Cutaneous larva migrans: A One Health Perspective on Familial Infection Among Tourists Returning from Southeast Asia.

Cutaneous larva migrans (CLM) is a dermatosis caused by accidental infestation with animal hookworms and is widely distributed in tropical and subtropical regions. Humans become infected when their skin comes into contact with soil contaminated with dog faeces. The filariform larvae penetrate and burrow into human skin, causing a condition known as "creeping eruption". We describe a case, well-documented by photos, of CLM infection in a family of three who returned from Thailand.

Selected biochemical parameters in the urine of HIV-infected patients in monitoring of kidney function.

Introduction: For years, there has been an increase in the number of cases of chronic kidney disease (CKD) in human immunodeficiency virus (HIV)-infected patients. Renal dysfunction can be caused by direct effects of HIV on the kidneys but also of applied combined antiretroviral therapy (cART). Therefore there is a need of renal function diagnosis to monitor the development of kidney disturbances. In this study the urinary levels of selected low molecular weight proteins (LMWP) in HIV-infected patients were measured and related to current CD4+ T lymphocyte (LT CD4+) count, the glomerular filtration rate (eGFR) value and the applied cART. Material and methods: The levels of 5 LMWP - kidney injury molecule-1 (KIM-1), neutrophil gelatinase associated lipocalin (NGAL), glutathione S-transferase α (GST-α) and π (GST-π) isoenzymes and neopterin (NPT) - in urine were measured in HIV-infected patients and healthy controls by enzyme-linked immunosorbent assay. Results: Taking into account the current LT CD4+ count, KIM-1, NGAL and GST-α showed statistically significant differences between groups with the CD4+ count < 500 and ≥ 500 cells (< 0.001). Depending on the eGFR, apart from KIM-1 and NGAL, NPT showed statistically significant differences in the investigated groups with normal and lower eGFR values (< 0.001). In terms of applied cART, the best parameters in the assessment of kidney damage were NGAL, GST-π and NPT (< 0.001). Conclusions: This research shows that the analyzed LMWP parameters are useful in the assessment of kidney damage in HIV patients during cART, especially NPT, NGAL and GST-π. However, future studies should be conducted on larger groups.

An epidemiological and retrospective study in a cohort qualified for SARS-CoV-2 vaccination in the region of Lower Silesia, Poland.

BACKGROUND: Since the beginning of the coronavirus disease (COVID-19) pandemic, numerous infections have been observed with various symptoms and degrees of severity. Not all patients have had a confirmation of infection made using reverse transcription polymerase chain reaction (RT-PCR) or antigen tests. It has been observed that some people, including convalescents or those without knowledge of a past infection, perform serological tests to detect anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. OBJECTIVES: We aimed to evaluate the levels of anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies in a cohort of convalescents and in individuals not previously infected, who were willing to get vaccinated. We also aimed to assess several socio-clinical factors associated with participants' humoral responses. MATERIAL AND METHODS: We recruited 298 individuals from the region of Lower Silesia who were willing to get vaccinated for SARS-CoV-2. The participants were divided into 2 groups: convalescents (group I) and participants without a past infection (group II). Several seropositive individuals in group II were identified, and they were transferred to group I, resulting in a final distribution of 171 individuals in group I and 127 individuals in group II. For serological testing, the QuantiVac anti-SARS-CoV-2 (IgG) enzyme-linked immunosorbent assay (ELISA) was used. RESULTS: The results showed the presence of anti-SARS-CoV-2 IgG antibodies in participants from group I, with an average number of 190.3 IU/mL. Twenty-three participants (13.45%) did not have a detectable level of antibodies despite a previous SARS-CoV-2 infection. In 21 participants (12.28%), antibodies were detected despite no previous symptoms of infection (average level: 145.0 IU/mL). CONCLUSION: Older participants were more likely to experience a symptomatic SARS-CoV-2 infection, and the severity of the symptoms was related to higher antibody titers seen later after COVID-19. Numerous individuals from group II were unaware of past SARS-CoV-2 infections. In several participants, antibodies were not detected despite a previous infection.

The relationship between knowledge about the pandemic and willingness to get vaccinated against SARS-CoV-2 in medical students in Poland: A cross-sectional survey.

The COVID-19 pandemic underlines the importance of targeting the groups with the highest risk of vaccine hesitancy, understanding their fears, and alleviating them. As the pandemic situation is very dynamic due to the appearance of new SARS-CoV-2 variants, concerns might also change over time. This is the first study to evaluate the vaccination rate and state of knowledge among medical students in Poland, comparing English and Polish divisions. We collected the data in 2 months. A total of 1,521 surveys were collected as follows: 273 students from the English division and 1,248 students from the Polish division answered the survey. The questionnaire was aimed at investigating students' awareness, knowledge, and apprehensions toward the COVID-19 pandemic and vaccines. The results were obtained for the following statements: good knowledge about ways of transmission is not statistically significant in determining if a student is vaccinated. Moreover, a year of study is not statistically significant in determining if a student knows all ways of COVID-19 transmission. Interestingly, the correlation between the statement "Keeping up to date with the upcoming vaccines is important for my role as a future health care worker" and being vaccinated against SARS-CoV-2 showed that 45.5% of unvaccinated students did not update their information about the vaccines and rated 1 out of 5 for this statement (p < 0.001). Even though the pandemic will not last forever, the obtained knowledge about the role of individual interests can be applied in many different life situations as this feature is statistically significant.

How Humoral Response and Side Effects Depend on the Type of Vaccine and Past SARS-CoV-2 Infection.

Since the end of December 2020, it has been possible to vaccinate against COVID-19. Our aim was to evaluate and compare the effectiveness of the vaccines available at the time of the mass vaccination program in Poland and also to look into the most common adverse side effects. Patients' anti-SARS-CoV-2 antibodies levels were checked before vaccination and after the first and after the second/last dose by the anti-SARS-CoV-2 QuantiVac ELISA (IgG) (EUROIMMUN MedicinischeLabordiagnostica AG; Luebeck; Germany) test. Before each blood collection, all patients filled out a questionnaire regarding experienced side effects. We observed that 100% of patients responded to the vaccinations. After the first dose, convalescents had much higher levels of anti-SARS-CoV-2 antibodies than naive patients, although after the second dose, 61 out of 162 convalescents (37.7%) had lower results than before. The comparison of immunological responses in the convalescents group after the first dose and in the naive group after the second dose showed that convalescents had higher antibody titers, which may suggest the possibility of changing the vaccination schedule for convalescents. The highest antibody titers after both the first and second doses were observed after Moderna shots. Fever was identified as a significant factor regarding higher levels of antibodies after the first and second doses of the vaccine.

Differences in Expression of Selected Interleukins in HIV-Infected Subjects Undergoing Antiretroviral Therapy.

The use of combined antiretroviral therapy (cART) inhibits the replication of the Human Immunodeficiency Virus (HIV) and thus may affect the functioning of the immune system, e.g., induce changes in the expression of certain cytokines. The aim was to examine the effect of cART on the expression of selected cytokines: interleukin -4, -7 and -15 in HIV-infected subjects. The test material was the plasma of HIV-infected men and healthy men (C, control group). The levels of interleukin were measured by immunoenzymatic method before cART and one year after treatment in relation to the C group. HIV-infected men were analyzed in subgroups depending on the HIV-RNA viral load, CD4+ and CD8+T-cell counts, and the type of therapeutic regimen. A significantly higher level of IL-4 was demonstrated in HIV-infected men before cART compared to those after treatment and in the control group. The use of cART resulted in a significant decrease in the level of IL-7 in HIV-infected men; however, high levels of IL-7 were associated with a low number of CD4+ T cells and CD8+ T cells. An increase in the level of IL-15 in HIV-infected men was noted after the use of cART. There was no difference in the expression of interleukins depending on the treatment regimen used. The study showed the effect of cART on the expression of interleukins, especially IL-4 and IL-7. Further research in this direction seems promising, confirming the role of these interleukins in the course of the disease.

Effect of Combined Antiretroviral Therapy on the Levels of Selected Parameters Reflecting Metabolic and Inflammatory Disturbances in HIV-Infected Patients.

Subjects infected with human immunodeficiency virus (HIV) treated with combined antiretroviral therapy (cART) show a greater predisposition to metabolic disturbances compared to the general population. The aim of the study was to assess the effect of cART on the level of selected parameters related to carbohydrate and lipid metabolism, cardiovascular diseases and inflammation in the plasma of HIV-infected patients against the uninfected. The levels of irisin (IRS), myostatin (MSTN), peptide YY (PYY), glucagon-like peptide-1 (GLP-1), dipeptidyl peptidase IV (DPP-4), fetuin A (FETU-A), pentraxin 3 (PTX 3), chemokine stromal cell-derived factor 1 (SDF-1), and regulated on activation normal T cell expressed and secreted (RANTES) in the plasma of HIV-infected patients and the control group were measured by immunoassay methods. HIV-infected patients were analyzed in terms of CD4+ T cells and CD8+ T cell count, HIV RNA viral load, and the type of therapeutic regimen containing either protease inhibitors (PIs) or integrase transfer inhibitors (INSTIs). The analysis of HIV-infected patients before and after cART against the control group showed statistically significant differences for the following parameters: IRS (p = 0.02), MSTN (p = 0.03), PYY (p = 0.03), GLP-1 (p = 0.03), PTX3 (p = 0.03), and RANTES (p = 0.02), but no significant differences were found for DPP-4, FETU-A, and SDF-1. Comparing the two applied therapeutic regimens, higher levels of all tested parameters were shown in HIV-infected patients treated with INSTIs compared to HIV-infected patients treated with PIs, but the differences were not statistically significant. The obtained results indicated significant changes in the expression of selected parameters in the course of HIV infection and cART. There is need for further research on the clinical usefulness of the selected parameters and for new information on the pathogenesis of HIV-related comorbidities to be provided. The obtained data may allow for better monitoring of the course of HIV infection and optimization of therapy in order to prevent the development of comorbidities as a result of long-term use of cART.

The Effect of Antiretroviral Therapy on SIRT1, SIRT3 and SIRT6 Expression in HIV-Infected Patients.

Human Immunodeficiency Virus (HIV) infection and the chronic use of combined antiretroviral therapy (cART) may affect the occurrence of certain disturbances in the body. There is growing interest in sirtuins-enzymes involved in the regulation of many metabolic processes in the organism and in the pathogenesis of many diseases which also exhibit potential antiviral activity. The aim of the study was to investigate the connection of cART to the expression of Sirtuin 1 (SIRT1), Sirtuin 3 (SIRT3) and Sirtuin 6 (SIRT6) in HIV-infected men. The plasma levels of sirtuins were measured before and one year after cART, and related to HIV viral load, lymphocytes T CD4+ and CD8+ count as well as the applied cART. The levels of sirtuins in plasma were measured in HIV-infected patients (n = 53) and the control group (n = 35) by immunoassay methods. There were statistically significant (p < 0.05) differences between SIRT6 in the HIV-infected patients before therapy and in the subgroups, depending on the count of lymphocytes T CD8+. There were significant differences in the levels of SIRT1 depending on the applied treatment regimen. The obtained results indicate the most significant changes in the expression of SIRT6 in the course of HIV infection and suggest an influence of the type of cART on the level of SIRT1, which indicates its important role in the course of HIV.

The association between hepatitis B virus infection and nonliver malignancies in persons living with HIV: results from the EuroSIDA study.

OBJECTIVES: The aim of this study was to assess the impact of hepatitis B virus (HBV) infection on non-liver malignancies in people living with HIV (PLWH). METHODS: All persons aged ≥ 18 years with known hepatitis B virus (HBV) surface antigen (HBsAg) status after the latest of 1 January 2001 and enrolment in the EuroSIDA cohort (baseline) were included in the study; persons were categorized as HBV positive or negative using the latest HBsAg test and followed to their first diagnosis of nonliver malignancy or their last visit. RESULTS: Of 17 485 PLWH included in the study, 1269 (7.2%) were HBV positive at baseline. During 151 766 person-years of follow-up (PYFU), there were 1298 nonliver malignancies, 1199 in those currently HBV negative [incidence rate (IR) 8.42/1000 PYFU; 95% confidence interval (CI) 7.94-8.90/1000 PYFU] and 99 in those HBV positive (IR 10.54/1000 PYFU; 95% CI 8.47-12.62/1000 PYFU). After adjustment for baseline confounders, there was a significantly increased incidence of nonliver malignancies in HBV-positive versus HBV-negative individuals [adjusted incidence rate ratio (aIRR) 1.23; 95% CI 1.00-1.51]. Compared to HBV-negative individuals, HBsAg-positive/HBV-DNA-positive individuals had significantly increased incidences of nonliver malignancies (aIRR 1.37; 95% CI 1.00-1.89) and NHL (aIRR 2.57; 95% CI 1.16-5.68). There was no significant association between HBV and lung or anal cancer. CONCLUSIONS: We found increased rates of nonliver malignancies in HBsAg-positive participants, the increases being most pronounced in those who were HBV DNA positive and for NHL. If confirmed, these results may have implications for increased cancer screening in HIV-positive subjects with chronic HBV infection.

HCV reinfection after HCV therapy among HIV/HCV-coinfected individuals in Europe.

OBJECTIVES: Although direct-acting antivirals (DAAs) can clear HCV in nearly all HIV/HCV-coinfected individuals, high rates of reinfection may hamper efforts to eliminate HCV in this population. We investigated reinfection after sustained virological response (SVR) in HIV/HCV-coinfected individuals in Europe. METHODS: Factors associated with odds of reinfection by 2 years after SVR in EuroSIDA participants with one or more HCV-RNA test and 2 years follow-up were assessed using logistic regression. RESULTS: Overall, 1022 individuals were included. The median age was 50 (interquartile range: 43-54 years), and most were male (78%), injection drug users (52%), and received interferon (IFN)-free DAAs (62%). By 24 months, 75 [7.3%, 95% confidence interval (CI): 5.7-8.9%] individuals were reinfected. Among individuals treated prior to 2014, 16.1% were reinfected compared with 4.2% and 8.3%, respectively, among those treated during or after 2014 with IFN-free and IFN-based therapy. After adjustment, individuals who had started treatment during or after 2014 with IFN-free or IFN-based therapy had significantly lower odds of reinfection (adjusted odds ratio = 0.21, 95% CI: 0.11-0.38; 0.43, 95% CI: 0.22-0.83) compared with those who had received therapy before 2014. There were no significant differences in odds of reinfection according to age, gender, European region, HIV transmission risk group or liver fibrosis. CONCLUSIONS: Among HIV/HCV-coinfected individuals in Europe, 7.3% were reinfected with HCV within 24 months of achieving SVR, with evidence suggesting that this is decreasing over time and with use of newer HCV regimens. Harm reduction to reduce reinfection and surveillance to detect early reinfection with an offer of treatment are essential to eliminate HCV.

Elderly Patient Care: A New Reality of the SARS-CoV-2 Pandemic.

Poland is among the European countries currently facing the second wave of the SARS-CoV-2 pandemic. A lot of studies confirm the mortality rate of COVID-19 increases with age. Considering the particularly adverse outcomes of a SARS-CoV-2 infection, preventing infections should be the priority for public health professionals. One method for preventing SARS-CoV-2 infections among eldery people may involve implementing procedures for limiting the spread of the pathogen, and providing education to medical staff, so as to bridge any gaps in knowledge on virus spread and post-infection or post-exposure management. Three residential medical centers in Poland were selected for evaluation of existing medical procedures to identify any errors in the current procedures applied for the prevention of SARS-CoV-2 spread in the facility. The project involved 4 steps: (1) Audit of the existing medical procedures; (2) Knowledge evaluation for the staff (n=185) in the senior- and disabled care facilities, administration of a knowledge test developed by the authors to assess knowledge on SARS-CoV-2 prevention; (3) Training for medical staff; (4) Updates and implementation of procedures. The knowledge test conducted revealed a lack of knowledge of medical personnel about SARS-CoV-2. The deficiencies of the surveyed group varied depending on the place of employment. Almost half of the surveyed medical centers (center No. 1 (52%) vs. center No. 2 (44%) vs. center No. 3(59%)) believed that elderly people usually do not show symptoms of SARS-CoV-2 infection. In the facility No. 1, 70% of respondents did know that SARS-CoV-2 can be transmitted via the alimentary route compared to center No. 2 and No. 3 where knowledge about it showed only 28,9% and 24,8% responders, respectively. Also, in facility No. 1, the least among the studied group (67%) knew that people with comorbidities were at risk of covid-19 compared to respondents from facility No. 2 and 3, where, respectively, 100% and 93% had such knowledge. Only 33.3% of the staff of facility No. 1 knew how to deal with a patient who will present symptoms such as temp >38 degrees with coughing or dyspnea while in institution No. 2 and 3, this knowledge was slightly higher at 44% and 60% respectively. The audit of the existing hygiene procedures used to limit the risk of SARS-CoV-2 spread demonstrated a number of shortcomings. Employees at the residential medical care centers included in the study had gaps in knowledge on the spread of SARS-CoV-2. The training sessions implemented at the next stage improved knowledge on SARS-CoV-2 infections. Additionally, decisions were made to modify certain procedures and introduce new ones to better prevent the spread of SARS-CoV-2.

Sirtuins as Interesting Players in the Course of HIV Infection and Comorbidities.

The sirtuins (SIRTs) are a family of enzymes from the group of NAD+-dependent deacetylases. Through the reaction of splitting the acetyl group of various transcription factors and histones they regulate many processes in the organism. The activity of sirtuins is linked to metabolic control, oxidative stress, inflammation and apoptosis, and they also affect the course of viral infections. For this reason, they may participate in the pathogenesis and development of many diseases, but little is known about their role in the course of human immunodeficiency virus (HIV) infection, which is the subject of this review. In the course of HIV infection, comorbidities such as: neurodegenerative disorders, obesity, insulin resistance and diabetes, lipid disorders and cardiovascular diseases, renal and bone diseases developed more frequently and faster compared to the general population. The role of sirtuins in the development of accompanying diseases in the course of HIV infection may also be interesting. There is still a lack of detailed information on this subject. The role of sirtuins, especially SIRT1, SIRT3, SIRT6, are indicated to be of great importance in the course of HIV infection and the development of the abovementioned comorbidities.

HCV resistance-associated substitutions following direct-acting antiviral therapy failure - Real-life data from Poland.

BACKGROUND: This study analysed the NS3 and NS5A mutation frequencies, persistence and drug susceptibility in a cohort of real-life patients, with failed hepatitis C virus (HCV) therapy following directly acting antiviral (DAA) treatment. METHODS: NS3/NS5A Sanger sequences from 105 patients infected with HCV genotype (G) 1a (6,5.7%), G1b (94,89.5%), G3a (4,3.8%), and G4 (1,1.0%) post DAA treatment failure were analysed. NS3 and NS5A resistance-associated substitutions (RASs) were identified using the geno2pheno algorithm and associated with clinical variables. Time trends were examined using logistic regression. RESULTS: NS5A RAS were found in 87.9% of sequences derived from patients exposed to this class of agents, whereas NS3 RAS was found in 59.1% of HCV protease-exposed subjects. The frequency of the NS3 RAS increased with fibrosis stage, from 40.0% among F0/F1 individuals to 81.8% among patients with liver cirrhosis (F4, p = 0.094). NS5A mutation frequencies were 7.6% for 28A/V/M, 10.6% for 30 K/Q/R, 42.4% for 31I/F/M/V, and 75.8% for 93H. For NS3, the most common RASs were 56F-23.7%, 168A/E/I/Y/T/V-14.0%, and 117H-5.4%. Susceptibility to glecaprevir/pibrentasvir, velpatasvir/voxlaprevir, and elbasvir/grazoprevir was retained in 92.9%, 43.4%, and, 25.3% of patients, respectively. The frequency of NS3 RAS decreased with time elapsed from failure to sampling (p = 0.034 for trend). NS5A RAS frequency remained stable over the 24-months. CONCLUSIONS: Following DAA treatment failure, NS5A and NS3 RASs were common with increasing frequency among patients with advanced liver disease. In most cases, despite the presence of RASs, susceptibility to DAA combinations with higher genetic barrier was retained.

Onchocerca jakutensis ocular infection in Poland: a new vector-borne human health risk?

BACKGROUND: Zoonotic onchocerciasis is a vector-borne disease, which involves many animal species, including large ungulates, boars, dogs, and sporadically, humans. So far, 39 cases of zoonotic onchocerciasis have been reported worldwide, 30 of which have been found in the last 20 years. Onchocerca nematodes are transmitted to humans by blood-sucking vectors during a blood meal. The following species have been responsible for zoonotic infections: Onchocerca cervicalis, O. dewittei japonica, O. gutturosa, O. jakutensis and O. lupi. In humans, the worms have usually been found in the subcutaneous tissues where they form subcutaneous nodules, induce inflammation of musculature, or penetrate the eye. Thirteen ocular zoonotic onchocerciasis cases have been reported so far. In the eye, nematodes were localized in the subconjunctival space, anterior chamber and within the vitreous body. METHODS: In a 39-year-old male patient, a writhing worm in the vitreous body of the left eye was detected and surgically removed. Laboratory identification of the worm was based on macroscopic and molecular identification, based on sequencing of the cytochrome c oxidase subunit 1 gene (cox1). Phylogenetic analysis of the first 250 nucleotide sequences showing the highest levels of similarity with the present isolate in a BLAST analysis was performed. RESULTS: Here, we report the first case worldwide of human ocular infection with O. jakutensis, a natural parasite of red deer. By exploiting a PCR assay, we detected the sequence almost identical to O. jakutensis (GenBank: KT001213.1; positions 1-650) with a single mismatch G/A at position 622. The sequence reported in this paper was deposited in the GenBank database under the accession number MK491767. CONCLUSIONS: Our case together with the previous case reports indicate that zoonotic Onchocerca worms exhibit no tissue specificity and an eye infection has been described in over one third of human zoonotic onchocerciasis cases. In terms of the growing number of cases of zoonotic onchocerciasis in Europe, the USA and Japan, attention should be paid to the diagnosis of subcutaneous nodules and eye infestations.

Assessment of dietary habits and lifestyle among people with HIV.

BACKGROUND: The aim of this study was to determine the consumption of specific food groups by people with HIV and to determine the quality of their diets. OBJECTIVES: To assess the relationship between selected eating habits and lifestyles of people infected with HIV. The research was conducted at the HIV/AIDS Preventative and Therapeutic Clinic of the Infectious Disease Prevention and Therapy Center at Wroclaw Health Center (SPZOZ Wroclaw), Poland. MATERIAL AND METHODS: The study was conducted in 2019 among 31 patients of a counselling center in Wroclaw. To determine the frequency of food consumption and eating habits, the KomPAN® questionnaire, prepared by employees of the Polish Academy of Sciences, was used. RESULTS: All study participants were characterized by a small degree of unhealthy features in their diets; 87% of the respondents also demonstrated a small degree of healthy features in their diets, although the responses they gave showed that they assessed their nutritional knowledge and diet highly. Consumption of sweet snacks and adding salt to cooked meals were prevalent. The respondents took part in moderate physical activity and rarely consumed highly processed fast food products, though they ate fish and legumes - an important part of the diet - with similar frequency. CONCLUSIONS: More attention should be given to the nutritional issues of patients treated for HIV, and emphasis should be placed on promoting healthy eating habits among this population. In the scientific literature, few such studies are available that address issues related to the diet of HIV-infected people.

Effect of comedication on ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin therapy in chronic hepatitis C - a real-world study.

AIM OF THE STUDY: This multicentre study aimed to examine the actual risk for drug-drug interactions in a cohort of Polish patients, and their impact on antiviral therapy. MATERIAL AND METHODS: Concomitant medications were analyzed in hepatitis C virus (HCV)-infected patients treated with still valuable therapy with OBV/PTV/r ± DSV ± RBV. An established online tool (http://www.hep-druginteractions.org/) was used to assess potential drug interactions. To assess the impact of comedications on virologic outcomes, HCV RNA levels were measured at given time points during and after the treatment. The results were compared between subgroups depending on the number of drugs used. RESULTS: Among the 209 patients included in this multicentre study, concomitant medications were taken by 140 (67.0%) patients. Modification of treatment due to expected interactions was required in 33 (15.8%) patients, of whom nine (4.3%) had at least one comedication replaced or discontinued. Sustained virologic response rates ranged from 95.1% to 100.0%, and were lowest in patients taking one to five comedications who were null-responders to pegylated interferon or cirrhotic. CONCLUSIONS: Although most HCV-infected patients received concomitant medications, only some required treatment modification. OBV/PTV/r ± DSV ± RBV was effective in all subgroups, irrespective of the number of comedications taken. Multimorbidity and polypharmacy in patients with chronic hepatitis C should not discourage the decision to initiate antiviral therapy, although caution should be exercised for potential drug-drug interactions.

A panel of urinary biochemical markers for the noninvasive detection of kidney dysfunction in HIV-infected patients.

INTRODUCTION: The use of antiretroviral therapy in HIV­infected patients can lead to disturbances in kidney function. Renal dysfunction can also be caused by the direct effects of HIV on the kidneys. The assessment of renal function is needed to monitor these patients for the development of chronic kidney disease. OBJECTIVES: The aim of this study was to identify urinary biochemical parameters for the assessment of kidney dysfunction in HIV­infected patients. PATIENTS AND METHODS: The study included 86 patients with HIV and 34 healthy controls. Spectrophotometry was used to measure the activity of the following enzymes: N­acetyl-ß­D­glucosaminidase (NAG), NAG isoenzyme B (NAG­B), galactosidase, ß­glucuronidase, alanyl aminopeptidase, and γ­glutamyltransferase. An enzyme­linked immunosorbent assay was used to assess the urinary concentrations of low­molecular­weight proteins: kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin, α­glutathione S­transferase, π­glutathione S­transferase, neopterin, ß2­microglobulin (ß2M), and retinol­binding protein (RBP). RESULTS: The urinary levels of all parameters except alanyl aminopeptidase were significantly higher in HIV­infected patients than in the control group. The statistical analysis revealed the following 4 parameters to have the best diagnostic value in: ß2M, NAG, KIM-1, and RBP. CONCLUSIONS: Our results indicate that among selected enzymes and low-molecular proteins, ß2M, NAG, KIM-1, and RBP are the best in assessing renal dysfunction in patients with HIV.