Введение. Вирусы гриппа представляют серьезную угрозу для здоровья населения Земли, вызывая сезонные эпидемии и эпизодические пандемии, которые приводят к высокой заболеваемости и летальным исходам. Грипп является заболеванием, для которого разработаны противовирусные средства с доказанной клинической эффективностью. Цель. Охарактеризовать разнообразие типов/субтипов вирусов гриппа, циркулирующих в эпидемический подъем заболеваемости в сезоны 2015–2016 и 2022–2023 гг., а также оценить эффективность и безопасность препарата осельтамивир. Материалы и методы. Проведен анализ данных пациентов, проходивших лечение в СПб ГБУЗ «КИБ им. С.П. Боткина», с диагнозом «грипп» (n=159) в период 2014–2015 гг. в 2 группах: пациенты, получавшие (группа 1, n=105) и не получавшие (группа 2, n=54) осельтамивир, – и показана эффективность препарата. Для сравнения данных применяли U-критерий Манна – Уитни, р≤0,05. Результаты. Грипп А (H1N1) выявлен у 42% пациентов (n=67), грипп А (H3N2) – у 31% (n=49), грипп B – у 20% (n=32). Температура на 3–5-й день чаще снижалась в группе принимавших осельтамивир (1-я группа – Ме 36,8(Q1/Q3; 36,4/38,2) в 1,1 раза меньше, чем во 2-й группе, – Ме 38,5(Q1/Q3; 37,2/38,8)), р=0,04. Лихорадка в 1-й группе составила 6,7±2,8 дня, что было в 1,4 раза меньше, чем во 2-й группе – 9,4±4,8 дня, р=0,034. В 1-й группе к 3–5-му дню чаще снижалась частота возникновения тошноты, слабости и ознобов: р=0,04, р=0,007 и р=0,05 соответственно. Заключение. В период подъема заболеваемости гриппом в 2014–2015 гг. в этиологической структуре преобладали субтипы А(H1N1), А(H3N2), В. Несмотря на тип вируса, препарат осельтамивир показал высокую эффективность и безопасность. В настоящее время осельтамивир является единственным лицензированным препаратом, доступным для всех возрастов, который применяется для лечения пациентов с подтвержденным гриппом. Introduction. Influenza viruses pose a serious threat to the health of the world’s population, causing seasonal epidemics and episodic pandemics that lead to high morbidity and mortality. Influenza is a disease for which antiviral agents have been developed with proven clinical efficacy. Purpose. To characterize the variety of types/subtypes of influenza viruses circulating during the epidemic rise in 2015–2016 years and 2022–2023 years as to evaluate the efficacy and safety of oseltamivir. Materials and Methods. An analysis of the data was performed of patients, that were treated in St. Petersburg Clinical Infectious Disease Hospital named after S. P. Botkin with a diagnosis of Influenza (n=159) in 2014–2015 years. The patients were spitted into two groups: patients who received (1st group n=105) and did not receive (2nd group n=54) oseltamivir. The effectiveness of the drug was shown. To compare the data, the Mann – Whitney U-test was used p≤0.05. Results. The influenza A (H1N1) was found in 42% (n=67), influenza A (H3N2) in 31% (n=49) and influenza B in 20% (n=32) of patients. Body temperature on 3–5 days decreased in the group taking oseltamivir (1st group – Me 36.8 (Q1/Q3; 36.4/38.2) 1.1 times less than in 2nd group Me 38.5 (Q1/Q3; 37.2/38.8)), p=0.04. Fever duration in group 1 was 6.7±2.8 days, which was 1.4 times less than in 2nd group – 9.4±4.8 days, p=0.034. In the first group of patients, by the 3rd–5th day, the incidence of nausea, weakness and chills more often decreased, p=0.04, p=0.007 and p=0.05. Conclusion. During the seasonal rise of the influenza incidence of 2014–2015 years in the etiological structure of influenza in patients’ subtypes A (H1N1), A (H3N2), B prevailed. Despite the type of virus, oseltamivir showed high efficacy and safety. Currently, oseltamivir is the only licensed drug available for all ages to be used for the treatment of patients with confirmed influenza.

Aim. To evaluate the efficacy and safety of riamilovir in the treatment of COVID-19 in adults. Materials and methods. The study included 180 patients with a laboratory-confirmed diagnosis of COVID-19 which fully meet the criteria for inclusion, non-inclusion and exclusion, signed a voluntary informed consent to participate in a clinical trial. Results. The efficacy, good tolerability and safety of the drug riamilovir in the treatment of COVID-19 have been established. Conclusion. As a result of a multicenter randomized double-blind clinical trial, the effectiveness of the drug riamilovir for therapeutic use in patients with COVID-19 according to the 1250 mg/day scheme (250 mg capsules 5 times per day) for 10 days was established. The drug riamilovir in a daily dose of 1250 mg for 10 days does not differ in safety from placebo.

Aim: To evaluate the diagnostic significance of the relationship between the level of microRNA-122 expression and liver fibrosis during HDV infection.Materials and methods. The expression of microRNA-122 was determined in 203 blood samples. Blood sampling was done from 53 patients with chronic viral hepatitis D, 49 patients with liver cirrhosis of HDV etiology, and 69 patients with newly diagnosed HBs antigenemia. The control group consisted of practically healthy individuals (n=32).Results. In patients with negative RNA HDV levels, the level of microRNA-122 in the blood serum was significantly higher than in samples with positive RNA HDV levels (14.0±2.8 2^-ΔΔCt and 1.6±0.17 2^-ΔΔCt) (p ˂ 0.005). Meanwhile, in healthy individuals, the expression of microRNA-122 was statistically significantly lower – 1.3±0.03 2^-ΔΔCt (p ˂ 0.005). Undetectable levels of HDV RNA in the serum were accompanied by a high HBV viral load and a significantly higher level of microRNA-122, which was 8.7 times higher than in the group of HDV RNA-positive patients (p<0.005). In patients with liver fibrosis F1, the expression of microRNA-122 was higher than in patients with liver fibrosis F2, F3, F4 (p = 0.0001). The lowest levels of microRNA-122 were observed in liver fibrosis F4. Conclusion. The expression level of microRNA-122 in blood serum during HDV infection decreases as liver fibrosis progresses. The development of cirrhosis is accompanied by a 3.7-fold drop in the level of microRNA-122 compared to the group of patients with chronic hepatitis D. MicroRNA-122 can be used in laboratory monitoring of patients with various stages of HDV infection as an indicator of the activity of the process, assessing the severity of liver damage and the rate of progression of liver fibrosis.> ˂ 0.005). In patients with liver fibrosis F1, the expression of microRNA-122 was higher than in patients with liver fibrosis F2, F3, F4 (p = 0.0001). The lowest levels of microRNA-122 were observed in liver fibrosis F4.Conclusion. The expression level of microRNA-122 in blood serum during HDV infection decreases as liver fibrosis progresses. The development of cirrhosis is accompanied by a 3.7-fold drop in the level of microRNA-122 compared to the group of patients with chronic hepatitis D. MicroRNA-122 can be used in laboratory monitoring of patients with various stages of HDV infection as an indicator of the activity of the process, assessing the severity of liver damage and the rate of progression of liver fibrosis.

The emergence of new strains of respiratory viruses, especially pandemic ones, resistant to antiviral drugs, dictates the need for further search for new molecules, or reformatting of existing drugs, expanding their indications for use. The use of broad­spectrum antivirals or immunomodulators is now well justified. The goal is to systematize published data on the effectiveness and safety of the drug inosine pranobex for acute respiratory viral infections, including influenza and the new coronavirus infection COVID­19. The results of in vivo and in vitro studies are summarized, which examine the mechanisms of influence of inosine pranobex on the human immune system and therapeutic effectiveness against a wide range of viral pathogens. The positive results of clinical studies conducted in different countries on ARVI and influenza are briefly described. A promising direction is the use of inosine pranobex in the treatment of COVID­19, which has been proven by its use in clinical trials in adults by researchers from different countries and is reflected in our review.

A hepatitis B virus (HBV) infection can progress to chronic hepatitis, leading to liver fibrosis, cirrhosis, and hepatocellular carcinoma. CX3CL1/Fractalkine plays a crucial role in recruiting immune cells that are responsible for protecting against HBV infection. The aim of this study was to measure CX3CL1/Fractalkine concentrations in the blood plasma of individuals infected with HBV and to evaluate the role of this chemokine in the development of liver tissue fibrosis. Our study included patients infected with HBV, patients infected with HCV, autoimmune hepatitis, and healthy donors. We analyzed the CX3CL1/Fractalkine concentrations in blood plasma using the xMAP technology. Our results showed that HBV-infected patients had lower concentrations of CX3CL1/Fractalkine. Furthermore, in HBV-infected patients with severe fibrosis/cirrhosis, we observed significantly lower concentrations of CX3CL1/Fractalkine compared to those with no/mild fibrosis. Our study revealed that CX3CL1/Fractalkine concentrations are significantly associated with the stage of fibrosis in HBV infection. We demonstrated that lowered CX3CL1/Fractalkine concentrations might have prognostic value for predicting fibrosis development in liver tissue. Our findings suggest that decreased concentrations of CX3CL1/Fractalkine are associated with an increased risk of progressive liver fibrosis, indicating the potential of this chemokine as a prognostic biomarker for the development of liver fibrosis.

The aim of the study was to compare the clinical efficacy and safety of two antiviral therapy medications that suppress viral replication (viral RNA polymerase inhibitors) in the treatment of patients with COVID-19: favipiravir and riamilovir.Material and methods. Clinical efficacy and safety were assessed based on a retrospective study of 1071 patients, including 561 patients who received favipiravir and 510 patients who received riamilovir.Results. A statistically significant reduction in the duration of symptoms and average hospital days was recorded among patients who received ramilovir in both moderate and severe forms of the disease compared with the group that received favipiravir. Inflammatory markers (CRP, fibrinogen) decreased faster in the riamilovir group.Conclusion. Riamilovir has demonstrated higher levels of clinical efficacy and safety in the treatment of COVID-19 compared to favipiravir.

Aim. Evaluation of the efficacy and safety of riamilovir as a drug for the prevention of coronavirus infection (COVID-19) in adults who have constant contact with COVID-19 patients as a result of living together. Materials and methods. The study included 750 adult participants living with patients with confirmed polymerase chain reaction method COVID-19, who had a negative polymerase chain reaction result for the SARS-CoV-2 virus at the initial level, met the criteria for inclusion, non-inclusion and exclusion, and signed a voluntary informed consent to participate in a clinical trial. Results. The efficacy, good tolerability and safety of the drug riamilovir for the prevention of COVID-19 infection among people who have come into contact with COVID-19 patients in a family focus of infection have been established. Conclusion. As a result of a multicenter randomized double-blind clinical trial, the effectiveness of the drug riamilovir for the prevention of COVID-19 infection was established. It was shown that the relative risk of disease in the group taking riamilovir for prophylaxis was 88.96% lower than in the control group. Based on the results of a clinical trial, in October 2023 Ministry of Health of the Russian Federation approved the inclusion of a new indication (prophylaxis of COVID-19 infection) in the instructions for the medical use of the drug riamilovir (trade name – Triazavirin®).

Chronic hepatitis C (CHC) represents a significant public health concern. In the majority of cases, the infection progresses to a chronic form, which is characterised by the development of fibrosis and cirrhosis of the liver. A plethora of cytokines and chemokines are generated as a consequence of inflammatory processes within the liver. These can exert a dual effect, both protective and damaging, particularly in relation to the death of hepatocytes and the progression of liver fibrosis. Furthermore, a number of growth factors have been identified as playing a role in the pathogenesis of CHC. The objective of the study was a comprehensive evaluation of a wide range of cytokines, chemokines and growth factors in the blood plasma of patients with CHC at varying stages of liver fibrosis. The study cohort comprised 63 patients diagnosed with CHC, who were divided into three groups according to the stage of liver fibrosis. The control group comprised healthy individuals (n = 32). Concentrations of the following cytokines were determined in plasma: Interleukins and some cytokines (IL-1α, IL-1β, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-9, IL-10, IL-12 (p40), IL-12 (p70), IL-13, IL-15, IL-17A, IL-17-E/IL-25, IL-17F, IL-18, IL-27, IFNα, IFNγ, TNFα, TNFβ); chemokines (CCL2/MCP-1, CCL3/MIP-1α, CCL4/MIP-1β, CCL7/MCP-3, CCL11/Eotaxin, CCL22/MDC, CXCL1/GROα, CXCL8/IL-8, CXCL9/MIG, CXCL10/IP-10, CX3CL1/Fractalkine) and growth factors (EGF, FGF-2, Flt-3L, G-CSF, M-CSF, PDGF-AA, PDGF-AB/BB, TGF-α, VEGF-A) by multiplex analysis based on xMAP technology. Nonparametric statistics methods were used for statistical analysis. As a result of the study, increased concentrations of cytokines IL-12 (p40), IL-15, IL-17E/IL-25, IL-27, IFNγ, TNFα, chemokines CXCL9/MIG and CXCL-10/IP-10 and growth factors FGF-2 and M-CSF were found at all stages of liver fibrosis. Elevated concentrations of cytokines IL-1α, IL-1β, IL-2, IL-6, IL-9, IL-10, IL-17F, IFNα, TNFβ, chemokines CCL2/MCP-1, CCL11/Eotaxin, CCL22/MDC and growth factors G-CSF, TGF-α, Flt-3L were found in severe liver fibrosis/cirrhosis. Correlation analysis revealed a relationship of high significance between the severity of liver fibrosis and the content of cytokines IL-6, IFNγ, TNFα, IL-7, chemokines CCL2/MCP-1, CCL11/Eotaxin, CXCL9/MIG, CXCL10/IP-10, CXCL1/GROα, growth factors TGF-α, PDGF-AA, PDGF-AB/BB. Thus, a certain profile of cytokines characteristic for CHC was revealed, cytokines, chemokines and growth factors significant for liver fibrosis in CHC were found.

Purpose. To study the features of the clinical course of coronavirus infection (COVID-19) in people living with HIV and risk factors for adverse outcomes. Materials and methods. The study included 523 patients with a confirmed diagnosis of COVID-19 occurring against the background of HIV infection and hospitalized from March 2020 to September 2021 on the basis of the GBUZ “S.P. Botkin KIB” in St. Petersburg. Two groups were formed: 1 – receiving antiretroviral therapy (n=204), 2 – not receiving ART (n=319). A comparative analysis of the results obtained during the examination was carried out using statistical methods: Mann-Whitney (p≤0.05) and the calculation of the relative risk (RR) when comparing the probability of the outcome of the disease depending on the presence of risk factors: respiratory rate ( NPV),% lung damage, levels of CD4 and C-reactive protein (CRP) with a significance level of p≤0.05. Results. Among the patients, persons aged 30 to 49 years predominated. In 50.5% of cases, coronavirus infection proceeded in the form of acute respiratory viral infections, pneumonia was diagnosed in 49.5%, which was subsequently complicated in 22.9% by the development of acute respiratory distress syndrome or sepsis in 2.1%. Severe course of COVID-19 was observed in non-adherent to ART, with CD4 lymphocyte count (≤50 cells/µl), multimorbidity and amounted to 45%. Conclusion. A feature of the course of COVID-19 in patients with HIV/SARS-COV-2 coinfection was a high number of deaths – 21.6%. In the overall structure of causes of death, the maximum share fell on HIV infection – 58.4%, COVID-19 – 24.8%, HIV/ COVID-19 –9.7% coinfection and other causes – 7.1%. Factors associated with the development of severe forms of coronavirus infection caused by SARS-COV-2 in HIV-infected patients who were hospitalized, the combination of which can be used as a predictor of death, have been identified: respiratory rate (RR) > 20 per minute, percentage of involvement lungs> 50%, CD4 lymphocyte level <40 cells/µl, CRP>50 mg/l, presence of three or more concomitant diseases.

Aim. To evaluate the efficacy and safety of OM-85 in the treatment of uncomplicated acute respiratory infections (ARI) in adults. Materials and methods. A double-blind, placebo-controlled, multicenter, randomized trial included 556 patients (18–60 years old) with mild and moderate ARI and negative results of polymerase chain reaction analysis for SARS-CoV-2 RNA and rapid test for influenza A and B viruses. Patients were randomized into two groups: in the first group (n=278), patients received OM-85 (Broncho-munal®) one capsule 7 mg/day for 10 days, while the second group (n=278) was treated with placebo in the same regimen. The primary endpoint was the dynamics of the severity of symptoms over 3, 5, 7 and 10 days of treatment according to the 21-item Wisconsin Upper Respiratory Symptom Survey (WURSS-21), which was assessed by the area under the curve. Secondary efficacy criteria were the dynamics of the severity of symptoms according to the Common Cold Questionnaire (CCQ), the time to the resolution of symptoms according to WURSS-21 and CCQ, the proportion of patients with body temperature below 37°C on each day of treatment, frequency of the need for systemic antibacterial therapy. Results. The superiority of OM-85 over placebo by primary endpoint was observed on the 5th, 7th and 10th days of treatment. OM-85 efficacy has also been proven by secondary criteria. OM-85 shortened the time until the symptoms of ARI resolved according to the WURSS-21 and CCQ, increased the proportion of patients with body temperature below 37°C by 2–9 days. The time needed to resolve the symptoms of disease in 20% of patients according to WURSS-21 was 7 and 9 days in patients taking OM-85 and placebo, respectively. Bacterial lysate increased the probability of complete disappearance of symptoms according to CCQ by 45.7% compared to placebo. The analysis of the frequency and severity of adverse events, laboratory tests, physical and instrumental examination results during treatment confirmed the good tolerability and safety of OM-85. Conclusion. The study confirmed the efficacy and safety of OM-85 in the complex treatment of ARI in adults.

Aim: To assess the current epidemiological situation and establish the dominant clinical profile of patients with chronic hepatitis C, taking into account the stage of the disease and the molecular genetic characteristics of the virus in the Republic of Tyva. Materials and methods: Based on the annual reports of the dispensary observation office of the Infectious Hospital of the Republic of Tyva, an electronic database was developed using the licensed Office Excel 2016 program, which included results on the health status of patients, clinical, laboratory and instrumental data, including molecular biological data with the determination of HCV genotypes. The analysis of the data of the state statistical reporting of infectious morbidity in the Russian Federation (form №2 "Information on infectious and parasitic diseases") was carried out. Analytical tables developed by specialists of the Scientific and Methodological Center of the Saint-Petersburg Pasteur Institute for the period 2012-2022. The data of the Reference Center for Monitoring Viral Hepatitis of the Federal State Budgetary Institution "Central Research Institute of Epidemiology" of Rospotrebnadzor were used. Results. Over the past two years, the decrease in incidence in the Republic of Tyva is likely due to a decrease in the number of examinations, a decrease in patients seeking outpatient care, and insufficient screening in the context of the COVID-19 pandemic. Clinical, laboratory and instrumental examination of patients with HCV revealed the predominance of HCV-infected genotype 1 (49.4%), with F0-F2 fibrosis in 79% of cases. The clinical profile of typical patients with chronic hepatitis C was established; whose share in the total structure of the examined was 38.4%. Conclusion: There is a tendency to reduce the incidence of chronic hepatitis C in the Republic of Tyva. Based on the clinical information base, the most typical characteristics of chronic hepatitis C patients living in the Republic of Tyva have been established.

The aim of this study was to assess the prevalence and study of the molecular genetic characteristics of the human immunodeficiency virus in pregnant women of the Republic of Guinea. Materials and methods. The material for the study was blood plasma samples of 972 pregnant women from the Republic of Guinea. The patients were examined for the presence of HIV infection serological (Ag+Ab) and molecular markers (RNA). For patients with a positive PCR result and a sufficient viral load (>500 c/ml), the genetic sequences of the pol gene fragment responsible for the synthesis of pro and rev proteins were obtained by Sanger sequencing. These sequences were used for phylogenetic analysis and examined for drug resistance mutations. Results and discussion. 12.96% of patients was positive in ELISA. Among women who were positive in ELISA, RNA was detected in 76.98% of cases, however, in 11 cases, RNA was detected in patients without serological markers of HIV infection, so the incidence of HIV RNA in the entire surveyed population was 11.11%. In the vast majority of cases, the circulating recombinant form 02_AG is found. Based on the analysis, we assume a significant contribution of recombinant forms of HIV to the genetic diversity of the virus in the region under study. The incidence of DR mutations was quite high (26.80%). The most frequent substitutions were in position 20 of the protease (70.10%, 95% CI 59.96–78.98%), of which the K20I mutation was dominant. In addition, the L10I/V mutation was relatively common, increasing the replication of viruses with other PI resistance mutations. Among the mutations associated with HIV resistance to NNRTIs, a non-polymorphic mutation V179T was found. Conclusion. An important factor influencing the effectiveness of Prevention of Mother to Child Transmission identified in this study was the high prevalence of PDR among pregnant women in Guinea. The high prevalence of drug resistance mutations found in this study in pregnant women, as well as in ART-naive women, indicates that current regimens in Guinea are insufficient to prevent vertical HIV infection.

The aim of the work is to assess the prevalence of hepatitis B virus drug resistance mutations and immune escape mutations in pregnant women in the Republic of Guinea.MATERIALS AND METHODS:Blood plasma samples obtained from 480 pregnant women from different regions of the Republic of Guinea with laboratory-confirmed viral hepatitis B were studied. Nucleotide sequences for genotype identification and mutation detection were obtained using nested-PCR followed by Sanger sequencing, based on overlapping pairs of primers spanning the complete genome of the virus.RESULTS AND DISCUSSION:In the examined group, the viral genotype E was the most prevalent (92.92%) compared with subgenotypes A1 (1.67%), A3 (1.46%), D1 (0.63%), D2 (1.04%) and D3 (2.29%). Among the examined HBV-infected pregnant women, 188 (39.17%) had undetectable HBsAg. Drug resistance mutations were detected in 33 individuals, which amounted to 6.88%. The following mutations were found: S78T (27.27%), L80I (24.24%), S202I (15.15%), M204I/V (42.42%). The presence of polymorphic variants not described as drug resistant has also been shown in positions associated with the development of drug resistance to tenofovir, lamivudine, telbivudine and entecavir (L80F, S202I, M204R). When analyzing the MHR and the region of a determinant, mutations were detected in 318 (66.25%) of pregnant women. In 172 of them, which amounted to 54.09%, multiple mutations were found. The amino acid substitutions in 13 positions associated with HBsAg-negative hepatitis B and/or potentially affecting HBsAg antigenicity were identified.CONCLUSION:The high prevalence of immune escape and drug resistance mutations potentially associated with false-negative result of HBsAg screening, prophylaxis failure, and virological failure of therapy that has been identified among treatment naive pregnant women imposes a serious problem.

Objective. To characterize the dynamics of the epidemic situation of chronic hepatitis C (HCV) in the Leningrad region (LR) for the period 2015–2022 and establish the most promising for therapy in LR schemes. Materials and methods. The data of Form No 2, the Federal Register of Patients with viral hepatitis, the Reference Center for Monitoring Viral Hepatitis, the chief freelance specialist in infectious diseases of the LO were used. To assess the effectiveness of various tactics of HCV therapy, the method of pharmacoeconomical analysis – "cost-effectiveness" was used. As a criterion for evaluating the economic effectiveness of therapy, the cost of one cured patient was shown, calculated according to the formula: the cost of one cured patient = the cost of the course / the effectiveness of the regimen. Results. Based on the cost-effectiveness analysis, it was revealed that in patients with HCV genotype 3, it is advisable to use pangenotype schemes, and patients with HCV Gt1b can be effectively treated with genotype-specific combinations. Stable positive dynamics in the main epidemiological indicators (morbidity, mortality, cumulative number, coverage of therapy) HCV is not traceable in the LO. Following the draft passport of the strategy to combat HCV and based on the cumulative number of patients in the LO, by 2025 It is necessary to cover more than 4,000 people with therapy, primarily about 1,700 patients with a late stage of the disease (F3–F4). In the LO, persons with the 3 genotype of the virus (48%), requiring the use of pangenotype regimens and with the 1b genotype (41%), who are able to be treated with genotype-specific schemes, predominate. Conclusion. In order to achieve the goal of elimination in the LO, it is necessary to increase screening. To improve the quality of examination of patients with HCV (PCR, genotyping, elastometry, etc.), it is necessary to develop and implement an outpatient diagnostic tariff of Mandatory Medical Insurance. Key words: Leningrad region, chronic hepatitis C, direct antiviral drugs, pangenotypic schemes, genotype-specific schemes, pharmacoeconomical analysis

Objective. To analyze the profile of a patient with virus-related liver cirrhosis examined at different levels of healthcare, to identify the main causes of death, and describe morphological changes in liver tissue. Patients and methods. This study included 921 patients with chronic viral hepatitis (CVH) treated in day hospitals, 844 patients treated in inpatient facilities, and 455 CVH patients who died. We analyzed autopsy results of 97 patients with clinical signs of liver cirrhosis and described morphological characteristics of liver tissue depending on the Child–Turcotte–Pugh score. Results. Chronic hepatitis C is the most prevalent form of hepatitis in both inpatient and outpatient units. The highest incidence of latent hepatitis B was observed among inpatients. The majority of outpatients with virus-related liver cirrhosis were employable (or employed), socially adapted, not addicted to alcohol, and had compensated disease (class A in 97%) with minimal clinical manifestations, and were motivated for treatment and examination. The mean age of inpatients was 50 years; 100% of them had some comorbidities; 90% of them had subcompensated or decompensated cirrhosis; 60% of them systematically abused alcohol. Conclusion. The majority of deceased patients were employable, abused alcohol, and were not systematically followed-up by a specialist. Almost one-third of them (30%) had subcompensated disease and incomplete cirrhotic transformation of hepatic tissue; they died due to other reasons. This affects the course of chronic virus-related hepatitis and comorbidities and necessitates the creation of integrated comprehensive models of healthcare. Key words: virus-related liver cirrhosis, comorbidity, morphological examination, latent hepatitis, chronic viral hepatitis

Healthcare workers are much more likely to be infected with HIV and hepatitis viruses compared to the general population. Although healthcare workers are more aware of HIV and hepatitis viruses, several countries in Africa lack a comprehensive grasp of disease routes and transmission risks. The aim of this study was to assess the prevalence of the serological and molecular biological markers of HIV and viral hepatitis among healthcare workers in the Republic of Guinea. The study material was 74 blood serum samples collected from healthcare workers who received additional training at the Institute of Applied Biological Research of Guinea (IRBAG, Kindia, Republic of Guinea). The markers examined included HBsAg, HBeAg, anti-HBs IgG, anti-HBcore IgG, anti-HCV qualitative determination, anti-HEV IgM and IgG, anti-HAV IgM and IgG, and anti-HIV. For viral DNA and RNA detection, nucleic acids were extracted from blood serum, and viral presence was inferred using real-time PCR with hybridization fluorescence detection. A high prevalence of viral hepatitis B markers was shown, and significantly fewer cases of viral hepatitis C and HIV were detected. Almost all examined medical workers had anti-HAV IgG antibodies, but no antibodies to hepatitis E virus. Apparently, the identified markers depend on the general prevalence of certain pathogens in the region and are associated with the traditions and characteristics of the country's residents.

The aim of the work was to estimate the prevalence of HIV, HBV and HCV markers among pregnant women and their male partners in the Republic of Guinea.Materials and methods. The material of the study was blood plasma samples from 140 pregnant women living in Kindia prefecture and N’Zerekore prefecture, as well as 60 male partners who reported sexual contact with HIV-infected persons. The samples were examined for the presence of serological (HBsAg, HBeAg, antibodies anti-HBs IgG, anti-HBcore IgG, anti-HBe IgG, anti-HCV IgG, Ag/Ab-HIV) and molecular (HBV DNA, HCV RNA, HIV RNA) markers.Results and discussion. The age of the examined pregnant women ranged from 13 to 55 years and was on average (26.29±9.67) years. The age of men varied from 15 to 60 years, on average – (29.05±11.99) years. When assessing the prevalence of serological markers, antibodies to HCV were detected in 2.14 % cases in women and in 3.33 % cases in men. Antibodies to HIV were found in 6.43 % and 6.67 % women and men, respectively. Serological markers associated with HBV were detected in 80.71 % (HBsAg – 13.57 %) of women and 81.67 % (15 %) of men. In the pregnant women, HCV RNA was not detected, HIV RNA was revealed in 1 case, HBV DNA was identified in 26 cases (18.57 %), including 5 % HBsAg-negative hepatitis B cases. In the men group, HCV RNA and HIV RNA were detected in 3.33 % and 6.67 % cases, respectively. HBV DNA was determined in 16.67 % of men, including latent hepatitis B in one person. A significantly higher incidence of HIV in men compared to women is shown (χ2=3.907 at p<0.05). The relative risk of HIV infection in men is nine times higher than in women: RR=9.333; p=0.0291; 95 % CI: 1.065–81.815 %. Four out of five identified HIV infection cases were co-infected with HBV and/or HCV. There is an obvious need to introduce screening for HIV, HCV, HBV, including latent hepatitis B, into routine laboratory diagnostics during examination of pregnant women and their partners, followed by couples counseling and vaccination against hepatitis B virus.

Pathological conditions of various natures are capable of mutual aggravation, significantly affecting the overall burden of the disease, its manifestations and severity. This analytical review is devoted to the interaction between pathogens of socially significant infections human immunodeficiency viruses (HIV), hepatitis C, Mycobacterium tuberculosis and SARS-CoV-2. Foreign and own data covering the issues of syndemia and interference of pathogens are presented. The results of epidemiological analysis in the North-Western Federal District (NWFD) are presented, which demonstrated the absence of a significant impact of the pandemic caused by a new coronavirus infection (COVID-19) on the epidemic incidence of HIV, viral hepatitis C or tuberculosis at the population level, which may be due to various mechanisms of transmission of infections and the required infectious dose of the pathogen. The absence of a negative effect of COVID-19 on mortality rates in HIV infection, viral hepatitis C and tuberculosis in the territories of the NWFD was noted. Special attention is paid to the clinical picture of the combined course of HIV infection, tuberculosis and COVID-19. The data are demonstrated, which allow us to conclude that the worst prognosis and risk of death are patients in the progressive stage of the disease, which is characterized by the presence of opportunistic infections, especially AIDS-indicator conditions, with disseminated tuberculosis and in the cirrhotic stage of viral hepatitis. The significance of severe manifestations of infectious pathology in cases of deterioration of the prognosis of COVID-19 is shown. Based on the experience of two years of the pandemic, the problems contributing to the syndrome of new coronavirus infection and other conditions, as well as the causes of high mortality from COVID-19, which include: limited resources for non-infectious areas of medical care; insufficient funding for planned and high-tech care; a decrease in the volume of primary diagnosis and detection of infectious and non-infectious pathology; delayed and limited research in areas; distraction of specialists from preventive and dispensary work outside of infectious pathology; shortage of medicines and consumables; social instability and deterioration of the well-being of the population, characteristic of pandemics. The role of a personalized approach to patients with concomitant somatic and infectious diseases as a preventive measure for the severe course and complications of COVID-19 is determined.

INTRODUCTION:The problem of transfusion safety in relation to parenteral viral hepatitis still remains relevant. Viral hepatitis B (HB) remains the most common viral infection transmitted through transfusion procedures. One of the natural phases of chronic hepatitis B (CHB) is occult hepatitis B infection (OBI), characterized by an undetectable HBsAg (regardless of the other serological markers content) in the presence of hepatitis B virus (HBV) DNA in the liver tissue and an extremely low, up to undetectable, level of viral load in the blood. In the Republic of Guinea, as in most countries on the continent, the prevention of HBV transmission through transfusion is still based on HBsAg serological testing of donors only. In this connection, OBI remains as a potential threat to blood transfusion safety. Detection of HBV DNA is a reliable preventive measure against transmission of the virus from donors with HBsAg-negative HBV infection, especially in highly endemic regions. In this regard, the study was conducted to substantiate recommendations for improving blood safety against the background of significant HBV prevalence in the Republic of Guinea.The aim of the work was the evaluation of serological and molecular markers of HBV infection in blood donors in the Republic of Guinea. MATERIAL AND METHODS:We examined 250 blood samples obtained from donors living in Conakry, Republic of Guinea. Samples were tested for the presence of serological (surface antigen, HBsAg; antibodies (ABs) to surface (anti-HBs IgG) and core (anti-HBc IgG) antigens) and molecular (DNA) markers of HBV infection. RESULTS AND DISCUSSION:The overall detection rate of hepatitis B markers was 83.2%; HBsAg was detected in 16.4% of all individuals. The high incidence of HBsAg in men (19.55%) compared to women (8.45%) was shown, the relative risk of HBV infection with the formation of HBsAg-positive chronic hepatitis B in males was also significantly higher. The prevalence of the HBV DNA in the study group was 30.4%, the OBI cases accounted for 15.6%. The prevalence of this form of the disease was shown in donors aged 30-49 years (24.78%), in the group of people younger than 30 years, the incidence was lower (8.73%), and at the age of over 50 years, OBI was not detected. Based on the phylogenetic analysis of 76 virus isolates, it was shown that genotype E prevails in the examined group (85.53%).Cases of pathogen DNA detection occurred in HBsAg-negative blood donors in the presence of anti-HBs IgG (n = 4), as well as in the simultaneous presence of ABs anti-HBs IgG and anti-HBc IgG (n = 7). The viral load exceeded 200 IU/ml in OBI samples. Escape mutations were detected by sequencing in each OBI sample, contributing to the virus escaping from diagnostic based on screening for HBsAg. CONCLUSION:Assessment of the prevalence viral hepatitis B markers in blood donors, determination of genotypes and clinically significant mutations of virus variants are necessary to ensure safe medical manipulations, control and prevention of the spread of this infectious agent.

BACKGROUND: According to the World Health Organization, viral hepatitis is one of the leading causes of death in the world. Mortality in hepatitis A varies from 0.1 to 2.1%, in hepatitis E from 0.1 to 4%, reaching 30% in pregnant women in the third trimester. From the outcomes and complications of hepatitis B and C, up to 1.4 million people die in the world every year. AIMS: Determine the current aspects of the epidemic process of acute viral hepatitis: in the conditions of polyethylene friendliness, the influence of socio-economic changes taking place in the Russian Federation and measures of specific immunoprophylaxis of hepatitis B and A. MATERIALS AND METHODS: The analysis of the data of the state statistical reporting of acute viral hepatitis in the Russian Federation (Form No. 2 Information on infectious and parasitic diseases) was carried out, the analytical tables developed by the Pasteur Research Institute of Epidemiology and Microbiology and the Reference Center for Monitoring Viral Hepatitis of the FBSI Central were analyzed. Research Institute of Epidemiology of Rospotrebnadzor. To establish the occurrence of polyetiology, a serological study was carried out by ELISA of 275 blood samples obtained from patients hospitalized in an infectious diseases hospital with a laboratory-confirmed diagnosis of hepatitis A (HAVAb IgM) for the presence of hepatitis B markers (HBsAg, HBsAb, HBcAb) and hepatitis С (HCVAb). RESULTS: The incidence of acute viral hepatitis has reached the elimination rate in children and adults. In 2009 the incidence of acute hepatitis C was 2.2 per 100 thousand of the population, in children under 14 years old ― 0.6 per 100 thousand of the population, and in 2020 the rate decreased to 0.66 per 100 thousand of the population in the whole country up to 0.1 in children. A characteristic feature of the modern epidemic process of hepatitis А is the shift in incidence to age groups 2039 years. The most common variants of polyetiology are hepatitis A + hepatitis B (74%). The incidence of parenteral hepatitis has been decreasing in the Russian Federation over the past decade due to ongoing anti-epidemic and preventive measures. CONCLUSION: The current trend in the epidemiology of acute viral hepatitis is a steady decrease in the incidence. The number of new cases of registration of both vaccine-controlled and non-managed acute viral hepatitis has been steadily declining in both children and adults. The most common variants of polyetiology are hepatitis A + hepatitis B (74%).Vaccinal prophylaxis of hepatitis A and hepatitis B remains a necessary measure to combat various variants of the course of mixed infections.