Biomedical subjects
Publications and source records attributed to J Slusarczyk.
This article presents the most common clinical manifestations of autoimmune phenomena occurring in HIV-infected patients. A connective tissue and articular diseases may constitute the important clinical syndromes in the course of infection or, in some patients, may present the first symptoms of clinically overt HIV infection.
The most common laboratory abnormalities in HIV infected patients due to autoimmune reactions are presented. The possible mechanisms of autoagressive disorders, particularly autoantibody synthesis and hematological disturbances are also discussed. The importance of the diagnostic and prognostic value of routinely performed tests was underlined.
40 asymptomatic HIV carriers and 45 AIDS patients were tested for anti-HBs (Hepatitis B Virus surface antigen), anti-RV (Rubella virus), anti-Toxo (Toxoplasma gondii), anti-CMV (Cytomegalovirus) and anti-HSV-1 (Herpes simplex virus type 1) antibody titers and compared with 83 persons characterized by risk behaviours but seronegative for HIV. The prevalence of these antibodies was very high and similar in all three groups studied, however, patients with AIDS had generally lower antibody titers when compared with asymptomatic carriers. The only exception being anti-HSV-1 which was present in high titre even in gravely ill patients. It seems that subjects with clinically overt HIV infection develop a serious disturbance in the humoral immune response with depressed specific antibody synthesis.
We compared the efficacy of intramuscular (im) and intradermal (id) administration of vaccine against HBV. Only one out of 25 im vaccinated subjects did not respond whereas all 25 id immunized persons developed anti-HBs above 10 IU/l. The mean serum level of anti-HBs in im and id vaccinated group was 2351 +/- 2358 IU/l and 1823 +/- 1502 IU/l, respectively (p = 0, 382; NS). It seems that the efficacy of both vaccine administration is very similar.
We studied 100 unselected parenteral drug abusers for infection with hepatitis C, B, A and D virus (HCV, HBV, HAV and HDV). Seventy-six percent had serological evidence of HCV infection. 12% were positive for HBsAg and at least one marker of HBV infection was present in 69%. These results were significantly higher than in a matched control population. Compared to controls, the prevalence of anti-HAV (65%) was not significantly increased in drug addicts. Of the anti-HCV-positive drug addicts, 80.3% had at least one marker of HBV infection compared to 33.3% of anti-HCV-negative cases (p less than 0.001). No such correlation was found between the prevalence of HCV or HBV infection markers and the presence of anti-HAV. Antibodies against HDV were detected in 16 (16%) of the samples from drug addicts. No significant association was found between antibodies to HCV and gender, age and duration of drug abuse. The risk of HBV infection increased significantly with years of drug abuse but was not associated with age and sex. The presence of anti-HAV was related to age only. Sixteen (16%) of the subjects were definitely positive for anti-HIV-1, but at the time of the study they were asymptomatic. No significant association was found between the presence of anti-HIV and the prevalence of serological markers of HBV, HCV, HAV and HDV infection.
The prevalence of HCV, HBV and HAV markers was investigated in unselected patients attending an outpatient alcoholic clinic. Anti-HCV were detected in 35 (24%) of 144 patients studied, and at least one marker of HBV infection was present in 72 (50%). These results are significantly higher than in a matched control population. The presence of anti-HCV was related to previous blood transfusions and familial history of alcoholism. We conclude that alcoholics should be considered a high risk group for both HCV and HBV infection.
A novel method based on mathematical analysis of the dose-response curve obtained by radioimmunoassay was used to determine anti-HBs affinity and concentration in 29 healthy subjects vaccinated with plasma-derived hepatitis B vaccine. Anti-HBs affinity as well as its serum concentration increased with time in most vaccine recipients; however, the pattern of affinity maturation varied widely between individual subjects. In 20 subjects the highest increase in antibody affinity was observed after the third dose of vaccine, whereas in nine cases values of affinity remained low and relatively constant throughout the time of the study.
The case of a 52-year-old male with chronic active type B hepatitis in whom severe exacerbation of liver disease was associated with interferon alpha treatment is described. It seems that patients with very active forms of chronic hepatitis B may experience severe and symptomatic exacerbation of liver disease during interferon treatment.
In 144 alcoholics--patients of alcoholic outpatient clinic anti-HAV antibodies were studied using the commercially available ELISA test. Anti-HCV antibodies were found in 86% of the alcoholics, and this prevalence was not higher than in the control group. No differences were found in the titre of antibodies against cytomegaly and herpes virus between the subjects with and without anti-HAV antibodies which suggests the specificity f the determined anti-HAV antibodies.
144 consecutive alcoholics attending an outpatient clinic were tested for the prevalence of anti-HCV with commercially available ELISA test (Abbott HCV EIA). Positive sera were further tested with neutralization assay (Abbott HCV Neutralization Assay). Anti-HCV were found in 35 (24%). There was no difference in the prevalence or mean titre of anti-CMV and anti-HSV between patients with and without anti-HCV what points to the specificity of tested antibodies.
The prevalence of anti-HCV and serological markers of HBV infection was tested in 100 unselected intravenous drug addicts admitted to a detoxification ward. Anti-HCV were present in 78% addicts, and at least one markers of HBV infection was present in 69% addicts. No correlation was found between anti-HCV status and age, gender, duration of addiction or anti-HIV presence. Furthermore, there was no difference in mean titres of anti-CMV and anti-HSV between subjects with and without anti-HCV what suggests that the anti-HCV tested were specific.
In the years 1982-1988 among patients admitted with the diagnosis of acute virus hepatitis to the Department of Infectious Hepatology, Institute of Infectious and Parasitic Diseases in Warsaw were 25 drug addicts. In 15 of them virus hepatitis B and in 10 virus hepatitis A was recognized. Virus hepatitis A had in the group of addicts a milder course than in controls not taking narcotics.
A patient with chronic active hepatitis B was treated with interferon alpha. Inhibition of HBV replication was associated with severe exacerbation of hepatitis. Treatment of chronic hepatitis B with interferon may lead to transient decompensation of liver function, especially in patients with high activity of morphological changes.
Prevalence of markers of HBV infection was tested in two cohorts of drug addicts: in 140 addicts whose sera were drawn in the years 1985-1986 and in 100 addicts whose sera were drawn in the years 1988-1989. HBsAg was found in 10 (7%) patients in the earlier cohort and in 12 (12%) addicts in the latter, while at least one marker of HBV infection was present in 39% and 69%, respectively No correlation was found between the presence of markers of HBV infection and age, gender, or HIV status, however, duration of drug abuse increased the risk of HBV infection. There was no difference in mean titres of anti-CMV and anti-HSV-1 between subjects with and without HBV markers what suggests that the tested markers were specific.
The course and outcome of acute type B hepatitis was analyzed in 30 heavy alcohol abusers. The course of the disease was very similar to that found among non-drinkers, the only difference being higher mean GGT activity and a higher frequency of hepatomegaly among alcoholics. All alcohol abusers cleared the infection in the space of 6 months. However, 2 months after admission, they were twice as likely to be HBsAg positive as controls. We conclude that alcohol abuse has little influence on the course and outcome of acute type B hepatitis.
To assess the epidemiology of hepatitis C virus (HCV) in Poland, anti-HCV was studied in patients with acute and chronic non-A, non-B (NANB) hepatitis, in healthy adults, and in subjects at risk. Anti-HCV prevalence was 2% in 152 blood donors, 78% in 95 parenteral drug addicts, 21% in 112 alcoholics, and 86% in 42 patients with chronic NANB hepatitis. Among 34 prospectively followed patients with acute NANB hepatitis 17 (50%) developed anti-HCV. It seems that HCV infection is responsible for the majority of NANB hepatitis in Poland and is common in parenteral drug abusers and alcoholics.
Among 530 consecutive patients hospitalized for acute hepatitis cytomegalovirus infection was diagnosed in 5 (0.9%). In 2 cases the infection was due to blood transfusion. The course of the disease was Got essentially different from hepatitis A, B, or non-A, non-B, however, clinical and biochemical manifestations of cholestasis were common. All biochemical abnormalities returned to normal within few weeks. In conclusion, it seems that cytomegalovirus is a rare cause of clinically overt hepatitis and its course is often cholestatic.
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