Clinical aspects and treatment of hepatocellular carcinoma in north-eastern Poland.

AIM OF THE STUDY: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, with poor treatment outcomes often because of delayed diagnosis. The aim of this study was to assess the co-incidence of cirrhosis, alcohol abuse, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and fatty liver disease in patients in the population of north-eastern Poland, to analyse the usefulness of α-fetoprotein (AFP) in the diagnosis of HCC and to assess the effectiveness of HCC treatment in this group. MATERIAL AND METHODS: The study involved 104 patients diagnosed with HCC. The age, sex, comorbidities, HCC risk factors and levels of AFP were analysed. The effect of antiviral therapy of HCV and HBV on HCC development was observed and the effectiveness of therapies used in the treatment of HCC was assessed. RESULTS: Over 90% of patients with HCC were older than 45 years. The incidence of HCC was higher in men than in women. Patients with HCC were also diagnosed with cirrhosis (72%), alcohol abuse (35%), HCV infection (35%), HBV infection (24%), and fatty liver disease (13%). HCC developed in 9/25 (36%) patients positive for HBV despite effective antiviral therapy. The highest AFP levels were found in HBV-positive patients. The mean survival time was 19 months for partial hepatectomy and 16 months for thermal ablation. CONCLUSIONS: The main predisposing factor for HCC is cirrhosis, followed by alcohol abuse and infection with HCV. Effective antiviral therapy for HBV does not prevent the development of HCC in all cases. Since 29% of patients were disqualified from HCC treatment due to an advanced stage of cancer, it indicates insufficient screening for HCC. Partial hepatectomy and radiofrequency ablation show comparable effectiveness in the treatment of HCC.

Effect of comedication on ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin therapy in chronic hepatitis C - a real-world study.

AIM OF THE STUDY: This multicentre study aimed to examine the actual risk for drug-drug interactions in a cohort of Polish patients, and their impact on antiviral therapy. MATERIAL AND METHODS: Concomitant medications were analyzed in hepatitis C virus (HCV)-infected patients treated with still valuable therapy with OBV/PTV/r ± DSV ± RBV. An established online tool (http://www.hep-druginteractions.org/) was used to assess potential drug interactions. To assess the impact of comedications on virologic outcomes, HCV RNA levels were measured at given time points during and after the treatment. The results were compared between subgroups depending on the number of drugs used. RESULTS: Among the 209 patients included in this multicentre study, concomitant medications were taken by 140 (67.0%) patients. Modification of treatment due to expected interactions was required in 33 (15.8%) patients, of whom nine (4.3%) had at least one comedication replaced or discontinued. Sustained virologic response rates ranged from 95.1% to 100.0%, and were lowest in patients taking one to five comedications who were null-responders to pegylated interferon or cirrhotic. CONCLUSIONS: Although most HCV-infected patients received concomitant medications, only some required treatment modification. OBV/PTV/r ± DSV ± RBV was effective in all subgroups, irrespective of the number of comedications taken. Multimorbidity and polypharmacy in patients with chronic hepatitis C should not discourage the decision to initiate antiviral therapy, although caution should be exercised for potential drug-drug interactions.

Nutritional status in patients with liver cirrhosis.

AIM OF THE STUDY: To evaluate the nutritional status in patients with liver cirrhosis, depending on the stage of the disease. Fatty body mass, lean body mass and fluid content were determined, as well as basal metabolic rate. MATERIAL AND METHODS: The study included 56 patients with liver cirrhosis, aged 54 ±12 years. Nutritional status was determined with the BMI and albumin serum concentration. Fatty body mass, lean body mass and fluid content, as well as basal metabolic rate, were estimated by bioelectrical impedance, using a MALTRON 907 analyzer. RESULTS: Based on albumin concentration, malnutrition was diagnosed in over 80% of patients, usually (100%) in patients with liver cirrhosis belonging to Child-Pugh class C. In all patients, high energy demand was found in relation to basal metabolic rate. Average fatty body mass was comparable in all patients and ranged from 24 to 30%. Fluid content in the tissues was comparable in all evaluated groups and did not correlate with accompanying ascites. Fluid excess was found in 25% of Child-Pugh class A patients, in 59% of class B patients and in 60% of class C patients. CONCLUSIONS: Malnutrition is present in over 80% of patients with liver cirrhosis, and its frequency correlates with the stage of liver insufficiency. Patients with liver cirrhosis show high energy demand for basal metabolic processes. Fluid excess is mainly found in patients with more severe liver injury, but it does not correlate directly with ascites.

Alcohol Dehydrogenase Isoenzymes and Aldehyde Dehydrogenase Activity in the Serum of Patients with Non-alcoholic Fatty Liver Disease.

BACKGROUND/AIM: Non-alcoholic liver disease (NAFLD) is one of the most common causes of chronic liver disease, and its prevalence and medical importance is increasing worldwide. Changes in enzyme activity in liver cells in various liver diseases are reflected by an increase in serum enzymatic activity. For example, alcohol dehydrogenase activity (ADH) and aldehyde dehydrogenase (ALDH), that occur in the liver in large quantities, correlate with disease severity during cirrhosis. In the current study, the activity of ADH isoenzymes and ALDH in the serum of patients with NAFLD was investigated. MATERIALS AND METHODS: Serum samples were collected for routine biochemical studies from 55 patients with NAFLD patients and from 50 healthy individuals. Class I and II ADH and ALDH activity were measured by spectrofluorometric method. Photometric methods were used to measure ADH class III, IV and total ADH activity. RESULTS: Total ADH activity was significantly higher in non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH) than in healthy individuals (44 and 48.5% activity, respectively). The median total activity of ADH was 1,164 mU/l in patients with NAFLD, 1,258 mU/l in NASH and 648 mU/l in the control group. The increase in ADH class I and II isoenzyme in serum of patients with NAFL and NASH was statistically significant. The activity of ADH I, ADH II, and total ADH significantly increased with increasing disease progression. CONCLUSION: The activity of isozymes of class I and II alcohol dehydrogenase in patients with NAFLD is enhanced and appears to be due to the release of these isoenzymes from damaged hepatocytes.

Occurrence and clinical characteristics of hepatocellular carcinoma in the north-eastern Poland

Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the third leading cause of cancerrelated mortality worldwide. Risk factors for this malignancy include liver cirrhosis, HBV or HCV infection, fatty liver disease. THE AIM OF STUDY: This study aims to assess the occurrence and clinical characteristics of HCC in the Northeastern Poland between 2011 and 2015. The number of primary lesions, their size and location within the liver were analysed. The risk factors for this cancer in studied population have been identified. The usefulness of AFP screening and imaging studies for the diagnosis of HCC were assessed. A preliminary analysis of the efficacy of anti-tumour therapy was performed. RESULTS: Sixty-seven patients (28% female and 72% male) with diagnosed HCC were enrolled. HCC diagnosis was established according to the criteria proposed by the International Consensus Group for Hepatocellular Neoplasia. Of the 67 patients in the study, 7 (10%) were aged 30 to 50 years and 60 patients (90%) were aged 51 years and older. During the period 2011-2015, an increase in HCC incidence was observed. In studied group the most prevalent (31%) were patients with 2 tumours localised in the 6th, 7th or 8th segments of the liver. Metastatic tumours were present in 15% and portal vein thrombosis in 9% of patients. Risk factors assessment revealed that in 72% of patients HCC coexisted with cirrhosis, 33% of patients were HCV-infected, 30% had HBV infection, and 15% were diagnosed with NASH. Elevated serum AFP level was observed in 83% of patients with liver cirrhosis, and in 58% of patients without cirrhosis (p <0.05). Liver transplantation was the best therapeutic option. The efficacy of ablation/resection in combination with sorafenib vs. ablation/partial resection was comparable. CONCLUSION: There has been an increase in the number of HCC cases in North-eastern Poland in last few years. HCC is more common in men aged 50 years and older. Increased serum AFP level is a useful marker for the diagnosis and monitoring of HCC treatment in patients with liver cirrhosis.

HBV or HCV and pregnancy

Despite effective anti-HBV prophylaxis, cases of acute and chronic inflammation are still occurring, including among pregnant women. Studies in Asia suggest considering antiviral treatment among pregnant women with viremia above 10 log6 copies / ml. Current guidelines exclude the use of caesarean section as a method to reduce the likelihood of neonatal infection. At the same time, there are no grounds to ban the breastfeeding of a baby born to an HBV-infected mother. HCV infection can adversely affect the course of pregnancy. As with HBV infection, caesarean section does not reduce the risk of infection. Also breastfeeding among these patients is not contraindicated. The inability to use appropriate prophylaxis in newborns is one of the reasons for the targeted treatment of HCV-infected women at the procreation age in the first place.

Hepatitis E virus infection--a new threat for Europe.

Of 20 million of patients infected with hepatitis E virus (HEV) worldwide 57 thousand dies each year. HEV-infection is not longer regarded as a diseases in developing endemic countries of Asia, Africa and Latin America. The majority of European countries faces increasing number of endemic infections. They are caused by seven different genotypes and be responsible for acute and chronic infections. HEV is of zoonotic origin causing infections in pigs and boars which are a source of infection for humans. Infections occur orally after consumption of infected water or meat. HEV-infection is most dangerous for patients receiving immunosuppressive therapy, infected with HIV, after transplantations of solid organs and elderly. In some patients, including pregnant women, acute HEV has a serious course with fatalities reaching even 25%. Chronic HEV-infection may develop in patients following solid organ transplantations and requires long-term antiviral therapy. HEV-infection is a growing public health problem in Europe, which implies the necessity of routine screening in selected populations, especially immunocompromised.

Antiviral therapy of chronic HBV infection in pregnancy.

We describe a 27-year-old hepatitis B virus (HBV)-infected pregnant woman, with a history of miscarriage a year ago. The patient has been HBsAg and HBeAg positive for 20 years but has never been treated for HBV infection, because of stable elevated alanine aminotransferase (ALT) activity and high viral load. Treatment with tenofovir disoproxil was introduced in the 10th week of pregnancy and HBV DNA became undetectable. The clinical course of pregnancy was normal and the patient gave birth by caesarean section to a healthy child. At birth the newborn was HBsAg negative, after 3 months of follow-up is healthy, and evaluation of HBV status will be scheduled shortly. The decision to treat HBV infection during pregnancy should be individualized.

Influence of HCV and HIV on development of cryoglobulinemia.

Cryoglobulinemic syndrome refers to a systemic inflammatory process that involves small and medium-sized vessels accompanied by multi-organ damage. The aim of the present study was to determine the incidence of cryoglobulinemia among patients infected with human immunodeficiency virus (HIV), hepatitis C virus (HCV) and HCV/HIV co-infection, as well as evaluation of cryoglobulinemia type. The association was evaluated between cryoglobulinemia and clinical symptoms, selected biochemical measures of liver and kidney function, virologic measures, as well as histopathological changes in the liver. One hundred and forty-one patients were enrolled (59 HCV mono-infected, 48 HIV mono-infected, and 34 HCV/HIV co-infected). Cryoglobulinemia was nearly five times less frequent among HIV mono-infected patients (10%) than HCV mono-infected (53%) and HCV/HIV co-infected patients (59%). Cryoglobulinemia was more frequent in patients infected with genotype 1 HCV than genotype 3 (63% vs. 46%, p=0.12). There was a lower incidence of cryoglobulinemia in HIV mono-infected patients treated with antiretroviral drugs (p=0.04). Cryoglobulinemia correlated with ALT activity (p=0.01) and HIV viral load (p<0.001). Symptoms were significantly more frequent among cryoglobulinemic patients than those without cryoglobulinemia (38% vs. 9%, p<0.001). The most common symptoms related to cryoglobulinemia, regardless of cryoglobulinemia type, were fatigue (38%), arthralgia (20%), polineuropathy (18%), and skin lesions (14%). In conclusion, HCV mono-infection and HCV/HIV co-infection, regardless of HCV genotype, are potent stimulators of cryoglobulinemia, with its symptomatic form occurring in about 40% of cases. Effective antiretroviral therapy seems to be protective against cryoglobulinemia development in HIV mono-infected patients.

Impact of rs12979860 polymorphism on liver morphology in chronic HCV infection.

AIM OF THE STUDY: To determine distribution of rs12979860 genotypes, their correlations with viral load as well as inflammatory activity and stage of liver fibrosis in patients infected with HCV genotype 1. MATERIAL AND METHODS: The study included 132 patients infected with HCV genotype 1b. Serum viral loads were obtained with the PCR method. Rs12979860 polymorphisms were determined by sequencing of PCR products. Liver biopsy was performed in all patients. RESULTS: CT, TT and CC alleles of rs12979860 polymorphism were detected in 58%, 20% and 22% of patients respectively. The highest viral load was observed in the TT and the lowest in the CC group (72.0 × 106 IU/ml vs. 2.1 × 106 IU/ml, p < 0.005). A significant correlation was demonstrated between patient's age and inflammatory activity as well as degree of liver fibrosis. No association was found between liver histopathology and HCV viral load or rs12979860 genotypes. CONCLUSIONS: There is an association between HCV viral load and rs12979860 polymorphism. Inflammatory activity and stage of liver fibrosis depend on age, but there is no relationship with rs12979860 genotypes and HCV viral load.

Effect of hepatitis B virus (HBV) infection on the course of pregnancy and newborns' health status.

INTRODUCTION: The effect of chronic hepatitis B virus (HBV) infection on pregnancy is not clear. Hepatitis B virus infection of newborns in the case of natural delivery occurs in 70-90% of cases. Risk factors of infection are the presence of serum HBeAg and HBV DNA level above 107 IU/ml. Active and passive prevention protect more than 95% of neonates born to mothers infected with HBV. The aim of the study was to determine the course of pregnancy in HBV-infected women, the mode of delivery, efficacy of prophylaxis against HBV infection in newborns, and health condition of newborns within the first years of life. MATERIAL AND METHODS: The course of 104 pregnancies in 69 women infected with HBV was monitored. Hepatitis B virus viral load was determined by PCR using the AmpliPre/COBAS TaqMan HBV system. Neonatal HBV infection and the health condition at birth and during the first year of life were analyzed. RESULTS: All included pregnant women were HBeAg negative. No clinically significant disorders were observed during pregnancy. Viral load measured in the third trimester did not exceed 107 IU/ml in any pregnant woman. Only 5 (8%) of them demonstrated levels above 105 IU/ml. Two women (1.9%) experienced a miscarriage, which was considered as not associated with HBV infection. The majority (56%) of pregnancies ended with spontaneous labor. Complete prevention against HBV was applied in 79% of newborns. Hepatitis B virus infection was diagnosed in 3 children who received incomplete or no prophylaxis. Hepatitis B virus infection occurred in 3 (2.9%) children born naturally, who did not receive proper prevention after delivery. The Apgar score in children born to mothers infected with HBV did not differ significantly from that in neonates born to healthy women from the same population. Allergic disorders developed in 17 children who underwent HBV prophylaxis. CONCLUSIONS: Low viral load in pregnant women infected with HBV and the absence of HBeAg reduce the probability of infection of newborns. Proper prevention carried out after delivery seems to be the most important method to prevent HBV infection in newborns.

The importance of sCD40 and sCD40L concentration in patients with chronic HCV infection and HIV co-infection.

CD40 receptor is activated by ligand CD40L (CD154) which is synthesized in inflammation by NK cells, monocytes and lymphocytes B. TRAF proteins are activated in cells by CD40 stimulation and next they stimulate different enzymatic pathways. High concentrations of CD40L stimulate CD40, and consequently STAT enzyme system inhibits the expression ofnonstructural proteins ofHCV NS3 and NS5A and E2 core in infected human hepatocytes. PURPOSE. The aim of the study was to evaluate the concentration of soluble components of the complex: sCD40 and sCD40L in the serum of patients infected with HCV and HCV/HIV-1 co-infected. The effect ofHCV genotype, HIV and HCV viral load and rs12979860 polymorphism on serum sCD40 and sCD40L was established among the patients. The influence of the number of CD3+, CD4+ and CD8+ on the concentrations of sCD40 and sCD40L was evaluated in the HIV-1 infected group MATERIALS AND METHODS. Serum concentrations of sCD40 and sCD40L were determined using ELISA in 68 HCV infected patients including 39 HCV monoinfected and 29 HCV/HIV-1 co-infected. RESULTS. Serum concentration of sCD40 and sCD40L was significantly higher in HCV and HCV/HIV coinfected patients compared to healthy subjects (25.7 and 23.2 v. 8.5 pg/ml and 12.7 and 7.3 v. 0.79 ng/ml). The concentration of sCD40L in patients with genotype CC rs12979860 was significantly higher compared to patients with Non-CC genotypes (11.8 v. 7.6 ng/ml, p < 0.018). CONCLUSIONS. High levels of sCD40 and sCD40L were detected among patients with chronic HCV and HCV/ HIV-1 infection The high concentration of sCD40L correlates with CC rs12979860 genotype.

SNP RS12979860 related spontaneous clearance of hepatitis c virus infection in HCV/HIV-1 coinfected patients.

UNLABELLED: CC genotype of SNP rs 12979860 promotes spontaneous HCV clearance in monoinfected patients. The aim of this analysis was evaluation of impact of rs12979860 polymorphism on HIV or HCV viral load, CD3, CD4 and CD8 count as well as HCV clearance among HCV/HIV coinfected patients. MATERIALS AND METHODS: The study included 41 consecutive HCV/HIV coinfected patients. HIV RNA, HCV RNA, HCV genotype and rs12979860 polymorphism sequence as well as CD3, CD4 and CD8 cells count were analyzed in all patients. RESULTS: CC genotype rs12979860 was identified in 16 from 41 patients. During at least 4 years follow-up, five genotype CC patients (31%) became HCV RNA undetectable, that was not a case in CT and TT patients. No statistical differences in HIV viral load and the number of CD3, CD4 and CD8 related to rs12979860 polymorphism were observed. The baseline level of HCV RNA in patients with CC genotype was significantly lower compared to patients with non-CC genotypes (88546 +/- 74181 vs. 726021 +/- 30709 IU/mL). CONCLUSION: CC genotype related to SNP rs 12979860 can affect the lower level of HCV viral load compared to patients with CT and TT genotypes and promotes spontaneous clearance of HCV RNA in HCV/HIV coinfected patients.

Distribution of HCV genotypes in Poland.

UNLABELLED: Available data on prevalence of HCV genotypes in Poland are insufficient. The aim of the study was the analysis of distribution of HCV genotypes in Poland over the period of recent 10 years regarding the age of patients and the regions of the country. MATERIAL AND METHODS: Analysis of HCV genotypes in Poland was carried out between 2003 and 2012, and included 14 651 patients from 22 centers where patients with chronic viral hepatitis C are diagnosed and treated. Genotypes were analyzed in age groups (< 20 years of age, 20-40 years of age, > 40 years of age) as well as in populations of HBV and HIV co-infections. RESULTS: Genotype (G) 1 infection was demonstrated in 79.4%, G2 -0.1%, G3- 13.8%, G4- 4.9%, G6-0.09% and mixed infections in 1.6%. There was no infection with genotype 5. The highest prevalence of G1 was observed in the Lódzkie voivodship (89.2%) and the Slaskie voivodship (86.7%) while the lowest one in the Warminsko-mazurskie (62.0%) and the Podlaskie voivodships (68.2%). Genotype 3 most commonly occurs in the Warminsko-mazurskie (28.1%), and the Podlaskie voivodships (23.0%) and is least common in the Malopolskie (7.9%) and the Lódzkie voivodships (9.0%). Genotype 4 is more common in the Kujawsko-pomorskie (11.7%) and the Podlaskie voivodships (8.6%) and relatively less common in the Lubelskie (1.1%) and the Lódzkie voivodships (1.8%). Prevalence of G1 infection in 2003-2004 was 72% and increased up to 85.6% in 2011-2012, that was accompanied by decrease of G3 prevalence from 17% to 8% in this period. In HBV co-infected (n = 83), G1 infection was demonstrated in 85.5%, G3 - in 7.2%, G4 -4.8%, and mixed genotypes in 6%. Among HIV co-infected (n = 391), a much lower prevalence of G1 (33.0%) and a high of G3 (40.4%) as well as G4 (24.0%) were observed. CONCLUSIONS: There is a geographic variability of HCV genotypes prevalence in Poland. Increase of HCV G1 infections and decrease of G3 and G4 were observed in the last 10 years. Genotypes G3 and G4 occur more often in HCV/HIV co-infected than in HCV mono-infected patients.

HBV mutations associated with lamivudine therapy.

UNLABELLED: Lamivudine (LMV) is still the most commonly used nucleoside analogue in majority of the world. Its administration rapidly leads to resistance associated with mutations in HBV polymerase. THE AIM of the study was to assess the prevalence, nature and the time of LMV resistant variants appearence during a long term therapy. PATIENTS AND METHODS: Study was carried out among 175 chronic hepatitis B patients treated with LMV. HBsAg, HBeAg as well as anti-HBe antibodies were detected by enzyme immunosorbent assay and HBV-DNA quantification was performed by RT-PCR. Mutations in HBV polymerase gen were detected by PCR using specific primers and direct sequencing. Liver biopsies were performed in 138 patients to evaluate grading and staging of chronic hepatitis by Scheuer's classification. RESULTS: Mean pre-treatment viral load was comparable among HBeAg-positive and negative patients (4.24 x 10(8) vs. 1.26 x 10(8) IU/ml). Mutations in HBV polymerase gen were detected in 96 patients. After 5 years of LMV therapy the prevalence of mutations was 51.9% in HBeAg-positive and 56.1% in HBeAg-negative. The most common mutations were observed at position 180, followed by 204, 202, and 169 of HBV polymerase gen. After average treatment period of 25 months in HBeAg-positive and 35 months in HBeAg-negative additional mutation 204 was observed in 81% and 77% respectively. CONCLUSIONS: Large majority of patients develop point mutations at positions 180 and 204 of HBV polymerase gene after 2 years of treatment with LMV. These mutations limit the efficacy of LMV but also yield cross-resistance with entecavir.

[Occurrence of autoantibodies in patients with alcoholic liver disease]. / Wystepowanie autoprzeciwcial wsród chorych z alkoholowym uszkodzeniem watroby.

UNLABELLED: Autoantigens are present in normal cells and tissues. However, in physiological conditions autoantigens pose no danger due to the phenomenon of immunologic tolerance. The loss of immunologic tolerance and following autoagression could result from the structure changes of autoantigens as an effect of the activity of chemical factors, such as acetaldehyde, which is metabolite of ethanol. The aim of the study was to evaluate of occurrence of autoantibodies in patients with alcoholic liver disease. MATERIAL AND METHODS: Ninety-five patients with chronic alcoholic liver disease and 16 healthy controls were enrolled in this study. The presence of autoantibodies against liver proteins were assessed. The occurrence of studied autoantibodies was evaluated with regard to the degree of liver damage. Inclusion criteria were: age over 21 yrs, at least 3-yrs history of alcoholic liver disease, HBV and HCV-negativity, absence of autoimmunological diseases. The presence of autoantibodies AMA-M2, SLA/LP, LKM-1, LC1, anti-F-actin, desmin and miozin in serum was assessed by immunoblotting method and ANA by ELISA. RESULTS: Autoantibodies were demonstrated in sera of 33% of patients. Single isolated autoantibodies were present in 24% of patients, whereas 9% of patients have several autoantibodies. The most prevalent were anti-F-actin (19%) and antinuclear antibodies (11%). Occurrence of anti-F-actin antibodies increased with degree of liver damage. CONCLUSIONS: Concluding these results suggest that alcohol may contribute to the activation of autoimmune processes, and particularly against contractile filaments of cells for which F-actin antibodies are produced.

[Predictive factors of virological response in chronically HCV infected]. / Czynniki predykcyjne odpowledzi wirusologicznej u chorych przewlekle zakazonych HCV.

Research on new antivirals drugs applied in the treatment of chronically HCV infected indicate that even the most perfect therapeutic molecules do not guarantee 100% efficacy. Since the beginning of the history of HCV infection treatment clinicians looked for predictors of treatment efficacy. Numerous studies confirm the high probability of cure in patients who cleared HCVinfectional 4 and 12 weeks of therapy. However despite of viral factors, recent research demonstrated predictive role of some host dependent factors. The most important role seems to play genetic factors including polymorphism rs12979860, as well as chemokins including first of all CXCL10 (IP-10). Very interesting seems to be also results of studies on association between vitamine D concentration and treatment efficacy. However in the future the most important predictive factor remain probably early on-treatment viral response.

[The occurrence of HCV genotypes and single polynucleotide polymorphisms of rs12979860 among HCV infected patients in northeastern Poland]. / Wystepowanie genotypów HCV i polimorfizmu SNP rs12979860 wsród zakazonych HCV pólnocno-wschodniej Polski.

UNLABELLED: HCV is responsible for the development of chronic hepatitis C, cirrhosis and hepatocellular carcinoma. The Polish population is mainly dominated by genotype 1 infections, genotypes 3 and 4 are less common. Studies have shown that changes in SNPrs12979860 of human chromosome 19 affect their ability to eliminate infection both spontaneously and during the antiviral therapy. THE AIM OF THIS STUDY was to evaluate the frequency of different HCV genotype infections in the Podlasie region during the period from 2002 to 2011 and to determine the frequency of particular genes associated with rs12979860 polymorphism amongst patients both eligible for treatment and currently undergoing the treatment. METHODS. Research and evaluation of the genotypes was performed in 923 cases of HCV and in 126 cases genes rs 12.97986 were identified (97 patients infected with genotype 1, 17--genotype 3 and 12--genotype 4). HCV infection was confirmed by the detection of HCV-RNA and it's genotype in serum with RT-nested--PCR (Syngen Biotech, USA). Rs12979860 polymorphism was detected by sequencing, using PCR. The final scores were determined using 3500 Genetic Analyzer (Applied Biosystems, Foster City, USA). RESULTS: HCV infection was more frequent among men (60%). Genotype 1 was found in 66% of patients, genotype 3 in 27% and genotype 4 in 7% of patients. During period of 10 years slow increase of genotype 4 HCV infection prevalence was observed. Among patients infected with genotype 1 HCV waiting for the treatment and those who already completed antiviral therapy the presence of genotype C/C was found in 21%, C/T in 59% and T/T in 20%. CONCLUSIONS: The most common in Northeastern Poland is genotype 1 of HCV. There has been a slow increase of infections with genotype 4. In 79% of patients infected with genotype 1 ofHCV genotypes C/T or T/T have been found which is an adverse prognostic factor of the treatment.

[Chronic HBV infection in patients with lymphoproliferative syndromes]. / Przewlekle zakazenie HBV u chorych z zespolami proliferacyjnymi.

Treatment of patients with neoplastic diseases of the lymphatic or lymphoreticular system and HBV infection can lead to reactivation of viral infection. Assessment of HBs antigen among this group is insufficient for the diagnosis of chronic HBV infection. Current research suggests the necessity of determining anti-HBc, antiHBs and HBV-DNA. Elimination of HBV as well as the influence of the virus on hepatocytes is associated with increased inflammatory and necrotic changes in the liver. Understandable, therefore, becomes a possibility of significant damage to hepatocytes caused by HBV during chemoimmunotherapy. Ofparticular importance in the reactivation of HBV are glicocorticosteroids acting as suppressants of the immune system and rituximab activating B cell apoptosis. Reactivation of HBV may occur in more than 60% of patients with positive HBs antigen and in approximately 50% of patients without HBsAg. Early therapy with nucleo(z)tide analogues significantly reduces the incidence ofHBV reactivation.

[Liver damage in the course of Langerhans cells histiocytosis--case report]. / Uszkodzenie watroby w przebiegu histiocytozy z komórek Langerhansa--opis przypadku.

Langerhans cell histiocytosis is a disorder of unknown etiology characterized by proliferation of histiocytes originating from dendric cells. It usually affects children. LCH is claimed to be a difficult diagnostic challenge. We present a case of multi-organ LCH with severe liver damage. Initial symptoms of disease, the results of additional tests including histological assessment of liver suggested an autoimmune hepatitis. Histopathological evaluation of sequentially occurring lesions in the intestines and lungs made it possible to clarify the diagnosis. As there is no effective treatment--the progression of the disease resulted in patient being qualified for liver transplantation.