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A spectrum of the opportunistic and associated diseases in patients with natural course of the HIV-infection
6. Babjuk M., Burger M., Zigeuner R. et al.//EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update -2013//Eur. Urology. - 2013. - Vol. 64, No 4. - P. 639-653.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-77-79
Bayjanov Allabergan Kadirovich, Research Institute of Virology, Ph. D. (candidate of Medical Science) Musabaeva Nargiza Erkinovna, Research Institute of Virology, Researcher E-mail: saodat.us@mail.ru
A spectrum of the opportunistic and associated diseases in patients with natural course of the HIV-infection
Abstract: The research has been aimed at studying of a degree of incidence of the opportunistic and associated diseases in patients with natural course of the HIV-infection. Development of a number of opportunistic diseases is the basic indicator of HIV-infection progression. Up to date, there are a number of scientific papers dedicated to studying of the opportunistic infections [1; 2]. Among the HIV-infected patients, tuberculosis [3] is mainly developed infection out of the opportunistic infections, which is one of the basis reasons for patients' death rate. The risk of tuberculosis reactivation in the HIV-infected patients with positive tuberculine test is 7-10% within a year, and 20-70% of new cases of active tuberculosis in the developing countries. Virus infections (CMV, virus hepatitis C, etc.) [4; 7] also have active influence on the immune system. It is known that the opportunistic diseases under the HIV-infection mutually aggravate the immune system state at the same time facilitating fast transition of the HIV-infection to the end stage of the disease. This is why there is a need to study a spectrum of the opportunistic diseases for the purpose of timely therapy of both the region-specific opportunistic diseases and the HIV-infection [5; 6; 8; 9].
Keywords: opportunistic diseases, chronic virus hepatitis B, C and D, cytomegalovirus infection, tuberculosis, lymphoma, chorioretinitis, pneumocystic pneumonia.
Materials and methods. The analysis of the opportunistic and associated diseases has been performed in 104 patients with natural course of the HIV-infection.
Among the examined patients 64 ones were male (61.5%), and female — 40 (38.5%). Average age of the patients was 39.9 years. Infection contamination periods in the examined patients varied from 2 to 10 years amounting in average to 5.20±0.31 years.
The opportunistic and associated diseases have been verified based on clinical-laboratory studies. Cytomegalovirus infection, virus hepatitis B, C, D and herpes simplex virus were identified on the basis of polymerase chain reaction (PCR). Pneumonogra-phy and head computed tomography were applied. Consultation
As you can see in the table, the HIV-infection in male-patients at the time of detection was observed at later stages as compared with women-patients (P<0.01). This was probably due to late seeking medical advice.
with an ophthalmologist together with eye-ground analysis were carried out in order to study eye damage under the cytomegalo-virus infection.
Results and discussion. In the course of patients allocation by gender and clinical stages the following fact should be taken into account that the number of male-patients at advanced HIV-infection stages (clinical stages 3-4) was practically twice as much as the female patients — 53 (50.9%) against 20 (19.2%) patients under P< 0.05. At detection of the HIV-infection 10 (9.60%) examined patients had the 1st clinical stage of the disease. 21 (20.2%) patients had the 2nd clinical stage, and — 30 (28.8%) patients had the 3rd clinical stage of the disease. 43 (41.4%) patients were under AIDS stage (4th clinical stage) (Table 1).
Allocation of patients with natural course of the HIV-dis-ease in accordance with the World Health Organization Classification (WHO) for the adolescents and the adults, depending on CD4-lymphocytes count, is shown in Table 2.
Table 1. - Allocation of the HIV-infected patients by gender and clinical stages of the disease (n=104)
HIV-infection stage Male-patients Female-patients Total
1st clinical stage 4 6.30 6 15.0 10 9.60
2nd clinical stage 7 10.,9* 14 35.0* 21 20.2
3rd clinical stage 19 29.7 11 27.5 30 28.8
4th clinical stage 34 53.1* 9 22.5* 43 41.4
Total 64 100 40 100 104 100
*P< 0.05
Sectiom 6. Medical science
Table 2. - Allocation of patients with natural course of the HIV-disease (n=194)
СD4-lymphocytes count HIV-infection clinical stage Total
I II III IV
1. >500/mm 3 6 (5.80%) 2 (1.90%) - - 8 (7.70%)
2. 200-499/mm3 4 (3.80%) 13 (12.5%) 18 (17.3) 19 (18.3%) 54 (51.9%)
3. <200/mm 3 - 6 (5.80%) 12 (11.5%) 24 (23.1%) 42 (40.4%)
Total 10 (9.60%) 21 (20.2%) 30 (28.8%) 43 (41.4%) 104 (100%)
The spectrum ofAIDS-defining conditions in the HIV-infected patients with natural course of the disease at the time of diagnostica-tion is shown in Table 3.
As you can see in the table, tuberculosis is at the first place among the secondary diseases in the HIV-infected patients with natural course of the disease. 33.6% falls to its share, of which pulmonary tuberculosis was detected in 13 (12.5%) patients and the HIV-associated tuberculosis was observed in 22 (21.1%) patients in the generalized form along with hematogenic dissemination of internal organs. Almost all of the patients with severe manifestations of the opportunistic diseases had CD4-count equal to <200 cells/mcl.
Table 3. - The spectrum of the opportunistic diseases and states of the HIV-infected patients with natural course of the disease (n=104)
Disease nosology abs. %
Generalized tuberculosis 22 21.1
Oesophageal candidiasis 21 20.2
HIV-cachexia (wasting syndrome) 20 19.2
HIV-encephalopathy 19 18.3
Generalized cytomegalovirus infection 18 17.3
Herpes simplex with frequent recurrence 17 16.3
Pulmonary tuberculosis 13 12.5
Pneumocystic pneumonia 12 11.5
Kaposi's sarcoma 11 10.6
Cerebral toxoplasmosis 6 5.80
Hairy leukoplakia 5 4.80
Cytomegalovirus chorioretinitis 4 3.80
Cerebral lymphoma 3 2.90
Relapsing mucocutaneous candidiasis was diagnosed in all patients, and systemic candidiasis with esophageal affection was detected in 21 patients amounting to 20.2% ofall the examined patients.
The generalized form of CMV (17.3%) with eye damage is at the second place by incidence of the secondary diseases; cytomegalovirus chorioretinitis was observed in 4 (3.80%) cases, including one case of detachment of the retina followed by blindness.
HIV-cachexia (wasting syndrome) was diagnosed in 19.1% of patients, and the HIV-associated encephalopathy — in 18.6% of cases (37 patients).
Pneumocystic pneumonia was diagnosed in 12 patients amounting to 11.5% among the detected opportunistic diseases.
Herpes simplex was observed in 17 (16.3%) patients; in 14 (13.5%) patients herpes simplex was manifested as mucous membrane canker; in two cases (1.90%) herpetic bronchitis was diagnosed by laboratory and instrumental procedures.
Specific weight of Kaposi's sarcoma in the HIV-infected patients amounted to 10.6%. At that, dermatitis was observed in 7.70% of cases (8 patients), and oral mucous membranes participating in the pathological process were observed in 3 patients (2.80%).
Cerebral toxoplasmosis was observed in 6 (5.80%) cases. Lymphoblastic cerebral lymphoma was diagnosed in 3 (2.90%) patients using head computed tomography.
Except the above states the following was diagnosed in the patients: hairy leukoplakia of the tongue — 4 (4.80%), repeated or disseminated herpes zoster — 7 (6.70%), peripheral neuropathy — 9 (8.60%). Among other symptoms the following was observed: human papilloma virus-induced dermatitis (condylomata acuminata) in 5.80% of cases (6 patients), surface fungal dermatitis in 9.60% (10 patients), noninfectious dermatitis as seborrheic dermatitis in 12.5% (13 patients), angular cheilitis in 11.5% (12 patients) of cases which are shown in Fig. 1.
Fig.1. Incidence of the opportunistic diseases in patients with natural course of the HIV-infection
Efficacy and safety of highly active antiretroviral therapy comprising tenofovir in patients with HIV infection
Among the associated diseases chronic virus hepatitis В was diagnosed in 18 (17.3%), chronic virus hepatitis С — in 35 (33.6%), В+D — in 8 (7.70%) and В+С+D — in 6 (5.80%) patients.
Therefore, the HIV-infection in patients under natural course of the disease is characterized by pathological process progressive course with progress of the generalized forms of tuberculosis and cytomegalovirus infection, systemic candidiasis, pneumocystic pneumonia, herpes simplex with frequent recurrence, which frequently result in severe consequences.
Conclusions:
1. The opportunistic diseases under the HIV-infection were often manifested by tuberculosis with process generalization, candidiasis with esophageal affection, cytomegalovirus infection with chorioretinitis complications and the risk of detachment of the retina, and herpes simplex with frequent recurrence;
2. Severe forms of the opportunistic diseases were mainly observed in the HIV-infected patients under the 4th clinical stage of the disease and under CD4-lymphocites count less than 200 cells/mcl;
3. Among the associated pathologies, the HIV-infection was frequently accompanied by chronic virus hepatitis C.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-79-81
Bayjanov Allabergan Kadirovich, Research Institute of Virology, Ph.D. (candidate of Medical Science) E-mail: saodat.us@mail.ru
Efficacy and safety of highly active antiretroviral therapy comprising tenofovir in patients with HIV infection
Abstract: The objective of the study was to evaluate the effectiveness and safety of highly active antiretroviral therapy regimens containing tenofovir — TDF in HIV patients. Three classes of antiretroviral agents today are commonly used for the specific treatment of patients with HIV: nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors (1, 5, 7). The other drugs of the same class — nucleoside reverse transcriptase inhibitors — were developed in the following years (3, 4). One of the current nucleoside reverse transcriptase inhibitor is Tenofovir (2). Inclusion of Tenofovir drug into antiretroviral therapies leads to suppression of the replicative capacity of human immunodeficiency virus. The nucleoside inhibitors bind stronger to reverse transcriptase than to host cell DNA polymerases. This provides them with a relatively selective effect on the virus. The drug Tenofovir (TDF) in 2001 was approved for use as part of antiretroviral therapy (ART) for the treatment of patients with HIV infection (6).
Key words: antiretroviral therapy, tenofovir, viral load, nucleotide and non-nucleoside reverse transcriptase inhibitor.
Materials and methods. In accordance with the objectives of this study we totally examined 101 patients with HIV infection admitted to the hospital of the Research Institute of Virology.
Among 101 HIV-infected patients forty-five were men and 56 were women (44,5% and 55,5%), respectively. Patients' age ranged from 21 to 61 years. The average age of the examined patients was 42,5 years. The diagnosis of HIV infection among the patients examined was established based on generally accepted clinical and epidemiological data, and further confirmed in the Republican AIDS Center by laboratory detection of specific antibodies to
the human immunodeficiency virus and its proteins using ELISA and immunoblotting. All patients were on antiretroviral therapy containing tenofovir.
The observation of the patients in the course of treatment included the collection of epidemiological history, medical history, clinical examination, evaluation of the severity of the principal disease and the severity of clinical symptoms, and the presence of opportunistic infections and comorbidities. Patients' clinical, immunological and virological indicators were studied at the 6th months after antiretroviral therapy. Monitoring the effectiveness
