Simona Ruta

• MD, PhD
• Professor (Full) at Carol Davila University of Medicine and Pharmacy

Background/Objectives: Romania remains endemic for measles due to suboptimal vaccine coverage rates. During the last three epidemics, the highest incidence of measles was recorded in children younger than 1 year, who should have been partially protected by maternal antibodies. A nationwide cross-sectional seroprevalence study was conducted on perso...

Background/Objectives: Romania remains endemic for measles due to suboptimal vaccine coverage rates. During the last three epidemics, the highest incidence of measles was recorded in children younger than 1 year, who should have been partially protected by maternal antibodies. A nationwide cross-sectional seroprevalence study was conducted on perso...

Cytomegalovirus infections and reactivations are more frequent in people living with HIV (PLWH) and have been associated with increased risk of HIV progression and immunosenescence. We explored the impact of combination antiretroviral therapy (cART) on latent CMV infection in 225 young adults parenterally infected with HIV during childhood. Anti-CM...

Post-Coronavirus Disease 2019 (post-COVID-19) syndrome represents a cluster of persistent symptoms following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection that can severely affect quality of life. The pathogenic mechanisms and epidemiology in different regions are still under evaluation. To assess the outcomes of post-COVID...

The hepatitis D virus (HDV) superinfection of individuals with chronic hepatitis B virus (HBV) infection causes severe liver damage and the poorest long-term prognosis among viral hepatitis. This is attributed to the unique pathogenic mechanisms of HDV characterized by a direct cytopathic effect on hepatocytes and a significant impairment of the ho...

Immunosuppressed individuals, such as people living with HIV (PLWH), remain vulnerable to severe COVID-19. We analyzed the persistence of specific SARS-CoV-2 humoral and cellular immune responses in a retrospective, cross-sectional study in PLWH on antiretroviral therapy. Among 104 participants, 70.2% had anti-S IgG antibodies, and 55.8% had signif...

Immunosuppressed individuals, such as people living with HIV (PLWH), remain vulnerable to severe COVID-19. We analyzed the persistence of specific SARS-CoV-2 humoral and cellular immune responses in a retrospective, cross-sectional study in PLWH on antiretroviral therapy. Among 104 participants, 70.2% had anti-S IgG antibodies and 55.8% had signifi...

More than 3 years after the start of SARS‐CoV‐2 pandemic, the molecular mechanisms behind the viral pathogenesis are still not completely understood. Long non‐coding RNAs (lncRNAs), well‐known players in viral infections, can represent prime candidates for patients' risk stratification. The purpose of the current study was to investigate the lncRNA...

Measles is targeted for elimination since 2001, with a significant reduction in cases recorded worldwide, but outbreaks occur periodically due to immunization gaps. This study analyzes the evolution of vaccination coverage rates (VCRs) in Romania, a EU country with large measles epidemics during the last two decades, including an ongoing outbreak i...

Approximately 62–72 million people are infected worldwide with HDV. Patients with chronic hepatitis D (CHD) have a higher risk of developing cirrhosis or hepatocellular carcinoma (HCC) and an increased mortality rate compared to those with chronic hepatitis B (CHB). The stage of liver fibrosis or the risk of developing HCC can also be estimated by...

In Romania, influenza vaccination of healthcare professionals is recommended, but not mandatory. This study aims to investigate the attitudes and behaviors of medical students and resident physicians—the youngest healthcare professionals—towards influenza immunization, focusing on the barriers and facilitators, as well as on the impact of the COVID...

HIV-HBV coinfected patients have higher rates of liver-related morbidity, hospitalizations, and mortality compared to HBV or HIV mono-infected ones. Clinical studies have shown an accelerated progression of liver fibrosis and an increased incidence of HCC, resulting from the combined action of HBV replication, immune-mediated hepatocytolysis, and H...

Introduction: An unusual cluster of myoclonic epilepsy was observed in a Romanian pediatric HIV cohort concurrent with measles outbreaks. We describe this particular form of subacute measles encephalitis (SME) in a group of HIV-infected children and adolescents with severe immunosuppression. Methods: This is a single-center study, starting in 19...

The availability of combined antiretroviral therapy (cART) has revolutionized the course of HIV infection, suppressing HIV viremia, restoring the immune system, and improving the quality of life of HIV infected patients. However, the emergence of drug resistant and multidrug resistant strains remains an important contributor to cART failure, associ...

During the first half of 2022, the World Health Organization reported an outbreak of acute severe hepatitis of unknown aetiology (AS-Hep-UA) in children, following initial alerts from the United Kingdom (UK) where a cluster of cases was first observed in previously well children aged <6 years. Sporadic cases were then reported across Europe and wor...

In the genomic medicine era, the emergence of SARS-CoV-2 was immediately followed by viral genome sequencing and world-wide sequences sharing. Almost in real-time, based on these sequences, resources were developed and applied around the world, such as molecular diagnostic tests, informed public health decisions, and vaccines. Molecular SARS-CoV-2...

Background The risk of liver fibrosis increases over time in HIV and HIV-HBV individuals even under antiretroviral treatment (ART), warranting a rigorous and periodic monitorization. Given the lower availability of transient elastography, we aimed to assess the longitudinal variation of two non-invasive liver fibrosis scores, APRI and Fib-4, in cas...

The number of deaths related to cardiovascular disease is increasing every year, despite all available therapies and the aggressive campaigns for lifestyle modification and prevention of risk factors. Atherosclerosis is a complex process underlying cardiovascular disease. Cytomegalovirus (CMV) is often associated to atherosclerosis and its clinical...

The continuous variability of SARS-CoV-2 and the rapid waning of specific antibodies threatens the efficacy of COVID-19 vaccines. We aimed to evaluate antibody kinetics one year after SARS-CoV-2 vaccination with an mRNA vaccine in healthcare workers (HCW), with or without a booster. A marked decline in anti-Spike(S)/Receptor Binding Domain (RBD) an...

The ongoing pandemic of coronavirus disease (COVID-19) stimulated an unprecedented international collaborative effort for rapid diagnosis, epidemiologic surveillance, clinical management, prevention, and treatment. This review focuses on the current and new therapeutical approaches, summarizing the viral structure and life cycle, with an emphasis o...

Background and Objectives: Romania has one of the highest prevalence of hepatitis B virus (HBV) infection in human immunodeficiency virus (HIV) patients, mostly in those parenterally infected during childhood; nevertheless, there are scarce data on the virological profile of co-infection. The objective of this study was to assess the prevalence of...

SARS-CoV-2 vaccines are highly efficient against severe forms of the disease, hospitalization and death. Nevertheless, insufficient protection against several circulating viral variants might suggest waning immunity and the need for an additional vaccine dose. We conducted a longitudinal study on the kinetics and persistence of immune responses in...

In Romania, the first phase of the COVID-19 vaccination campaign prioritized medical personnel, which included healthcare students. This study aimed to assess their knowledge, attitudes towards, and perception of COVID-19 vaccination. An anonymous, single-answer, 42-item online survey was conducted from 12 January until 3 March 2021, in the country...

We describe a series of severe neuroinvasive infections caused by Toscana virus, identified by real-time reverse transcription PCR testing, in 8 hospitalized patients in Bucharest, Romania, during the summer seasons of 2017 and 2018. Of 8 patients, 5 died. Sequencing showed that the circulating virus belonged to lineage A.

Bacillus anthracis is a sporulating Gram positive rod whose main route of entry being cutaneous. Anthrax meningitis is usually fulminant and fatal. We present here a case of anthrax meningoencephalitis complicated with brain abscess successfully treated. The patient was a shepherd, with onset of the disease seven days ago with fever, chills, occipi...

Over the last few years, immunotherapy for HIV in general and therapeutic vaccination in particular, has received a tremendous boost, both in preclinical research and in clinical applications. This interest is based on the evidence that the immune system plays a crucial role in controlling HIV infection, as shown for long-term non-progressors and e...

Viruses can alter the expression of host microRNAs (MiRNA s) and modulate the immune response during a persistent infection. The dysregulation of host MiRNA s by hepatitis B virus (HBV) contributes to the proinflammatory and profibrotic changes within the liver. Multiple studies have documented the differential regulation of intracellular and circu...

Background: WNV causes 1.4% of all central nervous system infections and is the most common cause of epidemic neuro-invasive disease in humans. Objectives: Our main objective was to investigate retrospectively West Nile virus neuroinvasive disease (WNND) cases hospitalized during 2010-2017 and identified factors that can influence prognosis. St...

HIV-associated neurocognitive disorders (HAND) continue to be reported even in patients with successful antiretroviral treatment. We investigated the prevalence of neurocognitive impairment and possible HIV-associated determinants of cognition in a Romanian cohort of young adults, parenterally infected with HIV during their first years of life. Two...

HIV-associated neurocognitive disorder (HAND) is characterized by chronic immune activation. We aimed to identify biomarkers associated with HAND and to investigate their association with cognitive function and sex, in a homogenous cohort of HIV-infected (HIV+) young adults, parenterally infected during early childhood. One hundred forty-four HIV+...

Background: Liver transplant (LT) recipients are at increased risk for developing metabolic syndrome. Early detection of NAFLD and other components of the metabolic syndrome is an important step in reducing morbidity and mortality. Methods: We assessed 60 liver transplant recipients for clinical and biological features, performed abdominal ultrasou...

We conducted a prospective study of patients hospitalized in a tertiary infectious diseases hospital with acute viral CNS infections between January 2015 and December 2016, to compare characteristics of patients with fatal evolution vs. patients with good outcome.

A free, community-run voluntary counseling and testing program was conducted for patients with HIV and viral hepatitis during 2010-2014 in Dobrogea, Romania, a region with high levels of under-diagnosing and under-reporting. Serologic screening of 36.132 individuals for HIV, HBV, and HCV infections was carried out using rapid chromatographic tests,...

We conducted a prospective analysis of patients hospitalized in a tertiary infectious diseases hospital with acute viral CNS infections between January 2014 and December 2016, to compare characteristics of patients with fatal evolution vs. patients with good outcome.

We conducted a retrospective analysis of patients admitted between November 2014 - August 2016 in IDICU of "Dr Victor Babes" Clinical Hospital of Infectious and Tropical Diseases from Bucharest.

Background: In Romania, after a major outbreak in 1996, West Nile neuroinvasive disease (WNND) was reported only in a limited number of cases annually. During 2016-2017, a significant increase in the number of WNND cases was reported at the national level, associated with high mortality rates. Methods: A retrospective analysis of all cases confi...

Objective: Liver transplant recipients often develop metabolic syndrome (MetS) and de-novo non-alcoholic fatty liver disease (NAFLD). Our aim was to evaluate the cardiovascular risk in these patients using CXCL10, a serum biomarker whose expression levels have been associated with inflammatory diseases Methods: We assessed 60 liver transplant reci...

Background and aims: Literature data suggest that HCV genotype-1b is present in 93-99% of the Romanian patients infected with hepatitis C virus (HCV). We present the genotyping tests recently performed on patients with HCV and advanced fibrosis eligible for the Direct-Acting Antiviral (DAA) therapy, as well as the prevalence of these cases across...

Background: Treatment with direct acting antiviral agents (DAAs) has provided sustained virological response rates in >95% of patients with chronic hepatitis C virus (HCV) infection. However treatment is costly and market access, reimbursement and governmental restrictions differ among countries. We aimed to analyze these differences among Europea...

The aim of our study was to evaluate the differences between children and adults concerning acute viral infections of central nervous system (CNS). CNS involvement is common during viral infections for children and adults, but evolution is more severe in adults and empirical treatment with antibiotics in more frequently in children.

Introduction: Sex differences in cognition of HIV positive (HIV+) patients are controversial. We aimed to investigate the relationship between cognition, HIV status, and sex, in a highly homogenous cohort of young Romanians parenterally infected during early childhood. Methods: 250 HIV+ participants were compared to age-matched HIV negative (HIV...

Background: Direct antiviral agents (DAA) showed very good results in terms of efficacy and safety in clinical trials, but real life data are still needed in order to confirm this profile. Material and methods: In Romania, through a nationwide government-funded programme in 2015-2016, approx.5800 patients with virus C liver cirrhosis received fu...

We characterized influenza B virus–related neurologic manifestations in an unusually high number of hospitalized adults at a tertiary care facility in Romania during the 2014–15 influenza epidemic season. Of 32 patients with a confirmed laboratory diagnosis of influenza B virus infection, neurologic complications developed in 7 adults (median age 3...

Results: HIV-1 pol sequencing, followed by phylogenetic and clustering analysis was performed on blood from 37 injecting drug users (IDUs) newly diagnosed with HIV infection. While HIV subtype F1, the dominant strain in Romania since 1990, remains prevalent, new subtypes were found including G, B, B/G and B/F recombinants. Overall, 27 of the avail...

Background: Recent studies have suggested that latent herpes virus infections can be associated with chronic periodontal sites that exhibit a predisposition to disease progression. The aim of this study was to identify the possible relationship between infections with CMV and EBV and the severity of periodontal disease. Materials and methods: Fi...

This study aimed to investigate the influence of antiretroviral therapy on methylation markers, in a group of HIV infected, heavily treated patients. Immune and molecular methods were used to investigate potential changes in methylation profile in DNA isolated from peripheral blood mononuclear cells collected from antiretroviral-experienced HIV inf...

AIM To determine whether hepatitis C virus (HCV) core substitutions play a role in the response to interferon-based treatment in Caucasian patients. METHODS One hundred eight HCV chronically infected patients initiating treatment with pegylated IFN plus ribavirin for 48 wk were tested for baseline substitutions at codons 70 and 91 of the viral cor...

We evaluated the impact of latent toxoplasmosis (LT) on neurocognitive (NC) and neurobehavioural functioning in young adults with and without chronic HIV infection, using a standardised NC test battery, self-reported Beck Depression Inventory, Frontal System Behavior Scale, MINI-International Neuropsychiatric Interview and risk-assessment battery....

Introduction: Chronic hepatitis C cases diagnosed in Romania were mostly related to unsafe parenteral treatments and blood transfusions; HCV genotype 1b was prevalent. During the last decade, an increasing number of HCV infections was reported among people who inject drugs (PWID). The aim of the current study was to test if this epidemiological sh...

MicroRNAs (miRNAs) are small, non-coding RNA species essential for the post-translational regulation of gene expression. Several miRNA have been proposed to contribute to Human immunodeficiency virus-1 (HIV-1) infection establishment, progression and latency. Among them, miR-29a seems to be of particular interest. The aim of this study was to inves...

Hemoglobinopathies, such as beta-thalassemia and sickle cell disease (SCD), are among the most common congenital diseases in the world, with high mortality and morbidity rates. The most straightforward approach to correct the main culprit in hemoglobinopathies - the imbalance between the amounts of alpha-like globins/betalike globins-will need to t...

O1 HIV-1 diversity in Bulgaria (current molecular epidemiological picture) Ivailo Alexiev, Reneta Dimitrova, Anna Gancheva, Asya Kostadinova, Mariyana Stoycheva, Daniela Nikolova, Ivaylo Elenkov O2 Knowledge, attitudes and practices of the general population on HIV/AIDS, hepatitis B and C in Romania Cătălin Tilișcan, Mioara Predescu, Bogdan Păunesc...

Microscopy techniques are often exploited by virologists to investigate molecular details of critical steps in viruses' life cycles such as host cell recognition and entry, genome replication, intracellular trafficking, and release of mature virions. Fluorescence microscopy is the most attractive tool employed to detect intracellular localizations...

Lipoic acid ligase (LplA) is an enzyme used for PRobe Incorporation Mediated by Enzymes (PRIME) labeling of proteins. Based on a previous described protocol for expression and subsequent purification of recombinant LplA ligase, we developed a new procedure in order to obtain recombinant gluthatione-S-transferase (GST)-LplA ligase fusion protein fro...

Proiect PNII nr. 88/2012 – HepGen : investigarea unor markeri virali si de gazda corelati cu lipsa de raspuns la tratamentul antiviral in hepatita cronica cu virus C.

Background: The Romanian HIV epidemic is characterized by a high prevalence among children born in the late '80s, perinatally infected. The impact of long-term treatment on their offspring is unknown. We evaluated the influence of prenatal care on the rate of premature birth among the HIV-exposed children of heavily treated HIV-infected mothers in...

The epidemiologic and clinical pattern of varicella-related hospitalizations recorded during 2002-2013 in Romania showed the highest hospitalization rate in the 0-1 year age group. Younger age and diagnosis after 2007 were independent predictors of varicella related complications, recorded in half of the hospitalized cases.

Hepatitis C virus (HCV) genotypes' monitoring allows real-time insight into the dynamic changes that occur in the global epidemiological picture of HCV infection.Intravenous drug use is currently the primary driver for HCV transmission in developed and developing countries. The distribution of HCV genotypes/subtypes differs significantly between pe...

Hepatitis B virus (HBV) is a DNA enveloped virus, which infects human liver leading to severe pathologies. The HBV genome is packed in a nucleocapsid, surrounded by the viral envelope containing three proteins: large (L), medium (M) and small (S), with different functions in the viral life-cycle. Functional labeling of HBV particle for imagistic st...

The prevalence and management of chronic Hepatitis B Virus (HBV) infection differ among European countries. The availability and reimbursement of diagnostics and drugs may also vary, determining distinct treatment outcomes. Herein, we analyze differences in medical facilities in care of chronic HBV infection across Europe. A survey was sent to the...

Periodontitis is a chronic inflammatory disease of polymicrobial etiology that could lead to the destruction of bones and tissues that support the teeth. In spite of the growing data on the pathogenic consortia associated with the disease, currently this information is poorly used to improve diagnostics or developing methods for monitoring the trea...

UNLABELLED: Gingival crevicular fluid (GCF) and saliva samples provide advantages for screening or sero-prevalence studies on HCV using less invasive methods. The study aimed to evaluate the performance of a rapid test for HCV-antibodies (HCV-Ab) screening in oral fluids among high-risk individuals with chronic liver disease.

Introduction: In the last years, we observed an alarming increase in the number of newly diagnosed HIV infected intravenous drug users (IDUs) co-infected with hepatitis viruses or with severe bacterial infections. The aim of our study was to assess the incidence, the demographic and clinical characteristics of IDUs diagnosed with HIV, HCV and tube...

Hepatitis B virus (HBV) is a DNA enveloped virus, which infects human liver leading to severe pathologies. The HBV genome is packed in a nucleocapsid, surrounded by the viral envelope containing three proteins: large (L), medium (M) and small (S), with different functions in the viral life-cycle. Functional labeling of HBV particle for imagistic st...

Abstract Heat shock proteins (HSP) represent important antigenic targets for the immune response, playing an important role in the pathology and infectious diseases control. The purpose of this work was to investigate the levels of HSP60 and HSP70 specific antibodies in the bloodstream of patients with different bacterial infections and cancer, in...

Background: People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatmen...

Serum alpha fetoprotein (AFP) is a commonly used marker in the screening for hepatocellular carcinoma. This study aims to evaluate the value of AFP as an early predictor of the evolution of chronic hepatitis C. In a retrospective study on 116 HCV-infected patients (62.9% females, mean age 49.13 ± 1.73 years), increased levels of serum AFP (> 7 ng/m...

MicroRNA (miRNA) are small- 19-24 nucleotides, non-coding RNA molecules that regulate translational and post-translational processes through mRNA degradation and protein translation repression, or sometimes through heterochromatin formation or activation of protein translation. Lately, miRNA are investigated as predictive biomarkers for the evoluti...

OBJECTIVES: To examine the impact of educational level and of the related life-style and behavioral factors on the acquisition of HPV infections. METHODS: A retrospective analysis of the socio-demographic variables in a cohort of 360 married women (aged 25-40 years), with a positive HPV-DNA result, who underwent cytological screening and HPV genoty...

Background: The number of young women living with HIV is significant worldwide. Developing effective adherence support interventions requires an understanding of genderspecific challenges. Among these, the transition to motherhood may change adherence patterns as women adjust to new life routines. We conducted a cross-sectional adherence (ADH) su...

A marked increase in the number of intravenous drug users requiring hospitalization, due to severe systemic infections and/or episodes of cytolysis, was registered in Bucharest, Romania during the last two years. Of these patients, 97.5% had serologic markers of HCV infection, 54.4% of HIV infection, 15.8% of HBV and 5.1% of HDV coinfection. Multip...

The Romanian HIV epidemic is characterized by the prevalence of a single particular HIV1 subtype, called F, a minor form, previously reported only in South America and Central Africa. Initially reported in the early '90s by serotyping studies in the large cohort of parenterally infected children, this subtype remained dominant during the following...

Patients with chronic hepatitis C (CHC) often have elevated serum iron markers, which may worsen liver injury. The aim of this study was to investigate the possible correlations between iron metabolism serum markers, HCV viral load, and liver disease severity in treatment-naive patients with chronic hepatitis C infection. Eighty five patients with...

Many Romanian children were infected nosocomially with human immunodeficiency virus (HIV) in the late 1980s. The Romanian-American Children's Center of Excellence in Constanţa continues to follow approximately 450 of these patients. In 2001, 414 of these patients were initiated on triple therapy including lopinavir/ritonavir. Data from this cohort...

Improved understanding of the HCV viral life cycle has led to the identification of numerous potential molecular targets for the development of new drugs. Direct acting antivirals -DAAs specifically target a viral encoded protein: the NS3-4A protease, involved in the posttranslational viral protein processing; the NS5B encoded viral polymerase, tha...

Transmitted HIV drug resistance (TDR) remains an important concern for individuals unexposed to antiretroviral treatment. Data on the prevalence of TDR, available mainly for HIV-1 subtype B, are now also emerging for other subtypes. In Romania, a steady predominance of subtype F was reported among both long-term survivor children and newly infected...

Due to a recent alarming increase in the number of HIV-HCV co-infected patients in Romania. A cross sectional study was conducted to assess the baseline predictors of liver disease evolution. 83 HIV-HCV co-infected patients, untreated for HCV infection, were evaluated for viral replication, liver fibrosis (estimated by a noninvasive marker - FIB4),...

Background: HIV-1 infected patients with transmitted drug resistance (TDR) begin treatment with a lower genetic barrier to resistance and a higher risk of early virologic failure. Considering the fact that data on non-B subtypes are limited, and subtype F is still prevalent in Romania, our goal was to assess the prevalence of TDR mutations in new...

The central nervous system can act as a compartment in which HIV can replicate independently from plasma, and also as a sanctuary in which, under suboptimal drug pressure, HIV antiretroviral genetic variants can occur. Continuous replication of HIV in brain can contribute to neurocognitive impairment. Therefore, reaching adequate concentrations of...

Background: The transmission of drug-resistant HIV-1 has important implicationsfor the successful management of antiretroviral therapy amonginfected individuals, restricting drug options and increasingthe risk of suboptimal treatment outcomes. Considering the fact that data on non-B subtypes are limited, and subtype F is predominant in Romania, our...