Andrzej Gładysz

Prevalence of Demodex spp. in eyelash follicles in different populations

Introduction The pathologic relevance of Demodex infestation in blepharitis is still controversial. The aim of the study was to determine the prevalence of Demodex spp. in eyelash follicles and its relationship to eye symptoms. Material and methods A total of 290 individuals were studied for the presence of Demodex folliculorum and Demodex brevis within eyelash follicles. Participants belonged to one of four groups: inpatients, drug abusers, health professionals, and medical students. Ten eyelashes were epilated from each subject, placed on microscope slides and examined for parasites. The sample was defined as positive if at least one parasite or parasites ova were present. The presence of parasites was analyzed according to age, gender, place of living, reported eye problems, and use of contact lenses or glasses. Results The prevalence of Demodex spp. infestation among all studied subjects was 41%, with the highest infestation rate among inpatients (p < 0.01) and elderly people (p < 0.001). No difference regarding the presence of Demodex was found between women and men (p = 0.76). Demodex folliculorum was about 2.4 times more frequent than D. brevis. The prevalence of Demodex spp. in subjects with and without eye complaints suggesting blepharitis was similar (41.6% vs. 40.2%, respectively, p = 0.9). On the other hand, wearing glasses was linked to Demodex infestation (48.4% vs. 32.3%, p < 0.01). Conclusions Demodex is a common saprophyte found in human eyelash follicles. Its presence might be related to some ocular discomfort; however, in the vast majority of cases the infestation seems to be asymptomatic.

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.

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.

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.

Pathogenesis of HIV-1 infection – chosen aspects

Summary Immunopathogenesis of HIV-1 infection is very complex but its understanding is vital for creating new and effective antiretroviral treatments and specific prophylaxis. The authors wanted to give the latest insight into the pathogenesis of HIV infection.

Therapeutic difficulties due to drug interactions of protease inhibitors with acenocoumarol in a HIV positive woman with Takayasu syndrome and pregnancy. A case report

Summary Introduction The use of antiretroviral drugs (ARV) is a complex problem, especially in patients requiring additional treatment due to the coexisting diseases. There is a number of limitations arising from interactions related to ARV pharmacokinetic properties, in particular those metabolised by P450 isoenzymes. Below we present a case of patient in which significant interactions between acenocoumarol and cART occurred. Case report A case of 39-year-old women with Takayasu syndrome and HIV infection is presented. As a result of inductive effects of lopinavir/r on the metabolism of acenocoumarol (lack of therapeutic effect after administration of 12 mg / day), in this patient, instead of lopinavir/r efavirenz was used. Then she could be treated with acenocoumarol in the dose of 4 mg/day again. However, because of pregnancy, she required further adjustment of therapy. Efavirenz was discontinued and nevirapine was commenced and instead of acenocoumarol – enoxaparin was used. Eventually the patient gave birth to a healthy child, by elective caesarean section at 38th week of pregnancy. In further therapy, antiretroviral treatment commenced during pregnancy was maintained. Conclusions There is a likelihood of an interaction between acenocoumarol and lopinavir/r. Induction of acenocoumarol metabolism may lead to the substantial decrease of anticoagulative properties of this agent. Difficulties in cART establishing cannot be excluded in patients requiring treatment with acenocoumarol or warfarin, particularly in cases where certain antiretroviral drugs are contraindicated.

JCV and BKV prevalence in people infected with HIV-1

Summary Human pathogenic viruses of the polyoma type were discovered only in the 70s of the 20th century. So far seroepidemiologic researches concerning these infections have been carried out on small groups and probably are not representative of the entire of population. They showed a past polyomaviruses infection in 35–85% people in a healthy population. In two cases: JSV and BKV reactivation plays a role in a development of diseases in people with impaired immunological response, e.g. HIV infection history. The aim of the study was to examine the frequency of prevalence of JCV and BKV in various body fluids and pathogenicity connected with these viruses in patients infected with HIV-1. The tests included 108 people of both sexes, in whom HIV-1 infection was diagnosed. JCV/BKV infection was diagnosed in 27 (25%) HIV-1 infected patients, where JCV constituted 18 (16.7%) cases and 9 (8.3%) BKV. The infections were proven on the basis of a presence of virus genetic material in urine. In none of the patients was JCV and BKV detected in blood and cerebrospinal fluid. In the patient group with TCD4 lymphocyte count 500 cell/μL JCV DNA was detected in urine in 9 (20.5%) cases and BKV DNA in 1 (2,3%) case.

Assessment of metformin therapy effect on selected parameters of glucose and lipid metabolism and the course of lipodystrophy in HIV-1 infected patients receiving protease inhibitors – pilot study

Summary Background Abnormalities in glucose and lipid metabolism as well as the occurrence of central adiposity are the most serious adverse effects of HAART (highly active antiretroviral therapy). They occur as the result of insulin resistance and hyperinsulinaemia. Metformin can reduce these abnormalities. The aim of the pilot study was to find out if there was any influence of metformin therapy on insulin level and selected lipid metabolism parameters as well as the possibility of stopping lipodystrophy progression in HIV-1 infected patients receiving protease inhibitors. Material and methods Twenty four HIV-1 infected subjects receiving protease inhibitors were enrolled into the study. Among them were 13 patients who got metformin and 11 patients of a control group. The time of observation was 6 months. At the beginning of the study and after 6 months the following parameters were tested: plasma HIV-RNA level, CD4(+) T cell count, level of insulin, free fatty acids, total cholesterol, HDL-cholesterol fraction, triglycerides, as well as BMI, the ultrasound assessment of the adipose tissue. Statistical analysis of the results was then performed. Results After 6 months of follow-up there were statistically no significant changes in insulin, total cholesterol, triglycerides, free fatty acids and HDL-cholesterol levels, compared with the results obtained at the beginning of the study both in the group receiving metformin and in the control. There were also no other statistically significant differences between the two groups. Additionally a positive influence of metformin on redistribution of abdominal adipose tissue and reduction of subcutaneous adipose tissue was observed in a group of patients with lipodystrophy. Conclusions 1. Metformin is not a useful drug in the therapy of metabolic abnormalities (glucose and lipids) due to protease inhibitors; 2. Metformin influences adipose tissue redistribution and thus can be recommended in the treatment of HIV-1 infected patients with lipodystrophy, to improve adherence and quality of life.

Three different manifestations of immune reconstitution disease in a HIV-1 positive man receiving effective HAART

Summary A patient with advanced immune deficiency due to HIV-1 infection had developed 3 different immune restoration diseases. Their manifestation depended on the stage of immune reconstitution. First pneumocystodosis was observed, then mycobacterial infection with enlargement of the abdominal lymph nodes and after seven months Burkits lymphoma.