The extent of B-cell activation and dysfunction preceding lymphoma development in HIV-positive people.

OBJECTIVES: B-cell dysfunction and activation are thought to contribute to lymphoma development in HIV-positive people; however, the mechanisms are not well understood. We investigated levels of several markers of B-cell dysfunction [free light chain (FLC)-κ, FLC-λ, immunoglobulin G (IgG), IgA, IgM and IgD] prior to lymphoma diagnosis in HIV-positive people. METHODS: A nested matched case-control study was carried out within the EuroSIDA cohort, including 73 HIV-positive people with lymphoma and 143 HIV-positive lymphoma-free controls. Markers of B-cell dysfunction were measured in prospectively stored serial plasma samples collected before the diagnosis of lymphoma (or selection date in controls). Marker levels ≤ 2 and > 2 years prior to diagnosis were investigated. RESULTS: Two-fold higher levels of FLC-κ [odds ratio (OR) 1.84; 95% confidence interval (CI) 1.19, 2.84], FLC-λ (OR 2.15; 95% CI 1.34, 3.46), IgG (OR 3.05; 95% CI 1.41, 6.59) and IgM (OR 1.46; 95% CI 1.01, 2.11) were associated with increased risk of lymphoma > 2 years prior to diagnosis, but not ≤ 2 years prior. Despite significant associations > 2 years prior to diagnosis, the predictive accuracy of each marker was poor, with FLC-λ emerging as the strongest candidate with a c-statistic of 0.67 (95% CI 0.58, 0.76). CONCLUSIONS: FLC-κ, FLC-λ and IgG levels were higher > 2 years before lymphoma diagnosis, suggesting that B-cell dysfunction occurs many years prior to lymphoma development. However, the predictive value of each marker was low and they are unlikely candidates for risk assessment for targeted intervention.

Opportunistic infections and other AIDS-defining illnesses in Poland in 2000-2002.

BACKGROUND: The introduction of highly active antiretroviral therapy (HAART) led to a decreased incidence of the most severe opportunistic infections (OIs) in HIV-infected patients. In Poland, HAART became widely used in 1998. MATERIALS AND METHODS: This study was based on data from medical records data collected in the years 2000-2002 from medical centers for HIV-infected patients in Poland. The aim of the study was to determine the incidence of opportunistic infections (OIs) and other AIDS defining illnesses (ADIs). The chi(2) test was used to determine any significant trends. RESULTS: The incidence of ADIs was 6.8, 6.5 and 4.8/100 persons/year in 2000-2002, respectively. The most common diagnosed OIs were: fungal infections, tuberculosis, recurrent pneumonia, PCP and toxoplasmosis. In patients receiving HAART (HAART+) the incidence of ADIs was significantly lower than in non-ARV-treated as well as in all HIV+ (p < 0.02, p < 0.001, p < 0.001, respectively). A significant decrease in the incidence of ADIs in HAART+ patients between 2000 and 2002 (p < 0.0001) was observed. From 25% to 30% of ADIs among HAART+ patients were diagnosed within the first 3 months of antiretroviral therapy. In HAART+ patients the most common ADIs were fungal infections and tuberculosis. The diagnosis of ADIs resulted in the recognition of HIV status in 8.7-8.9% of patients. CONCLUSIONS: Five years after the introduction of HAART the incidence of ADIs had declined. Fungal infections and tuberculosis were the most common OIs in HIV+ patients in Poland.

[Opportunistic infections in HIV-positive patients hospitalized in the Clinic of Infectious Diseases AMG]. / Infekcje oportunistyczne wystepujace u pacjentów zakazonych HIV hospitalizowanych w Klinice Chorób Zakaznych AMG.

UNLABELLED: Opportunistic infections are one of the major problem among HIV infected patients still connected with high mortality. The aim of the investigation is to evaluate the incidence and mortality from opportunistic infections in HIV infected population in Pomeranian region of Poland. The paper presents analysis of incidence of opportunistic infections among 141 AIDS patients hospitalised in Clinic for Infectious Diseases in Gdansk from 1988 to 2001/June/. In examined group 179 opportunistic infections were diagnosed. Most frequent was oesophageal candidiasis 58%, tuberculosis 29%, pneumocystis carinii pneumonia 21% and central nervous system toxoplasmosis 13%. The occurrence of opportunistic infections depends on CD4 count and rises with CD4 decline. Opportunistic infections were the reason of death in 33 from 74 cases/45%/. CONCLUSIONS: In examined group 28% of patients did not know about HIV infection when first opportunistic infection was diagnosed. Most frequent opportunistic infections in AIDS patients were oesophageal candidiasis, tuberculosis, pneumocystis carinii pneumonia and toxoplasmosis. In 98% of cases opportunistic infection developed when no HAART nor infection prophylaxis was administered. Opportunistic infection was the reason of death in 45% of cases, the most frequent were PCP and CNS toxoplasmosis.

[Sepsis in HIV-positive patients--own observation]. / Posocznice u HIV--dodatnich pacjentów w materiale wlasnym.

In the period of 1988-2001 (June) 24 HIV-positive patients with symptoms of sepsis were observed. Most of them (17 persons) were intravenous drug addicts, six patients were infected HIV trough sexual contact and one person-via blood transfusion. There were 26 cases analyzed (one of the patients went trough three episodes of sepsis). Bacterial sepsis dominated (22 cases). In three patients fungoid etiology was diagnosed, and one case was of mixed character. The highest risk factors of sepsis were: intravenous drug addiction and advanced stage of HIV infection.

[Staphylococcus aureus sepsis--still life threatening disease]. / Posocznica gronkowcowa--choroba nadal zagrazajaca zyciu.

We report an analysis of clinical course of 18 patients presenting with Staphylococcus aureus sepsis. Community acquired infection was caused by Methicillin susceptible S. aureus (MSSA) in 11 patients. MSSA in 3 and Methicillin Resistant S. aureus strains (MRSA) in 4 patients, were the etiologic factor in 7 patients with nosocomial infection. From anamnestic data patients presented with: elevated body temperature--18/18, arthralgia and myalgia--9/18, headache--8/18, nausea--6/18, chills--2/18. Physical examination on admission revealed: meningismus--12/18, hepatomegaly--11/18, purulent and haemorrhagic skin lesions--7/18 and impaired neurological status (Glasgow Coma Scale < or = 12)--6/18. The mean APACHE III score, calculated from data collected at diagnosis of sepsis was 47 (7-114). Several complications had been observed: endocarditis--10, purulent meningitis--5, focal CNS lesions--5, pneumonia--8, pulmonary abscess--3, hydrothorax--1, abscesses of the spleen--5, renum--4, osteomyelitis--2. 11/18 patients required ICU treatment. Ventilator assistance of respiration was necessary in 7/18. Acute thrombocytopenia (< 100,000/ml) was diagnosed in 60%. In 5 patients suppurative meningitis had been diagnosed with a mean pleocytosis-837 (173-1898) microL. The results of treatment were satisfactory in 11 patients, 3 patients required further surgical treatment (2--cardiosurgery, 1--orthopedic surgery), 4 patients died. Infection caused by community acquired MSSA strains had been characterized by severe clinical course with increased incidence of endocarditis, organ failure and abscess forming. We conclude that Staphylococcus aureus sepsis is still a life-threatening disease, which should be treated at centers with immediate access to imaging techniques of CNS and circulatory system as well as intensive care and cardiosurgery. Community acquired S. aureus sepsis compared with nosocomial infection is characterized by more severe clinical course and higher mortality, despite of a great susceptibility to most antibiotics of causative S. aureus strains.

Hepatotropic viruses seen by clinicians.

During last decades we have been witnessing substantial progress in hepatology, particularly in relation to viral hepatitis. Novel diagnostic tools allowed researchers to define new etiological agents, understand their epidemiology and pathogenesis as well as develop effective preventive measures. However, several important questions still remain to be answered and no satisfactory therapeutical agents for chronic hepatitis are available. Basic epidemiological, preventive and clinical aspects of viral hepatitis are being discussed in this paper.

Does hepatitis B virus or hepatitis C virus infection influence CD4 count in HIV-positive individuals?

Objective of the study was to determine whether there is any influence of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection on CD4 count decline rate in HIV-infected individuals. Retrospective analysis of consecutive CD4 counts was conducted in 72 HIV-infected untreated individuals (including 57 intravenous drug addict (i.v.d.a.)) in relation to their serological markers of HBV and HCV infection and the history of i.v. substance abuse. Anti-HBc seropositive individuals had slower CD4 count decline rates compared to anti-HBc seronegative ones (-0.20%/month vs. -2.90%/month, Kruskal-Wallis H = 4.77, p = 0.029). Anti-HCV serostatus had no influence on CD4 count decline rates (-0.47%/month for anti-HCV seropositive persons vs. -0.61%/month for anti-HCV seronegative ones, p = 0.91). History of i.v. substance abuse did not affect the CD4 count decline rates too (-0.83 for i.v.d.a. vs +0.74 for non-i.v.d.a., p = 0.26). In our study HIV-infected individuals seropositive for anti-HBc tended to have substantially lower CD4 count decline rates compared to seronegative ones. Neither anti-HCV serostatus nor the history of i.v. substance abuse influenced the CD4 count decline rate. This observation arises question about the possible nature (molecular?, immune-based?) of potential mutual interactions between HIV and HBV infections.

[HBV, HCV and HIV infections among drug addicts-residents of rehabilitation and social adjustment centers in the Gdansk district]. / Zakazenie HBV, HCV i HIV wsród narkomanów, mieszkanców osrodków rehabilitacji i resocjalizacji w województwie gdanskim.

Among 46 i.v. drug abusers we revealed HBV infection in 36, presence of anti-HCV antibodies in 33, and HIV infection in 21. Prevalence of HBV markers and anti-HCV antibodies increased with a period of time of i.v. drug abuse. The course of HBV and HCV infection was often subclinical. IgG levels turned out to be higher in HBV infected persons, with or without HIV infection.