HIV/HCV co-infection: clinical and therapeutic challenges

Can we better understand severe mental illness through the lens of Syndemics?

Current health care systems do not sufficiently address contributors, also known as modifiable behavior factors, to severe mental illnesses (SMI). Instead treatment is focused on decreasing symptom-experience rather than reducing the detrimental effect of biological predisposition and behavioral influences on illness. Health care services and patients alike call for a more comprehensive, individual approach to mental health care, especially for people with SMI. A Syndemics framework has been previously used to identify ecological and social contributors to an HIV epidemic in the 1990s, and the same framework is transferable to mental health research to identify the relationship between contributing factors and the outcomes of SMI. Using this approach, a holistic insight into mental illness experience could inform more effective health care strategies that lessen the burden of disease on people with SMI. In this review, the components of a Syndemic framework, the scientific contributions to the topic so far, and the possible future of mental health research under the implementation of a Syndemic framework approach are examined.

Synergistic effects of food insecurity and drug use on medication adherence among people living with HIV infection

Food insecurity and drug use are closely connected in the context of poverty, and both have been suggested to interfere with HIV medication adherence among people living with HIV/AIDS (PLWH). Yet the potential interaction between the two factors on adherence has not been examined. For this study we collected longitudinal data on HIV medication adherence among PLWH in Atlanta, GA, to assess a possible synergistic effect between the two factors on HIV medication adherence. People informed about the study came to the research site and completed an audio computer-assisted self-interview and instructions for pill counting. Over the next 5 weeks participants received three unscheduled follow-up phone assessments conducted 2 weeks apart to collect pill counts of their HIV medication. The prevalence of food insecurity was 60 % (488) and that of drug use was 33 % (274) in the sample of 809 participants. Among 770 participants who completed follow-up phone assessments, both food insecurity and drug use were associated with HIV medication adherence after adjusting for socio-demographic characteristics. The negative association between drug use and adherence persisted after further adjusting for health-related characteristics. Moreover, drug use appeared to moderate the effect of food insufficiency on adherence, with drug users who were food insufficient being the least likely to achieve 85 % adherence. Results from the current study demonstrate a synergism between food insecurity and drug use that may impede adherence among PLWH. The findings imply that the disruptive effects of food insecurity and drug use on adherence are likely to be intensified with the presence of each other, and encourage interventions to address the problem of HIV medication adherence from a multi-faceted perspective that takes into account detrimental combination of problem factors.

Ulcerogenic and intestinal motility/transit stimulating actions of nevirapine in albino Wistar rats

The antiretroviral is a non-nucleoside reverse transcriptase inhibitor of human immunodeficiency virus type 1. This study was undertaken to investigate the effect of nevirapine (NVP) administration on gastric acid secretion, pepsin secretion, mucosal secretion, intestinal motility, and transit using apparently healthy albino Wistar rats. Eighty albino Wistar rats (50-125 g body weight) from the start of the experiment were used for the study. Rats in the control group were fed normal rodent chow, while the NVP group was fed by gavage NVP (0.4 mg/kg body weight) two times daily (07:00 and 18:00 hours) in addition to normal rodent chow for 12 weeks. All animals were allowed free access to clean drinking water. Mean basal gastric output and peak acid output following histamine administration in the NVP-treated group were significantly higher (p < 0.001, respectively) compared to the control. Following cimetidine administration, there was significant decrease (p < 0.001) in peak acid output in the NVP-treated group compared to the control. The concentration of gastric pepsin, adherent mucus secretion, and mean value for ulcer score were significantly higher (p < 0.001) compared to their control group, respectively. There were significant increases (p < 0.05, respectively) in intestinal motility and basal contraction (p < 0.05) and increase in intestinal transit of the ileum of NVP-treated rats compared to their control, respectively. Results of the study suggest that NVP administration might provoke gastric ulceration in rats which may be caused by high pepsin, high basal acid output, and increased intestinal motility and transit.