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Introduction: This case report describes a serious complication of delayed human immunodeficiency virus (HIV) diagnosis in a patient initially misdiagnosed with palliative-stage cancer and subsequently diagnosed with B-cell lymphoma. This situation highlights the diagnostic challenges and treatment implications following HIV diagnosis, and underscores the critical importance of accurate and timely HIV detection in oncology patients. Case presentation: A 39-year-old man was initially diagnosed with lung cancer based on computed tomography and histopathologic findings. He was treated with 2 lines of chemotherapy over an 8-month period, the neoplastic lung lesions progressed, and he was referred to palliative care. Two years after his initial diagnosis, during the management of an actively bleeding gastric tumor, he was diagnosed with HIV and referred to an infectious disease unit. Immediate antiretroviral treatment was initiated after diagnosis, and further evaluation confirmed the presence of B-cell lymphoma. A retrospective review suggested that the initial cancer diagnosis was likely misinterpreted and was in fact lymphoma, a malignancy commonly associated with HIV. Lymphoma treatment was initiated, and after 1 year, the patient achieved HIV-1 virologic suppression and near-complete remission of all lesions. Conclusions: This case highlights the consequences of delayed HIV diagnosis, which can significantly alter treatment course and patient prognosis. The initial misdiagnosis of cancer and subsequent ineffective treatment highlights the importance of HIV testing, particularly in patients presenting with malignancy. It also highlights the role of multidisciplinary collaboration, the need for prompt initiation of antiretroviral therapy, and the efficacy of targeted anticancer therapies for HIV-associated malignancies. [ABSTRACT FROM AUTHOR]

Background The Russian invasion of Ukraine forced migration for safety, protection, and assistance. Poland is the primary sheltering country for Ukrainian refugees, providing support including medical care, which resulted in the rapid ∼15% increase in the number of followed-up people with human immunodeficiency virus (HIV) (PWH) in the country. Here, we present the national experience on HIV care provided for refugees from Ukraine. Methods Clinical, antiretroviral, immunological, and virologic data from 955 Ukrainian PWH entering care in Poland since February 2022 were analyzed. The dataset included both antiretroviral-treated (n = 851) and newly diagnosed (n = 104) patients. In 76 cases, protease/reverse transcriptase/integrase sequencing was performed to identify drug resistance and subtype. Results Most (70.05%) of the patients were female, with a predominance of heterosexual (70.3%) transmissions. Anti–hepatitis C antibody and hepatitis B antigen were present in 28.7% and 2.9% of the patients, respectively. A history of tuberculosis was reported in 10.1% of cases. Among previously treated patients, the viral suppression rate was 89.6%; 77.3% of newly HIV diagnosed cases were diagnosed late (with lymphocyte CD4 count <350 cells/μL or AIDS). The A6 variant was observed in 89.0% of sequences. Transmitted mutations in the reverse transcriptase were found in 15.4% treatment-naive cases. Two patients with treatment failure exhibited multiclass drug resistance. Conclusions Migration from Ukraine influences the characteristics of HIV epidemics in Europe, with an increase in the proportion of women and hepatitis C coinfected patients. Antiretroviral treatment efficacy among previously treated refugees was high, with new HIV cases frequently diagnosed late. The A6 subtype was the most common variant. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, a reduction in the life expectancy gap between people living with HIV (PLWH) and the general population has been observed, irrespective of CD4 lymphocyte count, due to widespread access to antiretroviral treatment. The increase in the life expectancy of PLWH has increased awareness of both the ageing process and gender discrepancies in immune restoration and survival. Materials and Methods: Longitudinal data were collected for 2240 patients followed up at the Hospital for Infectious Diseases in Warsaw, Poland (n = 1482), and the Department of Acquired Immunodeficiency, Pomeranian Medical University, Szczecin, Poland (n = 758). Immune restoration was measured from the time of starting combination antiretroviral therapy until achieving 500 CD4 lymphocytes/μL, 800 CD4 lymphocytes/μL, and CD4/CD8 lymphocyte ratios of > 0.8 and > 1.0. Full recovery was achieved when the patient was restored to both 800 CD4 lymphocytes/μL and a CD4/CD8 lymphocyte ratio > 1.0. Results: For all endpoints, immune restoration had a protective effect by reducing mortality. Patients who achieved immune restoration had a greater chance of reduced mortality than those who did not achieve immune restoration: for CD4 count > 500 cells/μL, HR = 5.4 (interquartile range: 3.09–9.41), p < 0.001; for CD4 > 800 cells/μL, HR = 5.37 (2.52–11.43), p < 0.001; for CD4/CD8 ratio > 0.8, HR = 3.16 (1.81–5.51), p < 0.001; for CD4/CD8 ratio > 1.0, HR = 2.67 (1.49–5.24), p = 0.001, and for full immune recovery, HR = 3.62 (1.63–8.04), p = 0.002. Conclusions: Immune restoration remains a powerful factor in improving the survival of PLWH, regardless of the speed of recovery. [ABSTRACT FROM AUTHOR]

Patient's genetic background, especially in the HLA and CCR5 regions, strongly influences outcomes of HIV-1 infection. Understanding how host genetic factors can contribute to disease progression can help guide intervention strategies. To date, it has been estimated that HLA and CCR5 loci account for around 13% of variations in viremia set point. However, a key question in understanding all complex phenotypes, including HIV-1 progression, is what degree of influence different genetic variants can have. Presence of a 32bp deletion in CCR5 gene is associated with slower progression of HIV infection and positive effect on survival among cART untreated patients. Some studies have assessed CCR5-Δ32 as the most potent protective variant, both in immunological and viremic context, unrelated to HLA. Variants of CCR2 (rs1799864) are associated with slower progression to AIDS. CX3CR1 variant (rs3732378) may limit the shift in HIV-1 tropism from R5 to X4. This polymorphism may influence both disease progression and HIV tropism. HLA-C -35 (rs9264942) C/C variant is associated with a significant reduction in HIV viral load compared to T/T homozygote. Moreover, HLA-B*5701 has been confirmed to be more common in patients with slow disease progression to AIDS. Patient's genetic background, especially in HLA and CCR5 regions, strongly influences the progression of HIV-1 infection as well as viremic and immunologic values. [ABSTRACT FROM AUTHOR]

Infection with the human immunodeficiency virus type 1 (HIV‐1) subtype B is most commonly acquired in Poland through men who have sex with men (MSM) comparable to the HIV epidemic in the Netherlands. Following a paper by Chris Wymant et al. on February 4, 2022 in Science on a highly virulent variant of HIV‐1 subtype‐B (VB‐variant) in the Netherlands raised concerns about the possibility of the variant dissemination to other European countries. We aim to report the spread of HIV‐1 VB‐variant, recently identified in the Netherlands, into other European regions. Subtype B pol gene fragments of protease (P), reverse transcriptase (RT), and integrase (IN) from our laboratory supplemented with publicly available sequences were inferred with VB samples from the Netherlands. For positively clustering samples, clinical observations were compiled. Between May 2009 and August 2014, three cases of VB sequences of Polish origin and one additional from Belgium were identified. Patients presented with elevated viral loads and fast CD4 decline as original characteristics. The mean number of base substitutions per site within the clade versus interclade variability showed a high intragroup sequence similarity, reflecting an ongoing MSM transmission cluster for Polish sequences. The sampling period coincides with the ongoing Dutch VB‐variant spread reported between 2003 and 2014. This study informs on phylogenetic descriptions, and clinical symptoms from the rare and emerging VBs placed in Poland. VB is not expanding since 2014 and the Inviduals infected with the VB virus can be treated successfully. Studies on the propagation of novel and potentially virulent virus variants in the undersampled regions add to the understanding of the pan‐European HIV‐1 transmission dynamics. [ABSTRACT FROM AUTHOR]

This case report provides data on unique challenges related to amoebiasis diagnostics and treatment in non-endemic regions. The presented case report is focused a 28-year-old male patient of Indian origin, temporarily living in Poland, who was diagnosed with an amoebic liver abscess. The patient presented with a range of non-specific symptoms including shortness of breath, chest pain, and fever. The differential diagnosis included cardio-pulmonary diseases, a range of tropical diseases such as malaria or typhoid fever, bacterial abscesses, and malignancies, necessitating a comprehensive, multi-modal diagnostic approach. This approach included an extensive review of patient history, physical examination, and various laboratory and imaging investigations. A further challenge in this case was the unavailability of standard cysticidal treatments in Poland, which required individualized therapeutic strategy. Despite these obstacles, the patient was successfully treated using an alternative regimen of intravenous metronidazole, ceftriaxone, doxycycline, chloroquine, and finally, trimethoprim/sulfamethoxazole (treatment with metronidazole was used as a base drug, due to the lack of typical cysticidal treatment, an alternative treatment was added: chloroquine is a recommended drug used in the treatment of pregnant patients, in addition, doxycycline showed in vitro activity against Entamoeba histolytica). This therapeutic journey underscored the value of adaptability in treatment protocols, particularly in regions where certain resources may not be readily available. This case report underlines the importance of broadening the differential diagnosis in non-endemic regions to include tropical diseases, particularly in the context of increasing global travel and migration. It also highlights the significance of employing comprehensive diagnostic strategies and adaptable treatment protocols in such scenarios. In addition, the report reiterates the need for global collaboration and education among healthcare providers to effectively manage tropical diseases, especially in non-endemic regions. Through its exploration of the complexities associated with diagnosing and managing amebiasis in a non-endemic region, this report offers valuable insights to clinicians worldwide., Competing Interests: Dr Miłosz Parczewski reports personal fees from ViiV/GSK, Gilead, Janssen, and MSD, outside the submitted work. The authors report no other conflicts of interest in this work., (© 2024 Aksak-Wąs et al.)

Background: Hepatitis C virus (HCV) resistance-associated variants (RAVs) have been shown to adversely affect treatment response of direct-acting antivirals. Identifying pre-existing RAVs and transmission networks among HIV/HCV genotype 1 (G1)-infected patients from Poland will assist in shaping surveillance strategies for HCV., Methods: NS3 and NS5A sequences were obtained from samples of 112 direct-acting antiviral-naive G1 patients (45 G1a and 67 G1b), of which 74 were chronically infected and 38 were diagnosed with acute hepatitis C (AHC). RAVs were identified using geno2pheno, and 98 concatenated NS3/NS5A alignments were constructed to identify transmission clusters using a maximum likelihood approach., Results: G1a was notably more prevalent compared with G1b among men-having-sex-with-men (MSM) (60.0% vs. 31.3%, P = 0.004), AHC cases (46.7% vs. 25.4%, P = 0.019), and patients diagnosed with syphilis (52.2% vs. 24.5%, P = 0.009). The overall NS3/NS5A RAVs frequency was 14.3% with variants occurring more often in G1a compared with G1b (27.5% vs. 5.2%, P = 0.005), mostly for NS3 due to the high prevalence of polymorphism Q80K. NS5A RAVs were only found in 2.9% of sequences. Significant clustering was observed for 73.5% of the Polish sequences, however, more common in G1a MSM compared with G1b (50.0% vs. 25.9%, P = 0.02). The identified clusters contained sequences originating from up to 5 Polish cities, located within a mean distance of 370 km., Conclusions: Close clustering of Polish strains suggests the presence of compartmentalized epidemics of MSM that fuel the spread of G1a variants. Particularly patients with AHC form a national transmission network, including clusters enriched with the NS3 Q80K polymorphism.