Background: In HIV negative population metabolic syndrome and steatosis are related to poorer neurocognitive (NC) performance. We investigated if similar relation exists in people living with HIV (PLWH). Methods:: We included male PLWH aged 20-65, with undetectable viral load for at least 6 months. Data on levels of education, anthropometric measurements, CD4 levels, ART, markers of metabolic syndrome, smoking and concurrent treatment were collected from database. Concentrations of TNF-α and IL-6 were measured. An ultrasound was used to establish the presence of steatosis, visceral fat thickness and carotid intima media thickness. An extensive NC assessment was done by an experienced neuropsychologist. Cognitive domains were defined as executive functions, divergent reasoning, visuo-constructional abilities, delayed recall and working memory and learning and were measured using a battery of 12 tests. Results: 88 PLWH were included (mean age 39,9 years), 51% on PIs, 46% on NNRTI; 20,4% had metabolic syndrome, 42% patients had steatosis. Weak but statistically significant negative correlations were found between the presence of metabolic syndrome, steatosis and VFT and cognitive domains (divergent reasoning, delayed recall and working memory). Poorer perfomrance in the domains of divergent reasoning and in the working memory were found in participants with steatosis (p=0,048 and 0,033 respectively). Conclusion: Although the sample size was relatively small, our results show consistent correlations between the observed neurocognitive variables and metabolic parameters. As central obesity is one of the contributors to NCI, it would be one of the modifiable factors to prevent further neurocognitive decline.

Background: Non-alcoholic fatty liver disease (NAFLD) represents the most common form of chronic liver disease in mono-infected (without concomitant hepatitis B and/or C virus infection) people living with human immunodeficiency virus (HIV). The proper and on time identification of at-risk HIV-positive individuals would be relevant in order to reduce the rate of progression from NAFLD into non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma.Objectives: The aim of this study was to explore visceral fat thickness (VFT) and anthropometric measurements associated with the development of NAFLD in patients mono-infected with HIV and on long-standing combination antiretroviral therapy (cART).Method: Eighty-eight (n = 88) HIV-positive male patients, average age 39.94 ± 9.91 years, and stable on cART, were included in this prospective study. VFT was measured using ultrasonography. Anthropometric measurements included body mass index (BMI), waist-to-hip ratio (W/H), waist-to-height ratio (WHtR), waist and hip circumference (WC, HC). Differences between variables were determined using the chi-square test. The receiver operating characteristic (ROC) curve and the Youden index were used to determine optimal cut-off values of VFT and hepatic steatosis. The area under the curve (AUC), 95% confidence intervals, sensitivity and specificity are reported for the complete sample. Significance was set at p < 0.05.Results: Patients with steatosis had significantly higher values of BMI, HC, WC, W/H and WHtR. The VFT was higher in patients with steatosis (p < 0.001). Specifically, VFT values above 31.98 mm and age > 38.5 years correlated with steatosis in HIV-positive patients, namely sensitivity 89%, specificity 72%, AUC 0.84 (95% CI, 0.76–0.93, p < 0.001), with the highest Youden index = 0.61. The sensitivity of the age determinant above this cut-off point was 84%, specificity 73% and AUC 0.83 (95% CI, 0.75–0.92, p < 0.001), with the highest Youden index of 0.57.Conclusion: In the absence of more advanced radiographic and histological tools, simple anthropometric measurements and VFT could assist in the early identification of persons at risk of hepatic steatosis in low- and middle-income regions.

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Sažetak Uvod. Hronična hepatitis C virusna infekcija u starijem životnom dobu nije mnogo proučavana iako se očekuje porast prevalencije ove bolesti u starijoj populaciji. Materijal i metode. U radu su prikazane kliničko-epidemiološke karakteristike hroničnog hepatitisa kod 153 bolesnika starosti 65 i više godina, lečenih na Klinici za infektivne bolesti Kliničkog centra Vojvodine u Novom Sadu. Rezultati. Nešto zastupljenije su bile osobe ženskog pola − 55,55%; hepatitis C virusna infekcija je najčešće otkrivena slučajno, prilikom drugih pregleda, i najčešće je stečena postransfuziono-u 42,48% slučajeva. Prosečna dužina trajanja infekcije bila je 28,48 godina; ubedljivo najčešće je bila izazvana genotipom 1 hepatitis C virusa i patohistološkim pregledom biopsije jetre se najčešće radilo o teškoj fibrozi i cirozi − 72,22% slučajeva. Uspeh antivirusne terapije primenjene kod 16 bolesnika iznosio je 62,5%. Zaključak. Antivirusna terapija se kod osoba starijeg životnog doba retko primenjuje, ali uspeh od 62,5% u našem uzorku ukazuje na opravdanu primenu terapije uprkos starosti i komorbiditetima.

Introduction. Until the 1990s, there was no available treatment for chronic hepatitis C, but during this decade the benefits of interferon-alfa therapy were reported. At the end of the 1990s, the pegylated interferon-alfa 2a/b has significantly altered the treatment, whereas direct acting antivirals have significantly affected the treatment. The aim of this study was to show the most significant predictive factors of therapy response among patients with chronic hepatitis C treated with pegylated interferon- alfa 2a/b and ribavirin. Material and Methods. A non-randomized retrospective study included 292 patients with chronic hepatitis C treated at the Clinic for Infectious Diseases, Clinical Center of Vojvodina, from 2008 to 2015. Results. The study showed that therapeutic response was not affected by sex, serum viral load, or if the therapy was applied for the first time or repeated. A sustained virological response was statistically significantly more frequent in younger patients, as well as in patients without extrahepatic manifestations. Cases with higher progression of fibrosis were associated with lower chance for sustained virological response. Genotype 1 showed to be a predictor of adverse response to therapy, and genotype 3 as a predictor of sustained virological response. Steatosis was significantly less frequent in patients with genotype 1 with sustained virological response. Patients with a shorter duration of infection were more prone to sustained virological response. Conclusion. A positive response to pegylated interferon-alfa 2a/b and ribavirin was found in 70.20% of patients with chronic hepatitis C. Elderly age, late detection of the infection, hepatitis C virus 1 genotype, fibrosis progression, presence of hepatic steatosis, and extrahepatic manifestations were risk factors for poor treatment outcome.