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.

Serum level of soluble intercellular adhesion molecule-1 in patients with acute viral hepatitis A or acute viral hepatitis B: lack of correlation with severity of the disease.

Serum soluble ICAM-1 (sICAM-1) was found to be increased in patients with chronic hepatitis. The aim of the study was the evaluation of sICAM-1 dynamics in patients with acute hepatitis A or hepatitis B. Serum level of sICAM-1 was determined in 13 patients with acute hepatic A, 19 patients with acute hepatitis B, and 20 healthy controls. Measurements were done four times, at the beginning of jaundice, in the 14th day of jaundice, at release from the hospital, and when biochemical indices of the liver function became normal. An increase in sICAM-1 was shown in the patients. There was no difference between patients with hepatitis A and those with hepatitis B. The sICAM-1 decreased in the course of recovery but the values in the last measurements were still higher than in the controls. There was no correlation of sICAM-1 and duration of hospitalization. The obtained results do not suggest sICAM-1 as diagnostic or prognostic marker in patients with acute hepatitis A or B.

[Tetanus in the Katowice district in the years 1976-1988]. / Tezec w województwie katowickim w latach 1976-1988.

Analysis of 89 tetanus cases that appeared in Katowice district in years 1976-1988 in comparison with country data has been made. Morbidity rate was lower than country and frequency in younger age groups was lower too. About a half of dead ill persons suffered of injuries that was unusual for tetanus infections circumstances, and about a quarter of dead persons suffered only of slight and superficial trauma. Attention has been paid to frequent mistakes in specific prevention with injured persons.