26o AIDS Supplement

AIDSAIDSH e l l e n i c A r c h i v e s

22, Supplement 1, 2014 Volume 22, Supplement 1, November 2014

AIDS

EDITION OF THE HELLENIC ASSOCIATION FOR THE STUDY AND CONTROL OF AIDS

http: //www.aids.org.gre-mail: [email protected] 1105-8900

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vii

AIDS

AIDS

: AIDS 6, 11527 . Fax: 210-6983945 e-mail: [email protected] Website: www.aids.org.gr

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ISSN 1105-8900

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e-mail : [email protected]

:

P.O BOX 14085 GR-11521 Athens

: 15.00 ..... 6.00 50.00 110.00

: Focus on Health .: 210-7223046 Fax: 210-7223220

AIDS 1/543/99, 2 . 122 18/02/1999

viii

HELLENIC ARCHIVES of AIDSQUARTERLY SCIENTIFIC EDITION OF THE HELLENIC ASSOCIATION

FOR THE STUDY AND CONTROL OF AIDS

Edited by the: Hellenic Association For the Study and Control of AIDS 6, Erythrou Stavrou Str., 115 27 Athens Tel. & Fax: (+30) 210-6983945 e-mail: [email protected] Website: www.aids.org.gr

ADVISORY BOARD

President: M. K. Lazanas

Vice-President: C. Gogos

Secretary: G. Chrysos

Special Secretary: V. Papastamopoulos

Treasurer: K. Thomatou

Members: P. Gargalianos-Kakolyris, P. Kollaras, A. Papadopoulos, V. Paparizos

EDITORIAL BOARD

Chairman: M. K. Lazanas

Editor in Chief: M. Chini

Asst. Editor in Chief: Ch. Loupa, G. Tsekes

Members: D. Agrafiotis, E. Choremi-Papadopoulou, G. Chrysos, G. Xylomenos, N. Magkafas, M. Maragkos, Z. Matsou, S. Metallidis, A. Papadopoulos, V. Paparizos, V. Papastamopoulos, D. Paraskevis, A. Psarra, N. Sipsas, . Tsalimalma, E. Vogiatzakis

ISSN 1105-8900

Scientific Correspondence: HELLENIC ARCHIVES of AIDS M. Chini, P.O Box 14085 11521 Athens Greece

e-mail Magazine: [email protected]

Subscriptions: P.O. BOX 14085 GR 11521 Athens

Annual Subscriptions: Doctors 15,00 Members of H.A.S.C.A 6,00 Societies Organizations Libraries 50,00 Abroad 110,00

Published By: Focus on Health Tel.: (+30) 210-7223046 Fax: 210-7223220

ix

AIDS 1408511521

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AIDS, 2014; 22(Suppl 1):1-70

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. (EQA, external quality assessment PT, proficiency testing). , HV, HIV , CD4+ .. UK-NEQAS, EMQN, CAP, QCMD, UNIQ, INSTAND, EHEQAS .. ISO 17043. SDI (Standard Deviation Index) : 3 .

(non conformity) , , .

1. . . 1 , - -

. - , 2006:7-11.2. . . 2007;24:58-78.3. Huisman W. European medical laboratory accreditation. Present situation and steps to harmonisation. Clin Chem Lab Med

2012;50:1147-52.4. International Standards Organisation. ISO 15189: Medical Laboratories-particular requirements for quality and competence. 2012.5. . . 1 ,

. - , 2003:99-111.6. Westgard JO, Klee GG. Quallity Management. In: Burtis CA, Ashwood ER, Bruns DE, editors. Tietz textbook of Clinical

Chemisty and Molecular Diagnostics.: Elsevier, 2005:485-529.7. - , , , , . -

. 1 , - . - - , 2006:53-6.

8. . ISO 15189: . 5o - , , 2008:19-30.

9. . ISO 15189. 8o , - , 2009:17-24.

10. . . 1 , - . - , 2003:52-85.

11. Davis BH, Dasgupta A, Kussick S, Han JY, Estrellado A. Validation of cell-based fluorescence assays: practice guidelines from the ICSH and ICCS-Part II-Preanalytical issues. Cytometry B Clin Cytom 2013;84:286-90.

12. Neumaier M, Braun A, Wagener C. Fundamentals of quality assessment of molecular amplification methods in clinical diagnostics. International Federation of Clinical Chemistry Scientific Division Committee on Molecular Biology Techniques. Clin Chem 1998;44:12-26.

13. . ( ). 18 , . - , 2005:127-41.

14. Barnett D, Louzao R, Gambell P, De J, Oldaker T, Hanson CA. Validation of cell-based fluorescence assays: practice guidelines from the ICSH and ICCS-Part IV-Postanalytical considerations. Cytometry B Clin Cytom 2013;84:309-14.

AIDS, 2014; 22(Suppl 1):1-70

9

15. . . , 2008.16. National Pathology Accreditation Advisory Council. Requirements for the validation of in-house in vitro diagnostic devices

(IVDs). Australia 2003.17. Tanqri S, Vall H, Kaplan D, Hoffman B, Purvis N, Porwit A, et al. Validation of cell-based fluorescence assays: practice guidelines

from the ICSH and ICCS-Part III-Analytical Issues. Cytometry B Clin Cytom 2013;84:291-308.18. OECD. Guidelines for quality assurance in molecular genetic testing. 2007.19. Panteghini M. Traceability as a unique tool to improve standardization in laboratory medicine. Clin Biochem 2009;42:236-40.20. Kessler HH, Raggam RB. Quality assurance and quality control in the routine molecular diagnostic laboratory for infectious

diseases. Clin Chem Lab Med 2012;50:1153-9.21. Wood B, Jevremovic D, Bene MC, Yan M, Jacobs P, Litwin V. Validation of cell-based fluorescence assays: practice guidelines

from the ICSH and ICSS-Part V-Assay Performance Criteria. Cytometry B Clin Cytom 2013;84:315-23.22. Sack U, Barnett D, Demirel GY, Fossat C, Fricke S, Kafassi N, et al. Accreditation of flow cytometry in Europe. Cytometry B Clin

Cytom 2013;84:135-42.

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AIDS, 2014; 22(Suppl 1):1-70

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3. HIV- . Laboratory Testing for the Diagnosis of HIV Infection: Up-dated Recommendations http://stacks.cdc.gov/view/cdc/23447.7

6. H HIV

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AIDS, 2014; 22(Suppl 1):1-70

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AIDS, 2014; 22(Suppl 1):1-70

15

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, - , .

HIV ISO 15189 2012.20,21 - .. . .. , - , ISO 9001 2008. , - - .

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., . ., , , ., .

, ( 9, 2, 17 2013) : - .

1. Laboratory Diagnosis of HIV in Adults: A review of Current Methods http://cid.oxfordjournals.org/content/early/2013/06/13/

cid.cit281.full2. http://biology.kenyon.edu/slonc/gene-web/Lentiviral/Lentivi2.html 3. http://hivbook.com/tag/viral-genome 4. Leitner T. Genetic subtypes of HIV-1 in Myers G. Korber BT, Foley BT et al Hyman Retroviruses and AIDS (Available on line at

http://hiv-web.lanl.gov).5. Robertson DL, Anderson JP, Bradac JA, et al. HIV-1 nomenclature proposal: a reference guide to HIV-1 classification. In: Kuiken

CL, Foley B, Hahn B, et al, eds. Human Retroviruses and AIDS 1999. Los Alamos, NM: Los Alamos National Laboratory; 1999:492-500 (Available on line at http://hiv-web.lanl.gov)

6. Clavel F. HIV-2, the West African AIDS virus. AIDS 1987;1:135-140.7. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations http://stacks.cdc.gov/view/cdc/23447.8. Immunoassays for the Diagnosis of HIV: Meeting Future Needs by Enhancing the Quality of Testing. Roderick J Chappel, Kim

M Wilson, Elizabeth M Dax Future. Microbiol. 2009;4(8):963-982.9. Abbott Diagnostics, .

HIV 1986-2005.10. Abbott Diagnostics, HIV Ag/Ab Combo, ARCHITECT, Assay insert Instructions 2013. www.abbottdiagnostics.com11. Enhanced immunoassay sensitivity using chemiluminescer acridinium esters with increased light output Anand Natrajan et

al. Analytical Biochemistry 406 (2010); 204-213.12. Chemiluminescence www.invitron.com13. HIV & AIDS Factors Known to Cause False-Positive HIV Antibody By Cristine Johnson http://www.virusmyth.com/aids/hiv/

cjtestfp.htm14. False-Positive Rate of a Fourth-Generation HIV Antigen/Antibody Combination Assay in an Area of Low HIV Prevalence.

Sinyoung Kim et al. Clin Vaccine Immunol October 2010 vol. 17 no. 10 1642-1644.15. HIV ... 2013.16. HIV Testing/hivbook.com/2011/10/29.17. FDA Approves First Rapid Diagnostic Test to Detect Both HIV-1 Antigen and HIV-1/2 Antibodies http://www.idsociety.org/FD

AApprovesFirstRapidDiagnosticTest.aspx18. First Rapid Home-Use HIV Kit Approved for Self-Testing.19. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm310545.htm20. . , O , 9 -

- , 2009.21. Quality control in Infectious Disease Serology NRL QC.22. Implementing SO 15189 in Kisumu, Kenya. Am J Clin Pathol 2010;134:410-418.23. 138/2005, . 3402/17-10-2005: .24. , : (14 2008,16

2010 17 2013).

AIDS, 2014; 22(Suppl 1):1-70

17

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AIDS .... 28- HIV . ( anti-HIV - Western Blot) HIV RNA p24 Ag HIV.

3.073 anti-HIV , .

94,83% HIV (1.743 1.838 ) - HIV RNA HIV . , HIV 93 , - HIV .

, AIDS , CDC HIV .

CDC - Western Blot HIV . - - - (EIA 4 ). - HIV . HIV1 HIV2. , HIV1 RNA HIV2 RNA.

-.

, (HIV RNA) HIV .

. cD4 .

CD4 (CD4) (HIV). CD4 , HIV -.1 HIV, CD4 - ( ) . , -

-, ...

AIDS, 2014; 22(Suppl 1):1-70

19

CD4 .1 CD4


20

. , .

. , , , . , - .

, . 1 - CD4.

1. CD4, .

/ /

EPICS XL, FC 500 (Beckmann Coulter)

FACSCalibur, Canto (BD)

PanLeukogating CD4

Tritest Multitest

30-300

30-300

EDTA 5

EDTA 48

FACSCount(BD)

Guava PCA (Millipore)

CyFlow SL and Counter (Partec)

FACSCount reagent CD4 reagent

Easy CD4, Easy CD4% Auto CD4

Partec Easy Count CD4 CD4%

AIDS, 2014; 22(Suppl 1):1-70

21

.

CD4 EDTA. ! - , . -, 48 , .

, , - 30C.5 , .

o -

. , , , , .

. . .

. , . CD4 , . , . 2 .

- Levey-Jennings . - 2SD ( 1). Levey-Jennings - ( Westgard).

2. .

*/

(C)

Beckmann Coulter

BD

BD

Immuno-Trol/low normal

Multi-Check/low normal

True count Control/ low, medium, high

FACSCalibur

6-9 (90 )

1

1

2-8

2-8

2-8


22

*/

(C)

Streck, Omaha

Streck

Streck

Synexa, Bellvile, South Africa

CD4 count/low, normal

CD4 Chex Plus/low, normal

CD4 Chex Plus BC/low, normal

LymphoSure/normal

Beckman Coulter

3

3

3

1

2-10

2-10

2-10

2-8

* .

Westgard . :12s 2S 3S13s 3S22s 2S 3SR4s 4S41s 1S10

, - . -. .

1. Levey-Jennings CD4.

CD4

/

l

3 SD 2 SD 1 SD

225

200

175

150

125

100

04/1

2/13

10/1

2/13

11/1

2/13

17/1

2/13

18/1

2/13

19/1

2/13

23/1

2/13

24/1

2/13

27/1

2/13

29/1

2/13

30/1

2/13

-

( ). . , 48 (, /) .

AIDS, 2014; 22(Suppl 1):1-70

23

CD4 CD4 (SOPs)

, . (SOPs) .

(, ). - . - - . .

. - CD4 . - .

. , () , - . .

.

.

. : , . CD4 ().

- CD4 .6 .

.

1. World Health Organization Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infec-tion Recommendations for a public health approach. 30 June 2013 ISBN: 978 92 4 150572 7.

2. Centers for Disease Control and Prevention. Guidelines for performing single-platform absolute CD4+ T-cell determinations with CD45 gating for persons infected with human immunodeficiency virus. MMWR Recomm Rep. 2003;52(RR-2):1-13.

3. Stevens W, Gelman R, Glencross DK, et al. Evaluating new CD4 enumeration technologies for resource-constrainedcountries. Nat Rev Microbiol. 2008;6(suppl):S29-S38.

4. Glencross DK, Janossy G, Coetzee LM, et al. Large-scale affordable PanLeucogated CD4 testing with proactive internal and external quality assessment: in support of the South African National Comprehensive Care, Treatment and Management Programme for HIV and AIDS. Cytometry B Clin Cytom. 2008;74B(suppl 1):S40-S51

5. Ruiz AR, Perez Fernandez I, Perea Baena JM, et al. Influence of sample storage time and temperature on lymphocyte subset counts using a FACSCount system [letter]. Haematologica. 2000;85:550-551.

6. Peter TF, Shimada Y, Freeman RR, et al. The need for standardization in laboratory networks. Am J Clin Pathol. 2009;131:867-874.


24

hIV

Kaposi.

Kaposi 1872, - 80 AIDS. -8 (HHV-8) 1994, .

Kaposi 4 : , , AIDS - . AIDS - HIV . , HIV .

, HHV-8, , tat HIV. - , - spindle-cells,

Kaposi , , / . - AIDS , - . HIV .

Kaposi AIDS (R). (PIs), - (NNRTIs). HAART HIV . Kaposi -. AIDS aposi, - . .

HIV - .

.

HIV AIDS (AIDS defining malignancies-ADM, Kaposi, non-Hodgkin - ) (non-AIDS defining malignancies-NADM).

, ADM NADM HAART . DAD, - , 58% NADM.

, ...,

-, ...., , ... .

AIDS, 2014; 22(Suppl 1):1-70

25

, , , - HIV 9 , . HAART CD4 . HIV HPV - . , - . - , HPV HIV .

NADM, HIV 12 - . HIV - , , Hodgkin, . HIV ADM.

, - , , , - CD4 . NADM , HPV, EBV, HBV HCV.

, , HPV, 16 18, . - - . . screening MSM , HPV, .

EACS - HIV , . , , HAART , - . , - , , .

NADM, - HAART -, . - , .

c hIV :

c.

C 2014 - - - telaprevir boceprevir ( ). sofosbuvir ( ), simeprevir ( )

-


26

daclatasvir ( ) 2013 - 2014, 2014 (EASL, 2014) (AASLD, - 2014) (WHO, 2014). , .... ( - 2013).

: 1. C , - (Metavir score F3-4), - HCV, HBV. 2. - sofosbuvir. 3. 12 1 . 4. - 24 48 . 5. C per os, , - ( , , ).

...:

... , ,

hIV. , : ...

. , - . - .

HIV, , , .

, : ) , ) , ) , - .

, , , , , , , -, .

, , - HIV, , , , , - .

, , .

-

AIDS, 2014; 22(Suppl 1):1-70

27

, , .

HIV - . -. .

- , : - , - HIV, , , , .

- hIV/aIDs - PraKsIs.

PRAKSIS , , , , . , PRAKSIS 2014, - - PRAKSIS - , HIV.

hIV : 2014

.

2011-2013, HIV - (). HIV - -. - HIV 2014. , , HIV XEN , - .

PRAKSIS

,

29

hIV : .

HIV . . . , - - .

microbicides (-) , HIV , - .

, - . , , .. . , , -9, HIV .

-. , , 2010, - Tenofovir gel 39% (CAPRISA 004). o , (VOICE study). Tenofovir gel (FACTS 001). - Dapivirine ( ) -. 4.500 2015. , (Raltegravir, Dapivirine/Darunavir, Tenofovir/Efavirenz, Darunavir/Maraviroc, UC871 ..). , 70 - .

HIV , . , , .

: -, , , - , , . , . . HIV.

hPV hIV.

HPV (Human papilloma virus, ), DNA - . 120 , 40 . ( 6 11) - , ( 16 18) - .

-, ..., & .

, , , ....


30

HPV 80% .

HPV HIV .

HPV HIV, , HIV - HPV, .

HAART PV . HAART - HPV , . , ART .

HPV (HPV 6, 11, 16 18) (HPV 16 18) . - HPV . - . . . HIV+ HIV-, .

, - HIV+ - . , / .

: ;.

- HIV . , , , . , . HIV /AIDS, - , libido, , - , . HAART, - . , , HIV .

, , . ( , , ..), , / -

MD, PhD, - , , & (....), , , ...

AIDS, 2014; 22(Suppl 1):1-70

31

( , , , ). HDL-. . / .

, , , . D - HIV , . , , OH-25- D.

In vitro HIV . HIV /AIDS, , . , - . - . - HIV -, .

- , , . .

- , . . , - , , - (St Johns wort), .

, - , . - .

33

.

HIV . : , -. - [MSM ( ), - (), ]. MSM - , .

- (--, -), - , , , . , , ( ), . - , , , . , (0,1%, , , - . , , MSM/ . , , , AIDS. - .

,


34

hIV .

HIV , . , , - . , - , - (.. ). - - .

, , CDC (late presenters) ( , - , , - HIV HAART-indicator diseases).

, - ( HIV ), -, , .

hIV ..

HIV HIV, .

, 1984 - 344 . , 124 - .

, - . , ! - . -, - .

HIV. 6 . 1 - , . 2 , . 3 , , - . .

,

AIDS, 2014; 22(Suppl 1):1-70

35

, ) , ) , ) , . , - . , , . 4 - - ( 3). 5 4 -, . , HIV , , test . , - 6 6 .

, - HIV , , .

.

, HIV , . 2012 35,3 - HIV, 3,3 2002 2,3 2012. AIDS , 2,3 2005 1,6 2012. , 5, - 34% WHO 2013.

, ...., 31/12/2013 13.622 (82,2% ) HIV ( AIDS). HIV . 2013 8,3 HIV 100.000 , 2010 5,5 100.000 . - HIV 2011 2012 (8,7 10,7 100.000 , ), (). 2013 2014 , - HIV . - HIV , , - , , .

HIV , HIV .

, ..., & , ... - ...


36

HIV (post-exposure prophylaxis, PEP) 80% -, (pre-exposure prophylaxis, PrEP) 44-92% HIV . - gel . - , HIV .

- .

- , - , , .

- .

DNA , , , , - .

:

1. 2. 3. 4. , pH 5. 6. 7. ,8. .

, , , - , .

, - , , , , - .

, , , .

, , .

, , , , -, , - , .

- - - , -. , , 60%. - , .

AIDS, 2014; 22(Suppl 1):1-70

37

72% .

, - , , , - . , , , - , , - .

, , - , 6-10 , , , , , - .

, , - , - (VOCs/Volatile Organic Compounds). . - , - , OPA, - - .

. - , , , . -, , , . , - .

, -. , , , -, .

Gram+ , . , , . Gram-. -, .

, , -, . - . , . , , , .

- , , ,


38

. - , , , .

- .

hIV .

HIV , 50%-90% . . , HIV .

HIV .

2011-24/10/2014 32 HIV , . .

32 , 31 , 39,5 ( 22 73 ). , 10 2 . , 10 17 . 17 , 6 : (1 ), (1), (1), Fordyce (1) (2). (34,4%) HIV Kaposi (1 ), (3), - (2), / (2), (1) (2) 11. CD4 9 75 /mm3 (200 /mm3.

, HIV- , - .

-, , , ,

39

01

cD4 . ,1 . ,2 . ,3 .. ,4 . -,5 . ,6 . ,7 . ,8 . ,9 . ,10 . ,11 . ,12 . 1

: (combined antiretroviral treatment - cART) HIV+ -, cART CD4 (CD4) HIV . - CD4 cART - , , CD4, cART / .

: AMACS (Athens Multi-center Cohort Study). 15 cART - -, 2002 , . CD4 .

: 1.525 . (85,4%) ( - ) 35,6 (30,2-43,7) . (56,9%) () - cART 2,7 (1,2-5,1) . CD4 . cART 100 CD4 /L, CD4 600 /L 5 cART. 250 CD4 /L - cART CD4 600 /L , 3 , . , , CD4 (800 /L) >350 CD4 /L. 5 , CD4 , .

: CD4 CD4 5 cART. cART , CD4 - CD4 350 /L. HIV .

1 , , ,

2 , .

3 , ...

4 , ... - ..

5... . 6 ,

7 , ,

8 , ...

9 , ..

10 , , ...

11 , ...

12 , 1 ...


40

02

hIV-1 : . ,1 . ,1 . ,2 . -,3 . ,4 .. ,5 . ,6 . ,7 . ,8 . ,9 . ,10 . ,11 . ,12 . 1

: (cART) - . - cART.

: AMACS (Athens Multi-center Cohort Study). 15 , - cART (Boosted-PIs) - (NNRTIs) 2002 . >90% . - .

: AMACS, 66,7% (n=3.733) - . 83,4% (n=3.115) 83,1% (n=3.102) . (50,2%) , 194 (5,2%) . 6.491 cART , 3.720 (57,3%) Boosted-PIs 2.771 (42,7%) NNRTIs. , 59,9% -. , 2002 2006 - 2006 2013. 2002-2004, - NNRTIs (85,3%) Boosted-PIs (80,5%). (IDUs) (OR=0,288, p-value3/, (p-value=0,009).

: . - IDUs . cART. - cART , - .

1 , , ,

2 , .

3... . 4 , ...

5 , ... - ..

6 , ,

7 ,

8 , ..

9 , ...

10 , ...

11 , 1 ...

12 , , ...

AIDS, 2014; 22(Suppl 1):1-70

41

03

. , . , . , . , . , . , .

: , , .

: -

: ... ( ), 2002, .

: 01/01/2007-01/01/2013 - 304 . 111 (36,5%) , 91 (29,4%) , 22 (7,5%) 15 (4,9%) - . , 65 (21,6%). 50,98%, (155 ) - 21-35 , 35,52% (108 ) 36-45 13,5% (41 ) 46-65. 91,1% . 66,77% (203 ) - , 10,85% (33 ) , 7,56% (23 ) 14,82 % (35 ) . 52,2% , 39,9% - , 7,9% . 78% - HBV. - , HBV, HCV HIV. 82,3% / HBV, HCV HIV, 9% (25 ) HbsAg(+), 6,8% (19 ) anti-HCV(+), 0,7% (2 ) HbsAg(+) anti-HCV(+) 1% (3 ) HIV(+).

: . . .

, ...


42

04

(linkage) (retention to care) () hIV : . ,1 . ,1 . ,1 . ,1 . ,2 . ,3 . ,3 . ,2 . ,2 . 1

: , 2011, V (). , - , HAART , - HIV . - HIV XEN.

: HIV : ) 3-6 HIV , ) - 3-6 , ) HAART, ) (HIV RNA

AIDS, 2014; 22(Suppl 1):1-70

43

: 11 (10 , 27 ) 18 . 10 , 7 3 , - 34 ( 28-46) HIV 7,6 . - A, B C . (IVF). IVF. - 2 6 - . HIV , 5 (4 -), 5 1 . , 2 , 3 2 C 3 , 2 . HIV 3, . 5 2 IVF. ART 4 , 2 5. 6/7 ART. - ART HIV . 4 ART , -, . , HIV (8 ). HIV 7 , ART 1-2 (1 status ). 1 - .

: HIV . - . , , - , .

06

(PaF) hIV : . , .. ,2 . ,3 . ,4 . ,2 . -,5 .. ,2 . ,4 .. 3

: (PAF) - . - PAF HIV .

: 21 - ... 1, 3, 6, 9 12 . tenofovir-DF/emtricitabine/ atazanavir-r (7 , 33%), abacavir/lamivudine/atazanavir-r (5 , 23,8%), abacavir/lamivudine/ efavirenz (4 , 19%), tenofovir-DF/emtricitabine/darunavir-r (4 , 19%) tenofovir-DF/emtricitabine/efavirenz (1 , 4,8%). , (MedDietScore) (FRAP). (RM ANOVA)

, ... - ...

, ,

3 - , ... - ...

4 -,

5 , ... .


44

PAF, PAF-CPT, lyso-PAF-AT, PAF-AH, Lp-PLA2 - , , - .

: PAF 1 (=-0,134, P=0,04). , PAF-CPT 9 (B= -0,37, P=0,06 B=0,018, P=0,04, ). - PAF-AH 3 Lp-PLA2 6 (=0,52, P=0,05 =0,542, P=0,06, ).

: A - PAF, . - PAF HIV .

07

hIV . ,1,2 . ,3 . ,3 . ,3 . ,3 .. ,3 . 2

: HIV (HAART). - HIV .

: 57 HIV (52 , 42 HAART), 42,711,4 , 24,74, -- .... - . , , - (MedDietScore).

: 27 kcal/kg/ (23, 42 kcal/kg/) 1,15 gr/kg/ (0,75, 1.46 gr/kg/). - 420 . (270, 660 .), 210 . (60, 450 .) 2,5 (0,5, 2,5 ). / 0,33 (0,13, 1 ), 20 . (8,5, 30 .), 0,33 (0, 1 ), 2 (1, 3 ), 1,5 (1, 2 ). 1 (1, 3 ). MedDietScore 286 . , 35% .

: , , , . , -. .

1 , ... - ...

2 -,

3 , , ... - ...

AIDS, 2014; 22(Suppl 1):1-70

45

08

/ hIV+ . ,1 . ,1 . ,1 . ,2 . ,1 . ,1 . ,2 . 1

: () / HIV .

: (cross-sectional) HIV+ .. ( ) (DEXA) WHO . - . , , (), , 25() D, HIV-RNA, CD4 , HAART, .

: 143 (117 , 96 MSM, 25,5, 77%, 116 -81%, 45 7,7, ). CD4 285 /L VL 68.851 /mL ( 28882-186881). DEXA CD4 403/L VL


46

: 60 (52 , 8 ) 3 . 45 , 96 , 15 . HAART 48 96 .

: (..) 39 . HAART, .. CD4+ 261 /l, .. 132.183 copies/ml. .. 166 mg/dl, HDL 36 mg/dl, LDL 101 mg/dl, 128 mg/dl 90 mg/dl, . , 17/53 LDL 130 mg/dL 19/53 HDL 160 mg/dL. 46/60 tenofovir DF/emtricitabine 14/60 abacavir/lamivudine. . 48 - (59/60 ), .. CD4 598 /l 58/60 (96,6%)

AIDS, 2014; 22(Suppl 1):1-70

47

: , Atripla. ( , - SPREAD) .

11

hIV cD4+ -. ,1 . ,2 . ,3 . ,3 . ,3 . ,3 . ,3 . ,4 . ,1,3 . ,1,3 . 1

: HIV , - CD4+ .

: ( 2001 2013) 919 HIV - AIDS . CD4+ , . , , (, , -) CD4+ CD4+ . , cut off ROC CD4+


48

12

hIV(+) . ,1 . ,2 . ,2 . ,1 . ,1 . ,1 . ,1 . ,1 . ,3 . ,2 . 2

: , Neisseria gonorrhoeae. , / , -. , , , , , , .

: HIV(+) ( 2013- 2014).

: - ( Gram ), .

: N. gonorrhoeae 6 , 3 (50%) HIV(+) . HIV(+) - N. gonorrhoeae 3 (42,9%) 7 HIV(+) . HIV(+) . - , . . . .

: N. gonorrhoeae - 125 mg .., 1 gr P.O. vibramycin ( 30% C. trachomatis). N. gonorrhoeae , - . Gram . . 40 , ( ). N. gonorrhoeae - N. gonorrhoeae . , , .

13

hIV . . , . , . , . , . , .

: HIV , - ,

1 , ...

2 ... & , ...

3

.

AIDS, 2014; 22(Suppl 1):1-70

49

. - (), , , , .

: 291 , - . , . , , . , - . 150 , , , - HIV . : 291 158 (54,3%) , , -, . , 73 , - . , 60 - . , - 133 (45,7%). 150 , 98 (65,3%), 28 24 , 52 (34,7%). - (p=0,032).

: HIV , - . , , , . - , .

14

Eviplera hIV+ 103. ,4 . ,1 . ,3 . ,2 . ,1 . ,3 . ,5 . ,1 . ,5 . ,4 . ,2 . 1

: 103 . , - . EVP 103 - .

: ( ) HIV+ , EVP 2013- 2014. EVP . 103 EVP . (on-treatment analysis, missing=excluded).

: 211 10 103 (9 , 6 , 8 MSM, 7/10 ) ( 34,9 - 2,2- ).

1 , ...

2 , ...

3 .

4 B , , ...

5 , ...


50

1 . , EVP (IQR1-3) 17 (11-24). CD4 330 /L (2/10 - VL>100.000 /mL). CD4 EVP 330/L VL 9506 /mL ( VL98%) EVP.

: EVP 103 . (Rokx C et al. HIV Med 2014;15:611), EVP STR , K103N.

15

Eviplera hIV . ,2 . ,1 . ,5 . ,1 . ,3 . ,4 . ,5 . ,2 . ,1 . ,3 . ,4 . ,2 . 1

: Eviplera (EVP) 2012 - / HIV+ . EVP HIV , .

: ( ) -HIV+ , EVP 2012- 2014. -, , . . (on-treatment analysis, missing=excluded).

: 104 (90 , 81 MSM, 81,6%) ( 33,9 - 2,2, ). 37/104 anti-HCV+ 2/104 HBsAg+. CD4 324 /L - VL EVP 29.439 /mL (14 VL>100.000). CD4 EVP 336/L VL 14.613 /mL (4 >100.000). H EVP (IQR1-3) 18 (13-22). VL 3 77,8% (42/54, - CD4 483/L), 94,7% 6 (54/57, CD4 527/L), 98% 12 (49/50, CD4 606/L) 100% 18 (20/20, CD4 559/L). >100.000 - 6 12 . , ALT 6 12 . >98% 85-93% 18 . EVP ( ). >2 WHO.

: EVP HIV+ . EVP -, .

1 , ...

2 , ...

3 .

4 B , , ...

5 , ...

51

01

dolutegravir , hIV(+) . , . , . , .

: H 3 (RTIs, NNRTIs PIs) . dolutegravir 2013, raltegravir. , dolutegravir .

: 53 HIV Kaposi 1995 (CD4 187, VL 54550 copies)*. ZDV (1995) DDI/3TC/saquinavir (1996) d4T/3TC/efavirenz/ritonavir 2000, . 2003 (VL 78073) tenofovir/tipranavir/ritonavir/stavudine 2007 . To 2008 (CD4 115, VL 109536) tenofovir/darunavir/ritonavir/raltegravir, . 2010 maraviroc (CR5 , CD4 214, VL 25662) 20 - . 2012 (CD4 94, VL 1.075.000) ** - rilpivirine tenofovir/3TC raltegravir maraviroc. 2013 (CD4 52, VL 460.757) . - - darunavir. tenofovir/3TC/maraviroc PI (saquinavir+lopinavir) - , , ( -, , ). 2014 (CD4 22, VL 1.049.000) dolutegravir 50 mg , saquinavir. , - CD4 (183, 213 276 1, 3 5 ), VL (695, 192 1 3 ) .

: , dolutegravir .

*CD4 /mm, VL=Viral load cop/ml, ** RT: M41L, E44D, D67N, L74V, V118I, M184V, T215C, T215Y, K219R, K103N, V179F, Y181C, PI: L10F, V11I, V32I, M46I, I54T, Q58E, A71V, G73S, T74P, I84V, L89V, L90M, L33V, K55R, K20I, .

02

Mycobacterium avium complex (MAC) . , . , . , . , . , .

: - MAC. . IV(+) MAC .

: 30 IV(+) CD4 17/mm3 - , . -

, , ...

, , ...


52

Pneumocystis jiroveci . - , . . -, tenofovir, emtricitabine efavirenz, . MAC iehl-Nielsen . . avium , , -, , . , -, efavirenz darunavir/ritonavir. H 5 . , - . 16 CD4 130/mm ( 2014).

: MAC , - - . . MAC - .

03

hIV(+) . ,1 . ,1 . ,1 . ,1 . ,3 . ,2 . 1,2

: HIV - .

: , 28 HIV - (CD4:39) tenofovir/emtricitabine, darunavir, ritonavir /. , ( ) . 15 (ART) , - . , -, , , - , , . - . , , , -ALA . . darunavir - - raltegravir atovaquone tenofovir/emtricitabine. human hemin (5 - 3 ). : , , ,

1 , ...

2 , ...

3 , ...

AIDS, 2014; 22(Suppl 1):1-70

53

(). , / . ART abacavir, lamivudine, raltegravir. - ( ), , -, , - .

: , 1/20.000. . , , - . , HIV . HIV -, ART .

04

hIV () () . , .

: o, . - , . HIV . neofor-mans , , () - . HIV , .

: 35 , , - , , - , , - . 10 g/dl =50.000/l Coombs IgG+/++. A - (large granular lymphocytes). . - , Kerning Bruzinski . - , , , , - , . , . , . V bc-Total, RPR, sAg, nti-HBs, CV . 38,5C, , - . Cryptococcus neoformans . 2

, ..


54

- .

: , . HIV - , .

05

hIV . .

: HIV - ( Hodgkin , , ). HIV . - HIV .

: 67 - . 15 2 , , . 10. - . WBC=2.580/l, b=11,2 gr/dl, Ht=34,3%, MCV=91,7 fl, MCH=29,9 pg, MCHC=32,7 g/dl, RDW=14,8%, PLT=90.000/l. TKE=90 mm. , LDH=593 U/L, 29 g/dl (59-158), 1555 ng/dl. , - , 12 . -. . . , , , - . , HIV.

: O HIV , - . - .

: HIV - , HIV .

06

hIV .

: - HIV . HPV.

, ..

AIDS, 2014; 22(Suppl 1):1-70

55

: 2011-2014 344 . 35 HIV. (high resolution anoscopy). . - .

: 7/35 ( 20%) - HPV. .

: , , , HIV - . HIV . , 20% HIV - HPV. -, ( ), . . - . .

07

aIDs . , .

3 HIV, , -- AIDS. , - AIDS , , . , AIDS . , AIDS . , 60% AIDS . 4,8 HIV. AIDS. - HIV (51%) . , (33,4%), HIV 2013 2014. , 1 3 HIV - . HIV. 28,5% , 17,3% HIV . AIDS. , 35 AIDS, 1,6 . , 3.386 AIDS 1,547 .

,


56

08

hIV(+) . , . , . , . , . , . , .

: - (ART), . - ART 2 .

: 101 350 . 2

AIDS, 2014; 22(Suppl 1):1-70

57

: 31 , , , 5. , - . , , -. - 24 . - , , . 4 . - 3 . - Treponema pallidum , VDRL , IgM IgG T. pallidum EIA TPHA 1/2560. . HIV 1 2 , ELISA , Western Blot . 2,4 - G. , Western Blot CD4 441, CD4/CD8 0,124 140.000 copies/ml, HIV .

: HIV - - . HIV , , . HIV . - - HIV. HIV HIV . , HIV .

10

hIV 33 . , .. , . , . , . , .. , ..

: , , , HIV , 33 .

: K , , , , -, , , - (HAART) , , . - . 2013-30/9/2014 / / Excel EPI5-Info (CDC, 2008). CD4 .

: 15, , (14 , . 37,9 ) HIV+ (5) , , - (2 ) , , . - 13/15 CD4 o 200 2/3 (10/15) 124. 4, Pneumocystis jirovecii. , , , HIV (),

, .. -


58

. , . 15, 4 . HAART - - 10, 4 .

: - , , -, , HIV . , , - HIV. , , 21 .

11

hIV . , . , . , . , . , . , .

: HIV HIV .

: 59 HIV , 65 , - . . - , HIV . , - C CDC.

: 69,664,88 . - 8/59 (13,5%), (13,4%). 58/59 (). . HIV . - 29 HIV (0,49 ) 196 - (3,32 ). HIV - (6/59) Kaposi (5/59). , - (40/59, 67,8%), (22/59, 37,3%), (20/59, 33,9%), (14/59, 23,72%) (9/59, 15,25%).

: , , , HIV -. . , , , . , - , .

12

hIV(+) . ,1 . ,2, . ,1 . ,2 . ,2 . ,2 . ,2 . ,1 . 2

: HIV(+) , , . , .

.

1 , ..

2 , ..

AIDS, 2014; 22(Suppl 1):1-70

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, - - 2014.

: 29 , HIV - 2012 abacavir/3TC atazanavir/ritonavir. - . . , . . . 8 , , , 50% . . - , - . . - RPR FTA Abs . G 2 . -, , .

: , - HIV(+) - . - .

13

Eviplera (XEn) hIV . ,5 . ,1 . ,1 . ,2 . ,4 . ,5 . ,3 . ,1 . ,3 . ,4 . ,2 . 1

: EVP, (STR), HIV+ -, .

: ( ) -HIV+ , EVP 2012- 2014. , . . (on-treatment analysis, missing=excluded).

: 38 XEN (2 , 28 ) ( 34,5 - - 2,1, , 37/38 anti-HCV+, 2/38 HBsAg+). 29/38 (, 26 /3 ). 11/38 (, , ). CD4 275 /L VL EVP 22.195 /mL (4 VL>100.000). CD4 EVP 292/L VL 1545 /mL. H EVP (IQR1-3) 16 (10-22). VL 72,2% 3 ( CD4 363/L), 88% 6 (CD4 331/L) 94,4% 12 (CD4 400/L). >98%

1 , ...

2 , ...

3 .

4 B , , ...

5 , ..


60

80% 12 . 12/37 (32%) 14/37 (37%) 3 6 , -. ALT. ALT >45 IU/L (12/38), -19, 6 +6 12 -5,6 (P>0,05). EVP (1 , 1 ). - >2 WHO.

: EVP HIV+ . EVP . , -, .

14

Eviplera : , hIV+ . ,1 . ,2 . ,1 . ,4 . ,3 . ,5 . ,1 . ,2 . ,5 . ,3 E. ,4 . ,2 . 1

: EVP , .

: ( ) HIV+ , EVP 2012- 2014. - , , - . . (on-treatment analysis, missing=excluded).

: 107 (91 -81 MSM) ( 40,9 -- 8,6- 5,7, ). - 1 . CD4 292 /L VL 63.000 /mL. CD4 700/L 79/107 (79,4%) VL

AIDS, 2014; 22(Suppl 1):1-70

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15

castleman hIV 8 (V8). , . , . , . , . , . , . , . , . , .

: Castleman (C). H C HHV 8, . A - -6 .1,2

: 42 (emtricitabine, tenofovir, darunavir, ritonavir), (, - ) 39C. CD4 191 /l HIV RNA. . .

: , - , . C, HHV 8 . rituximab . rituximab - , , , , . - , . rituximab -, , - L-6 (tocilizumab). A , PCT CRP , - .

: Castleman - L-6 , TNF-, IL-1, L-4, T-reg .3 - rituximab - . IL-6 HIV HHV-8 .

1. Sumerai JD, et al. Cancer Control. 2014 Oct;21(4):266-78.2. Carbone A et al., Int J Cancer 2014; Ap:27.3. Borden EC. J Lab Cllin Med 1994;123:824-29.

, ...


62

16

hIV . , . , . , . , . , . , . , . , . , .

: HIV . - - , o -, - - (Natural Killler Cells). IV , .1

: 31 - . - HIV ( ) HSV I HSV II. . tenofovir, emtricitabine ( CD4 399/L, HIV RNA 100.000 copies/ml) . . , , LDH, d-Dimers , , - . Epstein-Barr .

: - , HLH-2004 . - , ( , ), - . .

: HIV . , . .

1. Doyle T, et al. Curr Opin Infect Dis. 2009;22(1):1-6.

17

hIV, hBV hcV ... . . , . , . , . , . , . -

: - HIV, HBV HCV - .

, ...

, ... .

AIDS, 2014; 22(Suppl 1):1-70

63

: . 6/2011-10/2014 - HIV,HBV HCV. - -. HIV1,2 HBV/HCV - ( ) .

: 33 (33 -, 41 ). 82% , - (24%), (21%) (21%). (24%), (21%), (21%). - (79%), - (15%) (6%). , - . HBV 36%. O - HIV 6 (18%), HCV 3 (1 HIV), HBsAg 1 -, 12 (36%) - , - . 9 (27%) . - 1 HBV 6 (18%), 2 . 24% - HBV, - 6/7 (86%) . 33 HIV, HBV HCV .

: . , - HIV, HBV HCV. HBV - , .

18

-590 IL-4 hIV-1. ,1 . ,2 . ,1 . ,2 . ,1 . ,1 . ,1 . ,2 . ,1 . ,1 . ,1 . ,2 . ,1 . 1

: IL-4 IgE - - h2. IL-4 CCR5 CD4 R5 HIV-1 - -. C -590 IL-4 IL-4. -590 IL-4 HIV-1.

: 173 HIV-1 . 48 AIDS 125 .

1 , , , ,

2 , ...


64

-590 IL-4 Cytokine Genotyping Kit DYNAL/Biotech.

: 173 HIV-1 , 76,3%, 35,5 . - IL-4 -590. , , 1998, CD4 . -590 AIDS (35 - AIDS 5 ).

IL-4 -590

CC CT TT

133 (76.9%) 36 (20,8%) 4 (2,3%) 173 0,001

103 (77,4%)30 (22,6%)

25 (69,4%)11 (30,4%)

4 (3%)0 (0%)

132 (76,3%)41 (23,7%)

0,33

35,2 10,3 37,5 11,5 27,5 2 35,5 10,5 0,25

98

52 (39,1%) 9 (25%) 4 (100%) 65 (37,6%) 0,26

MSM 86 (64,6%) 23(63,8%) 4 (100%) 113 (65,3%) 0.5

CD4 368 345 389 358 0,78

AIDS

43 (32,3%)90 (67,7%)

5 (13,8%)31 (86,2%)

0 (0%)4 (100%)

48 (27,7%)125 (72,2%)

0,04

AIDS KaplenMeier AIDS .

: -590 - IL-4 . .

19

hIV-1 . ,1 . ,1 . ,1 . ,1 . ,1 . ,1 .. ,1 . ,1 . ,1 . ,1 . 1

: 2000-2010.

: 453 -. , -, . - . - .

: - .

1 , , , , ...

AIDS, 2014; 22(Suppl 1):1-70

65

NNRTIs

PIs

179 (39,5%) 274 (60,5%) 453 (100%) 0,001

149 (83,2 %) 220 (80,3 %) 369 (81,5 %) 0,254

35,9 11,7 41,5 12 39,3 12,2 0,001

>50 24 (13,4%) 68 (24,8%) 92 (20,3%) 0,002

15 18,5 8 14,4 10,8 16,5 0,001

AIDS 14 (7,8%) 70 (25,5%) 84 (18,5 %) 0,001

AIDS 17 (10,4%) 45 (22,1%) 62 (16,8%) 0,002

502,7 128,6 593,8 122,8 557,8 132,7 0,001

23,4 25,8

36,2 27,5 (54)17,9 23 (110)

30,1 25,5

47,3 23,8 (106)19,3 20 (132)

27,5 25,8

43,6 25,6 (160)18,7 21,3 (242)

0,007

0,0020,56

10473,4 9855,3 17749,5 14656,3 14874,4 13441,3 0,001

606,7 117,1 (110)NNRTIs (68) 576.2

83.5PIs (42) 643.9 117.4

578 127,2 (132)NNRTIs (30) 532.7

11.5PIs (102) 591.7 129.1

590,9 122,8 (242)NNRTIs (98) 563.41

94.1PIs (144) 607.3 127.6

0,08

82 (45,8%) 186 (67,9%) 268 (59,2%) 0,001

1 (49)2 (14)

>3 (18)

1 (79)2 (62)

>3 (41)

1 (128)2 (76)

>3 (59)

2000-2010 PIs (60.5%). PI ( 41,5 ), AIDS (25,5% 7,8%), AIDS (22,1% 10,4%). PIs. PIs (30,1 23,4) - . . NNRTIs. NNRTIs (45,8% 67,9%) - .

: NNRTIs . . PIs, NNRTIs. .


66

AIDS, 2014; 22(Suppl 1):1-70

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Overall Comparisonsa

Chi-Square df Sig.

Log Rank (Mantel-Cox) ,504 1 ,478

Breslow (Generalized Wilcoxon) 2,878 1 ,090

Tarone-Ware 1,797 1 ,180

Test of equality of survival distributions for the different levels of pivsnnrtis.a. switch = switch


68

20

hIV-1 2000-2010. ,1 . ,2 . ,1 . ,2 . ,2 . ,1 . ,1 . ,1 . ,1 . ,1 . ,1 . ,1 . ,1 . ,2 . ,1 . , . ,1 . 1

: HIV-1 2 NRTIs PI NNRTI - 2000-2010 .

- : 453 . , >18 , . - 6 >1000 , >14 . Kaplan-Meier.

: - . 44 . - NNRTIs (10% 9.4%) . PIs. (21.1 NNRTIs 19.3). .

NNRTIs

PIs

VF

179 (39,5%)18 (10%)

274 (60,5%)26 (9.4%)

453 (100%)44 (9.7%)

0,0010,008

VF

149 (83,2 %)14 (7.8%)

220 (80,3 %)20 (7.2%)

369 (81,5 %)34 (7.6%)

0,2540.32

VF

35,9 11,734.8 8.7

41,5 1243.1 10.4

39,3 12,239.7 10.4

0,0010.001

>50 VF

24 (13,4%)2 (1.1%)

68 (24,8%)7 (2.5%)

92 (20,3%)9 (1.9%)

0,0020.34

AIDS VF

14 (7,8%)3

70 (25,5%)2

84 (18,5 %)5

0,0010.35

17,9 23 (110)

21,1 16,4 (18)

19,3 20 (132)

19,3 16,4 (26)

18,7 21,3 (242)

20 16,2 (44)

0,56

0,45

2 NRTIs 10 (55.5%) 15 (57.6%) 25 (56.8%) 0.45

1 , , , , ...

2 , ...

AIDS, 2014; 22(Suppl 1):1-70

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- . - PI .

RTIs18 VF, 3

s26 , VF, 13

RT

RT

6 K103N 4 L10I, M36I 4 M184V 7 M36I

5 M184V 3 I13V 2 D67N, K70R, K103N 4 L89M, I13V, L10I

3 Y181C 2 L63P, I62V, I93L 1 V106I, E138A, L74V, Y75I, V75T, Y75A,

Y188L, T69N, G190A, K219Q

3 H69K, L63P

2 E44D 1 K20I, L19I, A71T, I54V,

H69K, L89M

2 L90M

1 V179D, M41L, L210W, T215Y,K101Q, G190A, G190S, P225H, D67N, K70R, K219Q, K219E,

V118I, A62V, V75I, K101I, Y115F, G190S

1 G16E, L33V, E35G, I54M, A71T, K20M, I62V, A71I,

V77I, I93L

: PIs NNRTIs. VF . PI .

21

hIV-1 .. ,1 . ,1 . ,3 . ,3 . ,1 . ,2 . ,3 . ,3 . ,3 . ,4 . ,4 J. Hezka,4 . ,4 . ,3 . 2

: HIV-1 DNA - , CD4 T - (Kostrikis et al., 2002, Tierney etal., 2003,Goujard et al., 2006).

: HIV-1 DNA, . , - HIV-1 DNA CD4 - .

: 94 HIV-1 - 2009-2010. .

1 , ... ,

2 ...

3 , , ... ,

4


70

HIV-1 DNA - (beacon) (real-time) PCR (Kostrikis et al 2002, Demetriou et al 2010). HIV-1 pol - REGA HIV-1 subtyping tool v2.0 (http://www.bioafrica.net/subtypetool), HIV Drug Resistance Database (http://hivdb.stanford.edu) Calibrated population resistance tool v.6 (Surveillance Drug Resistance Mutation list, 2009 http://hivdb.stanford.edu)

HIV-1 DNA, Mann-Whitney Pearson, HIV-1 Kruskal-Wallis.

: HIV-1 DNA 3.309 (IQR 2.889-3.631 log10 / 106 PBMC).

HIV-1 DNA - . - HIV-1 DNA CD4 - (R2 = 0,004, P = 0,969). HIV-1 (A, B, C, CRF- AG, CRF04-cpx, CRF-01, F1 G) . DNA.

: HIV-1 DNA - HIV-1 .

71

J. Hezka 69. 39, 45, 49, 50, 59,

60, 61, 62, 69. 56, 58. 43. 42, 62. 48. 51. 47, 63, 64, 68. 58. 64. 53, 54. 27. 58. 41, 46. - 39, 40, 42, 43, 45,

62. 48, 56. 48. 39, 40, 51. 39, 40, 42. 47, 63, 64, 68. 48, 56, 58. 42. 41.. 43. 57.. 34. 46. 45. 63, 64, 68. 61, 62. 45, 48, 51. 48. 44. 61, 62. 58. 44. 30. 42. 52. 51. 45, 49, 50, 59, 60. 39. 33. 56. 69

. 47, 63, 64, 68, 69. 2. 44. 3. 39, 40. 52. 63. 48. 17.. 26. 40. 63, 69. 24, 39, 40, 48, 49,

50, 56, 58, 59, 60. 61, 62. 52. 57. 46. 4. 41. 69. 61, 62.. 39, 40, 43, 45. 46. 58. 56. 51. 24, 42, 49, 50, 59,

60, 62. 63, 68, 69. 41, 46, 49, 50, 59,

60. 69. 51. 68. 61. 55. 56, 58. 47, 63, 64, 68, 69E. 42, 62. 56, 58. 42. 57. 41. 47. 48. 42, 62


72

. 48. 63. 47, 69. 27. 48 63, 68. 55. 43.. 64. 42, 45, 62. 45. 45. 53, 54. 3, 41, 46, 49, 50,

59, 60. 39, 40, 51. 39, 40. 68. 45, 49, 50, 59, 60,

61, 62. 38. 45. 47.. 43. 25. 29, 48, 49, 50, 56,

58, 59, 60. 45, 48, 51, 52. 56, 58. 46.. 57. 48. 69. 44. 56. 61, 62. 29, 40, 45, 49, 50,

59, 60, 61, 62.. 44. 64, 68. 48, 58. 1. 39, 40, 49, 50, 59, 60. 69

. 51. 47, 63, 68, 69. 45, 48, 51, 52. 42. 9. 43. 54. 42. 52. 50, 60.. 57.. 57. 41, 64, 68. 57. 58. 36. 39, 40. 40. 18. 63, 64, 68, 69. 35. 42. 62. 61, 62. 44, 45. 68. 34, 42, 49, 50, 59,

60. 68. 43. 56, 58. 47. 42, 46. 56, 58. 45. 63, 68. 43, 44, 45. 47, 68. 52. 47, 63, 64, 68, 69. 39, 40, 56, 58. 48 42, 49, 50, 59, 60

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26o AIDS Supplement

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