Coronary artery calcium score and other risk factors in patients at moderate and high risk of cancer therapy-related cardiovascular toxicity.

BACKGROUND: The presence and burden of coronary artery calcium (CAC) is a strong predictor of cardiovascular events. Current guidelines of the European Society of Cardiology (ESC) for cardio-oncology do not recommend the use of the CAC score to determine the status of risk in cancer patients. The aim of this study is to evaluate the presence and burden of CAC on cardiac tomography and the distribution of the cardiovascular toxicity risk factors in patients with moderate and high baseline risk of cancer therapy-related cardiovascular toxicity. METHODS: The study prospectively included cancer patients, diagnosed and qualified for systemic treatment with anthracycline chemotherapy. Clinical data and blood samples were collected from all patients. Additionally, the echocardiography and coronary computed tomography (CCTA) with the calculation of the coronary artery calcium (CAC) score were performed. RESULTS: A total of 80 patients (mean age 60.5 years, 75 female) were included in the study. The majority of patients (62, 77.5%) had breast cancer, 11 (13.8%) were diagnosed with sarcoma, and 7 (8.8%) with lymphoma. There were 42 (52.5%) patients classified as having moderate (MR) and 38 (47.5%) as having high risk (HR) of cancer therapy-related cardiovascular toxicity according to current ESC guidelines. In comparison with moderate risk, high risk patients were older and more likely to have hypertension, hyperlipidaemia and chronic kidney disease. The mean coronary artery calcium score was significantly higher in the HR group (150.4 vs. 24.8; p = 0.000). Furthermore, cardiac biomarkers were also higher in high-risk patients (p = 0.000). In echocardiographic parameters global longitudinal strain (GLS) was lower (p = 0.012), and diastolic dysfunction was more common in the HR group. However, the left ventricle ejection fraction (LVEF) was similar in the MR and HR groups. CONCLUSIONS: In patients at high and moderate risk for cancer therapy-related cardiovascular toxicity, cardiovascular toxicity risk factors were common and more prevalent in the high-risk group. The coronary artery calcium score was also significantly higher in the high-risk group. Assessing the presence and burden of coronary artery calcium is an attractive option to assess additional cardiovascular risk in cancer patients.

Detrimental effect of COVID-19 pandemic on patients with extremity bone sarcoma. Reference center experience.

1 BACKGROUND: COVID-19 pandemic had a major impact on the healthcare system globally. This work aims to evaluate COVID-19 impact on local treatment in bone sarcoma treated in a single, high-throughput institution. 2 METHODS: We have analyzed the local outcomes (i.e., possibility of limb sparing surgery) in all bone sarcoma patients treated between January 2016 and November 2022 in the main sarcoma reference center in Poland. Patients treated in the 2016-2019 period were regarded as "pre-pandemic" group, patients treated in 2020-2022 - "pandemic". Mann-Whitney U and Chi-square tests were used in the statistical analysis. No correction for multiple testing was applied. Tests with p < 0.05 were deemed significant. 3 RESULTS: There were 302 eligible patients identified. The group characteristics are presented in table 1. There were no differences in patient-related variables and histological subtypes of tumors between two groups. The tumor size did not differ (p = 0.053), when all tumor grades were considered, but high grade tumors were larger in the "pandemic" group (p = 0.034). This was reflected in the percentage of limb sparing surgeries which dropped from 83.3 % to 68.2 % ("pre-pandemic" vs. "pandemic", p = 0.004). This difference was even more stark in case of high grade tumors - 78 % vs. 54 % respectively (p = 0.001). 4 CONCLUSION: To our knowledge, this is the first report of the long lasting impact of COVID-19 pandemic on oncologic treatment outcomes in patients with malignant bone tumors.

Retrospective Observational Study to Determine the Epidemiology and Treatment Patterns of Patients with Triple-Negative Breast Cancer.

Triple-negative breast cancer (TNBC) poses a serious therapeutic challenge due to the occurrence of frequently aggressive, heterogenic, and metastatic tumours. The absence of therapeutic targets for traditional therapies is a hindrance to establishing a standardised therapy for TNBC. There is limited TNBCs epidemiological and real-world data about TNBC treatment regimens in Poland. We retrospectively analysed clinical data from our hospital registry from 2015 and 2020. A total of 8103 individuals with breast cancer were admitted to the MSCI, while 856 (10.6%) were diagnosed with TNBC. Most of the early-stage or locally advanced TNBC individuals had underlying conditions, presented mostly poorly differentiated (G3) stage II tumours and featured a bi-modal age distribution. On average, one-third of all tested TNBCs carried BRCA mutations and its identification impacted surgery preference. We observed a significant increase in the use of systemic therapy among TNBCs, whereas carboplatin and dose-dense regimens showed the most prominent upsurge in the neoadjuvant setting. Moreover, the use of neoadjuvants was positively correlated with less invasive breast and lymph node surgeries. The presented data align with general trends observed in other countries and will contribute to expanding knowledge in the planning of treatment regimens and their outcomes.

Cardiac valvular involvement in granulomatosis with polyangiitis in long-term observation.

INTRODUCTION AND OBJECTIVES: Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic autoantibody (ANCA)-associated systemic vasculitis and is characterized by inflammation of blood vessels. The aim of the present study was to assess cardiac valvular changes in patients with GPA in a cohort of 105 patients followed for a mean of six years. METHODS: We followed 105 patients (mean age 50.4 years, 67 female) for a mean of 6.2±1.3 years. Echocardiography and laboratory tests were performed in all patients. RESULTS: At baseline, 43% of patients were diagnosed with aortic regurgitation (AR), which was the most common valvular lesion. Moreover, it was the only valvular involvement that significantly increased during observation (p=0.01). In a multivariate model, only D-dimer level was a predictor of AR in this group of patients (OR 8.0 (95% CI: 1.7-38.2, p=0.01). CONCLUSIONS: Involvement of the heart valves is a common finding in patients with GPA, but significant valvular disease is a rare complication. The most common valvular disease in this group of patients is AR. Aortic valves are also the most prone to degeneration in the course of the vasculitis.

Modern Approach to Melanoma Adjuvant Treatment with Anti-PD1 Immune Check Point Inhibitors or BRAF/MEK Targeted Therapy: Multicenter Real-World Report.

BACKGROUND: The landscape of melanoma management changed as randomized trials have launched adjuvant treatment. MATERIALS AND METHODS: An analysis of data on 248 consecutive melanoma stage III and IV patients given adjuvant therapy in eight centers (February 2019 to January 2021) was conducted. RESULTS: The analyzed cohort comprised 147 melanoma patients given anti-PD1 (33% nivolumab, 26% pembrolizumab), and 101 (41%) were given dabrafenib plus trametinib (DT). The 2-year overall survival (OS), relapse-free survival (RFS), and distant-metastases-free survival (DMFS) rates were 86.7%, 61.4%, and 70.2%, respectively. The disease stage affected only the RFS rate; for stage IV, it was 52.2% (95% CI: 33.4-81.5%) vs. 62.5% (95% CI: 52.3-74.8%) for IIIA-D, p = 0.0033. The type of lymph node surgery before adjuvant therapy did not influence the outcomes. Completion of lymph node dissection cessation after positive SLNB did not affect the results in terms of RFS or OS. Treatment-related adverse events (TRAE) were associated with longer 24-month RFS, with a rate of 68.7% (55.5-84.9%) for TRAE vs. 56.6% (45.8-70%) without TRAE, p = 0.0031. For TRAE of grade ≥ 3, a significant decline in OS to 60.6% (26.9-100%; p = 0.004) was observed. CONCLUSIONS: Melanoma adjuvant therapy with anti-PD1 or DT outside clinical trials appears to be effective and comparable with the results of registration studies. Our data support a de-escalating surgery approach in melanoma treatment.

Prognostic value of coronary atherosclerosis and CAC score for the risk of chemotherapy-related cardiac dysfunction (CTRCD): The protocol of ANTEC study.

BACKGROUND: Cardiological complications of oncological treatment, including the most serious one, heart failure, constitute a significant and still unsolved clinical problem. A history of dyslipidemia and complications of atherosclerosis, including coronary artery disease, are established risk factors for cardiotoxicity in cancer patients. In recent years, a protective effect of statin treatment on the development of heart failure in cancer patients has been observed. This protocol describes a study aiming to assess the prognostic value of coronary atherosclerosis burden and the CAC score on the onset of cardiac dysfunction associated with cancer therapy. METHODS: ANTEC (Atherosclerosis iN chemoTherapy-rElated Cardiotoxicity) is a single-site, prospective, observational study to evaluate the influence of the coronary atherosclerosis and CAC score assessed by computed tomography on the development of left ventricular systolic dysfunction in cancer patients with at least moderate cardiotoxicity risk. A group of 80 patients diagnosed with cancer prior to high-dose anthracycline chemotherapy (doxorubicin ≥ 240 mg / m2 body weight or epirubicin ≥ 600 mg / m2 body weight), without a history of heart failure and coronary artery disease, will be included in the study. Patient follow-up is planned for 12 months. In all patients, coronary computed tomographic angiography (CCTA) will be performed once at the beginning of the study. The primary endpoint is the onset of cancer therapy-related cardiovascular toxicity, defined as mild, moderate, severe and very severe according to ESC 2022 Cardio-oncology guidelines. During follow up, echocardiography with GLS assessment will be performed every three months. Additionally, new biomarkers of atherosclerosis (IL-6, MPO, TNF-alpha) will be measured every 6 months. The study registration identifier on clinicaltrials.gov is NCT05118178. CLINICAL TRIALS REGISTRY: This study is listed on cinicaltrials.gov with identifier NCT05118178.

The Analysis of Trends in Survival for Patients with Melanoma Brain Metastases with Introduction of Novel Therapeutic Options before the Era of Combined Immunotherapy-Multicenter Italian-Polish Report.

Stage IV melanoma patients develop melanoma brain metastases (MBM) in 50% of cases. Their prognosis is improving, and its understanding outside the context of clinical trials is relevant. We have retrospectively analyzed the clinical data, course of treatment, and outcomes of 531 subsequent stage IV melanoma patients with BM treated in five reference Italian and Polish melanoma centers between 2014 and 2021. Patients with MBM after 2017 had a better prognosis, with a significantly improved median of overall survival (OS) after 2017 in the worst mol-GPA prognostic groups (mol-GPA ≤ 2): a median OS >6 months and HR 0.76 vs. those treated before 2017 (CI: 0.60−0.97, p = 0.027). In our prognostic model, mol-GPA was highly predictive for survival, and symptoms without steroid use did not have prognostic significance. Local therapy significantly improved survival regardless of the year of diagnosis (treated before or after 2017), with median survival >12 months. Systemic therapy improved outcomes when it was combined with local therapy. Local surgery was associated with improved OS regardless of the timing related to treatment start (i.e., before or after 30 days from MBM diagnosis). Local and systemic treatment significantly prolong survival for the poorest mol-GPA prognosis. Use of modern treatment modalities is justified in all mol-GPA prognostic groups.

Hepatitis C in Poland in 2020.

BACKGROUND: The year 2020 in the extent of HCV infection was set for the first milestones on the road to the eradication of HCV infection in 2030. In addition, in 2020 there was a global public health crisis - the COVID-19 pandemic. The aim of this paper was to assess the epidemiological situation of HCV infection based on epidemiological surveillance data in Poland in 2020. MATERIAL AND METHODS: Analysis of: 1) individual data from surveillance in 2020 conducted by EpiBaza system; 2) diagnosis rate from bulletins "Infectious diseases and poisonings in Poland" for the years 2014-2020; and 3) data about deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of Statistics Poland. RESULTS: In 2020, there was a significant decrease in the number of reported cases and thus in the diagnosis rate of HCV infection in Poland - 955 HCV infections were reported (2.49/100,000 - in comparison with 2019, 3.5 times less). The decrease occurred in all voivodeships (ranging from 0.50 to 6.37/100,000), we observe more districts in which HCV infections were not detected (in 2020 - 35.3%; in 2019 - 16.8%). The diagnosis rate of HCV infection in women and men was at a similar level. However, large disproportions are visible if age groups are considered in addition to gender. For years, we have observed a variation of the diagnosis rate of HCV infection depending on the environment of residence - also in 2020, higher values were reported overall in residents of urban than in rural areas (2.90 vs. 1.88/100,000). In 2.9% of newly diagnosed HCV infections, at the same time cirrhosis was already present, 0.4% had liver failure, and 0.1% had hepatocellular carcinoma. Among exposures of HCV infection, those related to nosocomial transmission still dominate (59%), also in acute hepatitis C (60%). One-third of reported infections were diagnosed in primary health care, and one in four were diagnosed during hospitalization. CONCLUSIONS: The data presented in this paper show that the COVID-19 pandemic deepened the inequalities observed for years in HCV areas. Establishing a diverse system of testing and linking to care in Poland, reaching those in the greatest risk of ongoing transmission of HCV infection, and providing methodologically correct studies to assess progress in the eradication of HCV infection is becoming increasingly urgent to achieve the planned 2030 WHO targets.

How sex and gender matter in infectious diseases - outcomes of the first Polish conference "A woman in an infectious diseases circle".

Occurrence of infectious disease in a woman is an interdisciplinary area of medicine. The common problem of lower recruitment of women to clinical trials leads to the necessity to rely in clinical practice on the exchange of practical experiences, specialist consultations and individualization of treatment. As the COVID-19 pandemic shows, there is a close relationship between infectious diseases and civilization diseases. People suffering from chronic diseases are both more susceptible to infection and the more severe course of an infectious disease. On the other hand, infection may accelerate or initiate the onset of a noncommunicable disease. Women, especially those living with HIV, are a group with an underestimated risk of high blood pressure or some cancers. Therefore, one of the main goals of the conference is to break the stereotypes of thinking about health, in which gender is the main determinant of some screening tests. Late presentation of women to medical care is a significant problem that is of great importance in the diagnosis and treatment of both communicable and non-communicable diseases. Women put family and professional responsibilities in the first place, and they are known to downplay their own health problems. It leads to the diagnosis of cardiovascular diseases or cancer at the stage of advanced changes, limiting the possibilities of effective therapy. Understanding gender attributed differences in the etiology and epidemiology of diseases allows for the improvement of patient care, as well as determines the right direction of reforms in the area of healthcare. It is essential to build models of care based on an interdisciplinary and patient-centered approach, with broad support from both stakeholders and NGOs. Each contact of the patient with the health care system should be seen as an opportunity for screening both in the area of civilization diseases, women's health, and infectious diseases corresponding to her lifestyle.

Neoadjuvant Pertuzumab Plus Trastuzumab in Combination with Docetaxel and Carboplatin in Patients with HER2-Positive Breast Cancer: Real-World Data from the National Institute of Oncology in Poland.

Neoadjuvant systemic therapy has now become the standard in early breast cancer management. Chemotherapy in combination with trastuzumab +/- pertuzumab targeted therapy can improve the rates of pathologic complete response (pCR) in patients with HER2-positive breast cancer. Achieving a pCR is considered a good prognostic factor, in particular, in patients with more aggressive breast cancer subtypes such as TNBC or HER2-positive cancers. Furthermore, most studies demonstrate that chemotherapy in combination with trastuzumab and pertuzumab is well tolerated. The retrospective analysis presented here concentrates on neoadjuvant therapy with the TCbH-P regimen, with a particular emphasis on patients over 60 years of age. We analysed the factors affecting the achievement of pCR and present the adverse effects of the applied therapies, opening discussion about optimizing the therapy of older patients with HER-2 positive breast cancer.

Integration of community-based testing data into national HIV surveillance in Poland, Serbia and Slovakia within the framework of INTEGRATE project.

BACKGROUND: Community-based voluntary counselling and testing contributes to early HIV diagnoses among key populations. Testing data from such decentralized services is however often not standardized nor linked to national surveillance systems. This study aimed to support the integration of community testing data into respective national surveillance and monitoring and evaluation systems for those infections. We present results from three national pilots, focused on improved data collection and transfer. METHODS:  Within the Joint Action INTEGRATE different pilot activities were planned and implemented according to the local context. In Slovakia, standardised data collection tools were implemented in three community testing services. The data generated was used to calculate the proposed indicators. In Poland, positive test results from the community testing database were linked to the national case-based surveillance database using confirmatory test number, to improve the completeness of behavioural data in the national database. In Serbia, voluntary counselling and testing forms were improved enabling identification of community-based testing. A system to generate unique client identifiers was initiated in the National registry of HIV cases to monitor linkage to care. RESULTS: All three sites were able to estimate most of the agreed indicators. In Slovakia during the study period 675 people were tested for HIV, 410 for hepatitis C and 457 for syphilis, with reactivity rates of 0.4, 2.5 and 1.8%, respectively. For HIV, 66.7% of reactive cases were confirmed and linked to care. In Poland, 28.9% of the community testing sites' records were linked to the national surveillance database (and accounted for 14.3% of all new diagnoses registered here during 2017-2018). Reactivity rate ranged between 1.9% and 2.1%. In Serbia, 80 persons were tested at community sites, from which two had a reactive HIV test result. By linking unique client identifiers from voluntary counselling and testing and National Registry of HIV cases databases, linkage to care within a two-month period was observed for one of two people with reactive HIV test result. CONCLUSIONS:  Pilot activities in the three countries demonstrate that integration of community-based testing data into surveillance systems is feasible and can help improve national surveillance data by providing key information.

HIV and AIDS in Poland in 2018.

AIM: The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2018 in comparison to the changes in preceding years. MATERIALS AND METHODS: Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. RESULTS: In 2018 there were 1,209 HIV cases newly diagnosed in Poland (diagnosis rate: 3.15 per 100,000), including 100 among non-Polish citizens. The frequency of newly detected HIV infections decreased by nearly 14.8% compared to the previous year and was higher by almost 6.8% compared to the median in 2012-2016 years. The total number of AIDS cases was 110 (incidence 0.29 per 100,000), and 23 people died from AIDS disease (0.06 per 100,000). New HIV diagnoses were reported mainly among people in age 30 to 39 years (37.8%) and among men (86.8%). Among cases with known transmission route, 77.0% concerned among men who had sexual contact with men (MSM). However, compared to the previous year, there was a significant decrease in the percentage of infected people in all key populations, related to higher risk of HIV infection. In addition, we observe the drop in total number of infected people in 2018 compared to the previous year. Whether these observations represent just fluctuations or a stable tendency, related to decreasing incidence in different key populations can only be assessed in the following years. The percentage of AIDS cases diagnosed at the same time with HIV diagnosis decreased by 4% percent points in comparison to 2017 (from 75.7% to 71.84% of all incident AIDS cases). CONCLUSIONS: Despite the decreasing total number of new HIV diagnoses overall and among different key populations compared to the previous year, it is too early to conclude that these are the results of positive preventive measures. Still, all actions should be taken to ensure timely linkage to care, considering the growing number of infected people among foreigners residing in Poland, and to improve the low frequency of testing towards HIV in the whole population.

Hepatitis C in Poland in 2016

INTRODUCTION: In 2016, the World Health Organization implemented a Global Strategy to eliminate viral hepatitis. For Hepatitis C, the goals of this Strategy include increased harm reduction coverage, improved safety of medical procedures and an increase the percentage of people diagnosed and treated. OBJECTIVE: This article aims are evaluating the epidemiological situation of HCV infections in Poland in 2016 in reference to the data from previous years. MATERIAL AND METHODS: Analysis of epidemiological situation of hepatitis C in Poland in 2016 was carried out on case-based data collected through routine surveillance system. Data on hepatitis C mortality from the Demographic Surveys and Labour Market Department of the Central Statistical Office were also included. RESULTS: In 2016, a total of 4,261 cases were reported. Diagnosis rate was 11.09 per 100,000, on the similar level as in 2015 (1% decrease), but in comparison to the median for the years 2010-2014 it increased by 88%. The most common possible route of HCV infection were medical procedures accounting for 69.8% of all cases and for 58.2% of acute hepatitis C virus infection cases. In 2016, 224 deaths due to hepatitis C were registered. In 2016, a hepatitis C outbreak was reported in malopolskie voivodeship (11 patients of the Hemato-oncolology Department, 129 people exposed). CONCLUSIONS: The increase of HCV diagnosis rate, which has been reported for last three years, is probably a consequence of improved the surveillance, including mandatory reporting of positive laboratory results, but also increased availability of HCV laboratory screening. Medical exposures are still an important route of transmission of HCV in Poland.

Potential adjustment methodology for missing data and reporting delay in the HIV Surveillance System, European Union/European Economic Area, 2015.

Accurate case-based surveillance data remain the key data source for estimating HIV burden and monitoring prevention efforts in Europe. We carried out a literature review and exploratory analysis of surveillance data regarding two crucial issues affecting European surveillance for HIV: missing data and reporting delay. Initial screening showed substantial variability of these data issues, both in time and across countries. In terms of missing data, the CD4+ cell count is the most problematic variable because of the high proportion of missing values. In 20 of 31 countries of the European Union/European Economic Area (EU/EEA), CD4+ counts are systematically missing for all or some years. One of the key challenges related to reporting delays is that countries undertake specific one-off actions in effort to capture previously unreported cases, and that these cases are subsequently reported with excessive delays. Slightly different underlying assumptions and effectively different models may be required for individual countries to adjust for missing data and reporting delays. However, using a similar methodology is recommended to foster harmonisation and to improve the accuracy and usability of HIV surveillance data at national and EU/EEA levels.

Next-generation sequencing analysis of a cluster of hepatitis C virus infections in a haematology and oncology center.

Molecular characterization of early hepatitis C virus (HCV) infection remains rare. Ten out of 78 patients of a hematology/oncology center were found to be HCV RNA positive two to four months after hospitalization. Only two of the ten patients were anti-HCV positive. HCV hypervariable region 1 (HVR1) was amplified in seven patients (including one anti-HCV positive) and analyzed by next generation sequencing (NGS). Genetic variants were reconstructed by Shorah and an empirically established 0.5% variant frequency cut-off was implemented. These sequences were compared by phylogenetic and diversity analyses. Ten unrelated blood donors with newly acquired HCV infection detected at the time of donation (HCV RNA positive and anti-HCV negative) served as controls. One to seven HVR1 variants were found in each patient. Sequences intermixed phylogenetically with no evidence of clustering in individual patients. These sequences were more similar to each other (similarity 95.4% to 100.0%) than to those of controls (similarity 64.8% to 82.6%). An identical predominant variant was present in four patients, whereas other closely related variants dominated in the remaining three patients. In five patients the HCV population was limited to a single variant or one predominant variant and minor variants of less than 10% frequency. In conclusion, NGS analysis of a cluster of HCV infections acquired in the hospital setting revealed the presence of low diversity, very closely related variants in all patients, suggesting an early-stage infection with the same virus. NGS combined with phylogenetic analysis and classical epidemiological analysis could help in tracking of HCV outbreaks.

Genital Chlamydia trachomatis infections in young adults - a school-based bio-behavioural study in urban areas, Poland, 2012 to 2015.

Context and AimOne of the most common sexually transmitted pathogens disproportionately affecting young people is Chlamydia trachomatis (CT). This study aimed to assess prevalence of CT among sexually active students (aged 18-19 years) in their final years of high school education in Warsaw and Krakow. Methods: The sample was selected from 61 clusters, each cluster representing one school. We described city, sex, type of school and their association with CT prevalence. To account for non-responders we applied inverse probability weighting. Results: Our study population consisted of 3,136 young adults eligible for CT screening, of whom 2,326 reported having had sexual intercourse within past 12 months. Of the 950 students who agreed to be tested, 39 were infected with CT. Weighted prevalence of CT was 3.9% (95% confidence interval (CI): 2.7-5.1); however, prevalence in the students in Warsaw (6.6%; 95% CI: 3.5-12.4) was six times higher (prevalence ratio (PR) = 5.9; 95% CI: 2.0-17.3) than in Krakow (1.1%; 95% CI: 0.5-2.6). In both settings, female students attending vocational-technical schools were most affected; the prevalence in this group was more than five times higher (PR = 5.2; 95% CI: 1.7-15.6) compared with female peers in high schools and more than three times higher (PR = 3.3; 95% CI: 1.0-10.7) compared with male peers attending vocational-technical schools. Conclusion: Our study suggested prevalence of CT infection among young people in Poland comparable with the European average, supporting implementation of a CT control programme as recommended in international guidelines.

The problem of elimination of HCV infections in Poland

The article concerns abbreviated presentation of the results obtained in the Project KIK / 35 "Prevention of HCV infection," sponsored by the Government of the Swiss Federation and the Ministry of Health of the Republic of Poland. The Project concerned the analysis of the prevalence of HCV infection in the adult population in Poland, the risk factors and groups at risk of these infections. Two sub-projects were related to separate subpopulations: pregnant women and drug users. Research in one sub-project focused on the hazards of HCV infections in medical institutions and non-medical facilities, where the procedures are performed with the interruption of tissue. In all sub-projects were carried out surveys, which served to check the knowledge ofn HCV infections, but also practical measures aimed at preventing these infections. One of the sub projects KIK / 35 "Education of medical staff and nonmedical as a key element in the prevention of blood-borne infections" was devoted entirely to the education of professionals responsible for the proper, safety, performance of procedures running with interruption of tissues." The results of these studies revealed significant shortcomings in the detection of existing infections and large gaps in knowledge about prevention. Taking into account the range of expertise needed, it turned out that the lack of information applies to both the general public and to many professionals. The project KIK / 35 in its summary refers to the risks of HCV infection, both known from the literature and disclosed the specificity of our country. The ultimate result of the Project NCI / 35 is to develop a strategy for the elimination of HCV infections in Poland. This strategy, strongly linked to the WHO strategy includes integrated, permanent preventive measures related tot he introduction of screening programs for early detection of HCV infections and treat them as important element in prevention. Special emphasis was put on universal access to diagnosis and treatment for all social groups.

Relating HIV testing patterns in Poland to risky and protective behaviour.

The aim of the study was to understand HIV testing patterns needed to improve access to early HIV diagnosis, and to investigate the spread of the virus in different populations. We examined prior testing history of individuals presenting for an HIV test across all 30 voluntary testing and counselling sites in Poland, 2008-2010 to determine factors associated with the testing rate using zero-truncated Poisson regression. Of 2397 persons presenting for an HIV test, 25 (1%) were HIV positive and 470 (19.6%) were repeat testers. The proportion of repeat testers was higher among men who have sex with men (MSM) at 37% (90/246), and people who inject drugs (PWID) at 32% (21/65). Higher testing rate was independently associated with exposure category (testing rate ratio, RR for MSM = 2.0, 95% CI 1.6-2.6, and 1.6, 0.9-2.6 for PWID), >5 sex partners (1.9, 1.4-2.7), high-risk partner (1.3, 1.1-1.6), urban residence (2.1, 1.3-3.5) and higher education attainment (1.1, 1.0-1.5). Inconsistent condom use with casual partners and sex under the influence of alcohol were associated with lower testing rates. There is a need to increase HIV testing uptake in Poland, especially among the rural population. Despite testing rates being higher among populations with higher risk of exposure to HIV (MSM and PWID), they still remain low, indicating the existence of barriers to testing.

Genetic Variability of Hepatitis C Virus (HCV) 5' Untranslated Region in HIV/HCV Coinfected Patients Treated with Pegylated Interferon and Ribavirin.

Association between hepatitis C virus (HCV) quasispecies and treatment outcome among patients with chronic hepatitis C has been the subject of many studies. However, these studies focused mainly on viral variable regions (E1 and E2) and usually did not include human immunodeficiency virus (HIV)-positive patients. The aim of the present study was to analyze heterogeneity of the 5' untranslated region (5'UTR) in HCV/HIV coinfected patients treated with interferon and ribavirin. The HCV 5'UTR was amplified from serum and peripheral blood mononuclear cells (PBMC) samples in 37 HCV/HIV coinfected patients treated for chronic hepatitis C. Samples were collected right before treatment, and at 2, 4, 6, 8, 12, 20, 24, 36, 44, 48, 60, and 72 weeks. Heterogeneity of the 5'UTR was analyzed by single strand conformational polymorphism (SSCP), cloning and sequencing. Sustained virological response (SVR) was achieved in 46% of analyzed HCV/HIV co-infected patients. Stable SSCP band pattern was observed in 22 patients (62.9%) and SVR rate among these patients was 23%. Decline in the number of bands and/or shift in band positions were found in 6 patients (17.1%), 5 (83%) of whom achieved SVR (p=0.009). A novel viral genotype was identified in all but one of these patients. In 5 of these 6 patients a new genotype was dominant. 5'UTR heterogeneity may correlate with interferon and ribavirin treatment outcome. In the analyzed group of HCV/HIV coinfected patients, viral quasispecies stability during treatment favored viral persistence, whereas decrease in the number of variants and/or emergence of new variants was associated with SVR. Among injection drug users (IDU) patients, a new genotype may become dominant during treatment, probably due to the presence of mixed infections with various strains, which have different susceptibility to treatment.

Hepatitis C in Poland in 2015

INTRODUCTION: On account of the asymptomatic course, no possibility to prevent by vaccination and the serious consequences of long-term infection (liver cirrhosis, hepatocellular carcinoma), hepatitis C (HCV infection) is a serious public health problem. OBJECTIVE: This article aims are evaluating the epidemiological situation of HCV infections in Poland in 2015 in reference to the data from previous years. MATERIAL AND METHODS: Analysis of epidemiological situation of hepatitis C in Poland was carried out on a basis of aggregated data from routine surveillance system published in annual bulletin "Infectious Diseases and Poisonings in Poland". Data on hepatitis C mortality from the Demographic Surveys and Labour Market Department of the Central Statistical Office were also included. In 2015, mandatory reporting included: 1) HCV infections diagnosed by physicians and 2) positive laboratory test results for HCV. RESULTS: In 2015, a total of 4,285 cases were reported (diagnosis rate 11.14 per 100,000). The diagnosis rate increased by 21% compared to 2014 (2014: 3 551 cases, 9.23 per 100,000) and doubled with respect to the median value in 2009-2013 (2,189 cases, 5.68 per 100,000). For the first time the diagnosis rates in men and women were comparable (11.10 per 100,000 vs. 11.19 per 100,000). The percentage of people hospitalized due to HCV infection at HCV diagnosis decreased (in 2015 - 39.0%, in 2014 - 48.4%). In 2015, 239 deaths due to hepatitis C were registered. CONCLUSIONS: The increased diagnosis rate of hepatitis C in 2015 may be a consequence of improved reporting, legislative changes (introduction of mandatory reporting of positive laboratory results) as well as enhanced publicity and other HCV control activities, including increased availability of HCV laboratory screening.