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

Effect of HCV Core Antigen and RNA Clearance during Therapy with Direct Acting Antivirals on Hepatic Stiffness Measured with Shear Wave Elastography in Patients with Chronic Viral Hepatitis C

To assess a combination of novel measures of therapeutic success in the treatment of chronic hepatitis C (CHC) infection, we evaluated liver stiffness (LS) with shear wave elastography and hepatitis C virus core antigen (HCVcAg) concentrations. We followed 34 patients during and after treatment with direct acting antivirals. All patients achieved a sustained virologic and serologic response and a significant increase of albumin levels. Decreases of alanine aminotransferase (ALT) activity and alpha-fetoprotein (AFP) level were observed during the treatment and follow-up period. A significant decrease in LS was observed between baseline, end of treatment (EOT), and at 24- and 96-week post-treatment follow-up. LS decline between EOT and 96-week follow-up (FU96) was observed in 79% of patients. Significant LS changes were seen in patients with advanced fibrosis, particularly in cirrhotics and in patients with ALT exceeding 100 IU/mL. There was a positive correlation between ALT activity and LS changes at the baseline versus FU96. A negative correlation was demonstrated between individual HCVcAg baseline concentrations and reduction of LS at the baseline versus FU96. In conclusion, we observed that LS significantly declined during and after antiviral treatment. It was accompanied by improvement in some liver function measures, and disappearance of both HCVcAg and HCV ribonucleic acid (HCV RNA)

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. Materials 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. Conclusions: 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

Zespół metaboliczny wśród osób zakażonych HIV w Polsce

   Background: Metabolic syndrome (MS) is usually diagnosed based on the presence of abdominal obesity, elevated blood pres­sure (BP), elevated fasting plasma glucose, high serum triglycerides (TG), and low high-density lipoprotein (HDL) cholesterol levels. Whether HIV is associated with a higher prevalence of MS than in the general population remains unclear. Aim: The aim of the study was to determine the incidence of MS in the population of HIV-infected adults and its association with clinical, virological, and biochemical features. Methods: Two hundred and seventy HIV-infected Caucasian adult patients were enrolled in the study and evaluated based on clinical records in the years 2013–2015. Results: Metabolic syndrome was diagnosed in 60 of 270 (22%) patients, 47 (24%) males and 13 (17%) females, mostly (72%) aged above 40 years. The percentage of patients with diagnosed MS in specific age groups in comparison to the general Polish population for females aged &lt; 40 years was 7% vs. 4%, and males in the same age — 18% vs. 9%, for females aged 40–59 years — 47% vs. 24.4%, and males — 33% vs. 28.3%. Particular components of MS in the MS population were found as follows: body mass index &gt; 30 kg/m2 in 29%, waist circumference exceeding 94 cm in men and 80 cm in woman — 87.5%, TG ≥ 150 mg/dL — 82%, HDL cholesterol &lt; 40/50 mg/dL (males/females) — 42%, systolic/diastolic BP ≥ 130 mmHg/≥ 85 mmHg — 83%, and fasting glucose &gt; 100 mg/dL — 42%. In stepwise multivariate logistic regression analysis, age (odds ratio [OR] 1.052, 95% con­fidence interval [CI] 1.018–1.088, p = 0.003) and nadir CD4 &lt; 350 cells/mm3 (OR 3.576, 95% CI 1.035–12.355, p = 0.04) were associated with MS. Patients with MS compared with those without this disorder had low, intermediate, high, and very high cardiovascular risk in 10% vs. 23%, 73% vs. 70%, 7% vs. 5%, and 10% vs. 2%, respectively (p = 0.006). Conclusions: Prevalence of MS in the HIV-infected population is higher than in the general Polish population. Age and low nadir CD4 were found to be associated with MS.Wstęp: Zespół metaboliczny (MS) zwykle jest rozpoznawany na podstawieo występowania otyłości brzusznej, zwiększonego ciśnienia tętniczego, podwyższonych stężeń glukozy na czczo i triglicerydów (TG), jak również obniżonego stężenia lipoprotein o niskiej gęstości (HDL). Wpływ zakażenia HIV na częstość występowania MS wśród osób zakażonych nie został dotychczas jednoznacznie określony. Cel: Celem pracy było określenie częstości występowania MS w populacji osób dorosłych zakażonych HIV, jak również jego zależności z parametrami klinicznymi, wirusologicznymi i biochemicznymi. Metody: Do badania włączono 270 dorosłych pacjentów rasy białej, zakażonych HIV. Analizowano dane pochodzące z dokumentacji medycznej prowadzonej w latach 2013–2015. Wyniki: Zespół metaboliczny rozpoznano u 60 z 270 (22%) pacjentów, 47 (24%) mężczyzn i 13 (17%) kobiet, w większości (72%) w wieku powyżej 40 lat. Odsetek chorych w poszczególnych przedziałach wiekowych, u których rozpoznano MS, w porównaniu z polską populacją ogólną, w przypadku kobiet 30 kg/m2 u 29%, obwód talii przekraczający 94 cm u mężczyzn i 80 cm u kobiet — 87,5%, stężenie TG ≥ 150 mg/dl — 82%, stężenie HDL 100 mg/dl — 42%. Na podstawie analizy wieloczynnikowej stwierdzono, że wiek (OR 1,052; 95% CI 1,018–1,088; p = 0,003) oraz nadir CD4 < 350 (OR 3,576; 95% CI 1,035–12,355; p = 0,04) były związane z wystąpieniem MS. U chorych z MS w porównaniu z osobami bez ZM stwierdzono niskie, umiarkowane, wysokie i bardzo wysokie ryzyko sercowo-naczyniowe, odpowiednio, w 10% vs. 23%, 73% vs. 70%, 7% vs. 5% oraz 10% vs. 2% przypadków (p = 0,006). Wnioski: Częstość występowania MS w populacji osób zakażonych HIV jest większa niż w polskiej populacji ogólnej. Wiek oraz mała liczba nadir CD4+ wiążą się z występowaniem zespołu metabolicznego