Browsing by Author "Dragovic, G. (23396934400)"

Background: A hepatitis C (HCV) cure is associated with changes in lipids and inflammatory biomarkers, but its impact on clinical endpoints among treated human immunodeficiency virus (HIV)/HCV coinfected persons is unclear. Methods: People living with HIV from EuroSIDA with a known HCV status after January 2001 were classified into strata based on time-updated HCV RNA measurements and HCV treatment, as either HCV antibody-negative; spontaneously resolved HCV; chronic, untreated HCV; cured HCV (HCV RNA-negative); or HCV treatment failures (HCV RNA-positive). Poisson regression was used to compare incidence rates between HCV groups for end-stage liver disease (ESLD; including hepatocellular carcinoma [HCC]), non-acquired immunodeficiency virus defining malignancy (NADM; excluding HCC), and cardiovascular disease (CVD). Results: There were 16 618 persons included (median follow-up 8.3 years, interquartile range 3.1-13.7). There were 887 CVD, 902 NADM, and 436 ESLD events; crude incidence rates/1000 person-years follow-up were 6.4 (95% confidence interval [CI] 6.0-6.9) for CVD, 6.5 (95% CI 6.1-6.9) for NADM, and 3.1 (95% CI 2.8-3.4) for ESLD. After adjustment, there were no differences in incidence rates of NADM or CVD across the 5 groups. HCV-negative individuals (adjusted incidence rate ratio [aIRR] 0.22, 95% CI 0.14-0.34) and those with spontaneous clearance (aIRR 0.61, 95% CI 0.36-1.02) had reduced rates of ESLD compared to cured individuals. Persons with chronic, untreated HCV infections (aIRR 1.47, 95% CI 1.02-2.13) or treatment failure (aIRR 1.80, 95% CI 1.22-2.66) had significantly raised rates of ESLD, compared to those who were cured. Conclusions: Incidences of NADM or CVD were independent of HCV group, whereas those cured had substantially lower incidences of ESLD, underlining he importance of successful HCV treatment for reducing ESLD. © 2019 The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.

Acute pancreatitis (AP) is a well-known adverse effect of nucleoside reverse transcriptase inhibitors (NRTIs). Therefore, we performed a prospective, cohort study to examine the incidence rates (IRs) and rate ratios (RRs) of AP for each NRTI. A total of 116 HIV patients were included in the final analysis comprising 445.6 person-years of follow-up. Twelve cases of AP were recorded. The lowest IR for AP was for didanosine (ddI) (IR = 0.03 per 100 person-years, 95% confidence interval [CI] = 0.01-0.05), and the highest for ddI + stavudine (d4T) (IR = 0.08, 95% CI = 0.07-012). Compared with ddl alone, the RR of AP was 2.21 (95% CI = 1.32-9.31) for d4T, and 3.13 (95% CI = 1.43-12.56) for ddI + d4T. Other risk factors for AP were CD4 cell count <200 cells/mm 3 and female sex. Our results suggest that the use of d4T alone or combined with ddI should not be used as first-line therapy, especially in women or patients with CD4-cell count <200 cells/mm 3 .

Purpose of investigation: The objective of this study was to predict preeclampsia using extreme-low first-trimester pregnancy-associated- plasma-protein-A-(PAPP-A), extreme-low free-beta-human-chorionic-gonadotropin-(free-βhCG)-levels, and extreme-high pulsatility- index (PI) of uterine arteries, as single and combined predictors for preeclampsia development in resource-limited-settings. Materials and Methods: First-trimester screening for PAPP A, free-βhCG, and PI was performed between 11-13 +6 gestation-weeks in nulliparous, normotensive women with singleton pregnancy with extremely-low PAPP-A (PAPP-A ≤ 0.52 MoM), extremely-low free- βhCG (free-βhCG ≤ 0.56 MoM) and extremely-high PI (≥ 2.52). Results: Of 85 pregnant women, 14 (16.5%) developed preeclampsia. PAPP-A ≤ 0.52 MoM and PI ≥ 2.52, as a single categorical variables, found to be with high OR for preeclampsia-development (OR = 7.07, 95% CI = 0.873-57.204, p = 0.067; OR = 5.098, 95% CI = 0.625-41.575, p = 0.128, respectively). The ROC-curve identified PAPP-A and PI as continuous variables to be significant predictors of preeclampsia (AUC = 0.864, 95% CI = 0.750-0.978, p = 0.000; AUC = 0.762, 95% CI = 0.598-0.925, p = 0.002, respectively). A prediction model for preeclampsia including PAPP-A ≤ 0.52 MoM + PI ≥ 2.52 was found to be significantly associated with preeclampsia (p = 0.027). Conclusion: The present study suggests that the firsttrimester extreme low-PAPP-A and increased Doppler-PI levels have significant predictive capability for preeclampsia.

Objectives: Survey was conducted to assess state of viral hepatitis care in Central and Eastern Europe (CEE). Methods: Representatives of 16 CEE countries completed on-line survey in April–May 2017 that collected information on basic epidemiology and availability of key services for HCV and HBV infections. Sources of information provided ranged from national surveillance data to expert opinion. Results: The burden of viral hepatitis varied between countries, ranging from 6,500 to 2 million for HCV and from 10,000 to 3 million for HBV. Access to routine HCV RNA testing and genotyping was reported by 11 and 9 countries, respectively. HCV resistance testing was available in 7 countries. Direct acting antivirals (DAAs) were available in 13 countries, most frequently Sofosbuvir and Ledipasvir/Sofosbuvir (12 countries apiece) and Ombitasvir/Paritaprevir/Dasabuvir (9 countries). HBV DNA testing and HBV genotyping were routinely available in 10 and 7 countries, respectively. Eleven countries reported available treatment with Tenofovir. Conclusions: There are gaps in viral hepatitis care in CEE. Despite the availability of registered modern drugs for HCV and HBV, the access to treatment is limited. Ensuring quality health care is essential to reduce the epidemic and achieve the WHO’s goal of eliminating viral hepatitis as a major public health challenge. © 2019, Czech National Institute of Public Health. All rights reserved.