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.

[Opportunistic infections in HIV-positive patients hospitalized in the Clinic of Infectious Diseases AMG]. / Infekcje oportunistyczne wystepujace u pacjentów zakazonych HIV hospitalizowanych w Klinice Chorób Zakaznych AMG.

UNLABELLED: Opportunistic infections are one of the major problem among HIV infected patients still connected with high mortality. The aim of the investigation is to evaluate the incidence and mortality from opportunistic infections in HIV infected population in Pomeranian region of Poland. The paper presents analysis of incidence of opportunistic infections among 141 AIDS patients hospitalised in Clinic for Infectious Diseases in Gdansk from 1988 to 2001/June/. In examined group 179 opportunistic infections were diagnosed. Most frequent was oesophageal candidiasis 58%, tuberculosis 29%, pneumocystis carinii pneumonia 21% and central nervous system toxoplasmosis 13%. The occurrence of opportunistic infections depends on CD4 count and rises with CD4 decline. Opportunistic infections were the reason of death in 33 from 74 cases/45%/. CONCLUSIONS: In examined group 28% of patients did not know about HIV infection when first opportunistic infection was diagnosed. Most frequent opportunistic infections in AIDS patients were oesophageal candidiasis, tuberculosis, pneumocystis carinii pneumonia and toxoplasmosis. In 98% of cases opportunistic infection developed when no HAART nor infection prophylaxis was administered. Opportunistic infection was the reason of death in 45% of cases, the most frequent were PCP and CNS toxoplasmosis.

[Sepsis in HIV-positive patients--own observation]. / Posocznice u HIV--dodatnich pacjentów w materiale wlasnym.

In the period of 1988-2001 (June) 24 HIV-positive patients with symptoms of sepsis were observed. Most of them (17 persons) were intravenous drug addicts, six patients were infected HIV trough sexual contact and one person-via blood transfusion. There were 26 cases analyzed (one of the patients went trough three episodes of sepsis). Bacterial sepsis dominated (22 cases). In three patients fungoid etiology was diagnosed, and one case was of mixed character. The highest risk factors of sepsis were: intravenous drug addiction and advanced stage of HIV infection.

[Psychoorganic and depressive syndrome in severe hepatic diseases]. / Zespól psychoorganiczny i depresyjny w ciezkich uszkodzeniach watroby.

Authors present the occurrence of the psychopathologic disorders in the group of 33 patients (23 women and 10 men) with severe hepatic disorders (mostly cirrhotic non-alcoholic). Patients in the 20-69 age range were treated in the Medical Academy in Gdansk in the years 1989-1993. 15 patients were examined twice at intervals from 6 months to 3 years. Using the Hamilton Depression Scale and psychiatric examination, the authors found depression in 5 cases. These patients were treated with thymoleptic. On the basis of the Organic Brain Damage Rating Scale (by Jarema M. and others) and psychiatric examination, the psychoorganic syndrome was confirmed in 4 cases. Correlation between the psychopathologic disorders and changes in some biochemical indicators was not found.

[HIV infections and their prophylaxis in the homosexual community of the Gdansk province]. / Zakazenia HIV i ich profilaktyka w spolecznosci homoseksualnej województwa gdanskiego.

From 1985 to the end of 1993, 15,000 investigations were performed in total, for HIV infection in the Province of Gdansk. Positive results of the tests were found in 316 persons, over 60% of whom being intravenous drug-addicts. In the group of persons reporting the possibility of infection through sexual contacts, the infection was found only in 15 out of 1755 studied subjects. Among homosexuals the infection was found in four out of 167 persons who underwent the investigation. In the whole group of 316 infected subjects this accounted for 1.2%. The above mentioned numbers are certainly too low. The causes of this should be seen in generally low attendance rate to the tests connected with low social awareness. However, in persons with different sexual orientation this is caused also by the fear of manifestation of their pecularity. In the activities for the control of HIV epidemic spreading in Poland indispensable is multi-sided educational initiative including the whole population, in which great help may be provided by homosexuals themselves. An evidence of this may be the results as yet of the cooperation between representatives of health care and homosexuals, discussed in the present paper.