Background: the microbiota of the gastrointestinal tract is one of the important factors that ensure the normal functioning of the human body. Patients with HIV infection are most susceptible to intestinal infections and changes in the composition of the microbiota, both due to exposure to the virus itself and as a result of reduced immunity. This article describes changes in the composition of the intestinal microflora of patients with HIV infection at the stage of secondary diseases, receiving antiretroviral therapy and not. Aims: to determine the composition of the gut microbiome in patients with HIV infection on and off antiretroviral therapy using DNA sequencing of the hypervariable regions of the 16S rRNA gene. Materials and methods: the object of the study was a group of patients in the amount of 10 people with a documented confirmed diagnosis of HIV infection and diarrheal syndrome. In order to clarify a possible etiological factor and determine the characteristics of the microbiocenosis of the gastrointestinal tract, stool analysis was performed using the 16s rRNA sequencing method. Results: the study revealed significant changes in the composition of the microbiome: depletion of the Bacteroidetes type, increased number of the Proteobacteria type. A statically significant difference was found in the composition of the types of microbiota in healthy people and patients with HIV infection (p0.05). The normal flora was represented by only two microorganisms: Bifidobacterium breve and Lactobacillus rhamnosus. Conditionally pathogenic microorganisms were identified: Enterococcus faecium, Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, Enterococcus durans, Klebsiella sp., Pantoea agglomerans, Klebsiella variicola, Enterococcus hirae, Escherichia coli TOP550-1, Clostridioides difficile, Staphylococcus aureus. These bacteria may be the cause of diarrheal syndrome in patients with HIV infection. Conclusions: HIV infection leads to a decrease in bacterial diversity, impoverishment of the normal flora, and the formation of a specific microbial profile. A number of conditionally pathogenic microorganisms can cause diarrhea in patients with HIV infection. Analysis of 16s rRNA sequencing can be used as a non-invasive method for diagnosing changes in the composition of the intestinal microflora and in order to clarify the etiological factor of diarrheal syndrome.
Lyell's syndrome or toxic epidermal necrolysis (TEN) is more common with human immunodeficiency virus (HIV) infection than in the general population. The article describes a clinical case of Lyell's syndrome in an HIV-infected patient who was first prescribed ART in combination with valganciclovir. The diagnosis was made on the basis of characteristic clinical manifestations and the exclusion of another similar pathology. On the background of the therapy, the rash regressed, the areas of damaged skin became epithelialized, the body temperature returned to normal. A differential diagnosis was made with measles, Stevens-Johnson syndrome, staphylococcal infection. Against the background of the therapy, the patient's condition was positive.
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