[Malignancy cases in HIV-positive patients in Lodz region in years 1992-2010]. / Zachorowania na nowotwory pacjentów zakazonych HIV z regionu Lódzkiego w latach 1992-2010.

UNLABELLED: Cancers are increasingly recognized as a complication of HIV infection. The traditional AIDS defining cancers (ADCs), including Kaposi sarcoma, cervical cancer, and non-Hodgkin's lymphoma, are common in HIV-positive individuals. However, in the period of antiretroviral therapy the incidence of non-AIDS-defining cancers (NADCs) has increased significantly. The aim of this study was to review the incidence and outcomes of cancers in HIV-infected patients. MATERIAL AND METHODS: Age, sex and CD 4 cells count at the moment of cancer diagnose were assessed. RESULTS: From 1992 to 2010 year cancers were diagnosed in 30 patients (one patient has two malignancies simultaneously). In study group ADCs were seen in 21 patients (68%) while NADCs were observed in 10 patients (32%). Mean age at the time of diagnose of ADCs and NADCs was 41.9 and 46.6 years, respectively. Mean CD4 cells count at the time of cancer diagnose of ADCs and NADCs was 177.5 and 201,0 cells/microL, respectively. The most common ADCs was non-Hodgkin's lymphoma and NADCs was lung cancer. In presented study only in 10 patients (33%) full remission of malignancy was reported. SUMMARY: ADCs are common group of cancers. Nowadays, in period of antiretroviral therapy NADCs are increasingly problem. The cancer-related mortality in HIV-positive patients is still significant.

Evolving patterns of HIV-1 transmitted drug resistance in Poland in the years 2000-2008.

The aim of the study was to determine the rate of transmission of drug resistant human immunodeficiency virus-1 (HIV-1) variants among therapy-naïve HIV positive patients in Poland in the year 2008, to compare the data with the results from the years 2000 to 2007 and to monitor patterns of HIV-1 subtypes present in Polish population and their evolution. Complete protease and part of reverse transcriptase regions were sequenced from the sera of patients directed to the laboratory for drug resistance testing. The Stanford's HIVdb program was used for the interpretation of results and subtyping. The variants scoring at least "intermediate resistance" for at least one drug were considered as resistant. The results obtained were compared to those obtained in the years 2000-2007. A total of 95 patients were enrolled in the 2008 study. Homosexual transmission of infection was documented in more than 55% of all cases. The overall prevalence of transmitted drug resistance (TDR) was 5.3% (3.9% in 2007, 5.8% in 2006, and 14.1% in the years 2002-2005). The study from the years 2000 to 2001 revealed 28.7% prevalence. Preliminary analysis of the first half of 2009 shows the ratio of 7.8%. In four (4.2%) cases drug resistance was associated with protease inhibitors class, in one case (1.1%) with resistance to non-nucleoside reverse transcriptase inhibitors class. In four cases (4.2%) non-B subtype was identified (C, G, CRF01_AE, CRF02_AG). An increase of percentage of drug resistant mutants-from 3.9% (2007) to 5.3% (2008)-was recognized. In this study, TDR was limited to single classes of antiretroviral drugs. HIV-1 subtype B prevails in Poland.

[Causes of antiretroviral therapy discontinuation in the outpatient HIV/AIDS clinic in Lodz]. / Przyczyny przerwania leczenia antyretrowirusowego w poradni nabytych zaburzen odpornosci w Lodzi.

UNLABELLED: Aim of the study was to assess when, why and which patients discontinued antiretroviral (ARV) therapy. MATERIAL AND METHODS: Retrospective analysis of the files of patients who started ARV therapy in 1997 - 2007 and were followed up for at least 2 years. RESULTS: The study group consisted of 183 patients--131 men (71,6%) and 52 women (28,4%), mainly former intravenous drug users (IDUs) (66,1%). At least one treatment discontinuation occurred in 71 persons (38,8%) and this happened usually in the first year of therapy. Treatment discontinuation was significantly more common in younger patients and in the individuals infected through intravenous drug use. Among 138 cases of ARV treatment discontinuation the main reasons were: neglecting of visits in HIV/AIDS clinic due to: return to drug addiction (28 cases), alcohol abuse (16 cases) or exacerbation of psychosis (10 cases), intolerance of the treatment--patient's decision (22 cases). In 62 cases no reason for visits neglecting was found. Less common causes of ARV therapy discontinuation were: fate events (11 cases) and doctor's decision (7 cases). CONCLUSIONS: Discontinuation of ARV therapy is a common problem emerging already in the first year of treatment. It occurs more frequently in former IDUs, so this group of patients needs a special preparation for ARV therapy.

[Efficacy of vaccination against hepatitis A in HIV infected adults from Lodz region--preliminary report]. / Ocena skutecznosci szczepienia przeciwko wirusowemu zapaleniu watroby typu A w grupie doroslych osób zakazonych HIV z regionu lódzkiego--doniesienie wstepne.

OBJECTIVE: To estimate the prevalence of anti-HAV-T in the group of HIV-positive adults and to assess the efficacy of vaccination against viral hepatitis A. MATERIAL AND METHODS: In HIV-infected outpatients anti-HAV-T was determined (electrochemiluminescence method). Patients susceptible to HAV infection were qualified for vaccination. RESULTS: In the group of 175 HIV-infected patients, 70 persons (40%) were anti-HAV-T positive. Prevalence of anti-HAV-T was significantly higher in patients over 35 years of age. Anti-HAV-T were present in all individuals older than 50 years. So far 47 patients have completed vaccination. Good response (detectable anti-HAV-T 1 month after booster dose) was obtained in 73,0% patients. Individuals with actual CD4 count above 200 cells/ul responded better (81,2%) than persons with CD4 count 200 cells/ul or lower (20%). Nadir CD4 count above 50 cells/ul predicted better response than 50 cells/ul or below (78,8% and 25% respectively). One year after vaccination anti-HAV-T were still detectable in 21 patients (56,8%). CONCLUSIONS: 1. Most of studied HIV-positive patients (60%) were susceptible to HAV infection and should be vaccinated. 2. Good response to vaccination was obtained in 73% of patients and it was higher in persons with actual CD4 count above 200 cells/ul and nadir CD4 count above 50 cells/ul.

[Transmission of HIV-1 drug resistance among newly diagnosed patients in Poland]. / Transmisja lekoopornych szczepów HIV-1 wsród osób nowo diagnozowanych w Polsce.

OBJECTIVE: HIV-1 drug resistance is becoming a growing concern. It is estimated that one out of ten newly diagnosed persons in Europe acquires HIV drug resistant strain. The aim of this study was to determine the transmission of drug resistance and identify the resistance patterns among naïve patients in Poland. METHODS: The patients were asked to complete a brief questionnaire concerning demographic and epidemiological data. Viral load and CD4/CD8 counts were detemined before drug resistance testing. The sequencing assay was performed according to manufacturer's protocol. MAIN OBSERVATIONS: In the analysed cohort 14.7% of patients acquired HIV-1 drug resistant strains; further 9.5% were infected with strains with "possibly lowered susceptibility". RESULTS: In all cases resistance to single class of antiretroviral drugs were identified. In the class of PIs resistance to NFV was the most common. The rates of drug resistance among NNRTIs were almost the same--about 5%. In the NRTI class the resistance to AZT and d4T was the most frequent. HIV-1 subtype B was identified in 88.8% of cases. CONCLUSIONS: The results of this study document high transmission rate of drug resistance in Poland and justify the necessity of common DR testing in our country.

[Acceptance of HIV+ patients by health care workers as experienced by seropositive patients in Lodz Region, Poland]. / Stopien akceptacji pacjentów HIV+ przez pracowników sluzby zdrowia w regionie lódzkim w ocenie samych zakazonych.

UNLABELLED: Intensive education on HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) problems is carried out in Poland for more than 20 years and involves also health care workers. The aim is to diminish the fear and prejudice concerning HIV+ persons, who should have equal access to medical care. The aim of the study was to find out the HIV+ patients' opinion on the attitude of medical personnel toward patients living with HIV/AIDS 22 years after epidemic start in Poland. MATERIAL AND METHODS: From April through July 2007, consecutive patients in AIDS outpatient setting in Lodz, Poland, were asked to fill in a questionnaire form anonymously. RESULTS: Questionnaire forms were filled in by 73 patients: 49 men and 24 women who knew about their serologic status for 3 months - 16 years (mean 5.9 +/- 3.3). Many patients who revealed their serologic status faced unfriendly attitude of medical staff (30.0-39.3% in various settings) and some of them were refused medical care because of HIV infection. It happened most frequently in the dentist practice (23.3%), but also in hospital settings: in surgery (7.1%), in other settings (except for AIDS outpatient clinic) 3.6%. Outpatient specialist clinics refused medical care of 6.3% of patients. Many patients living with HIV/AIDS (12.5-36.5%) did not reveal their seropositivity, mainly because of fear of treatment refusal or bad experience in the past. CONCLUSIONS: Discrimination of HIV positive patients by health care workers still happens in Lodz region and is not incidental. Education concerning HIV/AIDS infection is still necessary in medical personnel, especially in dentists.

[Staphylococcal toxic shock syndrome]. / Gronkowcowy zespól wstrzasu toksycznego.

[A case of menstrual toxic shock syndrome (TSS) in a woman aged 21 is reported. Diagnosis was made on clinical basis and was followed by successful treatment]