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Supplemental Material, sj-pdf-1-std-10.1177_09564624211019876 for Pre-exposure prophylaxis for HIV with oral tenofovir disoproxil fumarate/emtricitabine in men who have sex with men: Slovenian national demonstration project by Blaž Pečavar, Barbara Kokošar Ulčar, Manja Kordiš, Maja Pleško, Gabriele Turel, Tomaž Vovko and Janez Tomažič in International Journal of STD & AIDS

Slovenia is a small European country with a total of 547 HIV-infected individuals cumulatively reported by the end of 2011. However, the estimated incidence rate of HIV infections increased from 7.0 per million in 2003 to 26.8 per million in 2011. In this study, we assessed the prevalence of transmitted drug resistance (TDR) in the past 6 years (2005–2010) and analyzed the time trend of the proportion of men having sex with men (MSM) and HIV-1 subtype B among newly diagnosed individuals in a 15-year period (1996–2010) in Slovenia. Among 150 patients included in the study, representing 63% of HIV-1 newly diagnosed patients in 2005–2010, TDR was found in seven patients (4.7%). The prevalence of TDR to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, and protease inhibitors was 2% (3/150), 2% (3/150), and 0.7% (1/150), respectively. The majority of patients were infected with subtype B (134/150, 89%), while subtype A was detected in 6.0% (9/150), subtype D in 1.3% (2/150), and subtype G and CRF02_AG in 0.7% (one patient each). Three of 150 sequences could not be typed. Infection with subtype B was found to be significantly associated with male gender, Slovenia being reported as the country of the patient's nationality and origin of the virus, CDC class A, mode of transmission with homosexual/bisexual contact, sex with an anonymous person, and a higher CD4+ count. Among patients carrying the subtype B virus, an MSM transmission route was reported in 87% of patients. Although the prevalence of TDR in Slovenia is still below the European average, active surveillance should be continued, especially among MSM, the most vulnerable population for HIV-1 infection in this part of Europe.

Human cytomegalovirus, a member of the Betaherpesviridae, has the ability to establish lifelong persistent and usually latent infection. Following primary infection (asymptomatic or symptomatic: CMV mononucleosis), cytomegalovirus disease is generally restricted to the immunocompromised or immunologically immature host. In transplant patients, infection with cytomegalovirus from thedonor organ or the reactivation of cytomegalovirus in the recipient can lead to disease development. Cytomegalovirus remains one of the most importantinfections in solid organ transplant recipients and is associated with significant morbidity and mortality. Prevention and therapy of cytomegalovirus infections in solid organ transplantation are presented.

As biological agents interfere with immunity, there are potential concerns regarding increased rates of both common and unusual infections among treated patients. While most biologicals are generally safe, agents that inhibit tumornecrosis factor alpha and monoclonal antibodies against specific subsets of leukocytes may cause different, sometimes life threating infectious complications. The aim of this review is to present a comprehensive overview of the infectious risks associated with most important biological agents.

Infectious diseases are beeoming more complicated to diagnose and treat. History plays a eritical role in narrowing the differential diagnosis and deeiding on the most appropriate diagnostie tests. Symptoms of ten are transient and are sometimes reeal1ed by the patient only after repeated inquiry by the doetor. In addition to a eareful history, eareful physieal examination is also very important. History and physical examination of the most importam infeetious disease and syndromes are presented in the article

BACKGROUND: With the increased lifespan of HIV-1 infected patients, mostly dueto highly active antiretroviral therapy, hepatitis C virus (HCV) and hepatitis B virus (HBV) have recently emerged as important pathogens in these patients. HIV-1 infection has an important negative impact on the natural history of HCV and HBV infections, which has consequently caused increased liverassociated and overall morbidity and mortality in HIV-1 infected patients. Thus, liver disease is currently the second leading cause of death in HIV-infected persons in Europe. OBJECTIVE: To determine the prevalence of HBV and HCV infection in HIV-infected individuals in Slovenia. METHODS AND RESULTS: 356 out of 409 Slovenian individuals, confirmed as HIV positive by the end of 2008, were tested for the presence of HBV and HCV infection. Evidence of prior and current HBV infection was found in 77 (21.6%) and 14 (3.9%) of HIV-positive patients, respectively. 38 of 356 (10.7%) HIV-infectedindividuals were confirmed as anti-HCV positive, and 26 of them (68.4%) were also HCV RNA positive. Concomitant active HBV and HCV infection was found in only two HIV-positive individuals. CONCLUSION: In a study carried out on the highest proportion per entire population of HIV-infected individuals from a certain country or geographical region, Slovenia was identified as the country with the lowest prevalence of HCV infection among HIV-infected individuals.

Background. Two to six weeks after primary infection with HIV 50 to 90 percentof patients develop an acute retroviral syndrome which usually presentswith mononucleosis or flu-like illness. Due to nonspecific symptoms ARS is frequently misdiagnosed. Patients and methods. Data of Slovenian patients with acute retroviral syndrome is shown, as well as their symptoms, approaches to management and diagnostic particularities of primary HIV infection. Conclusions. The combination of particular symptoms and epidemiological data should lead us to consider the possibility of an early HIV infection. Izhodišča. Primarna okužba s HIV se pri 50 do 90 odstotkih okuženih oseb prvičklinično pokaže že v dveh do šestih tednih po okužbi kot akutni retrovirusni sindrom (ARS). Bolezen največkrat spominja na gripo ali infekcijsko mononukleozo. Bolniki in metode. Prikazani so slovenski bolniki z akutnim retrovirusnim sindromom, njihovi simptomi, potek zgodnje okužbe in znaki bolezni, možnosti zdravljenja in posebnosti pri diagnostiki. Zaključki. Nespecifični simptomi ARS sicer otežujejo diagnozo, vendar na osnovi klinične slike in epidemiološke anamneze lahko posumimo na okužbo s HIV.

Aims. Insulin resistance may be the primary event in the protease inhibitor-associated metabolic syndrome. Treatment with insulin sensitizers (metformin, rosiglitazone) can ameliorate insulin resistance. So far, the effects of these agents on blood lipids have not been well determined. The aimof the present study was to evaluate the effects of metformin and rosiglitazone treatment on lipid metabolism in HIV infected patients receivingprotease inhibitors containing HAART. Design and Methods. HIV infected male patients (>18 years) were eligible for the study if they had impaired glucose tolerance with insulin resistance, characterized by fasting insulin concentration greater then 20 mIU/L and if they were on stable antiretroviral therapy regimen including a protease inhibitor for at least 12 months prior to the study enrolment. The patients were randomly assigned to receive either 1 g/day metformin (metformin group, n=30) or 4 mg/day rosiglitazone maleate (rosiglitazone group, n=30) or no treatment (control group, n=30). The primary efficacy parameters were fasting plasma lipids, glucose levels and fasting insulin levels compared between baseline and week 48, by treatment groups. Results. The total cholesterol concentration in rosiglitazone group increased from 5.76+-7.1+-1.6 mmol/l (23% increase, p

Aim: HIV surveillance is essential for planing prevention and control activities as well as for assessing their impact. Methods: The data about thereported cases of HIV, AIDS, and AIDS deaths were collected, analysed, and interpreted at the Institute of Public Health of the Republic of Slovenia. TheEuropean surveillance definition was used. Results: Until the end of 2002, the annual reported incidence rates of HIV infection ranged from the lowest 1.5 per million population to the highest 10.5 per million population. Annual reported incidence rates of AIDS ranged from the lowest 0.5 per million population to the highest 8.0 per million population and AIDS deaths from the lowest 0 per million population to the highest 6.0 per million population. In numerous cases, the HIV diagnosis was established rather late. HIV infections have been already recognised in all Slovenian regions. By the end of 2002, thehighest cumulative incidence occurred in regions of Koper and Ljubljana (15.8 and 14.6 per 100.000 population) and the lowest in the region Ravne (4.1per 100.000 population). There were much more men (82%) than women (18%) among the cases. Most men presumably acquired their infection through sex withmen (59%) and most women through unprotected sexual intercourse with men from population groups at higher risk for infection (57%). Conclusion: Slovenia remains a country with a low level HIV epidemic. The most affected group are men who have sex with men. Fortunately, the rapid spread of HIV among injecting drug users and their sexual partners has not begun yet. PROBLEM: Children die mostly as occupants of motor vehicles in Slovenia. Yet approximately 52% of children do not ride appropriately restrained. BJECTIVES:To asses parental attitudes to car seat use by newborns to provide an epidemiological basis for preventive programmes. METHOD: Cross sectional survey was done in slovenian maternity hospitals. 1034 mothers were gathered up in the survey and there was 80% response. The odds ratio (OR) was calculated with the 95% confidence interval and the statistical significance at pL0.05. RESULTS: Parents intend to take their baby home using carrycot (58,2%), using infant seat from group 0 (28,2%), infant seat from group 0+ (6,8% and on their lap (5,8%). Young mothers (15-24 years) will take their baby home on their lap or using carrycot 1,5 times more frequently than older mothers (OR=1,51 (1,05-2,17); p=0,03) and mothers with low educational level twice as frequently as mothers with higher educational level (OR=2,17 (1,46-3,25); p

The routine screening protocol for Slovenian patients with established HIV infection is presented. Complete blood count is especially important in patients with HIV infection since anemia, leucopenia, lymphopenia and thrombocytopenia are found in 30% to 40% of patients. Serum chemistry panel iscommonly advocated in the initial evaluation of HIV infection due to high rates of hepatitis, multisystem diseases and multiple drugs that are potentially toxic. CD4 cell count is a standard test to stage the disease, to predict clinical progression and to make therapeutic decisions regarding antiviral treatment and prophylaxis for opportunistic pathogens. Quantitative plasma HIV RNA is useful for diagnosing acute HIV infection, for predicting progression in chronically infected patients and for therapeutic decisions andmonitoring. Genotypic resistance testing is indicated for chronically infected patients receiving antiretroviral drugs with treatment failure. Serological tests for hepatitis viruses, toxoplasmosis and cytomegalovirus infection, purified protein derivative (PPD) skin test, the venereal disease research laboratory (VDRL) test, Treponema pallidum hemagglutination (TPHA) test, Papanicolaou (PAP) smear test, fasting glucose and lipid profile are also performed. Chest x-ray is indicated for symptoms and signs suggesting pulmonary disease or newly detected positive PPD. When to start antiretroviraltherapy remains controversial. Though treatment is individualized, there are a lot of problems with compliance, adherence, tolerance, side effects, patient's quality of life and resistance of the virus.