OBJECTIVE: The aim of the study was the assessment of adherence to antiretroviral (ARV) treatment in a population of people living with HIV (PWH), improving the awareness of PWH, drawing attention to the risk of developing HIV drug resistance and subsequent treatment failure. METHODS: The basic cohort consisted of PWH followed up long-term at the HIV centre of the University Hospital Pilsen. Adherence to treatment was assessed by ARV levels. Nucleoside analogs were determined in urine by high pressure liquid chromatography (HPLC), in relation to clinical data, viral load (HIV RNA), and absolute CD4 and CD8 T cell counts. To assess mental and physical state of the patients, a modified SF-36 questionnaire was used to measure social relationships, education and ability to relax. RESULTS: From a group of 131 PWH, 18 (13.7%) with zero levels and 113 (86.3%) with any detectable ARV levels were followed for 6-12 months. A statistically significant lower viral load was demonstrated in patients who adhered to the treatment at the time of the test as indicated by ARV levels in the urine. CD4 T lymphocyte values in adherent patients were, as expected, statistically significantly higher. A significant difference for CD8 T lymphocyte was not demonstrated. A survey assessed subjective factors influencing the degree of adherence. PWH consider important: quality care enabling trust, low risk of developing opportunistic infections, self-sufficiency, quality of sleep, managing leisure activities, and good family relationships. Quality of life evaluation and satisfaction in the monitored areas were similar in both groups of PWH. CONCLUSIONS: Non-adherence leads to deterioration of CD4 and viral load levels and may be the cause of the development of HIV drug resistance and treatment failure on the part of the patient. PWH with zero or low urinary nucleoside levels were repeatedly instructed about the need for regular and sustained medication use. Regular checks with a laboratory examination service are needed to detect early emergence of resistance and side effects of the treatment, which are initially only detectable in the laboratory.

• MeSH
• adherence k farmakoterapii * psychologie   MeSH
• dospělí MeSH
• HIV infekce * farmakoterapie   psychologie   MeSH
• kohortové studie MeSH
• kvalita života * MeSH
• látky proti HIV * terapeutické užití   moč   MeSH
• lidé středního věku MeSH
• lidé MeSH
• počet CD4 lymfocytů MeSH
• virová nálož MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: This retrospective, observational, non-interventional study describes the demographics, characteristics, immunological and virological status, coinfections, healthcare unit of HIV diagnosis and follow-up status of Ukrainian refugees with newly diagnosed HIV in the Czech Republic, with a special focus on those with a late HIV diagnosis. METHODS: Ukrainian nationals with war refugee status, Ukrainian nationals with Czech Republic resident status and Czech Republic nationals who newly registered at HIV centres in the Czech Republic between March 2022 and June 2023 with a new diagnosis of HIV were included. Data were collected from medical records. The study was registered with the Czech State Institute for Drug Control (ID 2401240000). RESULTS: In total, 298 patients with a new HIV diagnosis were included in the study. Of these, 58 patients were Ukrainian refugees who were retained in care. This cohort had a mean age of 37.0 years (min-max 13-60) and most (62.1%) were women. More than half of the Ukrainian refugees in this study (60.3%) had a late HIV diagnosis; these patients were older than those with a prompt diagnosis (mean age 40.7 vs. 31.5 years, p < 0.001). Ukrainian refugees were infrequently diagnosed in primary care and significantly more likely to have a late HIV diagnosis (60.3% vs. 37.8%, p = 0.005) and be diagnosed at a later HIV stage (p = 0.021) than Czech nationals. CONCLUSION: Ukrainian refugees were more likely to have a late HIV diagnosis than Czech nationals.

• MeSH
• dospělí MeSH
• HIV infekce * diagnóza   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• opožděná diagnóza * statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• uprchlíci * statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Ukrajina MeSH

BACKGROUND: To date there remains much ambiguity in the literature regarding the immunological interplay between SARS-CoV-2 and HIV and the true risk posed to coinfected individuals. There has been little conclusive data regarding the use of CD4 cell count and HIV viral load stratification as predictors of COVID-19 severity in this cohort. METHODS: We performed a retrospective, observational cohort study on people living with HIV (PLWH) who contracted COVID-19 in central and eastern Europe. We enrolled 536 patients from 16 countries using an online survey. We evaluated patient demographics, HIV characteristics and COVID-19 presentation and outcomes. Statistical analysis was performed using SPSS 20.1. RESULTS: The majority of the study cohort were male (76.4%) and 152 (28.3%) had a significant medical comorbidity. Median CD4 cell count at COVID-19 diagnosis was 605 cells/μL [interquartile range (IQR) 409-824]. The majority of patients on antiretroviral therapy (ART) were virally suppressed (92%). In univariate analysis, CD4 cell count <350 cells/μL was associated with higher rates of hospitalization (p < 0.0001) and respiratory failure (p < 0.0001). Univariate and multivariate analyses found that an undetectable HIV VL was associated with a lower rate of hospitalization (p < 0.0001), respiratory failure (p < 0.0001), ICU admission or death (p < 0.0001), and with a higher chance of full recovery (p < 0.0001). CONCLUSION: We can conclude that detectable HIV viral load was an independent risk factor for severe COVID-19 illness and can be used as a prognostic indicator in this cohort.

• MeSH
• COVID-19 * epidemiologie   komplikace   MeSH
• HIV infekce * komplikace   farmakoterapie   epidemiologie   MeSH
• lidé MeSH
• počet CD4 lymfocytů MeSH
• respirační insuficience * MeSH
• retrospektivní studie MeSH
• SARS-CoV-2 MeSH
• testování na COVID-19 MeSH
• virová nálož MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• východní Evropa MeSH

OBJECTIVES: Influenza A and B viruses cause epidemics every year, with approximately 3-5 million serious cases and about 290,000 to 650,000 deaths worldwide. Most patients die from bacterial complications of influenza. The aim of our study was to describe the clinical pictures of influenza and the development of the complications in seniors over 65 years of age, who were treated in University Hospital Pilsen. The course of the disease and changes in laboratory parameters were evaluated with regard to the method of treatment performed. METHODS: A descriptive retrospective study was performed. Clinical and laboratory data of seniors with the diagnosis of influenza were extracted from electronic medical records and later analysed. The data were processed with Excel 2016 and Statistica. RESULTS: A collection of 261 seniors, of whom 218 were hospitalized and 43 treated in an outpatient setting, has been studied. Patients who later developed complications had elevated values of CRP, procalcitonin, urea, and creatinine. The antiviral drug oseltamivir was administered to 226 of 261 seniors. Forty-seven seniors (18.0%) died from influenza and its complications (severe pneumonia with acute respiratory insufficiency or heart failure). CONCLUSIONS: The course of influenza in seniors was usually more severe and required hospitalization along with antiviral treatment. The mortality rate in the monitored group exceeded 18%. Annual timely vaccination, but also other preventive measures, and maybe considering other risk groups are methods to prevent severe or even fatal cases of influenza.

• MeSH
• antivirové látky * terapeutické užití   MeSH
• chřipka lidská * epidemiologie   komplikace   MeSH
• hospitalizace statistika a číselné údaje   MeSH
• lidé MeSH
• oseltamivir terapeutické užití   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• virus chřipky A izolace a purifikace   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Chřipka je infekční onemocnění způsobené chřipkovými viry A, B a někdy i C. Onemocnění lze předcházet ve všech věkových skupinách díky každoročnímu sezónnímu očkování. Mezi skupiny obyvatelstva s vysokým rizikem závažného onemocnění s komplikacemi patří senioři, těhotné ženy a malé děti. Jak ukazuje naše kazuistika, neočkovaná osoba v produktivním věku v dobrém zdravotním stavu může při neléčené chřipce utrpět život ohrožující komplikace. Mezi nejčastější komplikace patří bakteriální pneumonie vedoucí k respirační insuficienci a kardiovaskulárním problémům. Odhaduje se, že v souvislosti s chřipkou dojde každoročně až k 645 000 úmrtí.

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Tularemie je infekční onemocnění způsobené drobnou gramnegativní bakterií Francisella tularensis. Patří mezi zoonotické infekce a v minulosti proběhlo v našich podmínkách několik významných epidemií. Diagnóza je často obtížná především pro horší dos­tupnost přímých vyšetřovacích metod. Sérologické vyšetření bývá v prvních fázích onemocnění nepřínosné. Základem je pečlivě odebraná epidemiologická anamnéza. Rozeznáváme několik klinických forem, přičemž plicní forma může být potenciálním následkem využití tularemie jako biologické zbraně.

Tularemia is an infectious disease caused by the tiny gram-negative bacterium Francisella tularensis. It belongs to zoonotic infections and in the past there have been several significant epidemics in our conditions. Diagnosis is often difficult mainly due to poorer availability of direct methods. Serological examination is usually unprofitable in the first stages of the disease. The basis for correct diagnosis is a carefully collected epidemiological anamnesis. We recognize several clinical forms, while the pulmonary form may be potentialy misused as a biological weapon.

• MeSH
• antibakteriální látky klasifikace   terapeutické užití   MeSH
• bakteriální zoonózy diagnóza   farmakoterapie   klasifikace   MeSH
• diferenciální diagnóza MeSH
• Francisella tularensis patogenita   MeSH
• kojenec MeSH
• lidé MeSH
• přenos infekční nemoci MeSH
• tularemie * diagnóza   epidemiologie   farmakoterapie   přenos   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: There are limited data on end-stage liver disease (ESLD) and mortality in people with HIV (PWH) coinfected with both hepatitis B virus (HBV) and hepatitis C virus (HCV). METHODS: All PWH aged greater than 18 under follow-up in EuroSIDA positive for HBsAg (HBV), and/or HCVRNA+, were followed from baseline (latest of 1 January 2001, EuroSIDA recruitment, known HBV/HCV status) to ESLD, death, last visit, or 31 December 2020. Follow-up while HCVRNA- was excluded. In two separate models, Poisson regression compared three groups updated over time; HIV/HBV, HIV/HCV, and HIV/HBV/HCV. RESULTS: Among 5733 included individuals, 4476 (78.1%) had HIV/HCV, 953 (16.6%) had HIV/HBV and 304 (5.3%) had HIV/HBV/HCV. In total, 289 (5%) developed ESLD during 34 178 person-years of follow-up (PYFU), incidence 8.5/1000 PYFU [95% confidence interval (CI) 7.5-9.4] and 707 deaths occurred during 34671 PYFU (incidence 20.4/1000 PYFU; 95% CI 18.9-21.9). After adjustment, compared with those with HIV/HCV, persons with HIV/HBV had significantly lower rates of ESLD [adjusted incidence rate ratio (aIRR) 0.53; 95% CI 0.34-0.81]. Those with HIV/HBV/HCV had marginally significantly higher rates of ESLD (aIRR 1.49; 95% CI 0.98-2.26). Those under follow-up in 2014 or later had significantly lower rates of ESLD compared with 2007-2013 (aIRR 0.65; 95% CI 0.47-0.89). Differences in ESLD between the three groups were most pronounced in those aged at least 40. After adjustment, there were no significant differences in all-cause mortality across the three groups. CONCLUSION: HIV/HBV-coinfected individuals had lower rates of ESLD and HIV/HBV/HCV had higher rates of ESLD compared with those with HIV/HCV, especially in those aged more than 40. ESLD decreased over time across all groups. CLINICALTRIALSGOV IDENTIFIER: NCT02699736.

• MeSH
• Hepacivirus MeSH
• HIV infekce * komplikace   MeSH
• konečné stadium selhání jater * MeSH
• lidé MeSH
• RNA MeSH
• virus hepatitidy B MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: In the last decade, substantial differences in the epidemiology of, antiretroviral therapy (ART) for, cascade of care in and support to people with HIV in vulnerable populations have been observed between countries in Western Europe, Central Europe (CE) and Eastern Europe (EE). The aim of this study was to use a survey to explore whether ART availability and therapies have evolved in CE and EE according to European guidelines. METHODS: The Euroguidelines in Central and Eastern Europe (ECEE) Network Group conducted two identical multicentre cross-sectional online surveys in 2019 and 2021 concerning the availability and use of antiretroviral drugs (boosted protease inhibitors [bPIs], integrase inhibitors [INSTIs] and nucleoside reverse transcriptase inhibitors [NRTIs]), the introduction of a rapid ART start strategy and the use of two-drug regimens (2DRs) for starting or switching ART. We also investigated barriers to the implementation of these strategies in each region. RESULTS: In total, 18 centres participated in the study: four from CE, six from EE and eight from Southeastern Europe (SEE). Between those 2 years, older PIs were less frequently used and darunavir-based regimens were the main PIs (83%); bictegravir-based and tenofovir alafenamide-based regimens were introduced in CE and SEE but not in EE. The COVID-19 pandemic did not significantly interrupt delivery of ART in most centres. Two-thirds of centres adopted a rapid ART start strategy, mainly in pregnant women and to improve linkage of care in vulnerable populations. The main obstacle to rapid ART start was that national guidelines in several countries from all three regions did not support such as strategy or required laboratory tests first; an INSTI/NRTI combination was the most commonly prescribed regimen (75%) and was exclusively prescribed in SEE. 2DRs are increasingly used for starting or switching ART (58%), and an INSTI/NRTI was the preferred regimen (75%) in all regions and exclusively prescribed in SEE, whereas the use of bPIs declined. Metabolic disorders and adverse drug reactions were the main reasons for starting a 2DR; in the second survey, HIV RNA <500 000 c/ml and high cluster of differentiation (CD)-4 count emerged as additional important reasons. CONCLUSIONS: In just 2 years and in spite of the emergence of the COVID-19 pandemic, significant achievements concerning ART availability and strategies have occurred in CE, EE and SEE that facilitate the harmonization of those strategies with the European AIDS Clinical Society guidelines. Few exceptions exist, especially in EE. Continuous effort is needed to overcome various obstacles (administrative, financial, national guideline restrictions) in some countries.

• MeSH
• COVID-19 * epidemiologie   MeSH
• HIV infekce * farmakoterapie   epidemiologie   MeSH
• inhibitory proteas terapeutické užití   MeSH
• látky proti HIV * terapeutické užití   MeSH
• lidé MeSH
• pandemie MeSH
• průřezové studie MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

• Klíčová slova
• inhibitory HIV kapsidy,
• MeSH
• fixní kombinace léků MeSH
• humanizované monoklonální protilátky MeSH
• inhibitory HIV fúze aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• inhibitory HIV-integrasy aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• inhibitory reverzní transkriptasy aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• látky proti HIV * aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• lidé MeSH
• rilpivirin aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• vysoce aktivní antiretrovirová terapie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH