Background: To prevent the spread of infectious diseases, several state armies implemented obligatory vaccination programs also practiced in the former Yugoslav National Army (YNA). Iatrogenic hepatitis B virus (HBV) transmissions during vaccinations in the armies were well documented, but to the best of our knowledge, no such study has been performed in the former Yugoslavia. Objectives: In the present study, we determined risk factors for acquiring chronic hepatitis B (CHB) infection in patients in Slovenia. This study focused on the detection of a statistically significant risk factor in males, namely “vaccination in the YNA”. Methods: One thousand seven hundred and twenty-nine patients from all Slovenian regions who tested positive for HBV surface antigen (HBsAg) at the national referential laboratory for viral hepatitis diagnostics between January 1997 and December 2010 were included retrospectively. Accordingly, demographic, epidemiological, virological, and clinical data were extracted from the medical documentation and were statistically analyzed. Results: For 1,122 (64.9%) out of 1,729 patients, data regarding risk factors for acquiring HBV infection were available. The risk factor for infection of almost 60% of HBV chronically infected individuals with available data, followed by “HBV infection in the family” (19.8%) and “blood/blood products transfusion before the nineties” (8%) was unknown. Seven males (0.6%) (mean age ± SD, 53.7 ± 4.50 years) reported “vaccination in the YNA” as a risk factor for acquiring chronic HBV infection. “Vaccination in the YNA” was a significant risk factor for CHB infection in men over 46 years of age (P = 0.006). Conclusions: A significant risk factor for infection in Slovenian men over 46 years of age was identified as “vaccination in the YNA”, which is specific to this geographic region and, to the best of our knowledge, has not been previously described in the peer-reviewed literature.

We report a case of Babesia crassa–like infection in an asplenic patient in Slovenia in 2014. We diagnosed the infection using microscopy, 18S rRNA sequencing, and serology and monitored parasitemia using digital PCR. With its increasing occurrence, babesiosis should be included in differential diagnoses for immunocompromised patients displaying fever.

Background: Hepatitis B virus (HBV) genotypes have been shown to have virological, clinical, and therapeutic implications. Knowledge about HBV genotype distribution in Slovenia is scarce. This study was the first to determine various characteristics of patients with chronic HBV infection with regard to HBV genotypes at the national level. Methods: HBV genotype determination was performed on randomly selected patients out of 1,729 patients from all Slovenian regions who tested positive for HBV surface antigen (HBsAg) at the national reference laboratory for viral hepatitis between January 1997 and December 2010. Demographic, epidemiological, virological, and clinical data were extracted from the medical records and statistically analyzed with regard to HBV genotypes. Results: A total of 186 HBsAg positive patients with the mean age of 40.1 years were identified from whom, 65.1% were male. 157 (84.4%) cases presented with genotype D, 23 (12.4%) with genotype A, and 6 (3.2%) with other HBV genotypes. Sexual transmission was more significantly associated with lower odds for HBV genotype D infection compared to blood-related risk factors (P = 0.023). Genotype A was significantly more common in men who had sex with men (P = 0.043). Compared to females with genotype D, genotype A positive women presented unknown risk factors more significantly (P = 0.002). Conclusions: HBV genotype D is the most prevalent genotype in Slovenia. However, future changes might be expected due to recent massive immigrations to Europe. Routine HBV genotyping is recommended in patients with certain risk factors prior to initiation of hepatitis B treatment.

POSTERSwere Grade 1/2.Serious AEs occurred in 5 (6%) patients in the TVR phase: anemia (4%), biliary colic and pyelonephritis (each 1%).TVR was permanently discontinued in 4 (5%) patients due to AEs.Conclusions: In this treatment-experienced population, the efficacy, safety and tolerability of TVR-based therapy were consistent with previous studies.A similar safety profile was observed in the overall treatment phase as in the TVR phase.

Objectives: The combination of pegylated interferon-α and ribavirin is a standard-of-care (SOC) treatment for chronic hepatitis C (CHC), and it achieves a sustained virological response (SVR) in 41-52% of genotype 1 and in 73-79% of genotype 3 patients. In a few clinical trials, the combination of fluvastatin and SOC increased the SVR in genotype 1 patients. Methods: This prospective study enrolled 179 naïve CHC patients. In the fluvastatin group patients received the combination of SOC and fluvastatin 80 mg daily; historical controls matching the study group in genotype, age and gender were treated with the SOC treatment only. Results: On-treatment viral responses as well as the SVR did not differ significantly between the two groups, except for the genotype 1 patients with a high viral load presenting a significantly higher SVR rate in the fluvastatin group (75%) compared to the control group (41%; p = 0.024). Multivariate logistic regression identified hepatitis C virus (HCV) genotype 3 infection (p < 0.001), age ≤40 years (p < 0.001), liver steatosis <5% (p < 0.01) and low viral load (p < 0.001) as independent predictors of an SVR. Conclusion: A combination of fluvastatin and SOC significantly improved the SVR in naïve CHC patients infected with HCV genotype 1 and high viral load, but it did not improve the SVR in patients infected with HCV genotype 3.

A combination of pegylated interferon and ribavirin presents standard of care (SOC) treatment for naïve chronic hepatitis C (CHC) patients with genotypes 1 and 3. In vitro studies demonstrated inhibitory effect of fluvastatin to hepatitis C virus (HCV) replication. In clinical trials combination of fluvastatin 20 mg daily and SOC improved sustained virological response (SVR) and significantly reduced viral relapse in CHC genotype 1 monoinfected patients. No studies were performed regarding the impact of fluvastatin on viral relapse in genotype 3 patients. The aim of this study was to investigate the impact of added fluvastatin to SOC on viral relapse in genotypes 1 and 3. The prospective study enrolled all over 162 naïve CHC genotypes 1 and 3 Caucasian patients, 64 in the study group that were treated with the combination of SOC and fluvastatin 80 mg daily, and 98 historical controls treated with SOC alone, matching the study group in genotype, age and gender. In the fluvastatin group there were 70% males, 88% aged ≤40 years, 94% with body mass index (BMI) ≤30, 41% with genotype 1, 73% presenting high baseline viral load (>400,000 IU/mL) and 55% having METAVIR stage <2 on liver biopsy. In the control group there were 60% males, 74% aged ≤40 years, 96% with BMI ≤ 30, 46% with genotype 1, 54% with high baseline viral load and 49% presenting METAVIR stage <2. No significant differences in baseline patients characteristics between the two groups were found except for higher viral load in the fluvastatin group (p = 0.023). Rapid (75% versus 70%), early (97% versus 97%) and end of treatment (94% versus 93%) viral responses as well as SVR (89% versus 80%) did not differ significantly between the fluvastatin and control group. Bivariate analysis showed that the combination of fluvastatin and SOC significantly decreased relapse rate in patients with HCV genotype 1 and high baseline viral load. Relapse was observed in only one patient (5%) in the fluvastatin group versus nine patients (41%) in the control group (p = 0.004). No significant difference in viral relapse between the two groups was found in genotype 1 patients with low baseline viral load (p = 0.492) and in genotype 3 patients (p = 0.758). Combination of fluvastatin 80 mg and SOC significantly reduces viral relapse in patients with CHC genotype 1 and high baseline viral load but not in genotype 1 patients with low baseline viral load and in genotype 3 patients.

In order to identify the main routes of hepatitis C (HCV) transmission and to determine the HCV genotype distribution and its dynamics during a 15-year period in Slovenia, HCV genotypes were detected using the INNO-LiPA HCV II (Innogenetics) test for serum samples obtained from 1,504 patients representing 72.6% of all patients with chronic hepatitis C diagnosed from 1993 to 2007. HCV genotype 1 was predominant (56%), followed by genotypes 3, 2, and 4, with a prevalence of 37.8%, 5%, and 1.2%, respectively. HCV genotypes 5 and 6 were not detected in any patient. Patients infected with HCV genotype 3 were significantly younger (mean age 28.9 +/- 8.5 years) than those infected with genotype 1 (mean age 38.9 +/- 14.8 years; P < 0.0001) and those infected with HCV genotype 2 (mean age 50.3 +/- 18.2 years; P < 0.0001). Intravenous drug use was identified as the most frequent possible HCV transmission route (34.3%), followed by medical-related transmission such as transfusion of HCV-contaminated blood or blood products, and hemodialysis (12.5%). Being an intravenous drug user was found to be strongly associated with HCV genotype 3 (OR, 3.71 [95% CI, 2.97-4-65]; P < 0.0001) and reporting infection by transfusion of blood or blood products was found to be strongly associated with HCV genotype 1 (OR, 3.28 [95% Cl, 2.18-4.95]; P < 0.0001). During the 15-year period, the proportion of genotype 3 increased substantially, reflecting the fact that the HCV epidemic in Slovenia is driven mostly by intravenous drug use. J. Med. Virol. 81:634-639, 2009. (C) 2009 Wiley-Liss, Inc.