The course of HIV infection depends on the degree of HIV suppression during ART.

The objective: to evaluate feasibility of using three factors: viral load (VL), HIV reservoir and CD8 T cells before ART initiation to estimate future levels of “residual” viremia and develop a predictive model.

Subjects and Methods. 74 naive patients with HIV infection were enrolled in the study. The HIV reservoir, VL and CD4, CD8 counts were tested before ART initiation and then every 6 months. The patients were followed up for 12 months. Discriminant analysis was used.

Results. After 12 months of ART, 69/74 (93.2%) patients had undetectable VL including 14 patients with residual viremia (RV) and 55 in whom no virus was detected. The probability of persisting RV after 12 months of ART was assessed first by one factor – VL prior to ART, after that by three factors – VL, HIV reservoir (HIV DNA), CD8 count prior to ART. A predictive model formula was generated using those factors: D = -5.288-0.001 CD8+1.342VL+0.08 HIV DNA. With discriminant function D>0.065, the patient has a high probability of RV after 12 months of ART; with D ≤0.065, the probability of RV is low. This prognosis should be taken into account when choosing an ART regimen ensuring its maximum optimization.

The objective: to evaluate VTEC in new tuberculosis patients and relapses, to determine main factors influencing its development (according to data of the patients admitted to Moscow tuberculosis hospitals)

Subjects and Methods. Based on the data of epidemiological tuberculosis monitoring system of Moscow, treatment outcomes of 4609 tuberculosis patients admitted to tuberculosis hospitals from 2020 to 2022 were retrospectively analyzed. The incidence of VTEC was estimated.

Results. Totally 214/4609 cases of VTEC were identified (4.6%; 95% CI 4.1-5.3%), among which the incidence of DVT made 3.5% (95% CI 3.0-4.1%), SVP 1.5% (95% CI 1.2-1.9%), and PATE 0.6% (95% CI 0.4-0.8%). The most significant risk factors of thrombotic complications in tuberculosis patients were identified, those factors included HIV infection (RR 3.8; 95% CI 2.7-4.5) and fibrous cavernous form of pulmonary tuberculosis (RR 9.1; 95% CI 4.7-17.6). The overall prevalence of VTEC in tuberculosis hospitals was 3 or more times higher than in general clinics (according to the published data).

Conclusion. The data obtained indicate that patients hospitalized for pulmonary tuberculosis face a high risk of VTEC development that requires prediction and prevention.

The objective: to analyze tuberculosis incidence and assess prevalence of latent tuberculosis infection (LTBI) among employees of Forensic Medicine Bureau (FMB) in Tyumen Region.

Subjects and Methods. Tuberculosis incidence was retrospectively studied, and employees of Forensic Medicine Bureau in Tyumen Region were examined in order to detect latent tuberculosis infection.

Results. In 2003-2022, the long-time average annual incidence made 105.4±23.6 per 10,000 workers. The number of employees who had suffered tuberculosis with up to 5 years of experience in the bureau was greater versus employees with 6-10 years of experience and 11-15 years of experience. The level of LTBI based on the TRA test results was 32.7±4.5%. Tuberculosis incidence and the rate of LTBI among employees performing autopsies were higher versus employees of other departments of Forensic Medicine Bureau.

The objective: to determine the involvement of lung mast cell carboxypeptidase A3 (SPA3) in the pathogenesis of COVID-19. Subjects and Methods. Samples of autopsy specimens from the lungs of patients who died of severe COVID-19 and patients who died of external causes were examined. On day 2 after the patient's death, the autopsy was performed and autopsy specimens were collected. Histological samples were prepared to analyze the degranulation activity of CPA3-positive mast cells (MCs). Correlations between protease profile and clinical and laboratory parameters were analyzed.

Results. In the patients died of COVID-19, the total numbers of CPA3-positive MCs, CPA3-positive MCs with signs of degranulation, and coadjacent CPA3-positive MCs (two CPA3-positive MCs sharing a common cytoplasm) were statistically significantly higher versus the patients from Control Group. Positive correlations were established between the total number of CPA3-positive MCs and CPA3-positive MCs with signs of degranulation with blood hemoglobin level (r = 0.491; p = 0.008; r = 0.521; p = 0.004), between the total number of CPA3-positive MCs degranulating CPA3-positive MCs and adjacent CPA3-positive MCs with total blood protein (r = 0.431, p = 0.020; r = 0.449, p = 0.015; r = 0.456, p = 0.013), and between CPA3-positive MCs with signs of degranulation and total number of CPA3-positive MCs with aPTT level (r = 0.428; p = 0.021; r = 0.374; p = 0.045). Negative correlations were established between the total number of CPA3-positive MCs and the level of INR (r = 0.812; p = 0.050), separately lying CPA3-positive MCs with the number of monocytes (r = 0.384; p = 0.044), jointly adjacent CPA3-positive Mcs with blood eosinophils (r = 0.420, p = 0.023).

The objective: to evaluate the safety of 39- and 24-week treatment regimens in the patients with rifampicin-resistant tuberculosis (RR-TB).

Subjects and Methods. Cohorts of patients with RR-TB were treated with the following regimens: 550 patients received modified short course treatment regimens (mSCT), and 139 patients were treated with BPaLM regimen. Serious adverse events (SAEs) and adverse events of special interest (AESI) of grade 3 or higher were assessed according to the EndTB Severity Grading Scale, Version 5.

Results. In mSCT cohort, 113 SAEs were reported, in BPaLM cohort, 12 SAEs were reported, at least 1 SAE was reported in 16.0% and 7.2% of patients, respectively. In mSCT cohort, 37 AESI were reported in 5.8% of patients. Of the 150 SAEs/AESI reported in mSCT cohort, 78.7% have resolved, 4.0% are being resolved, 0.7% have resolved with sequelae, and 2.7% have not resolved. Of the 12 SAEs in BPaLM cohort, 66.7% have resolved, 16.7% are being resolved, and 8.3% have resolved with sequelae. Drugs were discontinued in 16.8% of SAEs, 8.1% of AESI in mSCT cohort, and 25.0% of SAEs in BPaLM cohort. In mSCT cohort, 21 patients died during treatment, only in 6 patients the influence of anti-tuberculosis drugs on the fatal outcome could not be ruled out, in 15 cases there was no such a correlation. In BPaLM cohort, 1 patient died due to progression of concomitant cancer.

Conclusions. SAEs/AESI rarely occur with mSCT and BPaLM regimens and rarely lead to treatment discontinuation. Appropriate monitoring and management of SAEs/AESI is an important component of clinical practice.

The objective: to assess changes in the data on drug resistance of M. tuberculosis for 2015-2021 and compare it with data for 2012-2014.

Subjects and Methods. Using continuous sampling, the frequency of drug resistance of Mycobacterium tuberculosis (MTB DR) was studied in isolates from 151 pulmonary tuberculosis (PTB) patients and isolates from 805 extrapulmonary tuberculosis (EPTB) patients, who were treated at the clinic of St. Petersburg Research Institute of Phthisiopulmonology in 2015-2021. The results were compared with similar data for 2012-2014 which was published in 2016.

Results. In 2015-2021 versus 2012-2014, the overall frequency of MTB DR decreased by 4.2% in pulmonary tuberculosis patients (from 90.1 to 85.9%) and by 2.9% in extrapulmonary tuberculosis patients (from 80.2 to 77.4%). The structure of MTB DR in pulmonary tuberculosis changed insignificantly, the frequency of MDR decreased from 42.5 to 36.5%, and XDR (as per the definitions before 2022) remained the same – 39.5%. In extrapulmonary tuberculosis, the structure of MTB DR deteriorated due to lower frequency of MDR (from 66.3 to 48.3%) and higher frequency of XDR (from 3.2 to 19.0%, p<0.01).

The objective: to improve organizational measures for detection and diagnosing of tuberculous infection and tuberculosis in adolescents in the Republic of Kazakhstan.

Subjects and Methods. Screening was conducted among 27,648 adolescents aged 15-17 years from regions of the Republic of Kazakhstan with a high burden of tuberculosis. It was planned to use TRA tests and fluorography in parallel, while local doctors, district and school nurses, and nurses in vaccination rooms were preliminary trained by pediatric phthisiologists to perform the test, evaluate its results and monitor manifestations of adverse events (AEs) caused by TRA test.

Results. 27,648 adolescents (aged 15-17 years) were given TRA test. No adverse events were observed during TRA skin test. Latent tuberculous infection was diagnosed in 320 (1.2%) adolescents. During further examination, 10 patients were diagnosed with drug susceptible pulmonary tuberculosis with no bacillary excretion. Based on the study results, to detect LTBI and tuberculosis in adolescents, in addition to fluorography examination, it is necessary to use TRA skin test with in the groups facing a high risk of tuberculosis.

The objective: to study the regional prevalence of mycobacteriosis and the types of non-tuberculous mycobacteria causing mycobacteriosis in Mari El Republic and Vladimir Region, to conduct a comparative clinical and radiological analysis of mycobacteriosis and tuberculosis.

Subjects and Methods. Cultures of non-tuberculous mycobacteria available in the bank of the bacteriological laboratory of two regions were analyzed: 182 cultures in the Republic of Mari El and 44 cultures in Vladimir Region. Medical records and X-ray archives of patients who were found to be positive for non-tuberculous mycobacteria were retrospectively studied.

Results. The incidence of mycobacteriosis in Vladimir Region and Mari El Republic made 1.5 and 4.3 cases per 100,000 population, respectively. Cultures of non-tuberculous mycobacteria that caused mycobacteriosis belonged to diverse species, and M.avium-complex was the most common (76% of cases). There were no statistically significant differences in the location and extent of lesions in patients with mycobacteriosis and tuberculosis (p > 0.05). The frequency of positive results of Mantoux test with 2TU was comparable Positive results of TRA test were found significantly more often among patients with tuberculosis versus patients with mycobacteriosis (15/19 (78.9%) and 9/24 (37.5%), respectively; p < 0.05). However, this is insufficient for differential diagnosis of these diseases.

The article presents a rare case of verified pulmonary nodular lymphoid hyperplasia (PNLH) in a 49-year-old man with history of chemotherapy and radiation therapy for stage 3B Hodgkin lymphoma with metastases in peripheral lymph nodes and the spleen. It describes computed tomographic semiotics of PNLH and the histological signs of the specimens collected during surgical treatment.

The article describes a clinical case of a 62-year-old patient infected with SARS-CoV-2, in whom, 15 days after the onset of symptoms of COVID-19 with lung damage, chest computed tomography with contrast revealed concurrent subtotal obstruction of the pulmonary artery trunk and defects of its branches filling due to blood clots formed in situ. Against the background of anticoagulant therapy for 13 days, blood clots resolved in both central and peripheral parts of the lung venous bed.

The review analyzes of 69 publications and discusses treatment of drug-resistant tuberculosis from the standpoint of the influence on immune mechanisms that limit progression of inflammation and damage to lung tissue. Interferon-gamma is the most significant cytokine in tuberculosis infection pathogenesis. The article describes genotypic and phenotypic features of interferon-gamma production in various clinical forms of pulmonary tuberculosis. It presents the data supporting the therapeutic use of recombinant interferon-gamma and results of its clinical use as adjuvant treatment additionally to chemotherapy. It demonstrates the prospects for immunotherapy with Ingaron, the drug manufactured in Russia, for patients with multiple drug-resistant pulmonary tuberculosis.

This review analyzes 33 publications on the effectiveness of inhaled antibiotics in patients with cystic fibrosis and evaluates their effect on bacterial resistance.