Treatment of chronic hepatitis C in Croatian war veterans: experiences from Croatian reference center for viral hepatitis

Aim. To examine the risk factors, comorbidity, severity of liver disease, treatment course, and outcome in Croatian war veterans with chronic hepatitis C, especially those suffering from posttraumatic stress disorder (PTSD). ----- Methods. We collected medical records of 170 adult men diagnosed with chronic hepatitis C who started treatment with a combination of pegylated interferon-alpha and ribavirin between January 2003 and June 2009 at the Croatian Reference Centre for Viral Hepatitis. ----- Results. Participants' mean age was 43±9 years. Among 170 participants, there were 37 war veterans (22%). The main risk factor in veteran patients were operative procedures with transfusions (46% vs 5% in non-veterans; P<0.001) and in non-veteran patients intravenous drug use (42.1% vs 13%; P<0.001). The average duration of infection was longer in war veterans (14.5±3.4 vs 12.2±7.2 years; P=0.020). The percentage of PTSD comorbidity in the whole group was 11% (18/170) and in the war veterans group 49% (18/37). The prevalence of sustained virological response in patients with PTSD was 50% and in patients without PTSD 56%. Treatment reduction in patients with PTSD (33%) was higher than in patients without PTSD (12%; P=0.030). ----- Conclusion. Croatian war veterans are a group with high risk of chronic hepatitis C infection because many of them were wounded during the Croatian War 1991-1995. Considerations about PTSD as a contraindication for interferon treatment are unjustified. If treated, patients with PTSD have an equal chance of achieving sustained virological response as patients without PTSD

Etiology of Chronic Prostatitis Syndrome in Patients Treated at the University Hospital for Infectious Diseases »Dr. Fran Mihaljevi}« from 2003 to 2005

A total of 835 patients with symptoms of chronic prostatitis syndrome and no evidence of structural or functional lower genitourinary tract abnormalities were examined in a three year period at the Outpatient Department for Urogenital Infections, University Hospital for Infectious Diseases »Dr Fran Mihaljevi}« Zagreb, Croatia. Disease etiology was determined in 482 (57.72%) patients. Chlamydia trachomatis was proved to be the causative pathogen in 161 patients, Trichomonas vaginalis in 85, Escherichia coli in 68, Enterococcus in 51, Proteus mirabilis in 20, Klebsiella pneumoniae in 9, Streptococcus agalactiae in 15, Ureaplasma urealyticum in 49 patients with chronic prostatitis. Other patients had mixed infection. In 257 (53.32%) of 482 patients, the inflammatory finding (>10 WBCs/hpf) was found in EPS or VB3. Normal WBCs/hpf (<10) was found in 103 (63.98%) of 161 patients with symptoms of chronic prostatitis in whom C. trachomatis was detected in EPS or VB3, in 50 (58.82%) of 85 patients in whom Trichomonas vaginalis was isolated, and in 23 (46.94%) of 49 patients in whom Ureaplasma urealyticum was isolated

Treatment of chronic hepatitis C in Croatian war veterans: experiences from Croatian reference center for viral hepatitis

Aim To examine the risk factors, comorbidity, severity of liver disease, treatment course, and outcome in Croatian war veterans with chronic hepatitis C, especially those suffering from posttraumatic stress disorder (PTSD). Methods We collected medical records of 170 adult men diagnosed with chronic hepatitis C who started treatment with a combination of pegylated interferon-alpha and ribavirin between January 2003 and June 2009 at the Croatian Reference Centre for Viral Hepatitis. Results Participants’ mean age was 43 ± 9 years. Among 170 participants, there were 37 war veterans (22%). The main risk factor in veteran patients were operative procedures with transfusions (46% vs 5% in non-veterans; P < 0.001) and in non-veteran patients intravenous drug use (42.1% vs 13%; P < 0.001). The average duration of infection was longer in war veterans (14.5 ± 3.4 vs 12.2 ± 7.2 years; P = 0.020). The percentage of PTSD comorbidity in the whole group was 11% (18/170) and in the war veterans group 49% (18/37). The prevalence of sustained virological response in patients with PTSD was 50% and in patients without PTSD 56%. Treatment reduction in patients with PTSD (33%) was higher than in patients without PTSD (12%; P = 0.030). Conclusion Croatian war veterans are a group with high risk of chronic hepatitis C infection because many of them were wounded during the Croatian War 1991-1995. Considerations about PTSD as a contraindication for interferon treatment are unjustified. If treated, patients with PTSD have an equal chance of achieving sustained virological response as patients without PTSD

Efficacy of treatment with peginterferon alfa-2 plus ribavirin in patients with chronic hepatitis C infected with genotype 1 and low pretreatment viremia

Trajni virusološki odgovor nakon 48 tjedana liječenja kombinacijom pegiliranog interferona alfa-2 i ribavirina u bolesnika s kroničnim hepatitisom C inficiranih genotipom 1 postiže se u oko 55% bolesnika. Prethodne studije pokazale su da je kraća, 24-tjedna terapija u bolesnika s niskom početnom viremijom (<600 000 IU/mL) jednako učinkovita, ali uz praćenje rane virusne kinetike. Naša studija pokazuje da su bolesnici s niskom početnom viremijom veoma heterogena skupina bolesnika kod kojih trajni virusološki odgovor na liječenje nije bolji u odnosu na bolesnike s visokom viremijom (niska viremija SVR 53,2% (n = 94), visoka viremija SVR 50,8% (n = 122)). Bolesnici s niskom početnom viremijom u kojih nije postignut trajni virusološki odgovor imali su statistički značajno viši stupanj fibroze (stadij fibroze po Ishaku 3,47 u non-SVR grupi prema 2,94 u SVR+ grupi, p = 0,004) i bili su značajno starije životne dobi (46,4 godina u non-SVR grupi prema 39,6 godina u SVR+ grupi, p = 0,008). Od bolesnika s niskom početnom viremijom i cirozom jetre (n = 6) nitko nije postigao trajni virusološki odgovor, dok su oni sa stadijem fibroze 4/6 po Ishaku u 48% slučajeva bili non-responderi, tako da se stadij fibroze 4 nije pokazao kao značajan prediktivni faktor. Naši rezultati govore da su osim visine viremije na početku liječenja, značajni prediktivni faktori za uspjeh liječenja i stadij fibroze, naročito prisustvo ciroze, te starija životna dob.About 55% of patients with genotype 1 chronic hepatitis C infection have sustained response to 48-week therapy with pegylated interferon alfa-2 and ribavirin. Previous studies have shown that patients with low pretreatment viremia (< 600 000 IU/mL) can be treated for 24 weeks with similar efficacy as with 48-week therapy, when early viral kinetic is measured. Our study showed that patients with low pretreatment viral load (< 600 000 IU/mL) are very heterogenous group and sustained viral response to pegylated interferon alfa-2 and ribavirin therapy is not better than in high viral load group (low viremia patients SVR 53.2% (n = 94), high viremia patients SVR 50.8% (n = 122)). Pretreatment low viral load patients that did not achieve SVR (n = 44) had a significantly higher fibrosis stage (non-SVR fibrosis stage 3.47 Ishak score vs. SVR+ fibrosis stage 2.94; p = 0,004), and they were significantly older (non-SVR patients 46.4 years, SVR+ patients 39.6 years, p = 0.008). Low initial viremia patients with cirrhosis (n = 6) did not achieve SVR at all, while among patients with fibrosis stage 4/6, 52 % achieved SVR. Our results suggest that apart from viral load at the beginning of treatment, fibrosis stage is also a predicting factor for therapy outcome, particularly in older patients and patients with cirrhosis

Etiology of chronic prostatitis syndrome in patients treated at the university hospital for infectious diseases "Dr. Fran Mihaljević" from 2003 to 2005

A total of 835 patients with symptoms of chronic prostatitis syndrome and no evidence of structural or functional lower genitourinary tract abnormalities were examined in a three year period at the Outpatient Department for Urogenital Infections, University Hospital for Infectious Diseases "Dr. Fran Mihaljevic" Zagreb, Croatia. Disease etiology was determined in 482 (57.72%) patients. Chlamydia trachomatis was proved to be the causative pathogen in 161 patients, Trichomonas vaginalis in 85, Escherichia coli in 68, Enterococcus in 51, Proteus mirabilis in 20, Klebsiella pneumoniae in 9, Streptococcus agalactiae in 15, Ureaplasma urealyticum in 49 patients with chronic prostatitis. Other patients had mixed infection. In 257 (53.32%) of 482 patients, the inflammatory finding (>10 WBCs/hpf) was found in EPS or VB3. Normal WBCs/hpf (<10) was found in 103 (63.98%) of 161 patients with symptoms of chronic prostatitis in whom C. trachomatis was detected in EPS or VB3, in 50 (58.82%) of 85 patients in whom Trichomonas vaginalis was isolated, and in 23 (46.94%) of 49 patients in whom Ureaplasma urealyticum was isolated

Comparison of Clinical and Bacteriological Efficacy of Antimicrobial Treatment in Patients with Chronic Prostatitis Caused by Chlamydia trachomatis

Ispitali smo ukupno 194 bolesnika starija od 18 godina s kroničnim prostatitisom, od čega 38 bolesnika s kroničnim prostatitisom uzrokovanim klamidijom trahomatis. Za svakog bolesnika prikupljeni su sljedeći podaci: anamneza i težina simptoma kroničnog prostatitisa bodovan prema hrvatskom prijevodu upitnika o simptomima kroničnog prostatitisa (NIH-CPSI), klinički status uključujući digitorektalni pregled prostate, uzorci obriska uretre, selektivni uzorci urina i eksprimata prostate testom četiri čaše (metoda po Mearesu i Stameyu). Chlamydia trachomatis dokazivana je metodom DNK-RNK hibridizacije u obrisku uretre i eksprimatu prostate. Bolesnici s kroničnim bakterijskim prostatitisom liječeni su azitromicinom peroralno u ukupnoj dozi od 4,5 g kroz tri tjedna. Kliničko izlječenje podudaralo se s bakteriološkom eradikacijom (kappa >0,20.2<0.5)

Comparison of Clinical and Bacteriological Efficacy of Antimicrobial Treatment in Patients with Chronic Prostatitis Caused by Chlamydia trachomatis

Ispitali smo ukupno 194 bolesnika starija od 18 godina s kroničnim prostatitisom, od čega 38 bolesnika s kroničnim prostatitisom uzrokovanim klamidijom trahomatis. Za svakog bolesnika prikupljeni su sljedeći podaci: anamneza i težina simptoma kroničnog prostatitisa bodovan prema hrvatskom prijevodu upitnika o simptomima kroničnog prostatitisa (NIH-CPSI), klinički status uključujući digitorektalni pregled prostate, uzorci obriska uretre, selektivni uzorci urina i eksprimata prostate testom četiri čaše (metoda po Mearesu i Stameyu). Chlamydia trachomatis dokazivana je metodom DNK-RNK hibridizacije u obrisku uretre i eksprimatu prostate. Bolesnici s kroničnim bakterijskim prostatitisom liječeni su azitromicinom peroralno u ukupnoj dozi od 4,5 g kroz tri tjedna. Kliničko izlječenje podudaralo se s bakteriološkom eradikacijom (kappa >0,20.2<0.5)

Azithromycin in the Treatment of Prostatitis Due to U. urealyticum

U članku se prikazuje ispitivanje djelotvornosti i podnošljivosti ukupne doze od 4,5 grama azitromicina primijenjenog tijekom tri tjedna u liječenju 50 bolesnika s kroničnim prostatitisom uzrokovanim U. urealyticum. Klinički je izliječeno 40 bolesnika, a eradikacija ureaplazme postigla se u 45 bolesnika. Nije bilo nuspojava tijekom liječenja.This article shows the testing of effi cacy and tolerance of the total dose of 4.5 g of azithromycin administered over three weeks to 50 patients with chronic prostatitis due to U. urealyticum. The number of clinically cured patients was 40, and ureaplasma was eradicated in 45 patients. No adverse effects were reported

Diagnosis and treatment of hepatitis C

Virusološka dijagnostika HCV infekcije temelji se na primjeni standardiziranih seroloških i molekularnih testova. U molekularnoj dijagnostici HCV infekcije koriste se vrlo osjetljivi testovi za kvantifikaciju HCV RNK i genotipizaciju HCV-a. Genotip HCV-a važan je čimbenik pred-terapijske obrade bolesnika koji određuje trajanje liječenja, dozu ribavirina a omogućuje i procjenu vjerojatnosti uspjeha liječenja. Međutim, detekcija i/ili kvantifikacija HCV RNK u serumu preporučuje se za dokazivanje aktivne virusne replikacije u sklopu pred-terapijske obrade bolesnika kao i za praćenje virusološkog odgovora tijekom liječenja. Rezultati praćenja distribucije genotipova HCV-a u Referentnom centru za virusni hepatitis Ministarstva zdravstva R. Hrvatske pokazuju da je oko 60 % bolesnika s kroničnim hepatitisom C zaraženo genotipom 1 HCV-a, 36 % genotipom 3a, a svega 4 % bolesnika genotipovima 2 i 4. Zlatni standard liječenja kroničnog hepatitisa C (KHC) posljednjih sedam godina je kombinacija pegiliranog interferona alfa (PEG IFN) i ribavirina. Međutim, standardna terapija ne dovodi do izliječenja u 50 % bolesnika s genotipom 1, te oko 30 % bolesnika s genotipom 3a. Stoga se suvremeno liječenje bolesnika s kroničnim hepatitisom C temelji se na individualnom pristupu koji uključuje prilagodbu algoritma liječenja genotipu virusa, viremiji, stadiju fibroze te praćenju virusne kinetike. Modifikacija algoritma liječenja u bolesnika s genotipom 1 i sporim virusološkim odgovorom uključuje produljenje liječenja na 72 tjedna dok se liječenje bolesnika zaraženih genotipom 3a koji imaju nisku viremiju, a postignu brzi virusološki odgovor, liječenje može skratiti na 16 tjedana. Bolesnike s visokim stadijem fibroze (obilna vezivna septa) nije uputno liječiti prema visini viremije, jer u toj skupini bolesnika niska viremija ne predstavlja prediktor trajnog virusološkog odgovora. Bolesnike s akutnim hepatitisom C treba liječiti monoterapijom pegiliranim interferonom alfa u trajanju od 24 tjedna.Virological diagnostics of HCV infection is based on standardized serological and molecular assays. Molecular diagnostics of HCV infection includes assays for HCV RNK detection and/or quantification as well as genotyping assays. HCV genotype is an important parameter in the pre-treatment diagnostic workup that determines treatment duration, ribavirin dosage and represents an excellent predictor of treatment success. Detection and/or quantification of HCV RNK in the serum provides direct evidence of active viral replication in patients with chronic hepatitis C and enables determination of virological response during treatment. According to the Croatian Reference Center for Viral Hepatitis, 60 % of patients with chronic hepatitis C in Croatia are infected with genotype 1, 36 % of patients with genotype 3a and only 4 % of patients with genotypes 2 and 4. Standard treatment regimen for chronic hepatitis C over the past seven years is a combination of pegylated interferon alpha (PEG IFN) and ribavirin (guanosine analogue). However, standard treatment regimen based on the combination of PEG IFN and ribavirin for 48 weeks fails to achieve sustained viral response in 50 % of patients with genotype 1. Furthermore, 25 % of patients infected with genotype 3a will fail to respond to a standard 24 week regiment. Up-to date treatment of chronic hepatitis C should be individualized (treatment guided) according to the genotype, liver fibrosis, early viral kinetics and viremia. Modification of treatment algorithm in patients with genotype 1 who are late responders to treatment should include prolonged treatment (72 weeks). In patients infected with genotypes 2 and 3 and low viremia who are rapid responders, therapy can be shortened to 16 weeks. Patients with higher fibrosis rates (fibrotic septa) should not be treated according to viremia because in those patients viremia does not correlate with the ability to achieve sustained viral response. Meta-analysis of recent clinical trials on the treatment of acute hepatitis C showed that monotherapy with PEG IFN for 24 weeks is the suggested treatment regimen for this group of patients