[Overweight, obesity and underweight in HIV infected patients]. / Wystepowanie nadwagi, otylosci i niedoboru masy ciala u pacjentów zakazonych HIV.

INTRODUCTION: The history of HIV infection has always been associated with patient nutritional problems, initially in the form of wasting syndrome, and since the introduction of highly active antiretroviral therapy such metabolic disorders as lipodystrophy, obesity, insulin resistance, dyslipidemia that are risk factors for cardiovascular diseases have been observed. AIM: evaluation of nutritional disorders in HIV infected patients using anthropometric parameters: waist circumference, BMI (body mass index) and WHR (waist-hip ratio). MATERIAL AND METHODS: the study included 72 HIV infected patients (48 men, 24 women, average age 39.4). The control group comprised 27 not infected subjects, matched for age and sex. Physical examination with measurements of body mass, height, waist and hip circumference was performed and the values of two anthropometric parameters--body mass index and waist/hip ratio were calculated. RESULTS: BMI in the group of HIV infected patients was significantly lower than in the control group (23.6 vs. 25.6 kg/m2, p = 0.01). These BMI values are normal, but significantly lower in HIV-infected men compared with not infected, and no differences were found between women. Infected men are less likely to be overweight and obese than not infected ones. Underweight was noted in 6.8% of patients from the study group (6% of men and 4% of women). WHR was significantly higher in the study group comparing with the healthy subjects (0.92 vs. 0.86 p = 0.002), which resulted from significantly lower hip circumference among the infected patients (93.0 vs. 98.3, p = 0.002). Waist circumference was similar in both groups (85.1 vs. 84.0). The WHR value in the infected women was a result of insignificantly higher waist circumference and lower hip circumference. HIV infected women have significantly more often too large waist circumference comparing with not infected ones (46% vs 0%, p = 0.01). In the group of infected men, the WHR value was significantly affected only by low hip circumference, and larger waist circumference was observed with the same frequency as in the control group. According to IDF criteria the central obesity was more frequent in HIV infected than in not infected patients. According to the WHO criteria it was more often diagnosed in infected women compared with not infected ones, which was not recorded in the male group. CONCLUSIONS: The prevalence of overweight or obesity in the studied cohort of HIV infected patients is significantly lower than among the not infected people. At the same time the HIV infection is significantly more often accompanied by features of central obesity, expressed as abnormal waist circumference value. HIV infected patients have significantly lower BMI and higher WHR values. Higher WHR in the infected group is due to low hip circumference. HIV infected women usually have normal body weight and are significantly more likely than not infected women to show the features of central obesity as a result of increased waist circumference and low hip circumference. Men infected with HIV, compared with not infected ones, are characterized by lower, normal body weight, and their significantly higher WHR is determined by low value of hip circumference. Waist circumference seems to be an appropriate diagnostic criterion for central obesity in the studied population.

Impact of Combination Antiretroviral Treatment on Liver Metabolic Health in HIV-Infected Persons.

In the last three decades, there has been a considerable improvement in human immunodeficiency virus (HIV) therapy. Acquired immunodeficiency syndrome (AIDS) is no longer a common cause of death for people living with HIV (PLWH) in developed countries, and co-infections with hepatitis viruses can be effectively managed. However, metabolic syndrome and metabolic dysfunction-associated steatotic liver disease (MASLD) are emerging threats these days, especially as the HIV-positive population gets older. The factors for MASLD development in PLWH are numerous, including non-specific (common for both HIV-positive and negative) and virus-specific. We focus on what is known for both, and in particular, on the burden of antiretroviral therapy (ART) for metabolic health and liver damage. We review data on contemporary drugs, including different groups and some particular agents in those groups. Among current ART regimens, the switch from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide fumarate (TAF) and particularly its combination with integrase inhibitors (INSTIs) appear to have the most significant impact on metabolic disturbances by increasing insulin resistance, which over the years promotes the evolution of the cascade leading to metabolic syndrome (MetS), MASLD, and eventually metabolic dysfunction-associated steatohepatitis (MASH).

Subclinical carotid atherosclerosis and cardiovascular risk factors in HIV-infected patients.

BACKGROUND: HIV infected patients, especially those treated with antiretroviral (ARV) drugs, show an increased risk and incidence of cardiovascular disease. OBJECTIVES: The aim of this study was to evaluate the progression of subclinical atherosclerosis in the carotid arteries, expressed as the value of carotid intima-media thickness (cIMT) and the amount of atherosclerotic plaques, and to analyze the correlation between cIMT and risk factors for cardiovascular diseases in a cohort of HIV infected patients. METHODS: The analysis included 72 HIV infected patients, mean age 39.4 years, and 27 healthy HIV negative individuals, matched for age and sex. The data collected included evaluation of the infection, ARV treatment, past cardiovascular events, assessment of traditional and nontraditional risk factors for cardiovascular diseases, cIMT measurements and amount of atherosclerotic plaques in the carotid arteries. RESULTS: HIV infected patients show more advanced subclinical atherosclerosis in the carotid arteries (cIMT and plaques incidence). The cardiovascular risk profile of the HIV infected patients is significantly different from HIV negative people. Among the HIV positive group lower body mass index (BMI) and higher waist/hip ratio (WHR) are observed. The concentration of all cholesterol fractions is lower, whereas the concentration of triglycerides is higher. Cigarette smoking is more common among HIV-infected individuals. A strong statistical correlation between cIMT and age, hypertension, non-high-density lipoprotein (non-HDL) cholesterol and ARV time were found. Total and LDL cholesterol, and lifetime smoking exposure also affect the cIMT. The relationship between cIMT and current HIV RNA may indicate the impact of the current infection status on the cIMT dynamics in this subpopulation.

What Makes a Floor Slippery? A Brief Experimental Study of Ceramic Tiles Slip Resistance Depending on Their Properties and Surface Conditions.

The safety of the use of construction facilities should be a priority in today's busy world, where it is not difficult to get involved in an accident. Most of them, due to the pace at which we live today, are caused by slips, trips, and falls. This work presents a detailed analysis of the resistance of ceramic floors to these events, taking into account the surface properties and conditions (dry/wet), which, as presented, have a significant impact on the final slip resistance values. This study also investigates the relationship between surface roughness and anti-slip properties. According to the obtained results, it can be concluded that the surface roughness is not the main determinant of slip resistance, and the final value of it is influenced by many components that should be considered together and not be neglected when designing the surface finish. Furthermore, based on experimental measurements, it can be noted that the highest slip resistance in both wet and dry conditions showed the unglazed tiles with lapatto finish and the glazed tiles without any extra finish.

Associations between baseline biomarkers and lung function in HIV-positive individuals.

OBJECTIVE: The aim of this study was to analyse the association of baseline biomarker data with cross-sectional lung function and subsequent decline in lung function in HIV-positive persons. DESIGN: Lung function was modelled in all START pulmonary substudy participants who had baseline biomarker data and good-quality spirometry. In longitudinal analyses, we restricted to those participants with at least one good-quality follow-up spirometry test. METHODS: We performed linear regression of baseline forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC and their longitudinal slopes on log2-transformed baseline biomarkers with adjustment for age, sex, race, region, smoking status, baseline CD4+ T-cell counts and baseline HIV-RNA. Biomarkers included D-dimer, high-sensitivity C-reactive protein (hsCRP), interleukin (IL)-6, IL-27, serum amyloid A, soluble intercellular adhesion molecule (sICAM)-1, soluble vascular cell adhesion molecule (sVCAM)-1, albumin and total bilirubin. RESULTS: Among 903 included participants, baseline median age was 36 years, CD4+ cell count was 647 cells/µl, and 28.5% were current smokers. In adjusted analyses, elevated markers of systemic inflammation (hsCRP, IL-6 and serum amyloid A) were associated with lower baseline FEV1 and FVC. Elevated D-dimer and IL-6 were associated with worse airflow obstruction (lower FEV1/FVC). Despite these cross-sectional associations at baseline, no associations were found between baseline biomarkers and subsequent longitudinal lung function decline over a median follow-up time of 3.9 years (3293 spirometry-years of follow-up). CONCLUSION: Commonly available biomarkers, in particular markers of systemic inflammation, are associated with worse cross-sectional lung function, but do not associate with subsequent lung function decline among HIV-positive persons with early HIV infection and baseline CD4 T-cell counts more than 500 cells/µl.

[Generalized anxiety and neuroticism in patients suffering from somatic diseases]. / Lek uogólniony i neurotyzm u pacjentów chorych somatycznie.

AIM: The aim of this research is to present the severity of the generalized anxiety disorder (GAD) symptoms and its correlation with neuroticism among patients suffering from somatic diseases. METHODS: 184 subjects participated in the study: 45 inpatients undergoing haematological treatment (group 1), 46 inpatients from the internal ward (group 2), 48 patients infected with HCV prior to treatment (group 3) and 45 healthy persons from the control group (group 4). The patients' level of generalized anxiety was measured by means of the Present State Examination Questionnaire (PSE), whereas the level of neuroticism was measured by means of Eysenck's Personality Questionnaire (EPQ-R). RESULTS: The GAD was found to affect more patients with somatic diseases than people from the control group (group 1: 11%, 2: 8.7%, 3: 8.7% and 4: 6.7%). 14 out of 16 persons with GAD had the neuroticism value above median. Median scores of neuroticism were similar in all groups except for the control group in which the median value was slightly lower. The correlation between the level of neuroticism and the increase of generalized anxiety symptoms did not depend on the gravity of the somatic diseases. The value of correlation was found to be the highest among patients infected with HCV (0.73) and lower in the remaining two groups (0.54 and 0.58). The increase of generalized anxiety symptoms was proportional to the level of neuroticism, the regression line slope depended on subjective evaluation of gravity of the diseases. The regression line slope was found to be the highest amongst haematologically treated patients (1.54), smaller among patients from the general practice ward (0.84) and those infected with HCV (1.04), and the smallest among patients from the control group (0.15). CONCLUSIONS: Patients suffering from internal illnesses are much more vulnerable to GAD and have a higher level of GAD symptoms, especially ones with an elevated level of neuroticism. The regression line slope between GAD scores and neuroticism scores can be understood as an indicator of psychological stress.

[Neuropsychiatric symptoms related to interferon alpha]. / Objawy neuropsychiatryczne w trakcie leczenia interferonem alfa.

Neuropsychiatric symptoms are commonly related to interferon alpha treatment. The paper summarises the current knowledge about their aetiology, course, and treatment. Interferon alpha is a cytokine with antiviral and antineoplasmatic activity. It is commonly used in the treatment of chronic hepatitis C and B, malignant melanoma, Kaposi sarcoma, renal cancers, and some haematological malignancies. Treatment with interferon alpha is associated with depressive symptoms, cognitive disturbances, chronic fatigue syndrome, dysphoria, anxiety symptoms, anorexia, mania and psychotic states. Up to a half of the patients need psychiatric consultations, 10-25% of them need psychiatric treatment. Neuropsychiatric symptoms are the results of direct affection of CNS by interferon and induced cytokines. They increase hypothalamic-pituitary-adrenal (HPA) activity, alter thyroid function and lead to a behavioural syndrome called 'sickness behaviour'. Moreover interferon induces the activity of 2, 3 indoloamine dioxygenase, the enzyme which converts tryptophan into kynurenine, leads to a reduced level of tryptophan, and thus to a reduced level of central serotonin and to an increased level of neurotoxic kynurenine metabolites. Interferon also affects central opioid receptors and changes dopaminergic and noradrenergic neurotransmission. Serotonin selective reuptake inhibitors (SSRI), other antidepressants i.e. nortriptyline, benzodiazepines, naltrexone, and neuroleptics (for maniac and psychotic states) are used to treat interferon associated psychiatric symptoms. Psychological therapy may also be useful, as well as psychoeducation and behavioural interventions.

[Depressive symptoms during treatment with interferon alpha for HCV infection--preliminary report]. / Objawy depresyjne w trakcie leczenia interferonem alfa z powodu zakalenia HCV--doniesienie wstepne.

BACKGROUND: Interferon alpha, used in hepatitis C virus (HCV) infection causes many neuropsychiatric side effects: emotional disturbances, chronic fatigue, cognitive impairment, and psychotic states. They overlap with emotional disturbances and cognitive impairment caused by chronic HCV infection. AIM: To assess prevalence and severity of depressive symptoms in patients treated with interferon alpha due to HCV infection. METHODS: A total of 44 persons (27 men, 17 women) aged from 21 to 61 years old (median 45 years) treated due to chronic hepatitis were examined. They were treated with pegylated interferon alfa 2a and ribavirin. All of them underwent liver biopsy to assess liver inflammation, fibrosis, and steatosis as well as completed Eysenck's neuroticism questionnaire. Then, before treatment and after 12 weeks, they underwent biochemical and psychiatric examination. Biochemical examination included aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (G-GT), and HCV RNA. Psychiatric examination included Beck Depression Inventory (BDI), Hamilton Depressive Rating Scale (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS), and the SF-36 questionnaire. Diagnoses of depression were made basing on PSE questionnaire from Schedules of Clinical Assessment in Neuropsychiatry (SCAN version 2.0). RESULTS: Depressive disorders were diagnosed in 3 (6.8%) subjects before treatment and in 5 (11.4%) subjects after 12 weeks of treatment. A statistically significant increase of depressive rates was observed (medians: HDRS 6/11.5; MADRS 4/10; BDI 8/10.5). Quality of life dropped significantly in some SF - 36 scales: physical functioning, general health, vitality, and social functioning. Depressive ratings were independent of biochemical parameters (AST, ALT, G-GT), HCV RNA, liver inflammation, fibrosis, steatosis level, and HCV genotype. Ratings of neuroticism highly influenced all depressive ratings. Rise of depressive ratings was independent of neither any initial biochemical parameters nor the neuroticism level. CONCLUSIONS: Interferon alpha increases the severity of depressive symptoms. The rise is probably caused by biological activity of interferon and independent of initial ratings of depression.

[Neuropsychiatric disorders in HCV-infected people--own observations]. / Zaburzenia neuropsychiatryczne u osób zakazonych HCV--obserwacje wlasne.

UNLABELLED: Neuropsychiatric symptoms are commonly associated with chronic hepatitis C virus infection and its treatment. There are no Polish studies concerned this problem in patients during combination therapy (interferon and ribavirin). AIM: to examine the mood disorders an quality of life during the first 12 weeks of therapy. METHODS: The following research instruments were used: the Present State Examination (PSE), The Beck Depression Inventory, The Montgomery Asberg Depression Rating Scale, SF-36, Hamilton Depression Rating Scale. ALT, AST, GGT activity, HCV viral load and genotype, histological activity index of the liver was also measured. RESULTS: A group of 94 untreated patients (M=, K=) with hepatitis C was examined. 44 of them was examined secondly after 12 week of combination therapy. Depression disorders was observed in 4% pts before treatment and in 11% after 12 weeks therapy. In the group untreated patients there was two statistically significant correlations: between examined neuropsychiatric disorders and HCV viral load and necroinflammatory activity in the liver. CONCLUSIONS: The mood disorders are not so common in the patients with hepatitis C and could have biological etiology. The interferon based therapy increase the frequency and intensity of them.

[Contemporary opinions on the clinical symptoms, diagnosis and treatment of primary HIV infection]. / Wspólczesne poglady na klinike, diagnostyke i leczenie pierwotnego zakazenia HIV.

Primary HIV infection (PHI) includes period between HIV infection and occurrence of anti-HIV antibodies. It is characterized by a high viral load, transient decrease of CD4+ T cell count, high infectivity and, what is very important, lack of anti-HIV antibodies. During PHI acute retroviral disease may occur with a lot of non-characteristic symptoms. The patients (pts) visit general practitioners and influenza-like infections or other viral infections are recognized. The additional reason of lack of proper diagnosis and the delay in diagnosis of HIV infection is negative result of anti-HIV antibodies. That is why the HIV infection is usually diagnosed very late. Patients unconscious of their HIV infection may be a source of infection for other people. Opinions concerning management of PHI are different and are discussed in the paper. The purpose of the paper was to present the problem of primary HIV infection to the doctors of different specialties, who should think about PHI in pts with risky behaviours for HIV infection or presenting symptoms resembling acute retroviral disease.

Peripheral arterial disease and ankle-brachial index abnormalites in young and middle-aged HIV-positive patients in lower Silesia, Poland.

BACKGROUND: Peripheral arterial disease (PAD) is a clinical manifestation of atherosclerosis and mainly refers to elderly patients, having a negative impact on their functionality and quality of life. The findings of previous studies in HIV-infected patients have shown that cardiovascular risk is higher and PAD occurs more frequently than in the general population. There are also contradictory observations. Much less is known about the ankle-brachial index (ABI) value in asymptomatic HIV-infected patients. The aim of this study was to evaluate the prevalence of PAD and ankle-brachial index abnormalities as well as to determine risk factors related to the disease in a group of Polish HIV-positive patients. METHODS AND FINDINGS: One hundred and eleven young to middle aged HIV-positive subjects and 40 noninfected subjects were enrolled into the study. Resting ABI measurements were performed and cardiovascular risk was analysed as well. Subgroups were created according to the ABI values: low (PAD), borderline, normal, high and altered ABI. Symptomatic PAD was observed in 2 HIV-positive patients, asymptomatic PAD was not diagnosed. The ABI value is lower and more varied, in 22.5% of the study group altered ABI values were found. Six subjects demonstrated borderline ABI, and 15 high ABI, including >1.4. In the control group no low or very high values were reported. A relation between low ABI and cardiovascular family history and between altered ABI and high-density-lipoprotein cholesterol (HDL-C) level was demonstrated. CONCLUSIONS: In young and middle-aged HIV-positive patients, symptomatic PAD prevalence is comparable to that observed in the overall population. Among asymptomatic patients PAD is not reported. The ABI value in HIV-positive patients is more varied compared to the HIV-negative subjects; the altered ABI shows a strong relation with low HDL-C levels and metabolic syndrome.

Prevalence of Demodex spp. in eyelash follicles in different populations.

INTRODUCTION: The pathologic relevance of Demodex infestation in blepharitis is still controversial. The aim of the study was to determine the prevalence of Demodex spp. in eyelash follicles and its relationship to eye symptoms. MATERIAL AND METHODS: A total of 290 individuals were studied for the presence of Demodex folliculorum and Demodex brevis within eyelash follicles. Participants belonged to one of four groups: inpatients, drug abusers, health professionals, and medical students. Ten eyelashes were epilated from each subject, placed on microscope slides and examined for parasites. The sample was defined as positive if at least one parasite or parasite's ova were present. The presence of parasites was analyzed according to age, gender, place of living, reported eye problems, and use of contact lenses or glasses. RESULTS: The prevalence of Demodex spp. infestation among all studied subjects was 41%, with the highest infestation rate among inpatients (p < 0.01) and elderly people (p < 0.001). No difference regarding the presence of Demodex was found between women and men (p = 0.76). Demodex folliculorum was about 2.4 times more frequent than D. brevis. The prevalence of Demodex spp. in subjects with and without eye complaints suggesting blepharitis was similar (41.6% vs. 40.2%, respectively, p = 0.9). On the other hand, wearing glasses was linked to Demodex infestation (48.4% vs. 32.3%, p < 0.01). CONCLUSIONS: Demodex is a common saprophyte found in human eyelash follicles. Its presence might be related to some ocular discomfort; however, in the vast majority of cases the infestation seems to be asymptomatic.