AIMS: To present our experience with pre-exposure prophylaxis (PrEP) at the HIV Center of the Military University Hospital Prague, to characterize a set of PrEP candidates, to assess the efficiency and safety of PrEP and to measure the incidence of sexually transmitted diseases (STDs) in the studied cohort. MATERIAL AND METHODS: In total, 99 PrEP candidates (98 men who have sex with men and one woman) were monitored during an 18-month period. An initial examination included acquiring a history, performing a physical examination, screening for HIV (serology) and other STDs and performing renal function tests. RESULTS: In total, 81 candidates (in the cohort of 99 candidates) received PrEP. During the course of the 18-month period, none of the clients were newly infected with HIV, and no side effects of the provided medication were recorded. A total of 21% of the 99 PrEP candidates were initially tested positive for STDs, including two clients with HIV. A total of 14% of the 81 PrEP clients contracted an STD during the monitoring period. CONCLUSIONS: Experience amassed at the HIV Center of the Military University Hospital Prague over an 18-month period documented the demand for PrEP, assessed PrEP efficacy, indicated good tolerance and suggested that PrEP played a role in the decline in the HIV incidence in the Czech Republic. In addition, several new HIV cases and cases of other asymptomatic STDs were also detected.

• Klíčová slova
• HIV, pre-exposure prophylaxis, sexually transmitted diseases,
• MeSH
• HIV infekce * prevence a kontrola   MeSH
• homosexualita mužská statistika a číselné údaje   MeSH
• lidé MeSH
• ozbrojené síly * MeSH
• preexpoziční profylaxe * MeSH
• sexuální a genderové menšiny statistika a číselné údaje   MeSH
• vojenské nemocnice * statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVES: Pre-exposure prophylaxis (PrEP) for HIV infection is an important intervention for control of the HIV epidemic. The incidence of HIV infection is increasing in the countries of Central and Eastern Europe (CEE). Therefore, we investigated the change in PrEP use in CEE over time. METHODS: The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was initiated in February 2016 to compare standards of care for HIV and viral hepatitis infections in CEE. Data on access to PrEP were collected from 23 countries through online surveys in May-June 2017 (76 respondents) and in November 2018-May 2019 (28 respondents). RESULTS: About 34.2% of respondents stated that tenofovir/emtricitabine (TDF/FTC) was licensed for use in their country in 2017, and 66.7% that it was licensed for use in 2018 (P = 0.02). PrEP was recommended in national guidelines in 39.5% of responses in 2017 and 40.7% in 2018 (P = 0.378). About 70.7% of respondents were aware of "informal" PrEP use in 2017, while 66.6% were aware of this in 2018 (P = 0.698). In 2018, there were 53 centres offering PreP (the highest numbers in Poland and Romania), whereas six countries had no centres offering PreP. The estimated number of HIV-negative people on PreP in the region was 4500 in 2018. Generic TDF/FTC costs (in Euros) ranged from €10 (Romania) to €256.92 (Slovakia), while brand TDF/FTC costs ranged from €60 (Albania) to €853 (Finland). CONCLUSIONS: Although the process of licensing TDF/FTC use for PrEP has improved, this is not yet reflected in the guidelines, nor has there been a reduction in the "informal" use of PrEP. PrEP remains a rarely used preventive method in CEE countries.

• Klíčová slova
• Eastern and Central Europe, Euroguidelines in Central and Eastern Europe (ECEE), Europe, HIV, emtricitabine, pre-exposure prophylaxis, tenofovir,
• MeSH
• emtricitabin aplikace a dávkování   MeSH
• HIV infekce prevence a kontrola   MeSH
• látky proti HIV aplikace a dávkování   MeSH
• lidé MeSH
• preexpoziční profylaxe metody   statistika a číselné údaje   MeSH
• tenofovir aplikace a dávkování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• emtricitabin MeSH
• látky proti HIV MeSH
• tenofovir MeSH

OBJECTIVES: Pre-exposure prophylaxis (PrEP) for HIV infection has been introduced in only a few European countries. We investigated the potential to provide PrEP in the Central and Eastern European region, and in neighbouring countries. METHODS: The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was formed in February 2016 to review standards of care for HIV infection in the region. Information related to PrEP was collected through on-line surveys. Respondents were recruited by ECEE members based on their involvement in HIV care. RESULTS: Seventy-six respondents from 23 countries participated in the survey. Twenty-six (34.2%) respondents reported that PrEP [tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)] was registered by the drug registration authority in their country. Fifty-three (70.7%) respondents reported being aware of 'informal' PrEP use in their country. If they had access to PrEP, 56 (74.7%) would advise its use in their practice. Forty-five (59.2%) respondents had concerns regarding PrEP use, and 10 (13.3%) expressed the need for more training. Most of the respondents (88.2%) would provide PrEP to people with high-risk behaviours. CONCLUSIONS: PrEP is already used informally in some countries in the region. Physicians are keen to use PrEP if and when it is accessible. Obstacles towards implementing PrEP in those countries were mostly related to lack of national guidelines, drug registration and governmental strategy.

• Klíčová slova
• EACS, HIV, Euroguidelines, central Europe, eastern Europe, pre-exposure prophylaxis,
• MeSH
• bezpečný sex MeSH
• dospělí MeSH
• emtricitabin terapeutické užití   MeSH
• HIV infekce prevence a kontrola   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• preexpoziční profylaxe metody   statistika a číselné údaje   MeSH
• průzkumy a dotazníky MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• standardní péče MeSH
• tenofovir terapeutické užití   MeSH
• zdravotnický personál MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• emtricitabin MeSH
• tenofovir MeSH

OBJECTIVES: To assess the cost-effectiveness of pharmacological pre-exposure prophylaxis (PrEP) using a combination of emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) with respect to HIV transmission in high-risk patients in the Czech Republic. MATERIAL AND METHODS: A pharmacoeconomic model was constructed to compare costs and outcomes in a cohort with and without PrEP. Initially, a decision tree is used to evaluate short-term benefits of PrEP (proportion of HIV-infected individuals), followed by Markov cycles to simulate the course of the disease based on CD4 lymphocyte counts. The efficacy of PrEP, probability of transition between HIV infection stages, costs per category and quality of life data were derived from the literature. The results are presented as an incremental cost effectiveness ratio of incremental costs and incremental quality adjusted life-years (ICER/QALY) in a lifetime horizon with a 3% annual discount rate of costs and benefits. RESULTS: The FTC/TDF prophylaxis is dominant, that is, it generates lower costs and higher benefits (expressed as QALYs) in comparison with the control group without prophylaxis. A sensitivity analysis modelled all relevant parameters and all scenarios confirmed the PrEP dominance. CONCLUSIONS: A cost-effectiveness analysis in the Czech Republic setting confirmed that pharmacological PrPE intervention is cost-effective, or cost-saving, in a high-risk population of men having sex with men, using a lifetime horizon.

• MeSH
• analýza nákladů a výnosů * MeSH
• ekonomické modely MeSH
• HIV infekce * farmakoterapie   prevence a kontrola   MeSH
• kvalita života MeSH
• kvalitativně upravené roky života MeSH
• látky proti HIV * terapeutické užití   MeSH
• lidé MeSH
• preexpoziční profylaxe ekonomika   MeSH
• rozhodovací stromy MeSH
• sexuální a genderové menšiny MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• látky proti HIV * MeSH

Despite lower virulence, the omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) still poses a relevant threat for immunocompromised patients. A retrospective multicentric study was conducted to evaluate the efficacy of pre-exposure prophylaxis with tixagevimab/cilgavimab (Evusheld) with a 6-month follow-up for preventing severe COVID-19 in adult patients with hematology malignancy. Among the 606 patients in the cohort, 96 (16%) contracted COVID-19 with a median of 98.5 days after Evusheld administration. A total of 75% of patients had asymptomatic or mild severity of COVID-19, while just 25% of patients with SARS-CoV-2 positivity had to be hospitalized. Two patients (2%) died directly, and one patient (1%) in association with COVID-19. Eight patients (1.3%) of every cohort experienced adverse events related to Evusheld, mostly grade 1 and of reversible character. It was found that complete vaccination status or positive seroconversion was not associated with lower risk of COVID-19 infection. Previous treatment with an anti-CD20 monoclonal antibody was associated with higher rates of COVID-19, while previous treatment with anti-CD38 monoclonal antibody was not, as was the case for recipients of hematopoietic stem cell transplantation or CAR-T cell therapy. Presence of other comorbidities was not associated with more severe COVID-19. The results support the growing evidence for Evusheld's efficacy against severe COVID-19 in patients with hematology malignancies.

• Klíčová slova
• COVID-19, Hematology malignancy, SARS-CoV-2, Tixagevimab/cilgavimab,
• MeSH
• COVID-19 * MeSH
• dospělí MeSH
• hematologické nádory * komplikace   farmakoterapie   epidemiologie   MeSH
• lidé MeSH
• monoklonální protilátky MeSH
• preexpoziční profylaxe * MeSH
• retrospektivní studie MeSH
• SARS-CoV-2 MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• cilgavimab MeSH Prohlížeč
• monoklonální protilátky MeSH
• tixagevimab MeSH Prohlížeč

AIMS: Organophosphates (OPCs), useful agents as pesticides, also represent a serious health hazard. Standard therapy with atropine and established oxime-type enzyme reactivators is unsatisfactory. Experimental data indicate that superior therapeutic results can be obtained when reversible cholinesterase inhibitors are administered before OPC exposure. Comparing the protective efficacy of five such cholinesterase inhibitors (physostigmine, pyridostigmine, ranitidine, tacrine, or K-27), we observed best protection for the experimental oxime K-27. The present study was undertaken in order to determine if additional administration of K-27 immediately after OPC (paraoxon) exposure can improve the outcome. METHODS: Therapeutic efficacy was assessed in rats by determining the relative risk of death (RR) by Cox survival analysis over a period of 48 h. Animals that received only pretreatment and paraoxon were compared with those that had received pretreatment and paraoxon followed by K-27 immediately after paraoxon exposure. RESULTS: Best protection from paraoxon-induced mortality was observed after pretreatment with physostigmine (RR = 0.30) and K-27 (RR = 0.34). Both substances were significantly more efficacious than tacrine (RR = 0.67), ranitidine (RR = 0.72), and pyridostigmine (RR = 0.76), which were less efficacious but still significantly reduced the RR compared to the no-treatment group (paraoxon only). Additional administration of K-27 immediately after paraoxon exposure (posttreatment) did not further reduce mortality. Statistical analysis between pretreatment before paraoxon exposure alone and pretreatment plus K-27 posttreatment did not show any significant difference for any of the pretreatment regimens. CONCLUSIONS: Best outcome is achieved if physostigmine or K-27 are administered prophylactically before exposure to sublethal paraoxon dosages. Therapeutic outcome is not further improved by additional oxime therapy immediately thereafter.

• Klíčová slova
• carbamates, cholinesterase, cox analysis, organophosphate, oximes, paraoxon, pretreatment, prophylaxis, rat,
• MeSH
• analýza přežití MeSH
• cholinesterasové inhibitory aplikace a dávkování   toxicita   MeSH
• fysostigmin aplikace a dávkování   chemie   MeSH
• krysa rodu Rattus MeSH
• organofosfáty toxicita   MeSH
• oximy aplikace a dávkování   chemie   MeSH
• paraoxon chemie   toxicita   MeSH
• postexpoziční profylaxe MeSH
• potkani Wistar MeSH
• preexpoziční profylaxe MeSH
• proporcionální rizikové modely MeSH
• pyridostigmin-bromid aplikace a dávkování   chemie   MeSH
• ranitidin chemie   farmakologie   MeSH
• reaktivátory cholinesterázy farmakologie   MeSH
• takrin aplikace a dávkování   chemie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• cholinesterasové inhibitory MeSH
• fysostigmin MeSH
• organofosfáty MeSH
• oximy MeSH
• paraoxon MeSH
• pyridostigmin-bromid MeSH
• ranitidin MeSH
• reaktivátory cholinesterázy MeSH
• takrin MeSH

Reported incidence of human immunodeficiency virus (HIV) infection in the Czech Republic increased steeply over the past decade from 90 new cases in 2005 to 266 in 2015. This increase is almost exclusively attributed to sexual transmissions between men who have sex with men (MSM). In 2015, there were 79% (n=210) newly diagnosed cases among MSM, 17% (n=45) were attributed to heterosexual transmission and 1% (n=3) to people who inject drugs. Interventions targeted at MSM have not yet been prioritised in the broadly focused national HIV prevention strategy which this is envisaged to change in the programme set out for 2018 to 2022. The national budget for HIV prevention has been reduced, however, and this remains. Availability of voluntary counselling and testing has decreased substantially in the past decade. Post- and pre-exposure prophylaxis for sexual intercourse among MSM are not part of the HIV prevention policy and the concept of treatment as prevention is not fully recognised. Provision of a combined prevention strategy with a focus on MSM, reflecting the above factors including stigmatisation, should contribute to reverse the development of a concentrated HIV epidemic among MSM in the Czech Republic.

• Klíčová slova
• HIV/AIDS, MSM, PrEP, stigma,
• MeSH
• antiretrovirové látky aplikace a dávkování   MeSH
• dospělí MeSH
• epidemie * MeSH
• HIV infekce diagnóza   epidemiologie   prevence a kontrola   přenos   MeSH
• homosexualita mužská * MeSH
• lidé MeSH
• plošný screening MeSH
• postexpoziční profylaxe * MeSH
• preexpoziční profylaxe * MeSH
• zdraví - znalosti, postoje, praxe MeSH
• zdravotní politika MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• antiretrovirové látky MeSH

The paper presents fundamental knowledge concerning Bacillus anthracis and its potential terrorist misuse. The basic clinical forms are resumed with emphasis on inhalation infection from inspiration of B. anthracis spores. The AVA vaccine licensed in the United States, primary vaccination, protective efficacy of the vaccine, and adverse events are characterised. Stress is laid on pre-exposure and post-exposure prophylaxis of anthrax.

• MeSH
• antrax prevence a kontrola   přenos   veterinární   MeSH
• bioterorismus * MeSH
• chemoprofylaxe MeSH
• lidé MeSH
• očkovací schéma MeSH
• vakcíny proti antraxu * aplikace a dávkování   imunologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• vakcíny proti antraxu * MeSH

With no expected vaccine for HIV in the near future, we aimed to define the current situation and challenges for pre- and post-exposure prophylaxis (PrEP and PEP) in Central and Eastern Europe (CEE). The Euroguidelines CEE Network Group members were invited to respond to a 27-item survey including questions on PrEP (response rate 91.6%). PrEP was licensed in 68.2%; 95 centers offered PrEP and the estimated number on PrEP was around 9000. It was available in daily (40.1%), on-demand (13.3%), or both forms (33.3%). The access rate was <1−80%. Three major barriers for access were lack of knowledge/awareness among people who are in need (59.1%), not being reimbursed (50.0%), and low perception of HIV risk (45.5%). Non-occupational PEP was available in 86.4% and was recommended in the guidelines in 54.5%. It was fully reimbursed in 36.4%, only for accidental exposures in 40.9%, and was not reimbursed in 22.72%. Occupational PEP was available in 95.5% and was reimbursed fully. Although PrEP scale-up in the region has gained momentum, a huge gap exists between those who are in need of and those who can access PrEP. Prompt action is required to address the urgent need for PrEP scale-up in the CEE region.

• Klíčová slova
• Central and Eastern Europe, HIV, post-exposure prophylaxis, pre-exposure prophylaxis,
• Publikační typ
• časopisecké články MeSH

Background and Purpose- There are limited data on intravenous thrombolysis treatment in patients with ischemic stroke who have received prophylactic doses of low molecular weight heparins (LMWHs). We aimed to evaluate the safety and outcomes of intravenous thrombolysis treatment in stroke patients taking thromboprophylactic doses of LMWH. Methods- We analyzed 109 291patients treated with intravenous thrombolysis, recorded in the Safe Implementation of Treatments in Stroke International Thrombolysis Register between 2003 and 2017 not taking oral anticoagulants or therapeutic doses of heparin at stroke onset. One thousand four hundred eleven patients (1.3%) were on prophylactic LMWH for deep venous thrombosis prevention. Outcome measures were symptomatic intracerebral hemorrhage, parenchymal hematoma, death within 7 days and 3 months, and functional dependency at 3 months. Results- Patients on LMWH were older, had more severe strokes, more prestroke disability, and comorbidities than patients without LMWH. There was no significant increase in adjusted odds ratios (aOR) for symptomatic intracerebral hemorrhage (aOR, 1.02 [95% CI, 0.48-2.17] as per Safe Implementation of Treatments in Stroke -MOST, aOR, 0.95 [0.59-1.53] per ECASS II]), nor for 7-day mortality (aOR, 1.14 [0.82-1.59]), in the prophylactic LMWH group. The LMWH group had a higher aOR for 3-month mortality (aOR, 1.94 [1.49-2.53]) and functional dependency, aOR, 1.44 (1.10-1.90). Propensity score analysis matching patients on baseline characteristics removed differences between groups on all outcomes except 3-month mortality. Conclusions- Intravenous thrombolysis in patients with acute ischemic stroke on treatment with prophylactic doses of LMWH at stroke onset is not associated with an increased risk of symptomatic intracerebral hemorrhage or early death.

• Klíčová slova
• cerebral hemorrhage, comorbidities, hematoma, heparin, thrombosis,
• MeSH
• antikoagulancia aplikace a dávkování   MeSH
• cévní mozková příhoda diagnóza   farmakoterapie   mortalita   MeSH
• heparin nízkomolekulární aplikace a dávkování   MeSH
• intravenózní podání MeSH
• lidé MeSH
• preexpoziční profylaxe metody   MeSH
• senioři MeSH
• trombolytická terapie metody   mortalita   trendy   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antikoagulancia MeSH
• heparin nízkomolekulární MeSH