Incidence of tuberculosis and mycobacteriosis among HIV-infected patients — clinical and epidemiological analysis of patients from north-eastern Poland

INTRODUCTION: According to WHO data, among patients infected with HIV, tuberculosis occurs in about 30% of patients and causes approximately 25% of deaths due to AIDS worldwide. The incidence rate of tuberculosis in the Polish population was 22.2/100,000 in 2011, while the average in European Union countries in 2011 was 14/100,000. Since 1985 to 30 April 2013 HIV infection in Poland was confirmed in 16,588 patients, while the number of reported tuberculosis cases in HIV-infected individuals in 2011 was 26. The aim of this study was to assess the prevalence and clinical course of tuberculosis and mycobacterial disease in HIV-infected patients treated in the Department of Infectious Diseases and Hepatology in Białystok.MATERIAL AND METHODS: We analysed documentation of 577 HIV-infected patients, their demographic data, epidemiological status, degree of immunosuppression (T CD4 and CD8 numbers) and stage of HIV infection.RESULTS: Complete follow-up was possible in 389 patients, of whom 265 (68%) were male. Tuberculosis (TB) was diagnosed in 41 patients (10.5%) and mycobacteriosis in 4 patients (1.03%). In 19 patients (42%) HIV and TB or mycobacteriosis were diagnosed simultaneously. The median CD4 T lymphocyte count was lower in patients with a simultaneous diagnosis of HIV and tuberculosis or mycobacteriosis compared to the group in whom TB/mycobacteriosis was diagnosed later. The number of CD4 T-cells less than 50 cells/μL was found in 63.2% (12/19) of patients when HIV and TB or mycobacteriosis were diagnosed simultaneously and in 38.5% (10/26) of patients who were diagnosed with TB or mycobacteriosis later than the HIV infection (p = 0.14). The median HIV viral load in patients in whom HIV infection and tuberculosis or mycobacteriosis were diagnosed at the same time was higher than in other patients and this difference was statistically significant. Pulmonary tuberculosis was the most common form of clinical disease and accounted for 60% of all cases. Among the analysed cases with HIV and tuberculosis or mycobacteriosis coinfection, tuberculosis or mycobacteriosis was the cause of death in 8 patients, and 9 died of other causes.CONCLUSION: In our material of 389 HIV-infected patients, tuberculosis was diagnosed in 41 (10.5%) and mycobacterial diseases in 4 (1.03%). In 42% of co-infected patients (HIV+TB or mycobacteriosis) the diagnosis of both diseases was made at the same time. In these patients, a deep deficit of cellular immunity (CD4 < 50 cells/μL) was observed more frequently than in patients diagnosed with TB or mycobacteriosis in the later course of HIV. HIV RNA viral load was significantly higher in the group diagnosed simultaneously than in the remaining patients with HIV and TB or mycobacteriosis coinfection.WSTĘP: Zgodnie z danymi WHO wśród pacjentów zakażonych HIV, gruźlica występuje u około 30% pacjentów i jest przyczyną około 25% zgonów z powodu AIDS na świecie. Zapadalność na gruźlicę wśród populacji polskiej w 2011 roku wynosiła 22,2/100 000, natomiast średnia zapadalności w krajach Unii Europejskiej w 2011 roku — 14/100 000. W Polsce, od 1985 roku do 30 kwietnia 2013 roku potwierdzono 16 588 zakażeń HIV, natomiast liczba zgłoszonych w 2011 roku przypadków gruźlicy u zakażonych HIV wynosiła 26 przypadków. Celem pracy była ocena częstości i objawów klinicznych gruźlicy i mykobakterioz w materiale chorych zakażonych HIV, hospitalizowanych w Klinice Chorób Zakaźnych i Hepatologii Uniwersytetu Medycznego w Białymstoku.MATERIAŁ I METODY: Analizowano dokumentację 577 chorych zakażonych HIV. Analizowano dane demograficzne, epidemiologiczne, stan układu immunologicznego w zakresie limfocytów T CD4 i CD8, fazę zakażenia HIV.WYNIKI: Pełna obserwacja możliwa była u 389 pacjentów, z których 265 (68%) to mężczyźni. Gruźlicę rozpoznano u 41 pacjentów (10,5%), mykobakteriozy u 4 pacjentów (1,03%). U 19 pacjentów (42%) rozpoznanie gruźlicy lub mykobakteriozy było równoczasowe z diagnozą HIV. Mediana liczby limfocytów T CD4 była niższa u pacjentów z równoczesnym rozpoznaniem gruźlicy i zakażenia HIV w porównaniu do grupy, u której gruźlicę rozpoznano później. Liczbę limfocytów T CD4 niższą niż 50 kom./μl stwierdzono u 63,2% (12/19) pacjentów, u których zakażenie HIV i gruźlicę (albo mykobakteriozę) rozpoznano równocześnie oraz u 38,5% (10/26) pacjentów, u których te choroby rozpoznano w późniejszym czasie (p = 0,14). Mediana wiremii HIV u pacjentów, u których zakażenie HIV i gruźlicę lub mykobakteriozę zdiagnozowano równocześnie, była wyższa niż u pozostałych pacjentów i różnica ta była istotna statystycznie. Gruźlica płuc była najczęstszą postacią kliniczną choroby i stanowiła 60% wszystkich przypadków. Wśród analizowanych przypadków pacjentów z współwystępowaniem gruźlicy lub mykobakteriozy i HIV, gruźlica/mykobakterioza była przyczyną zgonu 8 pacjentów, natomiast 9 zmarło z innych przyczyn.WNIOSKI: W badanej populacji pacjentów gruźlicę rozpoznano u 41 pacjentów (10,5%), a mykobakteriozę u 4/389 pacjentów (1,03%). W 42% przypadków wśród badanych osób rozpoznanie zakażenia HIV i gruźlicy nastąpiło równoczasowo. W tej grupie chorych częściej obserwowano głęboki deficyt odporności komórkowej (limfocyty T CD4 < 50 kom./μl), a wiremia HIV RNA była istotnie wyższa niż w grupie chorych z HIV, u których gruźlicę lub mykobakteriozę rozpoznano później

Delayed diagnosis of human immunodeficiency virus infection in a patient with non-specific neurological symptoms and pancytopenia: a case report

INTRODUCTION: Both non-specific presentation and asymptomatic course of human immunodeficiency virus infection lead to undiagnosed long-term persistence of the virus in a patient's organism. CASE PRESENTATION: Here, we present a case of a 31-year-old Caucasian man with non-specific neurological symptoms and pancytopenia, who was referred to an internal medicine ward for further diagnosis. Upon admission to our hospital, he denied any past risky behaviors and refused to have his blood collected for human immunodeficiency virus testing. Later, he eventually provided consent to conduct the human immunodeficiency virus test which turned out to have a positive result. The overall clinical pattern indicated an advanced-stage of acquired immunodeficiency syndrome, which contrasted with the history he had provided. CONCLUSIONS: This case report indicates the need to consider human immunodeficiency virus/acquired immunodeficiency syndrome diagnosis in patients with non-specific neurological and hematological disorders. Our report also demonstrates difficulties that can be experienced by the physician while trying to obtain both a clear history and consent to perform human immunodeficiency virus testing

Human-Centered Programming: The Design of a Robotic Process Automation Language

RPA (Robotic Process Automation) helps automate repetitive tasks performed by users, often across different software solutions. Regardless of the RPA tool chosen, the key problem in automation is analyzing the steps of these tasks. This is usually done by an analyst with the possible participation of the person responsible for the given activity. However, currently there exists no one-size-fits-all description language, which would allow to record, process, and easily automate steps of specific tasks. Every RPA solution uses a different notation, which is not easily human-readable, editable, and which cannot be applied to a different automation platform. Therefore, in this paper, we propose a new eXtensible Robotic Language (XRL) that can be understood by both programmers and non-programmers to automate repetitive business processes.Comment: 8 page

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 Fisher's 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/mm(3) (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

Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe

Objectives: The aim of the study was to investigate the organization and delivery of HIV and tuberculosis (TB) health care and to analyse potential differences between treatment centres in Eastern (EE) and Western Europe (WE). Methods: Thirty‐eight European HIV and TB treatment centres participating in the TB:HIV study within EuroCoord completed a survey on health care management for coinfected patients in 2013 (EE: 17 respondents; WE:21; 76% of all TB:HIV centres). Descriptive statistics were obtained for regional comparisons. The reported data on health care strategies were compared with actual clinical practice at patient level via data derived from the TB:HIV study. Results: Respondent centres in EE comprised: Belarus (n = 3), Estonia (1), Georgia (1), Latvia (1), Lithuania (1), Poland (4), Romania (1), the Russian Federation (4) and Ukraine (1); those in WE comprised: Belgium (1), Denmark (1), France (1), Italy (7), Spain (2), Switzerland (1) and UK (8). Compared with WE, treatment of HIV and TB in EE are less often located at the same site (47% in EE versus 100% in WE; P < 0.001) and less often provided by the same doctors (41% versus 90%, respectively; P = 0.002), whereas regular screening of HIV‐infected patients for TB (80% versus 40%, respectively; P = 0.037) and directly observed treatment (88% versus 20%, respectively; P < 0.001) were more common in EE. The reported availability of rifabutin and second‐ and third‐line anti‐TB drugs was lower, and opioid substitution therapy (OST) was available at fewer centres in EE compared with WE (53% versus 100%, respectively; P < 0.001). Conclusions: Major differences exist between EE and WE in relation to the organization and delivery of health care for HIV/TB‐coinfected patients and the availability of anti‐TB drugs and OST. Significant discrepancies between reported and actual clinical practices were found in EE

Investigation of the freeze-out configuration in the ^{197}Au + ^{197}Au reaction at 23 A MeV

According to the model predictions, observation of toroidal objects is expected in collisions of heavy ion at low incident energies. Comparison between experimental data and model predictions which may indicate the formation of flat/toroidal nuclear systems is shown

Meeting the WHO 90% target : antiretroviral treatment efficacy in Poland is associated with baseline clinical patient characteristics

Introduction: Modern combined antiretroviral therapies (cART) allow to effectively suppress HIV-1 viral load, with the 90% virologic success rate, meeting the WHO target in most clinical settings. The aim of this study was to analyse antiretroviral treatment efficacy in Poland and to identify variables associated with virologic suppression. Methods: Cross-sectional data on 5152 (56.92% of the countrywide treated at the time-point of analysis) patients on cART for more than six months with at least one HIV-RNA measurement in 2016 were collected from 14 Polish centres. Patients’ characteristics and treatment type-based outcomes were analysed for the virologic suppression thresholds of <50 and <200 HIV-RNA copies/ml. CART was categorized into two nucleos(t)ide (2NRTI) plus non-nucleoside reverse transcriptase (NNRTI) inhibitors, 2NRTI plus protease (PI) inhibitor, 2NRTI plus integrase (InI) inhibitor, nucleos(t)ide sparing PI/r+InI and three drug class regimens. For statistics Chi-square and U-Mann Whitney tests and adjusted multivariate logistic regression models were used. Results: Virologic suppression rates of <50 copies/mL were observed in 4672 (90.68%) and <200 copies/mL in 4934 (95.77%) individuals. In univariate analyses, for the suppression threshold <50 copies/mL higher efficacy was noted for 2NRTI+NNRTI-based combinations (94.73%) compared to 2NRTI+PI (89.93%), 2NRTI+InI (90.61%), nucleos(t)ide sparing PI/r+InI (82.02%) and three drug class regimens (74.49%) (p < 0.0001), with less pronounced but significant differences for the threshold of 200 copies/mL [2NRTI+NNRTI-97.61%, 2NRTI+PI-95.27%, 2NRTI+InI-96.61%, PI/r+InI- 95.51% and 86.22% for three drug class cART) (p < 0.0001). However, in multivariate model, virologic efficacy for viral load <50 copies/mL was similar across treatment groups with significant influence by history of AIDS [OR:1.48 (95%CI:1.01–2.17) if AIDS diagnosed, p = 0.046], viral load < 5 log copies/mL at care entry [OR:1.47 (95%CI:1.08–2.01), p = 0.016], baseline lymphocyte CD4 count ≥200 cells/µL [OR:1.72 (95%CI:1.04–2.78), p = 0.034] and negative HCV serology [OR:1.97 (95%CI:1.29–2.94), p = 0.002]. For viral load threshold <200 copies/mL higher likelihood of virologic success was only associated with baseline lymphocyte CD4 count ≥200 cells/µL [OR:2.08 (95%CI:1.01–4.35), p = 0.049] and negative HCV status [OR:2.84 (95%CI:1.52–5.26), p = 0.001]. Conclusions: Proportion of virologically suppressed patients is in line with WHO treatment target confirming successful application of antiretroviral treatment strategy in Poland. Virological suppression rates depend on baseline patient characteristics, which should guide individualized antiretroviral tre0atment decisions

Light fragments production and isospin dependences in Sn+Ni and Sn+Al central collisions at 25MeV/A and 35MeV/A from reverse/isospin experiments

This paper presents the physical analysis results for the following reactions: 124Sn+64Ni, 124Sn+27Al, 124Sn+58Ni at 35MeV/A and 25MeV/A. The main goal of this studies was to find observables sensitive to isospin effects and to present the similarities/differences between the systems characterised by various charge asymmetry factor, defined as I = (NZ)=A. Theoretical simulations based on the Quantum Molecular Dynamics (QMD) model have been performed in order to compare them with the results of the analysis of experimental data. The first phase of the reaction was carried out with the code CHIMERA [1]. The sequential decay of hot fragments was simulated by the code COOLER [2]. The conclusions are as follows: there are observables sensitive to the isospin of the system, such as the Light Charged Particles (LCP) emission and their sensitivity is demonstrated more prominently in the analysis of central collisions at 35MeV/A. The theoretical calculations do not reproduce these relations well