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The review analyzes the prevalence and pathogenetic aspects of HIV infection. The main clinical and morphological variants of kidney damage in HIV infection are outlined. The prevalence of kidney damage in HIV infection is 20–30%, which are represented by such clinical and morphological variants as HIV-associated nephropathy (VAN), immunocomplex HIV-associated kidney disease, and thrombotic microangiopathy. In patients with HIV infection who are not treated with antiretroviral therapy (ART) the most common type of kidney disease is HIVAT. A decrease in the number of CD4+ cells, high viral load, advanced age, and the presence of kidney pathology in the next of kin are risk factors for the development of HIVAT. Specific risk factors for kidney damage in HIV infection are the use of antiretroviral drugs (tenofovir), the uncontrolled use of which is accompanied by tubular dysfunction. In HIV infection, the degree of immunodeficiency correlates with the severity of kidney damage. The most common histopathological manifestations of kidney damage in individuals with HIV infection are focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, immunoglobulin A nephropathy, and mesangioproliferative glomerulonephritis. Hypertension, nephrotic syndrome, and reduced CD4+ cells are predictive of renal failure in HIV infection. In patients with HIV infection who are treated with ART the appearance of hypokalemia, nocturia, polyuria, microhematuria, and/or subnephrotic proteinuria is indicative of tubulointerstitial disease. To assess the total filtration function of the kidneys in people with HIV infection, the most acceptable formula is CKD-EPI.
The review analyzes the prevalence and pathogenetic aspects of HIV infection. The main clinical and morphological variants of kidney damage in HIV infection are outlined. The prevalence of kidney damage in HIV infection is 20–30%, which are represented by such clinical and morphological variants as HIV-associated nephropathy (VAN), immunocomplex HIV-associated kidney disease, and thrombotic microangiopathy. In patients with HIV infection who are not treated with antiretroviral therapy (ART) the most common type of kidney disease is HIVAT. A decrease in the number of CD4+ cells, high viral load, advanced age, and the presence of kidney pathology in the next of kin are risk factors for the development of HIVAT. Specific risk factors for kidney damage in HIV infection are the use of antiretroviral drugs (tenofovir), the uncontrolled use of which is accompanied by tubular dysfunction. In HIV infection, the degree of immunodeficiency correlates with the severity of kidney damage. The most common histopathological manifestations of kidney damage in individuals with HIV infection are focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, immunoglobulin A nephropathy, and mesangioproliferative glomerulonephritis. Hypertension, nephrotic syndrome, and reduced CD4+ cells are predictive of renal failure in HIV infection. In patients with HIV infection who are treated with ART the appearance of hypokalemia, nocturia, polyuria, microhematuria, and/or subnephrotic proteinuria is indicative of tubulointerstitial disease. To assess the total filtration function of the kidneys in people with HIV infection, the most acceptable formula is CKD-EPI.
Aim. To determine the general patterns and distinctive features of the formation of the HIV epidemic in chronology in various administrative territories of the Vologda Region.Materials and methods. The data of the epidemiological survey maps of HIV infection foci, reports «Causes of mortality of HIV-infected», statistical observations were analyzed: form No. 61 «Information on the contingent of HIV-infected patients», form No. 4 of the Federal State Statistical Observation, forms of the Vologda Regional Center for the Prevention and Control of AIDS and Infectious Diseases, materials of the North-Western District Center for the Prevention and Control of AIDS. Dynamic monitoring of the HIV epidemic in the Vologda Region (since 1995) and evaluation of the effectiveness of the national project to combat HIV infections were carried out.Results and discussion. On the territory of the Vologda Region, the trend of stability of the indicator of HIV infection remains. The prevalence of the population is increasing, accompanied by the identification of patients at late stages with the manifestation of secondary diseases. In the region, the HIV epidemic corresponds to the main trends of the epidemic process in the North-Western Federal District (NWFD) with some differences. The dominant transmission routes are parenteral (39.9% in 2021) and heterosexual. Over the past 5 years, there has been an upward trend in homosexual transmission of infection among men who have sex with a men (MSM), the share of which increased in 2021 by 2 times compared to 2017 and amounted to 3.1%. The detection rate in 2021, calculated for 100 thousand surveyed, in the Vologda Region was 111.3 (in the NWFD — 160.1). The highest detection rate of HIV infection was observed among MSM — 14.3% (in the NWFD — 4.1%), among injecting drug users (IDUs) — 1.0% (in the NWFD — 1.1%), among persons in prison — 1.8% (in the NWFD — 1.8%). One of the main causes of death in HIV-infected patients is the late detection of the disease and the initiation of antiretroviral therapy (ART). During the entire period of observation, the epidemic was most intense in Cherepovets and Vologda, since 2000 there has been a gradual spread of infection with involvement in the process in rural areas.Conclusion. The results obtained demonstrate the importance of implementing different models of the main stages of diagnosis, prevention and treatment of people in urban and rural areas, which is included in the developing concept of personalized HIV medicine. It is necessary to carry out additional measures for the active identification and registration of dispensary patients, the formation of adherence to dispensary monitoring and therapy, the timely appointment of ART, the introduction of new approaches to providing medical care to HIV-infected patients in the districts of the region.
Aim. Determination of the causes of deaths and analysis of the survival of people living with HIV, depending on an adherence to dispensary observation and treatment. Materials and methods. The analysis of socio-demographic characteristics and clinical and laboratory data of 284 adult HIV patients observed in 1999–2011 at the Lomonosov Interdistrict Hospital named after I. N. Yudchenko was carried out. Patients who followed the prescribed monitoring regimen (at least 2 times a doctor’s visit during the year) were considered committed to dispensary supervision. Patients who observed the regularity and continuity of monitoring and receiving antiretroviral therapy (ART) were considered committed to treatment. Among the patients included in the study, 115 people were committed to treatment or follow-up and 169 patients were non-committed. Objective (biological) indicators of adherence and effectiveness of treatmentwere the number of CD4 lymphocytes and the level of HIV viral load. Based on the method of comparing survival curves, factors related to the life expectancy of HIV patients were assessed, taking into account the gender of patients, their adherence to monitoring and treatment, indicators of HIV viral load and the number of CD4 lymphocytes and the outcome of the disease from the moment of registration at the dispensary and over the next 120 months (after 3 months, 6 months, 1.5 years, 2 years, 5, 7 and 10 years). Results and discussion. Significant differences were found in the survival curves of patients who received and did not receive ART (117.9 and 91.4 months, p<0.005) and patients who were committed and non-committed to therapy (116.9 and 83.8 months, p<0.005). Regardless of adherence to outpatient follow-up and therapy, the survival time of women compared to men for the entire follow-up period was longer (105.0 and 92.4 months, respectively, p<0.005). Among those committed to treatment, 21% of patients died due to concomitant somatic pathology, 5% from injuries incompatible with life. In the group of those committedto follow–up, the causes of deaths in 12% were various somatic pathology, brain lymphoma — in 1% and injuries incompatible with life — in 3% of cases. The highest mortality rates were recorded among patients who were not exposed to ART (71%) and the routine of follow-up (52%). Almost half of these patients (49%) died from secondary HIV infections, of which 85% of cases were posthumously diagnosed with tuberculosis, mainly the pulmonary form of the disease. The second most common cause of death was violent death, including drug poisoning. Conclusion. Regular dispensary observation, timely initiation of ART and adherence to therapy make it possible to control the disease, prevent the development of opportunistic pathology, and improve the quality and life expectancy of patients with HIV infection. Despite the increased availability of ART and strategies for active involvement and retention of patients in dispensary care, issues of patient adherence to therapy remain key in the management of HIV patients.
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