The present and future disease burden of hepatitis C virus (HCV) infections with today's treatment paradigm - volume 2.

Morbidity and mortality attributable to chronic hepatitis C virus (HCV) infection are increasing in many countries as the infected population ages. Models were developed for 15 countries to quantify and characterize the viremic population, as well as estimate the number of new infections and HCV related deaths from 2013 to 2030. Expert consensus was used to determine current treatment levels and outcomes in each country. In most countries, viremic prevalence has already peaked. In every country studied, prevalence begins to decline before 2030, when current treatment levels were held constant. In contrast, cases of advanced liver disease and liver related deaths will continue to increase through 2030 in most countries. The current treatment paradigm is inadequate if large reductions in HCV related morbidity and mortality are to be achieved.

Impact of TTV and SENV infection in chronic hepatitis B or C on liver histology and therapy outcome.

AIM: To determine the influence of TTV and SENV on histological findings and viral response in patients with chronic viral hepatitis B and C. BACKGROUND: The clinical impact of TTV or SENV coinfections in these patients remains unclear. METHODS: Serum and liver biopsy specimens from chronic hepatitis B and C patients, 107 with liver biopsy and 105 who had finished complete antiviral therapy, were investigated for the presence of TTV and SENV. RESULTS: The Ishak score determined from 107 liver biopsy samples compared according to TTV or SENV coinfection was similar. Among 39 chronic hepatitis C patients with and 43 without virological response, we have found 9 and 3 SENV positive (p < 0.05) and 18 and 28 TTV positive patients, respectively (not significant). However 11 of 32 biopsy samples obtained in the responder's group and 19 of 31 in non-responders were TTV positive (p < 0.05). No similar differences were observed among 23 chronic hepatitis B patients. TTV clearance after interferon therapy exceeded 80%, clearance of SENV 90%. CONCLUSION: TTV or SENV infections did not negatively influence the severity of histological features or the antiviral response in patients with chronic hepatitis B and C. Both viruses were highly sensitive to interferon therapy (Tab. 5, Ref. 29).

[Epidemiological survey of hepatitis C at the Clinic of Infectology and Travel Medicine in Kosice]. / Epidemiologický prehl'ad hepatitidy C na Klinike infektológie a cestovnej medicíny v Kosiciach.

INTRODUCTION: The study objective was to evaluate epidemiological aspects in patients with hepatitis C treated at the Clinic of Infectology and Travel Medicine in Kosice. MATERIAL AND METHODS: A retrospective analysis was performed of 232 patients (132 males and 100 females, mean age 43.8 years) followed up and treated with the diagnosis of hepatitis C (HC) in 2003 through 2007. RESULTS: The probable sources of infection were most often blood transfusion (in 31% of patients), injecting drug use (9%) and invasive medical procedures (6%). Tattooing and piercing procedures were a potential route of infection in 4% of HC cases, while other risk factors were less common. None of the HC risk factors was identified in 41% of HC patients. HCV genotype was determined in 198 patients. HCV genotype 1 was detected in nearly 90% of the tested HC patients, HCV genotype 3 in 36.6%, HCV genotype 2 in 3 patients and HCV genotypes 4 and 6 in one patient each. Two HC cases were coinfections with HCV genotypes 1 and 3 or 1 and 4. The mean time interval from the first detection of elevated aminotransferase activity to the diagnosis and therapy institution was 6.3 years. CONCLUSION: The most common source of infection was blood transfusion, followed by injecting drug use and surgery. The prevailing HCV genotype is 1. In the future, it would be necessary to reduce the time interval from the detection of liver damage to the etiological diagnosis of HC, which has been too long.

[Prevalence of hepatitis C virus infection in Slovakia]. / Prevalencia infekcie vírusom hepatídy C v Slovenskej republike.

OBJECTIVE: To assess the prevalence of hepatitis C in the general Slovak population without any further evaluation or risk group stratification. MATERIAL AND METHODS: A total of 3,608 remnant serum specimens from epidemiological surveys in 1997 (1,484 specimens) and 2002 (2,124) were analyzed. These were from randomly selected persons over 15 years of age from all over Slovakia. The anti-HCV antibodies were detected using the 4th generation ELISA test. In case of positive or borderline results, the presence of HCV RNA was determined qualitatively. RESULTS: Of the 3,608 analyzed specimens, 55 (1.52 %) were anti-HCV-positive and 10 (0.28 %) were borderline positive. HCV RNA was detected in 24 cases (0.67 %). A comparison of the 1997 and 2002 results showed a statistically significant (p < 0.01) increase of anti-HCV-positive specimens. A similar--but not significant--increase was noted in HCV RNA-positive cases. Despite a slightly higher prevalence of HCV infection in females, no statistically significant gender differences were found. Whereas anti-HCV positivity increased slightly with age, most HCV RNA patients were from the middle age group, i.e. between 36 and 45 years of age. The geographic distribution of HCV cases across Slovakia was relatively even. CONCLUSIONS: The prevalence of anti-HCV antibodies in subjects representing the general population of Slovakia older than 15 years was 1.52 %; chronic HCV infection was confirmed in 0.67 % of cases.

Detection of SEN virus in the general population and different risk groups in Slovakia.

Sera of 426 adult persons were examined to assess the prevalence of SEN virus (SENV) infection in Slovakia and to determine the importance of different risk factors for parenteral transmission. SENV prevalence was determined by the PCR method using primers of SENV-D and SENV-H strains. Positive results were found in 10 of 37 patients with acute hepatitis of unknown etiology, 7 of 38 with acute hepatitis B, 17 of 44 with chronic hepatitis B, 29 of 102 with chronic hepatitis C, 36 of 72 hemodialysis patients, 2 of 33 health care workers and 24 of 100 persons from the control group. The highest prevalence of SENV was among hemodialysis patients, significantly higher than in the groups of health care workers, acute hepatitis B and controls. The lowest prevalence was in health care workers group, significantly lower also in comparison with groups of chronic hepatitis B and C. Among the possible risk factors of virus transmission the average duration of hemodialysis (1.15 vs. 0.50 years), number of surgeries (1.60 vs. 1.10) and transfusions (1.34 vs. 0.94) showed notable differences in terms of SENV infection. Bilirubin and aminotransferase levels did not differ between SENV-positive and -negative groups. No pathogenetic role of SEN virus in liver injury was confirmed.

[Travel during pregnancy and possibilities of vaccination]. / Cestovanie v tehotenstve a moznosti ockovania.

Pregnancy presents special medical problem where we need to take into account travel risks regarding pregnant women and the health limits as a consequence of pregnancy. It is also important to consider the fact that active prevention and treatment approaches are to a large degree limited by the pregnancy. The most optimal period for travelling is the second trimester. In most cases, the potential risk of administering the vaccine is theoretical and not based on clinical evidence. Pregnancy presents a special problem regarding many aspects of immunization: benefit of vaccination, potential disease risk to the mother and fetus and safety of vaccine to mother and fetus itself. In general, pregnant patients should avoid live vaccines. Vaccination with inactivated, conjugated, polysacahecride vaccines and toxoids is possible. The first trimester of pregnancy is the most vulnerable period because of theoretical risk of harmful effects to the fetus.

["Economy class syndrome"--common risk of travelers?]. / "Economy Class Syndrome"--casté riziko cestovatel'ov?

Economy class syndrome is the term for cases of venous thrombosis/, that start in connection with travelling for long distance. Syndrome occurs most frequently in economy class of flying. Because of crowded uncomfortable conditions by sitting, without movement during longer journey by plane can cause thrombosis, especially for patients with risk factors. Sequentially thrombembolism can occur. The most often risk factors are age, obesity, hormonal contraception, previous thrombosis in case history, smoking, immobilization, diabetes mellitus, diseases of vascular system and kidneys, and others.

[The incidence and clinical picture of hemorrhagic fever with renal syndrome in East Slovakia: the eastern and western type]. / Výskyt a klinický obraz hemoragickej horúcky s renálnym syndrómom (HFRS) na východnom Slovensku: západný a východný typ.

Hemorrhagic Fever with renal syndrome (HFRS) is endemic in East Slovakia. The paper presents the clinical picture of 4 serologically confirmed cases. Two of the 4 patients had serological evidence of recent Hantaan virus infection. Positive immunofluorescent reactions with Puumala virus (CG 18-20) were detected in the sera of the other two patients. The obtained results suggest the circulation of two serotypes of HFRS in Slovakia.

[Occurrence of acute infectious diarrhea during the lunar phases]. / Výskyt akútnych infekcných hnaciek v priebehu mesacného cyklu.

A chronobiometric analysis of 753 cases of acute infectious diarrhoea in adults in 1981-1990 in Kosice confirmed to a surprising extent recently reached conclusions of an investigation made by authors from Bratislava. The Kosice group comprised 352 cases of bacillary dysentery, 305 patients with salmonellosis, 72 with campylobacteriosis and 24 with yersiniosis. Statistically significantly fewer patients (p < 0.0001) were hospitalized during full moon, moon quarterly and new moon. In the intervals there were periods with a short-term increase of the daily admissions by cca 25%. This 7.38-day periodicity cannot be explained by the influence of the social 7-day week, as during observations extending over several years this rhythm is eliminated by a gradual shift across different phases of the moon. The authors did not find similar reports in the literature. For explanation, not only the organism of the host (variable immunity?) but also the infectious agent must be taken into account. More profound understanding of the mechanism may open the road to practical application of the described lunar relationship. Its knowledge can help already now to improve the organization of the health service.

[Löffler's endocarditis]. / Löfflerova endokarditída.

The authors describe Loeffler's endocarditis and the treatment of this clinical entity. Among diagnostic methods which drew attention to a cardiac affection associated with eosinophilia, non-invasive examination methods were of decisive importance. They comprised conventional electrocardiographic examination, X-ray of the chest and two-dimensional echocardiography.

[Liver biopsy in Slovakia]. / Biopsie pecene na Slovensku.

INTRODUCTION: Liver biopsy is the most specific diagnostic modality in hepatology, but information about its application in Slovakia is rather obscure. METHODS: The authors performed a correspondence study with the aim to find out how many biopsy examinations has been done in Slovakia in 2001, for which indications, what kind of techniques have been applied and which small or great complications were encountered. RESULTS: It was established that in the year 2001, 400 biopsies for diffuse liver diseases were performed. There were 296 percutaneous biopsies, 82 laparoscopic biopsies and 22 trans-jugular biopsies forming the survey. Acute viral hepatitis was the most frequent indication, whereas non-alcohol steatohepatitis was a rare indication in spite of the high prevalence. The frequency of great complications was 0.00025%. No death associated with this procedure was reported. CONCLUSION: Liver biopsy has been done in Slovakia in indications, ways and with the frequency of complications, which were comparable with data from literature.