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Background: The incidence of lung diseases is very high worldwide, especially in the case of lung cancer, pulmonary tuberculosis, and obstructive ventilatory dysfunctions. Alpha-1 an-titrypsin (AAT) is synthesized mainly by hepatocytes, and one of its roles is to inhibit protease activity in the body's biological fluids following the phenomenon of programmed cell death, which is also called apoptosis. Acute lung diseases, but especially chronic ones, can cause, in ad-dition to pulmonary and extrapulmonary manifestations, social and psychological impact, which is why a complex, interdisciplinary respiratory rehabilitation program is necessary. Objectives: Our study aimed to determine the correlation between alpha-1 antitrypsin values and lung dis-eases (pulmonary tuberculosis, lung cancer, asthma, and COPD) and to evaluate the influence of the individualized respiratory rehabilitation program in these diseases. Methods: We carried out a retrospective study between February 2022 and March 2023 in the Pneumology Department of the "Victor Babeș" Clinical Hospital of Infectious Diseases and Pneumoftiziology, Craiova. It in-cluded 189 patients diagnosed with pulmonary tuberculosis, lung cancer, or obstructive ventila-tory dysfunctions (chronic obstructive pulmonary disease – COPD or asthma). Alpha-1 antitryp-sin was collected from all patients. Respiratory rehabilitation was carried out both during hos-pitalization and in an out-patient setting for a maximum period of 6 months after discharge, with some patients even using telemedicine. Results: Increased values of alpha-1 antitrypsin were detected in advanced stages of the disease, and a clear improvement of clinical and func-tional parameters was observed after inclusion in the rehabilitation program. Conclusions: De-tection of alpha-1 antitrypsin deficiency (AATD) is rare. The majority of patients diagnosed with lung cancer in advanced stages showed increased values of alpha-1 antitrypsin, AAT being able to be used as a follow-up marker in response to oncological treatment. Respiratory rehabilita-tion benefits in pulmonary tuberculosis, lung cancer, COPD, and asthma, regardless of the form of the disease. An interdisciplinary approach is necessary for the optimal treatment and control of lung diseases.

Introduction. Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are two major causes of death worldwide. These two viruses share routes of transmission, and therefore, HIV–HBV coinfection is common and is associated with low plasma levels of CD4 T lymphocytes and accelerated liver disease progression. Maternal HIV and HBV infections have been individually associated with preterm birth and low birth weight. Case presentation. We describe the case of a 28-year-old patient, 14 weeks pregnant, asymptomatic, who performed Elisa-HIV 1,2 test within prenatal screening, with a positive result, in 2018. From the medical history, we mention that the patient is known for about 5 years with HBV-hepatitis D virus coinfection, for which she underwent interferon treatment for a year. ART was initiated after one month with lamivudine / zidovudine + lopinavir / ritonavir. The patient was adherent to ART (adherence ≥ 95%) during pregnancy. Before birth, the immunovirological evaluation revealed the suppression of maternal HIV viral load, a moderate degree of immunosuppression and undetectable HBV-DNA. The patient gave birth by caesarean section to a female child, with a gestational age of 36 weeks, birth weight of 1730 g, lenght = 43 cm, head circumference = 30 cm, APGAR score = 8 points. The child received antiretroviral prophylaxis with retrovir+epivir, human hepatitis B immunoglobulin and was vaccinated against hepatitis B. The newborn was not vertically infected with HIV and HBV. Conclusions. Good adherence to ART during pregnancy has been associated with HIV viral load and HBV-DNA suppression and it led to the birth of a child who has not been infected with HIV or HBV. Maternal HIV-HBV coinfection was a significant risk factor for preterm birth and low birth weight.

Introduction. Kaposi's sarcoma (KS) is a multicentric vascular neoplasia typically occurring in the context of immunodeficiency. Although the incidence of HIV-related KS has dramatically decreased and the prognosis improved due to the combined antiretroviral therapy (cART), KS remains an important cause of morbidity and mortality among people living with HIV. Case presentation. We describe the case of a-34-year-old patient from an urban area, who is admitted in the Dermatology Clinic from Emergency Clinical County Hospital Craiova reporting a 3-years history of painful infiltrated plaques on the left hand, in the groin area and on the left lower limb. Among the biological investigations ELISA test-HIV1,2 is performed, with a positive result so the patient is transferred to the HIV/ AIDS Department - „Victor Babes“ Clinical Hospital of Infectious Diseases and Pneumoftiziology Craiova. The patient underwent treatment with: antiretrovirals, antibiotics, antifungals, anticoagulants, vasodilators and symptomatic drugs. During hospitalization, the patient also developed violaceous lesions in the oral cavity, on the right foot and on the left ear lobe. Skin biopsy was performed and the histopathological examination confirmed the clinical suspicion of KS. The oncological treatment was initiated after about 2 months and the evolution of the patient has been favorable, with remission of mucocutaneous lesions more than 50%. Conclusions. Persistent skin lesions in a young patient can be an indicator marker for AIDS and the delayed HIV diagnosis may influence the prognosis.

Introducere. Sarcomul Kaposi (SK) este o neoplazie multicentrică vasculară, care apare, de obicei, în contextul imunodeficienţei. Deși introducerea terapiei antiretrovirale combinate (TARVc) a determinat o scădere remarcabilă a incidenţei SK asociat infecţiei cu HIV și o îmbunătăţire semnificativă a prognosticului, rămâne o cauză importantă de morbiditate și mortalitate în rândul pacienţilor HIV pozitivi. Prezentarea cazului. Pacient în vârstă de 34 de ani, se internează în Clinica de Dermatologie a Spitalului Clinic Judeţean de Urgenţă Craiova pentru apariţia unor placarde infiltrate, dureroase, localizate la nivelul mâinii stângi, inghinal și la nivelul piciorului stâng, ce au debutat în urmă cu aproximativ 3 ani. Se efectuează test ELISA-HIV 1,2, cu rezultat pozitiv și pacientul este internat la Compartimentul HIV/SIDA – Spitalul Clinic de Boli Infecţioase și Pneumoftiziologie „Victor Babeș“ din Craiova. Se instituie TARVc, tratament antibiotic, antimicotic, anticoagulant și simptomatic. Pe parcursul internării, pacientul prezintă extinderea leziunilor la nivelul cavităţii bucale, feţei plantare a piciorului drept și la nivelul lobului urechii stângi. Se efectuează biopsie de la nivelul leziunilor cutanate, iar examenul histopatologic confirmă diagnosticul de SK. După circa 2 luni, se iniţiază și tratament citostatic, evoluţia pacientului fiind favorabilă, cu remisiunea leziunilor cutaneo-mucoase în proporţie mai mare de 50%. Concluzii. Leziunile cutanate persistente la un pacient tânăr pot fi marker indicator de SIDA, întârzierea diagnosticului influenţând prognosticul infecţiei cu HIV.

The immune reconstitution inflammatory syndrome (IRIS) is a paradoxical inflammatory response that can occur in patients infected with the human immunodeficiency virus (HIV) in the first weeks after initiating antiretroviral therapy (ART). It can be manifested either by exposing an underlying infection, or by aggravating the symptoms of an opportunistic infection already diagnosed and under treatment. We present the case of a 24-year-old patient, diagnosed in September 2019 with HIV infection category C3. Extrapulmonary tuberculosis with lymph node and probably splenic metastases. Bacteremia with Staphylococcus aureus. Normocytic hypochromic anaemia – medium form. Antibacillary therapy and ART were initiated (10 days after treatment for tuberculosis). After about 2 weeks from the initiation of ART, the patient complained of intense lumbar pain with irradiation in the lower limbs. IRIS (bone tuberculosis) or a bone adverse reaction to ART was suspected, but the imaging examination (MRI-lumbar spine) reveals a lumbosacral disc herniation, the patient continuing ART, antibacillary treatment, adding neurological treatment. Conclusions. IRIS should be considered in patients diagnosed with HIV in late stages, in which the introduction of ART may be followed by the aggravation or occurrence of an opportunistic infection posing a problem of treatment and differential diagnosis.

Sindromul inflamator de reconstrucție imună (IRIS) este un răspuns inflamator paradoxal, care poate să apară la pacienţii infectaţi cu virusul imunodeficienței umane (HIV), în primele săptămâni după inițierea terapiei antiretrovirale (ART). Se poate manifesta fie prin demascarea unei infecții subiacente, fie prin agravarea simptomatologiei unei infecții oportuniste, diagnosticată deja și aflată în tratament. Prezentăm cazul unei paciente în vârstă de 24 de ani, diagnosticată în septembrie 2019 cu infecție HIV categoria C3, tuberculoză extrapulmonară cu determinări ganglionare și, probabil, splenice, bacteriemie cu Staphylococcus aureus, anemie hipocromă normocitară formă medie. S-au inițiat tratament antibacilar și ART (după 10 zile de la tratamentul pentru tuberculoză). După circa 2 săptămâni de la inițierea ART, pacienta a prezentat dureri lombare intense, cu iradiere la nivelul membrelor inferioare. A fost suspicionat IRIS (tuberculoză osoasă) sau o reacție adversă osoasă la ART, dar examenul imagistic (IRM-coloană lombară) evidențiază o hernie de disc lombo-sacrată, pacienta continuând ART, tratamentul antibacilar, adaugându-se tratamentul neurologic. Concluzii. IRIS trebuie avut în vedere la pacienții diagnosticați cu HIV în stadii tardive, la care introducerea ART poate fi urmată de agravarea sau apariția unei infecții oportuniste, punând probleme de tratament și diagnostic diferențial.

Objectives. To assess the level of adherence to combined antiretroviral therapy (cART) among pregnant women infected with HIV-1 in early childhood, registered in Craiova Regional Center for Monitoring and Evaluation of HIV / AIDS within „Victor Babes” Clinical Hospital of Infectious Diseases and Pneumoftiziology of Craiova (CRC) and to identify the main factors associated with non-adherence. Material and method. Retrospective study, during January 1st 2014 and December 31st 2019, with the analysis of the data mentioned in the medical records for the HIV-positive pregnant women registered within CRC. The level of adherence was assessed after applying an adherence questionnaire: 18-22 points (adherence ≥ 80%) and under 18 points (non-adherence < 80%). Results. The studied group included 71 patients and it was divided into two batches, depending on the route of HIV transmission: group A which included 48 pregnant women parenterally infected with HIV in early childhood and 23 pregnant women sexually infected with HIV. We found that the proportion of non-adherent patients was higher in sexually infected mothers (77.7%) compared to those parenterally infected, in early childhood (14.8%), with statistically significant differences (p = 0.001). The HIV viral load level was correlated with the level of adherence to cART (p = 0.005). Conclusions. Pregnant women infected with HIV-1 in early childhood had a higher level of adherence to cART compared to those sexually infected, directly correlated with HIV viremia.

Obiective. Evaluarea nivelului aderenței la terapia antiretrovirală combinată (TARVc) a gravidelor infectate cu HIV-1 în copilăria mică, aflate în evidența Centrului Regional de Monitorizare și Evaluare a Infecției HIV/ SIDA din cadrul Spitalului de Boli Infecțioase și Pneumoftiziologie „Victor Babeș“ Craiova (CRC) și identificarea principalilor factori asociați cu nonaderența. Material și metodă. Studiu retrospectiv, în perioada 01 ianuarie 2014 – 31 decembrie 2019, analizând datele consemnate în documentele medicale ale gravidelor HIV pozitive aflate în evidența CRC. Nivelul aderenței la TARVc a fost apreciat după aplicarea unui chestionar de aderență: 18-22 puncte (aderență ≥ 80%) și sub 18 puncte (nonaderență < 80%). Rezultate. Grupul studiat a cuprins 71 de paciente și a fost divizat în două loturi, în funcție de calea de infectare cu HIV: lotul A, ce a cuprins 48 de gravide infectate cu HIV pe cale parenterală, în copilăria mică, și lotul B, ce a cuprins 23 de gravide infectate cu HIV pe cale sexuală. Am constatat că proporția de paciente nonaderente la TARVc a fost mai mare în cadrul pacientelor infectate cu HIV pe cale sexuală (77,7%), comparativ cu cele infectate parenteral, în copilăria mică (14,8%), cu diferențe semnificative statistic (p = 0,001). A existat o corelație înalt semnificativă statistic între nivelul viremiei HIV și nivelul aderenței la TARVc (p = 0,005). Concluzii. Gravidele infectate cu HIV-1 în copilăria mică au avut un nivel crescut al aderenței, comparativ cu cele infectate pe cale sexuală, direct corelat cu viremia HIV.

Infecţia cu HIV încă este asociată cu o mare morbiditate maternă, feto-neonatală şi infantilă. Depistarea precoce a infecţiei cu HIV în cursul sarcinii şi iniţierea rapidă a terapiei antiretrovirale sunt corelate cu obţinerea unei încărcături virale HIV mai mici de 50 copii/ml, în acest caz riscul de transmitere materno-fetală a infecţiei fiind mai mic de 0,5%. Obiective. Determinarea ratei transmiterii materno-fetale a infecţiei cu HIV în rândul gravidelor HIV pozitive aflate în evidenţa Centrului Regional de Monitorizare şi Evaluare a Infecţiei HIV/SIDA din cadrul Spitalului de Boli Infecţioase şi Pneumoftiziologie „Victor Babeş” Craiova (CRC) şi identificarea unor corelaţii între aceasta şi anumiţi factori de risc. Material şi metodă. Studiu retrospectiv, 01 ianuarie 2014-31 decembrie 2019, asupra a 73 de gravide HIV pozitive, aflate în evidenţa Centrului Regional Craiova (CRC). Pentru pacientele incluse în grupul de studiu am analizat: date demografice, date epidemiologice, date clinice, date biologice, date furnizate de examenul ginecologic şi obstetrical, date privind tratamentul antiretroviral (TARV). Copiii au fost evaluaţi biologic până la vârsta de 18 luni. Rezultate. Am constatat o rată de transmitere materno-fetală de 6,3%. Pentru pacientele la care s-au aplicat măsuri complete de profilaxie, rata transmiterii materno-fetale a fost de 3%. Aplicarea măsurilor complete de profilaxie s-a corelat cu risc scăzut de transmitere verticală a infecţiei cu HIV (p = 0,006). Aderenţa scăzută la TARV s-a corelat cu risc înalt de transmitere materno-fetală a infecţiei cu HIV (p = 0,02), cu încărcătură virală HIV (ÎV-HIV) detectabilă (p = 0,0004) şi cu imunodepresie avansată (p = 0,02). Stadiul bolii gravidelor HIV pozitive nu s-a corelat cu riscul de transmitere verticală a infecţiei (p = 1). Nivelul ÎV-HIV a mamelor care au născut copii HIV pozitivi a fost mai mare decât la lotul general şi s-a corelat cu transmiterea materno-fetală (p = 0,04). Concluzii. Rata transmiterii materno-fetale în perioada studiată a fost relativ crescută (6,3%), din cauza aplicării incomplete a măsurilor de prevenţie, 12 dintre gravide fiind diagnosticate în timpul sarcinii sau la naşterea copilului. Transmiterea verticală a infecţiei cu HIV s-a corelat cu ÎV-HIV detectabilă şi aderenţă scăzută la TARV a gravidelor.

HIV infection is still associated with high maternal, feto-neonatal and infant morbidity. Early detection of HIV infection during pregnancy and early initiation of antiretroviral therapy are correlated with obtaining an HIV viral load of less than 50 copies/ml, in which case the risk of maternal-fetal transmission of the infection is less than 0.5%. Objectives. To establish the maternal-fetal transmission rate of HIV infection among HIV-positive pregnant women registered in Craiova Regional Center for Monitoring and Evaluation of HIV/AIDS within „Victor Babeş” Clinical Hospital of Infectious Diseases and Pneumoftiziology of Craiova (CRC) and to identify some correlations between it and certain risk factors. Material and method. Retrospective study, during January 1st, 2014-December 31st, 2019, on 73 HIV-positive pregnant women, registered by Craiova Regional Center (CRC). For the patients included in the study group we analysed: demographic data, epidemiological data, clinical data, biological data, data provided by gynaecological and obstetrical examination, data on antiretroviral treatment (ART). The children were biologically evaluated until the age of 18 months. Results. We found a maternal-fetal transmission rate of 6.3%. For patients with complete prophylaxis measures, the maternal-fetal transmission rate was 3%. The application of complete prophylaxis measures was correlated with a low risk of vertical transmission of HIV infection (p = 0.006). The low adherence to ART was correlated with a high risk of maternal-fetal transmission of HIV infection (p = 0.02), detectable viral-HIV load (VL-HIV) (p = 0.0004) and advanced immunosuppression (p = 0.02). The disease stage of HIV-positive pregnant women was not correlated with the risk of vertical transmission of the infection (p = 1). The level of HIV viral load of mothers who gave birth to HIV-positive children was higher than in the general group and correlated with the maternal-fetal transmission (p = 0.04). Conclusions. The maternal-fetal transmission rate in the studied period was relatively high (6.3%), due to the incomplete application of prevention measures, 12 of the pregnant women being diagnosed during pregnancy or childbirth. The vertical transmission of HIV infection was correlated with detectable HIV viremia and low ART adherence in pregnant women.