Late-stage HIV Infection Research Articles

ТУБЕРКУЛЕЗ ЛЕГКИХ У БОЛЬНЫХ ВИЧ-ИНФЕКЦИЕЙ НА ПОЗДНИХ СТАДИЯХ И ПСИХИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ

According to the data of a retrospective assessment of the medical histories of 238 patients, the features of the clinical course of pulmonary tuberculosis in patients with late-stage HIV infection and mental pathology in various morbid variants are considered in a comparative aspect. The data on age-sex and social characteristics, clinical, radiological and bacteriologicalfeatures of the course of the disease in the observed patients are presented. It was found that disseminated (39.4%) and generalized (24.5%) forms of the disease prevailed in patients with pulmonary tuberculosis and late-stage HIV infection in combination with mental illnesses. Bacterioexcretion was observed in 60.6% of patients, including 70.2% of patients with multidrug-resistant tuberculosis and 44.7% of patients with cavities. Distinctive clinical and radiological signs of the course of tuberculosis in patients with various comorbid variants of these nosologies are presented, which is essential for the development of patient-oriented management programs and improvement of treatment effectiveness in these severe categories of patients.

Risk factors and adverse drug reactions in HIV/AIDS patients at Undata Regional Hospital in Palu City, Indonesia

AIDS (acquired immunodeficiency syndrome) is a clinical manifestation of the late stage of HIV infection (human immunodeficiency virus). This virus attacks CD4 cells in the immune system which is an important component in fighting infection. Without treatment, HIV can gradually destroy the immune system and lead to AIDS. This study aims to identify risk factors and determine and identify the type of ADR in HIV/AIDS patients at Undata Regional General Hospital Palu, Central Sulawesi province. This study used a cross-sectional observation method with prospective data collection, with a sample of 126 patients. Based on the results of the study, patients with HIV/AIDS had the most risk factors, namely homosexuality as many as 73 patients (58%), at the clinical stage, namely stage 3, 50 patients (39%), on opportunistic infection data, namely candidiasis, 35 patients (33%), and the initial CD4 cell count of <200 cells/mm3 in 27 patients (21%). Patients with HIV/AIDS who experienced ADR using antiretroviral drugs were 255 out of a total of 126 patients. Types of ADR that occur in HIV/AIDS patients include fever (6%), dizziness (47%), nausea (12%), vomiting (7%), insomnia (15%), easy hunger (1%), Hb low (1%), weakness (1%), rash (9%), headache (1%). Overall, these findings contribute valuable information for developing targeted interventions and improving the overall care and outcomes for individuals with HIV/AIDS.

Features of clinical manifestations and diagnosis of comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients with late stages of HIV infection with immunodeficiency

Aim. To study the features of clinical manifestations and diagnosis of comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients with late stages of HIV infection with immunodeficiency.
 Materials and methods. The prospective study included 120 newly identified patients with disseminated pulmonary tuberculosis with Mycobacterium tuberculosis, stage IVB of HIV infection, in the phase of progression and in the absence of antiretroviral therapy, aged 2953 years, who were randomized into 1A and 2A main groups and 1B and 2B comparison groups. Group 1A included 29 patients with comorbidity and pneumocystis pneumonia and group 2A 31 patients with comorbidity of disseminated pulmonary tuberculosis, coronovirus pneumococcal pneumonia, and group 1B and 2B comprised 29 and 31 similar patients, but without coronovirus pneumonia. To diagnose coronavirus pneumonia, PCR of SARS-CoV-2 RNA was used in smears from the nasopharynx and oropharynx, in sputum or in endotracheal aspirate. To detect Pneumocystis jirovecii, the causative agent of pneumocystis pneumonia, a microscopic examination of diagnostic material from the respiratory tract with RomanovskyGiemse and GrokottGmri coloration was carried out, and to detect Streptococcus pneumoniae, the causative agent of pneumococcal pneumonia, the diagnostic material was seeded on special nutrient media with determination of the drug resistance of the resulting culture to broad-spectrum antibiotics. Statistical data processing was carried out using the Microsoft Office Excel 2019 program with the calculation of the average in the group and the standard error of the average, confidence interval.
 Results. The comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients in the late stages of HIV infection, in the phase of progression and in the absence of antiretroviral therapy was characterized by severe immunodeficiency, generalization of tuberculosis with multiple extrapulmonary lesions and severe pneumonia. This determines the similarity of clinical manifestations and respiratory symptoms, and also makes it difficult to visualize computed tomographic changes consisting of a complex simultaneous combination of four pathological syndromes: dissemination, pleural pathology, increased pulmonary pattern and adenopathy. Simultaneous layering of several pathologies with the same type of clinical manifestations and computed tomographic changes requires a comprehensive etiological diagnosis of specific diseases to prescribe timely comprehensive treatment and reduce the lethality of this heavy contingent of patients.
 Conclusion. Patients with disseminated pulmonary tuberculosis and HIV infection who are registered in the office of tuberculosis care for HIV-infected in the tuberculosis dispensary represent a high risk group of COVID-19 infection and the development of coronavirus pneumonia, and with severe immunodeficiency, pneumocystis and pneumococcal pneumonia, should be regularly subjected to preventive studies for timely detection of COVID-19, coronavirus, pneumocystis and pneumococcal pneumonia for the purpose of their emergency isolation and timely treatment.

Clinical features of the course of tuberculous meningitis in HIV-infected patients

Background. Central nervous system tuberculosis is one of the most severe forms of extrapulmonary tuberculosis, which is due to an unfavorable clinical course, a high incidence of neurological complications and deaths. Despite this, the problem of early diagnosis is still not solved.
 Aim. To study the clinical and laboratory-instrumental features of the early diagnosis of tuberculous meningitis in HIV-infected patients.
 Materials and methods. A retrospective analysis of 31 case histories of patients with tuberculous lesions of the meninges and central nervous system in the late stages of HIV infection who were treated at the Clinical Tuberculosis Dispensary of Krasnodar Territory in 20202022 was carried out. The data of clinical manifestations of the disease, the results of laboratory and instrumental methods of examination were analyzed. Statistical data processing was performed by Microsoft Office Excel 2021 with the calculation of averages, standard deviation.
 Results. Tuberculous lesions of the meninges and the central nervous system among HIV-infected people were more common in men of working age who were not previously registered in a tuberculosis dispensary. All HIV-infected patients had late stages of HIV infection with severe immunodeficiency: the content of CD4+ lymphocytes less than 100 cells was detected in 45.46%; from 100 to 200 cells/l of CD4+ lymphocytes were recorded in 36.36%, more than 200 cells/l in 18.18%. Also, in all the studied patients, the primary focus was established in the form of tuberculosis of the respiratory organs, represented in 56.52% of cases by disseminated pulmonary tuberculosis. More than 70% had generalized tuberculosis with damage to the kidneys, spleen, and peripheral lymph nodes. A feature of the manifestation of tuberculous meningitis in HIV-infected people can be considered a high frequency of acute increase in neurological symptoms. Of the cerebral manifestations, the most common were: headache, dizziness, photophobia. 13.04% of HIV-infected patients complained of nausea and vomiting. 91.30% showed signs of damage to the substance of the brain, represented by mono-, hemiparesis and damage to the cranial nerves, mainly IIIIV, VI, VII pairs. The composition of CSF in HIV-positive patients revealed the presence of mild pleocytosis (up to 100 cells/l) in 56.52% of cases. The nature of the change in the concentration of proteins, chlorides and glucose is nonspecific.
 Conclusions. The study revealed the features of medical and social characteristics, clinical and laboratory and instrumental picture of tuberculous meningitis in HIV-infected patients and without HIV infection.

Нейронспецифическая енолаза ликвора как объективный маркер когнитивных нарушений при ВИЧ-ассоциированной энцефалопатии

One of the main causes of cognitive dysfunction in a late stage of HIV infection is HIV-associated encephalopathy. The direct neurotropic impact of HIV creates the pathogenic basis for this clinical syndrome. The purpose — to evaluate the cognitive status and neuron-specific enolase (NSE) level in cerebrospinal fluid (CSF) in HIV-encephalopathy patients. Material and methods. 35 patients were included in the study. They were divided into two groups: 20 patients (9 females and 11 males) with cognitive dysfunction and confirmed diagnosis of HIV/AIDS and 15 patients (6 females and 9 males) were in comparison group. The cognitive status was investigated by mini-mental state examination (MMSE), international HIV-dementia scale (IHDS) and frontal assessment battery (FAB). CSF level of NSE were investigated by ELISA test. Results. Correlation between cognitive dysfunction severity and NSE level in CSF was determined in HIV-encephalopathy patients. Conclusion. NSE level changing in CSF is an objective indicator of clinical severity of HIV-encephalopathy and neurotropic impact of HIV.

Clinic and diagnosis and comorbidity of respiratory tuberculosis and viral pneumonia caused by <i>Herpes simplex virus, Cytomegalovirus Human</i> and SARS-CoV-2 in patients with late-stage HIV infection with immunodeficiency

Aim. To study the features of the social status, clinic and diagnosis of respiratory tuberculosis comorbidity and viral pneumonia caused by Herpes simplex virus type 1, Cytomegalovirus Human and SARS-CoV-2 in patients with late-stage HIV infection with immunodeficiency.
 Materials and methods. The prospective study included 25 patients with respiratory tuberculosis comorbidity with Mycobacterium tuberculosis, herpesvirus and coronavirus pneumonia, and 21 patients with respiratory tuberculosis with cytomegalovirus and coronavirus pneumonia (1a and 2a main groups) and, respectively, 25 and 21 similar patients, but without coronavirus pneumonia (1b and 2b comparison group), in the late stages of HIV infection with immunodeficiency. For the etiological diagnosis of herpesvirus- and cytomegalovirus pneumonia, PCR was used to detect the DNA of Herpes simplex virus type 1 and Cytomegalovirus Human in the diagnostic material of the respiratory tract, and for the etiological diagnosis of coronavirus pneumonia, PCR was used to detect SARS-CoV-2 RNA. Statistical data processing was carried out using the Microsoft Office Excel 2019 program with the calculation of the average in the group and the standard error of the average, confidence interval.
 Results. The comorbidity of respiratory tuberculosis, herpes-, cytomegalo- and coronavirus pneumonia in patients with late-stage HIV infection, in the phase of progression and in the absence of ART was characterized by severe immunodeficiency and generalization of tuberculosis with multiple extrapulmonary lesions. This determines the similarity of clinical manifestations and visualization of CT changes in this comorbidity, which makes it difficult to distinguish them due to the simultaneous layering of several pathologies with the same type of clinical manifestations at once and requires a comprehensive etiological diagnosis of specific diseases to prescribe timely comprehensive treatment and reduce the lethality of this heavy contingent of patients.
 Conclusion. Patients with tuberculosis of the respiratory system and HIV infection registered in the office of tuberculosis care for HIV-infected in the tuberculosis dispensary represent a high risk group of infection with COVID-19 and CVP disease, and with severe immunodeficiency and GWP and CMVP, should be regularly subjected to preventive studies for timely detection of COVID-19 for the purpose of their emergency isolation and treatment.

COVID-19-associated retinovasculitis in the late stage of HIV infection: a clinical case

A clinical case of retinovasculitis with coronavirus infection COVID-19 involving a female patient in the late stage of HIV infection is reported. The patient had no antiretroviral therapy. Clinical features of eye changes, their severity and dynamics influenced by the ophthalmic therapy were revealed. A relationship between the course of COVID-19 and the state of immunodeficiency causes by HIV was found. As a result of the long disease duration and the complications, the patient died.

Evaluation of colonoscopy results in HIV infected cases

Objective: GI system plays an important role in the clinical symptoms and pathogenesis of HIV infection. Significant progress has been made towards understanding the role of the GI system in both the early and late stages of HIV infection. In this study, our aim is to evaluate the results of colonoscopy in HIV-infected patients followed up in our clinic. Material and Methods: HIV (+) cases followed in our clinic were included in our study. The computer records of the cases were retrospectively examined and the findings of the patients who underwent colonoscopy were recorded. Age, gender, CD4 values and colonoscopy results of these patients were recorded simultaneously. Results: A total of 27 HIV-infected patients who underwent colonoscopy were included in our study. The mean age of the cases was 41.2, and the rate of males was 92.6% (25/27). It was observed that the mean age of patients with colonoscopy findings was 41.8, and the mean age of those without colonoscopy findings was 41.1. It was determined that 44.4% (12/27) of our cases in total had colonoscopic findings. While normal colonoscopic findings were reported in 15 (55.6%) of patients, benign anorectal diseases (fissure, hemorrhoids) were found in 7 (25.9%) and polyps were found in 3 of them (11.1%). CMV colitis was diagnosed in 2 (7.4%) patients with pathological diagnosis. Conclusion: As a result, although the number of our cases is small, it is observed that approximately 55% of patients have normal colonoscopy findings, but those with perianal disease and polyps have a higher CD4 count than those with normal colonoscopy. It has been revealed that patients with CMV infection also have a CD4 count of <200. Studies with more patients in HIV-infected patients will contribute to the diagnosis, follow-up, and treatment preferences of the patients.

The effect of a new coronavirus infection (COVID-19) on clinical and radiological manifestations in patients with comorbidity of respiratory tuberculosis, HIV-infection and opportunistic lung diseases: prospective study design

Aim. To study the features of clinical and radiological manifestations and diagnosis of COVID-19, respiratory tuberculosis and opportunistic lung infections (OIL) coinfection in patients with late stages of HIV-infection with immunodeficiency.&#x0D; Materials and methods. The study included 29 patients with COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in the late stages of HIV-infection with immunodeficiency (group 1) and 29 patients similar in all parameters without COVID-19 (group 2). All patients were underwent clinical and laboratory, radiation and bronchological examination, and microbiological, immunological, molecular genetic, cytological and histological examination of diagnostic material of the respiratory tract, cerebrospinal and pleural fluid, blood, urine and feces to identify pathogens of coinfection. Statistical data processing was carried out using the Microsoft Office Excel 2010 program with the calculation of the average in the group and the standard error of the average, confidence interval.&#x0D; Results. It has been established that co-infection with COVID-19, respiratory tuberculosis and opportunistic lung infections in patients with late stages of HIV-infection with immunodeficiency is manifested by a pronounced intoxication syndrome, bronchopulmonary manifestations and symptoms of damage to other organs and systems, which is due to the generalization of tuberculosis with extrapulmonary lesions and the development of opportunistic lung infections, as in patients without COVID-19. A computed tomogram of the chest organs with this coinfection visualizes the syndrome of dissemination, the syndrome of adenopathy and the syndrome of pathology of the pulmonary pattern, represented by the compaction of interstitial tissue in the frosted glass type, which is associated with the simultaneous layering of various pathologies, which complicates their differential diagnosis. This determines the similarity of clinical and radiological manifestations of COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in patients with late-stage HIV-infection with immunodeficiency, as in patients without COVID-19. This requires complex microbiological and molecular genetic research methods to identify specific pathogens for the appointment of timely treatment.&#x0D; Conclusion. Patients with COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in the late stages of HIV-infection with immunodeficiency pose a high risk of infection in a healthy population, taking into account their social maladaptation and non-adherence to examination and treatment. This requires an active diagnosis of COVID-19 in all patients with respiratory tuberculosis and HIV-infection who are registered in the office of anti-tuberculosis care for HIV-infected in an anti-tuberculosis dispensary, for emergency isolation and treatment.

The impact of legionellosis into fatal outcomes of pneumonia in Irkutsk

Aim. To study the diagnosis of legionellosis in patients who died because of pneumonia in Irkutsk (2016-2018).Materials and Methods. We performed 65 autopsies of patients who died from pneumonia in Irkutsk (2016-2018), studied their case histories, and interrogated 510 tap water samples for Legionella pneumophila by means of inoculation and polymerase chain reaction.Results. Among 65 fatal pneumonia outcomes registered in Irkutsk during 2016-2018, legionellosis has been confirmed in three cases (4.6%). Two of these patients were at the late stages of HIV infection while the third, 74-yearold, patient had multiple comorbid conditions. Nosocomial infection was suspected in one of these cases. None of these three patients left Irkutsk during the last month of their life. The assumed transmission factor was tap water, as Legionella pneumophila was found in tap water samples collected in 2013 and 2015.Conclusion. Patients with severe pneumonia need screening for legionellosis to perform the correct treatment, particularly during COVID-19 pandemic.

Dynamics of Plasmatic Levels of Pro- and Anti-Inflammatory Cytokines in HIV-Infected Individuals with M. tuberculosis Co-Infection.

Tuberculosis (TB) and HIV have profound effects on the immune system, which can lead to the activation of viral replication and negatively regulate the activation of T cells. Dysregulation in the production of cytokines necessary to fight HIV and M. tuberculosis may ultimately affect the results of the treatment and be important in the pathogenesis of HIV infection and TB. This work presents the results of a study of the expression of pro- and anti-inflammatory cytokines (IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-10, IL-1RA) in drug-naïve patients with dual infection of HIV/TB at the late stages of HIV-infection, with newly diagnosed HIV and TB, and previously untreated HIV in the process of receiving antiretroviral (ART) and TB treatment vs. a cohort of patients with HIV monoinfection and TB monoinfection. The study revealed that during a double HIV/TB infection, both Th1 and Th2 immune responses are suppressed, and a prolonged dysregulation of the immune response and an increased severity of the disease in pulmonary/extrapulmonary tuberculosis is observed in HIV/TB co-infection. Moreover, it was revealed that a double HIV/TB infection is characterized by delayed and incomplete recovery of immune activity. High levels of IL-6 were detected in patients with HIV/TB co-infection before initiation of dual therapy (2.1-fold increase vs. HIV), which persisted even after 6 months of treatment (8.96-fold increase vs. HIV), unlike other cytokines. The persistent enhanced expression of IL-6 in patients with dual HIV/TB co-infection allows the consideration of it as a potential marker of early detection of M. tuberculosis infection in HIV-infected individuals. The results of multivariate regression analysis showed a statistical trend towards an increase in the incidence of IRIS in patients with high IL-1Ra levels (in the range of 1550–2500 pg/mL): OR = 4.3 (95%CI 3.7–14.12, p = 0.53), which also allows IL-1Ra to be considered as a potential predictive biomarker of the development of TB-IRIS and treatment outcomes.

Comparison of Sleep Quality in Pre-HAART and on HAART HIV Patients

Background/aim: People with HIV are often reported to experience poor sleep quality. Factors that can cause poor sleep quality in HIV patients, including the use of ARV therapy. The pathophysiology of poor sleep quality in HIV patients is still unclear. Poor sleep quality is one of the complaints in the late stages of HIV infection, where it is suspected that HIV itself affects the biological center of sleep. This study was aimed to determine the comparison of sleep quality in HIV patients pre-HAART and with HAART more than 1 year. Method: This study uses data collection methods in the form of interviews with samples which will later be presented in the form of analytical observational study. Consecutive data collection on HIV patients before and after ARV therapy who was outpatient at the VCT outpatient clinic Dr. Soetomo General Hospital from June-July 2021. Data analysis using SPSS Version 23 for windows. Results: A total of 40 subjects were divided into HIV pre-HAART and on HAART. From the statistical analysis using SPSS program significant with p= 0.004 (OR 15.5 (95% CI (1.73-139.6)) Conclusion: HIV patients on HAART for more than 1 year are known to have increased 15.5 times the risk of poor sleep quality. Keywords: HIV, HAART, sleep quality.

Characteristics of new HIV diagnoses over 1995-2019: A clinic-based study in Montréal, Canada.

Characterization of populations at risk of acquiring HIV is required to inform the public health response to HIV. To identify potential changing needs in HIV prevention and care cascade, we aim to describe how the demographic profiles and exposure categories of newly diagnosed HIV positive individuals attending a large sexual health clinic in Montréal (Canada) evolved since the beginning of the antiretroviral therapy era in the mid-1990s. Using diagnosis data from participants of the Clinique médicale l'Actuel cohort of HIV-positive patients, we examined the distribution of exposure categories (sexual orientation, sexual behaviours, injection drug use, being born in an HIV-endemic country) by gender and year of diagnosis. Time trends in mean age and in the proportion of patients with late (CD4 <350 cells/μL) or advanced stage (CD4 <200 cells/μL) of HIV infection at diagnosis were assessed through meta-regressions. A total of 2,612 patients diagnosed with HIV between January 1st, 1995 and December 31st, 2019 were included. Overall, mean age was 35 years (standard deviation: 10 years) and remained stable over time. The proportion of patients with advanced stage of HIV infection decreased from 16% in 1995 to 4% in 2019. Although men who have sex with men (MSM) consistently accounted for the highest proportion of new diagnoses (77%, 2,022/2,612 overall), their proportion decreased since 2013. There was also a concomitant decrease in the proportion of people who inject drugs, with none of the newly diagnosed participants reporting injection drug use since 2017, and an important increase in the proportion of patients born in an HIV-endemic country (24%, 7/29 in 2019), especially among women. Compared to patients from non-endemic countries, those from HIV-endemic countries were characterized by higher proportions of heterosexuals (88% vs 17%) and of women (52% vs 7%), and were twice likely to get diagnosed at an advanced stage of HIV infection (32% vs 15%). In absolute numbers, MSM continue to account for the largest exposure category. However, patients from HIV-endemic countries, who tend to be diagnosed at later stages of HIV infection, constitute an increasing proportion of newly diagnosed individuals. These persons could face distinct barriers to rapid diagnosis. Tailoring HIV testing strategies and other prevention interventions to the specific unmet prevention needs of these individuals is warranted.

Клинический случай диагностики поздней стадии ВИЧ-инфекции у подростка с хореей

ВИЧ-инфекция среди возможных этиологических факторов неврологической патологии пока рассматривается редко, что приводит к поздней диагностике заболевания и несвоевременному началу специфической терапии. Неврологические проявления заболевания могут возникать в связи с прямым воздействием ВИЧ на нервную систему, оппортунистическими инфекциями и злокачественными новообразованиями, нейротоксичными эффектами антиретровирусного лечения и другими системными осложнениями. ВИЧ-ассоциированные неврологические расстройства вариабельны и представлены нейрокогнитивными нарушениями, энцефалопатией, миелопатией, полинейропатией, асептическим менингитом (менингоэнцефалитом). ВИЧ-энцефалопатия у детей проявляется в форме эмоциональных, когнитивных, двигательных, речевых нарушений. У взрослых больных как возможный клинический вариант ВИЧ-энцефалопатии рассматривается синдром хореи. В доступной литературе мы не встретили сообщений о развитии хорееподобного синдрома у ВИЧ-инфицированных детей. Описанный клинический случай демонстрирует диагностику поздней стадии ВИЧ-инфекции у ребенка 13 лет с синдромом хореи. Представленное клиническое наблюдение демонстрирует сложности диагностики ВИЧ-энцефалопатии у ребенка, что было связано с редким проявлением данного заболевания в детском возрасте в виде генерализованных гиперкинезов, а также с сокрытием матерью анамнестических данных о наличии у нее ВИЧ-инфекции. Таким образом, у детей с хореей диагноз возможен только при исключении заболеваний, ее вызывающих, а именно острой ревматической лихорадки, системного заболевания соединительной ткани, демиелинизирующих заболеваний, объемно-органической патологии центральной нервной системы, болезни Вильсона — Коновалова, а также ВИЧ-инфекции.

Epidemiological factors associated with the absence of previous HIV testing among HIV-positive persons in Singapore, 2012–2017

ObjectiveTo assess the temporal trend and identify risk factors associated with the absence of previous HIV testing prior to their diagnosis among HIV-positive persons in Singapore.Study designCross-sectional.Setting and participantsWe analysed...

Coronavirus infection in patients with HIV infection, features of the course

Purpose. Analyze and identify the features of the course of the new coronavirus infection (COVID-19) in HIV-infected patients.Materials and methods. An analysis of the course of coronavirus infection (COVID-19) was carried out in 16 patients with HIV infection who were hospitalized at the St. Petersburg State Budgetary Healthcare Institution Center for the Prevention and Control of AIDS and Infectious Diseases from April to October 2020. All patients underwent a study of biological material from the oropharynx and nasopharynx for COVID-19 and diagnosed based on a positive PCR result.Results. In HIV-infected patients with diagnosed coronavirus infection caused by COVID-19, signs of progression of HIV infection, clinical, immunological, virological (75%), opportunistic diseases and comorbidities (chronic viral hepatitis in the cirrhotic decompensated stage, cardiovascular diseases and others) (94%). A small sample of patients did not allow to determine with reliable accuracy the mutual influence of existing diseases and pathologies, but, of course, multiple comorbid pathologies play a role in the development of severe conditions and unfavorable outcomes. A clinical case is presented.Conclusion. The provoking factors have been identified that play a role in the development of infection and more severe forms of coronavirus infection caused by COVID-19 in HIV-infected patients (injecting drug use, alcohol abuse, late stage of HIV infection (4B, 4C) and progression of earlier stages (4A ), a low number of CD4 lymphocytes (less than 200 cells / μl), multiple comorbid pathology (HIV infection, opportunistic diseases, comorbidities, especially chronic liver damage in the stage of decompensated cirrhosis), absence, interrupted antiretroviral therapy, multiple changes of regimens, absence prevention of opportunistic diseases). A patient with HIV infection at ART. 4B with multiple comorbidity, the possibility of long-term persistence of the COVID-19 virus coronavirus with positive and negative results for more than 2 months and later development of lung damage caused by COVID-19 was established.

New coronoviral infection (COVID-19) combined with tuberculosis in patients at late stages of HIV infection with immunodeficiency

The study materials of 23 patients with COVID-19 with newly diagnosed tuberculosis at the late stages of HIV infection with an average CD4 + cells count not exceeding 30 cells/pl of blood and in the absence of antiretroviral therapy (the main group) and 23 patients with no COVID-19 (the comparison group) and the similar parameters are presented. The presence or absence of COVID-19 is characterized by social maladjustment, drug addiction, concomitant viral hepatitis B or C and COPD, generalized tuberculosis with extrapulmonary damage of various organs and the development of other opportunistic pulmonary infections, similar clinical and radiological manifestations, which can only be differentiated by microbiological and molecular genetic research methods. To prevent exogenous infection of the healthy population with COVID-19, it is imperative to organize an active regular examination of all patients with tuberculosis and HIV infection for COVID-19, especially at the later stages, in the TB care office for HIV-infected people at TB dispensaries.

New coronoviral infection (COVID-19) combined with tuberculosis in patients at late stages of HIV infection with immunodeficiency

The study materials of 23 patients with COVID-19, combined with newly diagnosed tuberculosis at the late stages of HIV infection with an average CD4+ cells count not exceeding 30 cells/μl of blood and in the absence of antiretroviral therapy (the main group) and 23 patients with no COVID-19 (the comparison group) and the similar parameters are presented. The presence or absence of COVID-19 is characterized by social maladjustment, drug addiction, concomitant viral hepatitis B or C and COPD, generalized tuberculosis with extrapulmonary damage of various organs and the development of other opportunistic pulmonary infections, similar clinical and radiological manifestations, which can only be differentiated by microbiological and molecular genetic research methods. To prevent exogenous infection of the healthy population with COVID-19, it is imperative to organize an active regular examination of all patients with tuberculosis and HIV infection for COVID-19, especially at the later stages, in the TB care office for HIV-infected people at TB dispensaries.

Genitourinary tuberculosis in the structure of autopsy morphological findings in deceased patients at the late stages of HIV infection

Introduction. The problem of tuberculosis (TB) has not lost its significance due to the overlapping epidemic of HIV infection and the addition of specific lesions at its late stages. It is due to the lack of adherence to antiretroviral therapy in a large number of patients. The high mortality rate in HIV-associated TB requires an increase in the interest of all doctors for the early detection of various TB localizations against the background of HIV, allowing the patient to be cured. For urologists, information on the frequency of genitourinary TB in HIV patients is of interest to improve its diagnosis. Purpose of the study. To identify the proportion of genitourinary TB in the structure of the specific lesions in patients with HIV-associated TB. Materials and methods. The case-records of 115 deceased patients with a combination of HIV infection and TB were retrospectively analyzed using a continuous method. The number of men among them was 81.7 ± 3.6% (94). The average age of men was 37.1 ± 27.2 years, women — 31.9 ± 6.3 years. The research results were processed statistically. Results. The average period from the moment of HIV infection detection to the registration of a lethal outcome was 2.8 ± 1.3 years, from the moment of TB diagnosis — 6.96 ± 7.3 years. The majority of patients with HIV infection had a stage of secondary diseases (93.1 ± 2.4%). At the time of admission to the TB dispensary, the average CD4 + lymphocyte level was 131.06 ± 75.8 cells/pL, 10.03 ± 2.5%. Anti-retroviral therapy was observed only in 19 (16.5 ± 3.5%) patients. In deceased patients disseminated pulmonary TB was more often verified at autopsy — 52.2 ± 4.7%, miliary — 7.8 ± 2.5%, infiltrative — 11.3 ± 3.0%. In patients with disseminated and miliary pulmonary TB, foci of dropout were often observed in the spleen (71.7 ± 5.8% and 55.6 ± 16.6%) and liver (46.7 ± 6.4% and 33.3 ± 15,7%). The kidney damage occurred in 60.0 ± 6.3% of patients with disseminated and 44.4 ± 16.6% miliary pulmonary TB. Kidneys TB was confirmed by bacterioscopic urine examination in three cases only (2.6 ± 1.5%) during life. Prostate TB was confirmed by analysis of expressed prostatic secretion on Mycobacterium tuberculosis (2.6 ± 1.5%) and was combined with kidney TB. The lesions of the lymphatic system during life were exposed in 17.4 ± 3.5% of patients. A pathomorphological examination revealed TB of intrathoracic lymph nodes in 37.4 ± 4.5%, intra-abdominal lymph nodes — in 22.6 ± 3.9%, peripheral — 6.1 ± 2.2%, more often in miliary and disseminated pulmonary TB. TB meningitis was registered in 31 cases as well as meningoencephalitis in 32 patients during life and at autopsy, respectively. Intestinal TB was confirmed by autopsy in 9.6 ± 2.7% of patients; during life, it was accompanied by the detection of the pathogen in the feces. The pancreatic TB was detected in 2.6 ± 1.5%, TB spondylodiscitis in 1.7 ± 1.2%, myocardial TB in 0.9 ± 0.9% and pericardium TB in 0.9 ± 0.9% cases. Conclusion. Thus, generalized TB is diagnosed in patients in the late stages of HIV infection, in the structure of which kidney damage is in second place, yielded only to spleen damage. Obtaining this information should form the alertness of urologists in terms of detecting and diagnosing genitourinary TB in patients with HIV infection.

1011. Efficacy and Safety of Doravirine in Treatment-Naïve Adults ≥50 Years Old With HIV-1

BackgroundNearly 50% of people living with HIV in the US are ≥50 years old. Older people are more likely to have late-stage HIV infection at diagnosis, greater risk for cardiovascular disease and certain cancers, and concurrent medications for common age-related conditions. Doravirine (DOR) is a next-generation NNRTI with activity against first-generation NNRTI-associated mutations, a neutral impact on lipids, and few drug-drug interactions with commonly used medications.MethodsWe compared Week 96 results from DOR Phase 2 and Phase 3 trials (P007, P018, and P021) in treatment-naïve adults ≥50 vs < 50 years old. 855 participants received DOR 100mg +2 NRTIs in P007 & P018 or fixed combination DOR/3TC/TDF in P021; 383 participants received ritonavir-boosted darunavir (DRV) +2 NRTIs in P018; and 472 received efavirenz (EFV) 600mg +FTC/TDF in P007 or fixed combination EFV/FTC/TDF in P021. Participants who took ≥1 dose of study drug were included; the Observed Failure approach was used for missing efficacy data. All analyses were done by descriptive statistics.ResultsOf 1710 participants, 187 (11%) were 50-70 (median 54) years old at study entry. Baseline characteristics and treatment outcomes are summarized below for participants < 50 vs ≥50 years old. The older cohort had more women, more participants with AIDS, and lower median CD4+ T-cell counts than the younger cohort, whereas baseline HIV-1 RNA was similar between age cohorts. Hypertension and use of analgesics were more common in older participants. In each treatment group, the older cohort had a higher proportion of participants with HIV-1 RNA< 50 copies/mL at week 96 and fewer discontinuations due to lack of efficacy than the younger cohort. Mean change in CD4+ T-cell count was similar between age cohorts in the DOR and DRV groups and was lower for older participants in the EFV group. Rates of drug-related AEs and serious drug-related AEs were similar between age cohorts across all treatment groups. Discontinuations due to drug-related AEs were similar between age cohorts in the DOR group and were slightly higher for older participants in the DRV and EFV groups.ConclusionDOR is a beneficial option for adults ≥50 years old, given its similar efficacy and favorable safety profile compared to younger adults.Doravirine Phase 2 and Phase 3 Trials in Treatment-Naïve Adults Disclosures Anthony Mills, MD, Gilead (Grant/Research Support, Advisor or Review Panel member)Janssen Pharmaceutica (Grant/Research Support, Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Shionogi (Grant/Research Support)ViiV Healthcare (Grant/Research Support, Advisor or Review Panel member) Elizabeth A. Martin, DO, MPH, MBA, Merck & Co., Inc. (Employee) Chih-Chin Liu, PhD, Merck & Co., Inc. (Employee) Martine Drolet, BPharm, LPH, MBA, Merck & Co., Inc. (Employee) Peter Sklar, MD, MPH, Merck & Co., Inc. (Employee)