EVALUATION OF CLINICAL CONDITION, IMMUNOSUPRESSION AND VIRAL ACTIVITY IN PATIENTS WITH HIV INFECTION

Abstract

Materials and methods. The course and the main clinical and laboratory parameters of HIV infection course were studied in 300 HIV patients featuring different clinical symptoms, general conditions and outcomes of their disease. The patients were followed up at Saint-PetersburgCenterfor Prevention and Control of AIDS and Infectious Diseases (AIDSCenter). A modified Karnofsky scale was used to assess the general physical conditions of the patients. The scale defines patient’s condition in 10% steps from 100% (normal conditions) to 0% (death). The patients were examined upon admission and in 6 and 12 months thereafter. They were assigned to two groups, 150 subjects each. Group 1 comprised patients who were hospitalized at advanced stages of HIV infection because of delayed diagnosis when HIV was already manifested clinically, the severity of patients’ conditions was determined by opportunistic or concomitant somatic and neurologic conditions determined, and CD4 cell counts were below 199 ml–1. This group also included patients who did not receive ART because of different reasons, including delayed HIV diagnosis, refusal to be treated, social and domestic circumstances etc., or either were treated irregularly, i.e., in prolonged non-treatment intervals or discontinued treatment. In this group, 28 patients discontinued ART, and the rest never received ART. Group 2 comprised HIV patients whose conditions were well preserved and CD4 cell counts were 200-350 ml–1. The patients were hospitalized for control examinations or for correction of therapy and had no severe clinical symptoms. The study did not involve active drug abusers and patients with endogenous mental disorders. ART was prescribed or renewed under in-hospital conditions according to indications, and the most adequate ART regimens were chosen. Measures to develop adherence to therapy were taken. Statistical treatment was carried out using Vortex ver. 6 and MS Excel 2010 software. Results: Significant negative correlations were found in both groups between the index of patients’ physical wellbeing, which was assessed using the modified Karnofsky Scale, and CD4 cell counts, HIV RNA levels, and the presence of severe opportunistic infections. Negative changes in the index were associated not only with the worsening of patient conditions but also with the need for repeated hospitalizations and prolonged rehabilitation and with unfavorable outcomes. When immunity was improved with ART, Karnofsky index changed positively in both groups, more so in the Group 2. Conclusion: Karnofsky index may be employed as a simple and easily available clinical approach useful in any medical discipline for assessing the general conditions of patients, in particular, for planning individual therapeutic regimens for HIV patients treated under outpatient and inpatient conditions.