Hepatitis: Begovac J

Puro V, De Carli G, Cicalini S, Soldani F, Balslev U, Begovac J, Boaventura L, Campins Martí M, Hernández Navarrete MJ, Kammerlander R, Larsen C, Lot F, Lunding S, Marcus U, Payne L, Pereira AA, Thomas T, Ippolito G, Anonymous00733. · Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCS, Rome, Italy. · Euro Surveill. · Pubmed #16282641 links to  free full text

Abstract: Exposure prevention is the primary strategy to reduce the risk of occupational bloodborne pathogen infections in healthcare workers (HCW). HCWs should be made aware of the medicolegal and clinical relevance of reporting an exposure, and have ready access to expert consultants to receive appropriate counselling, treatment and follow-up. Vaccination against hepatitis B virus (HBV), and demonstration of immunisation before employment are strongly recommended. HCWs with postvaccinal anti-HBs levels, 1-2 months after vaccine completion, >or=10 mIU/mL are considered as responders. Responders are protected against HBV infection: booster doses of vaccine or periodic antibody concentration testing are not recommended. Alternative strategies to overcome non-response should be adopted. Isolated anti-HBc positive HCWs should be tested for anti-HBc IgM and HBV-DNA: if negative, anti-HBs response to vaccination can distinguish between infection (anti-HBs >or=50 mUI/ml 30 days after 1st vaccination: anamnestic response) and false positive results(anti-HBs >or=10 mUI/ml 30 days after 3rd vaccination: primary response); true positive subjects have resistance to re-infection. and do not need vaccination The management of an occupational exposure to HBV differs according to the susceptibility of the exposed HCW and the serostatus of the source. When indicated, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible (within 1-7 days). In the absence of prophylaxis against hepatitis C virus (HCV) infection, follow-up management of HCV exposures depends on whether antiviral treatment during the acute phase is chosen. Test the HCW for HCV-Ab at baseline and after 6 months; up to 12 for HIV-HCV co-infected sources. If treatment is recommended, perform ALT (amino alanine transferase) activity at baseline and monthly for 4 months after exposure, and qualitative HCV-RNA when an increase is detected.

Bozicevic I, Rode OD, Lepej SZ, Johnston LG, Stulhofer A, Dominkovic Z, Bacak V, Lukas D, Begovac J. · Andrija Stampar School of Public Health, Rockefellerova 4, 10 000 Zagreb, Croatia. · AIDS Behav. · Pubmed #18690533 No free full text.

Abstract: We used respondent-driven sampling among men who have sex with men (MSM) in Zagreb, Croatia in 2006 to investigate the prevalence of HIV, other sexually transmitted infections and sexual behaviours. We recruited 360 MSM. HIV infection was diagnosed in 4.5%. The seroprevalence of antibodies to viral pathogens was: herpes simplex virus type-2, 9.4%; hepatitis A, 14.2%; hepatitis C, 3.0%. Eighty percent of participants were susceptible to HBV infection (HBs antigen negative, and no antibodies to HBs and HBc antigen). Syphilis seroprevalence was 10.6%. Prevalence of Chlamydia and gonorrhoea was 9.0%, and 13.2%, respectively. Results indicate the need for interventions to diagnose, treat and prevent sexually transmitted infections among this population.

Kolarić B, Tesić V, Ivanković D, Begovac J. · Croatian National Institute of Public Health, Zagreb, Croatia. · Coll Antropol. · Pubmed #17508480 No free full text.

Abstract: The aim of the study was to assess the prevalence of depression among Croatian patients infected with human immunodeficiency virus (HIV) and to make a comparison with patients with other acute and chronic infectious diseases. We assessed the depressive disorder using the Beck Depression Inventory questionnaire (BDI), without clinical confirmation. The BDI scores were examined in 80 HIV-infected persons and compared to 80 persons with chronic viral hepatitis and 78 with acute infectious diarrhea. All examinees were treated as outpatients at the University Hospital for Infectious Diseases in Zagreb in March and April of 2003. Prevalence of moderate and severe depression among HIV-infected was 16/80 (20%) with a 95% confidence interval 11% to 29%. Male patients with HIV or chronic viral hepatitis had a significantly higher BDI scores than males with acute infectious diarrhea (p = 0.017, Kruskall-Wallis, d.f. 2). Female patients with HIV infection tended to have a lower BDI score than females with chronic viral hepatitis or acute infectious diarrhea (p = 0.087, Kruskall-Wallis, d.f. 2). Prevalence of moderate and severe depression among Croatian HIV-positive patients is higher than the upper estimate for general population. Croatian males with chronic infectious disease have higher rate of depression than those with acute infectious disease.

Begovac J. · Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska. · Acta Med Croatica. · Pubmed #16381246 No free full text.

Abstract: Treatment of chronic hepatitis C in patients infected with the human immunodeficiency virus (HIV) is recommended when: 1) aminotransferase levels are repeatedly elevated; 2) CD4+ blood cell counts are above 350 per microl; and 3) HIV RNA plasma levels are less than 50 000 copies per milliliter. Treatment is not recommended for patients who inject illegal drugs, consume large amount of alcohol, or have a severe psychiatric disorder. Treatment of patients with normal aminotransferase levels can be considered in the context of a clinical trial or if stage F2 or worse has been histologically confirmed on a liver biopsy specimen. Liver biopsy is generally recommended prior to treatment. However, because of faster progression to fibrosis in HIV and hepatitis C virus (HCV) coinfected patients, if the patient declines liver biopsy it should not exclude him from treatment. Treatment with interferon and ribavirin (800 mg/day orally) is recommended. Pegylated interferon is preferred (180 microg of alfa-2a form and 1.5 mg/kg of alfa-2b form once weekly subcutaneously) because of poor results with the conventional form of interferon, however, treatment with conventional interferon (3 times weekly 3 million units subcutaneously) can be considered in HCV genotype 2 or 3 infection. All genotypes should be treated for 48 weeks. Since only patients who have a decline of HCV viremia of at least 2 logarithms after 12 weeks of treatment have a chance of cure, treatment should be discontinued in patients who do not achieve this target. Concurrent treatment with zidovudine and didanosine should be avoided because of additive toxicity. One should also be cautious when antiretroviral drugs with a greater potential for hepatotoxicity (nevirapine, ritonavir) are concurrently administered.

Vucelić B, Hrstić I, Begovac J, Bradarić N, Burek V, Colić-Cvrlje V, Duvnjak M, Kekez AJ, Kes P, Lesnikar V, Mise S, Morović M, Ostojić R, Pavić I, Stimac D, Vcev A, Vince A. · Zavod za gastroenterologiju, Klinika za unutrasnje bolesti, Klinicki bolnicki centar Zagreb, Kispatićeva 12, 10000 Zagreb, Hrvatska. · Acta Med Croatica. · Pubmed #16381229 No free full text.

Abstract: There has been a dramatic improvement in diagnostic procedures and therapy of viral hepatitis in the last 20 years. Improvements in therapy caused an increase in actual cost, however, with significant long-term savings through a decreased cost of treatment of advanced liver disease including liver transplantation. The Croatian National Board for Viral Hepatitis has decided to initiate the organization of consensus conference on viral hepatitis enabling the leading experts in the country to give the best possible recommendations for the diagnosis, prophylaxis and therapy in our circumstances. The Consensus Conference took place in Zagreb in June 2004, with update in March 2005, organized by the Croatian National Board for Viral Hepatitis, Reference Centers of the Ministry of Health for Chronic Liver Diseases, Infectious Diseases and AIDS, Croatian Society of Gastroenterology--Hepatology Section, Croatian Society for Nephrology, Dialysis and Transplantation, and Croatian Institute for Health Insurance. Invited experts provided written reports on the respective subjects that appear in this issue and their recommendations resulting in this consensus statement.

Seme K, Poljak M, Begovac J, Vince A, Tomazic J, Vidmar L, Kniewald T. · Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, Slovenia. · Acta Virol. · Pubmed #12387500 No free full text.

Abstract: 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 any of 244 HCV antibodies-negative/HIV-1-infected individual from both countries. A significant difference in the prevalence of HCV infection between blood (77.8% in Slovenia and 66.7% in Croatia) and sexual exposure risk groups (1.6% in Slovenia and 6.6% in Croatia) was found in both countries. In a study carried out on the highest proportion of entire population of HIV-1-infected individuals from a certain country or geographic region, Slovenia and Croatia were identified as countries with the second and third lowest prevalence of HCV infection among HIV-1/HIV-2 infected individuals worldwide.

Pyle GF, Oreskovic S, Begovac J, Thompson C. · Department of Health Promotion and Kinesiology University of North Carolina at Charlotte, NC, USA. · Eur J Epidemiol. · Pubmed #11338124 No free full text.

Abstract: This study examines the presence of hepatitis B as a possible precursor marker for HIV/AIDS in 10 districts of Zagreb, Croatia. There were a total of 931 cases of hepatitis B in Zagreb in the period 1979-1995, the annual rate ranging from 3.1 to 15.4 per 10,000. The highest relative risk for hepatitis B for the 1979-1995 period was in the Pescenica district (Relative risk (RR): 1.4). There were 108 cases of HIV/AIDS diagnosed in Croatia in the period 1986-1996, with 34% from Zagreb. The highest relative risk for HIV/AIDS was within the Pescenica district (RR: 2.3). Pescenica had also a significantly higher incidence of hepatitis B when compared to other districts (p = 0.005). The cumulative incidence of hepatitis B in Zagreb was directly related to levels of neighborhood discomfort as determined by an index including unemployment, inflation and housing conditions (p = 0.005). This research demonstrates that the poor areas of the city with higher incidence of hepatitis B hold the greatest threat for the spread of HIV/AIDS.