Acquired immune deficiency syndrome (AIDS) and late presentation in Poland - data from Test and Keep in Care (TAK) Polska project.

OBJECTIVES: Late presentation (LP) at HIV diagnosis is associated with worse prognosis and an increase in the number of new infections. We analyse the proportion of patients diagnosed late and factors related to LP in Poland in 2016-2017. METHODS: Data were obtained from 13 out of 17 HIV centres in Poland from 2016 and 2017, including date of diagnosis, age, sex, transmission route, anti-hepatitis C virus (anti-HCV), Venereal Diseases Research Laboratory (VDRL) antibodies, AIDS diagnosis, baseline HIV viral load and CD4 count. RESULTS: Out of 1522 patients, 88.9% were male with median age of 33.6 years. Men who have sex with men (MSM) comprised 69.4% of all new infections, heterosexual route of transmission (HTX) 18.2% and injecting drug use (IDU) 4.7%. Late presenters comprised 44.8% of the study group. Factors associated with LP were female sex [odds ratio (OR) = 1.5, 95% confidence interval (95% CI): 1.09-2.08], older age (OR = 1.59, 95% CI: 1.42-1.79 per decade), route of transmission (HTX: OR = 1.96, 95% CI: 1.50-2.56; IDU: OR = 3.17, 95% CI: 1.92-5.37), positive HCV results (OR = 1.90, 95% CI: 1.23-2.95) and syphilis diagnosis (OR = 2.06, 95% CI: 2.29-3.31). Adjusting for these factors, the only independent factors associated with LP were age (OR = 1.52, 95% CI: 1.35-1.71) and route of transmission (HTX: OR = 1.73, 95% CI: 1.23-2.44; IDU: OR = 2.24, 95% CI: 1.25-4.10). CONCLUSIONS: Late presentation in Poland follows European trends. A total of 44.8% of all newly diagnosed patients in Poland continue to present late or at the AIDS stage. Independent factors associated with LP/AIDS were older age, IDU and HTX. Patients from these groups should be targeted to improve early diagnosis and medical care.

Long-term trends in HIV care entry: over 15 years of clinical experience from Poland.

INTRODUCTION: Delay in HIV diagnosis and consequently late care entry with low CD4 counts remain a major challenge for the control of the HIV/AIDS epidemic. The aim of this study was to analyse the evolution of characteristics of the HIV epidemic in Poland. METHODS: Cross-sectional data were collected for 3972 HIV-infected patients followed up in 14 of 17 Polish HIV treatment centres in the years 2000-2015. Clinical data were analysed and factors associated with late presentation (baseline CD4 count < 350 cells/µL or history of AIDS-defining illness) and advanced HIV disease (baseline CD4 count < 200 cells/µL or history of AIDS) were identified. RESULTS: The majority (57.6%) of patients entered care late, while 35.6% presented with advanced HIV disease. The odds of being linked to care late or with advanced HIV disease increased consistently across age categories, increasing from 2.55 [95% confidence interval (CI) 1.46-4.47] for late presentation and 3.13 (95% CI 1.49-6.58) for advanced disease for the 21-30-year-old category to 5.2 (95% CI 1.94-14.04) and 8.15 (95% CI 2.88-23.01), respectively, for individuals > 60 years of age. Increased risks of late entry and advanced HIV disease were also observed for injecting drug users [adjusted odds ratio (aOR) 1.74 (95% CI 1.16-2.60) and 1.55 (95% CI 1.05-2.30), respectively], with lower aOR associated with the men who have sex with men transmission route [aOR 0.3 (95% CI 0.31-0.59) and 0.39 (95% CI 0.29-0.53), respectively]. The frequencies of cases in which patients were linked to care late and with advanced HIV disease decreased over time from 67.6% (2000) to 53.5% (2015) (P < 0.0001) and from 43.5% (2000) to 28.4% (2015) (P = 0.001), respectively. CONCLUSIONS: Despite improvements over time, most patients diagnosed with HIV infection entered care late, with a third presenting with advanced HIV disease. Late care entry remains common among people who inject drugs and heterosexual groups.

Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe.

OBJECTIVES: The aim of the study was to investigate the organization and delivery of HIV and tuberculosis (TB) health care and to analyse potential differences between treatment centres in Eastern (EE) and Western Europe (WE). METHODS: Thirty-eight European HIV and TB treatment centres participating in the TB:HIV study within EuroCoord completed a survey on health care management for coinfected patients in 2013 (EE: 17 respondents; WE:21; 76% of all TB:HIV centres). Descriptive statistics were obtained for regional comparisons. The reported data on health care strategies were compared with actual clinical practice at patient level via data derived from the TB:HIV study. RESULTS: Respondent centres in EE comprised: Belarus (n = 3), Estonia (1), Georgia (1), Latvia (1), Lithuania (1), Poland (4), Romania (1), the Russian Federation (4) and Ukraine (1); those in WE comprised: Belgium (1), Denmark (1), France (1), Italy (7), Spain (2), Switzerland (1) and UK (8). Compared with WE, treatment of HIV and TB in EE are less often located at the same site (47% in EE versus 100% in WE; P < 0.001) and less often provided by the same doctors (41% versus 90%, respectively; P = 0.002), whereas regular screening of HIV-infected patients for TB (80% versus 40%, respectively; P = 0.037) and directly observed treatment (88% versus 20%, respectively; P < 0.001) were more common in EE. The reported availability of rifabutin and second- and third-line anti-TB drugs was lower, and opioid substitution therapy (OST) was available at fewer centres in EE compared with WE (53% versus 100%, respectively; P < 0.001). CONCLUSIONS: Major differences exist between EE and WE in relation to the organization and delivery of health care for HIV/TB-coinfected patients and the availability of anti-TB drugs and OST. Significant discrepancies between reported and actual clinical practices were found in EE.

The root-vole Microtus oeconomus (Pallas, 1776): a new potential reservoir of Anaplasma phagocytophilum.

Anaplasma phagocytophilum infection is a recently emerged tick-borne zoonosis. The bacterium's reservoirs likely comprise cervids, some ruminants, rodents, and perhaps other small and intermediate-size mammals; the main vector in Europe is the Ixodes ricinus tick. The Bialowieza Primeval Forest is an ecosystem with a known prevalence of tick-borne pathogens. We studied the root-vole Microtus oeconomus to evaluate the natural infection of A. phagocytophilum. Intragranulocytic bacterial clusters (morulae) were not seen, but the A. phagocytophilum-specific nested polymerase chain reaction (PCR) product, targeting the rrs gene, was detected in two out of 30 rodent samples (GenBank accession nos. DQ361024 and DQ361025). Twenty-six root vole (86.6%) hosted ticks, mainly Dermacentor reticulatus larvae and nymphs. Only two rodents were parasitazed by I. ricinus single larvae. These data show the presence of natural infection of A. phagocytophilum among the root-vole M. oeconomus in the Bialowieza Primeval Forest ecosystem.

Auditing HIV Testing Rates across Europe: Results from the HIDES 2 Study.

European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32-97), lowest in Northern Europe (median 44%, IQR 22-68%) and highest in Eastern Europe (median 99%, IQR 86-100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0-4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested.

Medical procedures and the risk of iatrogenic hepatitis C infection: case-controlled study in north-eastern Poland.

Many hepatitis C virus (HCV)-infected individuals do not have any obvious risk factors and one of the putative sources of infection may be inadvertent exposure to infected blood or body fluids in the clinical setting. The aim of this study was to assess the role of medical procedures in transmission of hepatitis C in north-eastern Poland. In total, 194 patients with chronic hepatitis C were eligible for the study. The control group consisted of 275 age- and sex-matched individuals. Patients with a history of intravenous drug use were excluded. On multivariate analysis, transfusions [odds ratio (OR) = 3.7, 95% confidence interval (CI) 2.2-6.3], minor surgery (OR = 3.2, 95% CI 1.5-6.7) and dental care (OR = 2.3, 95% CI = 1.4-4.0) were independently associated with HCV infection. We conclude that apart from transfusion, minor medical procedures and dental care may carry a significant risk of hepatitis C infection. Improvements in basic hygiene routines and strict adherence to universal precautions may be essential to prevent iatrogenic transmission of the infection.

[Diversity in the clinical course of toxoplasma encephalitis in two patients infected with human immunodeficiency virus (HIV)]. / Róznorodnosc przebiegu klinicznego zapalenia mózgu wywolanego Toxoplasma gondii u dwóch chorych zakazonych ludzkim wirusem uposledzenia odpornosci(HIV).

The central nervous system (CNS) is the most common site of Toxoplasma gondii infection in HIV-positive patients, mainly due to reactivation of Toxoplasma cysts. The diagnosis is difficult since no sensitive and specific non-invasive diagnostic tests exist. The patient may present with rather unspecific signs and symptoms. We present atypical course of CNS-toxoplasmosis in two HIV-positive persons.

[Passive and active immunoprophylaxis of hepatitis A. New vaccines]. / Czynne i bierne uodparnianie przeciwko wirusowemu zapaleniu watroby typu A. Nowe szczepionki.

The actually available methods of active and passive immunoprophylaxis of hepatitis A are presented against the background of hepatitis A epidemiology in Poland. The indications, dosage, immunogenicity, immunization schedules and effectiveness of inactivated vaccines are described.

[Cryptosporidium parvum: an emerging threat to the man]. / Cryptosporidium parvum--wspólczesne zagrozenie czlowieka.

The current opinions on the biology, epidemiology and potential role of Cryptosporidium parvum as an emerging, highly infectious threat are presented. Available Polish data concerning the frequency of cryptosporidiosis were gathered and the diagnostic procedures, pathogenesis and treatment of cryptosporidiosis are described.

[Chronic hepatitis C and risk for hepatitis A infection]. / Przewlekle zapalenie watroby typu C A ryzyko zakazenia wirusem zapalenia watroby typu A.

The aim of this study was to determine the prevalence of anti-HAV antibodies and factors associated with HAV infection amongst patients with chronic hepatitis C. The prevalence of anti-HAV antibodies in hepatitis C patients was 69.2% and did not differ significantly from 63.3% observed in the group of healthy controls. In patients with chronic hepatitis C the occurrence of HAV antibodies was not associated with the duration of HCV infection, history of transfusions and surgeries. There was a tendency towards higher prevalence of anti-HAV in persons with history of numerous hospitalizations (60.8% of persons with the history of up to 5 hospitalizations were positive for anti-HAV and more than 84.6% of those with more than 5 hospitalizations). Only 38.5% of patients under 35 years had anti-HAV antibodies. In conclusion immunization against hepatitis A should be recommended for hepatitis C patients under 35 years of age, most of whom are not immune to HAV. Testing for anti-HAV prior to vaccination should be performed in individuals older than 35 because natural immunity is common.

[Endemic threat of Lyme borreliosis in Bialowicza forestry area]. / Zagrozenie endemiczne borelioza z Lyme w regionie Puszczy Bialowieskiej.

Lyme Borreliosis is a serious diagnostical and therapeutical problem in regions with high exposure of residents to ticks, which are Borrelia burgdorferi vectors. The aim of this study was to estimate occurrence of specyfic antibodies and symptoms of Lyme Borreliosis in Bialowieza area, as a region of potential endemic presence of this disease. Antibodies against B. burgdorferi were found, with an immunoenzymatic assay, in 71 from among 143 of examined persons (49.7%). Diagnosis of Lyme Borreliosis was established in 54 persons (37.7% of examined population) according to criterions of Lyme Disease Foundation and Centers for Diseases Control. Symptoms of joints involvement (polyarticular or restricted to knee joints) and peripheral nervous system involvement (predominantly radiculalgia lumbosacralis) were most frequently observed in clinical picture. These results motivate to recognize Bialowieza region as an endemic area of Borrelia burgdorferi infections.

[Risk of development of hepatitis B virus infection among alcoholics]. / Zagrozenia populacji osób naduzywajacych alkoholu zakazeniem wirusem hepatitis B (HBV).

The frequency of incidence of positive serological markers of hepatitis B virus infection among a population of alcoholics in the region of Bialystok has been analysed. It was demonstrated that the highest frequency of detection of hepatitis B virus infection appears in a group of patients with post-alcoholic liver cirrhosis (60 percent). Acute virus hepatitis of the B type in alcoholics is characterised by a tendency towards retarded seroconversion of HBe antigen to HBe antibody with a subsequent development of chronic infection and liver cirrhosis.

[Epidemiology of intra-marital infections with hepatitis B virus (HBV) among the patients hospitalized in the infectious disease clinics in the Bialystok region 1988-1990]. / Epidemiologia zakazen wewnatrzmalzenskich wirusem hepatitis B (HBV) w populacji chorych hospitalizowanych w oddzialach obserwacyjno-zakaznych Bialostocczyzny w latach 1988-1990.

Viral hepatitis B infection is worldwide epidemiological and clinical problem with same prophylactic difficulties concerned first of all married patients. The infection routes could be parenteral or homo/heterosexual contact. During 1988-1990 from hospitalized viral hepatitis B all patients (394), married patients was found 9% (34) persons with epidemiological documented viral hepatitis B infection, from his/her sexual married partner.

[Chronic viral hepatitis C in patient with Hand-Schüller-Christian disease]. / Przewlekle wirusowe zapalenie watroby typu C u pacjenta z choroba Handa-Schüllera-Christiana.

Chronic hepatitis C often occurs among patients with different diseases and may influence their natural history. From the other hand coexisting diseases may modify the hepatitis C infection. We present a case of a male patient with the histiocytosis X, earlier called Hand-Schüller-Christian disease with hepatitis C virus infection. The mild course of the chronic hepatitis C, not requiring anti-viral therapy, may be the result of immunomodulation relevant to Hand-Schüller-Christian disease.

[Vaccination against influenza and Guillain-Barre syndrome: are there any relations?]. / Szczepienia przeciwko grypie a zespól Guillain-Barré--wzajemne zaleznosci?

Influenza, a disease known for centuries, continues to be a major medical problem throughout the world with substantial economical and health impact. The risk of death related to influenza is higher among individuals over 65 years of age and those with chronic diseases. Vaccination against influenza was successfully applied in massive prophylaxis of the disease in different countries for many years. Although there are some well known and monitored adverse reactions to influenza vaccines, the evidence whether influenza vaccination might be causally associated with higher risk of Guillain-Barré syndrome is not clear. In this paper the available literature data concerning this problem were reviewed. Own experiences on influenza vaccination and plasmapheresis treatment of Guillain-Barré syndrome were presented.

[Echinococcus granulosus cysts in the liver. Ultrasonography findings during medical treatment]. / Torbiele watroby wywolane przez Echinococcus granulosus. Zmiany w obrazie ultrasonograficznym w czasie leczenia.

Since the sensitivity and specificity of serologic tests for echinococcosis is low, the role of imaging techniques is increasing. The goal of this study was to determine the usefulness of ultrasonography in diagnostics and classification of liver hydatid cysts and in the follow up after antiparasitic treatment. The study group of 35 persons, 26 women (mean age 42 years) and 9 men (mean age 39 years) was selected. The echography diagnosis was made using Toschiba scanner (SSH 140 A) with 3.75 and 7.5 MHz transducers. All 35 patients had positive results of serological tests for echinococcosis (EIA and/or indirect hemagglutination). The liver hydatid cysts (h.c.) are classified into seven types according to Caremani et all: I--simple h.c., II--multiple h.c., III--h.c. with detachment of the wall, IV--h.c. with mixed pattern with or without septations, V--heterogenous h.c., VI--hyperechoic h.c., VII--calcified h.c. The antiparasitic chemiotherapy with albendazole (10 mg/kg) was applied to 23 patients with total number of 59 h.c. of types I, II, III, IV, V. The observation points that cysts types I, II, III, IV, V respond to antiparasitic treatment. Our findings show that the sonographic patterns of cyst degeneration are seen with greater frequency in treated cysts than in nontreated ones.

[Efficacy of low-dose albendazole therapy in hydatic liver disease: a case report]. / Skutecznosc terapeutyczna malych dawek albendazolu w bablowicy watroby--opis przypadku.

Hydatid liver disease is the most common form of human echinococcosis in Poland. Epidemiological data show a rising number of cases recognised last years. It is probably because of easier availability of ultrasound examination and computed tomography in the diagnostic procedures. While surgery remains the only approach for a radical cure, the chemotherapy with albendazole has became a useful advance in the management of cystic echinococcosis for the problem patient (inoperable disease, widely disseminated cysts, high surgical risk, etc.). The authors describe a patient with hydatid liver disease successfully treated with albendazole as a alternative treatment to surgery. A cyclic treatment of 28 days with 2 week break in between for 9 months with low doses of albendazole (6 mg/kg) resulted in clinical improvement and involution of hepatic cysts.

[Immunity against tick-borne encephalitis in healthy residents of endemic areas]. / Odpornosc na kleszczowe zapalenie mózgu u osób zdrowych zamieskalych na terenach endemicznych.

Specific IgG antibodies against Tick-Borne Encephalitis Virus (anti-TBEV) at levels exceeding 60 VIEU/ml were detected in almost 14% of forestry workers and in 1.5% of other healthy persons, residents of the endemic area. Mean levels of anti-TBEV were similar in comparable subgroups of men and women, or subgroups of urban and rural residents, however, increased levels of these antibodies were found in elderly persons.

[Toxoplasmosis of the brain as an example of the opportunistic invasion of the women HIV positive]. / Toksoplazmoza mózgu jako przyklad inwazji oporutunistycznej u kobiety zyjacej z HIV.

Most toxoplasmosis infections occur in the brain. Cerebral toxoplasmosis is a specially serious complication in patients with AIDS. Similarly to other opportunistic pathogens, Toxoplasma gondii causes rapidly progressive, and often fatal disease in immunosuppressed patients. The diagnosis is difficult, since no sensitive and specific non-invasive diagnostic tests exist. The subject of our study is a 27-old female initially diagnosed with metastasis in central nervous system.

[Echinococcus granulosus and Echinococcus multilocularis invasions in north-eastern Poland]. / Inwazje echinococcus granulosus i Echinococcus multilocularis w pólnocno-wschodniej Polsce.

During the last 10 years 70 cases of echinococcosis were diagnosed in the Department of Infectious Diseases, Medical University School of Bialystok, of whom 63 were Echinococcus (E.) granulosus infections. The Urban population (70%) and women (60%) dominated among infected persons. Seven cases were due to E. multilocularis infection. A family and endemie focus of E. multilocularis human invasion has been identified.