Healthcare delivery for HIV-positive people with tuberculosis in Europe.

BACKGROUND: In a 2013 survey, we reported distinct discrepancies in delivery of tuberculosis (TB) and HIV services in eastern Europe (EE) vs. western Europe (WE). OBJECTIVES: To verify the differences in TB and HIV services in EE vs. WE. METHODS: Twenty-three sites completed a survey in 2018 (EE, 14; WE, nine; 88% response rate). Results were compared across as well as within the two regions. When possible, results were compared with the 2013 survey. RESULTS: Delivery of healthcare was significantly less integrated in EE: provision of TB and HIV services at one site (36% in EE vs. 89% in WE; P = 0.034), and continued TB follow-up in one location (42% vs. 100%; P = 0.007). Although access to TB diagnostics, standard TB and HIV drugs was generally good, fewer sites in EE reported unlimited access to rifabutin/multi-drug-resistant TB (MDR-TB) drugs, HIV integrase inhibitors and opioid substitution therapy (OST). Compared with 2013, routine usage of GeneXpert was more common in EE in 2018 (54% vs. 92%; P = 0.073), as was access to moxifloxacin (46% vs. 91%; P = 0.033), linezolid (31% vs. 64%; P = 0.217), and bedaquiline (0% vs. 25%; P = 0.217). Integration of TB and HIV services (46% vs. 39%; P = 1.000) and provision of OST to patients with opioid dependency (54% vs. 46%; P = 0.695) remained unchanged. CONCLUSION: Delivery of TB and HIV healthcare, including integration of TB and HIV care and access to MDR-TB drugs, still differs between WE and EE, as well as between individual EE sites.

Nonlinear anomalous Hall effect and negative magnetoresistance in a system with random Rashba field.

We predict two spin-dependent transport phenomena in two-dimensional electron systems, which are induced by a spatially fluctuating Rashba spin-orbit interaction. When the electron gas is magnetized, the random Rashba interaction leads to the anomalous Hall effect. An example of such a system is a narrow-gap magnetic semiconductor-based symmetric quantum well. We show that the anomalous Hall conductivity reveals a strongly nonlinear dependence on the magnetization, decreasing exponentially at large spin density. We also show that electron scattering from a fluctuating Rashba field in a two-dimensional nonmagnetic electron system leads to a negative magnetoresistance arising solely due to spin-dependent effects.

Antagonistic expression of hepatitis C virus and alpha interferon in lymphoid cells during persistent occult infection.

Detection of residual HCV in individuals with SVR after treatment of CHC can be significantly heightened by analyzing ex vivo mitogen-activated T and B lymphocytes and applying sensitive nucleic acid amplification assays. However, it remained unknown if synergistic activation of lymphocytes and monocytes would further augment HCV detection, if viral replication becomes universally upregulated in treated cells, and if examining sequential sera and lymphoid cells would improve detection of occult infection. Using paired sera and lymphoid cells collected 1 year apart from 17 individuals with normal liver enzymes for up to 72 months after SVR, it was found that simultaneous activation of lymphocytes and monocytes enhanced identification of silent HCV infection and revealed that in some cases monocytes were the principal immune cell type where HCV persisted. Testing of serial samples further increased detection of occult infection. Ultimately, by combining the above two approaches, all individuals with SVR were found to be silent carriers of HCV. Clonal sequencing revealed HCV variations in sera and lymphoid cells and evolution of viral genomes confirming ongoing virus replication. Surprisingly, similar to those with CHC, naive lymphoid cells from some individuals carried approximately 10(3) HCV copies/microg total RNA. HCV loads in naive lymphoid cells predetermined the outcome of ex vivo stimulation with respect to upregulation or inhibition of HCV replication. HCV RNA levels in occult infection were inversely proportional to the expression of IFNalpha and IFN-inducible MxA, but not to IFNgamma or tumour necrosis factor alpha in naive and mitogen-treated lymphoid cells.

[Epidemiology of HBV infections and possibilities for therapeutic actions in children and adolescents with end-stage renal failure treated with dialysis]. / Epidemiologia zakazen HBV i mozliwosci dzialan terapeutycznych u dzieci i mlodziezy ze schylkowa niewydolnoscia nerek leczonych nerkozastepczo.

Wide spreading of prophylaxis principles of HBV infections in dialysis centers decreased the HBV infection rate in general population of dialyzed patients in Poland last years. There is neither data concerned with HBV infection epidemiology in children and adolescents, nor data about anti-viral treatment possibilities and effects in this group of dialyzed patients. The aim of the study was evaluating of HBV infection rate in patients of pediatric dialysis centers and analysis of causes of infection and efficacy of treatment. Study was based on data sent in a query-answer by 8 biggest pediatric dialysis centers, all of them treating 210 patients. HBV infection was found much more often (16.6%) than in population of all hemodialyzed patients in Poland. More than 75% non-vaccinated patients was infected before dialysis therapy, remaining were infected during vaccination, before the protecting level of antibodies was gained. Big differences in HBV infection rate among centers are observed. Nowadays HCV infections (more than 40% patients infected) are a bigger issue. Only 10 patients in 5 centers had anti-viral treatment (5 with isolated HBV infection, 5 with mixed HBV/HCV infection). In 9 patients interferon-alpha and in 1 patient lamivudine was administered. Efficacy of interferon-alpha treatment was similar to the population of non-uremic children (33.3% vs. 50% of HBeAg elimination). Majority of patients quite well tolerated the drug. Only in 1 case interferon-alpha treatment had to be ceased because of side effects. In a boy treated with lamivudine, after 3 months elimination of viremia and decrease of ALAT activity was observed. HBV infection in patients of pediatric dialysis centers is still a serious matter. More strict applying of vaccination against hepatitis B before dialysis treatment is needed. The possibility of HBV infections therapy is limited, mostly for economical reasons.

[Epidemiology and clinical course of HCV infection in children and adolescents with chronic renal failure]. / Epidemiologia i ewolucja kliniczna zakazenia HCV u dzieci i mlodziezy z przewlekla niewydolnoscia nerek.

The aim of the study was to evaluate epidemiology and clinical course of HCV infection in children and adolescents with end-stage renal disease. The study involved 70 patients, aged 1-25 years, 31 M, 39 F: group of 40 dialysed (27 HD, 13 CAPD) and 30 patients suffering from different chronic renal disease as a control group. Anti-HCV antibodies were assayed by EIA 3rd gene (Abbott Diagnostic) and were sought by LIATEK HCV 3rd gene. HCv RNA was detected and measured by a standardised HCV RNA PCR assay (Amplicor Roche). HCV genotypes were identified by InnoLIPA (Innogenetics). HCV infection was diagnosed in 20 (50%) dialysed and in 3 (10%) non-dialysed patients. None of the HCV infected patients presented the clinical symptoms of hepatitis; the mild activity of ALT was observed in 8 cases only. HCV viremia was relatively low: 365 x 103 copies/mL in PD and 110,9 x 103 copies/mL in HD patients. 3 genotypes of HCV were identified: 1a, 1b and 4c/4d. In 3 cases liver biopsy was performed, no cirrhosis was diagnosed.

[Prevalence of anti-HAV antibodies in selected groups of children]. / Czestosc wystepowania przeciwcial anty-HAV w wybranych grupach dzieci.

Hepatitis A is a significant endemic and epidemic disease of global importance. There are few studies on the epidemiology of hepatitis A in Poland. The aim of this study was to investigate the prevalence of the antibodies to HAV (anti-HAV IgG) in children and adolescents living in urban and rural areas. Sera from 377 children were collected: 195 lived in Warsaw and 182 in rural area (voyevodship opolskie). The prevalence of anti-HAV was very low--9.3% and 3.8% respectively. This finding suggest that epidemiological shift from intermediate to low endemicity is possible in Poland and a new policy of prophylaxis hepatitis A may be necessary.

[Therapeutic efficacy of low-dose alpha interferon therapy in liver cirrhosis associated with HBV]. / Skutecznosc terapeutyczna niskich dawek interferonu alfa w wyrównanej marskosci watroby zwiazanej z zakazeniem HBV.

The aim of this study was the assessment the efficacy and safety of therapy with interferon alpha (Intron A) administered s.c. 3 MU x 3/week for 12 weeks for patients with HBV related liver cirrhosis (Child's class A). Fifteen patients completed therapy and 12 months follow-up. At the end of follow-up sustained response to the therapy, defined by clearance of HBV-DNA, normalization of ALAT activity in serum and improvement in the liver histology was achieved in 46.6% of treated patients. Moreover, among few patients from group of nonresponders (patients without sustained clearance of HBV-DNA) decrease of HBV-DNA level, ALAT activity in serum and improvement in the liver histology were observed. Adverse effects of IFN alpha therapy were typical, but in any case were no necessity terminate the therapy.

Long-term assessment of interferon responses in the HIV+ and AIDS patients.

Impairment of interferon (IFN) system in human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) became a basis for searching IFN responses to monitor the disease progression. For detailed investigations 16 HIV+/AIDS patients with at least 4 successively taken blood samples available for IFN determinations were selected. IFN responses were tested in two ways. Firstly, IFN level in plasma was measured. Secondly, capacity of IFN production by leukocytes was evaluated. The latter was determined in the whole blood assay, in which Newcastle disease virus (NDV) and phytohemagglutinin (PHA) were used as IFN-alpha and IFN-gamma inducers, respectively. The levels of IFN induced in whole blood leukocytes varied considerably in all individuals that had been tested. Nevertheless, two patterns of IFN responses were observed. In pattern I, patients had low levels of IFN in plasma and high levels of induced IFN-alpha and IFN-gamma. It was characteristic for 8 patients in good clinical condition. On the contrary, severe disease found in 2 patients was correlated with high levels of IFN in plasma and low levels of induced IFNs (pattern II). In 6 patients IFN responses were classified as intermediate pattern I/II suggesting transition from pattern I to pattern II. A variation of pattern I was found in the case of a patient defined as long-term survivor having relatively low levels of all IFN tested. The results suggested that interferon measurements reflected clinical condition of HIV+ patients showing not only past but also current immune changes.

[Ehrlichiosis: a new infectious disease]. / Erlichioza--nowa choroba zakazna.

Human ehrlichiosis is transmitted by ticks. For the first time it was described in 1987. The ethiologic agent is Ehrlichia chaffeenisis. The course of the disease may be mild, self-limited or sometimes severe finishing with dead. The main symptoms are: fever, leucopenia, thrombocytopenia, or pancytopenia. Tetracyclines are mostly efficient in the treatment.

Interferon and tumor necrosis factor responses of HIV+ patients as markers for monitoring of the AIDS progression.

The blood samples taken from 31 HIV+ and AIDS patients were used to study interferon (IFN) and tumor necrosis factor (TNF) responses. The IFN and TNF levels in plasma were determined. In the whole blood assay (whole blood diluted 1:10 with culture medium) Newcastle disease virus (NDV) and phytohemagglutinin (PHA) were used as cytokine inducers. Blood leukocytes of HIV+ patients produced significantly less IFN-alpha after NDV stimulation than the cells of healthy (HIV-) individuals. On the other hand, the production of IFN-gamma in response to PHA was impaired only in AIDS patients with stage CDC IV and CD4+ cell number < 200/microliters. These patients had also increased IFN levels in plasma. Particularly, the high level of IFN in plasma was frequently detected in patients with progressing AIDS with CD4+ cell number < 50/microliters. This type of IFN was identified as a mixture of acid-labile and acid-stable IFN-alpha. The IFN responses of HIV+ patients may be considered as markers for monitoring progression of AIDS and therapy.

[Comparative evaluation of active and passive-active immunization of newborn infants born to mothers with HBV infection]. / Porównawcza ocena skutecznosci uodpornienia czynnego i bierno-czynnego noworodków urodzonych przez matki zakazone HBV.

The results of the observation of humoral response in newborns from HBsAg-positive mothers after passive-active or active anti-HBV immunization was presented. Efficacy and safety of this prophylaxis was evaluated. We found similar percentage of anti-HBs response in the all groups of vaccinated children (about 85%).