Comparison between patients who interrupted ART and those with late HIV diagnosis

Early diagnosis of human immunodeficiency virus (HIV) and retention in care are cornerstones of better prognosis of people living with HIV (PLWH). The purpose of this study was to compare patients who discontinued antiretroviral treatment (ART) with those who were diagnosed late with HIV. In this retrospective analysis of PLWH under the care of one of the Infectious Diseases Clinics in Poland between 2020 and 2021, two sub-analyses were carried out. One comparing patients who relinked to care after treatment interruption ("Group A") with those who had late HIV diagnosis ("Group B"), another comparing group A to those who were adherent to ART ("Group C"). 215 patients were included in this study (Group A = 47, Group B = 53, Group C = 115). Those who discontinued ART more often used actively drugs (p = 0.001) in comparison to those with late HIV diagnosis. In both bivariate and multivariable analysis migrants were more often diagnosed late with HIV than interrupted ART (p = 0.004 and 0.015, respectively). In the second analysis, in the multivariable analysis female sex was not associated with treatment interruption, whereas active drug usage was. People using drugs have a higher risk of ART interruption. Migrants are more at risk of late HIV diagnosis. Adequate interventions should be made towards both groups.

The significance of glial cell line-derived neurotrophic factor analysis in Progressive Supranuclear Palsy

Progressive Supranuclear Palsy (PSP) is an atypical parkinsonism. Major subtypes of the disease: PSP-Richardson's Syndrome (PSP-RS) and PSP Parkinsonism Predominant (PSP-P) vary in clinical features, the pathomechanism remains unexplored. The aim of this work is to analyze the relevance of glial cell line-derived neurotrophic factor (GDNF) evaluation in the serum and cerebrospinal fluid (CSF) in PSP subtypes and to verify its significance as a possible factor in the in vivo examination. Authors assessed the concentration of GDNF in the serum and CSF of 12 patients with PSP-RS, 12 with PSP-P and 12 controls. Additionally authors evaluated patients using Unified Parkinson's Disease Rating Scale-III part (UPDRS-III), Frontal Assessment Battery (FAB) and Magnetic Resonance Imaging (MRI). The evaluation revealed significantly increased concentrations of GDNF in the CSF among PSP-RS patients and substantially increased concentrations of GDNF in the serum in PSP-P. Though the GDNF concentrations differentiated PSP subtypes, no correlations between with clinical factors were observed however certain correlations with atrophic changes in MRI were detected. GDNF is a factor which may impact the pathogenesis of PSP. Possible implementation of GDNF as a therapeutic factor could be a perspective in the search for therapy in this currently incurable disease.

Changes in Primary HIV-1 Drug Resistance Due to War Migration from Eastern Europe

In recent years, especially as a result of war in Ukraine, enormous movements of migration to Poland from eastern European countries have been reported, including people living with Human Immunodeficiency Virus (HIV). We have conducted multi-center, prospective study, which aimed to establish HIV-1 subtype and assess the presence of primary drug resistance mutations to nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors in antiretroviral treatment naïve patients. The clinical trial recruited 117 individuals during 2 years period (2020-2022). The prevalence of HIV-1 subtype A was statistically significantly more frequent in Ukrainian, and HIV-1 subtype B in Polish patients (p < 0.05). Drug resistance mutations were detected in 44% of all cases and the comparison of presence of mutations in the analyzed groups, as well as in the subgroups of subtype A and B HIV-1 has not revealed any significant differences (p > 0.05), nevertheless Polish patients had multidrug resistance mutations more frequent (p < 0.05). The results from our trial show no increased risk of transmission of multidrug resistant HIV strains in our cohort of Ukrainian migrants.Clinical trials. Gov number NCT04636736; date of registration: November 19, 2020.

Human Immunodeficiency Virus as a Risk Factor for Cardiovascular Disease

The developments in HIV treatments have increased the life expectancy of people living with HIV (PLWH), a situation that makes cardiovascular disease (CVD) in that population as relevant as ever. PLWH are at increased risk of CVD, and our understanding of the underlying mechanisms is continually increasing. HIV infection is associated with elevated levels of multiple proinflammatory molecules, including IL-6, IL-1β, VCAM-1, ICAM-1, TNF-α, TGF-β, osteopontin, sCD14, hs-CRP, and D-dimer. Other currently examined mechanisms include CD4 + lymphocyte depletion, increased intestinal permeability, microbial translocation, and altered cholesterol metabolism. Antiretroviral therapy (ART) leads to decreases in the concentrations of the majority of proinflammatory molecules, although most remain higher than in the general population. Moreover, adverse effects of ART also play an important role in increased CVD risk, especially in the era of rapid advancement of new therapeutical options. Nevertheless, it is currently believed that HIV plays a more significant role in the development of metabolic syndromes than treatment-associated factors. PLWH being more prone to develop CVD is also due to the higher prevalence of smoking and chronic coinfections with viruses such as HCV and HBV. For these reasons, it is crucial to consider HIV a possible causal factor in CVD occurrence, especially among young patients or individuals without common CVD risk factors.

Clinical Phenotypes of Progressive Supranuclear Palsy-The Differences in Interleukin Patterns

Progressive supranuclear palsy (PSP) is an atypical parkinsonian syndrome based on tau pathology; its clinical phenotype differs, but PSP with Richardson's syndrome (PSP-RS) and the PSP parkinsonism predominant (PSP-P) variant remain the two most common manifestations. Neuroinflammation is involved in the course of the disease and may cause neurodegeneration. However, an up-to-date cytokine profile has not been assessed in different PSP phenotypes. This study aimed to evaluate possible differences in neuroinflammatory patterns between the two most common PSP phenotypes. Serum and cerebrospinal fluid (CSF) concentrations of interleukin-1 beta (IL-1β) and IL-6 were analyzed using enzyme-linked immunosorbent assay (ELISA) kits in 36 study participants-12 healthy controls and 24 patients with a clinical diagnosis of PSP-12 PSP-RS and 12 PSP-P. Disease duration among PSP patients ranged from three to six years. All participants underwent basic biochemical testing, and neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) values were calculated. Due to a lack of neuropathological examinations, as all patients remain alive, total tau levels were assessed in the CSF. Tau levels were significantly higher in the PSP-P and PSP-RS groups compared to the healthy controls. The lowest concentrations of serum and CSF interleukins were observed in PSP-RS patients, whereas PSP-P patients and healthy controls had significantly higher interleukin concentrations. Furthermore, there was a significant correlation between serum IL-6 levels and PLR in PSP-RS patients. The results indicate the existence of distinct neuroinflammatory patterns or a neuroprotective role of increased inflammatory activity, which could cause the differences between PSPS phenotypes and clinical course. The causality of the correlations described requires further studies to be confirmed.

Central nervous system disorders after use of dolutegravir: evidence from preclinical and clinical studies

The evaluation of dolutegravir based on available preclinical and clinical studies reveals a risk of central nervous system (CNS) disorders associated with long-term use of the drug. The available literature on the pharmacokinetics of the drug, including its penetration of the blood-brain barrier, was reviewed, as well as clinical trials assessing the incidence of adverse effects in the CNS and the frequency of its discontinuation. This paper also summarizes the impact of factors affecting the occurrence of CNS disorders and indicates the key role of pharmacovigilance in the process of supplementing knowledge on the safety of drugs, especially those that are newly registered.

The prevalence of smoking cigarettes among HIV-infected patients after a decade. Single-center analysis

OBJECTIVES

Smoking habit is known to be a risk factor for the development of multiple diseases and conditions, premature death, and worse quality of life. The prevalence of smoking in PLWH is 2-3 times higher than in the general population. The study aimed to evaluate how the prevalence of smoking has changed among PLWH over the past decade.

METHODS

The data of n=204 PLWH hospitalized from November 2018 to November 2019 was analyzed. All patients filled out the survey including age, gender, the number of cigarettes smoked, the number of years as a smoker, and the impact of HIV diagnosis on the number of cigarettes smoked. The data was compared to a similar analysis performed in our department in 2009.

RESULTS

The study showed a decrease in the prevalence of smoking among PLWH over the past decade. In comparison to 2009, a statistically significant (p<0.05) reduction in the number of smoking individuals among ever and never smokers was observed both in males and in females.

CONCLUSIONS

The prevalence of smoking cigarettes among PLWH in our department has significantly decreased since 2009 but remains much higher than in the general population. Smoking cessation interventions provided by HIV care professionals are necessary and should be continued among PLWH.

Long-term Administration of 3-Di-O-Tolylguanidine Modulates Spatial Learning and Memory in Rats and Causes Transition in the Concentration of Neurotransmitters in the Hippocampus, Prefrontal Cortex and Striatum

The sigma-1 and sigma-2 (σ₁ and σ₂) receptors are found in high concentrations in the brain, and their altered expression leads to a variety of neuropsychiatric disorders. 3-di-tolylguanidine (DTG) stimulates the activity of both of these receptors. We assessed the effects of administering DTG to adult male Sprague Dawley rats on learning and memory consolidation processes and on the levels of neurotransmitters in selected brain structures. Spatial learning and memory were evaluated in the water maze test. The DTG was administered orally at daily doses of 3 mg/kg (DTG3), 10 mg/kg (DTG10) or 30 mg/kg (DTG30) for 10 weeks before and during the water-maze test. After completion of the experiment, the concentration of monoamines and their metabolites as well as amino acids in structures involved in cognitive performance - the hippocampus, prefrontal cortex, and striatum - were determined using high performance liquid chromatography (HPLC). The DTG10 group showed an improvement in memory processes related to the "new" platform location, whereas the DTG30 group was worse at finding the "old" platform location. Since the administration of DTG led to differences in dopaminergic transmission, it was assumed to influence memory processes in this way. Changes in histidine, serine, alanine, taurine, and glutamic acid levels in selected structures of the brains of rats with memory impairment were also observed. We conclude that long-term administration of DTG modulates spatial learning and memory in rats and changes the concentrations of neurotransmitters in the hippocampus, prefrontal cortex, and striatum..

Frailty and prefrailty in people living with HIV, with focus on women living with HIV

With the increasing lifespan of people living with HIV (PLWH), frailty and prefrailty are becoming topics which require more attention. The reciprocal interactions between chronic inflammation, comorbidities and frailty demonstrate the complex pathophysiology of frailty and its consequences. Female sex, HIV infection without antiretroviral treatment, reduced CD4 cell count, depression and cardiovascular disease are some of the risk factors for frailty among PLWH. Frailty predisposes to falls and can therefore lead to more frequent fractures, hospitalization and death, especially in women with osteoporosis. Continuous antiretroviral treatment, prevention of comorbidities such as depression and diagnosis of prefrailty are crucial interventions to slow the development of frailty. This review summarizes the literature on frailty in people living with HIV and discusses frailty management strategies in order to improve the health outcomes in women living with HIV.

Significance of Vascular Cell Adhesion Molecule-1 and Tumor Necrosis Factor-Alpha in HIV-Infected Patients

Background. The aim of this study was the evaluation of the correlation between VCAM-1 and TNF-alpha serum concentrations and various clinical and laboratory parameters in HIV-infected patients. Methods. All included subjects were patients of the Department of Infectious and Tropical Diseases and Hepatology of the Medical University of Warsaw in Poland in the years 2014–2016. The inclusion criteria were: confirmed HIV infection, Caucasian origin, and age > 18 years old. PCT, CRP, serum HIV-1 RNA, CD4/CD8 T cell count, PCR HCV RNA, HBsAg, VCAM-1, and TNF-alpha were measured. The VCAM-1 and TNF-alpha serum levels were evaluated by ELISA. Results. Seventy-two HIV-infected patients were included (16 women and 56 men: mean age 38.7 years, 66.6% cigarette smokers, 34.7% HCV co-infected HCV, and 27.8% ART-naïve). VCAM-1 concentrations were significantly higher in HIV/HCV co-infected patients than in HIV mono-infected patients (125.6 ± 85.4 vs. 78.4 ± 58.6 ng/mL, p = 0.011) and ART-naïve in comparison to patients on cART (121.9 ± 76.5 vs. 69.4 ± 57.1 ng/mL, p = 0.003). The significant positive correlation between HCV-infection and VCAM-1 and negative correlation between cART use and VCAM-1 was confirmed in multivariate analyses. The only variable associated significantly with TNF-alpha concentration was lymphocytes T CD8+ cell count (p = 0.026, estimate = 0.033). Conclusions. Successful cART and HCV eradication seemed to play an important role in the reduction of endothelial dysfunction and persistent inflammation in HIV-infected patients. CD8 T cell count seemed to be one of the markers of the pro-inflammatory state in HIV-infection patients.

Impact of Combined Antiretroviral Therapy on Metabolic Syndrome Components in Adult People Living with HIV: A Literature Review

The development of metabolic derangements as a result of HIV treatment has been an important area of research since the introduction of zidovudine in the 1980's. Antiretroviral therapy has intensely evolved in the last three decades, with new drugs gradually incorporated into everyday clinical practice. With the life expectancy of people living with HIV rapidly approaching that of their HIV-negative counterparts, the influence of these antiretrovirals on the development of the components of the metabolic syndrome remains of major interest to clinicians and their patients. In this review, we aimed to discuss the impact of cART on components of the metabolic syndrome, i.e., weight, plasma lipid levels, plasma glucose levels, and blood pressure, describing the influence of cART classes and of individual antiretrovirals. We also aimed to outline the limitations of the research conducted to date and the remaining knowledge gaps in this area.

Challenges in diagnosing fever in traveler returning from tropical ares - is it dengue or chikungunya? Case report

Arthropod-borne viral infections caused by dengue virus (DENV) and chikungunya virus (CHIKV) are prevalent in the same regions and are spread by the same mosquito type (Aedes) and have similar clinical manifestations. This study emphasized the challenges of diagnosing fever in a patient returning from a tropical area. We report a case of a 52-year-old patient who presented with fever, myalgia, and headache after travelling to Laos and Thailand. After ten days of the disease, the diagnosis of chikungunya was made. Recent travel history should be a standard part of assessment when consulting febrile patients and is essential for further diagnosis. Malaria should permanently be excluded from travellers returning from tropical regions with fever. In the differential diagnosis, dengue, chikungunya, and other mosquito-borne infections should be considered. Patients wishing to travel to such areas need to be educated beforehand on the necessary preventative measures.

Cerebral Toxoplasmosis, CMV and Bacterial Pneumonia with Decreasing CD4+ T-Cell Count as Results of Antiretroviral Therapy Discontinuation-A Case Report

Cerebral toxoplasmosis occurs mainly in immunocompromised hosts as a reactivation of latent Toxoplasma gondii infection. In the diagnostic process, magnetic resonance imaging (MRI), serum testing, and biopsy are used. We describe a case of a 43-year-old HIV-positive patient presenting with altered levels of consciousness, aphasia, and hemiparesis. The patient had a history of antiretroviral therapy discontinuation for about 3 years. MRI revealed lesions, suggesting cerebral toxoplasmosis and subacute hemorrhage, serum tests for Toxoplasma gondii were positive. Antiparasitics and glycocorticosteroids were administered. A decline in viral load and clinical improvement were observed, however CD4+ T-cell count continued to decrease. The patient’s state worsened, he developed CMV and bacterial pneumonia, which led to his death. What is crucial in the management of an HIV-infected patient is effective and continuous antiretroviral therapy. Discontinuation of the treatment may result in AIDS and lead to poor recovery of the CD4+ T-cell population, even after reimplementation of antiretroviral therapy and a decrease in viral load.

Weight and body mass index increase after switch from tenofovir disoproxil fumarate to tenofovir alafenamide fumarate-containing treatment in an antiretroviral therapy-experienced group

Tenofovir alafenamide fumarate (TAF) is an alternative to tenofovir disoproxil fumarate (TDF). Currently, TAF is increasingly being used because of its non-inferior antiviral properties, lower risk of nephrotoxicity, and lower decrease in bone mineral density than TDF. There is growing evidence of unfavorable effects of TAF on weight and body mass index (BMI) in antiretroviral therapy (ART)-experienced patients treated with TAF-based ART. The aim of this study was to evaluate whether switching from TDF-containing to TAF-containing ART is associated with an increase in BMI and body weight in ART-experienced patients. Two study groups were established: 32 patients who switched from TDF to TAF only and 68 patients who switched from TDF to TAF along with changes to other components of the ART regimen. Significant weight gain and BMI increase was observed during the first year after initiation of TAF-containing ART regimens in both groups (mean change +1.91 kg and +0.61 kg/m2 in the first group and +1.50 kg and +0.49 kg/m² in the second group). During the second year of TAF-based treatment, a sustained trend of body weight and BMI increase was noted only in the second group (mean change +1.46 kg, + 0.46 kg/m²). Analysis of body weight changes in certain subpopulations from the second group (selected based on patients' baseline characteristics) revealed a significant weight gain within two years after the switch in patients over 50 years old and in those whose ART had lasted longer than 10 years. These findings suggest that a possible impact of TAF on weight gain should be taken into account when selecting ART components, especially in older patients or those with a long history of antiretroviral treatment.

Cowpox: How dangerous could it be for humans? Case report

Cowpox is a rare zoonosis transmitted to humans mainly from cats. The disease usually causes skin lesions; however, the ocular form may lead to other serious complications. We describe a case of cowpox in a rare location of the upper eyelid of an immunocompetent male, which lead to necrosis of the upper eyelid, keratitis and leucomatous opacity, and the neovascularization of the cornea. The patient underwent several surgeries, including reconstruction surgery of the eyelids, correction of the medial canthus, and corneal neurotization with supraorbicular nerve transplantation. Suspicion of cowpox should be made in patients where there are poorly healing skin lesions accompanied by a painful black eschar with erythema and local lymphadenopathy. Ocular cowpox may lead to serious complications and possibly mimic anthrax. Diagnosis of cowpox can be confirmed by detection of cowpox virus DNA by polymerase chain reaction. Patients should be advised to protect themselves while handling sick animals.

Risk Factors of Hypovitaminosis D in HIV-Infected Patients on Suppressive Antiretroviral Therapy

Low serum vitamin D levels are very common in human immunodeficiency virus (HIV)-infected patients. In our cross-sectional study, we investigated the association between 25-hydroxyvitamin D (25(OH)D) levels and serum inflammation markers [C-reactive protein (CRP), white blood cells (WBC), D-dimers, platelet count (PLT)] in 148 HIV-infected patients on combined antiretroviral therapy [28 on tenofovir alafenamide (TAF)] and 40 healthy controls. The controls were significantly older (56.6 ± 19.1 years for HIV(-) vs. 45.1 ± 11.8 years for HIV(+); p = .001) and more females were observed in this group (65% for HIV(-) vs. 16.7% for HIV(+); p = .001). The vitamin D serum level was comparable in the two studied groups (74.2 ± 35.9 nmol/L for HIV(+) vs. 78.0 ± 27.6 nnmol/L for HIV(-), p = .545). In HIV-infected group, a significant positive correlation between CD4+ cell percentage and vitamin D level was observed (r = 0.17; p = .036). Furthermore, the significant negative correlation between vitamin D level and CD8+ cell percentage, PLT, CRP, and D-dimers was seen. In univariate analysis, only TAF use and AIDS status was associated with vitamin D level deficiency. No other antiretroviral (ARV) drug nor gender or smoking had influence on vitamin D serum level. In multivariate analysis, only AIDS status and CRP level were correlated with vitamin D level (slope estimate = 11.6 and p = .032 and slope estimate = -0.83 and p = .002; respectively). In summary, we report that low vitamin D level may be associated with high CRP level in HIV-infected patients on suppressive antiretroviral therapy, especially in AIDS phase. More larger studies are required to assess our observation concerning TAF use and vitamin D level in HIV-positive patients.

Hepatopathy of unknown etiology - is liver biopsy a good tool in differential diagnosis?

INTRODUCTION

Liver biopsy is a well-known method for the diagnosis and evaluation of chronic diffuse liver diseases, especially among patients with "hepatopathy of unknown origin".

MATERIAL AND METHODS

In the years 2014-2015 we performed 259 liver biopsies in 28 patients (22 females, 6 males, aged 18-65 years, mean: 45 years) with an initial diagnosis of "hepatopathy of unknown origin". The liver biopsies of these 28 patients were revised by two independent pathologists.

RESULTS

Histopathological features of autoimmune conditions were found in 11 cases, steatohepatitis with/without Mallory bodies in 7, simple steatosis without inflammation in 2 cases. In the other 8 cases the histopathological features were non-specific but pointed to vanishing bile duct syndrome, hemochromatosis, acute inflammation or fibrosis without inflammation. Surprisingly, only mild fibrosis without inflammatory infiltrates was present in one patient with a high titer of antinuclear antibodies (ANA > 1 : 3200). Mild cholestasis with bilirubinostasis was found in 4 cases. One patient had prominent lobular iron deposits and is now under observation for hemochromatosis. Vanishing bile duct syndrome as ductopenia without any signs of inflammation was found in one patient with suspicion of primary biliary cirrhosis. In one liver biopsy specimen we found normal liver architecture without inflammation or steatosis in a patient with elevated ALT and GGT, negative for viral antibodies and autoantibodies.

CONCLUSIONS

Liver biopsy - despite the increasing access to new, non-invasive methods - remains a useful method in the differential diagnosis of liver diseases.

Mild hyperbilirubinemia as a marker of oesophageal varices in HCV-related compensated cirrhotic patients

The natural course of compensated liver cirrhosis caused by chronic hepatitis C virus (HCV) infection is still a very interesting problem in hepatology. The prognostic usefulness of the Child-Pugh and MELD score in compensated liver cirrhosis is still debated. Consequently, several attempts have been made to determine parameters other than included in the Child-Pugh score, which could be helpful in the prognosis of compensated liver cirrhosis assessment.

AIM

The aim of study was to identify a clinical or laboratory markers correlated with higher risk of liver decompensation among HCVinfected patients with compensated liver cirrhosis and presence or absence of esophageal varices.

MATERIALS AND METHODS

The study included 176 HCV-infected patients with compensated liver cirrhosis (74 women and 102 men) registered in the Clinical Database of Patients with Liver Cirrhosis - e-Hepar. All patients were monitored during 252 weeks for the occurrence of liver failure symptoms and the development of hepatocellular carcinoma (HCC).

RESULTS

The presence of esophageal varices was significantly associated with total bilirubin ≥2.0 mg/dl, platelets ≤110.0 G/L and 6 points in Child-Pugh score (p<0.05). The cumulative 252 weeks incidence of clinical decompensation was higher in patients with varices in comparison to patients without them (p<0.05). Variceal hemorrhages were observed in 9 cases (23.1%). During the follow-up period 9 patients died due to HCC complications.

CONCLUSIONS

Our findings underline the prognostic value of serum bilirubin (even mild elevation) and platelet count in HCV-infected patients with compensated liver cirrhosis. We have confirmed that liver decompensation is more frequent and more rapid in patients with compensated liver disease and concomitant oesophageal varices.

Cryoglobulinemia and its correlation with clinical extrahepatic manifestations in chronic hepatitis C

Cryoglobulinemia is a condition with a confirmed relationship with HCV infection, but many other extrahepatic symptoms are also present in hepatitis C. Aim: The aim of this study was to assess the incidence and type of extrahepatic manifestations and cryoglobulinemia as well as their correlation with clinical symptoms in Polish patients. Material and methods: 246 consecutive patients with hepatitis C were studied. Clinical symptoms were assessed by anamnesis and a clinical investigation. Cryoglobulins were estimated by a method basing on their ability to reverse precipitation in temperature +4ºC. Monoclonality of cryoglobulins was estimated by agarophoresis immunotyping – capillary electrophoresis and immunofixation. The presence of classical rheumatoid factor (RF-IgM) was tested using ELISA. Anti-nuclear antibodies (ANA) were tested using the indirect immunofluorescence method. Anti-CCP, anti-SSA, anti-α-fodrin antibodies, RF IgG, IgM and IgA were assessed using commercial enzymatic tests. Statistical methods were: Fisher exact test, generalized additive models, odds ratios with 95% confidence intervals, aid of spline curve, SAS system version 9.4. Results: Cryoglobulins were found in 93 persons (37.8%). Type II cryoglobulinemia was detected in 28 persons. Patients with cryoglobulinemia were elder (p<0.0004). 54 patients (21.95%) manifested clinical extrahepatic symptoms. Arthralgia was found in 27 cases (10.98%). Skin changes were found in 22 patients (8.94%). 12 persons had glomerulonephritis (4.88%). 11 patients (4.47%) had sicca syndrome. 6 patients developed peripheral polyneuropathy (2.4%). 4 persons developed B cell lymphoma (1.63%). There was no correlation between presence of symptoms and grading, staging, age, HCV genotype, and the presence of autoantibodies. Extrahepatic manifestations were present more frequently in women (p<0.0008).

The effects of CD4 nadirs on vessel stiffness in HIV patients undergoing antiretroviral therapy

BACKGROUND

There are many factors associated with human immunodeficiency virus (HIV) patients having a greater risk of cardiovascular diseases (CVD). HIV damages vessel endothelium through chronic inflammation, which, combined with dys-lipidaemia, arterial hypertension, and antiretroviral therapy leads to the progression of atherosclerotic changes.

AIM

Our goal was to determine if a CD4 nadir along with immunological, inflammatory, biochemical, and metabolic mark-ers can be associated with higher vessel stiffness and therefore an increased risk of CVD in patients undergoing antiretroviral therapy for HIV.

METHODS

Endothelial damage was evaluated in 20 patients (including four female) during successful antiretroviral therapy. We assessed the endothelial stiffness by recording the reactive hyperaemia of peripheral arteries using an Endo-PAT2000 (ITAMAR®) device. This device allowed us to measure the arterial tonometry and to determine the augmentation index for a pulse rate of 75/min (AI@75). We set the normal value for vessel stiffness at reactive hyperaemia index (RHI) > 1.67, as recommended by the manufacturer. Additionally, we recorded the length of antiretroviral therapy, number of CD4 lymphocytes, CD4 nadir, HIV viremia, and biochemical and immunologic results. Finally, we compared patients with normal and dysfunctional endothelium.

RESULTS

The only parameter significantly differentiating between the group with and group without endothelium dysfunction was platelet count (p = 0.012).

CONCLUSIONS

We were not able to confirm the significance of a CD4 nadir in the progression of endothelial stiffness in HIV patients. However, platelet values could be an important complementary marker for assessing the risk for CVD amongst HIV patients undergoing antiretroviral treatment.

Generalized Posttransplant Kaposi Sarcoma without Mucocutaneous Manifestations in the First Liver Transplantation in an HIV-Positive Patient in Poland: A Case Report and Review of Literature

BACKGROUND Kaposi sarcoma (KS) is the most frequent skin cancer in solid organ recipients, and also a typical malignancy in HIV-infected persons. CASE REPORT We describe here a rare case of primary nodal KS without mucocutaneous manifestations, diagnosed in a 20-year-old HIV/HBV co-infected patient 12 months after liver transplantation (LT), the first one performed in a HIV-positive patient in Poland. The course of the disease was very aggressive; the patient died four weeks after general lymphadenopathy appearance. In the autopsy, KS infiltration was found in numerous lymph nodes and in the lung' apexes without skin or other organs' involvement. CONCLUSIONS In conclusion, posttransplant KS may present as general lymphadenopathy without mucocutaneous manifestations, thus mimicking posttransplant lymphoproliferative disorder, which is often the first clinical suspicion. Lymph node histopathological examination is necessary to make the right diagnosis.

Real-world effectiveness and safety of ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin in hepatitis C: AMBER study

BACKGROUND

Virologic and safety outcomes of ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin (OBV/PTV/r ± DSV ± RBV) therapy have shown high sustained virologic response (SVR) rates and good tolerability in most patient populations in pre-registration studies.

AIM

To confirm these clinical trial findings in the treatment of genotype 1 and 4 hepatitis C under real-world conditions.

METHODS

Patients enrolled for treatment with OBV/PTV/r ± DSV ± RBV based on therapeutic guidelines were included, and the regimen was administered according to product characteristics. Clinical and laboratory data, including virologic response, were collected at baseline, end of treatment (EOT) and 12 weeks after EOT.

RESULTS

A total of 209 patients with chronic hepatitis C were enrolled, most were genotype 1b-infected (84.2%) and 119 (56.9%) had liver cirrhosis. Among these, 150 (71.7%) had failed previous anti-viral therapies and 84 (40.2%) were null-responders. At 12 weeks after EOT, SVR was achieved by 207 (99.0%) patients, ranging from 96.4% to 100.0% across subgroups. All Child-Pugh B and post-orthotopic liver transplantation patients achieved SVR. Adverse events occurred in 151 (72.2%) patients and were mostly mild and associated with the use of RBV. Serious adverse events, including hepatic decompensation, renal insufficiency, anaemia, hepatotoxicity and diarrhoea, were reported in eight (3.8%) patients. In five (2.4%) patients, adverse events led to treatment discontinuation. On-treatment decompensation was experienced by seven (3.3%) patients.

CONCLUSIONS

The results of our study confirm previous findings. They demonstrate excellent effectiveness and a good safety profile of OBV/PTV/r± DSV±RBV in HCV genotype 1-infected patients treated in the real-world setting.

Symptomatic co-infection with Babesia microti and Borrelia burgdorferi in patient after international exposure; a challenging case in Poland

The report presents a well-documented case of symptomatic co-infection of Babesia microti and Borrelia burgdorferi in a Polish immunocompetent patient after travelling to Canada and the USA.

Pigment epithelium-derived factor and matrix metalloproteinase-9 in liver cirrhosis

BACKGROUND/AIM

The aim of this study was to assess the role of serum pigment epithelium-derived factor (PEDF) and matrix metalloproteinase-9 (MMP-9) in progression of liver cirrhosis and development of hepatocellular carcinoma (HCC).

PATIENTS AND METHODS

Serum levels of PEDF and MMP-9 were tested in 212 patients with liver cirrhosis and in a control group of 30 healthy volunteers. HCC was diagnosed in 45 of the 212 patients studied (21%).

RESULTS

Serum PEDF and MMP-9 were higher in the study group than that in the control group (P < 0.001). In patients with alcoholic or mixed (alcoholic and viral hepatitis-related) cirrhosis, serum PEDF was higher than that in other patients (13970.2 ± 13406.9 ng/ml vs. 8563.5 ± 9602.7 ng/ml, P = 0.008). In patients with viral hepatitis-related cirrhosis, significantly higher PEDF levels were recorded in those with HCC (13429.1 ± 12045.8) than that in patients without HCC (6660.1 ± 7927.1; P = 0.04). There was a trend for higher serum MMP-9 in patients with HCC (5778.7 ± 12426.6 vs. 1389.8 ± 1944.7 in those without HCC; P = 0.07). Significant negative correlation between serum MMP-9 and serum alpha-fetoprotein in patients with HCC was observed (r = -0.54; P = 0.04).

CONCLUSION

Serum PEDF and MMP-9 could be auxiliary markers in diagnosis of HCC, especially in patients with low alpha-fetoprotein level. Alcohol consumption can affect serum PEDF.

The role of serum I-FABP concentration in assessment of small intestine mucosa among HIV-infected patients

Objectives:

The intestinal fatty acid binding protein (I-FABP) is a useful marker in the assessment of damages and inflammation to the small intestinal mucosa. We have investigated the influence of HIV infections and antiretroviral treatment on the small intestine mucosa aided by the evaluation of I-FABP concentration levels.

Methods:

We included in the study: 31 HIV-infected patients with antiretroviral therapy (ART) treatment (T), 32 HIV-infected patients not treated with ART (NT), and 18 healthy volunteers as a control group. The concentrations of I-FABP were measured in serum using a sandwich enzyme immunoassay kit: Human I-FABP.

Results:

The median level of I-FABP in the serum of HIV-infected patients was 2.10 ± 2.56 ng/mL and did not significantly differ between T and NT (2.32 ± 2.69 ng/mL vs. 1.89 ± 2.45 ng/mL). However, the I-FABP serum level was significantly higher in HIV-infected patients when compared to the group control (2.10 ± 2.56 ng/mL vs. 1.26 ± 1.18 ng/mL; P = 0.048). We recorded a correlation for treated HIV-infected patients between Viral load and I-FABP serum level (r = −0.66; P <0.05).

Conclusions:

Elevated serum I-FABP level in HIV-infected patients confirm that HIV causes damage to the intestinal mucosa. I-FAB is a useful marker in the assessment of intestinal damage in HIV-infected patients.

Procalcitonin as a Biomarker of the Early Stage of Bacterial Infections in HIV/AIDS Patients

We observed that low concentrations of procalcitonin (PCT) in the early stages of bacterial infection among HIV/AIDS patients are not always associated with a good prognosis. Many of our patients developed sepsis despite a PCT level of <0.5 ng/ml on the first days of infection. The aim of our study was to assess whether laboratory standards for PCT in patients with HIV/AIDS correlate with their clinical condition. We analyzed the concentration of PCT and other inflammatory markers in the early stages of bacterial infection among 40 HIV-infected patients and 52 AIDS patients enrolled for the study. The control group consisted of 37 healthy individuals. In comparison with PCT and WBC, PCT proved to be the most reliable in the early stages of bacterial infection. To conclude, we suggest new PCT cut-off ranges for HIV/AIDS patients with bacterial infection.

Distribution of HCV genotypes in Poland

Available data on prevalence of HCV genotypes in Poland are insufficient. The aim of the study was the analysis of distribution of HCV genotypes in Poland over the period of recent 10 years regarding the age of patients and the regions of the country.

MATERIAL AND METHODS

Analysis of HCV genotypes in Poland was carried out between 2003 and 2012, and included 14 651 patients from 22 centers where patients with chronic viral hepatitis C are diagnosed and treated. Genotypes were analyzed in age groups (< 20 years of age, 20-40 years of age, > 40 years of age) as well as in populations of HBV and HIV co-infections.

RESULTS

Genotype (G) 1 infection was demonstrated in 79.4%, G2 -0.1%, G3- 13.8%, G4- 4.9%, G6-0.09% and mixed infections in 1.6%. There was no infection with genotype 5. The highest prevalence of G1 was observed in the Łódzkie voivodship (89.2%) and the Slaskie voivodship (86.7%) while the lowest one in the Warmińsko-mazurskie (62.0%) and the Podlaskie voivodships (68.2%). Genotype 3 most commonly occurs in the Warmińsko-mazurskie (28.1%), and the Podlaskie voivodships (23.0%) and is least common in the Małopolskie (7.9%) and the Łódzkie voivodships (9.0%). Genotype 4 is more common in the Kujawsko-pomorskie (11.7%) and the Podlaskie voivodships (8.6%) and relatively less common in the Lubelskie (1.1%) and the Łódzkie voivodships (1.8%). Prevalence of G1 infection in 2003-2004 was 72% and increased up to 85.6% in 2011-2012, that was accompanied by decrease of G3 prevalence from 17% to 8% in this period. In HBV co-infected (n = 83), G1 infection was demonstrated in 85.5%, G3 - in 7.2%, G4 -4.8%, and mixed genotypes in 6%. Among HIV co-infected (n = 391), a much lower prevalence of G1 (33.0%) and a high of G3 (40.4%) as well as G4 (24.0%) were observed.

CONCLUSIONS

There is a geographic variability of HCV genotypes prevalence in Poland. Increase of HCV G1 infections and decrease of G3 and G4 were observed in the last 10 years. Genotypes G3 and G4 occur more often in HCV/HIV co-infected than in HCV mono-infected patients.

Results of liver transplantation in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw in patients with chronic hepatitis B and C viruses infection

INTRODUCTION

Cirrhosis related to hepatitis C virus (HCV) and hepatitis B virus (HBV) infection is the most frequent indication for liver transplantation worldwide. Progress in prophylaxis of posttransplant HBV recurrence has led to major improvements in long-term outcomes of patients after liver transplantation. Conversely, impaired posttransplant survival of patients with HCV infection was reported in several studies, mainly due to recurrence of viral infection. The purpose of this study was to compare long-term results of liver transplantation between patients with HBV monoinfection, HCV monoinfection and HBV/HCV coinfection.

MATERIAL AND METHODS

A total of 1090 liver transplantations were performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw between December 1994 and May 2012. After exclusion of patients with cirrhosis of non-viral etiology, patients with malignant tumors, and patients with acute liver failure, the final study cohort comprised 209 patients with HBV (HBV+/HCV- subgroup; n = 56) or HCV (HBV-/HCV+ subgroup; n = 119) monoinfection or HBV/HCV coinfection (HBV+/HCV+; n = 34). These subgroups of patients were compared in terms of long-term results of transplantations, defined by 5-year patient and 5-year graft survival estimates.

RESULTS

Overall and graft survival rates after 5-years for the whole study cohort were 74.5% and 72.6%, respectively. Five-year overall survival was 70.4% for patients within the HBV+/HCV- subgroup, 77.8% for patients within the HBV-/HCV+ subgroup, and 68.5% for patients within the HBV+/HCV+ subgroup. The corresponding rates of graft survival were 67.0%, 76.3%, and 68.5% for patients within the HBV+/HCV-, HBV-/ HCV+, and HBV+/HCV+ subgroups, respectively. Observed differences were non-significant, both in terms of overall (p = 0.472) and graft (p = 0.461) survival rates.

CONCLUSIONS

Both overall and graft survival rates after liver transplantations performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw in patients with HBV and HCV infection are comparable to those reported by other European and American centers. In contrast to other studies, obtained results do not confirm the negative impact of HCV infection on long-term outcomes of patients.

Evolving patterns of HIV-1 transmitted drug resistance in Poland in the years 2000-2008

The aim of the study was to determine the rate of transmission of drug resistant human immunodeficiency virus-1 (HIV-1) variants among therapy-naïve HIV positive patients in Poland in the year 2008, to compare the data with the results from the years 2000 to 2007 and to monitor patterns of HIV-1 subtypes present in Polish population and their evolution. Complete protease and part of reverse transcriptase regions were sequenced from the sera of patients directed to the laboratory for drug resistance testing. The Stanford's HIVdb program was used for the interpretation of results and subtyping. The variants scoring at least "intermediate resistance" for at least one drug were considered as resistant. The results obtained were compared to those obtained in the years 2000-2007. A total of 95 patients were enrolled in the 2008 study. Homosexual transmission of infection was documented in more than 55% of all cases. The overall prevalence of transmitted drug resistance (TDR) was 5.3% (3.9% in 2007, 5.8% in 2006, and 14.1% in the years 2002-2005). The study from the years 2000 to 2001 revealed 28.7% prevalence. Preliminary analysis of the first half of 2009 shows the ratio of 7.8%. In four (4.2%) cases drug resistance was associated with protease inhibitors class, in one case (1.1%) with resistance to non-nucleoside reverse transcriptase inhibitors class. In four cases (4.2%) non-B subtype was identified (C, G, CRF01_AE, CRF02_AG). An increase of percentage of drug resistant mutants-from 3.9% (2007) to 5.3% (2008)-was recognized. In this study, TDR was limited to single classes of antiretroviral drugs. HIV-1 subtype B prevails in Poland.

[Physiological functions of L-ornithine and L-aspartate in the body and the efficacy of administration of L-ornithine-L-aspartate in conditions of relative deficiency]

L-ornithine-L-aspartate (LOLA) is a stable salt of two natural nonessential L-amino acids: ornithine and aspartic acid. It is formulated and marketed in low and high doses. Low doses are used as a food supplement and high doses (above 5 g) as a medicinal product to lower blood ammonia concentration and to eliminate symptoms of hepatic encephalopathy associated with liver cirrhosis. The aim of this review is to present physiological roles of L-ornithine and L-aspartate in the human body, to assess conditions under which these amino acids could be deficient, to analyze consequences of these deficiencies, and to review the current state of knowledge on the effects of LOLA administration. The data used in this publication result from searches of different electronic databases such as Cochrane Trials Register, MEDLINE, PubMed, Medscape, or Google Scholar, with a cut-off date of November 29, 2009, using terms: L-ornithine-L-aspartate, ornithine aspartate, ornithine, Hepa-Merz, ornithine deficiency, hyperammonemia, hepatic encephalopathy, and liver cirrhosis. Both amino acids play key roles in ammonia detoxification and in proline and polyamine biosyntheses. Polyamines are considered critical for DNA synthesis and cell replication and have been shown to stimulate hepatic regeneration. Supplementation with ornithine in animal models demonstrated enhanced wound breaking strength and collagen deposition. It has been shown in vitro, in vivo and in perfused organs that urea synthesis from ammonia is limited by endogenous ornithine and that ornithine can pharmacologically promote urea formation to a greater degree than any ammonia supply. Administration of LOLA in high doses reduced high blood ammonia induced either by ammonium chloride or protein ingestion or existing as a clinical complication of cirrhosis. In health and with proper diet, L-ornithine and L-aspartate are synthesized de novo in sufficient quantities, but in the states of disease, tissue damage, organ insufficiency, excessive metabolic demand, growth, pregnancy, or urea cycle enzyme deficiencies, these amino acids need to be supplemented with the food. The review of available data indicate that there is direct and indirect (resulting from physiology) scientific rationale for dietary use of LOLA, depending on an individual's physiological, metabolic or pathological conditions. In conditional ornithine deficiency, daily supplementation with LOLA at doses about 1 g/day is safe and, as demonstrated in vitro, should be sufficient to saturate tissue ornithine concentration to prevent postprandial hyperammonemia and to stimulate tissue regeneration.

[Influence of concomitant illness on clinical manifestations and severity of A/H1N1 influenza infection among patients hospitalized in the Hospital of Infectious Diseases in Warsaw--clinical cases]

Many cases of swine flu is mild or even asymptomatic. The recent cases have been much more severe, and many patients have presented pneumonia, respiratory failure and acute respiratory distress syndrome (ARDS). Illness-related fatalities have been recorded among individuals hospitalized in The Hospital For Infectious Diseases in Warsaw, Poland. There were 109 patients (age: 17-71y), with A/H1N1 infection confirmed by PCR. In this article have shown cases of H1N1 influenza - related complications. We observed bacterial superinfections associated with swine flu, ARDS and shock syndrome, secondary bacterial pneumonia and neurological complications. Severe hypoxemia, multilobar pneumonia, and dramatic signs and symptoms progression, were reported in 8 individuals. All patients required admission to intensive care unit and the mechanical ventilation. One patient died due to ARDS and encephalitis. Many people have experienced risk factors, e.g.: asthma, sarcoidosis, or chronic bronchitis and other pulmonary illness. One patient after renal transplant with immunosuppressive therapy recovered, as well as two patients with chronic lymphatic leucaemia in remission. Two woman with clinically-relevant obesity have developed rapid progression of respiratory insufficiency and were still on mechanical ventilation. Influenza A/H1N1 were observed in 10 pregnant women, without co-morbidities. Three of them developed interstitial pneumonia. Consequently pregnant women with confirmed pandemic A/H1N1 infection received treatment with oseltamivir.

IN CONCLUSION

Among 109 hospitalized individuals with A/H1N1 infection, eight (7%) developed severe pulmonary complications, and one of this patient died. The risk factors of progression to acute respiratory distress syndrome (ARDS) have all of this group patients.

[Clinical manifestations, diagnosis and treatment of swine flu (A/H1N1) infection among patients hospitalized in the Hospital of Infectious Diseases in Warsaw in 2009]

The aim of this paper was the evaluation of clinical characteristics, demographics and therapeutic response for oseltamivir, among patients with swine flu confirmed, hospitalized in the Hospital For Infectious Diseases in Warsaw, Poland.

MATERIAL

We have observed infection A/H1N1 occurrence in 109 patients (Female-64, Male-45, aged 17-71 y), hospitalized between August and December 2009. The influenza specific test PCR (TaqMan A/H1N1) were used to pandemic flu confirmation.

RESULTS

Out of 109 analyzed patients, 67% were young, before 40 y. old. The largest infected group were patients between 20 and 29 years. Among multiple acute symptoms we observed high temperature, cough, myalgia and neurological manifestations, very frequent. In 42 patients (38%) the interstitial pneumonia were observed. Eight patients developed severe respiratory insufficiencies -ARDS (7%) and one died. We observed also 10 infections A/H1N1 influenza during pregnancy, with good oseltamivir tolerance and without recent perinathal complications.

CONCLUSIONS

Among 109 individuals with swine flu influenza, 67% have not complicated clinical manifestation and they recovered during 3-4 days. Eight patients developed ARDS and one of them died. Test PCR for influenza A/H1N1 was the basis in diagnostics procedures of the new pandemic influenza confirmation. Oseltamivir safety and tolerability were verified in patients with new variant infection A/H1N1.

[Toll-like receptors in viral hepatitis]

Toll-like receptors (TLRs) are part of the innate immune system. They recognize some protein, lipid, and nucleic structures that are common in microorganisms such as bacteria and viruses but not present in the human body. The stimulation of TLRs initiates the activation of an intracellular signaling network which results in the secretion of proinflammatory cytokines, mainly type I interferons, TNF-alpha, and IL-6. TLR2, TLR3, TLR4, TLR8, and TLR9 take part in the recognition of viral infections, four of them by discerning nucleic acids, with TLR3 recognizing dsRNA, TLR7 and TLR8-ssRNA, and TLR9-DNA. The role of TLRs in the development of infections and other inflammatory states, neoplasms, and autoimmune disorders is under investigation. The importance of TLRs in the natural course of hepatitis B and C and in the treatment of these diseases are the subject of particular interest. Attempts to apply TLR7 and TLR9 agonists in the treatment of chronic hepatitis type C are underway. A better understanding of the role of TLRs in the complex immunological phenomena accompanying viral hepatitis might put the therapeutic possibilities in these infections into a new perspective.

[Visceral leishmaniasis as a threat for non-endemic countries]

Global warming, globalisation, and constantly increasing number of people involved in long-distance tourism and travel to exotic destinations are likely to increase the number of cases of exotic diseases "imported" to nonendemic countries. One of the often forgotten and neglected diseases has been visceral leishmaniasis (VL or kala-azar). The disease is endemic to 62 countries, with India and Sudan accounting for the majority of the cases. It is typically fatal if left untreated. Each year about 500 000 new cases are reported worldwide, and 50 000 die as a result of the disease. Kala-azar is present in the Mediterranean Europe and 70% of cases are imported to non-endemic countries of European Union from that area. Immunocompromised status of patients, like HIV carriers are the principal prospective target for kala-azar. HIV/VL-coinfected patients have significantly higher relapse rates and decreased life expectancy. There is no formal system of reporting imported cases in Europe, except from Germany. In non-endemic countries, including Poland, there is usually the substantial delay between the onset of symptoms and the final diagnosis, with an average exceeding 3 months. This fact suggests that physicians are not familiar with leishmania infections. Despite progress in vaccine development, the only way to prevent the infection is avoiding sandfly bites. Mosquito nets, wearing appropriate clothes and repellents containing DEET (diethyl toluamide) can reduce number of bites and protect also from the other vector-borne diseases like malaria or dengue. Education concerning kala-azar risk and ways of the disease prevention is a needed for tourists and the other travelers.

[Tuberculosis and HIV infection--main diagnostic and therapeutic problems]

Tuberculosis pertains to every third HIV-positive person in a world. Therefore HIV infection is considered the most evident risk factor for the primary tuberculosis or relapse of latent tubercular infection. Pulmonary tuberculosis is the most frequent clinical presentation in HIV-positive individuals, although the frequency of extrapulmonary tuberculosis is increasing with the CD4+ count reduction. Tuberculin skin testing and bacteriological tests are regarded as a "gold standard" of diagnosis. Molecular diagnostics and evaluation of a whole-blood interferon-gamma release assay for the detection of Mycobacterium tuberculosis are not cost-effective therefore their application is limited. DOTS programs are recommended for the antimycobacterial treatment in HIV-infected patients. The increasing drug resistance of Mycobacterium tuberculosis (multi-drug resistant tuberculosis--MDRTB) is emerging problem in the field of tuberculosis management.

[Transmission of HIV-1 drug resistance among newly diagnosed patients in Poland]

OBJECTIVE

HIV-1 drug resistance is becoming a growing concern. It is estimated that one out of ten newly diagnosed persons in Europe acquires HIV drug resistant strain. The aim of this study was to determine the transmission of drug resistance and identify the resistance patterns among naïve patients in Poland.

METHODS

The patients were asked to complete a brief questionnaire concerning demographic and epidemiological data. Viral load and CD4/CD8 counts were detemined before drug resistance testing. The sequencing assay was performed according to manufacturer's protocol.

MAIN OBSERVATIONS

In the analysed cohort 14.7% of patients acquired HIV-1 drug resistant strains; further 9.5% were infected with strains with "possibly lowered susceptibility".

RESULTS

In all cases resistance to single class of antiretroviral drugs were identified. In the class of PIs resistance to NFV was the most common. The rates of drug resistance among NNRTIs were almost the same--about 5%. In the NRTI class the resistance to AZT and d4T was the most frequent. HIV-1 subtype B was identified in 88.8% of cases.

CONCLUSIONS

The results of this study document high transmission rate of drug resistance in Poland and justify the necessity of common DR testing in our country.

Concentrations of ssDNA in liver tissue and its correlation with sFas and sFasL in serum of patients infected with HBV, HCV, HCV and HIV

PURPOSE

The concentration of nucleic acids that undergo apoptosis (ssDNA) determines the actual activity of programmed cell death. ssDNA concentrations in liver tissue of patients with chronic HBV, HCV and HCV and HIV infections were assessed. The concentration of this nucleic acid was analyzed in relation to the concentrations of serous apoptosis indicators, sFas and sFasL receptor proteins, the activity of inflammatory processes and fibrosis in liver tissue as well as HBV, HCV and HIV viraemia.

PATIENTS

The study included 153 patients: 48 chronic HBV infected, 86 chronic HCV infected and 19 HCV and HIV infected.

PATIENTS AND METHODS

The concentrations of HBV-DNA, HCV-RNA and HIV-RNA were determined by use of RT-PCR method. CD3+, CD4+ and CD8+ lymphocytes count were detected in HIV infected patients' blood by use of a flow cytometer. The concentration of ssDNA was determined by use of monoclonal antibodies and ELISA tests. The concentrations of sFas and sFasL in serum were determined by use of an immunoenzymatic method (ELISA).

RESULTS

The concentration of ssDNA in liver tissue of both HCV and HBV infected patients was higher in comparison to those co-infected with HCV and HIV (1332 x 10(-6) g/mg, +/-664 x 10(-6); vs 1508 x 10(-6) microg/mg, +/-810 x 10(-6); vs 886 x 10(-6) microg/mg, +/- 388 x 10(-6); p < 0.004). No correlation between ssDNA concentration and HBV and HCV viraemia was observed. In patients infected with HCV genotype 3, the concentration of ssDNA was 1343 x 10(-6) microg/mg, +/-700 x 10(-6), comparable from patients infected with genotype 1, 296 x 10(-6) microg/mg, +/- 615 x 10(-6). The highest concentration of ssDNA in liver tissue was detected in HBV infected patients with low inflammatory activity (1645 x 10(-6) microg/mg, +/-987) and low fibrosis (1606 x 10(-6) microg/mg, +/- 876 x 10(-6). Mild inflammatory changes and low fibrosis were observed in all HCV and HIV infected patients. No correlation between ssDNA concentration in liver tissue and HIV viraemia (r = 0.03; p = 0.90), HCV, CD8+ and CD4+ count (r = -11; p = 0.66) was observed. The concentration of ssDNA among HCV and HIV infected patients correlated with the concentration of sFas in serum (r = 0.52; p < 0.02).

CONCLUSIONS

HCV, HBV and HIV viraemias do not correlate with ssDNA concentration in liver tissue. In patients with HCV and HIV infections, CD4+ and CD3+ counts do not correlate with the concentration of ssDNA in liver tissue. HIV infection seems to inhibit apoptosis processes in liver tissue of HCV and HIV co-infected patients. In the case of HCV and HIV infections, the concentration of sFas in serum correlates with the concentration of ssDNA in liver tissue.

[Proton magnetic resonance spectroscopy in the liver of HIV and HCV coinfected patients]

The 1H MR spectroscopy (1H MRS) creates possibility of non-invasive study of morphological changes 1H MRS and metabolic disturbance of the liver. The aim of study was estimated of 1H MRS in investigation of liver metabolic changes, with special regard of lipids in patients with HCV and HIV/HCV infection.

MATERIAL AND METHODS

Research was moved among patients with HCV infection and in HCV/ HIV co infection. 1H MRS of the liver was moved with use of system Picker, Eclipse 1.5 T. Investigation were executed with use of tube of whole body, with use of sequence PRESS 35 (TE 35 ms, TR 1500 ms, nex 192). Suppression of water was made of MOIST method. Voxel about sizes 3x3x3 (27 cm3) were located in right piece of liver on basis of paintings T2- dependence in front and transverse planes.

RESULT

In group of HCV patients without HIV infection were observed over 6 x increase proportion of PME/TL (0.112; p = 0.001) and 2 x increase of Glx/TL (0.042; p = 0.02) in refer to control group. In patients with HCV and HIV infection were observed significance increase of Glu/ TL - 328%, Glx/TL - 458% and PME/TL 728% in comparison to control group. The patients with only HCV infection were statistical significance decrease of TL level in comparison to control group (43.2 +/- 9.4 v. 74.1 +/- 12.2; p = 0.09). The patients with HCV and HIV infection, level of TL was lowered in refer patients with only HCV infection (20.7 +/- 5.6; p < 0.05).

CONCLUSIONS

Proton magnetic resonance spectroscopy of the liver is useful diagnostic method in detecting of parenchyma liver damage and to make up supplement of histology diagnosis.

Metabolic disturbances in liver 1H MR spectroscopy in HIV and HCV co-infected patients as a potential marker of hepatocyte activation

PURPOSE

To evaluate proton magnetic resonance spectroscopy (1H MRS) features in order to assess hepatocellular activation in chronic hepatitis C and human immunodeficiency virus/hepatitis C (HIV/HCV) co-infected patients.

MATERIAL AND METHODS

Liver in vivo 1H MR spectra were obtained in 14 patients with hepatitis C virus infection (HCV), 20 HIV/HCV co-infected individuals, and 24 healthy volunteers. Resonances of lipids, glutamine/glutamate (Glx), phosphomonoesters (PME), glycogen/glucose (Glc) were assessed and metabolite ratios to total lipids (TL) were calculated.

RESULTS

A significant increase in Glx/TL and PME/TL was observed in the HCV group as compared to healthy individuals. Patients with HIV and HCV co-infection had a further increase of all metabolite ratios. Changes in metabolite ratios were due to both the increase in particular metabolite contents and to the decrease in lipid levels. HIV/HCV-infected patients treated with highly active anti-retroviral therapy (HAART) showed elevated PME and Glx levels and significantly decreased TL compared to patients not undergoing anti-retroviral treatment.

CONCLUSIONS

Our findings suggest clinical usefulness of liver 1H MR spectroscopy in detecting even slight disturbances in liver metabolism.

Antiretroviral therapy and its influence on the stage of brain damage in patients with HIV - 1H MRS evaluation

BACKGROUND

MR proton spectroscopy (1H MRS) enables early detection of metabolic changes, which occur in the course of AIDS Dementia Complex Syndrome (ADC). The goal of the study was the evaluation of highly active antiretroviral therapy (HAART) and its influence on the character and intensity of metabolic changes in brain 1H MRS spectra in clinically asymptomatic HIV-infected patients as well as search for correlation between the treatment and 1H MR spectroscopy results and immune deficit degree.

MATERIAL/METHODS

In the group of 20 HIV+ patients, the examination of the central nervous system (CNS), MR and 1H MRS were conducted twice:before HAART treatment and during the therapy; on average after 6 months (4 -9 months of treatment).

RESULTS

The levels of NAA/Cr in the control MRS examination were close to the values observed before treatment. However, statistically significant increase in NAA/Cho ratio (p<0.05) was noticed. The control examination showed statistically decrease of Cho/Cr and mI/Cr ratios, though statistically insignificant (p>0.05). NAA and Cr contents in reference to the signal of non-suppressed water increased insignificantly in the follow-up examination. However, statistically significant decrease in Cho/H(2)O and mI/H(2)O levels (p<0.05) was observed.

CONCLUSIONS

The therapy with HAART affects normalization of metabolite levels in the central nervous system in clinically asymptomatic HIV+ patients and diminishes the risk of ADC occurrence. Myoinositol and choline levels estimated in 1H MRS might be the indices for antiretroviral treatment efficacy.

[Yellow fever]

Yellow fever is a mosquito born viral illness that causes hemorrhagic fever in tropical Africa and South America. An estimated 200 000 people are still infected annually. There is no antiviral therapy available and vaccination is major strategy in the control yellow fever. From 60 years ago is available very safe and efficient vaccine. The vaccine is a live attenuated virus strain 17D. Recently identified vaccine associated viscerotropic diseases (YFV-AVD). This paper describes knowledge about yellow fever disease, vaccine associated adverse events and actually recommendation for vaccine use.