PREDICTORS OF HIV INFECTION PROGRESSION BEFORE PRESCRIPTION AND ON ART

The search for predictors of the progression of HIV infection to the clinical stage IV in patients before prescription and on antiretroviral therapy (ART) is an urgent scientific and practical task. The study aimed to identify predictors of the progression of HIV infection to the clinical stage IV in patients before prescribing and on the background ART based on the determination of clinical and genetic markers. A retrospective cohort study of 181 HIV-infected patients was conducted. For statistical data processing, regression analysis was used. Independent predictors of the progression of HIV infection to clinical stage IV in HIV-infected patients prior to ART were: male (p = 0,037), parenteral HIV transmission (p = 0,004), conclusion experience (p = 0,020), body mass index (BMI) less than 18.5 kg / m2 (p = 0,040), initial viral load (HV) of HIV> 1.0 x 105 copies / ml (p = 0,034), initial level of CD4 + T-lymphocytes <350 cells / μl (p = 0,000), hemoglobin level below 100 g/l (p = 0,001), the presence of which increases the risk of HIV progression to the clinical stage IV prior to prescribing ART. Independent predictors of the progression of HIV infection to the clinical stage IV in HIV-infected patients receiving ART were: parenteral transmission of HIV infection (p = 0,053), previous incarceration (p = 0,043), low adherence to ART (p = 0,028) , the initial level of CD4 + T-lymphocytes <350 cells/μl (p = 0,020), hemoglobin level below 100 g/l (p = 0,015) and carriage of the 299 Gly allele of the TLR4 gene (p = 0,016).

Modes of HIV transmission among adolescents and young adults aged 10–24 years in Kenya

Understanding how HIV is acquired can inform interventions to prevent infection. We constructed a risk profile of 10–24 year olds participating in the 2012 Kenya AIDS Indicator Survey and classified them as perinatally infected if their biological mother was infected with HIV or had died, or if their father was infected with HIV or had died (for those lacking mother’s data). The remaining were classified as sexually infected if they had sex, and the remaining as parenterally infected if they had a blood transfusion. Overall, 84 (1.6%) of the 5298 10–24 year olds tested HIV positive; 9 (11%) were aged 10–14 and 75 (89%) 15–24 years. Five (56%) 10–14 year olds met criteria for perinatal infection; 4 (44%) did not meet perinatal, sexual or parenteral transmission criteria and parental HIV status was not established. Of the 75 HIV-infected, 15 to 24 year olds, 5 (7%) met perinatal transmission, 63 (84%) sexual and 2 (3%) parenteral criteria; 5 (7%) were unclassified. Perinatal transmission likely accounted for 56% and sexual transmission for 84% of infections among 10–14 year olds and 15–24 year olds, respectively. Although our definitions may have introduced some uncertainty, and with the number of infected participants being small, our findings suggest that mixed modes of HIV transmission exist among adolescents and young people.

Cutaneous Manifestations in HIV Infected Libyan Patients

Cutaneous manifestations of human immunodeficiency virus (HIV) disease may result from HIV infection itself, or from opportunistic disorders secondary to the declined immunocompetence due to the disease. A total of 220 HIV positive patients, treated in the Benghazi Center of Infectious Diseases and Immunology over a period of 14 years (January 2003 to November 2016), were included in a retrospective study. The patients' age ranged from 7 to 46 years. The study was conducted by reviewing the patients' records using the management information system (MIS). Statistical analysis of the data was carried out by the t-test and Chi square test. Among the studied patients, 119 (54.1%) were males and 101 (45.9%) were females, and most of them (78.6%) were 10 – 19 years of age. The predominant mode of transmission was parenteral transmission, in 95% of patients, and positive family history was observed in 12% of patients. Among the total number of visits to dermatologists, 93% of patients had a single disease. Of the total number of skin diseases diagnosed during the visits, parasitic infestations were seen in 92 patients (21.0%), eczematous and related disorders in 78 patients (17.8%), viral infections in 71 patients (16.2%), bacterial infections in 41 patients (9.3%), and fungal infections in 35 patients (7.9%). Dermatophyte infections were the most common fungal infections recorded in 19 patients (4.3%), followed by Candida infection in 11 patients (2.5%). Warts were found in 5.9% of viral infections, followed by herpes zoster (4.1%). HIV positive patients should be examined for skin disorders, because early diagnosis and management of such problems improves the quality of life in these patients.

EPIDEMIC SITUATION FOR HIV-INFECTION IN SIBERIAN FEDERAL REGION IN 2014

Aim. Analyze main epidemiologic indicators for HIV-infection on the territory of SFR for the period from 2012 to 2014 with allotment of contributions of regions into the epidemic for development of personalized regional program for further containment of HIV spread. Materials and methods. Data of main statistical forms and monthly reports of all the regions situated on the territory of the district were used. Results. At large, on both the studied territory and some regions a tendency of growth of HIV-infection morbidity with predominant parenteral transmission was detected. HIV-infection continues to be detected most frequently in young able-bodied population. The number of patients detected for the first time at AIDS stage increases annually, and an increase of lethality among HIV-infected was noted. Conclusion. Prognostic data for the next year are indicated.

An Epidemiologic Investigation of a Case of Acute Hepatitis E

Hepatitis E virus (HEV) is considered a zoonotic infection in developed nations. A case of acute hepatitis E in a researcher following a scalpel injury while working on a pig prompted a seroepidemiologic study to identify potential modes of transmission and determine the seroprevalence of HEV among animal handlers at the institute. Sera from personnel (n= 64) in two animal facilities and age/sex-matched blood donors (n= 63) as controls were tested for IgG anti-HEV and, if positive, for IgM anti-HEV and HEV RNA. Sera and stool from pigs aged 6 to 12 weeks from the breeding farm and older pigs from animal facilities were tested similarly. The median age of personnel was 36 years, 74% were white, 56% were male, and 74% had direct exposure to pigs. The prevalence of anti-HEV was 3.1% among personnel compared to 3.2% among blood donors; none were positive for IgM anti-HEV or HEV RNA. IgG anti-HEV was detected in sera from 10% of pigs aged 6 to 8 weeks, 80% aged 10 weeks, 100% aged 12 weeks, and 76% aged >12 weeks. HEV RNA was detected in stool but not sera from three 12-week-old pigs. Sequencing revealed HEV genotype 3 with ∼10% difference between the patient and pig sequences. Parenteral transmission is a potential mode of acute HEV infection. The low and similar seroprevalence of anti-HEV between the at-risk group and age-matched blood donors suggests low transmission risk with universal precautions among animal handlers.

Growth Abnormalities in Children with Chronic Hepatitis B or C

Background. It has been suggested that chronic hepatitis B infection leads to growth impairment, but data are inconsistent and underlying factors are not defined.Methods. Children and adolescents with chronic hepatitis B (HBV) or C (HCV) were retrospectively evaluated for growth, weight, antiviral treatment, biochemical signs of liver inflammation, route of infection, and HBV DNA, respectively.Results. In all, 135 children (mean age 6.1 years, 81 male, 54 female) with HBV (n=78) or HCV (n=57) were studied. Route of infection was vertical in 50%, parenteral in 11%, and unknown in 39%. ALT levels were above 1.5 times above normal in 30% while 70% had normal/near normal transaminases. 80% were Caucasian, 14% Asian, 1% black, and 4% unknown. Mean baseline height measured in SDS was significantly lower in the study population than in noninfected children (boys −1.2, girls −0.4,P<0.01). 28 children were below 2 standard deviations of the norm while 5 were above 2 standard deviations. SDS measures in relation to individual factors were as follows: elevated ALT: boys −1.4, females −0.5 (P<0.01), ALT normal/near normal: boys +0.4, females +0.6; parenteral transmission: boys −3.3, girls −0.9 (P<0.01), vertical transmission: boys −0.2, females −0.2. Antiviral treatment itself or HBV-DNA load did not reach statistically significant differences.Conclusions. Chronic HBV or HCV may lead to compromised growth which is mostly influenced by liver inflammation. Our data may argue for early antiviral treatment in children with significant ALT elevation.

Transmission routes and risk factors for autochthonous hepatitis E virus infection in Europe: a systematic review

SUMMARYIncreasing numbers of non-travel-associated hepatitis E virus (HEV) infections have been reported in Europe in recent years. Our objective was to review the evidence on risk factors and transmission routes of autochthonous HEV infection and hepatitis E in Europe in order to develop recommendations for future research, prevention and control. A systematic literature review was performed to identify all primary reports and studies published during 1998–2008 on hepatitis E in humans and animals in Europe by searching Pubmed, reference lists of major articles and international conference proceedings. Each of the 106 included studies was categorized into one of three evidence levels (EL) based on study design and diagnostic methodology. The evidence was generally weak (73 were assigned to EL1, two to both EL1 and EL2, and 30 to EL2), further compounded by the use of poorly validated serological assays in some studies. Only one case-control study was assigned to EL3. Persons with autochthonous hepatitis E infection were on average older than the general population and predominantly male. There was no evidence for one main transmission route of HEV infection or risk factor for hepatitis E. However, zoonotic transmission seemed likely and person-to-person transmission too inefficient to cause clinical disease. Multiple routes of transmission probably exist and should be further investigated through analytical studies and reliable diagnostic kits. Based on current evidence that points to zoonotic transmission from pigs, thorough cooking of all porcine products, prevention of cross-contamination in the kitchen and improved education for occupationally exposed people (e.g. pig farmers, veterinarians and sewage workers) may help prevent HEV infection. Although evidence for parenteral transmission is limited, it is recommended that a risk assessment is undertaken.

Increase in hepatitis A cases in the Czech Republic in 2008 – an update

In 2008, 1,616 cases of hepatitis A were reported in the Czech Republic, more than a 10-fold increase compared with the annual number of cases registered in 2003-2007. The infection was initially associated with injecting drug users, most probably by person-to-person contact or parenteral transmission, and in the second half of the year continued to spread among the general population with increased susceptibility.