Phylogenetic analysis showed a high degree of genetic relationship between these cases of infection. In 2016, after a car accident, two patients were hospitalized in the intensive care unit. After some time, both were diagnosed with HIV infection. Four HIV-infected patients were in intensive care at the same time. Phylogenetic analysis was carried out in two newly identified individuals and one putative source. The association of infections in newly identified patients was shown, the alleged source could not be established.Conclusion. The use of molecular genetic methods in epidemiological investigations significantly improves the quality and accuracy of deciphering epidemic chains of HIV infection. 
客观的在HIV感染病例的调查中使用系统发育分析来确定可能的感染源。材料和方法。使用试剂盒ViroSeq(Celera)进行HIV基因组测序。系统发育树是使用Mega 6程序中的最大似然方法构建的。作为比较组,使用了来自克拉斯诺亚尔斯克地区的40份HIV感染患者样本,以及从国际GenBank数据库中提取的25个不同HIV亚型的核苷酸序列。在bootstrap分析中评估了结果树的可靠性,bootstrap是对一千个随机结构的分支旋转测试。结果和讨论。本文介绍了克拉斯诺亚尔斯克地区五例可能的医院和职业HIV感染传播机制的流行病学调查病例。2013年,对与一名艾滋病毒感染患者在同一家医院接受治疗的三人的感染情况进行了研究。在新发现的个体中显示出艾滋病毒的密切遗传关系,由于死亡,可能的来源无法检查。2013年第二次流行病学调查。显示了新诊断的艾滋病毒感染妇女与先前确定的艾滋病毒状况患者之间的感染病例关联。两人同时在同一家医疗机构。为了确定病毒的传播方向,使用了感染持续时间的测试。2014年,在四家医疗机构接受医疗护理后,该患者被确认为艾滋病毒阳性。所有医院都有确诊感染艾滋病毒的人。其中三人已接受检查。没有系统发育关系被证实,第四个死亡,材料无法从他那里获得。2015年,一名护士在照顾一名艾滋病毒阳性患者时受伤。系统发育分析显示,这些感染病例之间存在高度的遗传关系。2016年,一场车祸后,两名患者在重症监护室住院。一段时间后,两人都被诊断出感染了艾滋病毒。四名艾滋病毒感染者同时接受重症监护。对两个新鉴定的个体和一个推定来源进行了系统发育分析。新发现的患者感染的关联已经显示,但无法确定所谓的来源。结论在流行病学调查中使用分子遗传学方法大大提高了破译艾滋病毒感染流行链的质量和准确性。
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引用次数: 0
Pharmacokinetic and pharmacodynamic features of antiretroviral products 抗逆转录病毒药物的药代动力学和药效学特征
Q4 Medicine Pub Date : 2022-11-09 DOI: 10.22328/2077-9828-2022-14-3-7-23
A. Useinova, E. Egorova, S. P. Maryanenko, Vitalii B. Kaliberdenko, K. N. Koryanova, K. E. Grogoryan
Introduction. Since the appearance of the immune deficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) at the beginning of 1980s, humanity started to understand elementary processes, underlying biology of HIV that enabled to develop safe and efficient treatment methods. Currently HIV therapy includes combined treatment regimen that allows combined drug interaction.Objective. To study the features of pharmacokinetics and pharmacodynamics, and also drug interaction of specific product groups, affecting human immunodeficiency virus.Materials and methods. Analytical review is based on analysis of literary sources of scientific database (PubMed, Cochrane Library, Сyberleninka) that contains information about peculiarities of pharmacokinetic and pharmacodynamic antiretroviral products’ interaction (ARVP) when used by HIV-infected patients for the period 1995–2022. Results and discussion. The current study enabled to summarize the research results, devoted to the issue of combined ARVP use by HIV-infected patients, and also to identify variants of irrational ARVP combination, caused by increased risk of toxicity with their simultaneous application.Conclusion. Studying the characteristics of each medical product, used in HIV infection therapy, allows to choose optimal pharmacotherapy regimens, taking into account individual patient characteristics, and also to predict and prevent the risk of adverse reactions in the future.
介绍。自20世纪80年代初免疫缺陷病毒(HIV)和获得性免疫缺陷综合征(AIDS)出现以来,人类开始了解HIV的基本过程和潜在生物学,从而能够开发安全有效的治疗方法。目前的艾滋病治疗包括联合治疗方案,允许联合药物相互作用。研究影响人类免疫缺陷病毒的特定产物群的药代动力学和药效学特点及药物相互作用。材料和方法。分析性综述基于对科学数据库(PubMed, Cochrane图书馆,Сyberleninka)文献来源的分析,该数据库包含1995-2022年期间hiv感染患者使用抗逆转录病毒产品时药代动力学和药效学相互作用(ARVP)的特性信息。结果和讨论。本研究对hiv感染者联合使用ARVP的研究结果进行了总结,并对不合理的ARVP联合用药的变异进行了识别,这些变异是由于同时使用ARVP增加了毒性风险。研究用于艾滋病毒感染治疗的每种医疗产品的特性,可以选择最佳的药物治疗方案,同时考虑到个体患者的特征,还可以预测和预防未来不良反应的风险。
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引用次数: 0
COVID-19 i in the setting of acute lymphoblastic leukaemia (case analysis, resulting in death) 新冠肺炎i在急性淋巴细胞白血病中的应用(病例分析,导致死亡)
Q4 Medicine Pub Date : 2022-08-31 DOI: 10.22328/2077-9828-2022-14-2-73-82
D. Ivanov, Y. Petrenko, V. А. Reznik, V. N. Timchenko, Е. B. Pavlova, Т. М. Chernova, С. L. Bannova, G. V. Kondratyev, О. L. Krasnogorskaya, М. А. Shakmayeva, М. B. Paneyah, Е. P. Fedotova, R. Nasyrov
A new coronaviral infection in the Russian Federation is registered less in a child treatment than in an adult one. Children’s COVID-19 is mainly asymptomatic or in mild, severe form occurs rarely. The percentage of paediatric-age patients that require in-patient medical care is from 5,7% to 20% of children with COVID-19. However, clinical observations show that children’s COVID-19 may be severe and extremely severe, also resulting in death. A risk group of unsmooth course of the new coronaviral infection is patients with serious comorbide pathology, in particular oncohematological disease, passing radiation, chemotherapy, transplantation of hematopoietic stem cells. Acute lymphoblastic leukaemia, the most frequent paediatric-age oncological disease, may be one of the factors, predisposing to severe course of the new coronaviral infection. However, COVID-19 is likely to cause the deterioration of leukaemia treatment and an adverse outcome. The article presents a clinical observation of a 12-year-old child with a critical form of the new coronaviral infection and acute lymphoblastic leukaemia in the post-transplantation period. The accumulation of COVID-19 was accompanied by deterioration in the underlying disease. Despite high-quality medical care, using modern technologies, the child had progressive deterioration with a poor outcome.
在俄罗斯联邦,儿童治疗中登记的新型冠状病毒感染少于成人治疗。儿童新冠肺炎主要为无症状或轻度、重度,很少发生。需要住院治疗的学龄儿童患者比例为新冠肺炎儿童的5.7%至20%。然而,临床观察表明,儿童新冠肺炎可能是严重和极其严重的,也会导致死亡。新型冠状病毒感染过程不顺利的一个风险群体是患有严重合并症的患者,尤其是肿瘤血液病的患者,他们正在接受放疗、化疗和造血干细胞移植。急性淋巴细胞白血病是最常见的儿科年龄肿瘤学疾病,可能是导致新型冠状病毒感染严重过程的因素之一。然而,新冠肺炎可能会导致白血病治疗的恶化和不良后果。这篇文章介绍了一名12岁儿童的临床观察,该儿童在移植后患有严重的新型冠状病毒感染和急性淋巴细胞白血病。新冠肺炎的积累伴随着潜在疾病的恶化。尽管使用了现代技术提供了高质量的医疗护理,但该儿童病情逐渐恶化,结果不佳。
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引用次数: 1
Analysis of HIV prevalence, tuberculosis and their combinations in the territory of Chechen Republic 车臣共和国境内艾滋病毒流行率、结核病及其组合的分析
Q4 Medicine Pub Date : 2022-08-31 DOI: 10.22328/2077-9828-2022-14-2-62-72
Н. H. Murtazhaliev, Е. V. Alieva, V. Rassokhin
Objective. Analyse the prevalence of combined HIV/TB infections in the territory of Chechen Republic for 2013–2020.Materials and methods. The research was held by «the Republican Centre for AIDS Prevention and Control», Grozny and «The Republican Centre of Phthisiopulmonology», Grozny. It analysed the data of outpatient and inpatient charts of 148 HIVinfected with tuberculosis, identified in the period from 2013 to 2020 and being under dispensary observation in the Republican Centre of AIDS Prevention and Control, Chechen Republic.Results and discussion. The study reports that HIV prevalence in absolute terms and figures per 100.000 people decreased from 223 (16,8) in 2013 to 117 (7,9) in 2020. It should be noted that with the growth in number of checked people, tuberculosis prevalence as well as in the case of HIV infection decreased in absolute terms and figures per 100.000 of the population in the sampling period. If in 2013 it amounted 466 (35,1), in 2020 it was already 299 (20,2). Among HIV-infected citizens of Chechen Republic 167 people with tuberculosis were also detected in the sampling period. From among the combined HIV- and tuberculosis infected, 148 people subjected to regular medical check-up. The prevalence of combined HIV/TB infections per 100.000 people tended to decrease from 2013 to 2020 as well as the overall HIV prevalence without tuberculosis and tuberculosis without HIV. These changes are quite significant from 1,6 to 0,06.Conclusion. The issues of HIV infection combined with tuberculosis remains actual for all constituent entities of the Russian Federation, including Chechen Republic, based on socio-economic, demographic, epidemiological and clinical reasons. The decline in incidence and prevalence of HIV, tuberculosis and combined HIV/TB infections in the territory of Chechen Republic in 2013–2020 may have occurred due to increase in the level of economic development, favourable social programs and stabilization of demographic situation, демографической ситуации, overall reduction of substance abuse, including parenterally injectable. There is also improvement of material and technical equipment, staffing of infectious and anti-tuberculosis service. It is required to have further study of the epidemic process specificities of socially significant infections (HIV, TB, viral hepatitis) that acquire new features and characteristics during the pandemic of the new coronaviral infection.
目标。分析2013-2020年车臣共和国境内艾滋病毒/结核病合并感染的流行情况。材料和方法。这项研究是由格罗兹尼的“共和国艾滋病预防和控制中心”和格罗兹尼的“共和国细菌学中心”进行的。它分析了2013年至2020年期间在车臣共和国艾滋病预防和控制中心接受药房观察的148名艾滋病毒感染结核病患者的门诊和住院图表数据。结果和讨论。该研究报告称,艾滋病毒感染率的绝对值和每10万人的数字从2013年的223(16,8)下降到2020年的117(7,9)。应当指出,随着接受检查人数的增加,在抽样期间,结核病患病率以及艾滋病毒感染率的绝对值和每10万人的数字都有所下降。如果在2013年达到466(35,1),到2020年已经达到299(20,2)。在车臣共和国感染艾滋病毒的公民中,抽样期间还发现167人患有肺结核。在艾滋病毒和结核病合并感染者中,有148人接受了定期体检。从2013年到2020年,每10万人中艾滋病毒/结核病合并感染的流行率以及不含结核病的艾滋病毒总体流行率和不含艾滋病毒的结核病总体流行率趋于下降。从2006年到2006年,这些变化相当显著。基于社会经济、人口、流行病学和临床原因,艾滋病毒感染与结核病合并的问题仍然存在于包括车臣共和国在内的俄罗斯联邦所有组成实体。2013-2020年,车臣共和国境内艾滋病毒、结核病和艾滋病毒/结核病合并感染的发病率和流行率下降,可能是由于经济发展水平的提高、有利的社会方案和人口状况的稳定、демографической ситуации、药物滥用(包括静脉注射)的总体减少。材料和技术设备以及传染病和抗结核服务的人员配备也有所改善。需要进一步研究在新型冠状病毒感染大流行期间获得新特征和特征的社会重大感染(HIV、TB、病毒性肝炎)的流行过程特异性。
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引用次数: 0
Тhree similar cases of plasmablastic lymphoma in HIV-infected persons Тhree hiv感染者浆母细胞淋巴瘤的类似病例
Q4 Medicine Pub Date : 2022-08-31 DOI: 10.22328/2077-9828-2022-14-2-83-90
N. Klimova, А. А. Gaus, А. О. Ramzina, I. V. Bazhuhina
X-ray morphological and clinical picture with three cases of plasmablastic lymphoma among HIV-infected with a distinctive localization of neoplastic process in the head-neck area is observed. Plasmablastic lymphoma is quite a rare pathology, characterized by extremely aggressive course of the disease and multiplicity of damage. Due to this fact, it represents a medical issue, as late diagnosis of the tumor leads to a high frequency of relapse and, accordingly, to poor prognosis.
观察了3例hiv感染的浆母细胞淋巴瘤的x线形态和临床表现,肿瘤过程在头颈部区域具有独特的定位。浆质母细胞淋巴瘤是一种非常罕见的疾病,其特点是病程极具侵袭性和损伤的多样性。由于这一事实,这是一个医学问题,因为肿瘤的晚期诊断导致复发的频率很高,因此预后不良。
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引用次数: 0
Medicinal products me too: value in the pharmaceutical market 医药产品我也是:医药市场的价值
Q4 Medicine Pub Date : 2022-08-31 DOI: 10.22328/2077-9828-2022-14-2-91-97
V. Borovskaya, A. A. Kurilyov, A. Kolbin
Introduction. According to expert estimates, most of medicinal products, presented in the pharmaceutical market, are metoo. However, there is no established definition of the term.The objective of research is to assess the value of medicinal products metoo for the modern society.Materials and Methods. Systematic observation and analysis of publications, related to medicinal products metoo.Results and discussion. It was found that despite the spread of medicinal products metoo, this term is not defined in the legal sphere of any country which means there is no judicial system to control the appearance of innovative products in the market, raising doubt about the objectivity of financing, costs refund of medical technologies. Meanwhile, there are possible advantages among the medicinal products metoo, both comparing each other and regarding premium ones in their category.Conclusion. On the one hand, metoo is considered to be low-innovative medicinal products. However, there can be more effective and safer medicinal products among them, comparing already existing ones in the pharmaceutical market. On the other hand, such a wide spread leads to some obstacles for really innovative products, premium in their category. Therefore, metoo is a pressing issue for the world scientific community.
介绍。据专家估计,医药市场上的大多数医药产品都是metoo。然而,这个术语并没有确定的定义。研究的目的是评估医药产品metoo对现代社会的价值。材料与方法。对与药品metoo相关的出版物进行系统的观察和分析。结果和讨论。研究发现,尽管医药产品metoo的传播,但这一术语在任何国家的法律领域都没有定义,这意味着没有司法系统来控制创新产品在市场上的出现,这使人们对医疗技术融资、成本退还的客观性产生了怀疑。同时,医药产品之间也可能存在优势,无论是相互比较还是同类产品的溢价。一方面,metoo被认为是低创新的医药产品。但是,与医药市场上已有的产品相比,其中可能有更有效、更安全的药品。另一方面,如此广泛的传播给真正创新的产品带来了一些障碍,在他们的类别中是溢价的。因此,metoo是世界科学界迫切需要解决的问题。
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引用次数: 0
On the procedure for referring citizens 18 years and older with HIV-AIDS for medical and social examination (to help a practicing doctor) 关于转介18岁及以上感染艾滋病毒/艾滋病的公民进行医疗和社会检查的程序(帮助执业医生)
Q4 Medicine Pub Date : 2022-08-31 DOI: 10.22328/2077-9828-2022-14-2-98-105
E. M. Ugleva, T. Y. Yamschikova
The article discusses the main points of the form 088/u «Referral for medical and social examination (MSE) by a medical organization: drawn up by specialists of medical organizations (MO), when sending citizens for medical and social examination, causing difficulties in filling out for specialists of the MO and containing the greatest informative for MSE.
文章讨论了088/u表格“医疗组织的医疗和社会检查(MSE)转诊”的要点:由医疗组织的专家起草,在派遣公民进行医疗和社会审查时,导致填写MO专家的困难,并为MSE提供了最大的信息。
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引用次数: 0
Genetic profile and characteristics of HIV-1 drug resistance mutation in the Krasnodar region over the 2014 to 2019 2014 - 2019年克拉斯诺达尔地区HIV-1耐药突变基因谱及特征分析
Q4 Medicine Pub Date : 2022-08-30 DOI: 10.22328/2077-9828-2022-14-2-20-30
А. Antonova, А. S. Tumanov, А. V. Lebedev, Е. V. Kozyennova, L. N. Glinkina, V. Kulagin, А. B. Shemshura, P. V. Lebedev, L. V. Khoteleva, M. Bobkova
Objective. Molecular genetic analysis of AIDS-1, having spread in the territory of Krasnodar region over the 2014 to 2019, including analysis of drug resistance mutationMaterials and methods. The study used the collection of samples, obtained from 478 HIV-infected people, living in the territory of Krasnodar region over the 2014 to 2019; out of them 155 received antiretroviral therapy (ART). Genotyping of the obtained samples was carried out with the further phylogenetic analysis, including detailed analysis of identified unique recombinant forms of HIV-1.Results. It is shown that HIV-1 sub-subtype A6 (80,5%) continues dominating in the territory of Krasnodar region, genetic variant B (9,2%) is the second most common one. Also 11 unique recombinant forms (URFs) were discovered, 10 out of which are the result of A6 and B genetic variants recombination. Drug resistance mutations were registered with 114 patients, received ART (73,6%); primary mutations — M184V and A62V. Provisional indicator of transmissible drug resistance in the population of naïve patients is 4,6% (15/323); primary mutations — K103N и G190S. Conclusion. The analysis of genetic profile and HIV-1 drug resistance mutation is carried out in the territory of Krasnodar region over the 2014 to 2019.
客观的2014年至2019年在克拉斯诺达尔地区传播的AIDS-1的分子遗传学分析,包括耐药性突变的分析材料和方法。该研究使用了2014年至2019年期间居住在克拉斯诺达尔地区的478名艾滋病毒感染者的样本;其中155人接受了抗逆转录病毒治疗。对获得的样本进行了基因分型和进一步的系统发育分析,包括对已鉴定的独特重组形式的HIV-1进行了详细分析。结果表明,HIV-1亚型A6(80.5%)在克拉斯诺达尔地区继续占主导地位,遗传变体B(9.2%)是第二常见的变体。此外,还发现了11种独特的重组形式(URF),其中10种是A6和B基因变体重组的结果。114名接受抗逆转录病毒治疗的患者登记了耐药性突变(73,6%);主要突变——M184V和A62V。幼稚患者群体中传播性耐药性的临时指标为4.6%(15/323);主要突变K103NиG190S。结论2014年至2019年,在克拉斯诺达尔地区进行了基因图谱和HIV-1耐药性突变分析。
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引用次数: 2
Аdverse events underlying antiretroviral therapy in children with HIV infection Аdverse艾滋病毒感染儿童抗逆转录病毒治疗的潜在事件
Q4 Medicine Pub Date : 2022-08-30 DOI: 10.22328/2077-9828-2022-14-2-40-49
E. Gordon, E. Yastrebova, A. Podymova
Introduction. Human immunodeficiency virus infection can alter properties of blood vessels in children and increase the risk of development of cardiovascular diseases in the future. Today the actual contribution of the effects of both HIV infection and antiretroviral therapy into such changes remains unknown. Objective. We seek to assess adverse events, including metabolic disorders (dyslipidemias), underlying antiretroviral therapy, and to determine the relation between metabolic disorders and intima injury in children receiving antiretroviral therapy (ART).Materials and methods. The adverse events were investigated within the framework of a prospective and retrospective study. The study included evaluation of biochemical parameters in relation to the therapeutic regimen; calculation of atherogenic index of plasma; and determination of incidence of dyslipidemia in children. In addition to standard tests, children on ART were evaluated for insulin resistance (using HOMA-IR) and submitted to diagnostic imaging including Doppler ultrasonography of brachiocephalic arteries and veins.Results. Children on protease inhibitor-based ART have higher total cholesterol, LDL and triglyceride levels in comparison to both children on NNRTI-based ART and children who do not receive ART. LDL levels in children on long-term ART remained within the tolerance range and were clearly higher than those in children who did not receive ART. Carotid IMT was higher in children on NNRTI-based ART in comparison to those who received protease inhibitor-based therapy; and the correlation analysis conducted revealed positive correlation between the age and carotid IMT: The later ART was prescribed, the greater IMT was, which most likely was attributable to HIV effects.Conclusion. Prescription of antiretroviral therapy at an older age results in changes in the intima-media complex, which may give evidence to vasoprotective effects of the therapy. Since HIV is directly involved in causing injury to the intima, it is advisable to start managing HIV infection in children as soon as they are diagnosed with the infection; and children to whom ART is prescribed at an older age and who develop dyslipidemia should be additionally evaluated by medical imaging with Doppler ultrasonography with carotid IMT measurement.
介绍人类免疫缺陷病毒感染会改变儿童血管的特性,并增加未来患心血管疾病的风险。今天,艾滋病毒感染和抗逆转录病毒治疗对这种变化的实际影响仍然未知。客观的我们试图评估不良事件,包括代谢紊乱(血脂异常),潜在的抗逆转录病毒治疗,并确定接受抗逆转录病毒疗法(ART)的儿童代谢紊乱和内膜损伤之间的关系。材料和方法。在前瞻性和回顾性研究的框架内对不良事件进行了调查。该研究包括评估与治疗方案相关的生化参数;血浆动脉粥样硬化指数的计算;以及确定儿童血脂异常的发生率。除了标准测试外,接受ART治疗的儿童还接受了胰岛素抵抗评估(使用HOMA-IR),并接受了诊断成像,包括臂头动脉和静脉的多普勒超声检查。后果与基于NNRTI的ART儿童和未接受ART的儿童相比,基于蛋白酶抑制剂的ART儿童的总胆固醇、低密度脂蛋白和甘油三酯水平更高。长期接受ART儿童的低密度脂素水平仍在耐受范围内,明显高于未接受ART儿童。与接受蛋白酶抑制剂治疗的儿童相比,接受基于NNRTI的ART的儿童颈动脉IMT更高;进行的相关性分析显示,年龄与颈动脉IMT呈正相关:ART开得越晚,IMT越大,这很可能归因于HIV的影响。结论老年人服用抗逆转录病毒疗法会导致内膜-中层复合体的变化,这可能为该疗法的血管保护作用提供证据。由于艾滋病毒直接导致内膜损伤,建议在儿童被诊断为感染后立即开始管理艾滋病毒感染;以及年龄较大且出现血脂异常的儿童,应通过多普勒超声和颈动脉IMT测量的医学成像进行额外评估。
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引用次数: 0
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HIV Infection and Immunosuppressive Disorders
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