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Saine ME, Szymczak JE, Moore TM, Bamford LP, Barg FK, Schnittker J, Holmes JH, Mitra N, Re VL. Determinants of stigma among patients with hepatitis C virus infection. J Viral Hepat 2020; 27:1179-1189. [PMID: 32500618 PMCID: PMC9390068 DOI: 10.1111/jvh.13343] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022]
Abstract
Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV treatment and elimination. The determinants of HCV-related stigma, including the impacts of stage of HCV treatment (ie spontaneously cleared; diagnosed, untreated; previously treated, not cured; currently being treated; and treated, cured) and coinfection with human immunodeficiency virus (HIV), remain unknown. To address these gaps, we conducted a cross-sectional study among patients with a history of HCV infection (n = 270) at outpatient clinics in Philadelphia from July 2018 to May 2019. We evaluated stigma using the validated HCV Stigma Scale, adapted from the Berger HIV Stigma Scale. Associations among HCV-related stigma and hypothesized demographic, behavioural, and clinical risk factors were evaluated by multivariable linear regression. Most participants (95.5%) experienced HCV-related stigma. Mean stigma scores did not differ significantly between HCV-monoinfected and HIV/HCV-coinfected participants (P = .574). However, we observed significant interactions between HIV status and multiple determinants; therefore, we stratified analyses by HIV status. Among HIV/HCV-coinfected participants, previous HCV treatment without cure, female gender, Hispanic/Latinx ethnicity and some college education were significantly associated with higher HCV-stigma scores. An annual income of $10 000-$40 000 was associated with significantly lower stigma scores. No significant associations were observed among HCV-monoinfected participants. We found that most participants experienced stigma associated with HCV diagnosis. While stigma scores were similar between HCV-monoinfected and HIV/HCV-coinfected participants, the determinants associated with HCV stigma differed by HIV status. Understanding how experiences of stigma differ between HCV-monoinfected and HIV/HCV-coinfected patients may aid in the development of targeted interventions to address the HCV epidemic.
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Affiliation(s)
- M. Elle Saine
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia E. Szymczak
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tyler M. Moore
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura P. Bamford
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA
| | - Frances K. Barg
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jason Schnittker
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA,Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
| | - John H. Holmes
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Vincent Lo Re
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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El-Shabrawi MH, Kamal NM, Mogahed EA, Elhusseini MA, Aljabri MF. Perinatal transmission of hepatitis C virus: an update. Arch Med Sci 2020; 16:1360-1369. [PMID: 33224335 PMCID: PMC7667440 DOI: 10.5114/aoms.2019.83644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/02/2018] [Indexed: 12/17/2022] Open
Abstract
Infection with hepatitis C virus (HCV) is a major health problem worldwide. A large proportion of perinatal HCV infections are silent and may present later in adulthood with long-term complications. HCV has no effective immune prophylaxis and hence appropriate follow-up of all infants born to HCV-infected mothers is necessary. Universal antenatal screening for HCV is largely debatable. Intrauterine and partum transmission of HCV are both possible and higher rates are associated with a high maternal serum viral load (> 106 copies per milliliter), concomitant HIV infection, prolonged or difficult delivery, and invasive fetal monitoring during delivery. Infection during pregnancy and infancy needs to be investigated more in order to design management strategies for perinatal transmission of HCV most effectively. The recently approved new-generation, oral, direct-acting antiviral drugs may open a new era in HCV therapy for pregnant women and infected infants if proved to be safe during conception and infancy.
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Affiliation(s)
| | - Naglaa M. Kamal
- Department of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Egypt
| | - Engy A. Mogahed
- Department of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Egypt
| | - Mona A. Elhusseini
- Department of Obstetrics and Gynecology, Red Crescent Hospital, Cairo, Egypt
| | - Mohamed F. Aljabri
- Department of Pediatrics and Pediatric Neurology, Alhada Armed Forces Hospital, Taif, Saudi Arabia
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Bokharaei-Salim F, Keyvani H, Esghaei M, Zare-Karizi S, Dermenaki-Farahani SS, Hesami-Zadeh K, Fakhim S. Prevalence of occult hepatitis C virus infection in the Iranian patients with human immunodeficiency virus infection. J Med Virol 2016; 88:1960-6. [PMID: 27463051 DOI: 10.1002/jmv.24474] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 12/23/2022]
Abstract
Occult hepatitis C virus (HCV) infection is a new form of chronic HCV infection described by the presence of the genomic HCV-RNA in liver biopsy and/or peripheral blood mononuclear cell (PBMC) samples, and undetectable levels or absence of HCV-RNA and in the absence or presence of anti HCV antibodies in the plasma specimens. The aim of the present study was to evaluate the occurrence of occult HCV infection (OCI) among Iranian subjects infected with human immunodeficiency virus (HIV) using RT-nested PCR. From March 2014 until April 2015, 109 Iranian patients with established HIV infection were enrolled in this cross-sectional study. After extraction of viral RNA from the plasma and PBMC samples, HCV-RNA status was examined by RT-nested PCR using primers from the 5'-NTR. HCV genotyping was conducted using RFLP analysis. For the confirmation of HCV genotyping by RFLP method, the PCR products were sequenced. Of the 109 patients, 50 were positive for antibodies against HCV. The HCV-RNA was detected in PBMC specimens in 6 (10.2%) out of the total 59 patients negative for anti-HCV Abs and undetectable plasma HCV-RNA and also from 4 (8.0%) out of the total 50 patients positive for anti-HCV Abs and undetectable plasma HCV-RNA. HCV genotyping analysis showed that 6 (60.0%) patients were infected with HCV subtype 3a, 3 (30.0%) were infected with HCV subtype 1a and 1 (10.0%) patient was infected with HCV subtype 1b. This study revealed the incidence of OCI (9.2%) in HIV-infected Iranian patients. Hence, designing prospective studies focusing on the detection of OCI in these patients would provide more information. J. Med. Virol. 88:1960-1966, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Farah Bokharaei-Salim
- Department of Virology, Iran University of Medical Sciences, Tehran, Iran.,HIV Laboratory of National Center, Deputy of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Keyvani
- Department of Virology, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Esghaei
- Department of Virology, Iran University of Medical Sciences, Tehran, Iran
| | - Shohreh Zare-Karizi
- Department of Genetic, Islamic Azad University, Varamin Pishva Branch, Tehran, Iran
| | | | | | - Shahin Fakhim
- Faculty of Engineering, Department of Civil Engineering, Payame Noor University, Karaj, Iran
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Guzmán-Fulgencio M, Berenguer J, Jiménez-Sousa MA, Pineda-Tenor D, Aldámiz-Echevarria T, García-Broncano P, Carrero A, García-Álvarez M, Tejerina F, Diez C, Vazquez-Morón S, Resino S. Association between IL7R polymorphisms and severe liver disease in HIV/HCV coinfected patients: a cross-sectional study. J Transl Med 2015; 13:206. [PMID: 26123260 PMCID: PMC4487067 DOI: 10.1186/s12967-015-0577-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 06/19/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Interleukin-7 (IL-7) is a critical factor for T cell development and for maintaining and restoring homeostasis of mature T cells. Polymorphisms at α-chain of the IL-7 receptor (IL7R or CD127) gene are related to evolution of HIV-infection, but there are no data concerning the evolution of hepatitis C virus (HCV) infection. The aim of this study was to analyze the association between IL7R polymorphisms and severe liver disease in HCV/HIV coinfected patients. METHODS We performed a cross-sectional study in 220 naïve patients who underwent a liver biopsy. IL7R polymorphisms (rs6897932, rs987106 and rs3194051) were genotyped using the GoldenGate(®) assay. The outcome variables were: (a) liver biopsy: advanced fibrosis (F ≥ 3), severe activity grade (A3); (b) non-invasive indexes: advanced fibrosis (APRI ≥1.5 and FIB-4 ≥3.25). Logistic regression analysis was used to investigate the association between IL7R polymorphisms and outcome variables. This test gives the differences between groups and the odds ratio (OR) for liver disease. RESULTS Patients with rs6897932 CC genotype had higher likelihood of having A3 than patients with rs6897932 CT/TT (adjusted odds ratio (aOR) = 4.16; p = 0.026). Patients with rs987106 TT genotype had higher odds of having F ≥ 3 (aOR = 3.09; p = 0.009) than rs987106 AA/AT carriers. Finally, patients with rs3194051 AA genotype had higher odds of having severe liver fibrosis (F ≥ 3; APRI ≥1.5, and FIB4 ≥3.25) than patients with rs3194051 AG/GG genotype [aOR = 2.73 (p = 0.010); aOR = 2.52 (p = 0.029); and aOR = 4.01 (p = 0.027); respectively]. The CTA haplotype (comprised of rs6897932, rs987106, and rs3194051) carriers had higher odds of having F ≥ 3 (aOR = 1.85; p = 0.012), APRI ≥1.5 (aOR = 1.94; p = 0.023), and FIB4 ≥3.25 (aOR = 2.47; p = 0.024). Conversely, the CAG haplotype carriers had lower odds of having F ≥ 3 (aOR = 0.48; p = 0.011), APRI ≥1.5 (aOR = 0.48; p = 0.029), and FIB4 ≥3.25 (aOR = 0.29; p = 0.010). CONCLUSIONS The presence of IL7R polymorphisms seems to be related to severe liver disease in HIV/HCV coinfected patients, because patients with unfavorable IL7R genotypes (rs6897932 CC, rs987106 TT, and rs3194051AA) had a worse prognosis of CHC.
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Affiliation(s)
- María Guzmán-Fulgencio
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda-Pozuelo, Km 2.2, Majadahonda, 28220, Madrid, Spain.
| | - Juan Berenguer
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - María A Jiménez-Sousa
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda-Pozuelo, Km 2.2, Majadahonda, 28220, Madrid, Spain.
| | - Daniel Pineda-Tenor
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda-Pozuelo, Km 2.2, Majadahonda, 28220, Madrid, Spain.
| | - Teresa Aldámiz-Echevarria
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Pilar García-Broncano
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda-Pozuelo, Km 2.2, Majadahonda, 28220, Madrid, Spain.
| | - Ana Carrero
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Mónica García-Álvarez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda-Pozuelo, Km 2.2, Majadahonda, 28220, Madrid, Spain.
| | - Francisco Tejerina
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Cristina Diez
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Sonia Vazquez-Morón
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda-Pozuelo, Km 2.2, Majadahonda, 28220, Madrid, Spain.
| | - Salvador Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III (Campus Majadahonda), Carretera Majadahonda-Pozuelo, Km 2.2, Majadahonda, 28220, Madrid, Spain.
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Pineda-Tenor D, Berenguer J, Jiménez-Sousa MA, García-Alvarez M, Aldámiz-Echevarria T, Carrero A, Vázquez-Morón S, García-Broncano P, Diez C, Tejerina F, Guzmán-Fulgencio M, Resino S. FTO rs9939609 polymorphism is associated with metabolic disturbances and response to HCV therapy in HIV/HCV-coinfected patients. BMC Med 2014; 12:198. [PMID: 25367448 PMCID: PMC4224698 DOI: 10.1186/s12916-014-0198-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/02/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Fat Mass and Obesity-Associated Protein (FTO) gene rs9939609 single nucleotide polymorphism (SNP) has been associated with obesity, metabolic syndrome, insulin resistance (IR), and type 2 diabetes mellitus in the general population. The aim of our study was to examine for the first time the association of the rs9939609 polymorphism with metabolic disturbances, liver disease and virologic response to hepatitis C virus (HCV) therapy with pegylated-interferon-alpha plus ribavirin (pegIFNα/RBV) in human immunodeficiency virus (HIV)/HCV coinfected patients. METHODS We carried out a cross-sectional study in 261 patients, of whom 178 were subsequently treated with pegIFNα/RBV therapy. FTO rs9939609 and IFNL3 rs12980275 polymorphisms were genotyped by GoldenGate®. The main outcomes were: 1) metabolic disturbances: insulin resistance (homeostatic model assessment (HOMA-IR)) and overweight (body mass index (BMI)); 2) liver disease (Metavir score): significant fibrosis (F ≥2) and steatosis (>10% fatty hepatocytes); and 3) virologic response to HCV treatment: sustained virologic response (SVR). RESULTS The rs9939609 AA genotype was associated with higher values of BMI (adjusted arithmetic mean ratio (aAMR) = 1.08; 95% confidence interval (95%CI) = 1.03 to 1.14; P = 0.002) and HOMA-IR (aAMR = 1.32; 95%CI = 1.03 to 1.69; P = 0.027). Patients with an rs9939609 AA genotype had higher likelihoods of achieving values of BMI ≥27.5 kg/m2 (adjusted odds ratio (aOR) = 3.46; 95%CI =1.17 to 10.21; P = 0.024), HOMA-IR ≥2.5 (aOR = 2.09; 95%CI = 1.02 to 4.32; P = 0.045), significant fibrosis (aOR = 2.34; 95%CI =1.02 to 5.36; P = 0.045) and steatosis (aOR = 3.65; 95%CI = 1.29 to 10.36; P = 0.015). The rs9939609 AT/AA genotype decreased the likelihood of achieving SVR (aOR = 0.58; 95%CI = 0.34 to 0.99; P = 0.044). A decision tree was performed with the genotypes of HCV, IFNL3 and FTO. The incorporation of rs9939609 significantly improves the prediction of SVR (P <0.05). The overall accuracy was 68.2%. CONCLUSIONS Patients carrying the unfavourable AT/AA genotype of rs9939609 polymorphism had higher odds of metabolic disturbances and a lower likelihood of achieving successful virologic response to HCV therapy.
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Medrano J, Álvaro-Meca A, Boyer A, Jiménez-Sousa MA, Resino S. Mortality of patients infected with HIV in the intensive care unit (2005 through 2010): significant role of chronic hepatitis C and severe sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:475. [PMID: 25159592 PMCID: PMC4176576 DOI: 10.1186/s13054-014-0475-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/23/2014] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The combination antiretroviral therapy (cART) has led to decreased opportunistic infections and hospital admissions in human immunodeficiency virus (HIV)-infected patients, but the intensive care unit (ICU) admission rate remains constant (or even increased in some instances) during the cART era. Hepatitis C virus (HCV) infection is associated with an increased risk for hospital admission and/or mortality (particularly those related to severe liver disease) compared with the general population. The aim of this study was to assess the mortality among HIV-infected patients in ICU, and to evaluate the impact of HIV/HCV coinfection and severe sepsis on ICU mortality. METHODS We carried out a retrospective study based on patients admitted to ICU who were recorded in the Minimum Basic Data Set (2005 through 2010) in Spain. HIV-infected patients (All-HIV-group (n = 1,891)) were divided into two groups: HIV-monoinfected patients (HIV group (n = 1,191)) and HIV/HCV-coinfected patients (HIV/HCV group (n = 700)). A control group (HIV(-)/HCV(-)) was also included (n = 7,496). RESULTS All-HIV group had higher frequencies of severe sepsis (57.7% versus 39.4%; P < 0.001) than did the control group. Overall, ICU mortality in patients with severe sepsis was much more frequent than that in patients without severe sepsis (other causes) at days 30 and 90 in HIV-infected patients and the control group (P < 0.001). Moreover, the all-HIV group in the presence or absence of severe sepsis had a higher percentage of death than did the control group at days 7 (P < 0.001), 30 (P < 0.001) and 90 (P < 0.001). Besides, the HIV/HCV group had a higher percentage of death, both in patients with severe sepsis and in patients without severe sepsis compared with the HIV group at days 7 (P < 0.001) and 30 (P < 0.001), whereas no differences were found at day 90. In a bayesian competing-risk model, the HIV/HCV group had a higher mortality risk (adjusted hazard ratio (aHR) = 1.44 (95% CI = 1.30 to 1.59) and aHR = 1.57 (95% CI = 1.38 to 1.78) for patients with and without severe sepsis, respectively). CONCLUSIONS HIV infection was related to a higher frequency of severe sepsis and death among patients admitted to the ICU. Besides, HIV/HCV coinfection contributed to an increased risk of death in both the presence and the absence of severe sepsis.
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Calderon Y, Cowan E, Schramm C, Stern S, Brusalis C, Iscoe M, Rahman S, Verma R, Leider J. HCV and HBV testing acceptability and knowledge among urban emergency department patients and pharmacy clients. Prev Med 2014; 61:29-33. [PMID: 24382298 DOI: 10.1016/j.ypmed.2013.12.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 12/16/2013] [Accepted: 12/21/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Hepatitis C and hepatitis B are public health problems in the United States and remain largely undiagnosed. In response to the availability of rapid, point of care hepatitis tests, we assessed hepatitis knowledge and acceptability of hepatitis testing during an emergency department (ED) or pharmacy visit. METHODS From June 2010 to May 2011, an anonymous prospective survey was administered to a convenience sample of New York City ED patients and pharmacy clients. RESULTS The study population (N=2078) was 54% female, 36% Hispanic and 41% black. Mean age was 39, SD ± 15 years. The majority (72%;1480/2,2060) of the participants responded that they would get tested if free testing were offered, and 67% (1272/1912) of those responded that they would test for hepatitis B/C in conjunction with HIV. Participants who had previously tested for hepatitis had higher mean knowledge scores than those who had never tested. Pharmacy clients, those of black race, and those with higher mean knowledge scores would be more willing to accept hepatitis B/C testing if offered. CONCLUSIONS Urban ED patients and pharmacy clients were receptive to hepatitis testing. Most individuals would elect to be tested for hepatitis with HIV, which raises the possibility of integrated testing.
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Affiliation(s)
- Yvette Calderon
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA; Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Ethan Cowan
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA; Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Sam Stern
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA
| | | | - Mark Iscoe
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Sara Rahman
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Rajesh Verma
- Department of Emergency Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Jason Leider
- Internal Medicine, Jacobi Medical Center, Bronx, NY, USA; Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Jiménez-Sousa MA, Berenguer J, Fernández-Rodríguez A, Micheloud D, Guzmán-Fulgencio M, Miralles P, Pineda-Tenor D, García-Álvarez M, López JC, Aldámiz-Echevarria T, Carrero A, Resino S. IL28RA polymorphism (rs10903035) is associated with insulin resistance in HIV/HCV-coinfected patients. J Viral Hepat 2014; 21:189-97. [PMID: 24438680 DOI: 10.1111/jvh.12130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/01/2013] [Indexed: 12/18/2022]
Abstract
Hepatitis C virus (HCV) infection is associated with insulin resistance (IR), although mechanisms leading to IR in these patients are not completely understood. The aim of this study was to evaluate the association of interleukin 28B (IL28B) and interleukin 28 receptor alpha (IL28RA) polymorphisms with IR among human immunodeficiency virus (HIV)/HCV-coinfected patients. We carried out a cross-sectional study on 203 patients. IL28B (rs8099917) and IL28RA (rs10903035) polymorphisms were genotyped by GoldenGate(®) assay. IR was defined as homeostatic model assessment (HOMA) values ≥3.00. Univariate and multivariate generalized linear models (GLM) were used to compare HOMA values and the percentage of patients with IR according to IL28B and IL28RA genotypes. In total, 32% (n = 65/203) of the patients had IR. IL28B rs8099917 TT was not significantly associated with HOMA values and IR. In contrast, rs10903035 AA was significantly associated with high HOMA values taking into account all patients (P = 0.024), as well as the subgroups of patients with significant fibrosis (P = 0.047) and infected with HCV genotype 3 (P = 0.024). Additionally, rs10903035 AA was significantly associated with IR (HOMA ≥3.00) in all patients (adjusted odds ratio (aOR) = 2.02; P = 0.034), in patients with significant fibrosis (aOR = 2.86; P = 0.039) and HCV genotype 3 patients (aOR = 4.89; P = 0.031). In conclusions, IL28RA polymorphism (rs10903035) seems to be implicated in the glucose homeostasis because AA genotype increases the likelihood of IR, but this association was different depending on hepatic fibrosis and HCV genotype.
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Affiliation(s)
- M A Jiménez-Sousa
- Unit of Viral Infection and Immunity, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
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Edelman EJ, Gordon KS, Glover J, McNicholl IR, Fiellin DA, Justice AC. The next therapeutic challenge in HIV: polypharmacy. Drugs Aging 2013; 30:613-28. [PMID: 23740523 PMCID: PMC3715685 DOI: 10.1007/s40266-013-0093-9] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the adoption of combination antiretroviral therapy (ART), most HIV-infected individuals in care are on five or more medications and at risk of harm from polypharmacy, a risk that likely increases with number of medications, age, and physiologic frailty. Established harms of polypharmacy include decreased medication adherence and increased serious adverse drug events, including organ system injury, hospitalization, geriatric syndromes (falls, fractures, and cognitive decline) and mortality. The literature on polypharmacy among those with HIV infection is limited, and the literature on polypharmacy among non-HIV patients requires adaptation to the special issues facing those on chronic ART. First, those aging with HIV infection often initiate ART in their 3rd or 4th decade of life and are expected to remain on ART for the rest of their lives. Second, those with HIV may be at higher risk for age-associated comorbid disease, further increasing their risk of polypharmacy. Third, those with HIV may have an enhanced susceptibility to harm from polypharmacy due to decreased organ system reserve, chronic inflammation, and ongoing immune dysfunction. Finally, because ART is life-extending, nonadherence to ART is particularly concerning. After reviewing the relevant literature, we propose an adapted framework with which to address polypharmacy among those on lifelong ART and suggest areas for future work.
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Affiliation(s)
| | | | | | - Ian R. McNicholl
- />UCSF Positive Health Program at San Francisco General Hospital, University of California, San Francisco, CA USA
| | - David A. Fiellin
- />Yale University Schools of Medicine and Public Health, New Haven, CT USA
| | - Amy C. Justice
- />Yale University Schools of Medicine and Public Health, New Haven, CT USA
- />VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516 USA
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Farías AA, Kremer LE, Allende L, Díaz MDP, Pisano MB, Contigiani MS, Ré VE. Determinants of immunological and virological responses to antiretroviral therapy amongst HIV-infected adults in central Argentina: negative influence of hepatitis C infection. Trans R Soc Trop Med Hyg 2013; 107:432-7. [PMID: 23761392 DOI: 10.1093/trstmh/trt043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to update the epidemiological data on the prevalence of coinfection with hepatitis C virus (HCV) and HIV, and to identify whether specific clinical and epidemiological factors influenced the response of HIV-positive adults to highly active antiretroviral therapy (HAART). METHODS This retrospective observational cohort study of 238 HIV-infected patients evaluated the effect of different epidemiological and clinical parameters (including HCV coinfection) on therapy response among HIV-infected adults initiating HAART. Multiple logistic regression models were used to identify factors associated with therapy response and estimated risk coefficients. RESULTS Seroprevalence of HCV infection in this population was 26% (62/238). We did not observe a significant association between immunological or virological response relating to patient gender or HAART regimen. However, this analysis showed that HCV serological status, age at HIV diagnosis, duration of treatment and WHO clinical stage of AIDS (<200 CD4 cells/ml independently of viral load either < or > to 100,000 copies/ml), were significantly associated with immunological and virological responses to HAART. CONCLUSIONS These results show further evidence that hepatitis C serostatus is associated with a reduced response to HAART.
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Affiliation(s)
- Adrián Alejandro Farías
- Facultad de Ciencias Médicas, Instituto de Virología Dr J M Vanella, Universidad Nacional de Córdoba, Córdoba, Argentina.
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11
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Zhao YS, Su SI, Lv CX, Zhang XF, Lin L, Sun XG, Lin B, Fu JH. Seroprevalence of hepatitis C, hepatitis B virus and syphilis in HIV-1 infected patients in Shandong, China. Int J STD AIDS 2013; 23:639-43. [PMID: 23033517 DOI: 10.1258/ijsa.2012.011411] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To determine the seroprevalence of hepatitis C virus (HCV), hepatitis B virus (HBV) and syphilis in HIV-1-infected patients and related risk factors in Shandong province, China, we tested all eligible participants between 2000 and 2010 for the presence of anti-HCV antibody, hepatitis B surface antigen (HBsAg) and non-treponemal antibodies for syphilis after informed consent. Among 2087 HIV-infected patients, anti-HCV antibody was present in 41.2%, HBsAg in 12.6% and rapid plasma reagin (RPR) reactivity in 19.6%. In the multivariate logistic regression model, male gender (adjusted odds ratio [aOR] = 1.41), minority ethnicity (aOR = 1.72), syphilis infection (aOR = 1.40), former paid blood donors (aOR = 3.36), blood transfusion recipients (aOR = 2.91) and injection drug users (aOR = 1.98) were significantly associated with HCV infection. HCV infection (aOR = 1.40) and being men who have sex with men (aOR = 2.38) were significantly associated with syphilis infection. Co-infection with HCV, HBV and syphilis was observed frequently in all described subgroups of HIV infection. The results of this study suggest that it is necessary to screen for these viruses and syphilis in all Chinese HIV-infected patients.
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Affiliation(s)
- Y S Zhao
- Shandong Academy of Medicine of Sciences, Jinan, China
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12
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Guzmán-Fulgencio M, Berenguer J, García-Álvarez M, Fernández-Rodríguez A, Jiménez-Sousa MA, Alvarez E, Micheloud D, López JC, Miralles P, Cosín J, Catalán P, Resino S. IL28B polymorphisms are associated with severity of liver disease in human immunodeficiency virus (HIV) patients coinfected with hepatitis C virus. J Infect 2013; 66:170-8. [PMID: 23103287 DOI: 10.1016/j.jinf.2012.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/13/2012] [Accepted: 10/21/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the association of IL28B polymorphisms and severity of liver disease among human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients. METHODS We carried out a cross-sectional study on 223 patients. Liver biopsies were evaluated according to Metavir score. IL28B polymorphisms (rs12980275, rs8099917, rs7248668, and rs11881222) were genotyped using GoldenGate(®) assay. RESULTS IL28B polymorphisms were in strong linkage disequilibrium, especially the couples rs12980275/rs11881222 and rs8099917/rs7248668. For all patients, the rs12980275 A allele increased the odds for significant fibrosis (F ≥ 2) odds ratio (OR) = 1.68; p = 0.018) and more rapid fibrosis progression (FPR ≥ 0.075 fibrosis units/year) (OR = 1.64; p = 0.035), and decreased the odds for liver steatosis (OR = 0.61; p = 0.046). Furthermore, the rs8099917 T allele increased the odds for F ≥ 2 (OR = 1.93; p = 0.020), FPR ≥ 0.075 (OR = 2.08; p = 0.021), and elevated ALT (≥80 IU/l) (OR = 1.78; p = 0.048). For HCV-genotype 1 patients, rs12980275 A and rs8099917 T alleles decreased the odds for liver steatosis (OR = 0.22; p < 0.001 and OR = 0.39; p = 0.048; respectively). For HCV-genotype 3 patients, the rs12980275 A allele increased the odds for F ≥ 2 ((OR = 6.30; p = 0.012), FPR ≥ 0.075 (OR = 6.40; p = 0.025), and elevated ALT (OR = 4.12; p = 0.037); and the rs8099917 T allele also increased the odds for F ≥ 2 (OR = 7.56; p = 0.027), FPR ≥ 0.075 (OR = 50.8; p = 0.012), and elevated ALT (OR = 5.39; p = 0.043). However, we did not find significant trends in patients infected with HCV-genotype 4. CONCLUSION The major alleles of IL28B (rs12980275 A, rs11881222 A, rs8099917 T, and rs7248668 G) are associated with increased odds of liver disease severity in HIV patients infected with HCV-genotype 3. In contrast, HCV-genotype 1 patients carrying the major alleles of IL28B polymorphisms had lower odds for liver steatosis.
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Affiliation(s)
- María Guzmán-Fulgencio
- Unit of HIV/Hepatitis coinfection, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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13
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Coinfection by human immunodeficiency virus and hepatitis C virus: noninvasive assessment and staging of fibrosis. Curr Opin Infect Dis 2012; 25:564-9. [PMID: 22744318 DOI: 10.1097/qco.0b013e32835635df] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This review presents recent findings on noninvasive alternatives for the diagnosis of fibrosis and cirrhosis in patients who are coinfected with HIV and hepatitis C virus (HCV). RECENT FINDINGS APRI, FIB-4, and Forns were accurate indices for the diagnosis of cirrhosis [area under the receiver operating characteristic curve (AUROC) >0.80] but not for the diagnosis of significant and advanced fibrosis (AUROC < 0.80). Diagnostic accuracy was affected by CD4 T-cell count and alanine aminotransferase levels. An artificial neural network to predict significant fibrosis was highly accurate (AUROC of 0.853), outperforming simple noninvasive indices. Derivations of the FibroMeter panel (FibroMeter HICV and FibroMeter HICV) achieved high diagnostic accuracy for significant fibrosis (AUROC of 0.823 and 0.833, respectively). Transient elastography had higher predictive accuracy than previously validated panels for diagnosis of advanced fibrosis (F ≥ 3) and cirrhosis (0.93 and 0.99, respectively). However, misclassification as F ≥ 3 was more common among patients with steatosis than among those without steatosis (25 versus 5%, P = 0.01). Moreover, transient elastography can predict clinically significant and severe portal hypertension in HIV/HCV-coinfected patients. SUMMARY Both biomarkers and transient elastography can accurately diagnose fibrosis and cirrhosis and are better at excluding than at predicting liver disease in HIV/HCV-coinfected patients.
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Xu CH, Shen T, Zheng JJ, Tu J, Zhang WD, Lu FM. Higher dN/dS ratios in the HCV core gene, but not in the E1/HVR1 gene, are associated with human immunodeficiency virus-associated immunosuppression. Arch Virol 2012; 157:2153-62. [PMID: 22825695 DOI: 10.1007/s00705-012-1390-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 05/17/2012] [Indexed: 12/12/2022]
Abstract
Coinfection with HCV and HIV is prevalent among former commercial blood donors in some rural areas in China. Genetic variability of the HCV core and E1/HVR1 was investigated in 23 patients chronically infected with HCV-1b, with or without concomitant HIV infection. Genetic variability in the core sequence was higher under HIV-associated immunocompromised conditions. Both the Shannon entropy values at each nucleotide position and the dN/dS values at each codon were statistically higher in HIV/HCV-coinfected patients with lower CD4+ T cell counts (p-values were <0.0001 and equal to 0.0372, respectively). The more significant difference of dN/dS value occurred in a specific subregion of the core gene that is enriched in CTL/Th epitopes (p = 0.0083). The dN/dS values of full-length core antigen were found to be negatively correlated with the S/CO ratio of plasma anti-HCV antibodies. By contrast, no significant difference in genetic diversity/complexity and dN/dS values in the E1/HVR1 region was found between those two groups. These results suggest that the dN/dS ratio in the core gene, but not in the E1/HVR1 gene, is influenced more by host CD4+ T cell-mediated cellular immunity.
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Affiliation(s)
- Chun-Hui Xu
- Department of Microbiology, Peking University Health Science Center, Beijing 100191, China
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Cameron BA, Emerson CR, Workman C, Kelly MD, Lloyd AR, Post JJ. Alterations in Immune Function are Associated with Liver Enzyme Elevation in HIV and HCV Co-infection after Commencement of Combination Antiretroviral Therapy. J Clin Immunol 2011; 31:1079-83. [DOI: 10.1007/s10875-011-9587-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 08/31/2011] [Indexed: 01/22/2023]
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Shrosbree J, Post FA, Keays R, Vizcaychipi MP. Anaesthesia and intensive care in patients with HIV. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2011. [DOI: 10.1016/j.tacc.2011.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Holodniy M, Brown ST, Cameron DW, Kyriakides TC, Angus B, Babiker A, Singer J, Owens DK, Anis A, Goodall R, Hudson F, Piaseczny M, Russo J, Schechter M, Deyton L, Darbyshire J. Results of antiretroviral treatment interruption and intensification in advanced multi-drug resistant HIV infection from the OPTIMA trial. PLoS One 2011; 6:e14764. [PMID: 21483491 PMCID: PMC3069000 DOI: 10.1371/journal.pone.0014764] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 01/05/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Guidance is needed on best medical management for advanced HIV disease with multidrug resistance (MDR) and limited retreatment options. We assessed two novel antiretroviral (ARV) treatment approaches in this setting. METHODS AND FINDINGS We conducted a 2×2 factorial randomized open label controlled trial in patients with a CD4 count≤300 cells/µl who had ARV treatment (ART) failure requiring retreatment, to two options (a) re-treatment with either standard (≤4 ARVs) or intensive (≥5 ARVs) ART and b) either treatment starting immediately or after a 12-week monitored ART interruption. Primary outcome was time to developing a first AIDS-defining event (ADE) or death from any cause. Analysis was by intention to treat. From 2001 to 2006, 368 patients were randomized. At baseline, mean age was 48 years, 2% were women, median CD4 count was 106/µl, mean viral load was 4.74 log(10) copies/ml, and 59% had a prior AIDS diagnosis. Median follow-up was 4.0 years in 1249 person-years of observation. There were no statistically significant differences in the primary composite outcome of ADE or death between re-treatment options of standard versus intensive ART (hazard ratio 1.17; CI 0.86-1.59), or between immediate retreatment initiation versus interruption before re-treatment (hazard ratio 0.93; CI 0.68-1.30), or in the rate of non-HIV associated serious adverse events between re-treatment options. CONCLUSIONS We did not observe clinical benefit or harm assessed by the primary outcome in this largest and longest trial exploring both ART interruption and intensification in advanced MDR HIV infection with poor retreatment options. TRIAL REGISTRATION Clinicaltrials.gov NCT00050089.
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Affiliation(s)
- Mark Holodniy
- VA Palo Alto Health Care System, Palo Alto, California, United States of America
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Sheldon T. Brown
- James J. Peters VA Medical Center, Bronx, New York, United States of America
- Department of Medicine, Mt. Sinai School of Medicine, New York, New York, United States of America
| | - D. William Cameron
- University of Ottawa at The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Canadian HIV Trials Network, St Paul's Hospital, Vancouver, British Columbia, Canada
- * E-mail:
| | - Tassos C. Kyriakides
- VA Cooperative Studies Program Coordinating Center, West Haven, Connecticut, United States of America
| | - Brian Angus
- Nuffield Department of Medicine, The John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | - Joel Singer
- Canadian HIV Trials Network, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Douglas K. Owens
- VA Palo Alto Health Care System, Palo Alto, California, United States of America
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Aslam Anis
- Canadian HIV Trials Network, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ruth Goodall
- MRC Clinical Trials Unit, London, United Kingdom
| | - Fleur Hudson
- MRC Clinical Trials Unit, London, United Kingdom
| | - Mirek Piaseczny
- Canadian HIV Trials Network, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - John Russo
- VA Cooperative Studies Program Coordinating Center, West Haven, Connecticut, United States of America
| | - Martin Schechter
- Canadian HIV Trials Network, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Lawrence Deyton
- Department of Veterans Affairs, Office of Public Health and Environmental Hazards, Washington, D.C., United States of America
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HIV infection and the liver: the importance of HCV-HIV coinfection and drug-induced liver injury. Clin Liver Dis 2011; 15:131-52. [PMID: 21111997 DOI: 10.1016/j.cld.2010.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis C virus-Human immunodeficiency virus (HCV-HIV) coinfections are identified in up to 30% of patients infected with HIV and in 8% of patients infected with HCV. Now that progression of HIV and deaths due to AIDS can be prevented by highly active antiretroviral therapy (HAART), it is clear that HCV coinfection is associated with accelerated progression to cirrhosis and increased liver-related morbidity and mortality. Antiviral therapy with pegylated interferon and ribavirin for HCV in HCV-HIV coinfected patients is less successful than in patients with HCV monoinfection, and HAART can cause drug-induced liver injury. Multiple barriers limit the number of HCV-HIV coinfected patients who receive antiviral therapy for HCV, and the role of orthotopic liver transplantation (OLT) in HIV monoinfected and HCV-HIV coinfected patients remains controversial. Clinical trials of HCV-specific protease or polymerase inhibitors combined with pegylated interferon and ribavirin are needed urgently in coinfected patients, both before and after OLT.
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Abstract
Hepatitis C virus (HCV) leads to disproportionate morbidity and mortality in the HIV-positive population. A new era of anti-HCV therapeutics is emerging, with many direct antiviral agents and immunomodulating drugs in clinical development. This review discusses HCV treatments in development, with special attention to four agents being studied actively among HIV/HCV-co-infected persons.
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Affiliation(s)
- Valerianna K Amorosa
- Department of Medicine, University of Pennsylvania, 8th Floor, Philadelphia VAMC, Philadelphia, PA 19104, USA.
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20
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Ananthakrishnan AN, McGinley EL, Fangman J, Saeian K. Hepatitis C/HIV co-infection is associated with higher mortality in hospitalized patients with hepatitis C or HIV. J Viral Hepat 2010; 17:720-9. [PMID: 20002558 DOI: 10.1111/j.1365-2893.2009.01232.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Up to 10% of all patients with Hepatitis C virus (HCV) infection are co-infected with human immunodeficiency virus (HIV); 25-30% of HIV patients are co-infected with HCV. The aim of this study was to examine the association of HCV/HIV co-infection with outcomes of hospitalized patients compared to those with HCV or HIV monoinfection. Using the 2006 Nationwide Inpatient Sample, patients with HCV or HIV monoinfection or HCV/HIV co-infection were identified using ICD-9-CM codes. We compared liver-related and infection-related admission between the three groups of patients. Multivariate logistic regression was performed to identify independent predictors of in-hospital mortality. A total of 474,843 discharges with HCV monoinfection, 206,758 with HIV monoinfection and 56,304 with HCV/HIV co-infection were included. Liver-related admissions were more common in co-infected patients (15.4%) compared to those with HIV monoinfection (3.3%, P < 0.001). Primary infectious hospitalizations were more common in HIV monoinfection (33.9%) compared to co-infected patients (26%, P < 0.001). HCV/HIV co-infection was associated with higher mortality compared to HCV monoinfection (OR 1.41, 95% CI 1.20-1.65) but not when compared to monoinfected-HIV patients. HCV-associated cirrhosis or complications thereof conferred four times greater mortality risk in patients with HIV (OR 3.96, 95% CI 3.29-4.79). The rate of hospitalization for HCV/HIV co-infected patients (23.5%) was significantly higher than those with HCV (14.8%) or HIV (19.9%) (P < 0.001). HCV/HIV co-infection is associated with significantly higher rates of hospitalization and is a risk factor for in-hospital mortality compared to patients with isolated HCV.
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Affiliation(s)
- A N Ananthakrishnan
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Bova C, Ogawa LF, Sullivan-Bolyai S. Hepatitis C treatment experiences and decision making among patients living with HIV infection. J Assoc Nurses AIDS Care 2010. [PMID: 19853480 DOI: 10.1016/j.jana.2009.07./009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
Hepatitis C infection is a major problem for approximately 250,000 HIV-infected persons in the United States. Although HIV infection is well-controlled in most of this population, they suffer liver-associated morbidity and mortality. Conversely, hepatitis C virus (HCV) treatment uptake remains quite low (15%-30%). Therefore, the purpose of this qualitative study was to explore HCV treatment experiences and decision making in adults with HIV infection. The study sample included 39 coinfected adults; 16 in the HCV-treated cohort (who were interviewed a maximum of 3 times) and 23 in the HCV-nontreatment cohort. Analysis of interviews identified 2 treatment barriers (fears and vicarious experiences) and 4 facilitating factors (experience with illness management, patient-provider relationships, gaining sober time, and facing treatment head-on). Analysis of these data also revealed a preliminary model to guide intervention development and theoretical perspectives. Ultimately, research is urgently needed to test interventions that improve HCV evaluation and treatment uptake among HIV-infected patients.
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Bova C, Ogawa LF, Sullivan-Bolyai S. Hepatitis C treatment experiences and decision making among patients living with HIV infection. J Assoc Nurses AIDS Care 2009; 21:63-74. [PMID: 19853480 DOI: 10.1016/j.jana.2009.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 07/16/2009] [Indexed: 12/18/2022]
Abstract
Hepatitis C infection is a major problem for approximately 250,000 HIV-infected persons in the United States. Although HIV infection is well-controlled in most of this population, they suffer liver-associated morbidity and mortality. Conversely, hepatitis C virus (HCV) treatment uptake remains quite low (15%-30%). Therefore, the purpose of this qualitative study was to explore HCV treatment experiences and decision making in adults with HIV infection. The study sample included 39 coinfected adults; 16 in the HCV-treated cohort (who were interviewed a maximum of 3 times) and 23 in the HCV-nontreatment cohort. Analysis of interviews identified 2 treatment barriers (fears and vicarious experiences) and 4 facilitating factors (experience with illness management, patient-provider relationships, gaining sober time, and facing treatment head-on). Analysis of these data also revealed a preliminary model to guide intervention development and theoretical perspectives. Ultimately, research is urgently needed to test interventions that improve HCV evaluation and treatment uptake among HIV-infected patients.
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Cao MM, Li G, Ren H, Pan W, Zhao P, Qi ZT. RNA interference effectively degrades mRNA and inhibits protein expression of GBV-C E2 gene in Huh7 cells. Virus Genes 2009; 39:324-9. [PMID: 19809871 DOI: 10.1007/s11262-009-0405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 09/21/2009] [Indexed: 11/30/2022]
Abstract
The GB virus C/hepatitis G virus (GBV-C/HGV) is a Flaviviridae member that despite its nonpathogenicity, has become of great interest given that it could inhibit the replication of the human immunodeficiency virus (HIV). Therefore, a better knowledge of the viral protein E2 has become our aim. In this study, a GBV-C model cell system (HuhEG) which expressing a fusion protein of the GBV-C E2 protein and enhanced green fluorescent protein (EGFP) stably was established. And the expression of these proteins was silenced effectively by the two E2 gene-specific siRNAs and an EGFP gene-specific siRNA. This inhibition is sequence-specific and extensive (90%). This HuhEG/specific siRNAs system can provide an approach for investigating the association between GBV-C E2 and HIV replication, which may be of potential value in the development of novel prophylactic or therapeutic agents for HIV infection.
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Affiliation(s)
- Ming-Mei Cao
- Department of Microbiology, Second Military Medical University, Shanghai, China
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Yotsuyanagi H, Kikuchi Y, Tsukada K, Nishida K, Kato M, Sakai H, Takamatsu J, Hige S, Chayama K, Moriya K, Koike K. Chronic hepatitis C in patients co-infected with human immunodeficiency virus in Japan: a retrospective multicenter analysis. Hepatol Res 2009; 39:657-63. [PMID: 19473427 DOI: 10.1111/j.1872-034x.2009.00517.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM A nationwide survey in Japan revealed that nearly one-fifth of human immunodeficiency virus (HIV)-positive patients are co-infected with hepatitis C virus (HCV). We conducted a study to further analyze the features of liver disease in HIV-HCV co-infected patients. METHODS We analyzed 297 patients from eight hospitals belonging to the HIV/AIDS Network of Japan. RESULTS HCV genotypes 1, 2, 3, 4 and mixed genotypes were detected in 55.2, 13.7, 18.9, 0.9 and 11.3% of patients, respectively, in contrast to the fact that only genotypes 1 and 2 are detected in HCV mono-infected patients in Japan. This is compatible with the transmission of HCV through imported blood products contaminated by HCV. Sixteen of 297 HIV-HCV co-infected patients had advanced liver disease accompanied by ascites, hepatic encephalopathy or hepatocellular carcinoma. The average age of such patients was 41.1 +/- 14.0 years, which was much younger than that of HCV mono-infected patients with the same complications. The progression speed of liver disease estimated from the changes in the levels of serum albumin, bilirubin, or platelet was slower in patients who achieved sustained virological response with interferon treatment than in those who did not receive it. The overall sustained virological response rate to interferon treatment was 43.3%. CONCLUSIONS Our findings suggest that liver disease is more advanced in HIV-HCV co-infected patients than in HCV mono-infected patients, and interferon treatment may retard the progression of liver disease in such patients.
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Affiliation(s)
- Hiroshi Yotsuyanagi
- Department of Internal Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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