The treatment of HIV infection in Latvia by using highly active antiretroviral therapy (HAART) was started in 1996. The prevalence and tendencies of HIV drug resistance among treated and treatment-naive patients in Latvia in the years 2006-2007 were evaluated in this study. Data of HIV genotyping, performed in 132 HIV-1 infected during years 2006-2007 by TRUGENE HIV-1 genotyping assay (BayerHealthCare-diagnostics) are included in the study.Analysis of data showed that in the group of treatment-naive individuals majority carried wild type virus. Prevalence of resistance-associated mutations (RAMs) in the treatment-naive group according to IAS list was 28%. In most cases it was NRTI mutation A62V that is associated with multinucleoside resistance caused by Q151M, its effect in the absence of Q151M is not known. By many authors A62V is supposed to be a result of polymorphism in RT gene and is excluded from the list of resistance mutations. High prevalence of A62V is typical for HIV-1 subtype A. As majority of treatment-naive cases (89%) in this study were with HIV-1 subtypes A or AE, we excluded A62V mutation and estimated RAMs prevalence in group of treatment-naive HIV-infected individuals as 7%. Minor PI mutations were not included in analyses. In Europe published rates generally very between 5% and 15%.In the group of treatment-experienced HIV infected people 25/75 were with HIV-1 subtype B, the rest part -with non-B subtypes: A/AE (35/75), CRF -01AE (7/75), B/AE (4/75) and others. In treatment-experienced patients RAMs prevalence was estimated as 58.6%. Most frequently RAMs were found for nucleoside reverse trans criptase inhibitors (NRTI) (49.3%) followed by non-nucleoside reverse transcriptase inhibitors (NNRTI) (22.6%) and protease inhibitors (PI) (16%).In the group of NRTI mutations M184V (26/75; 34.6%), A62V (12/75; 16.0%) and T215Y (8/75; 10.6%), in NNRTI mutations K103N (10/75; 13.3%), G190S (6/75; 8.0%), in PI group mutations L90M (6/75; 8.0%) and M461/L (6/75; 8.0%) occurred most frequently.The following drug susceptibility was predicted according to the Trugen expert interpretations: in 33/75 (44%) patients no evidence of resistance, in 21/75 (28%) patients resistance to 1 drug class (NRTI -16/75 NNRTI -4/75, PI -1/75), in 17 patients (22.6%) resistance to 2 drug classes (NRTI+NNRTI -9/75, NRTI+PI -7/75, NNRTI+PI -1/75) and in 3/75 (4%) patients resistance to all 3 classes of drugs (NRTI+NNRTI+PI).We conclude, that prevalence of RAMs in treatment-naive HIV infected persons in Latvia is comparable with prevalence in Europe. The origin of predominated mutation A62V associated with NRTI at present is not clear. In more than half of treated HIV infected patients HIV resistance to at least one HAART class was predicted. NRTI+NNRTI 12.0% no evidence of resistance 44.0% NRTI 21.3% NRTI+PI 9.3% 3 classes 4.0% NNRTI+PI 1.3% PI 1.3% NNRTI 5.3%
Under observation were 122 young children (up to 3 years of age), who were identified markers of active forms of herpes virus infections. Markers were studied by PCR in blood, smear from tonsils, saliva, cerebrospinal fluid, urine with determination DNA of HSV 1—2 type, EBV, CMV, HHV-6 type, antigens were determined by indirect immunofluorescence in blood lymphocytes, by ELISA in serum — antibodies of the classes IgM and IgG. Herpesvirus infection occurs at an early age and contributes to the formation of various infectious and somatic pathology. In children from birth to 1 year of life, CMV infection in the form of a mono-infection with symptoms of CNS damage, generalized forms, neutropenia is more common (79% of cases). In children aged 1 to 2 years, in 76% of cases, HHV-6 infection is detected, more often in mixed variants. Patients of this group are observed with a long subfebrile condition, neutropenia, infectious mononucleosis. In the third year of life, there is an increase in infection of children with EBV, with approximately the same frequency of EBV and HHV-6, most often in mixed forms, the clinical manifestations of which is a typical symptom complex of infectious mononucleosis. At this age, the active persistence of herpes viruses contributes to the formation of a group of frequently ill children. Thus, when examining young children with various pathologies, it is necessary to diagnose herpes virus infection using modern methods to detect its active forms for the timely administration of etiotropic therapy.
The article presents the stages of implementation of the principles of lean production in the healthcare of the Russian Federation, outlines the goals and prospects of projects to optimize the quality and safety of medical care, emphasizes the role of nursing specialists in improving the ideology of a patient-oriented medical organization.
The article is devoted to an urgent problem of public health, i.e. ensuring the quality and safety of emergency tetanus immunization. The issues of storage of immunobiological drugs are considered. The technology of administration of tetanus toxoid and anti-tetanus serum is presented.
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