Anita Olczak

Opportunistic Infections and Other AIDS-defining Illnesses in Poland in 2000-2002

AbstractBackground:The introduction of highly active antiretroviral therapy (HAART) led to a decreased incidence of the most severe opportunistic infections (OIs) in HIV-infected patients. In Poland, HAART became widely used in 1998.Materials and Methods:This study was based on data from medical records data collected in the years 2000–2002 from medical centers for HIV-infected patients in Poland. The aim of the study was to determine the incidence of opportunistic infections (OIs) and other AIDS defining illnesses (ADIs). The χ2 test was used to determine any significant trends.Results:The incidence of ADIs was 6.8, 6.5 and 4.8/100 persons/year in 2000–2002, respectively. The most common diagnosed OIs were: fungal infections, tuberculosis, recurrent pneumonia, PCP and toxoplasmosis. In patients receiving HAART (HAART+) the incidence of ADIs was significantly lower than in non-ARV-treated as well as in all HIV+ (p < 0.02, p < 0.001, p < 0.001, respectively). A significant decrease in the incidence of ADIs in HAART+ patients between 2000 and 2002 (p < 0.0001) was observed. From 25% to 30% of ADIs among HAART+ patients were diagnosed within the first 3 months of antiretroviral therapy. In HAART+ patients the most common ADIs were fungal infections and tuberculosis. The diagnosis of ADIs resulted in the recognition of HIV status in 8.7–8.9% of patients.Conclusions:Five years after the introduction of HAART the incidence of ADIs had declined. Fungal infections and tuberculosis were the most common OIs in HIV+ patients in Poland.

Transmitted HIV drug resistance in antiretroviral-treatment-naive patients from Poland differs by transmission category and subtype

OBJECTIVES The surveillance of HIV-transmitted drug resistance mutations (t-DRMs), including temporal trends across subtypes and exposure groups, remains a priority in the current management of the epidemic worldwide. METHODS A cross-sectional analysis of 833 treatment-naive patients from 9 of 17 Polish HIV treatment centres. Partial pol sequences were used to analyse drug resistance with a general time reversible (GTR)-based maximum likelihood algorithm used for cluster/pair identification. Mutation frequencies and temporal trends were investigated. RESULTS t-DRMs were observed in 9% of cases (5.8% for NRTI, 1.2% NNRTI and 2.0% PI mutations) and were more common among heterosexually infected (HET) individuals (13.4%) compared with MSM (8.3%, P = 0.03) or injection drug users (IDUs; 2.9%, P = 0.001) and in MSM compared with IDUs (P = 0.046). t-DRMs were more frequent in cases infected with the non-B variant (21.6%) compared with subtype B (6.6%, P < 0.001). With subtype B a higher mutation frequency was found in MSM compared with non-MSM cases (8.3% versus 1.8% for IDU + HET, P = 0.038), while non-B variants were associated with heterosexual exposure (30.4% for HET versus 4.8% for MSM, P = 0.019; versus 0 for IDU, P = 0.016). Trends in t-DRM frequencies were stable over time except for a decrease in NNRTI t-DRMs among MSM (P = 0.0662) and an NRTI t-DRM decrease in HET individuals (P = 0.077). With subtype B a higher frequency of sequence pairs/clusters in MSM (50.4%) was found compared with HET (P < 0.001) and IDUs (P = 0.015). CONCLUSIONS Despite stable trends over time, patterns of t-DRMs differed notably between transmission categories and subtypes: subtype B was associated with MSM transmission and clustering while in non-B clades t-DRMs were more common and were associated with heterosexual infections.

Distribution and time trends of HIV-1 variants in Poland: Characteristics of non-B clades and recombinant viruses.

The spread of HIV-1 subtypes varies considerably both worldwide and within Europe, with non-B variants commonly found across various exposure groups. This study aimed to analyse the distribution and temporal trends in HIV-1 subtype variability across Poland. For analysis of the subtype distribution, 1219 partial pol sequences obtained from patients followed up in 9 of 17 Polish HIV treatment centres were used. Subtyping was inferred using the maximum likelihood method; recombination was assessed using the bootscanning and jumping profile hidden Markov model methods. Subtype B dominated in the studied group (n=1059, 86.9%); in 160 (13.1%) sequences, non-B variants were present [A1 (n=63, 5.2%), D (n=43, 3.5%), C (n=22, 1.8%), and F1 (n=2, 0.2%)]. In 25 (2.1%) cases circulating recombinant forms (CRFs) were found. Five A1 variants (0.4%) were unique AB recombinant forms (URF) not previously identified in Poland. Non-B clades were notably more common among females (n=73, 45.6%, p<0.001) and heterosexual individuals (n=103, 66.5%, p<0.001) and less frequent among men who have sex with men (MSM) (n=27, 17.42%, p<0.001). HIV-1 viral load at diagnosis was higher among non-B cases [median: 5.0 (IQR: 4.4-5.6)] vs. [median: 4.8 (IQR: 4.3-5.4) log copies/ml for subtype B (p<0.001)] with a lower CD4(+) lymphocyte count at baseline [median: 248 (IQR: 75-503) for non-B vs. median: 320 (IQR: 125-497) cells/μl for subtype B; p<0.001]. The frequency of the non-B subtypes proved stable from 2008 (11.5%) to 2014 (8.0%) [OR: 0.95 (95% CI: 0.84-1.07), p=0.4], with no temporal differences for exposure groups, gender, age and AIDS. Despite the predominance of subtype B, the variability of HIV in Poland is notable; both CRFs and URFs are present in the analysed population. Non-B variants are associated with heterosexual transmission, more advanced HIV disease and have stable temporal frequencies.

The Spectrum of Malignancies among Adult HIV Cohort in Poland between 1995 and 2012: A Retrospective Analysis of 288 Cases.

The aim of the study The aim of the study was to evaluate the spectrum of AIDS-defining malignancies (ADMs) and non-AIDS-defining malignancies (NADMs) in HIV-infected patients in Poland. Material and methods A retrospective observational study was conducted among HIV-infected adult patients who developed a malignancy between 1995 and 2012 in a Polish cohort. Malignancies were divided into ADMs and NADMs. Non-AIDS-defining malignancies were further categorised as virus-related (NADMs-VR) and unrelated (NADMs-VUR). Epidemiological data was analysed according to demographic data, medical history, and HIV-related information. Results were analysed by OR, EPITools package parameters and Fishers exact test. Results In this study 288 malignancies were discovered. The mean age at diagnosis was 41.25 years (IQR20-81); for ADMs 38.05 years, and for NADMs-VURs 46.42 years; 72.22% were male, 40.28% were co-infected with HCV. The risk behaviours were: 37.85% IDU, 33.33% MSM, and 24.31% heterosexual. Mean CD4+ at the diagnosis was 282 cells/mm3 (for ADMs 232 and for NADMs-VUR 395). Average duration of HIV infection at diagnosis was 5.69 years. There were 159 (55.2%) ADMs and 129 (44.8%) NADMs, among whom 58 (44.96%) NADMs-VR and 71 (55.04%) NADMs-VUR. The most frequent malignancies were: NHL (n = 76; 26.39%), KS (n = 49; 17.01%), ICC (n = 34; 11.81%), HD (n = 23; 7.99%), lung cancer (n = 18; 6.25%) and HCC (n = 14; 4.86%). The amount of NADMs, NADMs-VURs in particular, is increasing at present. Male gender (OR = 1.889; 95% CI: 1.104–3.233; p = 0.024), advanced age: 50–60 years (OR = 3.022; 95% CI: 1.359–6.720; p = 0.01) and ≥ 60 years (OR = 15.111; 95% CI: 3.122–73.151; p < 0.001), longer duration of HIV-infection and successful HAART (OR = 2.769; 95% CI: 1.675–4.577; p = 0) were independent predictors of NADMs overall, respectively. Conclusions In a Polish cohort NHL was the most frequent malignancy among ADMs, whereas HD was the most frequent among NADMs. Increased incidence of NADMs appearing in elderly men with longer duration of HIV-infection and with better virological and immunological control was confirmed. As HIV-infected individuals live longer, better screening strategies, especially for NADMs-VUR, are needed. The spectrum of cancer diagnoses in Poland currently does not appear dissimilar to that observed in other European populations.

Time trends in HIV-1 transmitted drug resistance mutation frequency in Poland.

In Poland, the HIV epidemic has shifted recently from being predominantly related to injection drug use (IDU) to being driven by transmissions among men‐who‐have‐sex‐with‐men (MSM). The number of new HIV cases has increased in the recent years, while no current data on the transmitted drug resistance associated mutations (tDRM) frequency trend over time are available from 2010. In this study, we analyze the temporal trends in the spread of tDRM from 2008 to 2013.

Gynecologic infections in HIV-infected women

Summary The number of women infected with HIV and diagnosed of AIDS is increases all over the world. The predominant mode of HIV transmission in this population is sexual intercourse. Women are at risk of other infections sharing the route of transmission. The presence of sexually transmitted diseases increased the risk of acquire and transmission HIV. The compressive gynecologic evaluation should be an important and standard component of medical care for HIV infected women.

Tuberculosis in HIV-infected patients in the HAART era

Summary Tuberculosis in one of the most common opportunistic infections in HIV infected patients. HIV promotes progression of Mycobacterium tuberculosis latent infection to active disease and in turn M tuberculosis enhances HIV replication. During eight year period 51 cases of tuberculosis was recognized in Department of Infectious Diseases and Hepatology in Bydgoszcz. Only 4 patients were on antiretroviral therapy and of those who never received antiretroviral treatment; 70% had a CD4 count >100 cells/ml at the time of tuberculosis, and the high proportion (25.4%) of patients were diagnosed with HIV infection concurrently with tuberculosis. Diagnosis was confirmed by isolation of Mycobacterium tuberculosis and by the detection of nucleic acids of pathogen in 96.1% patients. The sputum smear was positive only in 5 cases of pulmonary tuberculosis and in three cases of disseminated tuberculosis was the most common clinical manifestation of disease in study population. A total of 8 patients with pulmonary involvement the chest radiograph examination was normal. Tuberculosis in HIV infected patients is in spite of availability of antiretroviral therapy a serious medical and epidemiological problem.

Atazanavir, a promising option in therapy in HIV infected patients with liver injury and hyperbilirubinemia – a case report

Summary The prevalence of liver disease among individuals infected with HIV is more frequent then in general population. The most common causes of clinical overt and subclinical hepatitis are infections with HCV, HBV, opportunistic pathogens, neoplasmas and drug related hepatotoxicity. All HIV infected individuals with symptoms of liver injury are in need of detailed diagnostic procedures in establishment of exact diagnosis. Treatment of HIV infection in those cases poses difficulties. This paper prescribe a case of HCV infected patient with advanced stage of HIV disease and hepatobiliary diseases.

Efficacy and safety of atazanavir-based regimens in routine management of HIV-infected adults

Summary The aim of this retrospective cohort study was to evaluate safety and efficacy of atazanavir in routine clinical practice. Of 62 patients treated with atazanavir-based regimen, therapy was discontinued in 3 (4.8%) cases, one (1,6%) patient died, but the cause was not associated with treatment. The mean increased of CD4 cell count was 197 cells/mL. We found low rate of adverse events in analyzed population and favorable lipid profiles.

The role of nevirapine in the antiretroviral therapy

Summary In the presented multicenter study an attempt was made to evaluate the role of nevirapine used in treatment of HIV-seropositive patients in both groups: naive as well as experienced. The therapeutic effect was evaluated while analysing the HIV-RNA level and the increase in CD4 cell count. The reasons for which the new schema with nevirapine was introduced in experienced patients were as well analysed. Among these reasons were mainly side effects of different character. On the basis of the obtained results very good virologic response was reported in both groups, naive and previously treated. Immunologic response in both populations discussed was similar though the initial level of CD4 was two times lower in naive patients in comparison with experienced population.