Which factors hinder the decision of Polish HIV-positive patients to take up antiretroviral therapy?

The implementation of highly active antiretroviral therapy (HAART) in 1996 has significantly reduced mortality and morbidity for HIV-positive patients worldwide. However not all eligible persons start HAART. To identify reasons for therapy refusal by HIV-positive persons we performed a questionnaire study. The investigation was conducted among 321 HIV-positive individuals and focused on the decision to take up antiretroviral treatment. Out of 71 untreated patients, 34 (47.9%) admitted that in their case the therapy was not indicated, whereas 20 (28.3%) were afraid of potential side effects that might change their appearance, e.g. face lipoatrophy. Only the treated patients had been prepared to take up therapy, although 17 patients (6.0%) had not received any explanation of the therapy principles, aims or necessity to comply with medication regime. The therapy is generally not discussed with the patients for whom it is not currently indicated, which may contribute to the fixation of fears and prejudices. Doctors who treat HIV-positive patients should be aware of the prejudices and fears their patients have towards antiretroviral therapy in order to react properly and by means of the available antiretroviral drugs help prolong life and improve its quality.

[Toxoplasmosis of the brain as an example of the opportunistic invasion of the women HIV positive]. / Toksoplazmoza mózgu jako przyklad inwazji oporutunistycznej u kobiety zyjacej z HIV.

Most toxoplasmosis infections occur in the brain. Cerebral toxoplasmosis is a specially serious complication in patients with AIDS. Similarly to other opportunistic pathogens, Toxoplasma gondii causes rapidly progressive, and often fatal disease in immunosuppressed patients. The diagnosis is difficult, since no sensitive and specific non-invasive diagnostic tests exist. The subject of our study is a 27-old female initially diagnosed with metastasis in central nervous system.

[The level of triglycerides, total cholesterol and HDL cholesterol in various stages of human immunodeficiency virus (HIV) infection]. / Stezenia triglicerydów, cholesterolu calkowitego i cholesterolu HDL w róznych stadiach zakazenia ludzkim wirusem uposledzenia odpornosci (HIV).

In 63 HIV-infected individuals the levels of concentration plasma triglicerides, total cholesterol and HDL cholesterol were determined by the level of immunological deficiency defined according to the CD4 lymphocytes count. The analyzed markers of lipid disorder allow to draw the following conclusions: 1. Along with the increase of immunological deficiency and clinical development of the HIV infection the disorders, which are indicated by the increase in trigliceride levels and decreased plasma concentrations for HDL cholesterol, intensify as well. 2. HIV-infected persons, particularly those treated with protease inhibitors, should have carefully monitored lipid metabolism.

[What motivates people to get tested for HIV antibodies?]. / Co sklania ludzi do wykonania testów anty-HIV?

The aim of the study was to evaluate reasons for anti-HIV testing among persons admitted to Outpatient Counseling Unit. Serum examination for antibodies against HIV were performed in 389 persons during 8 years of the Unit activity. The most frequently it was analysed in intravenous drug users. However there are still many persons who are urged for this analysis before invasive medical procedures. Knowledge on HIV/AIDS in Poland seems to remain on the very low level in public as well as in medical staff.

[Inflammation of the brain caused by Toxoplasma gondii in patients infected with human immunodeficiency virus (HIV)]. / Zapalenie mózgu wywolane Toxoplasma gondii u osób zakazonych ludzkim wirusem uposledzenia odpornosci (HIV).

Reactivation of latent Toxoplasma gondii infection in patients with HIV infection is responsible for life-threatening disease. We present the aetiology, epidemiological data, diagnostic method, signs, symptoms, and therapy of Toxoplasma gondii encephalitis.

[Candida humicola infection of the central nervous system in an HIV-infected patient: a case report]. / Infekcja Candida humicola osrodkowego ukladu nerwowego u pacjenta zakazonego ludzkim wirusem uposledzenia odpornosci (HIV)--opis przypadku.

HIV infection and parenteral drug abuse are at increased risk of developing Candida infection. Central nervous system (CNS) infection is an exceptional finding. We present fatal CNS infection by Candida humicola in drug abuser at late stage of HIV disease. In MEDLINE we have found only 3 reports about pathogenicity Candida humicola in humans (ophthalmopathy, conjunctivitis, melanonychia). Our case report suggests, that spectrum of pathogens dangerous to persons with AIDS increases.

[Diversity in the clinical course of toxoplasma encephalitis in two patients infected with human immunodeficiency virus (HIV)]. / Róznorodnosc przebiegu klinicznego zapalenia mózgu wywolanego Toxoplasma gondii u dwóch chorych zakazonych ludzkim wirusem uposledzenia odpornosci(HIV).

The central nervous system (CNS) is the most common site of Toxoplasma gondii infection in HIV-positive patients, mainly due to reactivation of Toxoplasma cysts. The diagnosis is difficult since no sensitive and specific non-invasive diagnostic tests exist. The patient may present with rather unspecific signs and symptoms. We present atypical course of CNS-toxoplasmosis in two HIV-positive persons.

[Prophylaxis after occupational exposure to human immunodeficiency virus (HIV)]. / Profilaktyka po zawodowej ekspozycji na ludzki wirus uposledzenia odpornosci (HIV).

Reasons for seeking consultation among health care workers due to potential or supposed risk of HIV infection were analyzed. From August 1990 till July 1996 41 health care providers were consulted including: 22 nurses, 1 student of nursing college, 3 midwives, 4 laboratory workers and 7 physicians (surgeons and gynaecologist). Type of exposure to HIV and applying of safety precautions were evaluated in each case. In 10 cases the offer of postexposure prophylaxis with zidovudine was accepted (6 nurses, 1 student of nursing college, 3 surgeons). Exposure to HIV was described as: needlestick immediately after it was used in a HIV/AIDS patient, injury with a surgical needle while operating on an HIV infected blood. In the remaining cases the fear of HIV infection was due to work without protective gloves (nurses, laboratory workers), performing surgery on HIV (+) patient, (surgeons, nurses) or short-time contact of HIV infected blood with undamaged skin (nurses). Following conclusions can be drawn from our study: 1. Health care workers undertake safety precautions only when they are informed about HIV seropositivity of the patient. 2. Patients whose HIV serologic status is not known are considered not to create health risk for medical staff. 3. The level of knowledge of health care workers about risk of acquiring HIV infection, lack of risk and ways of diminishing the risk is poor. 4. None of followed health care workers was HIV-seropositive after occupational exposure to HIV.

[Multiorgan changes in AIDS in a reported case]. / Wielonarzadowe zmiany w AIDS na podstawie obserwowanego przypadku.

The clinical course of HIV infection and results of autopsy examination in 49 years old patient was shown. The attention was paid to difficulties of diagnosis of opportunistic infections in a patients with advanced HIV disease. Variety of infectious factors, that could affect a patient with significant immunodeficiency was outlined.

[Parasitic infections in AIDS]. / Inwazje pasozytnicze w AIDS.

The list of infections, threatening patients with impaired immunological system, especially infected with HIV, prolongs systematically. The review of literature data concerning species known up to now as AIDS defining parasitic infections (Pneumocystis carinii, Toxoplasma gondii, Cryptosporidium, Isospora belli, Microsporidium and Cyclospora) is presented.

["Prognostic markers" in serum of active and passive intravenous drug users infected with human immunodeficiency virus (HIV)]. / "Markery prognostyczne" w surowicy czynnychibiernychnarkomanów zakazonych ludzkim wirusem uposledzenia odpornosci (HIV).

The analyse of neopterin (NPT), beta 2-microglobulin (beta 2-M) and immunoglobulin A (IgA) in active and passive intravenous drug users was made to show the influence of intravenous drug taking on the level of so called "prognostic markers" in the serum of HIV infected persons. The intravenous drug users remained in the same, symptom-free stage of infection. The level of NPT in active drug users was higher than in passive drug users (statistically essential difference). In both analysed groups the level of NPT considerably exceeded the norm range (10 nmol/l). The differences in beta 2-M concentrations between analysed groups were not statistically essential, although higher values were observed in active drug users. The concentration of IgA in analysed persons were within the norm range. Current life conditions of the HIV-infected persons should be taken into consideration when estimating prognostic values of analysed indices.

[Levels of neopterin in serum of narcotics abusers infected with human immunodeficiency virus (HIV)]. / Stezenie neopteryny w surowicy krwi narkomanów zakazonych ludzkim wirusem uposledzenia odpornosci (HIV).

Concentration of neopterin (NPT) was measured in 3-6 months intervals in the serum of HIV-infected drug users taking continuously intravenous drugs and those who stopped the habit (MONAR, ZOZ). After 6-12 months of observation the mean NPT concentration was higher in the active drug users what was statistically essential. The outcome of our study indicates that current state of the patient concerning taking of drugs must be taken under consideration when NPT concentration is assessed as marker of progression of HIV disease.

[Microsporidiosis: a new protozoan disease in persons infected with human immunodeficiency virus (HIV)]. / Microsporidiosis--nowa choroba pierwotniakowa u osób zakazonych ludzkim wirusem uposledzenia odpornosci (HIV).

The list of infections, threatening patients with impaired immunological system, especially infected with HIV, prolongs systematically. Since early eighties many authors pay attention to little known type of protozoan: Microspora. More and more often new microsporidia species are described as a cause of disease, especially in patients with AIDS. We present review of literature data concerning species known up to now as pathogenic for man: Encephalitozoon cuniculi, Encephalitozoon hellem, Nosema connori and Nosema corneum, Pleistophora sp., as well as enteropathogenic for AIDS-patients-Enterocytozoon bieneusi and Septata intestinalis.

[Incidence of so-called hepatic failure syndrome in relation to infection with hepatitis B virus (HBV) in epidemiological and environmental studies of the rural population in the Suwalki and Bialystok regions 1978-1990]. / Dynamika wystepowania t.z.w. zespolu niedomogi watroby (ZNW) w relacji z zakazeniem wirusem hepatitis B (HBV) w badaniach epidemiologiczno-srodowiskowych populacji rolniczej regionu Suwalszczyzny i Bialostocczyzny w latach 1978-1990.

In years 1979-1991 has been analysed the selected health epidemiological indices is related with liver pathology and viral hepatitis B infections in rural population of Bialystok region. In 11,086 analysed persons of an agricultural sector the frequency of antigenemia HBs (0.25-2.5%) was higher that in control groups of urban populations (0.3-0.6%). In 12 years time period observation of chronic hepatopathy syndrome, demonstrated the increased tendency with parallel pathologic increased values of serum A1AT activity and with increased tendency of HBs antigenemia.

[Dynamics of immunologic reactivity in the acute phase of virus hepatitis B]. / Zur Dynamik der immunologischen Reaktivität in der akuten Phase der Virushepatitis B.

In 15 patients with acute icteric viral hepatitis B the immunological reactivity was tested. The examinations were performed on the 1st, 7th, and 14th day of hospitalization. They consisted of the determination of the HBsAg and its antibodies in the serum, of the percentage of the B- and T-lymphocytes, of the lymphocyte transformation test under the influence of phytohaemagglutinin, of the lymphocyte migration inhibitory test when the HBsAg is present as well as of the determination of the IgG, IgA and the IgM-level. A decreased percentage of the T-lymphocytes, a decreased blastic transformation and an inhibition of the lymphocyte migration was proved. After a transient increase in the first and second examination the IgG-level returned to the normal in the third examination, whereas the IgM-level increased. Finally dynamics and importance of the cellular reactivity in the pathogenesis of viral hepatitis B are discussed.