Epidemiology and course of infectious diseases during the COVID-19 pandemic. Report 1. HIV infection, hepatitis c and tuberculosis

Cover Page

Cite item

Full Text

Abstract

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.

About the authors

Nikolay A. Belyakov

Pavlov First St. Petersburg State Medical University; St. Petersburg Pasteur Institute

Email: beliakov.akad.spb@yandex.ru

PhD, MD (Medicine), Professor, RAS Full Member, Head of the Department of Socially Significant Infections, Chief Researcher, Head of North-West District Center for Prevention and Control of AIDS

Russian Federation, St. Petersburg; 14, Mira str., St. Petersburg, 197101

Ekaterina V. Boeva

Pavlov First St. Petersburg State Medical University; St. Petersburg Pasteur Institute

Author for correspondence.
Email: kathrine.boeva@gmail.com

PhD (Medicine), Assistant Professor, Department of Socially Significant Infections, Infectious Disease Doctor, Head of Department of Chronic Viral Infection in North-West District Center for Prevention and Control of AIDS

Russian Federation, St. Petersburg; 14, Mira str., St. Petersburg, 197101

Zinaida M. Zagdyn

Research Institute of Phthisiopulmonology

Email: dinmetyan@mail.ru

PhD, MD (Medicine), Senior Researcher, Scientific and Methodological Department

Russian Federation, St. Petersburg

Elena V. Esaulenko

St. Petersburg Pasteur Institute

Email: eve-gpmu@mail.ru

PhD, MD (Medicine), Professor, Head of the Viral Hepatitis Laboratory

Russian Federation, 14, Mira str., St. Petersburg, 197101

Dmitry A. Lioznov

Pavlov First St. Petersburg State Medical University

Email: dlioznov@yandex.ru

PhD, MD (Medicine), Head of the Department of Infectious Diseases and Epidemiology

Russian Federation, St. Petersburg

Olga E. Simakina

St. Petersburg Pasteur Institute

Email: r154ao@gmail.com

PhD (Medicine), Researcher, Laboratory of Immunology and Virology of HIV infection

Russian Federation, 14, Mira str., St. Petersburg, 197101

References

  1. Азовцева О.В., Пантелеев А.М., Карпов А.В., Архипов Г.С., Вебер В.Р., Беляков Н.А., Архипова Е.И. Анализ медико-социальных факторов, влияющих на формирование и течение коинфекции ВИЧ, туберкулеза и вирусного гепатита // Инфекция и иммунитет. 2019. Т. 9, № 5–6. С. 787–799. [Azovtzeva O.V., Panteleev A.M., Karpov A.V., Arkhipov G.S., Weber V.R., Belyakov N.A., Arkhipov E.I. Analysis of medical and social factors affecting the formation and course of co-infection HIV, tuberculosis and viral hepatitis. Infektsiya i immunitet = Russian Journal of Infection and Immunity, 2019, vol. 9, no. 5–6, pp. 787–799. (In Russ.)] doi: 10.15789/2220-7619-2019-5-6-787-799
  2. Багненко С.Ф., Беляков Н.А., Рассохин В.В., Трофимова Т.Н., Самарина А.В., Симаненков В.И., Симбирцев А.С., Ястребова Е.Б., Боева Е.В., Лукина О.В., Строкова Л.А., Бакулина Н.В., Бакулин И.Г., Ковеленов А.Ю., Тотолян А.А. Начало эпидемии COVID-19. СПб.: Балтийский медицинский образовательный центр, 2020. 326 с. [Bagnenko S.F., Belyakov N.A., Rassokhin V.V., Trofimova T.N., Samarina A.V., Simanenkov V.I., Simbirtsev A.S., Yastrebova E.B., Boeva E.V., Lukina O.V., Strokova L.A., Bakulina N.V., Bakulin I.G., Kovelenov A.Yu., Totolian A.A. The beginning of the COVID-19 epidemic. St. Petersburg: Baltic Medical Educational Center, 2020. 326 p. (In Russ.)]
  3. Багненко С.Ф., Полушин Ю.С., Шлык И.В., Теплов В.М., Карпова Е.А., Гаврилова Е.Г., Афанасьев А.А., Хряпа А.А., Бовкун И.В., Калмансон Л.М., Малинина Д.А., Скворцова Р.Д., Коробенков Е.А. Опыт работы ПСПбГМУ им. И.П. Павлова по оказанию помощи больным с новой коронавирусной инфекцией: первые итоги и уроки // Вестник анестезиологии и реаниматологии. 2021. Т. 18, № 2. С. 7–16. [Bagnenko, S.F., Polushin Yu.S., Shlyk I.V., Teplov V.M., Karpova E.A., Gavrilova E.G., Afanasyev A.A., Khryapa A.A., Bovkun I.V., Kalmanson L.M., Malinina D.A., Skvortsova R.D., Korobenkov E.A. The Pavlov University experience in medical assistance for patients with the novel coronavirus infection: first results and lessons. Vestnik anesteziologii i reanimatologii = Messenger of Anesthesiology and Resuscitation, 2021, vol. 18, no. 2, pp. 7–16. (In Russ.)] doi: 10.21292/2078-5658-2021-18-2-7-16
  4. Беляков Н.А., Багненко С.Ф., Рассохин В.В., Трофимова Т.Н., Колбин А.С., Лукина О.В., Симбирцев А.С., Трофимов В.И., Емельянов О.В., Кабанов М.Ю., Незнанов Н.Г., Рыбакова М.Г., Исаева Е.Р., Дидур М.Д., Тотолян А.А. Эволюция пандемии COVID-19. СПб.: Балтийский медицинский образовательный центр, 2021. 410 с. [Belyakov N.A., Bagnenko S.F., Rassokhin V.V., Trofimova T.N., Kolbin A.S., Lukina O.V., Simbirtsev A.S., Trofimov V.I., Emel’yanov O.V., Kabanov M.Yu., Neznanov N.G., Rybakova M.G., Isaeva E.R., Didur M.D., Totolian A.A. The evolution of the COVID-19 pandemic. St. Petersburg: Baltic Medical Educational Center, 2021. 410 p. (In Russ.)]
  5. Беляков Н.А., Багненко С.Ф., Трофимова Т.Н., Рассохин В.В., Незнанов Н.Г., Тотолян А.А., Лобзин Ю.В., Дидур М.Д., Лиознов Д.А., Рыбакова М.Г., Колбин А.С., Харит С.М., Климко Н.Н., Пантелеев А.М., Стома И.О., Ястребова Е.Б. Последствия пандемии COVID-19. СПб.: Балтийский медицинский образовательный центр, 2022. 464 с. [Belyakov N.A., Bagnenko S.F., Trofimova T.N., Rassokhin V.V., Neznanov N.G., Totolyan A.A., Lobzin Yu.V., Didur M.D., Lioznov D.A., Rybakova M.G., Kolbin A.S., Kharit S.M., Klimko N.N., Panteleev A.M., Stoma I.O., Yastrebova E.B. Consequences of the COVID-19 pandemic. St. Petersburg: Baltic Medical Educational Center. 2022. 464 p. (In Russ.)]
  6. Беляков Н.А., Боева Е.В., Симакина О.Е., Светличная Ю.С., Огурцова С.В., Серебрякова С.Л., Эсауленко Е.В., Загдын З.М., Язенок А.В., Лиознов Д.А., Стома И.О. Пандемия COVID-19 и ее влияние на течение других инфекций на Северо-Западе России // ВИЧ-инфекция и иммуносупрессии. 2022. Т. 14, № 1. С. 7–24. [Belyakov N.A., Boeva E.V., Simakina O.E., Svetlichnaya Yu.S., Ogurtsova S.V., Serebryakova S.L., Esaulenko E.V., Zagdyn Z.M., Yazenok A.V., Lioznov D.A., Stoma I.O. COVID-19 pandemic and its impact on other infections in Northwest Russia. VICh-infektsiya i immunosupressii = HIV Infection and Immunosuppressive Disorders, 2022, vol. 14, no. 1, pp. 7–24. (In Russ.)] doi: 10.22328/2077-9828-2022-14-1-7-24
  7. Беляков Н.А., Рассохин В.В. ВИЧ-инфекция и коморбидные состояния. СПб.: Балтийский медицинский образовательный центр, 2020. 680 с. [Belyakov N.A., Rassokhin V.V. HIV infection and comorbid conditions. St. Petersburg: Baltic Medical Educational Center, 2020. 680 p. (In Russ.)]
  8. Беляков Н.А., Трофимова Т.Н., Кулагина Е.Н., Митюрин Д.В., Соколов А.Р., Тучапский А.К., Фирсов В.В., Шелаев Ю.Б., Шелаева Е.П. По следам мировых эпидемий. От юстиниановой чумы до новой коронавирусной инфекции. СПб.: Лики. 2021. 296 с. [Belyakov N.A., Trofimova T.N., Kulagina E.N., Mityurin D.V., Sokolov A.R., Tuchapskii A.K., Firsov V.V., Shelaev Yu.B., Shelaeva E.P. In the footsteps of the world’s epidemics. From Justinian plague to a new coronavirus infection. St. Petersburg: Liki, 2021. 296 p. (In Russ.)]
  9. Винокуров А.С., Никифорова М.В., Оганесян А.А., Винокурова О.О., Юдин А.Л., Юматова Е.А. COVID-19. Поражение печени — особенности визуализации и возможные причины // Медицинская визуализация. 2020. Т. 24, № 3. С. 26–36. [Vinokurov A.S., Nikiforova M.V., Oganesyan A.A., Vinokurova O.O., Yudin A.L., Yumatov E.A. COVID-19. Liver damage — visualization features and possible causes. Meditsinskaya vizualizatsiya = Medical Visualization, 2020, vol. 24, no. 3, pp. 26–36. (In Russ.)] doi: 10.24835/1607-0763-2020-3-26-36
  10. Вирус иммунодефицита человека – медицина: Руководство для врачей / Под ред. Н.А. Белякова, А.Г. Рахмановой. 2-е издание. СПб.: Балтийский медицинский образовательный центр, 2011. 656 с. [Human immunodeficiency virus-medicine: a guide for physicians. Eds. N.A. Belyakov, A.G. Rakhmanova. 2nd ed. St. Petersburg: Baltic Medical Educational Center, 2011. 656 p. (In Russ.)]
  11. ВИЧ-инфекция и коморбидные состояния в Северо-Западном федеральном округе Российской Федерации в 2018 году: аналитический обзор. Под ред. Н.А. Белякова. СПб.: ФБУН НИИЭМ имени Пастера, 2019. 56 с. [HIV infection and comorbid conditions in the Northwestern Federal District of the Russian Federation in 2018: analytical review. Ed. by N.A. Belyakov. HIV infection and comorbid conditions in the North-Western Federal District of the Russian Federation in 2018. Analytical review. St. Petersburg: St. Petersburg Pasteur Institute, 2019. 56 p. (In Russ.)]
  12. Зубань О.Н., Смирнова О.В., Решетников М.Н. COVID-19 у больных ВИЧ и туберкулезом // Туберкулез и социально значимые заболевания. 2021. № 1. С. 32–39. [Zuban O.N., Smirnova O.V., Reshetnikov M.N. COVID-19 in tuberculosis patients: single care center experience. Tuberkulez i sotsial’no znachimye zabolevaniya = Tuberculosis and Socially Significant Diseases, 2021, no. 1, pp. 32–39. (In Russ.)]
  13. Курганова Т.Ю., Мельникова Т.Н., Ковалев Н.Ю., Огурцова С.В., Симакина О.Е., Загдын З.М., Беляков Н.А. Эпидемиология трех коинфекций: ВИЧ, вирусного гепатита и туберкулеза — в Вологодской области как модель развития инфекций в Северо-Западном федеральном округе // ВИЧ-инфекция и иммуносупрессии. 2020. Т. 12, № 1. С. 7–16. [Kurganova T.Yu., Melnikova T.N., Kovalev N.Yu., Ogurtsova S.V., Simakina O.E., Zagdyn Z.M., Belyakov N.A. Epidemiology of three coinfections: HIV, viral hepatitis and tuberculosis in the Vologda region as a model of infection development in the northwestern federal district. VICh-infektsiya i immunosupressii = HIV Infection and Immunosuppressive Disorders, 2021, vol. 13, no. 1, pp. 7–16. (In Russ.)] doi: 10.22328/2077-9828-2021-13-1-7-16
  14. Мазус А.И., Нагибина М.В., Бессараб Т.П., Цыганова Е.В., Литвинова Н.Г., Белова Е.Г., Набиуллина Д.Р., Кесаева М.Ю. COVID-19/ВИЧ коинфекция: характеристика пациентов Московского мегаполиса // Терапия. 2021. Т. 46, № 4. С. 18–24. [Mazus A.I., Nagibina M.V., Bessarab T.P., Tsyganova E.V., Litvinova N.G., Belova E.G., Nabiullina D.R., Kesaeva M.Yu. COVID-19/HIV coinfection: characteristics of patients of the Moscow metropolis. Terapiya = Therapy, 2021, vol. 46, no. 4, pp. 18–24. (In Russ.)] doi: 10.18565/therapy.2021.4.18-24
  15. Мишина А.В., Мишин В.Ю., Эргешов А.Э., Собкин А.Л., Сергеева Н.В., Пилипенко С.В., Романов В.В. Новая коронавирусная инфекция (COVID-19), сочетанная с туберкулезом, у больных на поздних стадиях ВИЧ-инфекции с иммунодефицитом // ВИЧ-инфекция и иммуносупрессии. 2021. Т. 13, № 1. С. 80–87. [Mishina A.V., Mishin V.Yu., Ergeshov A.E., Sobkin A.L., Sergeeva N.V., Pilipenko S.V., Romanov V.V. New coronoviral infection (COVID-19) combined with tuberculosis in patients at late stages of HIV infection with immunodeficiency. VICh-infektsiya i immunosupressii = HIV Infection and Immunosuppressive Disorders, 2021, vol. 13, no. 1, pp. 80–87. (In Russ.)] doi: 10.22328/2077-9828-2021-13-1-80-87
  16. Стопкоронавирус.рф. Оперативные данные. [Stopcoronavirus.rf. Operational data. (In Russ.)] URL: https://Стопкоронавирус.рф (28.04.2022)
  17. Сыраева Г.И., Колбин А.С., Сергеева Т.А., Мишинова С.А. Регистрация сообщений о нежелательных лекарственных реакциях при лечении COVID-19 в Российской Федерации и США // Клиническая фармакология и терапия. 2022. Т. 31, № 1. С. 91–96. [Sirayeva G.I., Kolbin A.S., Sergeeva T.A., Mishinova S.A. Registration of of drug adverse reactions during treatment of COVID-19 in the Russian Federation and the United States. Klinicheskaya farmakologiya i terapiya = Clinical Pharmacology and Therapy, 2022, vol. 31, no. 1, pp. 91–96. (In Russ.)] doi: 10.32756/0869-5490-2022-1-91-96
  18. Тестов В.В., Стерликов С.А., Васильева И.А., Сидорова И.А., Михайлова Ю.В. Федеральный регистр лиц, больных туберкулезом, как инструмент мониторинга влияния противоэпидемических мероприятий, вызванных пандемией COVID-19, на систему оказания противотуберкулезной помощи // Туберкулез и болезни легких. 2020. Т. 98, № 11. С. 6–11. [Testov V.V., Sterlikov S.А., Vasilyeva I.А., Sidorova I.А., Mikhaylova Yu.V. Federal register of TB cases as a tool for monitoring the impact of COVID-19 pandemic response activities on the TB care system. Tuberkulez i bolezni legkikh = Tuberculosis and Lung Diseases, 2020, vol. 98, no. 11, pp. 6–11. (In Russ.)] doi: 10.21292/2075-1230-2020-98-11-6-11
  19. Управление федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека по городу Санкт-Петербургу. О распространении новой коронавирусной инфекции, вызванной штаммом «омикрон» в Санкт-Петербурге. [Department of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being in the city of St. Petersburg. On the spread of a new coronavirus infection caused by the omicron strain in St. Petersburg. (In Russ.)] URL: https://78.rospotrebnadzor.ru/covid-19 (03.05.2022)
  20. Федеральная служба государственной статистики. [Federal State Statistics Service. (In Russ.)] URL: https://rosstat.gov.ru (28.04.2022)
  21. Ahmadi M.H. Would the interference phenomenon be applied as an alternative option for prophylaxis against COVID-19? Bioimpacts, 2021, vol. 11, no. 3, pp.169–172. doi: 10.34172/bi.2021.12
  22. Alexandridi M., Mazej J., Palermo E., Hiscott J. The Coronavirus pandemic – 2022: viruses, variants & vaccines. Cytokine Growth Factor Rev., 2022, vol. 63, pp. 1–9. doi: 10.1016/j.cytogfr.2022.02.002
  23. Almeida-Filho N. Syndemic, infodemic, pandemic of COVID-19: towards a pandemiology of emerging diseases. Salud Colect., 2021, vol. 17: e3748. (In Spanish). doi: 10.18294/sc.2021.3748
  24. Bajaj J.S., Garcia-Tsao G., Biggins S.W., Kamath P.S., Wong F., McGeorge S., Shaw J., Pearson M., Chew M., Fagan A., de la Rosa Rodriguez R., Worthington J., Olofson A., Weir V., Trisolini C., Dwyer S., Reddy K.R. Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort. Gut, 2021, vol. 70, pp. 531–536. doi: 10.1136/gutjnl-2020-322118
  25. Chen J., Wang R., Gilby N.B., Wei G.W. Omicron variant (B.1.1.529): infectivity, vaccine breakthrough, and antibody resistance. J. Chem. Inf. Model., 2022, vol. 62, no. 2, pp. 412–422. doi: 10.1021/acs.jcim.1c01451
  26. Chen T., Wu D., Chen H., Yan W., Yang D., Chen G., Ma K., Xu D., Yu H., Wang H., Wang T., Guo W., Chen J., Ding C., Zhang X., Huang J., Han M., Li S., Luo X., Zhao J., Ning Q. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ, 2020, vol. 368: m1091. doi: 10.1136/bmj.m1091
  27. Gao Y., Liu M., Chen Y., Shi S., Geng J., Tian J. Association between tuberculosis and COVID-19 severity and mortality: a rapid systematic review and meta-analysis. J. Med. Virol., 2021, vol. 93, no. 1, pp. 194–196. doi: 10.1002/jmv.26311
  28. Johns Hopkins University and Medicine. Coronavirus resource center. April, 5, 2022. URL: https://coronavirus.jhu.edu/map.html
  29. Nagarakanti S.R., Okoh A.K., Grinberg S., Bishburg E. Clinical outcomes of patients with COVID-19 and HIV coinfection. J. Med. Virol, 2021, vol. 93, pp. 1687–1693. doi: 10.1002/jmv
  30. NIH. COVID-19 Treatment guidelines. Special considerations in people with HIV. Retrieved January 23, 2021. URL: https://www.covid19treatmentguidelines.nih.gov/special-populations/hiv (25.01.2022)
  31. Papanikolaou V., Chrysovergis A., Rizos V., Tsiambaos E., Katsinis S., Manoli A., Papouliakos S., Roukas D., Mastronikolis S., Peschos D., Batistatou A., Kyrodimos E., Mastronikolis N. From delta to Omicron: S1RBD/S2 mutation/deletion equilibrium in SARS-CoV-2 defined variants. Gene, 2022, vol. 814: 146134. doi: 10.1016/j.gene.2021.146134
  32. Piret J., Boivin G. Viral Interference between respiratory viruses. Emerg. Infect. Dis., 2022, vol. 28, no. 2, pp. 273–281. doi: 10.3201/eid2802.211727
  33. Singer M. Development, coinfection, and the dynamics of pregnancy in Sub-Saharan Africa. Infect. Dis. Poverty, 2013, vol. 2, no. 1: 26. doi: 10.1186/2049-9957-2-26
  34. Singer M. Introduction to Syndemics: a critical systems approach to public and community health. Jossey-Bass, 2009. 304 p.
  35. Ssentongo P., Heilbrunn E.S., Ssentongo A.E., Advani S., Chinchilli V.M., Nunez J.J., Du P. Epidemiology and outcomes of COVID-19 in HIV-infected individuals: a systematic review and meta-analysis. Sci. Rep., 2021, vol. 11: 6283. doi: 10.1038/s41598-021-85359-3
  36. Tesoriero J.M., Swain C.A.E., Pierce J.L., Zamboni L., Wu M., Holtgrave D.R., Gonzalez C.J., Udo T., Morne J.E., Hart-Malloy R., Rajulu D.T., Leung S.J., Rosenberg E.S. Elevated COVID-19 outcomes among persons living with diagnosed HIV infection in New York state: results from a population-level match of HIV, COVID-19, and hospitalization databases. MedRxiv, 2020, 11.04.20226118. doi: 10.1101/2020.11.04.20226118
  37. Tsai A.C., Mendenhall E., Trostle J.A., Kawac I. Co-occurring epidemics, syndemics, and population health. Lancet, 2017, vol. 389, iss. 10072, pp. 978–982. doi: 10.1016/s0140-6736(17)30403-8
  38. Western Cape Department of Health in collaboration with the National Institute for Communicable Diseases, South Africa. Risk factors for COVID-19 death in a population cohort study from the Western Cape Province, South Africa. Clin. Infect. Dis., 2020, vol. 73, no. 7, pp. e2005–e2015. doi: 10.1093/cid/ciaa1198
  39. WHO. Tracking SARS-CoV-2 variants. May 25, 2022. URL: https://www.who.int/en/activities/tracking-SARS-CoV-2-variants
  40. Yang J., Zheng Y., Gou X., Pu K., Chen Z., Guo Q., Ji R., Wang H., Wang Y., Zhou Y. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int. J. Infect Dis., 2020, vol. 94, pp. 91–95. doi: 10.1016/j.ijid.2020.03.017

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Figure 1. Morbidity and mortality rate related to various SARS-CoV-2 strains as well as extended preferable patient age

Download (66KB)
Indexing metadata
3. Figure 2. Morbidity rate for HIV-infection, chronic HCV-infection and tuberculosis before and after the onset of COVID-19 in the Northwestern Federal District of the Russian Federation

Download (68KB)
Indexing metadata

Copyright (c) 2022 Belyakov N.A., Boeva E.V., Zagdyn Z.M., Esaulenko E.V., Lioznov D.A., Simakina O.E.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies