Hryzhak I. Toxoplasmosis infection in HIV-infected persons: the peculiarities of course of the disease, diagnostics, optimization of treatment

The dissertation developed the concept of managing persons with HIV-associated toxoplasma infection. The solution of the problem of prophylaxis, diagnosis and treatment of toxoplasmosis in HIV-infected individuals at three levels of influence is proposed. Basing on the developed system of additional complex indicators of assessment of HIV-epidemic situation and effectiveness of the work of center of AIDS prevention in Ivano-Frankivsk region the first and all discovered people living with HIV in region, the conditional annual intensity of epidemic, the annual rate of transition to AIDS, the mortality of HIV-infected individuals, the fullness of coverage by dispansery supervission, the coverage of antiretroviral therapy, the integrated point of epidemic was estimated during 2005-2015 years. The influence of antiretroviral therapy for prevention of AIDS morbidity and toxoplasmic encephalitis in HIV-infected population was studied in 2008-2015 years. The seroprevelence of toxoplasma invasion among HIV-infected persons and its impact on antiretroviral therapy result was found. The attributable, relative, population attributable risk, population attributable risk fraction for toxoplasmosis of the brain in HIV-infected population were established. The concept of complex immunopathology in HIV-infected individuals was supplemented and the immunological predictors of toxoplasmic encephalitis was found. It was applied the immunotropic therapy with ribonucleic acid drug for an increase of level of CD4+T-lymphocytes and eliminating the risk of toxoplasmic encephalitis developing. The algorithm of diagnostics of various clinical forms of toxoplasma infection which based on one-time analysis of clinical symptoms, the serological profile of antibodies to toxoplasma and the degree of immunodeficiency was developed. It was proposed the method of improving the efficiency of diagnosis of cerebral toxoplasmosis in individuals with AIDS which based upon magnetic resonans imaging methods and detection the anti-toxoplasma IgG in the blood and cerebrospinal fluid. For synergistic enhancement of the chemotherapy effectiveness it was proposed the application of specific immunoglobulin for non-AIDS-indicator forms of toxoplasmosis and normal immunoglobulin for intravenous introduction for cerebral toxoplasmosis and their effectiveness had been studied.