Dorota Rogowska-Szadkowska

Which factors hinder the decision of Polish HIV-positive patients to take up antiretroviral therapy?

Abstract The implementation of highly active antiretroviral therapy (HAART) in 1996 has significantly reduced mortality and morbidity for HIV-positive patients worldwide. However not all eligible persons start HAART. To identify reasons for therapy refusal by HIV-positive persons we performed a questionnaire study. The investigation was conducted among 321 HIV-positive individuals and focused on the decision to take up antiretroviral treatment. Out of 71 untreated patients, 34 (47.9%) admitted that in their case the therapy was not indicated, whereas 20 (28.3%) were afraid of potential side effects that might change their appearance, e.g. face lipoatrophy. Only the treated patients had been prepared to take up therapy, although 17 patients (6.0%) had not received any explanation of the therapy principles, aims or necessity to comply with medication regime. The therapy is generally not discussed with the patients for whom it is not currently indicated, which may contribute to the fixation of fears and prejudices. Doctors who treat HIV-positive patients should be aware of the prejudices and fears their patients have towards antiretroviral therapy in order to react properly and by means of the available antiretroviral drugs help prolong life and improve its quality.

HIV infections in otolaryngology

Summary HIV (human immunodeficiency virus) infection may produce no clinical symptoms for 10 years on average. However, after many years of infection most people develop symptoms that indicate progression of the disease. There are no regular characteristic symptoms or early stage, and no logical sequence of AIDS indicator disorders has been observed. People who are not aware of the infection are referred to physicians of various specializations, including otolaryngologists. It is on their knowledge about HIV infections, among other factors, that early diagnosis of the disease depends. Appropriate and quick introduction of anti-retroviral drugs may let a person with HIV live decades longer.

Primary HIV infection

Summary The article describes clinical image of the primary HIV, as well as diagnosis opportunities at this stage of the infection. It presents the data concerning indications for initiation of antiretroviral therapy and the meaning of diagnosis the infection at this stage both for the patient and the public health.

Opinions and attitudes of students before completion of medical studies toward men who have sex with men (MSMs) and injection drug users (IDUs) living with HIV/AIDS

Summary In 2000 National AIDS Centre organised studies about knowledge, attitudes and opinions of students at Polish medical universities related to HIV and AIDS. Among other results they showed that more than 60% of respondents revealed fear of AIDS, almost 60% of students agreed with the statement that HIV/AIDS is a disease of injection drug users (IDUs) and men who have sex with men (MSMs). Between 2004 and 2006 the same questionnaire was applied to students of the 6th year of the medical studies at the Medical University of Bialystok, who should have already obtained information on HIV/AIDS in their education programme. The studys objective was to check whether the attitude of future doctors to HIV/AIDS, MSMs and IDUs has changed. More than a half – 123 (52.8%) of students before completion of medical studies feel that there is a risk of getting infected with HIV while performing their professional duties and as many as 34.9% of the respondents admit that they fear AIDS. The study revealed homophobic attitudes as well as resentment against addicts. The obtained results show that in the process of educating future doctors more attention should be paid to the issues of human sexuality, as well as addictions. This may lead to reduction of discrimination experienced or felt frequently by HIV-positive patients. This is especially important as the life-span of HIV-positive persons is getting much longer.

Transmission of HIV through needlestick injuries in the community setting

Summary The frequency of community-acquired needle-stick injuries increases in line with the rise in intravenous drug abuse. This review will examine evidence for HIV survival outside the body and transmission of HIV through needlestick injuries in the community setting.

Microbicides in HIV infection prophylaxis – not only ethical challenges

Summary The increasing number of HIV infections transmitted through heterosexual contacts and the increasing incidence of infections in women make it urgently needed to find a chemical agent which could be applied locally and could prevent HIV and other sexually transmitted diseases. However, the previous experience with nonoxynol-9 and subsequent suspension of clinical studies on other preparations are not optimistic. In the absence of an effective HIV vaccine, even a partially active microbicide would still be a highly desirable intervention.

2008 Nobel Prize for Medicine or Physiology for discovery of HPV and HIV viruses – short history of discovery of HIV

Summary In 2008 the Nobel Prize for Medicine or Physiology was divided and half of it awarded discovery of the human papilloma virus (HPV) and its correlation with womens cervical cancer, and the other half – discovery of the human immunodeficiency virus (HIV). The latter part raised many comments and controversies. As 25 years have passed since the HIV virus was identified, the short history of this discovery was recalled, as it is quite forgotten now.

Bone Metabolism Markers and Bone Mineral Density in Patients on Long-Term Acenocoumarol Treatment: A Cross-Sectional Study

The aim of this study was to evaluate levels of osteocalcin (OC), osteoprotegerin (OPG) and total soluble receptor activator of nuclear factor-κB ligand (RANKL), and bone mineral density (BMD) in patients on long-term acenocoumarol (AC) treatment. The cross-sectional study was carried out in 42 patients treated long-term with AC and 28 control subjects. Serum concentrations of OC, OPG, and sRANKL were measured using enzyme linked immunosorbent assay (ELISA) kits, and BMD at the femoral neck and lumbar spine were assessed by dual energy X-ray absorptiometry. A significantly decreased concentration of OC was found in AC users compared to control subjects (4.94 ± 2.22 vs. 10.68 ± 4.5; p < 0.001). Levels of OPG, sRANKL logarithm (log), sRANKL/OPG log ratio, and BMD were comparable between. In female AC users, positive correlations between OC and RANKL log, and between OC and RANKL/OPG log ratio (p = 0.017; p = 0.005, respectively), and a negative correlation between OC and OPG (p = 0.027) were found. Long-term AC anticoagulation significantly decreases OC concentration, but does not affect other bone metabolism markers or BMD. Our results also suggest the possibility that long-term treatment with AC may alleviate bone resorption in postmenopausal women.

Is medical marijuana legalisation possible in Poland

OBJECTIVES In some countries of the world it is legal to use plant-based marijuana for therapeutic purposes. When we had learned that 7,000 petitioners (including doctors) signed the petition to enable access to marijuana for patients in the Czech Republic, we decided to examine the knowledge about marijuanas medical properties among Polish medical students. METHODS Anonymous questionnaire study was conducted on a group of 181 of students of the last (sixth) year of medical school. RESULTS It was demonstrated that students are not provided with sufficient information about therapeutic administration of plant-based marijuana during medical studies. The majority of interviewees mentioned only one indication for medical marijuana use. All students did not interchange medical conditions for which marijuana is used in 30 USA states or Canada. DISCUSSION Marijuana smoking for medical purposes differs from recreational smoking, and its effect does not depend on occurrence of symptoms from the central nervous system. Few studies, that were carried out along with numerous previously unreported cases of patients, demonstrated that plant-derived marijuana had therapeutic effect on many diseases where conventional medicine was of no help. CONCLUSION All doctors, including medical students, should receive more information about the therapeutic properties of marijuana.

The story of Bulgarian nurses in Libya accused on no grounds of purposeful infection of children with HIV

Summary The paper presents the story of Bulgarian nurses, charged with alleged guilt for purposeful contamination of children in a hospital in Benghazi with HIV. Despite scientific evidence presented by world-appreciated medical authorities, who said that the children had been infected before the nurses ever came to Libya, they were kept for almost 10 years in prison, tortured, sentenced to death twice. Only after Bulgaria became a member of the European Union, the nurses regained freedom.