Co-infection assessment in HBV, HCV, and HIV patients in Western Saudi Arabia

HIV in Three Groups of Young People from Medellín: General Population, Organizations for People with Socioeconomic Vulnerability, and Men Who Have Sex with Other Men

Introduction

In Colombia, there are no studies that analyze the effect of socioeconomic vulnerability and belonging to the group of men who have sex with other men (MSM) on the prevalence of HIV in young people.

Objective

To compare the prevalence of HIV in three groups of young people from Medellín-Colombia: general population, socioeconomic vulnerability and MSM.

Methods

This cross-sectional analytical study included 2449 young people from the general population, 1736 from institutions that serve young people in situations of socioeconomic vulnerability, and 2269 MSM. The prevalence of infection in each group was determined, statistical differences were identified using Pearson's Chi-square and Trend's Chi-square, and crude and adjusted odds ratios were estimated using logistic regression with 95% confidence intervals. Analyses were performed in SPSS 29.0.

Results

HIV prevalence was 0.8% in the general population group, 1.3% in young people with socioeconomic vulnerability, and 5.6% in MSM. The groups with the highest HIV were as follows: (i) in MSM it was 4.1 compared to the general population, (ii) between 25-28 years of age it was 2.9 times compared to those under 20 years, (iii) in men it was 10 times that registered in women, (iv) in young people with primary, secondary, technical and university studies it was 7.1; 6.7; 11.0 and 14.5 times that found in those who did not register studies, (v) in affiliates of the subsidized health regime it was 2.2 times and in those without affiliation 2.4 times compared to the infection in affiliates of the contributory health regime.

Conclusion

HIV prevalence was high, and explained by socioeconomic vulnerability, having sex between men, gender, age, education, and health affiliation, demonstrating the intersectionality of determinants of the health system, socioeconomic status, and determinants individuals in the occurrence of HIV in young people in Medellín.

Human immunodeficiency virus in Saudi Arabia: Current and future challenges

INTRODUCTION

Understanding the pathophysiology of HIV infection has been crucial to the design of effective anti-viral strategies. HIV infection is declining worldwide due to early diagnosis and the effective long-term use of anti-retroviral therapy. New infections decreased from 3.3 million in 2002-2.3 million in 2012. However, in the Middle East and North Africa (MENA), an estimated 83,000 individuals still acquired the virus, with 37,000 morbidities reported. The first incidence of acquired immunodeficiency syndrome (AIDS) from the Kingdom of Saudi Arabia (KSA) was reported in 1984. By the end of 2013, around 1509 patients had been diagnosed with HIV infection. HIV surveillance has improved in KSA with advances in medical care, counseling, family planning, diagnostic evaluation, and anti-retroviral therapy, but challenges remain. Patients receiving anti-retroviral therapy still show significant morbidity and mortality. Further targeted treatment regimens and preventive strategies are required to control HIV infection in KSA. Progress towards meeting the 90-90-90 goals for HIV in the MENA has also not been systematically monitored.

METHOD

In this review, we examine current screening programs, therapeutic modalities, the emergence of drug resistance, and future perspectives for HIV-associated health care in KSA.

CONCLUSION

The aim is to offer insight for healthcare policymakers to comply with the UNAIDS 2020 vision program and help establish the prevailing paradigms in the HIV community for an AIDS-free generation and the 90-90-90 goals for diagnosis.

HIV in the Kingdom of Saudi Arabia: Can We Change the Way We Deal with Co-Infections

The first incidence of acquired immunodeficiency syndrome (AIDS) from the Kingdom of Saudi Arabia (KSA) was reported back in 1984, and by the end of 2013, around 1509 patients were diagnosed with HIV infection. Recently in 2018, the Saudi ministry of health released that the incidence of HIV in Saudi Arabia is 3 cases of HIV for every 10,000 of the population. Having said that, the surveillance of HIV will face a range of challenges in KSA despite proper medical care, counseling, family planning, diagnostic, evaluation, and the use of effective anti-retroviral therapy. Patients who underwent anti-retroviral therapy showed significant reduction in morbidity as well as mortality. On the other hand, further targeted treatment and preventive strategies are warranted to control HIV co-infections in the KSA. In addition, progress towards meeting the WHO 90-90-90 goals for HIV not only at KSA but at the MENA region too, which is that of the population, 90% are diagnosed, 90% undergoing treatment, and 90% under viral control, is not being systematically monitored. In this review, we discuss the common co-infections with HIV infections that are reported in KSA, which when compared to international trends, it is similar for both viral hepatitis and tuberculosis. Although those co-infections exist, they are presented in different ratios and percentages when compared to the international reported data. These differences mandates defining and introducing new resilient methods of treatment and preventive measures. In this review, we offer an insight into healthcare policymakers to be compliant with UNAIDS 2020 vision program. We also discuss some of the gaps and recommendations to achieve the WHO 90-90-90 goal.

Developing a multidisciplinary HCV direct-acting antivirals utilization management and assessment program

BACKGROUND

The introduction of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infections has revolutionized outcomes for patients with HCV. Cost-effective use of these antivirals in addition to ensuring patient adherence is of paramount importance.

OBJECTIVES

The goal of this article is to describe the processes by which a tertiary care, multisite institution managed the complexities involved in administering DAA treatment and managing the increased cost of therapy. Specifically, the objectives of this article are to describe the development of a multidisciplinary HCV management program and the role of pharmacists in this program, including formulary management strategies and monitoring of DAAs use in our institution, development of guidelines, electronic prescribing protocols and order sets, and specific outcomes based on a concurrent medication use evaluation.

PRACTICE DESCRIPTION

King Faisal Specialist Hospital and Research Centre is a tertiary care referral hospital. As a tertiary referral hospital, it offers primary and highly specialized inpatient and outpatient medical care. The process of selecting and developing institutional HCV management program is described.

PRACTICE INNOVATION

This article provides key details regarding how a multidisciplinary HCV program using DAAs can be implemented successfully at a tertiary care facility. Key facets of our innovation include establishing formulary guidelines, setting up eligibility criteria for patients, and establishing an HCV taskforce and multidisciplinary HCV program clinic.

EVALUATION

Medication use evaluations were regularly conducted to monitor sustained virologic response rates, adherence to guidelines, adverse reactions, and drug interactions.

METHODS

Formulary guidelines, setting up an eligibility criterion for patients, and an HCV taskforce and multidisciplinary HCV program clinic were established.

RESULTS

The involvement of pharmacists in a multidisciplinary HCV program in outpatient settings resulted in improved formulary decision making, reduction of costs, and improvement of adherence to institutional guidelines.

PRACTICE IMPLICATIONS

The role of a pharmacist in the management of patients with HCV with DAAs is important. Pharmacists play an integral part in medication management and overall reduction in health care expenditure. Many disease management programs can be complemented with pharmacists to improve patient care and reduce cost.

CONCLUSION

HCV treatment is challenging, and a multidisciplinary approach to treat HCV is critical. It is a rapidly evolving field; therefore, it requires dynamic formulary management and collaborative practice approaches to monitor pharmacotherapy carefully and efficiently. Clinical pharmacists play a pivotal role within the multidisciplinary team by providing support to both patients and health care providers with regard to the treatment of HCV.

Management of hepatitis B and hepatitis C coinfection: an expert review

INTRODUCTION

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections share common routes of transmission. HBV/HCV coinfection can lead to interactions affecting mechanisms of infection and therapy.

AREAS COVERED

In the review, we present epidemiology of HBV/HCV coinfection and current therapeutic options for both viruses. The possibility of drug-drug interactions during the treatment of coinfected patients is discussed. However, the major part of the review is dedicated to interactions between viruses and risk of HBV reactivation during HCV treatment with direct-acting antivirals (DAA). Finally, we analyze available international and national guidelines for the management of HBV reactivations related to DAA administration.

EXPERT OPINION

The most important international societies' guidelines include comments on HBV/HCV coinfection, but due to their inconsistency we present a proposal of management for HBV/HCV coinfected patients focusing mostly on HBV reactivation in patients treated for HCV. We provide some advice that should be considered in future guidelines for the management of HBV/HCV coinfection.

Epidemiological Features and Risk Factors for Acquiring Hepatitis B, Hepatitis C, and Syphilis in HIV-Infected Patients in Shaanxi Province, Northwest China

Human immunodeficiency virus (HIV)-infected patients are at a higher risk for co-infection with Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Treponema pallidum (TP; the agent causing syphilis) than the general population. The prevalence of HBV, HCV, and syphilis has geographic differences and varies from region to region among HIV-positive individuals. A retrospective study was carried out on HIV-positive individuals between June 2011 and June 2016 in Shaanxi Province. Univariate and multivariate logistic regression analyses using stepwise regression analysis regarding risk factors for HIV–HBV, HIV–HCV, and HIV–syphilis co-infection. HBV–HCV, HCV–syphilis, HBV–syphilis, and HBV–HCV–syphilis co-infection rates were 1.7%, 2.2%, 2.6%, and 0.1%, respectively. The rate of ineffective hepatitis B vaccine immunization was as high as 30.2% among HIV-positive individuals. Ethnicity (OR = 31.030, 95% CI: 11.643–82.694) and HIV transmission routes (OR = 134.024, 95% CI: 14.328–1253.653) were the risk factors for HCV infection in HIV-positive individuals. Among the HIV-positive individuals with the antibodies of TP, the rate of homosexual transmission was also higher, but heterosexual transmission was lower (OR = 0.549 95% CI: 0.382–0.789) The HIV-infected patients in Shaanxi Province had the characteristics of low active detection rate and late diagnosis. The high rate of ineffective vaccination against HBV suggests a need for improved vaccination services.

Hepatitis B Virus Molecular Epidemiology, Host-Virus Interaction, Coinfection, and Laboratory Diagnosis in the MENA Region: An Update

Hepatitis B virus (HBV) is an enveloped partial double-stranded DNA virus that can cause acute and chronic hepatitis. According to the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), 257 million people are living with HBV. Moreover, 20,900 acute hepatitis B cases were reported in 2016. Hepatitis B is highly prevalent in the African, Western Pacific, Eastern Mediterranean, South-East Asia, and European regions, respectively. Due to the high mutational rate of HBV and lack of reverse transcriptase proofreading activity, ten different genotypes with different geographical distributions have been identified. HBV pathogenesis and severity of infection depend on several host and viral factors, particularly, the genetic variability of both the host and virus. Although HBV infection is a global health concern, there is a lack of adequate studies and reports in the Middle East and North Africa (MENA) region. Here, we provide a review on HBV epidemiology, pathogenesis, host-pathogen interactions, coinfection with selected viruses, and laboratory diagnosis, focusing on studies conducted in the MENA region to determine the current situation of the HBV infection and outline the future study areas.

Epidemiological and Clinical Characteristics of HIV Infected Patients at a Tertiary Care Hospital in Oman

Objectives

In 2015, the Joint United Nations Program on HIV/AIDS (UNAIDS) set a target that 90% of all people living with HIV will know their HIV status, 90% of those diagnosed will receive antiretroviral therapy, and 90% of those receiving antiretroviral therapy will have viral suppression by 2020. We sought to elucidate the epidemiological and clinical characteristics of HIV infected patients at the Infectious Diseases Clinic at Royal Hospital, Oman, with a focus on the UNAIDS 90-90-90 achieved rates.

Methods

We conducted a retrospective analysis of the medical records of 326 HIV infected patients from 1989 to 2016. Data collected included demographics, Word Health Organization (WHO) staging, laboratory analyses, and treatment outcomes.

Results

The overall mean age of the cohort was 36.0±15.0 years, and 60.4% (n = 197) were males. The majority of patients acquired HIV through heterosexual transmission (58.9%; n = 192). At the time of the first clinic visit, 26.1% (n = 85) of patients had WHO stage 4 HIV infection. The rates of HIV/HBV and HIV/HCV coinfections were 2.7% and 5.8%, respectively. The baseline CD4+ cells count was < 200 cells/mm³ in 38.0% (n = 124) of patients, 201-500 cells/mm³ in 30.1% (n = 99) of patients, and > 500 cells/mm³ in 27.0% (n = 88) of patients. The baseline HIV RNA titer was greater than 1000 copies/mL³ in 74.5% (n = 243) of the cohort. A total of 96.3% (n = 314) of patients received antiretroviral therapy, most commonly non-nucleoside reverse transcriptase inhibitor-based regimens. HIV genotype resistance testing was performed in 165 patients (50.6%) either at baseline in treatment naïve patients or following treatment failure. Among the 326 patients included, 22 patients (6.7%) died, and 29 patients (8.9%) were lost to follow-up.

Conclusions

Regarding the UNAIDs 90-90-90 target, over a quarter of the patients presented late with WHO stage 4 HIV disease, 96.3% of cohort patients received antiretroviral treatment, and 71.5% achieved virological suppression.

Cluster of differentiation 4+ T-cell counts and human immunodeficiency virus-1 viral load in patients coinfected with hepatitis B virus and hepatitis C virus

BACKGROUND:

Coinfections of human immunodeficiency virus (HIV) with hepatitis viruses may affect the progress of disease and response to therapy.

OBJECTIVES:

To study the incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfections in HIV-positive patients and their influence on HIV-1 viral load and cluster of differentiation 4+ (CD4+) T-cell counts.

MATERIALS AND METHODS:

This pilot study was done on 179 HIV-positive patients attending antiretroviral therapy (ART) centre. Their blood samples were tested for HIV-1 viral load, CD4+ T-cell counts, hepatitis B surface antigen, anti-HCV antibodies, HBV DNA and HCV RNA polymerase chain reaction.

RESULTS:

Among the 179 patients, 7.82% (14/179) were coinfected with HBV and 4.46% (8/179) with HCV. Median CD4+ T-cell count of HIV monoinfected patients was 200 cells/μl and viral load was 1.67 log₁₀ copies/μl. Median CD4+ T-cell counts of 193 cells/μl for HBV (P = 0.230) and 197 cells/μl for HCV (P = 0.610) coinfected patients were similar to that of HIV monoinfected patients. Viral load was higher in both HBV and HCV infected patients but statistically significant only for HCV (P = 0.017). Increase in CD4+ T-cell counts and decrease in HIV-1 viral load in coinfected patients on 2 years of ART were lower than that in HIV monoinfected patients.

CONCLUSION:

HBV/HCV coinfected HIV patients had similar CD4+ T-cell counts as in HIV monoinfected patients, higher HIV viral load both in chemo-naive patients and in those on ART as compared to HIV monoinfected patients. However, this study needs to be done on a large scale to assess the impact of coinfection on CD4 count and HIV viral load with proper follow-up of patients every 6 months till at least 2 years.

High prevalence of syphilis, HBV, and HCV co-infection, and low rate of effective vaccination against hepatitis B in HIV-infected patients in West China hospital

To investigate the epidemiological features and risk factors of HBV, HCV, and syphilis infection among HIV-infected patients in West China Hospital. A retrospective study was conducted with HIV-infected patients from 2014 to 2016 in West China hospital, SCU. Serum makers for HBV, HCV, and syphilis were detected. Among 894 HIV-infected patients, the prevalence of HIV/HBV, HIV/HCV, HIV/syphilis co-infections was 14.4%, 5.7%, and 18.9% respectively. HIV/HBV/HCV, HIV/HCV/syphilis, and HIV/HBV/syphilis triple co-infection was 7 (0.7%), 12(1.3%), 29(3.2%) respectively. The rate of effective vaccination against HBV was only 7.7% in HIV-infected patients. Age (OR = 0.243 95% CI: 0.114 -0.518), ethnicity (OR = 3.654 95% CI: 1.849-7.218) and education level (OR = 0.140 95% CI: 0.033-0.606) are risk factors affecting HIV/HCV co-infection. A high prevalence of HIV/syphilis, HIV/HBV, and HIV/ HCV co-infection can be observed in west China. The rate for HIV-infected patients who were effectively vaccinated against HBV was fewer than 10%.