Summary A patient diagnosed with late-presenting HIV infection [CD4 count 86 cells/mm3, viral load (VL) 95 000 copies RNA/mL], treated with DRV/c 800/150 mg (Rezolsta®) and TDF/FTC 200/245 mg, was hospitalized with ischemic brain stroke, confirmed by CT scan and MRI. Motor functions quickly recovered, but nausea, abdominal heaviness, ascites, and hepatosplenomegaly appeared. Laboratory investigations revealed anaemia, thrombocytopenia, normal transaminases, increased GGT and negative serological tests for HBV and HCV and she was diagnosed with Gastroenterologists diagnosed liver cirrhosis. After 20 days of hospital treatment, the patient recovered from the stroke and ascites but with persisting anaemia and thrombocytopenia. Liver cirrhosis had been confirmed, and relevant treatment had been administered. Six months later, an MRI of the brain revealed an improved image. Follow-up showed stabilized somatic and neurologic status, improved laboratory parameters, stable T-helper count and undetectable viral load (VL). ART regimen continued with Raltegravir 400 mg (Isentress®) 2×1 tablet/24 h, TDF/FTC 200/245 mg 1 tablet/24 h. Three months later, the patient continued her treatment continued abroad. The increased access to precise diagnosis and treatment with improved adherence has transformed the HIV-infection into a manageable chronic health condition, even in complicated cases.
Background Viral hepatitis C (VH C) is a global health problem with overall prevalence in 3-5% of the human population. This study provides the relevance of viral genome characterization in clinical settings. Methods Retrospective study was conducted upon epidemiological, demographic, clinical, laboratory and viral characteristics in fifty cases of VH C confirmed with positive anti-HCV, evaluated by ELISA. Thirty eight of cases were hospitalized in different clinics of the University Hospital “Dr Georgi Stranski” - Pleven (2017-2018) and remainders were blood-donors registered in Regional Center of Transfusion Hematology - Pleven. The viral load and genotype of HCV had been investigated by Real-Time PCR in Laboratory of Virology at Military Medical Academy - Sofia. Results The prevalence of cases was equal and highest in age groups 30-39 years and 60-69 years (24%, respectively). Males were 69.81% (p < 0.05). Surgical interventions (26.32%), blood infusions (23.68%) and hemodialysis (15.79%) were at highest risk for VHC (p > 0.05). Thirty hospital patients were with chronic VH C (78.95%) (p < 0.05). Clinical symptoms suggestive viral hepatitis were adynamia (39.47%; OR 5.25), anorexia (28.95%; OR 2.16), heaviness in the abdomen (21.05%; OR 23.33), and 52.63% of patients were asymptomatic (p < 0.0005). Laboratory investigations revealed slightly or moderately elevated total bilirubin (mean 53.27±37.38 µmol/L; 95% CI 18.48-88.06) and transaminases - ASAT (mean 231.36±155.82 IU/L; 95% CI 79.91-382.80) and ALAT (mean 294.48±196.26 IU/L; 95% CI 96.37-492.59) (p > 0.05). Investigation of viral load of HCV revealed 22 samples with detectable viral load (range 683-673 720 copies/ml). All isolates of HCV had been proved to be genotype 1b. Conclusions VH C is mostly asymptomatic. Screening for anti-HCV in risk groups and genotyping of HCV will improve surveillance, reduce nosocomial HCV-infections, facilitate therapeutic management and prevent complications of infected individuals. Key messages • Screening for anti-HCV in risk groups and genotyping of HCV improves surveillance and reduces nosocomial HCV-infections. • Screening for anti-HCV facilitates therapeutic management and prevents complications of infected individuals.
Issue Viral hepatitis C (VH C) is a global problem of the public health. Different interventions for achieving the Global Health Sector Strategy on viral hepatitis targets (65% reduction in HCV-related deaths, 90% in new infections and 90% of infections diagnosed by 2030) were considered. Increased diagnosis and treatment rates would be required to achieve these targets in all countries, even with the introduction of high sustained viral response therapies. Description of the problem The latest global HCV disease burden estimates showed that about 71.1 million people worldwide are viremic, corresponding to a prevalence of 1%. The prevalence of HCV is not homogenous: the WHO Eastern-Mediterranean Region is with the highest number of infected subjects (15 millions), followed by the European Region (14 million). In Bulgaria, the incidence of VH C is 0.63-1.30 at 100 000 population (2008-2020) and in Pleven region is 0.38-3.8, respectively. Results Retrospective study was conducted upon epidemiological, demographic, clinical, laboratory and viral characteristics in fifty cases of VH C confirmed with positive anti-HCV, evaluated by ELISA. Thirty eight of cases were hospitalized in different clinics of the University Hospital “Dr Georgi Stranski”-Pleven (2017-2018) and remainders were blood-donors registered in Regional Center of Transfusion Hematology-Pleven. Surgical interventions (26.32%), blood infusions (23.68%) and hemodialysis (15.79%) were at highest risk for VH C. Twenty five hospital patients were with chronic VH C (66%), five with cirrhosis (13%) and eight (21%) with acute hepatitis C. Twenty of the patients (53%) were asymptomatic about hepatitis and were hospitalized because of different comorbidities (p < 0.0005). Lessons We propose an algorithm for early diagnosis of VH C based on mandatory screening for anti-HCV in risk groups, especially before invasive procedures. The early detection of HCV infection will reduce the complications and nosocomial infections. Key messages • Different scenarios developed to achieve the WHO Targets in all countries assume an implementation of national policies to prevent new infections and to diagnose current infections through screening. • The early detection of HCV infection will reduce the complications and nosocomial infections.
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