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.

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.

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.

The role of the tissue factor and its inhibitor in the development of subclinical atherosclerosis in people living with HIV.

INTRODUCTION: HIV infection is associated with an increased risk of cardiovascular disease in connection with atherosclerosis and thromboembolic complications. The pathogenesis of atherosclerosis is still unclear in this group of patients. Studies on pathogenesis of atherosclerosis in the general population emphasize the role of the extrinsic pathway of blood coagulation, particularly the tissue factor (TF) and tissue factor pathway inhibitor (TFPI). The effect of persistent activation of the immune system on enhanced expression of TF on the surface of monocytes in subjects infected with HIV is known to be correlated with the level of HIV RNA in blood serum. STUDY AIM: The aim of this study was to evaluate the concentration of TF and its inhibitor TFPI in blood plasma, the impact of traditional and non-traditional cardiovascular risk factors on their concentration and the impact of both markers of haemostasis on the severity of subclinical atherosclerosis as assessed by the intima-media measurement of the carotid artery in HIV infected patients. MATERIALS: The study included 121 HIV-infected people with known clinical, immunological and virological status. The control group consisted of 42 healthy individuals, selected in terms of age and sex. RESULTS AND CONCLUSIONS: Higher concentrations of TF occurred in HIV-infected patients with a low current plasma HIV RNA level, nadir CD4+ T-cell count and longer duration of cumulative antiretroviral treatment. In multivariate analysis, it was the length of cumulative NRTI treatment that impacted on the concentration of TF. The determinants of cardiovascular disease (CVD) risk factors and inflammatory markers did not show any effect on the concentrations of TF. The TFPI level in HIV-infected patients was significantly higher than in the control group and was negatively correlated with the current level of HIV RNA and nadir CD4+ T-cell count, being higher in patients subjected to antiretroviral treatment. It was shown that the higher the cardiovascular risk and the higher the levels of total cholesterol, low-density lipoprotein cholesterol (LDL) and non-high-density lipoprotein cholesterol (non-HDL), the higher the concentrations of TFPI observed. The levels of TF and TFPI were positively correlated with carotid intima media thickness (cIMT); in the multivariate analysis, TF, non-HDL cholesterol and lifetime smoking (pack-years) independently affected the growth of cIMT. A similar effect on cIMT was demonstrated by TFPI.

Risk of occupational exposure to the HBV infection in non-clinical healthcare personnel.

BACKGROUND: Occupational risk of blood-borne infections is investigated mostly among nurses and doctors, studies concerning non-clinical health personnel (nCHP) being rare. The analysis of the occupational exposure to the hepatitis B virus (HBV) infection and the history of vaccination against the HBV in the nCHP group has been the aim of the study. MATERIAL AND METHODS: A retrospective analysis of 458 cases of the occupational exposure to biological agents was conducted: group I - doctors (N = 121, 28%), group II - nursing staff (N = 251, 55%), group III - nCHP (N = 86, 19%). RESULTS: In the group III the source was usually unknown (group: I - 0.83%, II - 11.16%, III - 86.05%, p < 0.001), and the proportion of individuals vaccinated against hepatitis B before the exposure was the lowest (group: I - 98.35%, II - 97.19%, III - 77.91%, p < 0.001). In this group most exposures resulted from injuries caused by needles/sharps deposited in waste sacks (60%) or anywhere outside of the medical waste container (5%). The possibility of the HBV infection risk during the exposure was found in 25 cases and was significantly more frequent in the group III. The qualification for the HBV post-exposure prophylaxis was also significantly more frequent in the group III. CONCLUSIONS: The exposure to the occupational risk of the HBV infection also concerns the non-clinical healthcare personnel. The non-clinical healthcare personnel comprises one of the main groups of the HBV post-exposure recipients. It is essential to determine the causes of the low hepatitis B vaccination coverage in the nCHP and consider introduction of mandatory vaccination in this group in Poland. Med Pr 2016;67(3):301-310.

Current Possibilities to Assess the Degree of Liver Fibrosis in Patients with Haemophilia Infected with HCV--Review.

Haemophilia is an entity, wherein the HCV infection rate is greater than in the general population and ranges between 70-90%. The majority of HCV infections were acquired by hemophiliacs in the 1980s, by the use of infected cryoprecipitate or fresh frozen plasma preparations. It is therefore highly likely that many of them, more than twenty years after the infection, have developed advanced liver disease. Until recently, in order to assess its severity, it was necessary to perform a liver biopsy. Currently, we observe rapid developments of non-invasive methods that are particularly useful in patients with bleeding disorders. The most popular include elastography (Fibroscan, SWE) and the algorithms based on measurements of the relevant blood parameters (e.g. FibroTest, Fibrometer, APRI index). Ease of implementation of these studies, no need for hospitalization of the patient or specific preparation for surgery, allow for quick and minimally invasive assessment of liver disease progression and classification of the patient to the appropriate antiviral therapy.

Regional differences in self-reported HIV care and management in the EuroSIDA study.

INTRODUCTION: EuroSIDA has previously reported a poorer clinical prognosis for HIV-positive individuals in Eastern Europe (EE) as compared with patients from other parts of Europe, not solely explained by differences in patient characteristics. We explored regional variability in self-reported HIV management at individual EuroSIDA clinics, with a goal of identifying opportunities to reduce the apparent inequalities in health. METHODS: A survey (www.chip.dk/eurosida/csurvey) on HIV management was conducted in early 2014 in all currently active EuroSIDA clinics. Responders in EE were compared with clinics in all other EuroSIDA regions combined (non-EE). Characteristics were compared between regions using Fishers exact test. RESULTS: A total of 80/97 clinics responded (82.5%, 12/15 in EE, 68/82 in non-EE). Participating clinics reported seeing a total of 133,532 patients [a median of 1300 per clinic (IQR 700-2399)]. The majority of clinics requested viral load and CD4 measurements at least every six months for patients on as well as off ART (EE 66.7%, non-EE 75%, p=0,72). Significantly fewer EE clinics performed resistance tests before ART as well as upon treatment failure (Figure 1). Half of the EE clinics indicated following WHO guidelines (EE 50%, non-EE 7.4%, p<0.0001), whereas most non-EE clinics followed EACS guidelines (non-EE 76.5%, EE 41.7%, p=0.017). The majority of EE clinics and » non-EE clinics indicated deferral of ART initiation in asymptomatic individuals until CD4 ≤350 cells/mm(3) (Figure 1). There were no significant regional differences in screening haematology, liver or renal function, which the majority of clinics reported to do routinely. However, EE clinics reported screening significantly less for cardiovascular disease (CVD), and only about half screened for tobacco use, alcohol consumption and drug use (Figure 1). Screening for cervical cancer and for anorectal cancer was low in both regions (Figure 1). CONCLUSIONS: We found significant regional variability in self-reported HIV management across Europe, with less resistance testing, screening for CVD and substance use in EE. EE clinics indicated deferral of ART initiation for longer than non-EE clinics. Adherence to international guidelines for cervical cancer screening was poor in both regions. Whether differences in HIV management are reflected in clinical outcomes deserves further investigation.

Frequency of human endogenous retroviral sequences (HERV) K113 and K115 in the Polish population, and their effect on HIV infection.

BACKGROUND: The human genome contains about 8% of endogenous retroviral sequences originated from germ cell infections by exogenous retroviruses during evolution. Most of those sequences are inactive because of accumulation of mutations but some of them are still capable to be transcribed and translated. The latter are insertionally polymorphic HERV-K113 and HERV-K115. It has been suggested that their presence and expression was connected with several human diseases. It is also believed that they could interfere with the replication cycle of exogenous retroviruses, including HIV. RESULTS: Prevalence of endogenous retroviral sequences HERV-K113 and HERV-K115 was determined in the Polish population. The frequencies were found as 11.8% for HERV-K113 and 7.92% for HERV-K115. To verify the hypothesis that the presence of these HERVs sequences could affect susceptibility to HIV infection, comparison of a control group (HIV-negative, not exposed to HIV; n = 303) with HIV-positive patients (n = 470) and exposed but uninfected (EU) individuals (n = 121) was performed. Prevalence of HERV-K113 and HERV-K115 in the EU group was 8.26% and 5.71%, respectively. In the HIV(+) group we detected HERV-K113 sequences in 12.98% of the individuals and HERV-K115 sequences in 7.23% of the individuals. There were no statistically significant differences between groups studied. CONCLUSION: The frequency of HERV-K113 and HERV-K115 sequences in Poland were found to be higher than usually shown for European populations. No relation between presence of the HERVs and HIV infection was detected.

The investigation of specific biochemical markers in monitoring kidney function of drug addicts.

INTRODUCTION: An increasingly important issue in the Polish population is drug abuse. It leads to extensive damage of parenchymal organs, including kidney. Establishing early markers of organ damage and their monitoring during rehabilitation therapy is therefore of pivotal importance. This study evaluated the utility of highly specific and selective markers (NGAL, IL-18, a and π-GST isoenzyme, and ß2-M). The influence of opioid drugs and other factors on kidney function (HIV and HCV infections, duration and the kind of drugs abused) was determined. MATERIALS AND METHODS: Urine collected from 83 subjects who abused drugs and 33 healthy volunteers was tested with ELISA using specific antibodies (IBL, Biotron, Bioporto-Diagnostics). HIV infection was confirmed with western-blotting and HCV with PCR. CD4 lymphocytes were quantified with flow cytometry. RFLP and PCR were used to determine the viral load of HIV and HCV (genotype). RESULTS: A significant increase of IL-18, NGAL and ß2M activity in heroin addicts compared to the control group was noted as well as the influence of HIV infection on NGAL and ß2M excretion. A statistically significant (p=0.04) correlation between the viral load and IL-18 concentration was noted while no significant influence of the duration and the kind of drugs abused, the route of intake or the age of addicts was seen. Only the NGAL concentration was sex dependent and significantly higher in women. DISCUSSION: This study showed the specific, clinical utility of IL-18, NGAL, and ß2M in the evaluation of renal function in drug addicts. Early detection of nephropathy with biochemical indicators might help prevent severe conditions that require hospitalization and intensive care.

The effects of mortality reminders on posttraumatic growth and finding benefits among patients with life-threatening illness and their caregivers.

Individuals confronted with a life-threatening illness often report posttraumatic growth (PTG) or finding benefits in disease. These positive evaluations of personal strength, perceptions of improved personal relations and new possibilities may represent a defensive response (cf Janus-face model). Three studies investigated the effects of mortality reminders on reports of PTG or benefit findings among people living with life-threatening illness or their caregivers. 80 people living with HIV (study 1), 164 breast cancer survivors (study 2) and 50 family caregivers for a patient with huntington disease (study 3) were randomly assigned to the experimental (mortality reminders) or control conditions. Across three studies, those exposed to mortality reminders reported lower PTG or benefit finding, compared to the controls. These effects were moderated by time elapsed since diagnosis: mortality reminders led to lower PTG/benefit finding among those who received the diagnosis more recently. The results provide an insight into the defensive character of PTG/finding benefits in illness and changes in the function of these beliefs over time elapsing since diagnosis.

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.

[Influence of different physical conditions on HIV infectivity]. / Czynniki wplywajace na zakaznosc HIV.

To date it has been impossible to establish borderline physical conditions which prevent HIV from infecting human cells. Full inactivation of the virus is not necessary to lose its capacity for infection--often damage of the mechanisms concerning e.g. HIV entry into the cell or integration with host DNA is sufficient. The presence of HIV RNA in a sample under certain conditions does not mean that the virions are infectious. Viral infectivity under certain conditions depends on temperature, humidity, sunlight, atmospheric pressure, pH of the environment, disinfectants, coagulation inhibitors, and the kind and amount of infectious biological material, especially HIV viremia in it. At present the influence of high temperature on HIV infectivity, inactivation or HIV RNA level is the best known phenomenon, while the influence of low temperature on the above parameters has been examined in less detail. In the paper the authors present the influence of various parameters on HIV infectivity, especially temperature variation.

Inhibition of vesicular stomatitis virus replication in the course of HIV infection in patients with different stages of immunodeficiency.

The replication of vesicular stomatitis virus (VSV) in isolated human leukocytes has been used to measure the level of nonspecific antiviral immunity. However, during infection with some pathogens, the main effect observed is caused by interaction between the pathogen and VSV. This was also noted in advanced stages of HIV infection, when an inverse association between HIV viral load and VSV replication was found. The mutual effect was markedly stronger than the correlation between the VSV replication level and CD4(+) T-cell count. Since successful antiretroviral therapy is associated with a decrease in HIV viremia to undetectable levels, the effect of such therapy on VSV replication was expected and confirmed in this investigation. In fact, increased VSV titers were observed together with decreased HIV viral load, particularly in the case of efficient therapeutic schemes, for example those including lopinavir/ritonavir. The results showed that VSV replication capacity reflected the progression of HIV infection. Moreover, the presence of interferon in the plasma of AIDS patients was found to be only partially responsible for the inhibition of VSV replication. The results suggest a specific HIV-VSV interaction, whether direct or indirect. Thus the VSV replication assay may be applied in evaluating the stage of HIV infection.

Non-Hodgkin's lymphoma as a rare manifestation of immune reconstitution disease in HIV-1 positive patients.

Combination antiretroviral therapy (cART) can improve immune system function through suppression of HIV-1 replication. However, paradoxical immune response may develop in some patients as a result of effective therapy followed by immune restoration. The phenomena is known as IRS, immune reconstitution syndrome/immune recovery syndrome. IRS can develop within weeks to months after cART is commenced and the time is related to the type of the disease. There are but scant reports concerning IRS-NHL (non-Hodgkin's lymphoma) in HIV-1 positive subjects. We observed 4 (33%) cases of IRS-NHL out of 12 patients in whom NHL was diagnosed. As a result of potent cART they reached viral suppression in a mean time of 15 weeks followed by a rise in CD4(+) T cells within 16.5 weeks. The diagnosis of NHL was established at a mean time of 36 weeks after cART was introduced and 20 weeks after the CD4 T cell increase was achieved. This may indicate that the immune reconstitution as a result of cART was a predisposing factor for the development of NHL in our patients. There was prompt progression of the disease and the outcome was fatal in all cases. IRS-NHL should be suspected in any case of lymphadenopathy, generalized or limited to the abdomen or periphery, which develops after immune recovery due to potent cART within a few months.

Lung cancer as an immune reconstitution disease in an HIV-1 positive man receiving HAART.

A case of small-cell lung cancer with prompt worsening of the clinical course was observed in a patient with significant immune restoration after receiving effective highly active antiretroviral therapy (HAART) for seven months. Rapid and enormous enlargement of metastatic liver was the main symptom. Chest x-ray showed an enlargement of the left hilus. The patient died 22 days after the onset of the fulminant disease. We suggest that the occurrence and aggressive course of the lung cancer resulted from the development of immune reconstitution syndrome.

[The role of brain magnetic resonance studies in the diagnostics of central nervous system lesions in HIV-1 positive patients]. / Rola rezonansu magnetycznego mózgowia w diagnostyce zmian w osrodkowym ukladzie nerwowym u pacjentów zakazonych HIV-1.

UNLABELLED: Approximately 10% of persons infected with human immunodeficiency virus (HIV) and 75-90% patients with acquired immunodeficiency syndrome (AIDS) present neurological symptoms. This group causes the greatest diagnostic difficulties among AIDS patients. The purpose of the study was to demonstrate the usefulness of the magnetic resonance imaging (MR) of the central nervous system (CNS) in the diagnosis and differentiation of primary and secondary lesions. MATERIAL AND METHODS: Fifty one patients with the symptoms suggesting CNS involvement were enrolled into the study. In 40 of them AIDS diagnosis was established based on the picture of CNS lesions. MR studies were performed using EDGE-ECLIPSE 1.5 T unit with FSE sequences, T1- and T2-weighted images, before and after paramagnetic contrast agent injection, in sagittal, coronal and transverse planes. In almost all cases FLAIR technique was also used. Thirteen persons were examined several times. Altogether we executed 62 studies. Magnetic resonance results were compared with the results of laboratory tests and sometimes histopathological examination at autopsy. RESULTS: Pathological findings were visible on MR of CNS in 37 (92.5%) of 40 patients with AIDS. In 8 (20%) cases the diagnosis of AIDS dementia complex (ADC) was established. Toxoplasmosis was diagnosed in 9 (22.5%) cases, tuberculosis in 6 (15%), cryptococcosis in 5 (12.5%) patients, progressive multifocal leukoencephalopathy (PML) in 3 (7.5%) patients, primary lymphoma also in 3 (7.5%), and atypical mycobacteriosis in 2 patient. In 1 (2.5%) case we could not establish the final diagnosis. We described the patterns of MR appearance in the different types of lesions mentioned above based on our findings and the literature review. CONCLUSIONS: Magnetic resonance imaging has a high sensitivity in identifying lesions of the central nervous system. It is very useful, together with the results of other tests, in the final diagnosis of the lesions in the CNS. Magnetic resonance plays also an important role in the treatment planning and monitoring of the efficacy of therapy used in AIDS patients.

[Hepatitis D virus superinfection--a rare cause of occupational disease]. / Nadkazenie wirusem zapalenia watroby typu D jako rzadka przyczyna choroby zawodowej.

The authors present a case of occupational HDV infection in a 38-year-old nurse, HBsAg carrier, injured by a needle contaminated with blood of a drug user infected with HIV, HBV and HCV. After 2 months she developed acute viral hepatitis. HBV, HCV, HIV, CMV, EBV and other non-viral liver diseases were excluded. Finally, based on the source of exposure with high probability of HDV infection, the patient's positive serological test for HDV, and the result of histological examination of the liver, the diagnosis of viral hepatitis type D was established. Our case report suggests the need to consider possible occupational HDV infection in certain circumstances as described above.