Human herpesvirus 8 (HHV-8) is associated with Kaposi sarcoma (KS), multicentric Castleman disease (MCD), and primary effusion lymphoma (PEL), important causes of morbidity among people living with HIV. Data on these diseases remain limited from Central and Eastern Europe compared with Western Europe. We conducted a multicentre cross-sectional survey, using an online questionnaire distributed to HIV physicians within the Euroguidelines in Central and Eastern Europe Network Group, comprising epidemiology, diagnostic capacity, and management of HHV-8-related diseases. Twenty-six HIV treatment centres from 22 countries participated, providing care for 36,845 people living with HIV. A total of 55 cases of KS (1.49 per 1000 PLWH) were reported, of which 35 (63.6%) had visceral involvement. MCD and PEL were uncommon, with 7 and 4 cases, respectively. Diagnostic capacity varied between centres: computed tomography was available in 80.8%, bronchoscopy in 30.8%, and gastroscopy in 23.1%. Antiretroviral therapy alone was the most common first-line treatment for limited KS, while pegylated liposomal doxorubicin was accessible as first-line and/or second-line treatment in 46.2% of centres. HHV-8-related diseases remain uncommon but clinically relevant complications of HIV infection in Central and Eastern Europe. Regional variability in diagnostic resources and treatment availability highlights the need for strengthened referral pathways and guideline-adherent care.

BACKGROUND Human brucellosis remains endemic in Bosnia and Herzegovina (B&H), yet integrative studies explaining transmission patterns, population structure, and susceptibility profiles in an endemic setting are lacking. This study aimed to characterise human Brucella melitensis (B. melitensis) isolates from B&H using a combined epidemiological, phenotypic, and genomic approach. METHODS A total of 60 B. melitensis blood isolates obtained from patients with confirmed brucellosis between 2015 and 2021 were selected from a multicentre collection for phenotypic antimicrobial susceptibility testing (AST) and whole-genome sequencing (WGS). Broth microdilution (BMD) in three different broth media was used and interpreted according to the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Genomic analyses included phylogenomic contextualisation using publicly available genomes, and screening for acquired antimicrobial resistance determinants and virulence-associated genes. RESULTS Human brucellosis predominantly affected working-age males and was strongly associated with occupational and household exposure. While phenotypic AST showed that first-line antimicrobials remain effective in vitro, the results were significantly impacted by both the choice of culture media and the interpretive framework, with major discrepancies observed between CLSI and EUCAST classification, particularly for streptomycin and trimethoprim-sulfamethoxazole. WGS revealed a high degree of clustered genomic homogeneity within the East Mediterranean lineage. No acquired antimicrobial resistance (AMR) genes were detected, while a conserved virulence gene repertoire was observed across isolates, including genes associated with membrane adaptation such as mprF. CONCLUSIONS Human brucellosis in B&H is characterised by sustained endemic transmission within a genetically conserved B. melitensis population. Integration of epidemiological, phenotypic AST, and genomic data highlights the importance of interpreting susceptibility patterns in the light of Brucella's slow evolutionary dynamics and local epidemiological context. The genomic baseline established in this study supports future One Health surveillance integrating human and animal reservoirs.

Early in 2020, the WHO recommended that existing drugs be evaluated as a repurposed resource to fight the SARS-CoV-2 pandemic. Here, we investigate the trends of using repurposed and off-label drugs among people living with HIV in Central and Eastern Europe (CEE). From November 2020 to May 2021, data on the clinical outcomes of HIV-positive patients diagnosed with COVID-19 were collected on eCRFs (SurveyMonkey® platform, Inc. San Mateo, CA, USA). Factors associated with the off-label drugs available at this time (chloroquine, hydroxychloroquine, favipiravir, oseltamivir, and lopinavir/ritonavir) were identified using logistic regression models. Of the 557 HIV-positive patients assessed with COVID-19 disease, 67 (12.0%) received off-label drugs, as well as 11.6% (16/138) of hospitalized and 12.2% (51/419) of ambulatory patients (p = 0.8564). In the adjusted logistic regression model, higher odds of off-label drug use were found in patients who had their diagnoses confirmed by an RT PCR test (aOR 5.08 [95%CI 1.17–22.0], p = 0.0396), and who came from a non-EU region (aOR 6.79 [95%CI 3.51–13.1], p < 0.0001). The only factor decreasing the odds of off-label drug use was co-infection (aOR 0.31 [95%CI 0.10–0.94], p < 0.0395). In a cohort of HIV patients from the CEE, 12% were prescribed off-label drugs for COVID-19. Symptomatic patients with confirmed SARS-CoV-2 infection or who were from non-EU countries were more likely to receive a repurposed drug. Drug repurposing is an immediate solution to emerging pandemics. All data regarding the safety and effectiveness of such use should be monitored, reported, and publicly available. Access patterns within and outside the EU should be analyzed to prevent potential inequalities in access to care during epidemics in European settings.

Introduction: Coinfection with HIV and tuberculosis (TB) represents a significant clinical and public health challenge, as tuberculosis remains one of the leading opportunistic infections among people living with HIV. Immunosuppression caused by HIV infection increases the risk of developing active tuberculosis as well as disseminated and severe clinical forms of the disease. The aim: This study aimed to analyze the prevalence, clinical characteristics, and outcomes of HIV-tuberculosis coinfection among patients treated at a tertiary care center in the Republic of Srpska. Methods: A retrospective study was conducted, including patients diagnosed with HIV infection between 2016 and 2026 who were treated at the Clinic for Infectious Diseases, University Clinical Center of the Republic of Srpska. Demographic data, clinical characteristics, CD4 lymphocyte counts, the presence of active or latent tuberculosis, comorbidities, and treatment outcomes were analyzed. Results: The study included 103 patients with HIV infection. Mycobacterium tuberculosis infection was confirmed in 21 patients (20.38%). Active tuberculosis was diagnosed in 5 patients (4.85%), while latent tuberculosis infection was identified in 16 patients (15.53%) using the IGRA test. All patients with active tuberculosis were male, predominantly aged 20-40 years, with a mean CD4 lymphocyte count of 48 cells/µL. The most common clinical form was cavitary pulmonary tuberculosis. Latent tuberculosis was more frequently detected in patients aged 40-60 years, with a mean CD4 count of 295 cells/µL. Conclusion: Although the overall prevalence of tuberculosis among people living with HIV is relatively low, coinfection remains a significant clinical challenge due to its association with advanced immunosuppression and severe clinical forms of disease. Early screening for latent tuberculosis and timely initiation of preventive therapy represents key strategies for reducing morbidity and mortality in this population.

The Central and Eastern Europe (CEE) region differs in access to HIV and co-infections care and treatment. The aim of the study was to analyze the relation between the severity of the COVID-19 disease and HIV specific factors in the European Union (EU) Countries and in non-European Union (non-EU) Countries.The study was conducted between November 2020 and May 2021. Euroguidelines in Central and Eastern Europe (ECEE) Network Group was collecting observational data on HIV-positive patients diagnosed with COVID-19. In total, 16 countries from CEE (Poland, Czech Republic, Ukraine, Croatia, Turkey, Romania, Belarus, Estonia, Lithuania, Greece, Georgia, Albania, Hungary, Serbia, Bosnia and Herzegovina, and Bulgaria) submitted data on HIV-positive patients using an electronic case report form (eCRF). Chi-Square test was used for group comparisons.In total 557 patients were included into the analyses: 361 from EU and 196 from non-EU countries. Access to remdesivir was 1.5% in non-EU countries vs 3.9% in EU-countries (p= 0.1952) . Symptoms of COVID-19 occurred more often in non-EU countries (93.3%) vs non-EU countries (83.6%) [p=0.0009], as well as hospitalization 32.8% vs. 20.8% respectively [0.0027]. Death/ICU was 4.8% in non-EU countries vs 3.4% in EU-countries (p=0.4877). In total 18 (3.23%) patients found out about HIV diagnosis during COVID-19, which was comparable in two groups (11 [3.0%] in UE countries vs. 7 [3.6%] in non-UE countries; p=0.8029).Patients from non- EU countries were more likely to be COVID-19 symptomatic and hospitalized. Access to antiviral therapy for SARS-CoV-2 was very low for all CEE countries.

<p><strong>Introduction. </strong>Infection caused by the novel coronavirus (SARSCoV-2) emerged in 2019 in China and rapidly spread worldwide. This highly contagious virus is transmitted primarily through respiratory droplets and may lead to Severe Acute Respiratory Syndrome (SARS). The World Health Organization (WHO) declared Coronavirus Disease 2019 (COVID-19) a global pandemic on March 11, 2020. This study analyzed patients hospitalized at the University Clinical Center of Re<br />public of Srpska (UCC RS) during the first 12 months of the pandemic.<br /><strong>Methods.</strong> Data from all patients with laboratory-confirmed SARSCoV-2 infection, diagnosed using real-time reverse transcription polymerase chain reaction (RT-PCR), were collected between March 2020 and March 2021. Patients were analyzed according to age, sex, severity of clinical presentation, duration of hospitalization, and the outcome.<br /><strong>Results. </strong>One year after the first confirmed COVID-19 case in Republic of Srpska, a total of 5,956 COVID-19&ndash;positive patients were hospitalized, including 3,662 males and 2,294 females. The mean duration of hospitalization was nine days, with a statistically significant difference across clinics (p = 0.001). Patients older than 60 years represented the most prevalent age group. During the observed period, 84.53% of patients recovered, while 15.47% died. Cardiovascular diseases were the most common comorbidities, presented in 24.71% of patients.<br /><strong>Conclusion.</strong> Male patients were more frequently hospitalized than females, with statistically significant sex differences observed only at the Anaesthesia and Intensive Care Clinic (p &lt; 0.05). Patients older than 60 years were more susceptible to severe complications and fatal outcomes, with a predominance of male sex.</p>

Introduction The implementation of nationwide viral hepatitis C elimination programs is challenging in Central and Eastern European countries (CEEC). It is reasonable to start by targeting specific populations, such as people living with HIV (PLWH), who are at higher risk of acquiring HCV or developing HCV-related complications. Methods Euroguidelines in Central and Eastern Europe Network Group consists of experts in the field of infectious diseases from 26 countries in the region. Between April 26th and June 23rd 2023, the group performed an on-line survey consisting of 32 questions. The questionnaire assessed the status of HCV micro-elimination in 2022. Results Twelve HIV centers from 11 countries responded: Albania, Bosnia and Herzegovina, Croatia, Czech Republic, Estonia, Greece, Hungary, Macedonia, Moldova, Serbia and Ukraine. All centers screen for HCV antibody all PLWH at entry into care. The seroprevalence of anti-HCV was <5% in 5 centers (Albania, Croatia, Serbia, North Macedonia and Hungary), 30.2% in Estonia and 29% in Ukraine, Greece and Moldova had high seroprevalence as well, 15.3% and 15.6% respectively. The prevalence of HCV viremia in antibody-positive PLWH was very high in Greece (85%), while in most other treatment centers it ranged from 4.2% to 38.2%. There is also a screening policy of annual HCV-testing of HCV-antibody negative persons in all centers by either testing all PLWH or those considered at risk. Direct-acting antiviral agents (DAA) were not available in one country (Albania). Among PLWH who entered care in 2022, nine out of 12 ECEE centers reported cases of HCV/HIV coinfection, with five centers indicating that at least 50% of these individuals were HCV-viremic. Conclusions HCV screening in PLWH followed by access to DAA treatments were available in all but one center. Microelimination of HCV in PLWH in the majority of surveyed HIV treatment centers in CEEC has not been achieved and efforts to reach this goal need to be strengthened.

The aim of this study was to analyze the clinical course and outcome of the disease in patients with chronic obstructive pulmonary disease (COPD) who were hospitalized at the Clinic for Infectious Diseases of the University Clinical Center of the Republic of Srpska (UCCRS), in the period from November 30, 2024 to April 1, 2025, due to confirmed influenza. The study included 125 hospitalized patients with microbiologically confirmed influenza. Among them, 20.8% had COPD, of which 48% were male and 52% female, with an average age of 68.6 years and the majority had influenza A (76%), while 24% had influenza B. The mortality rate among patients with COPD was 8%, compared to 32% in patients without COPD. Laboratory findings showed higher levels of C-reactive protein and procalcitonin in patients with COPD, indicating a more pronounced inflammatory response. Additionally, COPD patients had higher levels of D-dimer, suggesting an increased tendency toward thrombosis. Radiological analyses revealed various forms of pneumonia, with 48% of COPD patients showing negative radiological findings despite elevated CRP levels. Oxygen therapy and de-obstructive treatments were more frequently administered in COPD patients, while antibiotics were included in the treatment of all COPD patients. The results suggest the need for a specific therapeutic approach in this group of patients patient group. Also, vaccination against influenza is a key preventive measure that can prevent influenza, reduce the severity of the disease if it occurs, and improve the outcome, especially in patients with COPD, who are more susceptible to more serious complications.

Background: Seasonal flu represents a significant public health challenge and cause of morbidity and mortality, especially among vulnerable populations. The aim of our study is to describe demographic and clinical characteristics of patients hospitalized for laboratory of confirmed influenza during the 2024/2025. season.Methods: The data of patients hospitalized in the Clinic for infectious diseas of the University Clinical Center of the Republic of Srpska from December 2024 to March 2025 were restrospectively analyzed. The diagnosis of influenza was confirmed by PCR testing from a nasopharyngeal swab. Data were collected on age, sex, comorbidities, laboratory findings, therapy, the need for oxygen support and mechanical ventilation, the outcome of treatment.Results: A total of 175 patients, average age 63, were hospitalized. Influenza A was confirmed by PCR test in 78 (44.6%), and Influenza B in 20 patients (11.4%). The most common symptoms on admission were fever, cough and muscle pain. Chronic diseases were present in 155 patients (88.6%), while only 12 patients (6.9%) were vaccinated against influenza. Pneumonia was radiographically diagnosed in 102 patients (58%). Antiviral therapy was used in 160 patients (91.4%). 54 patients (30.9%) required oxygen support, while 7 patients (4%) were on mechanical ventilation. A fatal outcome was recorded in 8 patients (4.6%).Conclusion: Low vaccination rate and high proportion of chronic diseases among the hospitalized indicates to patients the need for stronger vaccination promotion and early intervention in risk groups. Timely diagnosis and adequate therapy remain key factors in prevention of severe forms of disease and reduction of mortality.

<p><strong>Introduction. </strong>Lyme neuroborreliosis (LNB) can manifest during the early and late stages of Lyme disease (LD). The aim of this study is to determine epidemiology and clinical findings in patients with LNB.&nbsp;<br /><strong>Methods.</strong> The research was conducted in Banja Luka at the University Clinical Center of Republic of Srpska (UCC RS) during a four-year period from 10/2017 to 10/2021. The research included 51 patients admitted to the hospital with some neurological symptoms that could lead to the LNB diagnosis. Patients had lumbar puncture with cytochemical analysis of cerebrospinal fluid (CSF), ELISA anti-Borrelia IgM/IgG in serum and CSF, Immunoblot anti-Borrelia IgM/IgG in serum, and other documentation about epidemiology and clinical findings in LNB. &nbsp;<br /><strong>Results.</strong> A statistically significant (p=0.017) higher proportion of female patients was observed. Most patients were between 50 and 60 years old. Most of them were retirees (31.37%), farmers, medical technicians followed with forestry workers, students etc. Most of examinees did not have information on previous tick bite (64.71%). The largest number (72.55%) did not have data on previous skin changes. The largest number of neurological symptoms at admission related to the feeling of tingling and weakness in the extremities, headache, dizziness and some ophthalmological symptoms. Patients also suffered from consciousness and speech disorder, anxiety, paresis n.VII. The largest number of examinees had some neurological symptoms up to three months prior the admission to the hospital. &nbsp;<br /><strong>Conclusion. </strong>Symptoms of LNB can be quite non-specific or possibly even mimic other neurological diseases. Involvement&nbsp;<br />of peripheral nervous system is dominant in adult patients. It is necessary to work on early diagnosis of LD and it is mandatory to report it to the national epidemiological service.&nbsp;</p>