Comparison of Demographic, Epidemiological, Immunological, and Clinical Characteristics of Patients with HIV Mono-infection Versus Patients Co-infected with HCV or/and HBV: A Serbian Cohort Study.

OBJECTIVE: The study aimed to correlate the status of hepatitis C (HCV) and hepatitis B virus (HBV) co-infection in patients with human immunodeficiency virus (HIV) infection with clinical and demographic data prior to starting highly active antiretroviral therapy (HAART) and assess the impact of HCV and HBV co-infection on the natural history of HIV infection. PATIENTS AND METHODS: The study involved a total of 836 treatment-naive patients with available serological status for HBV and HCV at the point of therapy initiation. Patients were stratified into four groups: HIV mono-infection, HIV/HCV, HIV/HBV, and HIV/HCV/HBV co-infection. Demographic, epidemiological, immunological and clinical characteristics were analyzed in order to assess the possible impact of HCV and HBV co-infection on HIV - related immunodeficiency and progression to AIDS. RESULTS: The prevalence of HCV and HBV co-infection in our cohort was 25.7% and 6.3%, respectively. Triple HIV/HCV/HBV infection was recorded in 1.7% of the patients. In comparison with those co-infected with HCV, patients with HIV mono-infection had lower levels of serum liver enzymes activity and higher CD4 cell counts, and were less likely to have CD4 cell counts below100 cells/µL and clinical AIDS, with OR 0.556 and 0.561, respectively. No difference in the development of advanced immunodeficiency and/or AIDS was recorded between patients with HIV monoinfection and those co-infected with HBV, or both HCV/HBV. CONCLUSION: HIV/HCV co-infection was found to be more prevalent than HIV/HBV co-infection in a Serbian cohort. Co-infection with HCV was related to more profound immunodeficiency prior to therapy initiation, reflecting a possible unfavorable impact of HCV on the natural history of HIV infection.

Seasonality of trichinellosis in patients hospitalized in Belgrade, Serbia.

A retrospective study of the course and outcome of trichinellosis in a series of 50 patients hospitalized at the Institute for Infectious and Tropical Diseases in Belgrade between 2001 and 2008 was performed. Clinical diagnosis of trichinellosis was based upon the patients' clinical history, symptoms and signs, and eosinophilia. The occurrence of cases showed a strong seasonality (P < 0.0001). The incubation period ranged between one and 33 days. The mean time between onset of symptoms and admission was nine days. Family outbreaks were the most frequent. Smoked pork products were the dominant source of infection (76%). Fever was the most frequent clinical manifestation (90%), followed by myalgia (80%) and periorbital edema (76%). 43 patients were examined serologically and 72% of them had anti-Trichinella antibodies. Eosinophilia and elevated levels of serum CK and LDH were detected in 94, 50 and 56% of the patients, respectively. All patients responded favorably to treatment with mebendazole or albendazole, but eight developed transient complications. Trichinellosis remains a major public health issue in Serbia.

The prognosis of highly active antiretroviral therapy (HAART) treated HIV infected patients in Serbia, related to the time of treatment initiation.

BACKGROUND: With the introduction of highly active antiretroviral treatment (HAART) an impressive improvement in patient survival and quality of life has bee observed. However, the optimal timing of initial HAART is still under consideration. OBJECTIVE: To investigate the prognosis of HAART treated patients in Serbia, related to the timing of HAART initiation. STUDY DESIGN: A series of 563 patients on HAART was retrospectively analyzed to investigate treatment response and survival. RESULTS: After a mean of 6 years (range 1-14) of treatment with PI-based and/or NNRTI-based regimens, a favorable response was achieved in 72.4%, treatment failure occurred in 7.9%, while 19.7% had a dissociative immunological/virological response. If treatment was initiated during primary HIV infection it took a shorter time to achieve a favorable response than in patients who began HAART in chronic HIV infection (2.7+/-2.2 years vs. 6.9+/-2.7 years, P<0.01). A higher proportion of patients with primary HIV infection then those treated in the chronic phase achieved a favorable response to HAART (88.4% vs. 71.9%, P=0.045). Patients who initiated HAART when their CD4 cell counts were below 200 cells/microL needed longer treatment for favorable response (8 years vs. 6 years, log rank P<0.01). Forty-seven (8.3%) patients died. The overall estimated survival was 13 years. Patients older then 40 and IVDU were more likely to die during HAART (OR 2.6, 95% CI 1.1-5.9, P=0.016, and OR 2.0, 95% CI 1.0-3.7, P=0.02, respectively). However, reaching and maintaining undetectable viremia was an independent predictor of longer survival (OR 11.3, 95% CI 4.6-27.7, P<0.01). CONCLUSION: Reaching and maintaining undetectable viremia during HAART predicted longer survival, even if sub-clinical immunodeficiency remained.

The prognosis of CMV retinitis among patients with AIDS in Serbia.

BACKGROUND: Cytomegalovirus (CMV) end-organ diseases, including CMV retinitis, are major opportunistic events in terminal AIDS patients. METHODS: A retrospective study of 30 AIDS patients with CMV retinitis treated between 1997 and 2007 in Serbia was conducted to examine the prognosis and factors associated with survival. RESULTS: Eighteen (60%) patients survived the mean follow-up period of 46.4+/-36 months. Patients' sex, mode of HIV transmission or previous AIDS diagnosis did not affect survival. Bilateral CMV retinitis predicted dissemination of CMV disease and poor prognosis (OR 7.8, 95% CI 1.3-47.0, P=0.012), but was not associated with blindness (P=0.33). Among patients treated with HAART and CMV therapy the probability of surviving 10 years was 70%, while in those on CMV therapy alone, the median survival was 10 months (log rank P=0.00). However, HAART itself was not sufficient to prevent blindness and the major predictor of blindness was a baseline CD4 cell count of less than 50/microL (OR 6.8, 95% CI 1.1-41.8, P=0.03). After CMV disease, most patients suffered other opportunistic events regardless of HAART introduction. CONCLUSION: Even in the HAART era patients with advanced immunodeficiency and CMV retinitis may not escape from the high risk mortality group, while survivors commonly lose sight.

Focal tuberculosis of the liver with local hemorrhage in a patient with acquired immunodeficiency syndrome.

Tuberculosis of the liver is common in patients with acquired immunodeficiency syndrome (AIDS). Tuberculous liver granulomas in such patients are usually atypical. The liver granulomas may be even totally absent, but liver tissue usually reveals numerous acid-fast bacilli. Focal tuberculosis of the liver is a less common form of liver tuberculous infection. We present a 33-year old white homosexual man infected with the human immunodeficiency virus. He had three tumour-like lesions in the left liver lobe, which were subsequently diagnosed as focal hepatic tuberculosis with local hemorrhage. This unusual presentation of liver tuberculosis indicates the necessity of an aggressive diagnostic approach for the evaluation of focal liver lesions in patients with AIDS.

Multiple abscesses of the liver caused by Campylobacter jejuni.

A 37-year-old woman developed multiple liver abscesses caused by Campylobacter jejuni, as a consequence of unrecognized and inadequately treated Campylobacter enteritis. The diagnosis was established by isolation of Campylobacter jejuni from blood and pus obtained from one of the liver abscesses during laparoscopy. The abscesses were successfully treated with intravenously and orally administrated antibiotic drugs, without further percutaneous drainage.

[Correlation between immunological markers and clinical course of HIV infection]. / Klinicko-imunoloske odlike razvoja HIV infekcije.

The interaction of human immunodeficiency virus (HIV) with CD4 molecule, which is expressed on various human cells is the crtical event in the pathogenesis of HIV infection. Decreased number and functional anergy of CD4+ T cells, which are the most important immunoregulatory cells, cause severe immunodeficiency. Having in mind that there is a significant correlation between clinical course of HIV infection and laboratory markers it is possible to predict progression of HIV infection toward acquired immunodeficiency syndrome (AIDS). These markers can be divided into four categories: (1) measures of viral production; (2) the specific immune response to HIV; (3) nonspecific immune system activation; (4) measurements of immune system damage. In addition, the use of these predictors can improve clinical management of HIV-infected individuals.

[Neurological disorders associated with HIV infection]. / Neuroloske komplikacije HIV infekcije.

Neurological diseases occur frequently in patients infected with human immunodeficiency virus (HIV). There are three main groups of central nervous system (CNS) dysfunction: (1) direct effects of HIV; (2) opportunistic infections; (3) opportunistic neoplasms. On the basis of clinical characteristics it is possible to differentiate focal and diffuse pathologic alterations of CNS. The starting point of evaluation of CNS dysfunction is computed tomography (CT). If the focal lesions are not present on CT scan, it is necessary to carry out cerebrospinal fluid (CSF) examination.

[Treatment and prophylaxis of opportunistic infections in individuals infected with HIV]. / Lecenje i profilaksa oportunistickih infekcija u bolesnika inficiranih HIV-om.

The primary causes of morbidity and mortality in persons infected with the human immunodoficiency virus are oportunistic infections. Infection with the human immunodeficiency virus (HIV) induces progressive quantitative and qualitative defects in CD4 (T helper) lymphocytes. Macrophage and monocyte function may also be impaired as a result of HIV infection. Consequently, patients in the later stages of HIV infection (ARC and AIDS) frequently experiency infections against which either cellular od humoral immunity, or both, are important. A large number of viruses, bacteria, fungi and protozoa are capable of infecting persons with ARC or AIDS. Much of recent research efforts has been targeted at new techniques to diagnose, treat and to prevent certain opportunistic infections. Treatment is often long and ardous for both patient and physician. This review provides a practical introduction to the treatment and prevention (primary prophylaxis, secondary prophylaxis, supression, or maintenance therapy) of the most common opportunistic infections associated with HIV.

[Antiretroviral therapy of acquired immunodeficiency syndrome (AIDS)]. / Antiretrovirusna terapija sindroma stecene imunodeficijencije (AIDS-om).

The unique nature of the replication cycle of the retroviruses, including HIV, offera number of possible targets for chemotherapeutic agents. These are RNA viruses which have the capacity to make DNA copies through their characteristic enzyme, reverse transcriptase, encoded in the pole region of the viral genoma. Reverse transcription is an attractive target for therapeutic intervention as this event is uniquelly associated with retroviruses. Dideoxynucleoside analogues can compete with endogenous nucleosides that are the natural substrate for reverse transcriptase or may be incorporated intro the growing chain of proviral DNA and terminate elongation. Reverse transcriptase inhibition is the principal mechanism of action of zidovudine (AZT) and related nucleosides, dideoxyinosine (ddl) and dideoxycitidine (ddC), which all attach to reverse transcriptase to the same site. This review will discuss current approaches to the antiretroviral therapy in AIDS patients. Several well controlled clinical trials have established both the efficacy and toxicity of AZT in patients with AIDS and severe ARC and it was shown that this drug decreased the incidence and severity of opportunistic infections, with the highly significant reduction in early mortality. The efficacy of newer reverse transcriptase-inhibiting nucleoside derivatives will be discussed too, as well as the issue of combination therapies.

[Pulmonary manifestations of acquired immunodeficiency syndrome (AIDS)]. / Plucne manifestacije sindroma stecene imunodeficijencije (AIDS-om).

The lungs are the principal target organ in the infectious complications of acquired immunodeficiency syndrome (AIDS) and this predisposition to infections is not the regional manifestation of systemic immunologic deficiency induced by human immunodeficiency virus (HIV) only, because HIV also affects lung's own complex system of local defense mechanisms. It was demonstrated that pulmonary host defenses were compromised by.direct infection of alveolar macrophages with HIV and decreased production of solubile factors by lymphocytes derived from bronchoalveolar lavage fluid was shown. The most common infectious causative agents are facultative intracellular pathogens including Pneumocystis carinii, Cryptococcus neoformans, Mycobacterium tuberculosis and cytomegalovirus, which reflects the specific defects of cell-mediated immunity. AIDS patints have, in addition, an increased incidence of infections with capsulated bacteria such as Haemophilus influenzae and Sterptococcus pneumoniae which are associated typically with the impairment of the humoral immune response. High-grade pathogens such as M. tuberculosis tende to reactivate early in the progression of immunodeficiency whereas low-grade pathogens such as P. carinii only emerge when the defect is more advanced. The profound immunodeficiency in AIDS patients means that clinical features may be quite atypical and blunted.

[Imported malaria--clinical problems]. / Importavana malarija--aktuelan klinicki problem.

Over the period from 1985 to 1989, 107 patients suffering from malaria were treated in the Institute for Infectious and Tropical Diseases in Belgrade. The eradication of malaria in Yugoslavia was carried out in 1960 and all the new cases originated from different African countries. Most of these patients were Yugoslav citizens working in these countries. Plasmodium falciparum was the cause of malaria in most of them. The parasytologic analysis of dense drops and smears of peripheric blood revealed it in 81 (75.5%) patients. Taking into account the great problem of treatment of malaria resistant to Resorchin (over 50% in our patients) the great role of chemioprophylaxix, antimalaric agents and appropriate vaccination is emphasized.