Durability of response to vaccination against viral hepatitis A in HIV-infected patients: a 5-year observation.

The aim of this study was to estimate the prevalence of total antibodies to hepatitis A virus (anti-HAV-T) in the group of HIV-positive adults in Lodz region of Poland, and to evaluate the response and long-term immunity after vaccination against hepatitis A virus. In the group of 234 HIV-infected patients, 72 persons (30.8%) were anti-HAV-T positive (>20 IU/L). In multivariate analysis, two independent factors associated with the presence of anti-HAV-T were identified: the age of patients (OR = 1.07) and the presence of antibodies to hepatitis C virus (OR = 2.87). Vaccination was completed in 83 patients. Good response (anti-HAV-T >20 IU/L one month after the booster dose) was obtained in 79.5% of patients. In patients with CD4 >200 cells/µL in multivariate analysis only presence of antibodies to hepatitis C virus was a prognostic factor for the response to vaccination (OR = 0.13). Among responders available for the follow-up, 82% (50 out of 61) had detectable anti-HAV-T at 1 year and 75.5% (37 out of 49) at 5 years. Our results demonstrate that most of the studied HIV-positive patients were susceptible to hepatitis A virus infection. Most HIV-infected adults with high CD4 counts had a durable response even up to 5 years after vaccination. Patients with a HIV/hepatitis C virus coinfection displayed a worse response to vaccination.

Effect of interferon alfa and ribavirin treatment on hepatitis C virus RNA in serum and peripheral blood mononuclear cells in children with chronic hepatitis C.

UNLABELLED: The correlations between the severity of hepatic lesions, age, gender, HBV co-infection and negativisation of HCV-RNA from serum and peripheral blood mononuclear cells (PBMC) after treatment of chronic hepatitis C (CHC) were analysed. 41 children (11 F/ 30 M), aged 5-16 years (mean 10 +/- 2.8), were treated with IFN-alpha and ribavirin for 12 months. Sustained negativisation of HCV-RNA from serum was achieved in 25 patients (61%), in 3 (7%) it reappeared after treatment, and in 13 (32%) it was ineffective. Clearance of HCV did not correlate with age (p = 0.65), sex (p = 0.13), past HBV infection (n = 22 anti-HBc +) (p = 0.24), maximum pre-treatment ALT activity (p = 0.06), grade of inflammation (p = 0.33) or stage of fibrosis (p = 0.9) in liver biopsy. It was achieved in 6/16 children previously resistant to IFN-a monotherapy and in 19/25 naive (p = 0.017). HCV-RNA was detected in PBMC in 9/24 (37%) seronegative children and in 1/21 (5%) in comparative group of seronegative adults; p = 0.004. Persistence of HCV-RNA in PBMC after combined treatment occurred in 5/10 (50%) patients resistant to previous IFN-alpha monotherapy, 6/35 (20%) of them cleared HCV from PBMC (p = 0.04). CONCLUSIONS: Age and gender, infection route, history of HBV infection or severity of histopathologic liver lesions had no influence on the efficacy of treatment with IFN-alpha and ribavirin. Clearance of HCV from serum and from PBMC occurs less frequently in patients previously resistant to IFN-alpha. Children with CHC require longitudinal observation after successful antiviral treatment as in 37% of those considered to be free from the virus by ordinary measures, HCV-RNA was found in PBMC.

99mTc-HEPIDA plasma clearance as a diagnostic tool. Total plasma v. specific hepatic clearance.

BACKGROUND: (99m)Tc-HEPIDA total plasma clearance has been used for assessment of hepatic parenchyma damage. However, the radiopharmaceutical used is being partly cleared from plasma also by the urinary tract. As the share of the latter route in total elimination of the compound is not well known, the aim of the study was to investigate the percentage of (99m)Tc-HEPIDA eliminated by the kidneys and by the liver. MATERIAL AND METHODS: To this aim total plasma clearance of the compound and urinary part were determined by the methods employed here in 117 patients and in 16 healthy volunteers. The pure hepatic clearance was calculated as the difference between total plasma and the urinary clearance of (99m)Tc-HEPIDA. RESULTS: The urinary clearance in patients amounted from 2.6 to 78% of total clearance; in the healthy volunteers the corresponding range was from 8.6 to 28%. Pronounced spread of the urinary clearance (coefficient of variation = 35%) and lack of correlation between the urinary and total clearance make it necessary to take account of urinary elimination in each patient in whom reasonably accurate assessment of hepatic clearance is required. CONCLUSION: Further studies on the diagnostic efficacy of pure hepatic clearance and its change with age in healthy patients appear necessary.

[Interferon alpha--treatment predictive response factors in group of adults patients with chronic hepatitis C]. / Czynniki predykcyjne odpowiedzi na leczenie interferonem--alpha 2b u doroslych chorych na przewlekle zapalenie watroby typu C.

INTRODUCTION: Chronic hepatitis C (CHC) is a serious clinical problem. Serious sequelae of the disease such as liver cirrhosis and hepatocellular cancer warrant the search for efficacious therapeutic methods. It is assumed that some initial clinical and laboratory data may predict the therapeutic response. However, before they can be used in clinical practice, objective evaluation of their value is to be performed. AIM OF THE STUDY: Evaluation of IFN-alpha efficacy in treatment of patients with chronic hepatitis C. Evaluation of factors predictive for results of treatment (therapeutic response) in patients with chronic hepatitis C treated with IFN alpha2b. Evaluation of cumulative prognostic value of the significant features. MATERIAL AND METHODS: Fifty four adult patients with chronic hepatitis C were treated with IFN-alpha for 6 months. Follow up was continued for 18 months after the end of treatment period. In the studied group, 19 clinical, biochemical and histologic features were the subjects of statistical analysis. RESULTS AND CONCLUSIONS: In 18.5% of patients the therapeutic response on IFN-alpha2b therapy was sustained, in 48.2% the response was transitory. In the remaining 33.3% of patients no therapeutic response were achieved. Discriminatory analysis revealed that duration of HCV infection, alcalic phosphatase activity in serum, histologic activity index, extensiveness of inflammation and biliary canaliculus proliferation in liver biopsy specimen before the IFN alpha2b treatment, are useful features predictive for the results of treatment. The cumulative prognostic value of these features in patients with chronic hepatitis C is 69%.

[Evaluation of persistence of IFN-alpha treatment response in chronic hepatitis C patients according with HCV-RNA presence in PBMC]. / Ocena trwalosci odpowiedzi na leczenie IFN-alpha chorych na przewlekle zapalenie watroby typu C na podstawie obecnosci HCV-RNA w komórkach jednojadrowych krwi obwodowej.

BACKGROUND: The current criterion of cure of chronic hepatitis C (CHC) is the absence of HCV-RNA in hepatocytes and peripheral blood mononuclear cells (PBMC), as these cells are considered for the place of protracted viral replication. PURPOSE: Evaluation of HCV-RNA presence in serum, freshly isolated PBMC and cultured PBMC, taken from patients responding to interferon alfa2b therapy, after 42 months of follow-up. Fifty four adults with CHC was treated with interferon alfa-2b (IFN-alpha 2b). Evaluation of HCV-RNA presence in serum were performed using RT-PCR method, before the therapy, and after 6 and 18 months of follow-up. All patients received interferon alpha-2b for 6 months. After 18 months of follow-up, results of treatment (ALT activity and presence of HCV-RNA in serum) were retrospectively analyzed. In 10 of 54 patients (18.5%) normalization of ALT activity and negativization of HCV-RNA in serum were observed. After 42 months of follow-up, in these 10 patients, the presence of HCV-RNA in serum, in freshly isolated PBMC and cultured PBMC, were evaluated. RESULTS: After 42 months of follow-up, HCV-RNA was not found in serum of any patient. In 3 of 10 patients HCV-RNA was present in freshly isolated PBMC. After 3-day-culture of PBMC, HCV-RNA was found in another patient. After 6 days of culture, results of RT-PCR test were negative in all cases. CONCLUSIONS: Absence of HCV-RNA in serum as well as in freshly isolated PBMC after 42 months of follow-up after the treatment of CHC, is not synonymous with eradication of virus. Three-day-culture of PBMC may be a valuable method, allowing for detection of subtreshold amounts of HCV. Longer, 6-day-culture seems to be invaluable diagnostically.

[Effectiveness of antiviral treatment of patients with chronic hepatitis C (a Polish multicenter study)]. / Efektywnosc leczenia przeciwwirusowego przewleklego zapalenia watroby typu C (wieloosrodkowe badania pòlskie).

Interferon alpha (INF) is routine treatment in patients with chronic hepatitis C. Many controlled investigations were evaluated to establish the optimal schedule of treatment with sustained virological and biochemical response. Recently, multicentre meta-analyses suggest that combination therapy (INF + Ribavirin) was more effective than treatment with interferon alone. The aim of this study was to compare the efficacy of four schedules of antiviral treatment in 445 patients with chronic hepatitis C. Combination therapy (INF + Ribavirin) given for 6 mo. and monotherapy (INF) for 18 mo. were more effective than interferon alone given for 6 mo. Treatment with INF alone for 6 mo. was demonstrated to be insufficient.

[Levels of interleukin-6 in cerebrospinal fluid of patients with meningitis]. / Stezenie interleukiny-6 w plynie mózgowo-rdzeniowym u chorych na zapalenie opon mózgowo-rdzeniowych.

UNLABELLED: Interleukin-6 (IL-6) is a multifunctional cytokine that regulates the immune response, differentiation of B cells, activation of T lymphocytes and acute phase reactions. AIM OF THE STUDY: Quantitation of interleukin-6 in cerebrospinal fluid from patients with purulent bacterial meningitis (PBM) and viral meningitis (VM) on the first day of hospitalization. PATIENTS AND METHODS: IL-6 activity was measured in cerebrospinal fluid (CSF) of 15 children with VM (predominantly 13/15 caused by mumps virus) in age ranging from 2.5 to 15 years and 13 patients with PBM (age ranging from 18 to 52 years). The control group consisted of 10 patients with meningeal syndrome and normal laboratory estimation of CSF (white cells count, concentration of glucose and protein). The IL-6 assays were performed using immunoenzymatic method, ELISA (Amersham) technique. RESULTS: Increased levels of IL-6 were detected in the CSF of patients with bacterial meningitis and with viral meningitis. CSF IL-6 levels were 6 times greater in patients with purulent bacterial versus viral meningitis. The highest level of IL-6 was observed in a 18 years old patient with pneumococcal meningitis who died. CONCLUSION: We suggest that cytokine levels may be valuable in distinguishing patients with purulent bacterial meningitis from viral meningitis and may help in prognosis of patients with purulent meningitis.

[Epidemic of ECHO type 30 virus meningitis in children from the Lodz region in the years 1995 and 1996]. / Epidemie zapalenia opon mózgowo-rdzeniowych wywolane przez wirusa ECHO 30 u dzieci w regionie lódzkim w 1995 i w 1996 roku.

Two epidemics of ECHO virus type 30 meningitis were compared with the special emphasis on the course of the disease and results of the laboratory investigations. The first epidemic occurred in 1995 and the second one in 1996. Between 20 August and 20 October 1995, thirty six children, and between 11 July and 15 October 1996, ninety one children were admitted to the Department of Infectious Diseases, Medical University of Lódz. All children were 3 to 15 years old, the median age was 9.08 years in the 1995 epidemic and 8 years in the 1996 epidemic. The common symptoms were headache, fever, vomiting and nuchal rigidity. The course of both epidemic was mild, there were no complications and serious sequelae of the disease. Typical symptoms were found more frequently in patients in 1996 epidemic. Patients in 1996 had higher CSF pleocytosis and the percentage of granulocytes in the CSF than patients in 1995. From the other side, patients in the 1995 epidemic had higher fever of longer duration than patients in the 1996 epidemic.

Acute phase proteins in serum and cerebrospinal fluid in the course of bacterial meningitis.

We carried out estimations of the following acute phase proteins: C-reactive protein (CRP), alpha-1-antitrypsin (AAT), alpha-1-acid glycoprotein (AAG), alpha-2-ceruloplasmin (CER), and alpha-2-haptoglobin (HPT) in serum and in cerebrospinal fluid (CSF) in patients with bacterial meningitis (BM, n = 30) and viral meningitis (VM, n = 30). We have shown that determinations of concentrations of AAG and CRP in serum and CER in CSF are useful in differentiation between BM and VM. The diagnostic power of these three tests (the areas under their ROC curves equal 0.942, 0.929, and 0.931, respectively) is bigger, though statistically not significantly, than that of traditional parameters of BM in CSF, i.e., total protein concentration and white blood cell count. Determination of AAG, CRP, and AAT in serum is a valuable monitoring marker in the course of BM treatment. Convenience of serum sampling constitutes an advantage over traditional BM parameters in CSF.

[Epidemiologic-clinical analysis of purulent meningitis in adults: material from the Clinic of Infectious Diseases AM in Lodz in the years 1990-1991]. / Analiza epidemiologiczno-kliniczna ropnego zapalenia opon mózgowo-rdzeniowych u doroslych: material Kliniki Chorób Zakaznych AM w Lodzi w latach 1990-1991.

Authors have presented 81 cases of bacterial meningitis in adult patients (pts) treated in the Clinic for Infectious Diseases in the years 1990-1991. The aim of the study was the clinical and epidemiological analysis of the bacterial meningitis. Clinical symptoms, time between first symptoms and onset of hospitalisation and treatment, coexisting diseases and their influence on the course of the disease were considered in the analysis. The aetiological agent was found in 21% of cases. In the study group 75.3% were pts 26-65 years old. 77.8% were male pts. In 65.4% pts delay in hospitalisation and therapy exceeded 24 hours, 41.9% was longer than 48 hours. 18% of pts were afebrile. In the study group only 34.6% of pts were free of coexisting diseases.

[Treatment outcome of purulent meningitis in adults from material of the Clinic of Infectious Diseases AM in Lodz in the years 1990-1991]. / Wyniki leczenia ropnego zapalenia opon mózgowo-rdzeniowych u doroslych w materiale Kliniki Chorób Zakaznych AM w Lodzi w latach 1990-1991.

81 patients (pts) with bacterial meningitis hospitalised in the Clinic for Infectious Diseases in the years 1990-1991 were treated according to two therapeutic schedules. First: young pts (under 40 years), without coexisting diseases obtained Penicillin G and aminoglycoside and/or synthetic penicillin. Second: pts over 40 years old with coexisting diseases or cases of recurrent meningitis were treated with third-generation cephalosporins and aminoglycoside and/or synthetic penicillin. The mortality was 16% in the study group. 11 of 13 pts with coexisting diseases died. Neurologic sequelae were found in 23% of pts. The complete recovery was obtained in 34% of pts, more often (35.9%) in a group treated with third--generation cephalosporins comparing to 29.4% with other antibiotic therapy.

[Humoral response observed among second year dental students vaccinated against hepatitis B]. / Dynamika odpowiedzi humoralnej u studentów ii roku stomatologii po szczepieniu przeciwko wirusowemu zapaleniu watroby typu B.

The aim of the study was the follow-up of humoral response after vaccination against hepatitis B. 115 students of dentistry were vaccinated with Engerix-B vaccine. 100% of seroconversion to anti-HBs was observed 3 months after vaccination, and 97.1% 12 months post vaccination. The GMT of anti-HBs was higher in women then in men, but in 12 months observation the decrease of GMT was more rapid in female group. Any severe adverse reactions of vaccination were observed.

[Usefulness of establishing chosen acute phase proteins concentrations in serum and cerebrospinal fluid for differential diagnosis and monitoring of purulent meningitis in adults. I]. / Przydatnosc oznaczania stezen wybranych bialek ostrej fazy w surowicy krwi i plynie mózgowo-rdzeniowym do diagnostyki róznicowej i monitorowania przebiegu ropnych zapalen opon mózgowo-rdzeniowych u doroslych. I. Stezenie bialek ostrej fazy w surowicy krwi.

40 adult patients were examined: 24 with purulent meningitis and 16 with lymphocytic meningitis. The control group consisted of 100 healthy people. In purulent meningitis patients in the 1st, 3rd, 5th, 7th, 14th and 28th day of the disease, concentrations of the following acute phase proteins were measured in serum: C-reactive protein, alpha 1-antitripsin, alpha 1-orosomucoid, alpha 2-ceruloplasmin, alpha 2-macroglobulin and alpha 2-haptoglobin. In lymphocytic meningitis patients concentrations of the above mentioned acute phase proteins were measured only in the 1st day of the disease. Usefulness of establishing alpha 2-haptoglobin, alpha 1-antitripsin, alpha 2-ceruloplasmin and particularly C-reactive protein concentrations for differential diagnosis of purulent and lymphatic meningitis was proved. Evaluation of C-reactive protein and alpha 1-antitripsin concentration kinetics proved to be fully useful for monitoring of seriousness of the course of purulent meningitis, and together with evaluation of the clinical condition of the patient it can constitute a valuable marker of effectiveness of the disease treatment.

[Usefulness of establishing chosen acute phase proteins concentrations in serum and cerebrospinal fluid for differential diagnosis and monitoring of purulent meningitis in adults. II]. / Przydatnosc oznaczania stezen wybranych bialek ostrej fazy w surowicy krwi i plynie mózgowo-rdzeniowym do diagnostyki róznicowej i monitorowania przebiegu ropnych zapalen opon mózgowo-rdzeniowych u doroslych. II. Stezenie bialek ostrej fazy w plynie mózgowo-rdzeniowym.

40 adult patients were examined: 24 with purulent meningitis and 16 with lymphocytic meningitis. In the course of purulent meningitis concentrations of the following acute phase proteins were measured in the cerebrospinal fluid: C-reactive protein, alpha 1-antitripsin, alpha 1-orosomucoid, alpha 2-ceruloplasmin, alpha 2-macroglobulin and alpha 2-haptoglobin in the 1st, 3rd, 5th, 7th, 14th and 28th day of the disease. In lymphocytic meningitis patients concentrations of the above mentioned acute phase proteins were measured only in the 1st day of the disease. Full usefulness of establishing concentrations of all the above mentioned acute phase proteins within the first five days of the purulent meningitis for differential diagnosis of purulent and lymphatic meningitis was proved. Evaluation of concentration kinetics of acute phase proteins in cerebrospinal fluid for monitoring of the course of purulent meningitis is of a limited value.

[Increased activity of aminotransferases (ALAT, AspAT) in pregnant women threatened with immature and premature delivery treated with fenoterol]. / Wzrost aktywnosci aminotransferaz (ALAT, AspAT) u ciezarnych z zagrazajacym porodem niewczesnym i przedwczesnym, leczonych fenoterolem.

2330 pregnant women were admitted to the 2nd Department of Pregnancy Pathology at the Polish Mother's Memorial Hospital (PMMH) in Lódz, Poland, during the period from 28th March, 1989 to 30th June, 1991. Out of the group 1055 pregnancies were treated because of the risk of premature delivery (45.28%). In five (5) cases a significant rise of ALAT and AspAT aminotransferase activity occurred during fenoterol therapy. Laboratory tests excluded infectious etiology in the rise of the enzymes in question (no markers typical for HBV, HAV infection). Toxic injury of hepatic cells being suspected, fenoterol therapy was withdrawn, followed by a decrease of aminotransferases activity to normal values in those five (5) cases. No increase in the activity of ALAT and AspAT occurred in further follow up of the pregnant women in pregnancy and in puerperium. Since no other hepatotoxic factors appeared, it may be assumed that a chronic administration of fenoterol can cause transient injuries of hepatic cells. For this reason all pregnant women treated with betamimetics require examinations of the liver.

[Evaluation of seroconversion after voluntary vaccination against hepatitis B in students at the University of Lodz]. / Ocena serokonwersji po dobrowolnych szczepieniach przeciw wirusowemu zapaleniu watroby typu B studentów Akademii Medycznej w Lodzi.

We have evaluated the results of the first action of voluntary vaccination against hepatitis B in the students of Medical University of Lódz using Energix-B vaccine (20 micrograms) in schedule 0, 1, 6 months. Few students applied for the vaccination: only 48.4% of persons planned for vaccination completed the schedule. Seroconversion rate (anti-HBs > 10u/l) in this group was 93.9%. Three doses of vaccine applied inconsistently with schedule resulted in the immunological response in 3 out of 4 students observed. Two doses of vaccine resulted in the effective response in 13 out of 16 students observed. One doses of vaccine proved to be ineffective. The blood tests performed prior to vaccination showed the presence of the HBV markers in 9.6% of students (HBsAg in 2.1% of persons and anti-HBs in 5.3/of persons).