Liliana Lucia Preoțescu

Non-invasive quantification of liver fibrosis regression following successful treatment of chronic hepatitis C with direct acting antivirals

Abstract Introduction. The past years have revolutionized the treatment of hepatitis C virus (HCV) infection, with high rates of sustained virologic response (SVR). Furthermore, liver fibrosis has recently been redefined as a dynamic, reversible process. Methods. We performed a prospective cohort study to assess the role of laboratory evaluations and non-invasive measurement of liver stiffness in establishing the right time for starting treatment and in assessing the regression of liver fibrosis in Romanian patients treated with direct acting antivirals (DAA) for genotype 1b chronic hepatitis C. Results. We present the results for 102 patients, with a mean age of 58.5 years, and a rate of SVR of 100%. Our study has ruled out older age (p=0.628), IL28B non-CC genotype (p=0.693), baseline viral load above the cutoff of 600,000 IU/mL (p=0.353), and the presence of diabetes mellitus (p=0.272) or baseline steatosis (p=0.706) as factors potentially influencing the regression of liver fibrosis following DAA treatment of HCV infection with the 3D regimen. The quantitative regression of liver stiffness was inversely correlated with the duration of HCV infection (p=0.017), suggesting that timely treatment might associate better outcomes in terms of liver fibrosis. Conclusion. Our study’s results point towards the need to start DAA treatment earlier in patients with HCV infection.

Performance of shear-waves elastography in the non-invasive assessment of liver fibrosis in chronic hepatitis in the Romanian population

Results We have examined a total of 80 patients with chronic hepatitis, of which 58.8% had HCV infection, 16.3% HBV infection, 6.3% HBV + HDV coinfection, 2.5% ASH, 2.5% HIV infection and 13.8% had idiopathic liver involvement. The male-to-female ratio was 0.86:1, and the mean age was 48.6 ± 14.9 years. The mean duration of hepatic disease evolution was 7.6 ± 5.7 years, longer for HCV infection (mean 8.3 ± 5.9 years) than for HBV infection (4.75 ± 3.9 years, p = 0.028). The overall mean SWE liver stiffness was 9.6 ± 5.3 kPa, higher in patients with HCV infection (10.8 ± 5.9 kPa) than in those with HBV infection (6.98 ± 1.9 kPa, p = 0.009). Overall, 37.5% of patients were classified as F0-F1 on SWE, 25.0% F2, 8.8% F3 and 28.7% F4. Liver cirrhosis was present in 28.7% of patients and hepatocellular carcinoma had already been diagnosed in 6.3% of all patients and in 21.7% of all patients with cirrhosis (5 cases, of which 4 had been previously diagnosed with cirrhosis with HCV – 3 cases, and HBV +HDV – 1 case, and 1 had an idiopathic cause for liver involvement and a stiffness corresponding to F0-F1 on SWE).

Vaccination of health care workers in Romania

Methods We collected information about HCWs vaccination policies and regulation implemented through laws and also data about specific vaccination (seasonal influenza, hepatitis B, measles, mumps, rubella and varicella). We conducted 5 focus groups with 39 participants (nurses, physicians, infection control personnel, public health and policy makers), as part of the HProImmune (Promotion of Immunizations for Health professionals in Europe) project activities, in order to understand the risk perception behaviors towards vaccination and barriers stopping HCWs from immunization. We followed for each focus group a specific discussion guide elaborated by the HProImmune project.

HIV viral load assessment in multiple sanctuaries – case presentation

Case report We present the case of a 57 year-old male patient, diagnosed with HIV infection for 14 years, and polyexperienced to antiretroviral (ARV) therapy (history of over 15 past ARV regimens). Early on in the evolution of HIV infection, the patient developed arterial hypertension, cardiomyopathy, 80% bi-carotid atheromatosis, and neurocognitive impairment. The patient also developed dyslipidemia and significant lipodystrophy correlated with the use of first generation protease inhibitors. The impressive size of the buffalo hump led to impaired respiratory movements and trachea compression (identified through bronchoscopy, which had been indicated for the differential diagnosis of lung cavities; unfortunately because of the tracheal compression, bronchoscopy could not be performed). A surgical intervention for lipodystrophy had to be deferred because of the inability to maintain a stable ARV regimen, with undetectable viral loads. In Sep 2010 we managed to establish a stable ARV regimen, with boosted darunavir plus etravirine plus raltegravir. Plasma viral load decreased slowly, but it fluctuated, and it was only in Jan 2013 that the patient reached stable undetectable levels, and at this point, his CD4 cell count had increased to 321 cells/cmm. In early 2014, after the patient had been virally suppressed for approximately one year, he was referred to a plastic surgery clinic, where he underwent successful lipoaspiration of 12 kg of adipose tissue from the buffalo hump, along with reconstruction of adipose facial features. Thus, the surgical procedure had a double role, both esthetic and functional, leading to improved pulmonary ventilation and a better tolerability to performing daily activities. Given the history of difficulty maintaining a suppressed viral load in his patient, we assessed the potential HIV compartmentalization: after 6 months of consistently undetectable viremia, we performed sperm viral load (undetectable) and CSF viral load (undetectable), and after one year of viral suppression, we performed a viral load from the adipose tissue (results still in process).

Dual infection with Acinetobacter baumannii and Klebsiella pneumoniae in a patient with multiple comorbidities – case presentation

Case report A 35 year-old male patient presented to our clinic in May 2014 for progressive malaise, low-grade fever and nausea. His medical history revealed chronic glomerulonephritis and renal failure with hemodialysis from 2005 to 2010; kidney transplant in 2010, with transplant rejection and positive CMV-IgM in March 2014. He also presented arterial hypertension, ischemic heart disease and left ventricular hypertrophy since 2010, multiple episodes of sepsis and pneumonia with Klebsiella spp. through digestive microbial translocation (colonic ulcerations), and a double aortocoronary bypass in March 2014. The thoracotomy incision had healed almost completely, but the right calf incision presented signs of infection. His concomitant therapy included anti-hypertensive agents, antiplatelet therapy, ganciclovir, immune-suppression therapy with mycophenolic acid, and prednisone (10 mg/day). On admission, the clinical exam was normal, except for bilateral lower limb edema and inflammation of the right calf incision area, with multiple patches of exposed soft tissue and suppuration. Biologically, he presented pancytopenia (WBC 2,100 cells/μL, hemoglobin 6.8 g/dL, thrombocytes 137,000 cells/μL), nitrogen retention syndrome (urea 147.4 mg/dL, creatinine 4.4 mg/dL). The patient’s reactivity was quite low given the concomitant immune-suppressive treatment, with ESR 38 mm/1h, fibrinogen 351 mg/dL, and CRP 10 mg/L. Urine cultures, repeated blood cultures and procalcitonin were negative, but the smear from the right calf incision wound identified inflammatory cells and Gramnegative coccobacilli, and CLED cultures grew smooth, yellow, lactose-fermenting colonies. Microscan (Siemens, Munich, Germany) identified carbapenemase-producing Klebsiella pneumoniae (KPC) and the strain was subcultured and grew a smooth, grey, non-lactose-fermenting colony, identified on VITEK (bioMerieux, Paris, France) as Acinetobacter baumannii. Both strains were resistant to all tested drugs except for colistin and tigecycline. As both strains initially grew in a single isolated culture, with homogenous morphology, it took repeated cultures to separate the two strains. The patient’s evolution was favorable under treatment with tigecycline and local instillations of colistin.

A cohort study in the assessment of liver fibrosis and markers of disease progression in hepatitis B and D coinfection

Results We assessed data from 64 patients (of which 27 were males 42%) with a median age of 54±14 (range: 23 to 64 years). The median fibrosis was 0.44±0.23 and the median necroinflammatory activity was 0.54±0.24. The median FIB-4 score was 1.89±3.23 at the second visit versus 1.26±2.07 at the third visit. The median APRI score was 1.18±1.67 at the second visit compared to 1.79 ±2.53 at the third visit (p=0.05, 95%CI: 0.0389, 0.43681). Regression analysis showed a correlation between FibroTest (considered the gold standard in this study, in the absence of histology data from liver biopsy), FIB-4 (p=0.43) and APRI (p=0.011).

Promotion of health care workers immunization in Europe – the main objective of the HProImmune project

Background The National Institute for Infectious Diseases “Prof. Dr. Matei Bals” is participating during 2012-2014 in the European project “HProImmune Promotion of immunization among health care workers in Europe”, coordinated by the Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis from Greece and co-funded by DG SANCO Public Health Work Program 2008-2013. The general objective of this project is to promote vaccination coverage of health care workers (HCWs) in different health care settings by developing a tailored communication toolkit.

Hepatitis B virus vaccination status of sixth year medical students

Background Hepatitis B virus (HBV) infection can associate a high risk of progression to chronic hepatitis, particularly when infection occurs at younger ages. For this particular reason, newborn vaccination has been introduced in national immunization schedules in countries where the infection has a medium to high prevalence. We assessed the vaccination status of students in their final year of medical university training during 20112013. This category is at risk of professional exposure to HBV and given the timeline of introduction of HBV vaccination in Romania, they probably have not been vaccinated at birth, but rather during middle or high school education.