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Warsaw, Poland

Kowalska J.D.,HIV Out Patient Clinic | Kowalska J.D.,Medical University of Warsaw | Czeszko-Paprocka H.,Central Analytical Laboratory | Firlag-Burkackaa E.,HIV Out Patient Clinic | And 2 more authors.
HIV and AIDS Review | Year: 2013

Background: Tuberculosis remains an important healthcare problem in Poland. At the same time tuberculosis is the most common AIDS defining condition diagnosed in HIV-positive persons in Poland. Therefore, we have investigated the prevalence of latent TB infection among healthcare staff of HIV hospital. Material and methods: The interferon gamma release assay (IGRA) was offered to all hospital staff. Participants filled in a self-report questionnaire on demographics, work position, time of employment, occupational and non-occupational contact with TB. In statistical analysis nonparametric tests were used for group comparison. A multivariable logistic regression model was developed including all variables with p < 0.1 in univariable models. Results: Overall 86 (20.9%) of 411 HCW participated in the study. Those with positive IGRA test (12.8%) were older, more likely to undergo TB treatment in the past or having a history of home TB contact. There was no statistical difference between the groups in duration of employment, occupational exposure or its frequency. Factors remaining statistically associated with positive IGRA test was age (OR 1.11, [95% CI: 1.00-1.22]) and home TB contact (OR 36.9, [95% CI: 1.97-688.8]), whereas duration of employment (OR 0.98, [95% CI: 0.89-1.09]) and active TB in the past (OR 0.99, [95% CI: 0.04-25.3]) revealed to be non-significant. Conclusion: The prevalence of latent TB infection among healthcare staff was slightly higher than the one reported in other high income countries. However the risk of acquiring tuberculosis among healthcare workers of HIV hospital was mainly linked to non-occupational exposures. IGRA screening may serve as an important tool in limiting tuberculosis transmission. © 2013 Polish AIDS Research Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Kowalska J.D.,HIV Out Patient Clinic | Kowalska J.D.,Medical University of Warsaw | Kubicka J.,HIV Out Patient Clinic | Siwak E.,HIV Out Patient Clinic | And 4 more authors.
AIDS Research and Therapy | Year: 2016

Background: Rates of first antiretroviral therapy (cART) modifications are high in most observational studies. The age-related differences in treatment duration and characteristics of first cART modifications remain underinvestigated. With increasing proportion of older patients in HIV population it is important to better understand age-related treatment effects. Methods: Patients were included into this analysis, if being cART naïve at the first visit at the clinic. Follow-up time was measured from the first visit date until first cART modification or 28 February 2013. First cART modification was defined as any change in the third drug component i.e. protease inhibitor (PI), non-nucleoside reverse transcriptase inhibitor (NNRTI), integrase inhibitor or fusion inhibitor. Cox proportional hazard models were used to identify factors related to first cART modification in three age groups: <30, 30-50 and >50. Results: In total 2027 patients with 14,965 person-years of follow-up (PYFU) were included. The oldest group included 136 patients with 1901, middle group 1202 with 8416 PYFU and youngest group consisted of 689 patients with 4648 PYFU. Median follow-up time was 5.8 (IQR 3.4-9.4) years, median time on first cART was 4.4 (IQR 2.1-8.5) years. 72.4 % of patients started PI-based and 26.1 % NNRTI-based regimen. In total 1268 (62.5 %) patients had cART modification (non-adherence 30.8 %, toxicity 29.6 %). Durability of first cART was the best in patients over 50 y.o. (log-rank test, p = 0.001). Factors associated with discontinuation in this group were late presentation (HR 0.45, [95 % CI 0.23-0.90], p = 0.02) and PI use (HR 2.17, [95 % CI 1.18-4.0], p = 0.01). Conclusions: Rates of first cART modifications or discontinuation were comparable in all groups; however older patients were significantly longer on first cART regimen. © 2016 Kowalska et al.

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