Postmarketin{ko ispitivanje djelotvornosti i podno{ljivosti lije~enja vulvovaginalne kandidoze fl... more Postmarketin{ko ispitivanje djelotvornosti i podno{ljivosti lije~enja vulvovaginalne kandidoze flukonazolom i klotrimazolom Vi{nja [KERK 1) , prof., dr. sc., dr. med., specijalist infektolog Jerko JAK[I] 2) , mr. pharm. Tamara @ARKOVI] 1) , dr. med, znanstveni novak Davorin [KALKO 1) , dr. med., primarijus, specijalist ginekologije i opstetricije Josip BEGOVAC 1) , prof. dr. sc., dr. med., specijalist infektolog 1) Klinika za infektivne bolesti »Dr. Fran Mihaljevi}«, Zagreb 2) Pliva Hrvatska d.o.o. Klju~ne rije~i flukonazol klotrimazol vulvovaginalna kandidoza
ObjectivesThe aim of the study was to evaluate the long‐term response to antiretroviral treatment... more ObjectivesThe aim of the study was to evaluate the long‐term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)‐, darunavir/ritonavir (DRV/r)‐, and lopinavir/ritonavir (LPV/r)‐containing regimens.MethodsData were analysed for 5678 EuroSIDA‐enrolled patients starting a DRV/r‐, ATZ/r‐ or LPV/r‐containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART‐naïve subjects (8%) at ritonavir‐boosted protease inhibitor (PI/r) initiation; (2) ART‐experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV‐1 RNA copies/mL; and (3) ART‐experienced patients (48%) initiating the new PI/r with a VL >500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements >200 copies/mL ≥24 weeks after PI/r initiation. Kaplan–Meier and multivariable Cox models were used to compare risks of failure by PI/r‐based regimen. The main analysis was pe...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2010
To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and rena... more To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients. Cross-sectional multicenter survey of EuroSIDA clinics during 2008. Prevalence of ESRD was 0.5%. Of 122 patients with ESRD 96 were on dialysis and 26 had received a RT. Median age was 47 years, 73% were males and 43% were black. Median duration of HIV infection was 11 years. Thirty-three percent had prior AIDS; 91% were receiving antiretrovirals; and 88% had undetectable viral load. Median CD4(+)T-cell count was 341 cells per cubic millimetre; 20.5% had hepatitis C coinfection. Most frequent causes of ESRD were HIV-associated nephropathy (46%) and other glomerulonephritis (28%). Hemodialysis (93%) was the most common dialysis modality; 34% of patients were on the RT waiting list. A poor HIV control was the reason for exclusion from RT waiting list in 22.4% of cases. All the RT recipients were all alive at the time of the survey. Acute rejection was reported in 8 patients (30%). Functioning graft was present in 21 (80%). This is the first multinational cross-sectional study of ESRD among European HIV population. Low prevalence of ESRD was found. Two-thirds of patients were excluded from RT for non-HIV/AIDS-related pathologies. Most patients had a functioning graft despite a high acute rejection rate.
Since 25-hydroxy vitamin D (25(OH)D) deficiency has been associated with higher risk of morbidity... more Since 25-hydroxy vitamin D (25(OH)D) deficiency has been associated with higher risk of morbidity and mortality in different settings, this study examined the association between 25(OH)D level and disease progression in HIV-infected patients with prospective follow-up in the EuroSIDA study. Methods A group of 2000 patients were randomly selected from those with stored samples after stratification by region.
Introduction Data on safety and effectiveness of RPV from the real-world setting as well as compa... more Introduction Data on safety and effectiveness of RPV from the real-world setting as well as comparisons with other NNRTIs such as efavirenz (EFV) remain scarce. Methods Participants of EuroSIDA were included if they had started a RPV- or an EFV-containing regimen over November 2011-December 2017. Statistical testing was conducted using non-parametric Mann–Whitney U test and Chi-square test. A logistic regression model was used to compare participants’ characteristics by treatment group. Kaplan–Meier analysis was used to estimate the cumulative risk of virological failure (VF, two consecutive values > 50 copies/mL). Results 1,355 PLWH who started a RPV-based regimen (11% ART-naïve), as well as 333 initiating an EFV-containing regimen were included. Participants who started RPV differed from those starting EFV for demographics (age, geographical region) and immune-virological profiles (CD4 count, HIV RNA). The cumulative risk of VF for the RPV-based group was 4.5% (95% CI 3.3–5.7%)...
Probiotici su živi mikroorganizmi koji primijenjeni u dostatnoj količini mijenjaju sastav i metab... more Probiotici su živi mikroorganizmi koji primijenjeni u dostatnoj količini mijenjaju sastav i metaboličku aktivnost mikroflore ili utječu na imunološki sustav što djeluje povoljno na zdravlje čovjeka. Lactobacillus acidophilus je najbolje proučena acidofilna bakterija koju prirodno nalazimo u jogurtu i acidofilnom mlijeku. Cilj ovog ispitivanja je bio istražiti djelotvornost i podnošljivost vaginalne primjene probiotika Lactobacillus acidophilus u bolesnica sa simptomima kolpitisa. U ovom prospektivnom ispitivanju djelotvornosti i podnošljivosti sedmodnevne primjene Lactobacillus acidophilus solucije za vaginalnu primjenu u žena s kolpitisom – probiotik Lactobacillus acidophilus se pokazao djelotvoran s obzirom da je 42 od ukupno 50 liječenih žena bilo klinički izliječeno. Klinički uspjeh bio je češći u žena iznad 50 godina starosti, te u žena koje su imale simptome iritacije i svrbeža. Lactobacillus acidophilus solucija za vaginalnu primjenu se pokazala izrazito podnošljiva s obzirom...
The European Commission funded a project for the standardisation of the management of occupationa... more The European Commission funded a project for the standardisation of the management of occupational exposures to HIV/blood-borne infections and antiretroviral post-exposure prophylaxis (PEP) in Europe. Within this project, the following recommendations and rationale were formulated by experts representative of participating countries. Based on assessment of the exposure, material, and source characteristics, PEP should be started as soon as possible with any triple combination of antiretrovirals approved for the treatment of HIV-infected patients; initiation is discouraged after 72 hours Rapid HIV testing of the source could reduce inappropriate PEP. HIV testing should be performed at baseline, 4, 12, and 24 weeks, with additional clinical and laboratory monitoring of adverse reactions and potential toxicity at week 1 and 2. HIV resistance tests in the source and direct virus assays in the exposed HCW are not recommended routinely. These easy-to-use recommendations seek to maximise PEP effect while minimising its toxicity and inappropriate use.
Objectives: To establish a methodology for evaluating the hepatitis C continuum of care in HIV/HC... more Objectives: To establish a methodology for evaluating the hepatitis C continuum of care in HIV/HCV co-infected individuals and to characterise the continuum in Europe on 1/1/2015, prior to widespread access to direct-acting antiviral (DAA) therapy. Methods: Stages included in the continuum were: anti-HCV antibody positive, HCV-RNA tested, currently HCV-RNA positive, ever HCV-RNA positive, ever received HCV treatment, completed HCV treatment, follow-up HCV-RNA test, and cure. Sustained virologic response (SVR) could only be assessed for those with a follow-up HCV-RNA test, and was defined as a negative HCV-RNA result measured more than 12 or 24 weeks after stopping treatment. Results: Following stages of the HCV continuum of care were defined: anti-HCV positive (n=5173), HCV-RNA tested (4207/5173; 81.3%), currently HCV-RNA positive (3179/5173; 61.5%), ever HCV-RNA positive (n=3876), initiated HCV treatment (1693/3876; 43.7%), completed HCV treatment (1598/3876; 41.2%), follow-up HCV-RNA test to allow SVR assessment (1195/3876; 30.8%), and cure (629/3876; 16.2%). The proportion that achieved SVR was 52.6% (629/1195). There were significant differences between regions at each stage of the continuum (p<0.0001). Conclusions: In the proposed HCV continuum of care for HIV/HCV co-infected individuals we found major gaps at all stages, with almost 20% of anti-HCV positive individuals having no documented HCV-RNA test and a low proportion achieving SVR, in the pre-DAA era.
HIV-positive people have increased risk of infection-related malignancies (IRMs) and infection-un... more HIV-positive people have increased risk of infection-related malignancies (IRMs) and infection-unrelated malignancies (IURMs). The aim of the study was to determine the impact of aging on future IRM and IURM incidence. People enrolled in EuroSIDA and followed from the latest of the first visit or 1 January 2001 until the last visit or death were included in the study. Poisson regression was used to investigate the impact of aging on the incidence of IRMs and IURMs, adjusting for demographic, clinical and laboratory confounders. Linear exponential smoothing models forecasted future incidence. A total of 15 648 people contributed 95 033 person-years of follow-up, of whom 610 developed 643 malignancies [IRMs: 388 (60%); IURMs: 255 (40%)]. After adjustment, a higher IRM incidence was associated with a lower CD4 count [adjusted incidence rate ratio (aIRR) CD4 count < 200 cells/μL: 3.77; 95% confidence interval (CI) 2.59, 5.51; compared with ≥ 500 cells/μL], independent of age, while a...
ATRIPLA is licensed for use only in HIV-positive persons whose viral loads <50 for ≥ 3 months.... more ATRIPLA is licensed for use only in HIV-positive persons whose viral loads <50 for ≥ 3 months. We investigated the use of ATRIPLA as first-line antiretroviral therapy (ART) in EuroSIDA using a web-based survey performed in Autumn 2012. 96/112 clinics (85.7 %) completed the survey. Recommendations when initiating first-line ART was TRUVADA plus efavirenz in 36 (37.5 %), ATRIPLA in 35 (36.5 %), a different first-line regimen in 12 clinics (12.5 %), and no recommendation in 7 clinics (7.3 %). ATRIPLA was commonest in Northern (15/21 clinics; 71.4 %), and least common in Eastern Europe (2/31 clinics; 6.5 %; p < 0.0001). Over one-third of the participating clinics in this survey were using ATRIPLA as first-line antiretroviral therapy, despite EMA recommendations.
BACKGROUND: In the combined antiretroviral therapy (cART) era, non-acquired immunodeficiency synd... more BACKGROUND: In the combined antiretroviral therapy (cART) era, non-acquired immunodeficiency syndrome (AIDS)-defining malignancies account for more morbidity and mortality in human immunodeficiency virus-infected patients than AIDS-defining malignancies. However, conflicting data have been reported on the relationship between immunodeficiency and the development of some non-AIDS-defining malignancies. METHODS: A total of 14,453 patients from the prospective, multinational EuroSIDA cohort were included. Malignancies were classified as virusrelated, non-virus-related epithelial, and other. The incidence of non-AIDS-defining malignancies was calculated stratified by current CD4 count. Poisson regression was used to investigate factors associated with the development of non-AIDS-defining malignancies. RESULTS: A total of 356 non-AIDS-defining malignancies occurred, with an incidence rate of 4.3 per 1000 person years of follow-up (95% confidence interval [CI], 3.8-4.7); 172 (48.3%) were virusrelated, 135 (37.9%) were non-virus-related epithelial, and 49 (13.7%) were classified as other. Anal (69 cases), lung (31 cases), and melanoma (13 cases), respectively, were the most common non-AIDS-defining malignancies within each group. After adjustment, current CD4 was associated with virus-related non-AIDS-defining malignancies (incidence rate ratio [IRR], 0.81 per doubling; 95% CI, 0.75-0.88; P < .0001) and non-virus-related epithelial non-AIDSdefining malignancies (IRR, 0.84; 95% CI, 0.75-0.95; P ¼ .004), but not with other non-AIDS-defining malignancies (IRR, 1.04; 95% CI, 0.83-1.31; P ¼ .73). Current CD4 count was also associated with anal cancer (IRR, 0.86; 95% CI, 0.75-0.99; P ¼ .03), Hodgkin lymphoma (n ¼ 52; IRR, 0.83; 95% CI, 0.73-0.95; P ¼ .005), and lung cancer (IRR, 0.76; 95% CI, 0.64-0.90; P ¼ .0002). CONCLUSIONS: A low current CD4 count was associated with an increased incidence of certain non-AIDS-defining malignancies. Starting cART earlier to reduce the proportion of patients with a low CD4 count may decrease the rate of developing many common non-AIDS-related malignancies. A randomized trial to explore this strategy is urgently needed. Cancer 2010;
The aim of this study was to determine the prevalence of transmitted drug resistance (TDR) in new... more The aim of this study was to determine the prevalence of transmitted drug resistance (TDR) in newly diagnosed and treatment-naive HIV-infected patients from Croatia and evaluate a possible contribution of transmission clusters to the spread of resistant virus. The study enrolled treatment-naive HIV-infected patients that entered clinical care at the Croatian Reference Center for HIV/AIDS between 2006 and 2008. The protease gene and a part of the reverse transcriptase gene of the HIV-1 genome were sequenced by using the Trugene HIV-1 Genotyping System. The prevalence of transmitted drug resistance was analyzed by using the surveillance drug resistance mutations (SDRM) list recommended by the WHO in 2009. We report findings for 118 of 180 eligible patients (65.6% coverage). SDRM were detected in 26 of 118 patients (22.0%) who were infected with subtype B and belonged mostly to the men having sex with men (MSM). The majority of patients with primary resistance carried SDRM associated with resistance to nucleoside analogues reverse transcriptase inhibitors (NRTIs, 23 of 118 patients, 19.5%). The most frequently found NRTI SDRM was T215S (17 of 118 patients, 14.4%). SDRM associated with resistance to nonnucleoside reverse transcriptase inhibitors were detected in three (2.5%) patients and primary resistance to protease inhibitors was not detected. Non-B subtypes were detected in 13/118 patients (11%). A total of 12 transmission pairs and eight distinct transmission clusters were identified with the largest cluster harboring sequences from 19 patients; among them all but two were carrying the T215S mutation. This study showed a high prevalence of TDR in newly diagnosed MSM from Croatia and is an important contribution concerning the relationship between local transmission clusters and the spread of resistant virus.
A pharmacokinetics study was performed in HIV-infected patients who used indinavir/ritonavir (800... more A pharmacokinetics study was performed in HIV-infected patients who used indinavir/ritonavir (800/100 mg twice a day) plus efavirenz in the European and South American Study of Indinavir, Efavirenz and Ritonavir. Indinavir plasma concentrations were similar to values previously obtained in healthy volunteers who used the same combination. Efavirenz concentrations were higher than reported before. The pharmacokinetic data suggest that indinavir/ritonavir plus efavirenz (without dose modifications) should be effective in treatment-naive patients, and this was supported by the treatment response of the participants.
Journal of the European Academy of Dermatology and Venereology, 2021
Testing for HIV is critical for early diagnosis of HIV infection, providing long‐term good health... more Testing for HIV is critical for early diagnosis of HIV infection, providing long‐term good health for the individual and prevention of onward transmission if antiretroviral treatment is initiated early. The main purpose of the 2021 European Guideline on HIV Testing in Genito‐Urinary Settings is to provide advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito‐urinary or dermato‐venereology clinics across Europe. The guideline presents the details of best practice and offers practical guidance to clinicians and laboratories to identify and offer HIV testing to appropriate patient groups.
The prevalence of hepatitis C virus (HCV) infection in the population of human immunodeficiency v... more The prevalence of hepatitis C virus (HCV) infection in the population of human immunodeficiency virus 1 (HIV-1)-infected individuals from Slovenia and Croatia was determined. One hundred and sixty-six out of a total of 188 Slovenian HIV-1-infected individuals and 120 subjects who were randomly chosen out of a total 342 Croatian HIV-1 antibodies-positive individuals were tested for HCV infection. Detection of HCV antibodies was carried out by a third generation enzyme-linked immunoassay (ELISA) and the positive samples were additionally tested by a third generation immuno-blot assay. Additionally, the presence of HCV RNA was determined in all serum samples by a qualitative polymerase chain reaction (PCR). Twenty-four (14.5%) out of 166 Slovenian and 18 (15.0%) out of 120 Croatian HIV-1-infected individuals were HCV antibodies-positive. Nineteen out of 24 (79.2%) Slovenian and 13 out of 18 (72.2%) Croatian anti-HCV positive individuals were also viremic. HCV RNA was not detected in an...
There are currently few data on the long-term risk of cancer and death in individuals taking ralt... more There are currently few data on the long-term risk of cancer and death in individuals taking raltegravir (RAL). The aim of this analysis was to evaluate whether there is evidence for an association. Methods The EuroSIDA cohort was divided into three groups: those starting RAL-based combination antiretroviral therapy (cART) on or after 21 December 2007 (RAL); a historical cohort (HIST) of individuals adding a new antiretroviral (ARV) drug (not RAL) to their cART between 1 January 2005 and 20 December 2007, and a concurrent cohort (CONC) of individuals adding a new ARV drug (not RAL) to their cART on or after 21 December 2007. Baseline characteristics were compared using logistic regression. The incidences of newly diagnosed malignancies and death were compared using Poisson regression. Results The RAL cohort included 1470 individuals [with 4058 person-years of follow-up (PYFU)] compared with 3787 (4472 PYFU) and 4467 (10 691 PYFU) in the HIST and CONC cohorts, respectively. The prevalence of non-AIDS-related malignancies prior to baseline tended to be higher in the RAL cohort vs. the HIST cohort [adjusted odds ratio (aOR) 1.31; 95% confidence interval (CI) 0.95-1.80] and vs. the CONC cohort (aOR 1.89; 95% CI 1.37-2.61). In intention-to-treat (ITT) analysis (events:
This study examines the relationship between sexual behaviors and prevalence of herpes simplex vi... more This study examines the relationship between sexual behaviors and prevalence of herpes simplex virus-type 2 (HSV-2) among African-American college women. Subjects (n = 138) were recruited randomly from a state university to participate in a study regarding sexual attitudes and behaviors and to have their blood drawn for type-specific HSV seroprevalence. Sera were analyzed for 96 college women with a mean age of 21 years. Of the 96 women, 29 (30%) were HSV-2 seropositive. The results of this study revealed that a history of sexually transmitted disease was predictive of HSV-2 infection. Number of lifetime partners, however, was not related to HSV-2 seropositivity. Four (31%) of the 13 women who reported only one lifetime partner were seropositive. These findings indicate that for young African-American college women, the risk of being infected with HSV-2 is high even with only one lifetime partner. Behavioral strategies focused on decreasing the number of sexual partners are not like...
Postmarketin{ko ispitivanje djelotvornosti i podno{ljivosti lije~enja vulvovaginalne kandidoze fl... more Postmarketin{ko ispitivanje djelotvornosti i podno{ljivosti lije~enja vulvovaginalne kandidoze flukonazolom i klotrimazolom Vi{nja [KERK 1) , prof., dr. sc., dr. med., specijalist infektolog Jerko JAK[I] 2) , mr. pharm. Tamara @ARKOVI] 1) , dr. med, znanstveni novak Davorin [KALKO 1) , dr. med., primarijus, specijalist ginekologije i opstetricije Josip BEGOVAC 1) , prof. dr. sc., dr. med., specijalist infektolog 1) Klinika za infektivne bolesti »Dr. Fran Mihaljevi}«, Zagreb 2) Pliva Hrvatska d.o.o. Klju~ne rije~i flukonazol klotrimazol vulvovaginalna kandidoza
ObjectivesThe aim of the study was to evaluate the long‐term response to antiretroviral treatment... more ObjectivesThe aim of the study was to evaluate the long‐term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)‐, darunavir/ritonavir (DRV/r)‐, and lopinavir/ritonavir (LPV/r)‐containing regimens.MethodsData were analysed for 5678 EuroSIDA‐enrolled patients starting a DRV/r‐, ATZ/r‐ or LPV/r‐containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART‐naïve subjects (8%) at ritonavir‐boosted protease inhibitor (PI/r) initiation; (2) ART‐experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV‐1 RNA copies/mL; and (3) ART‐experienced patients (48%) initiating the new PI/r with a VL >500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements >200 copies/mL ≥24 weeks after PI/r initiation. Kaplan–Meier and multivariable Cox models were used to compare risks of failure by PI/r‐based regimen. The main analysis was pe...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2010
To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and rena... more To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients. Cross-sectional multicenter survey of EuroSIDA clinics during 2008. Prevalence of ESRD was 0.5%. Of 122 patients with ESRD 96 were on dialysis and 26 had received a RT. Median age was 47 years, 73% were males and 43% were black. Median duration of HIV infection was 11 years. Thirty-three percent had prior AIDS; 91% were receiving antiretrovirals; and 88% had undetectable viral load. Median CD4(+)T-cell count was 341 cells per cubic millimetre; 20.5% had hepatitis C coinfection. Most frequent causes of ESRD were HIV-associated nephropathy (46%) and other glomerulonephritis (28%). Hemodialysis (93%) was the most common dialysis modality; 34% of patients were on the RT waiting list. A poor HIV control was the reason for exclusion from RT waiting list in 22.4% of cases. All the RT recipients were all alive at the time of the survey. Acute rejection was reported in 8 patients (30%). Functioning graft was present in 21 (80%). This is the first multinational cross-sectional study of ESRD among European HIV population. Low prevalence of ESRD was found. Two-thirds of patients were excluded from RT for non-HIV/AIDS-related pathologies. Most patients had a functioning graft despite a high acute rejection rate.
Since 25-hydroxy vitamin D (25(OH)D) deficiency has been associated with higher risk of morbidity... more Since 25-hydroxy vitamin D (25(OH)D) deficiency has been associated with higher risk of morbidity and mortality in different settings, this study examined the association between 25(OH)D level and disease progression in HIV-infected patients with prospective follow-up in the EuroSIDA study. Methods A group of 2000 patients were randomly selected from those with stored samples after stratification by region.
Introduction Data on safety and effectiveness of RPV from the real-world setting as well as compa... more Introduction Data on safety and effectiveness of RPV from the real-world setting as well as comparisons with other NNRTIs such as efavirenz (EFV) remain scarce. Methods Participants of EuroSIDA were included if they had started a RPV- or an EFV-containing regimen over November 2011-December 2017. Statistical testing was conducted using non-parametric Mann–Whitney U test and Chi-square test. A logistic regression model was used to compare participants’ characteristics by treatment group. Kaplan–Meier analysis was used to estimate the cumulative risk of virological failure (VF, two consecutive values > 50 copies/mL). Results 1,355 PLWH who started a RPV-based regimen (11% ART-naïve), as well as 333 initiating an EFV-containing regimen were included. Participants who started RPV differed from those starting EFV for demographics (age, geographical region) and immune-virological profiles (CD4 count, HIV RNA). The cumulative risk of VF for the RPV-based group was 4.5% (95% CI 3.3–5.7%)...
Probiotici su živi mikroorganizmi koji primijenjeni u dostatnoj količini mijenjaju sastav i metab... more Probiotici su živi mikroorganizmi koji primijenjeni u dostatnoj količini mijenjaju sastav i metaboličku aktivnost mikroflore ili utječu na imunološki sustav što djeluje povoljno na zdravlje čovjeka. Lactobacillus acidophilus je najbolje proučena acidofilna bakterija koju prirodno nalazimo u jogurtu i acidofilnom mlijeku. Cilj ovog ispitivanja je bio istražiti djelotvornost i podnošljivost vaginalne primjene probiotika Lactobacillus acidophilus u bolesnica sa simptomima kolpitisa. U ovom prospektivnom ispitivanju djelotvornosti i podnošljivosti sedmodnevne primjene Lactobacillus acidophilus solucije za vaginalnu primjenu u žena s kolpitisom – probiotik Lactobacillus acidophilus se pokazao djelotvoran s obzirom da je 42 od ukupno 50 liječenih žena bilo klinički izliječeno. Klinički uspjeh bio je češći u žena iznad 50 godina starosti, te u žena koje su imale simptome iritacije i svrbeža. Lactobacillus acidophilus solucija za vaginalnu primjenu se pokazala izrazito podnošljiva s obzirom...
The European Commission funded a project for the standardisation of the management of occupationa... more The European Commission funded a project for the standardisation of the management of occupational exposures to HIV/blood-borne infections and antiretroviral post-exposure prophylaxis (PEP) in Europe. Within this project, the following recommendations and rationale were formulated by experts representative of participating countries. Based on assessment of the exposure, material, and source characteristics, PEP should be started as soon as possible with any triple combination of antiretrovirals approved for the treatment of HIV-infected patients; initiation is discouraged after 72 hours Rapid HIV testing of the source could reduce inappropriate PEP. HIV testing should be performed at baseline, 4, 12, and 24 weeks, with additional clinical and laboratory monitoring of adverse reactions and potential toxicity at week 1 and 2. HIV resistance tests in the source and direct virus assays in the exposed HCW are not recommended routinely. These easy-to-use recommendations seek to maximise PEP effect while minimising its toxicity and inappropriate use.
Objectives: To establish a methodology for evaluating the hepatitis C continuum of care in HIV/HC... more Objectives: To establish a methodology for evaluating the hepatitis C continuum of care in HIV/HCV co-infected individuals and to characterise the continuum in Europe on 1/1/2015, prior to widespread access to direct-acting antiviral (DAA) therapy. Methods: Stages included in the continuum were: anti-HCV antibody positive, HCV-RNA tested, currently HCV-RNA positive, ever HCV-RNA positive, ever received HCV treatment, completed HCV treatment, follow-up HCV-RNA test, and cure. Sustained virologic response (SVR) could only be assessed for those with a follow-up HCV-RNA test, and was defined as a negative HCV-RNA result measured more than 12 or 24 weeks after stopping treatment. Results: Following stages of the HCV continuum of care were defined: anti-HCV positive (n=5173), HCV-RNA tested (4207/5173; 81.3%), currently HCV-RNA positive (3179/5173; 61.5%), ever HCV-RNA positive (n=3876), initiated HCV treatment (1693/3876; 43.7%), completed HCV treatment (1598/3876; 41.2%), follow-up HCV-RNA test to allow SVR assessment (1195/3876; 30.8%), and cure (629/3876; 16.2%). The proportion that achieved SVR was 52.6% (629/1195). There were significant differences between regions at each stage of the continuum (p<0.0001). Conclusions: In the proposed HCV continuum of care for HIV/HCV co-infected individuals we found major gaps at all stages, with almost 20% of anti-HCV positive individuals having no documented HCV-RNA test and a low proportion achieving SVR, in the pre-DAA era.
HIV-positive people have increased risk of infection-related malignancies (IRMs) and infection-un... more HIV-positive people have increased risk of infection-related malignancies (IRMs) and infection-unrelated malignancies (IURMs). The aim of the study was to determine the impact of aging on future IRM and IURM incidence. People enrolled in EuroSIDA and followed from the latest of the first visit or 1 January 2001 until the last visit or death were included in the study. Poisson regression was used to investigate the impact of aging on the incidence of IRMs and IURMs, adjusting for demographic, clinical and laboratory confounders. Linear exponential smoothing models forecasted future incidence. A total of 15 648 people contributed 95 033 person-years of follow-up, of whom 610 developed 643 malignancies [IRMs: 388 (60%); IURMs: 255 (40%)]. After adjustment, a higher IRM incidence was associated with a lower CD4 count [adjusted incidence rate ratio (aIRR) CD4 count < 200 cells/μL: 3.77; 95% confidence interval (CI) 2.59, 5.51; compared with ≥ 500 cells/μL], independent of age, while a...
ATRIPLA is licensed for use only in HIV-positive persons whose viral loads <50 for ≥ 3 months.... more ATRIPLA is licensed for use only in HIV-positive persons whose viral loads <50 for ≥ 3 months. We investigated the use of ATRIPLA as first-line antiretroviral therapy (ART) in EuroSIDA using a web-based survey performed in Autumn 2012. 96/112 clinics (85.7 %) completed the survey. Recommendations when initiating first-line ART was TRUVADA plus efavirenz in 36 (37.5 %), ATRIPLA in 35 (36.5 %), a different first-line regimen in 12 clinics (12.5 %), and no recommendation in 7 clinics (7.3 %). ATRIPLA was commonest in Northern (15/21 clinics; 71.4 %), and least common in Eastern Europe (2/31 clinics; 6.5 %; p < 0.0001). Over one-third of the participating clinics in this survey were using ATRIPLA as first-line antiretroviral therapy, despite EMA recommendations.
BACKGROUND: In the combined antiretroviral therapy (cART) era, non-acquired immunodeficiency synd... more BACKGROUND: In the combined antiretroviral therapy (cART) era, non-acquired immunodeficiency syndrome (AIDS)-defining malignancies account for more morbidity and mortality in human immunodeficiency virus-infected patients than AIDS-defining malignancies. However, conflicting data have been reported on the relationship between immunodeficiency and the development of some non-AIDS-defining malignancies. METHODS: A total of 14,453 patients from the prospective, multinational EuroSIDA cohort were included. Malignancies were classified as virusrelated, non-virus-related epithelial, and other. The incidence of non-AIDS-defining malignancies was calculated stratified by current CD4 count. Poisson regression was used to investigate factors associated with the development of non-AIDS-defining malignancies. RESULTS: A total of 356 non-AIDS-defining malignancies occurred, with an incidence rate of 4.3 per 1000 person years of follow-up (95% confidence interval [CI], 3.8-4.7); 172 (48.3%) were virusrelated, 135 (37.9%) were non-virus-related epithelial, and 49 (13.7%) were classified as other. Anal (69 cases), lung (31 cases), and melanoma (13 cases), respectively, were the most common non-AIDS-defining malignancies within each group. After adjustment, current CD4 was associated with virus-related non-AIDS-defining malignancies (incidence rate ratio [IRR], 0.81 per doubling; 95% CI, 0.75-0.88; P < .0001) and non-virus-related epithelial non-AIDSdefining malignancies (IRR, 0.84; 95% CI, 0.75-0.95; P ¼ .004), but not with other non-AIDS-defining malignancies (IRR, 1.04; 95% CI, 0.83-1.31; P ¼ .73). Current CD4 count was also associated with anal cancer (IRR, 0.86; 95% CI, 0.75-0.99; P ¼ .03), Hodgkin lymphoma (n ¼ 52; IRR, 0.83; 95% CI, 0.73-0.95; P ¼ .005), and lung cancer (IRR, 0.76; 95% CI, 0.64-0.90; P ¼ .0002). CONCLUSIONS: A low current CD4 count was associated with an increased incidence of certain non-AIDS-defining malignancies. Starting cART earlier to reduce the proportion of patients with a low CD4 count may decrease the rate of developing many common non-AIDS-related malignancies. A randomized trial to explore this strategy is urgently needed. Cancer 2010;
The aim of this study was to determine the prevalence of transmitted drug resistance (TDR) in new... more The aim of this study was to determine the prevalence of transmitted drug resistance (TDR) in newly diagnosed and treatment-naive HIV-infected patients from Croatia and evaluate a possible contribution of transmission clusters to the spread of resistant virus. The study enrolled treatment-naive HIV-infected patients that entered clinical care at the Croatian Reference Center for HIV/AIDS between 2006 and 2008. The protease gene and a part of the reverse transcriptase gene of the HIV-1 genome were sequenced by using the Trugene HIV-1 Genotyping System. The prevalence of transmitted drug resistance was analyzed by using the surveillance drug resistance mutations (SDRM) list recommended by the WHO in 2009. We report findings for 118 of 180 eligible patients (65.6% coverage). SDRM were detected in 26 of 118 patients (22.0%) who were infected with subtype B and belonged mostly to the men having sex with men (MSM). The majority of patients with primary resistance carried SDRM associated with resistance to nucleoside analogues reverse transcriptase inhibitors (NRTIs, 23 of 118 patients, 19.5%). The most frequently found NRTI SDRM was T215S (17 of 118 patients, 14.4%). SDRM associated with resistance to nonnucleoside reverse transcriptase inhibitors were detected in three (2.5%) patients and primary resistance to protease inhibitors was not detected. Non-B subtypes were detected in 13/118 patients (11%). A total of 12 transmission pairs and eight distinct transmission clusters were identified with the largest cluster harboring sequences from 19 patients; among them all but two were carrying the T215S mutation. This study showed a high prevalence of TDR in newly diagnosed MSM from Croatia and is an important contribution concerning the relationship between local transmission clusters and the spread of resistant virus.
A pharmacokinetics study was performed in HIV-infected patients who used indinavir/ritonavir (800... more A pharmacokinetics study was performed in HIV-infected patients who used indinavir/ritonavir (800/100 mg twice a day) plus efavirenz in the European and South American Study of Indinavir, Efavirenz and Ritonavir. Indinavir plasma concentrations were similar to values previously obtained in healthy volunteers who used the same combination. Efavirenz concentrations were higher than reported before. The pharmacokinetic data suggest that indinavir/ritonavir plus efavirenz (without dose modifications) should be effective in treatment-naive patients, and this was supported by the treatment response of the participants.
Journal of the European Academy of Dermatology and Venereology, 2021
Testing for HIV is critical for early diagnosis of HIV infection, providing long‐term good health... more Testing for HIV is critical for early diagnosis of HIV infection, providing long‐term good health for the individual and prevention of onward transmission if antiretroviral treatment is initiated early. The main purpose of the 2021 European Guideline on HIV Testing in Genito‐Urinary Settings is to provide advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito‐urinary or dermato‐venereology clinics across Europe. The guideline presents the details of best practice and offers practical guidance to clinicians and laboratories to identify and offer HIV testing to appropriate patient groups.
The prevalence of hepatitis C virus (HCV) infection in the population of human immunodeficiency v... more The prevalence of hepatitis C virus (HCV) infection in the population of human immunodeficiency virus 1 (HIV-1)-infected individuals from Slovenia and Croatia was determined. One hundred and sixty-six out of a total of 188 Slovenian HIV-1-infected individuals and 120 subjects who were randomly chosen out of a total 342 Croatian HIV-1 antibodies-positive individuals were tested for HCV infection. Detection of HCV antibodies was carried out by a third generation enzyme-linked immunoassay (ELISA) and the positive samples were additionally tested by a third generation immuno-blot assay. Additionally, the presence of HCV RNA was determined in all serum samples by a qualitative polymerase chain reaction (PCR). Twenty-four (14.5%) out of 166 Slovenian and 18 (15.0%) out of 120 Croatian HIV-1-infected individuals were HCV antibodies-positive. Nineteen out of 24 (79.2%) Slovenian and 13 out of 18 (72.2%) Croatian anti-HCV positive individuals were also viremic. HCV RNA was not detected in an...
There are currently few data on the long-term risk of cancer and death in individuals taking ralt... more There are currently few data on the long-term risk of cancer and death in individuals taking raltegravir (RAL). The aim of this analysis was to evaluate whether there is evidence for an association. Methods The EuroSIDA cohort was divided into three groups: those starting RAL-based combination antiretroviral therapy (cART) on or after 21 December 2007 (RAL); a historical cohort (HIST) of individuals adding a new antiretroviral (ARV) drug (not RAL) to their cART between 1 January 2005 and 20 December 2007, and a concurrent cohort (CONC) of individuals adding a new ARV drug (not RAL) to their cART on or after 21 December 2007. Baseline characteristics were compared using logistic regression. The incidences of newly diagnosed malignancies and death were compared using Poisson regression. Results The RAL cohort included 1470 individuals [with 4058 person-years of follow-up (PYFU)] compared with 3787 (4472 PYFU) and 4467 (10 691 PYFU) in the HIST and CONC cohorts, respectively. The prevalence of non-AIDS-related malignancies prior to baseline tended to be higher in the RAL cohort vs. the HIST cohort [adjusted odds ratio (aOR) 1.31; 95% confidence interval (CI) 0.95-1.80] and vs. the CONC cohort (aOR 1.89; 95% CI 1.37-2.61). In intention-to-treat (ITT) analysis (events:
This study examines the relationship between sexual behaviors and prevalence of herpes simplex vi... more This study examines the relationship between sexual behaviors and prevalence of herpes simplex virus-type 2 (HSV-2) among African-American college women. Subjects (n = 138) were recruited randomly from a state university to participate in a study regarding sexual attitudes and behaviors and to have their blood drawn for type-specific HSV seroprevalence. Sera were analyzed for 96 college women with a mean age of 21 years. Of the 96 women, 29 (30%) were HSV-2 seropositive. The results of this study revealed that a history of sexually transmitted disease was predictive of HSV-2 infection. Number of lifetime partners, however, was not related to HSV-2 seropositivity. Four (31%) of the 13 women who reported only one lifetime partner were seropositive. These findings indicate that for young African-American college women, the risk of being infected with HSV-2 is high even with only one lifetime partner. Behavioral strategies focused on decreasing the number of sexual partners are not like...
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Papers by J. Begovac