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1.
J Med Virol ; 96(2): e29482, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38381668

RESUMO

The human immunodeficiency virus type 1 (HIV-1) A6 sub-subtype is highly prevalent in Eastern Europe. Over the past decade, the dissemination of the A6 lineage has been expanding in Poland. The recent Russian invasion of Ukraine may further escalate the spread of this sub-subtype. While evolutionary studies using viral sequences have been instrumental in identifying the HIV epidemic patterns, the origins, and dynamics of the A6 sub-subtype in Poland remain to be explored. We analyzed 1185 HIV-1 A6 pol sequences from Poland, along with 8318 publicly available sequences from other countries. For analyses, phylogenetic tree construction, population dynamics inference, Bayesian analysis, and discrete phylogeographic modeling were employed. Of the introduction events to Poland, 69.94% originated from Ukraine, followed by 29.17% from Russia. Most A6 sequences in Poland (53.16%) formed four large clades, with their introductions spanning 1993-2008. Central and Southern Polish regions significantly influenced migration events. Transmissions among men who have sex with men (MSM) emerged as the dominant risk group for virus circulation, representing 72.92% of migration events. Sequences from migrants were found primarily outside the large clades. Past migration from Ukraine has fueled the spread of the A6 sub-subtype and the current influx of war-displaced people maintains the growing national epidemic.


Assuntos
Epidemias , Infecções por HIV , HIV-1 , Minorias Sexuais e de Gênero , Masculino , Humanos , Filogenia , Polônia/epidemiologia , Homossexualidade Masculina , HIV-1/genética , Infecções por HIV/epidemiologia , Teorema de Bayes
2.
Clin Infect Dis ; 76(10): 1716-1724, 2023 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-36857116

RESUMO

BACKGROUND: The human immunodeficiency virus (HIV) type 1 A6 variant is dominating in high-prevalence Eastern European countries, with increasing prevalence over the remaining regions of Europe. The recent war in Ukraine may contribute to further introductions of this A6 lineage. Our aim was to model the transmission dynamics of the HIV-1 A6 variant between Poland and Ukraine. METHODS: HIV-1 A6 partial pol sequences originating from Poland (n = 1185) and Ukraine (n = 653) were combined with publicly available sequences (n = 7675) from 37 other countries. We used maximum likelihood-based tree estimation followed by a bayesian inference strategy to characterize the putative transmission clades. Asymmetric discrete phylogeographic analysis was used to identify the best-supported virus migration events across administrative regions of Poland and Ukraine. RESULTS: We identified 206 clades (n = 1362 sequences) circulating in Poland or Ukraine (63 binational clades, 79 exclusively Polish, and 64 exclusively Ukrainian). Cross-border migrations were almost exclusively unidirectional (from Ukraine to Poland, 99.4%), mainly from Eastern and Southern Ukraine (Donetsk, 49.7%; Odesa, 17.6% regions) to the Central (Masovian, 67.3%; Lodz, 18.2%) and West Pomeranian (10.1%) districts of Poland. The primary sources of viral dispersal were the Eastern regions of Ukraine, long affected by armed conflict, and large population centers in Poland. CONCLUSIONS: The Polish outbreak of the A6 epidemic was fueled by complex viral migration patterns across the country, together with cross-border transmissions from Ukraine. There is an urgent need to include war-displaced people in the national HIV prevention and treatment programs to reduce the further spread of transmission networks.


Assuntos
Infecções por HIV , HIV-1 , Humanos , Ucrânia/epidemiologia , Polônia/epidemiologia , HIV-1/genética , União Europeia , Teorema de Bayes , Funções Verossimilhança
3.
Clin Infect Dis ; 76(10): 1708-1715, 2023 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-36888680

RESUMO

BACKGROUND: The Russian invasion of Ukraine forced migration for safety, protection, and assistance. Poland is the primary sheltering country for Ukrainian refugees, providing support including medical care, which resulted in the rapid ∼15% increase in the number of followed-up people with human immunodeficiency virus (HIV) (PWH) in the country. Here, we present the national experience on HIV care provided for refugees from Ukraine. METHODS: Clinical, antiretroviral, immunological, and virologic data from 955 Ukrainian PWH entering care in Poland since February 2022 were analyzed. The dataset included both antiretroviral-treated (n = 851) and newly diagnosed (n = 104) patients. In 76 cases, protease/reverse transcriptase/integrase sequencing was performed to identify drug resistance and subtype. RESULTS: Most (70.05%) of the patients were female, with a predominance of heterosexual (70.3%) transmissions. Anti-hepatitis C antibody and hepatitis B antigen were present in 28.7% and 2.9% of the patients, respectively. A history of tuberculosis was reported in 10.1% of cases. Among previously treated patients, the viral suppression rate was 89.6%; 77.3% of newly HIV diagnosed cases were diagnosed late (with lymphocyte CD4 count <350 cells/µL or AIDS). The A6 variant was observed in 89.0% of sequences. Transmitted mutations in the reverse transcriptase were found in 15.4% treatment-naive cases. Two patients with treatment failure exhibited multiclass drug resistance. CONCLUSIONS: Migration from Ukraine influences the characteristics of HIV epidemics in Europe, with an increase in the proportion of women and hepatitis C coinfected patients. Antiretroviral treatment efficacy among previously treated refugees was high, with new HIV cases frequently diagnosed late. The A6 subtype was the most common variant.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , HIV-1 , Refugiados , Humanos , Feminino , Masculino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Polônia/epidemiologia , HIV-1/genética , Antirretrovirais/uso terapêutico , DNA Polimerase Dirigida por RNA/uso terapêutico , Farmacorresistência Viral/genética
4.
Infection ; 51(2): 379-387, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35882773

RESUMO

PURPOSE: Immunocompromised patients are postulated to be at elevated risk of unfavorable outcomes of COVID-19. The exact effect of HIV infection on the course of COVID-19 remains to be elucidated. The aim of the study was to describe the epidemiological and clinical aspects of SARS-CoV-2 infection in HIV-infected individuals. METHODS: The HIV-positive patients who were diagnosed with SARS-CoV-2 infection were identified through thirteen specialist HIV clinics routinely following them due to HIV treatment. The data were collected between November 2020 and May 2021 through an on-line electronical case report form (SurveyMonkey®). The collected information included demographics, lifestyle, comorbidities, HIV care history, COVID-19 clinical course and treatment. Logistic regression models were used to identify factors associated with the odds of death or hospitalization due to COVID-19. RESULTS: One hundred and seventy-three patients with HIV-SARS-CoV-2 coinfection were included in the analysis. One hundred and sixty-one (93.1%) subjects had a symptomatic course of the disease. Thirty-nine (23.1%) of them were hospitalized, 23 (13.3%) necessitated oxygen therapy. Three (1.8%) patients required admission to the intensive care unit and 6 (3.5%) patients died. The presence of comorbidities and an HIV viral load of more than 50 copies/mL were linked to the increased odds of hospitalization (OR 3.24 [95% CI 1.27-8.28]) and OR 5.12 [95% CI 1.35-19.6], respectively). CONCLUSIONS: As depicted by our analyses, HIV-positive patients with comorbidities and/or uncontrolled HIV replication who are diagnosed with SARS-CoV-2 infection should be considered of high risk of poor COVID-19 outcome and followed up carefully.


Assuntos
COVID-19 , Infecções por HIV , Humanos , COVID-19/epidemiologia , COVID-19/complicações , SARS-CoV-2 , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Polônia/epidemiologia , Hospitalização , Replicação Viral
5.
BMC Infect Dis ; 23(1): 314, 2023 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-37165346

RESUMO

BACKGROUND: The purpose of the study was to compare the results of AI (artificial intelligence) analysis of the extent of pulmonary lesions on HRCT (high resolution computed tomography) images in COVID-19 pneumonia, with clinical data including laboratory markers of inflammation, to verify whether AI HRCT assessment can predict the clinical severity of COVID-19 pneumonia. METHODS: The analyzed group consisted of 388 patients with COVID-19 pneumonia, with automatically analyzed HRCT parameters of volume: AIV (absolute inflammation), AGV (absolute ground glass), ACV (absolute consolidation), PIV (percentage inflammation), PGV (percentage ground glass), PCV (percentage consolidation). Clinical data included: age, sex, admission parameters: respiratory rate, oxygen saturation, CRP (C-reactive protein), IL6 (interleukin 6), IG - immature granulocytes, WBC (white blood count), neutrophil count, lymphocyte count, serum ferritin, LDH (lactate dehydrogenase), NIH (National Institute of Health) severity score; parameters of clinical course: in-hospital death, transfer to the ICU (intensive care unit), length of hospital stay. RESULTS: The highest correlation coefficients were found for PGV, PIV, with LDH (respectively 0.65, 0.64); PIV, PGV, with oxygen saturation (respectively - 0.53, -0.52); AIV, AGV, with CRP (respectively 0.48, 0.46); AGV, AIV, with ferritin (respectively 0.46, 0.45). Patients with critical pneumonia had significantly lower oxygen saturation, and higher levels of immune-inflammatory biomarkers on admission. The radiological parameters of lung involvement proved to be strong predictors of transfer to the ICU (in particular, PGV ≥ cut-off point 29% with Odds Ratio (OR): 7.53) and in-hospital death (in particular: AIV ≥ cut-off point 831 cm3 with OR: 4.31). CONCLUSIONS: Automatic analysis of HRCT images by AI may be a valuable method for predicting the severity of COVID-19 pneumonia. The radiological parameters of lung involvement correlate with laboratory markers of inflammation, and are strong predictors of transfer to the ICU and in-hospital death from COVID-19. TRIAL REGISTRATION: National Center for Research and Development CRACoV-HHS project, contract number SZPITALE-JEDNOIMIENNE/18/2020.


Assuntos
COVID-19 , Humanos , COVID-19/diagnóstico por imagem , Inteligência Artificial , SARS-CoV-2 , Mortalidade Hospitalar , Inflamação , Biomarcadores , Estudos Retrospectivos
6.
HIV Med ; 23(11): 1173-1183, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36372396

RESUMO

OBJECTIVES: The aim of this study was to analyse patients newly diagnosed with HIV who were originally admitted to hospitals with suspicion of COVID-19. METHODS: This was a retrospective case series undertaken at four sites. Only adults with new HIV diagnosis and COVID-19 exclusion hospitalized in 2020-2021 were included. Demographic, clinical and laboratory data were collected from medical records. RESULTS: Twenty-five patients were included in the analysis: 19 men (76%), 11 of Ukrainian origin (44%). The median age was 38.5 years (range 25-59). The mode of HIV transmission was heterosexual for 11 (44%) patients, eight (32%) were men who have sex with men and three (12%) were people who inject drugs. The median duration of symptoms prior to hospital presentation was 20.6 days (range 3-90). The median number of SARS-CoV-2 tests per patient was 2.62 (range 1-7). All SARS-CoV-2 tests were negative. Screening for HIV was performed on average on the 18th day of hospitalization (range 1-36 days). Twenty-three patients (92%) were late presenters, 22 (88%) had advanced disease, and 19 (76%) were in the AIDS stage. The median CD4 T-cell count was 72 cells/µL (range 3-382). The rate of positive HIV testing at the two sites where it was available for people with suspected COVID-19 was 0.13% (7/5458 during the study period). CONCLUSIONS: We strongly recommend introducing the HIV screening test in the diagnostic algorithm for every patient suspected of having COVID-19, presenting with clinical and/or radiological pulmonary symptoms.


Assuntos
COVID-19 , Infecções por HIV , Minorias Sexuais e de Gênero , Adulto , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , SARS-CoV-2 , COVID-19/diagnóstico , Pandemias , Estudos Retrospectivos , Polônia/epidemiologia , Homossexualidade Masculina , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Teste de HIV
7.
Przegl Epidemiol ; 76(4): 443-449, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-37017180

RESUMO

There is a well-documented link between infectious diseases, especially HIV, armed conflict, lack of respect for human rights and migration. War leads to disruption of services, increased vulnerability to violence and social hardships that put individuals and especially women at risk of infections such as HIV. HIV in Europe is highly associated with migration, with over 40% of new infections being diagnosed among migrants. Our aim was to provide an overview of the factors that put migrant populations, and especially migrant women, at risk for HIV infection and to illustrate this from three different perspectives: 1) recent migration from the Ukraine, and Polish experiences in provision of HIV care to Ukrainian migrants; 2) successful HIV programs targeting African migrant women in the United Kingdom (UK); 3) the impact of the prolonged crisis and women's rights violations during the internal Afghanistan conflict. We conclude that although they may be dramatically different, situations having detrimental health effects in women often share common underlying causes, and therefore may potentially be addressed by applying universal principles that emphasise the importance of self-management of health needs, empowerment of vulnerable communities and building community strengths. As crisis situations are often unpredictable, and shortage of resources common, empowerment of communities and creation of systematic policies that proactively address women's specific needs is crucial to ensuring that vulnerable populations are able to thrive in their new environment, thereby becoming contributors to, rather than being seen as burdens to society. This can only be achieved by continuous dialogue between women's communities, health care providers, policy makers and other stakeholders involved in the care of women.


Assuntos
Infecções por HIV , Feminino , Humanos , Infecções por HIV/epidemiologia , Polônia , Direitos Humanos , Direitos da Mulher , Migração Humana
8.
Folia Med Cracov ; 61(4): 5-44, 2021 12 28.
Artigo em Inglês | MEDLINE | ID: mdl-35180200

RESUMO

The complex course of the COVID-19 and the distant complications of the SARS-CoV-2 infection still remain an unfaded challenge for modern medicine. The care of patients with the symptomatic course of COVID-19 exceeds the competence of a single specialty, often requiring a multispecialist approach. The CRACoV-HHS (CRAcow in CoVid pandemic - Home, Hospital and Staff) project has been developed by a team of scientists and clinicians with the aim of optimizing medical care at hospital and ambulatory settings and treatment of patients with SARS-CoV-2 infection. The CRACoV project integrates 26 basic and clinical research from multiple medical disciplines, involving different populations infected with SARS-CoV-2 virus and exposed to infection. Between January 2021 and April 2022 we plan to recruit subjects among patients diagnosed and treated in the University Hospital in Cracow, the largest public hospital in Poland, i.e. 1) patients admitted to the hospital due to COVID-19 [main module: 'Hospital']; 2) patients with signs of infection who have been confirmed as having SARS-CoV-2 infection and have been referred to home isolation due to their mild course (module: 'Home isolation'); 3) patients with symptoms of infection and high exposure to SARS- CoV-2 who have a negative RT-PCR test result. In addition, survey in various professional groups of hospital employees, both medical and non-medical, and final-fifth year medical students (module: 'Staff') is planned. The project carries both scientific and practical dimension and is expected to develop a multidisciplinary model of care of COVID-19 patients as well as recommendations for the management of particular groups of patients including: asymptomatic patient or with mild symptoms of COVID-19; symptomatic patients requiring hospitalization due to more severe clinical course of disease and organ complications; patient requiring surgery; patient with diabetes; patient requiring psychological support; patient with undesirable consequences of pharmacological treatment.


Assuntos
COVID-19 , Hospitais Especializados , Humanos , Pandemias , Recursos Humanos em Hospital , SARS-CoV-2
9.
Przegl Epidemiol ; 74(1): 89-107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32500989

RESUMO

Skin and soft tissue infections (SSTIs) are a group of diseases usually caused by bacteria, and connected with different clinical picture, course, and prognosis. The increasing incidence of SSTIs is associated mainly with aging of the population, the increasing number of metabolic diseases, especially diabetes mellitus, as well as cardiovascular diseases. Although SSTIs are often benign and usually does not require medical consultations, some of them may cause a systemic infection. In this situation, knowledge of the principles of diagnostic work-up and therapy is essential. The principles of recognition and treatment of skin and soft tissue infections, including new biocidal drugs, are presented.


Assuntos
Antibacterianos/uso terapêutico , Dermatopatias Bacterianas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico , Bactérias , Humanos , Staphylococcus aureus Resistente à Meticilina , Polônia/epidemiologia , Dermatopatias Bacterianas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia
10.
Postepy Dermatol Alergol ; 35(5): 481-484, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30429705

RESUMO

INTRODUCTION: Recent outbreaks of syphilis occurred predominantly in men who have sex with men (MSM). A significant proportion of syphilis cases occur in MSM who had more than one episode of syphilis. This group may play an important role in syphilis transmission. AIM: To identify factors associated with the risk of syphilis reinfection. MATERIAL AND METHODS: Forty-four MSM patients with the first episode of syphilis who were treated at the Department of Dermatology at the Jagiellonian University School of Medicine in Krakow, Poland were included in this study. After completing the treatment, the RPR testing was done every 3 months for 2 years in every patient. In the study period, we identified 12 (22%) cases of syphilis reinfection, eight of which were asymptomatic. Clinical, demographic and behavior data from patients with only one episode of syphilis were compared with those collected from repeaters. RESULTS: Individuals with syphilis reinfection had concomitant HIV infection more frequently, reported a higher number of sexual partners and had sex in sex on premises venues more frequently (p < 0.05). In the multivariate analysis, we found that being HIV-infected MSM and having sex in sex on premises venues independently correlated with a higher risk of syphilis reinfection (OR = 9.6, 95% CI: 2.2-42.5 and OR = 5.6, 95% CI: 1.4-22.5, respectively). CONCLUSIONS: Results of our study highlight a strong need for frequent and repeated screening among MSM patients (especially those with concomitant HIV infection) with the first episode of syphilis and taking detailed patient's history regarding also demographic and behavior data. We should also improve prevention policies to reduce risk behaviors in this population.

11.
J Med Virol ; 89(12): 2122-2129, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28390164

RESUMO

AIM: To assess the efficacy and tolerability of dual therapy containing raltegravir (RAL) and ritonavir boosted darunavir (DRV/r) in HIV-1-infected treatment-experienced patients. METHOD: Retrospective analysis of 81 HIV-1-infected treatment-experienced patients (56 male and 25 female, 5 Polish centers) who switched to RAL/DRV/r. RESULTS: The main reasons for the introduction of dual therapy were renal dysfunction (16/81 patients-19.8%) and virologic failure on previous regimens (15/81 patients-18.5%). At 48 weeks the treatment was continued in 58/81 (71.6% of patients). In three patients the therapy was discontinued because of virologic failure. However, no mutations to DRV or integrase inhibitors (InI) were detected. At 48 weeks of treatment CD4+ lymphocyte count increased statistically significantly (median 121 cells/µL) P < 0.005. The main reasons for the discontinuation of therapy were treatment simplification (11/23-47.8% patients), adverse events (7/23 patients 30.4%), virologic failure (3/23 patients 13.0%). All patients who switched to RAL/DRV/r therapy because of prior renal impairment were maintained on the treatment for 48 weeks. In this group, before the introduction of dual therapy eGFR (estimated glomerular filtration rate) <60 mL/min/1.72 m2 was reported in nine patients and after 48 weeks in four patients (56.3% vs 25%) (P > 0.05). We found a statistically significant decrease in the prevalence of proteinuria or eGFR <60 mL/min/1.72 m2 (93.8% vs 37.5%; P = 0.004 before and after the introduction of dual therapy, respectively). CONCLUSIONS: Dual therapy was effective and safe for the vast majority of antiretroviral-experienced subjects. Such therapy can be recommended especially for patients with renal impairment or NRTIs intolerance.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Darunavir/uso terapêutico , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , Raltegravir Potássico/uso terapêutico , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Darunavir/administração & dosagem , Darunavir/efeitos adversos , Quimioterapia Combinada , Feminino , Infecções por HIV/virologia , Inibidores da Protease de HIV/administração & dosagem , Inibidores da Protease de HIV/efeitos adversos , HIV-1/efeitos dos fármacos , Humanos , Rim/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Proteinúria/etiologia , RNA Viral , Raltegravir Potássico/administração & dosagem , Raltegravir Potássico/efeitos adversos , Estudos Retrospectivos , Carga Viral/efeitos dos fármacos
12.
Med Sci Monit ; 23: 682-694, 2017 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-28167814

RESUMO

BACKGROUND Monitoring of drug resistance-related mutations among patients with recent HIV-1 infection offers an opportunity to describe current patterns of transmitted drug resistance (TDR) mutations. MATERIAL AND METHODS Of 298 individuals newly diagnosed from March 2008 to February 2014 in southern Poland, 47 were deemed to have recent HIV-1 infection by the limiting antigen avidity immunoassay. Proviral DNA was amplified and sequenced in the reverse transcriptase, protease, and gp41 coding regions. Mutations were interpreted according to the Stanford Database algorithm and/or the International Antiviral Society USA guidelines. TDR mutations were defined according to the WHO surveillance list. RESULTS Among 47 patients with recent HIV-1 infection only 1 (2%) had evidence of TDR mutation. No major resistance mutations were found, but the frequency of strains with ≥1 accessory resistance-associated mutations was high, at 98%. Accessory mutations were present in 11% of reverse transcriptase, 96% of protease, and 27% of gp41 sequences. Mean number of accessory resistance mutations in the reverse transcriptase and protease sequences was higher in viruses with no compensatory mutations in the gp41 HR2 domain than in strains with such mutations (p=0.031). CONCLUSIONS Despite the low prevalence of strains with TDR mutations, the frequency of accessory mutations was considerable, which may reflect the history of drug pressure among transmitters or natural viral genetic diversity, and may be relevant for future clinical outcomes. The accumulation of the accessory resistance mutations within the pol gene may restrict the occurrence of compensatory mutations related to enfuvirtide resistance or vice versa.


Assuntos
Proteína gp41 do Envelope de HIV/genética , Infecções por HIV/virologia , Inibidores da Protease de HIV/uso terapêutico , Protease de HIV/genética , Transcriptase Reversa do HIV/genética , HIV-1/genética , Adulto , DNA Viral/genética , Farmacorresistência Viral , Feminino , Proteína gp41 do Envelope de HIV/antagonistas & inibidores , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/farmacologia , Transcriptase Reversa do HIV/antagonistas & inibidores , HIV-1/enzimologia , HIV-1/metabolismo , Humanos , Masculino , Mutação , Polônia , Polimorfismo Genético , Prevalência , Provírus/genética , Adulto Jovem
13.
J Antimicrob Chemother ; 70(1): 233-42, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25248322

RESUMO

OBJECTIVES: The surveillance of HIV-transmitted drug resistance mutations (t-DRMs), including temporal trends across subtypes and exposure groups, remains a priority in the current management of the epidemic worldwide. METHODS: A cross-sectional analysis of 833 treatment-naive patients from 9 of 17 Polish HIV treatment centres. Partial pol sequences were used to analyse drug resistance with a general time reversible (GTR)-based maximum likelihood algorithm used for cluster/pair identification. Mutation frequencies and temporal trends were investigated. RESULTS: t-DRMs were observed in 9% of cases (5.8% for NRTI, 1.2% NNRTI and 2.0% PI mutations) and were more common among heterosexually infected (HET) individuals (13.4%) compared with MSM (8.3%, P = 0.03) or injection drug users (IDUs; 2.9%, P = 0.001) and in MSM compared with IDUs (P = 0.046). t-DRMs were more frequent in cases infected with the non-B variant (21.6%) compared with subtype B (6.6%, P < 0.001). With subtype B a higher mutation frequency was found in MSM compared with non-MSM cases (8.3% versus 1.8% for IDU + HET, P = 0.038), while non-B variants were associated with heterosexual exposure (30.4% for HET versus 4.8% for MSM, P = 0.019; versus 0 for IDU, P = 0.016). Trends in t-DRM frequencies were stable over time except for a decrease in NNRTI t-DRMs among MSM (P = 0.0662) and an NRTI t-DRM decrease in HET individuals (P = 0.077). With subtype B a higher frequency of sequence pairs/clusters in MSM (50.4%) was found compared with HET (P < 0.001) and IDUs (P = 0.015). CONCLUSIONS: Despite stable trends over time, patterns of t-DRMs differed notably between transmission categories and subtypes: subtype B was associated with MSM transmission and clustering while in non-B clades t-DRMs were more common and were associated with heterosexual infections.


Assuntos
Fármacos Anti-HIV/farmacologia , Farmacorresistência Viral , Infecções por HIV/transmissão , Infecções por HIV/virologia , HIV/efeitos dos fármacos , Adulto , Estudos Transversais , Feminino , Genótipo , HIV/classificação , HIV/genética , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de Mutação , Polônia/epidemiologia , Prevalência , Análise de Sequência de DNA , Produtos do Gene pol do Vírus da Imunodeficiência Humana/genética
14.
Contemp Oncol (Pozn) ; 19(3): 226-35, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26557764

RESUMO

THE AIM OF THE STUDY: The aim of the study was to evaluate the spectrum of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs) in HIV-infected patients in Poland. MATERIAL AND METHODS: A retrospective observational study was conducted among HIV-infected adult patients who developed a malignancy between 1995 and 2012 in a Polish cohort. Malignancies were divided into ADMs and NADMs. Non-AIDS-defining malignancies were further categorised as virus-related (NADMs-VR) and unrelated (NADMs-VUR). Epidemiological data was analysed according to demographic data, medical history, and HIV-related information. Results were analysed by OR, EPITools package parameters and Fisher's exact test. RESULTS: In this study 288 malignancies were discovered. The mean age at diagnosis was 41.25 years (IQR20-81); for ADMs 38.05 years, and for NADMs-VURs 46.42 years; 72.22% were male, 40.28% were co-infected with HCV. The risk behaviours were: 37.85% IDU, 33.33% MSM, and 24.31% heterosexual. Mean CD4+ at the diagnosis was 282 cells/mm(3) (for ADMs 232 and for NADMs-VUR 395). Average duration of HIV infection at diagnosis was 5.69 years. There were 159 (55.2%) ADMs and 129 (44.8%) NADMs, among whom 58 (44.96%) NADMs-VR and 71 (55.04%) NADMs-VUR. The most frequent malignancies were: NHL (n = 76; 26.39%), KS (n = 49; 17.01%), ICC (n = 34; 11.81%), HD (n = 23; 7.99%), lung cancer (n = 18; 6.25%) and HCC (n = 14; 4.86%). The amount of NADMs, NADMs-VURs in particular, is increasing at present. Male gender (OR = 1.889; 95% CI: 1.104-3.233; p = 0.024), advanced age: 50-60 years (OR = 3.022; 95% CI: 1.359-6.720; p = 0.01) and ≥ 60 years (OR = 15.111; 95% CI: 3.122-73.151; p < 0.001), longer duration of HIV-infection and successful HAART (OR = 2.769; 95% CI: 1.675-4.577; p = 0) were independent predictors of NADMs overall, respectively. CONCLUSIONS: In a Polish cohort NHL was the most frequent malignancy among ADMs, whereas HD was the most frequent among NADMs. Increased incidence of NADMs appearing in elderly men with longer duration of HIV-infection and with better virological and immunological control was confirmed. As HIV-infected individuals live longer, better screening strategies, especially for NADMs-VUR, are needed. The spectrum of cancer diagnoses in Poland currently does not appear dissimilar to that observed in other European populations.

15.
Folia Med Cracov ; 54(3): 49-55, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25694095

RESUMO

On March 2014 the WHO notified the outbreak of Ebola virus disease (EVD) in Guinea, and infection quickly spread to another West African countries including Sierra Leone, Liberia and Nigeria. Current outbreak is the largest in the history, since discovery of the virus in 1976. Imported cases and infection among healthcare workers in Europe and United States have elucidated necessity of better education of medical staff. Clinicians must be familiar with clinical picture of EVD, differential diagnosis and therapeutic approach, as rapid diagnosis and prompt introduction of supportive therapy can have a significant impact on the survival.


Assuntos
Ebolavirus/patogenicidade , Epidemias/estatística & dados numéricos , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/terapia , África Ocidental/epidemiologia , Controle de Doenças Transmissíveis/métodos , Ebolavirus/isolamento & purificação , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/transmissão , Humanos , Fatores de Risco
16.
Folia Med Cracov ; 54(3): 5-16, 2014.
Artigo em Polonês | MEDLINE | ID: mdl-25694090

RESUMO

Ebola is one of the most virulent zoonotic RNA viruses causing in humans haemorrhagic fever with fatality ratio reaching 90%. During the outbreak of 2014 the number of deaths exceeded 8.000. The "imported" cases reported in Western Europe and USA highlighted the extreme risk of Ebola virus spreading outside the African countries. Thus, haemorrhagic fever outbreak is an international epidemiological problem, also due to the lack of approved prevention and therapeutic strategies. The editorial review article briefly summarizes current knowledge on Ebola virus disease epidemiology, etiology, pathogenesis, clinical presentation, diagnosis as well as possible prevention and treatment.


Assuntos
Surtos de Doenças/prevenção & controle , Ebolavirus/crescimento & desenvolvimento , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/prevenção & controle , África/epidemiologia , Controle de Doenças Transmissíveis/métodos , Países Desenvolvidos/estatística & dados numéricos , Saúde Global , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/virologia , Humanos , Fatores de Risco
17.
Pol Arch Intern Med ; 2024 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-39351971

RESUMO

INTRODUCTION: Mpox is a zoonotic disease caused by the mpox virus (MPXV). Sporadic cases reported before 2022 were almost universally linked to direct contact with animals or travel to endemic regions in Africa. However, in 2022, a significant shift occurred with human-to-human transmission, leading to a global outbreak in 117 countries. In Poland, 217 cases of mpox were reported. OBJECTIVES: The aim of this study was to evaluate the epidemiology, clinical presentations, laboratory findings, and co-infections with sexually transmitted pathogens among patients with mpox. PATIENTS AND METHODS: A retrospective analysis of all mpox cases diagnosed at the University Hospital in Kraków between June 2022 and November 2022 was performed. RESULTS: Forty-five patients aged 19-48 years (median age 34) were diagnosed with mpox. Most of them were male 44 (98%) and 42 (93%) identified themselves as men who have sex with men (MSM). Twenty-two (49%) of the patients had previously been diagnosed with HIV. During mpox diagnosis, new cases of sexually transmitted infections (STIs) were identified. Specifically, 4 patients (9%) were newly diagnosed with HIV, 5 with syphilis, 4 with Chlamydia trachomatis, 3 with Neisseria gonorrhoeae infection, and 2 with Ureaplasma urealyticum infection; among this group, 4 patients (33%) had more than one sexually transmitted co-infection. CONCLUSIONS: The mpox outbreak in Kraków in 2022 primarily affected MSM and was transmitted through sexual contact. Healthcare professionals should be aware of emerging STIs. Educational initiatives should emphasize the importance of vaccinations, safe sexual practices and regular testing.

18.
Pol Arch Intern Med ; 134(5)2024 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-38483266

RESUMO

INTRODUCTION: Acute kidney injury (AKI) is a serious and common complication of SARS­CoV­2 infection. Most risk assessment tools for AKI have been developed in the intensive care unit or in elderly populations. As the COVID­19 pandemic is transitioning into an endemic phase, there is an unmet need for prognostic scores tailored to the population of patients hospitalized for this disease. OBJECTIVES: We aimed to develop a robust predictive model for the occurrence of AKI in hospitalized patients with COVID­19. PATIENTS AND METHODS: Electronic medical records of all adult inpatients admitted between March 2020 and January 2022 were extracted from the database of a large, tertiary care center with a reference status in Lesser Poland. We screened 5806 patients with SARS­CoV­2 infection confirmed with a polymerase chain reaction test. After excluding individuals with lacking data on serum creatinine levels and those with a mild disease course (<7 days of inpatient care), a total of 4630 records were considered. Data were randomly split into training (n = 3462) and test (n = 1168) sets. A random forest model was tuned with feature engineering based on expert advice and metrics evaluated in nested cross­validation to reduce bias. RESULTS: Nested cross­validation yielded an area under the curve ranging between 0.793 and 0.807, and an average performance of 0.798. Model explanation techniques from a global perspective suggested that a need for respiratory support, chronic kidney disease, and procalcitonin concentration were among the most important variables in permutation tests. CONCLUSIONS: The CRACoV­AKI model enables AKI risk stratification among hospitalized patients with COVID­19. Machine learning-based tools may thus offer additional decision­making support for specialist providers.


Assuntos
Injúria Renal Aguda , COVID-19 , Registros Eletrônicos de Saúde , Humanos , COVID-19/complicações , COVID-19/epidemiologia , Injúria Renal Aguda/etiologia , Masculino , Feminino , Pessoa de Meia-Idade , Polônia , Idoso , Adulto , Medição de Risco/métodos , SARS-CoV-2 , Algoritmos , Algoritmo Florestas Aleatórias
19.
Viruses ; 16(10)2024 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-39459930

RESUMO

With the widespread use of integrase inhibitors and the expanding use of long-acting cabotegravir in both pre-exposure prophylaxis and antiretroviral treatment, molecular surveillance on the transmission of integrase resistance has regained clinical significance. This study aimed to determine the frequency of INSTI-transmitted drug resistance mutations (DRMs) among treatment-naïve individuals in Poland from 2016 to 2023. INSTI resistance was analyzed in 882 antiretroviral treatment-naïve individuals using Sanger sequencing. Integrase DRMs were defined based on the Stanford HIV drug resistance database scores. Phylogeny was used to investigate subtyping and clustering. For the analysis of time-trends, logistic regression was used. Major (E138K and R263K) integrase mutations were detected in 0.45% of cases with minor resistance observed in 14.85%, most commonly (13.95%) E157Q. Overall, no major clusters of transmitted drug resistance were identified, and the transmission of E157Q showed a decreasing trend (p < 0.001). While the frequency of sub-subtype A6 increased, it was predominantly found among migrants and associated with L74 mutations. The frequency of major integrase-transmitted DRMs remains low, despite the changes in subtype variability. Surveillance of changing HIV molecular variation patterns is vital from the perspective of the optimal use of integrase inhibitors, especially due to expanding long-acting cabotegravir implementation.


Assuntos
Farmacorresistência Viral , Infecções por HIV , Inibidores de Integrase de HIV , Integrase de HIV , HIV-1 , Mutação , Filogenia , Farmacorresistência Viral/genética , Polônia/epidemiologia , Humanos , Infecções por HIV/virologia , Infecções por HIV/transmissão , Infecções por HIV/epidemiologia , Infecções por HIV/tratamento farmacológico , Integrase de HIV/genética , HIV-1/genética , HIV-1/efeitos dos fármacos , HIV-1/classificação , Feminino , Adulto , Masculino , Inibidores de Integrase de HIV/farmacologia , Pessoa de Meia-Idade , Variação Genética , Genótipo , Adulto Jovem
20.
Vaccines (Basel) ; 11(5)2023 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-37242997

RESUMO

The development of COVID-19 vaccines has been a triumph of biomedical research. However, there are still challenges, including assessment of their immunogenicity in high-risk populations, including PLWH. In the present study, we enrolled 121 PLWH aged >18 years, that were vaccinated against COVID-19 in the Polish National Vaccination Program. Patients filled in questionnaires regarding the side effects of vaccination. Epidemiological, clinical, and laboratory data were collected. The efficacy of COVID-19 vaccines was evaluated with an ELISA that detects IgG antibodies using a recombinant S1 viral protein antigen. The interferon-gamma release assay (IGRA) was applied to quantitate interferon-gamma (IFN-γ) to assess cellular immunity to SARS-CoV-2. In total, 87 patients (71.9%) received mRNA vaccines (BNT162b2-76 (59.5%), mRNA-1273- 11 (9.1%)). A total of 34 patients (28.09%) were vaccinated with vector-based vaccines (ChAdOx Vaxzevria- 20 (16.52%), Ad26.COV2.S- 14 (11.6%)). A total of 95 (78.5%) of all vaccinated patients developed a protective level of IgG antibodies. Only eight PLWH (6.6%) did not develop cellular immune response. There were six patients (4.95%) that did not develop a cellular and humoral response. Analysis of variance proved that the best humoral and cellular response related to the administration of the mRNA-1273 vaccine. COVID-19 vaccines were found to be immunogenic and safe in PLWH. Vaccination with mRNA vaccines were related to better humoral and cellular responses.

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