The anemia prevalence and the association between complete blood count analysis and renal function parameters in HIV-1-infected patients

OBJECTIVES

To determine the anemia prevalence and the correlation between complete blood count (CBC) analysis and renal function parameters in HIV-1-infected population.

METHODS

It was a single-center study set in Warsaw (Poland) over a 3-year period. The study was performed in 214 adult HIV-1- infected patients (180 males and 34 females, aged from 20 to 69 years old, mean age 39.55 years, 130 on combined antiretroviral therapy, cART). Glomerular filtration rate (GFR) was estimated using the re-expressed Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. In statistical analyses U Mann-Whitney and Spearman correlation test as logistic regression analysis was used.

RESULTS

25.2% of studied patients were anemic. In all of them, estimated GFR (eGFR) was positively correlated with red blood cells (RBC) and platelet (PLT) count, and negatively correlated with mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC). All these correlations were statistically significant (p < 0.001) and independent of gender and used type of eGFR formula. In logistic regression analysis, lower eGFR strongly predicted lower RBC and PLT levels (p < 0.0001; OR 0.08, 95%CI: 0.03, 0.22 and OR 0.99, 95%CI: 0.987, 0.993, respectively).

CONCLUSIONS

Our findings suggest a strong association between CBC and renal function in ARV-treated HIV-infected patients who fulfilled the criteria of anemia. Consequently, eGFR in all HIV-infected subjects with anemia, especially on treatment with nephrotoxic drugs and concomitant thrombocytopenia, should be monitored more frequently then standardly recommended every 3-6 months.

Hepatitis A and hepatitis A virus/HIV coinfection in men who have sex with men, Warsaw, Poland, September 2008 to September 2009

We describe the epidemiology and characteristics of hepatitis A among men who have sex with men (MSM)who had been hospitalised due to the infection in Warsaw, Poland, from September 2008 to September 2009. A total of 50 men were analysed; their median age was 28 years (range: 17–43). None had travelled to hepatitis A-endemic regions during the six months before hospitalisation nor had they been vaccinated against hepatitis A. Of the 50 men, 40 had been tested before hospitalisation or on admission for the presence of anti-HIV antibodies: six were coinfected with HIV.The six HIV-positive MSM were significantly older than those who were HIV negative – median age: 37 years(range: 26–43) versus 28 years (range: 17–43); p=0.02.No difference in disease severity or the duration of hospitalisation was observed, however, between the two groups. Our study underlines the need to screen MSM for hepatitis A and to vaccinate them against hepatitis A. Given the ages of the MSM in our study,we recommend that this be carried out in Poland when the MSM are aged 20–35 years. This should apply not only to MSM with multiple casual partners but also to those in monogamous relationships.

Hepatitis A and hepatitis A virus/HIV coinfection in men who have sex with men, Warsaw, Poland, September 2008 to September 2009

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Comparative analysis of the new chronic kidney disease epidemiology collaboration and the modification of diet in renal disease equations for estimation of glomerular filtration rate in HIV type 1-infected subjects

Recently, a new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was presented as a better alternative to the modification of diet in renal disease (MDRD) formula for GFR estimation (eGFR) in patients with relatively well-preserved kidney function. The main objective of our study was to compare the eGFR results arrived by the new CKD-EPI to the older MDRD equation in antiretroviral (ARV)-naive and ARV-treated HIV-1-infected patients. The study was performed in 287 adult HIV-1-infected patients and was an evaluation comparing eGFR results based on age, gender, race, and serum creatinine. The biggest difference in estimated glomerular filtration rate (eGFR) measured by the two formulas was seen in ARV-naive men with well-preserved kidney function (p = 0.001). Moreover, we found a significant negative correlation between mean difference in eGFR measured by the two equations and the age of the studied subjects (r = -0.37, p < 0.001). No correlation was observed between mean difference in eGFR and HIV viral load (r = -0.15, p = 0.2). Independent of the equation used, a significant decrease of eGFR in ARV-treated in comparison to ARV-untreated HIV-1-infected patients was seen (p < 0.001). In conclusion, in HIV-1-infected subjects, especially in ARV-naive men with well-preserved kidney function, eGFR measured by MDRD and CKD-EPI formulas varies strongly following the method used. Such discrepancies may be important in everyday clinical practice and must be confirmed by additional studies using GFR measured with a reference method.

Thyroid dysfunction in antiviral therapy of chronic hepatitis C

BACKGROUND/AIMS

Thyroid disorders are common dysfunctions during HCV infection and IFN-therapy. The aim of the study was to evaluate the general risk of thyroid disorders' development in chronic HCV-infected patients and their possible relationship with HCV genotype, type of used IFN-alpha and viral response.

METHODOLOGY

A study was performed in 89 patients with chronic hepatitis C (57 males, 32 females) and 25 healthy subjects. All HCV-infected patients were treated by IFN-alpha and RBV for a period depending on the HCV genotype. Hematological parameters, liver and thyroid function tests were analyzed. Serum Tpo-Ab and TG-Ab were detected by semiquantitative ELISA. In statistical analyses U Mann-Whitney and Spearman correlation tests were used. Ap value < 0.05 was considered significant.

RESULTS

Twelve (13.5%) CHC patients developed thyroid disorders during IFN-alpha therapy. Thyroid disorders were more often detected in females, in 3a-genotype-infection and in patients treated with natural leukocyte IFN-alpha. Seven (7.6%) Tpo-Ab and/or TG-Ab positive patients were noticed. Four of them (57.1%) developed hypothyroidism during IFN-alpha therapy.

CONCLUSION

This study demonstrated low effect of IFN-alpha therapy on thyroid disorders development and on TPO-Ab and TG-Ab serum level in chronic HCV-infected patients.

[Efficacy and safety of vaccination against yellow fever of persons traveling to endemic areas]

AIM

To asses the yellow fever effectiveness in persons traveling to the endemic regions, and the frequency of adverse events related to vaccine as well as the change of neutralizing antibodies in time.

METHODS

Fifty three persons (25 males and 28 females, mean 43.5 years) vaccinated against yellow fever in 2004-2008 were involved to the study. In 2009 the level of serum anti-yellow fever antibodies was measured by neutralization test. MAIN OBSERVATION AND RESULTS: None of studied person demonstrated adverse events related to yellow fever vaccine. Four subjects (7.5%) did not respond appropriately to the vaccine. There was no correlation between the level of neutralizing antibodies and gender, age, co-morbidities presence and duration of time after vaccination.

CONCLUSIONS

Currently used anti-yellow fever vaccine demonstrates high level of efficacy and safety. Above 92% of studied persons had protective level of neutralizing antibodies. Moreover, the postvaccinal response seems to be long-term and does not depend on time period from vaccination or other factors.

[HCV entry as a new therapeutic target in chronic hepatitis C]

According to WHO data the hepatitis C virus (HCV) has already infected 170 million people worldwide, and 750,000 of them in Poland what amounts some 1.4% of general country population. Currently used antiviral therapy with pegylated interferon alpha and ribavirin has only 50% effectiveness. Many new drugs and molecules, especially inhibiting viral replication, are studied in preclinical and clinical trials. However, still unknown HCV entry process can be a new, promising therapeutic target in chronic HCV infection.

Signal transduction pathways in liver and the influence of hepatitis C virus infection on their activities

In liver, the most intensively studied transmembrane and intracellular signal transduction pathways are the Janus kinase signal transduction pathway, the mitogen-activated protein kinases signal transduction pathway, the transforming growth factor β signal transduction pathway, the tumor necrosis factor α signal transduction pathway and the recently discovered sphingolipid signal transduction pathway. All of them are activated by many different cytokines and growth factors. They regulate specific cell mechanisms such as hepatocytes proliferation, growth, differentiation, adhesion, apoptosis, and synthesis and degradation of the extracellular matrix. The replication cycle of hepatitis C virus (HCV) is intracellular and requires signal transduction to the nucleus to regulate transcription of its genes. Moreover, HCV itself, by its structural and non-structural proteins, could influence the activity of the second signal messengers. Thus, the inhibition of the transmembrane and intracellular signal transduction pathways could be a new therapeutic target in chronic hepatitis C treatment.

[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.