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Aim of the study According to the World Health Organization (WHO) strategy, elimination of hepatitis C virus (HCV) as a major public health threat by 2030 includes diagnosis and cure of 90% of those infected between 2015 and 2030. The aim of this study is to estimate the realistic possibility to achieve the WHO elimination targets in Poland. Material and methods The Polish population was established according to data from Statistics Poland for the year 2017. Treatment efficacy was estimated based on publications in time-frames depending on the availability of therapeutic options in Poland. The mortality of HCV-infected patients was assumed on the basis of Statistics Poland and the EpiTer-2 database The number of annual antiviral treatments was estimated based on data from the National Health Fund. Two scenarios were considered, without and with intervention dependent on the national screening program. Results The current diagnosis rate in Poland was calculated as 31%. The scenario without intervention resulted in gradual reduction of annual treatments accompanied by a decrease in the number of infected patients in 2030 to 118 000 (0.31% of the current Polish population), which is only 38% compared with 2015 established as a baseline by WHO. Introduction of the HCV screening program, which includes 3 million people annually, would increase treatment uptake to 12 000 per year and reduce the number of HCV-infected persons in Poland by 90%. Conclusions The urgent implementation of the national screening program for HCV in Poland is essential to achieve the WHO goal by 2030. The screening strategy should include up to 3 million persons annually to achieve treatment uptake of 12 thousand patients per year.

Successful antiviral treatment for hepatitis C virus (HCV) infection is crucial to prevent progression of the disease and its most serious complications. Therapy options have changed over the years with improvement of treatment efficacy, safety and simplification. They evolved from interferon and ribavirin combination administered for 24-72 weeks through interferon (IFN)-based triple therapies with 24-48 weeks duration to the all-oral, well-tolerated direct-acting antiviral regimens lasting for 8-16 weeks and with almost 100% cure rates. The benefits of shorter treatment duration are cost reduction, access to therapy for more patients, and lower risk of adverse events and nonadherence. This review summarizes data on treatment options, focusing on the recommended durations of different regimens depending on HCV genotype, severity of liver disease and history of previous therapy. According to currently available data, shortening treatment below 8 weeks does not provide additional benefits, although the further simplification of therapy is still a subject of study.

Aim of the study The purpose of the study was to select the optimal target population for a possible national hepatitis C virus (HCV) screening program in Poland, based on the most recent available data. Material and methods The analysis included 723,654 participants from different populations screened for anti-HCV. Testing was performed in the whole blood using rapid anti-HCV kits. Presence of HCV RNA was additionally demonstrated in some anti-HCV positive patients with the real-time polymerase chain reaction method. Results Altogether 3,548 anti-HCV positive individuals were identified, so the prevalence rate in the whole studied population was 0.5%. The highest percentage (1.2%) was shown by diagnostic laboratories, which offered rapid testing for patients visiting their offices during the HCV awareness campaign. Relatively high anti-HCV prevalence of 0.6-0.7% was noted in hospitals and in private medical centers, as well as during music concerts. Surprisingly, the lowest prevalence (0.2%) was observed in general practitioners’ offices. Among 502 anti-HCV positive individuals tested additionally for HCV RNA, viremic presence was demonstrated in 40%. Conclusions Anti-HCV testing in Poland should be carried out using rapid anti-HCV kits at the patients’ admission to the hospitals and should also be offered to patients during their visits for any purpose in diagnostic laboratories or private medical centers.

A 52-year-old woman with chronic hepatitis C virus genotype 3 infection developed clinically symptomatic mixed cryoglobulinemia. She started pegylated interferon and ribavirin therapy and in week 12 became negative for HCV RNA with resolution of clinical signs of cryoglobulinemia. The dual treatment was discontinued due to interferon-related bilateral retinopathy. After therapy cessation, relapse of HCV RNA and recurrence of symptomatic cryoglobulinemia were observed. While waiting for the antiviral retreatment option she developed glomerulonephritis with renal impairment. Successful HCV eradication was achieved with 24-week treatment of sofosbuvir and ribavirin despite this regimen being considered as suboptimal therapy for genotype 3 HCV infection. A sustained virological response resulted in lasting resolution of clinical symptoms of mixed cryoglobulinemia.

Aim of the study To collect and analyse data obtained from HCV opinion leaders/experts from central European countries, on factors which can affect the WHO target of HCV elimination by 2030. Material and methods Data were collected from opinion leaders/experts involved in management of HCV infections in Central European countries which participated in 9th Conference of the Central European Hepatologic Collaboration (Warsaw, 10-11 October 2019). A dedicated questionnaire collected current information related to HCV elimination in Bulgaria, Croatia, the Czech Republic, Hungary, Latvia, Lithuania, Poland and Slovakia. Results The HCV prevalence rate in particular countries varied from 0.2% to 1.7%. In most central European countries all the HCV infected population is eligible for reimbursement of treatment. However, in some countries there are still some limitations related to the stage of the disease and people who inject drugs. All countries have access to at least one pangenotypic regimen. The most common barrier to HCV elimination in all countries is insufficient political will to establish priority for HCV. None of the reporting countries has established a national screening programme. Conclusions Access to therapy for HCV is similar and the majority of patients in Central Europe can be treated according to the current guidelines. Unfortunately there are still some limitations and a lack of political will to implement national screening programmes. According to collected data HCV elimination will not be possible in the region by 2030.

Although chronic hepatitis C virus (HCV) infection affect 185 million people world-wide, pathomechanism of liver damage is still unclear. Electron microscopy can reveal liver injury in very early stage and help understanding the mechanisms that is crucial in the pathogenesis of chronic hepatitis C. We present the morphological changes in the liver of HCV infected 24-year-old female patient, using light and transmission electron microscopy. Examination by TEM revealed wide range of specific subcellular abnormalities in hepatocellular ultrastructure. The most common observed changes were ring-shaped nuclei with intranuclear inclusion, megamitochondria, and “membranous web” structures – the hallmark of RNA-viruses infection.

The aim of the study Was to analyze the efficacy achieved with regimens available for chronic hepatitis C (CHC) in Poland between 2013 and 2016. Material and methods Data were collected from 29 centers and included 6786 patients with available sustained virologic response (SVR) data between 1 January 2013 and 31 March 2016. Results The sustained virologic response rate for genotypes (G) 1a, 1b, 2, 3 and 4 was 62%, 56%, 92%, 67% and 56% respectively; 71% patients (n = 4832) were treated with pegylated interferon α (Peg-IFNα) and ribavirin (RBV), with SVR rates of 58%, 49%, 92%, 67% and 55% respectively. The sustained virologic response among 5646 G1 infected patients was the lowest with natural interferon α (7%, n = 70) or PegIFN (50%, n = 3779) with RBV, and improved in those receiving triple regimens of Peg-IFN + RBV combined with boceprevir (47%, n = 485), telaprevir (64%, n = 805), simeprevir (73%, n = 132) or sofosbuvir (70%, n = 23). The sustained virologic response with interferon-free regimens of sofosbuvir and RBV (n = 7), sofosbuvir and simeprevir (n = 53), and ledipasvir and sofosbuvir (n = 64) achieved 86%, 89% and 94% respectively. The highest SVR of 98% was observed with ombitasvir/paritaprevir combined with dasabuvir (n = 227). Patients infected with G3 (n = 896) and G4 (n = 220) received mostly Peg-IFN + RBV with SVR of 67% and 56% respectively. Interferon-free regimens were administered in 18 G3/G4 patients and all achieved an SVR. Sofosbuvir combined with Peg-IFN and RBV was administered to 33 patients with an SVR rate of 94%, and a similar rate was achieved among 13 G2 patients treated with interferon and RBV. Conclusions We observed significant differences in efficacy of HCV regimens available in Poland at the turn of the interferon era. The data will be useful as a comparison for therapeutic options expected in the next few years.

Aim of the study To assess predictors of sustained virological response (SVR) in patients with chronic hepatitis C virus (HCV) genotype 3 treated with standard therapy. Material and methods We retrospectively investigated data of 116 consecutive treatment-naïve patients chronically infected with HCV genotype 3, treated with pegylated interferon alpha (PegIFNα) and ribavirin (RBV) for 24 weeks. HCV RNA at week 4 (rapid virological response – RVR) and week 12 (early virological response – EVR) were measured in 85 and 105 patients respectively. Liver biopsy data were available for 103 patients. The variables were compared between patients with an SVR and those without. Results Overall 70.7% of patients achieved an SVR. Pretreatment factors including younger age, mild liver fibrosis as well as normal values of gamma-glutamyl transferase (GGT) and platelet count were significantly associated with higher SVR rate in univariate analysis. In the multivariate analysis only baseline platelet count > 140 000/µl and normal GGT activity were correlated with higher SVR rate. At weeks 4 and 12 HCV RNA was undetectable in 34.1% and 84.8% of patients respectively. The SVR rate was significantly higher in patients with an RVR compared to those without (p = 0.002). Only 2 patients with a rapid and early virological response did not achieve an SVR; both had negative pretreatment prognostic factors. Conclusions In treatment-naïve patients with genotype 3 HCV infection, low baseline platelet count and elevated GGT activity were significantly associated with poor response to PegIFNα and RBV. Achieving a rapid and early virological response was associated with higher likelihood of an SVR.

Stanozolol is a 17α-alkylated synthetic anabolic steroid used illegally by bodybuilders. We present a 19-year-old man who was taking 50 mg of stanozolol intramuscularly, every other day for 2 months, to improve muscle mass. On admission, his bilirubin concentration was 44.34 mg/dl. The serum levels of liver enzymes were normal, with only alanine aminotransferase being slightly elevated. Liver biopsy revealed toxic hepatitis of minor grade with periportal fibrosis and intrahepatic cholestasis. Medical treatment of the patient was conservative. Despite the therapy the patient's general condition deteriorated - bilirubin level increased to 56.64 mg/dl, and INR rose to 1.7. Then we decided to administer low doses of hydrocortisone. As a result of the treatment, bilirubin concentration was 14.61 mg/dl after 2 weeks. Finally all hepatic enzymes returned to normal values 5 months after stanozolol was discontinued. This treatment appears to be safe and leads to a more rapid reduction of bilirubin.