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Mostafavi E, Ebrahimi B, Doosti-Irani A, Mirzazadeh A. Prevalence of hepatitis B, hepatitis C, and tuberculosis among people living with HIV in Iran: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:777. [PMID: 39097724 PMCID: PMC11297631 DOI: 10.1186/s12879-024-09676-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/25/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Up to now several studies estimate the prevalence of HBV, HCV, and TB among people living with HIV (PLWH) in Iran; however, their results are inconsistent. This study aimed to estimate the overall prevalence of HBV, HVC, and TB among Iranian PLWH. METHODS In this systematic review and meta-analysis six databases including Medline, Web of Science, Scopus, MagIran, Scientific Information Database (SID), and Barakat Knowledge network system were searched up to October 2023 with no language restriction. All studies estimated the prevalence of HBV, HCV, and TB among PLWH in Iran were included. The random-effects model was used to report the study estimates. Results were reported at a 95% confidence interval (CI). RESULTS Out of 1050 retrieved references, 58 articles met the eligibility criteria. Overall among PLWH, HBV prevalence was 13.0% (95% CI: 11.0, 15.0), HCV prevalence was 54% (95% CI: 45.0, 64.0), and TB prevalence was 19% (95% CI: 13.0, 24.0). The results from multivariate meta-regression analysis showed no statistically significant association between HBV and TB prevalence with the year of study, quality of studies, age, gender, and persons who inject drugs (PWID). HCV prevalence was significantly associated with PWID. CONCLUSION We found HBV, HCV, and TB infections are common among PLWH in Iran and required to be screened and treated with effective and timely services.
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Affiliation(s)
- Ehsan Mostafavi
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Bahram Ebrahimi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Science, Hamadan, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, San Francisco, CA, USA
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Rafiemanesh H, Shadloo B, Amin-Esmaeili M, Rahimi Y, Gholami J, Rahimi-Movaghar A. Prevalence of Tuberculosis among People Who Use Drugs in Iran: A Systematic Review and Meta-analysis. ADDICTION & HEALTH 2023; 15:219-227. [PMID: 38026719 PMCID: PMC10658100 DOI: 10.34172/ahj.2023.1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/28/2023] [Indexed: 12/01/2023]
Abstract
Background Drug use, especially injecting drug use, is associated with a higher risk of tuberculosis (TB). This study aimed to systematically review the prevalence of TB among people who use drugs (PWUD) in Iran. Methods A systematic search was conducted in international and national databases. All studies that provided data on the prevalence of TB among PWUD based on screening tests and diagnosis from 1990 up to August 2019 were assessed. Meta-analysis was performed on the prevalence of active TB among people who inject drugs (PWID). Findings Overall, nine studies were included. The studies were carried out from 1994 to 2012 in seven out of the 31 provinces of Iran. Seven studies provided data on the prevalence of TB diagnosis among 1087 PWID. The pooled prevalence of TB diagnosis was 10.1% (95% CI: 4.5, 15.8) in studies carried out in hospitals and 0.54% (95% CI: 0.04, 1.04) in other settings. Conclusion The present review suggests an approximately 40 times higher prevalence of TB among PWID compared to the general population. However, most of the included studies were conducted on a subpopulation of drug users, and caution should be exercised when generalizing the findings.
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Affiliation(s)
- Hosein Rafiemanesh
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Alborz University of Medical Sciences, Karaj, Iran
| | - Behrang Shadloo
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Yekta Rahimi
- Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
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Roshanaei G, Imani R, Poorolajal J, Asghari-Jafarabadi M, Mohammadi SM. Modeling the survival in patients with HIV by the presence of competing risks for death: sub-distribution and cause-specific hazard approach. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Najafi Z, Taj L, Dadras O, Ghadimi F, Moradmand B, SeyedAlinaghi S. Epidemiology of HIV in Iran. Curr HIV Res 2020; 18:228-236. [PMID: 32503409 DOI: 10.2174/1570162x18666200605152317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 05/06/2020] [Indexed: 02/08/2023]
Abstract
:
Iran has been one of the active countries fighting against HIV/AIDS in the Middle East
during the last decades. Moreover, there is a strong push to strengthen the national health management
system concerning HIV prevention and control. In Iran, HIV disease has its unique features,
from changes in modes of transmission to improvement in treatment and care programs, which can
make it a good case for closer scrutiny. The present review describes the HIV epidemic in Iran from
the first case diagnosed until prevention among different groups at risk and co-infections. Not only
we addressed the key populations and community-based attempts to overcome HIV-related issues in
clinics, but we also elaborated on the efforts and trends in society and the actual behaviors related to
HIV/AIDS. Being located in the Middle East and North Africa (MENA) region, given the countryspecific
characteristics, and despite all the national efforts along with other countries in this region,
Iran still needs to take extra measures to reduce HIV transmission, especially in health education.
Although Iran is one of the pioneers in implementing applicable and appropriate policies in the
MENA region, including harm reduction services to reduce HIV incidence, people with substance
use disorder continue to be the majority of those living with HIV in the country. Similar to other
countries in this region, the HIV prevention and control programs aim at 90-90-90 targets to eliminate
HIV infection and reduce the transmission, especially the mother-to-child transmission and
among other key populations.
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Affiliation(s)
- Zeinab Najafi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Taj
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Dadras
- Department of Health Informatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fatemeh Ghadimi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | | | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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Edge CL, King EJ, Dolan K, McKee M. Prisoners co-infected with tuberculosis and HIV: a systematic review. J Int AIDS Soc 2016; 19:20960. [PMID: 27852420 PMCID: PMC5112354 DOI: 10.7448/ias.19.1.20960] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 10/01/2016] [Accepted: 10/24/2016] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Almost from the beginning of the HIV epidemic in 1981, an association with tuberculosis (TB) was recognized. This association between HIV and TB co-infection has been particularly evident amongst prisoners. However, despite this, few studies of TB in prisons have stratified results by HIV status. Given the high prevalence of HIV-positive persons and TB-infected persons in prisons and the documented risk of TB in those infected with HIV, it is of interest to determine how co-infection varies amongst prison populations worldwide. For this reason we have undertaken a systematic review of studies of co-infected prisoners to determine the incidence and/or prevalence of HIV/TB co-infection in prisons, as well as outcomes in this group, measured as treatment success or death. METHODS A literature search was undertaken using the online databases PubMed, Embase, IBSS, Scopus, Web of Science, Global Health and CINAHL Plus. No restrictions were set on language or publication date for article retrieval, with articles included if indexed up to 18 October 2015. A total of 1975 non-duplicate papers were identified. For treatment and outcome data all eligible papers were appraised for inclusion; for incidence/prevalence estimates papers published prior to 2000 were excluded from full text review. After full text appraisal, 46 papers were selected for inclusion in the review, 41 for incidence/prevalence estimates and nine for outcomes data, with four papers providing evidence for both outcomes and prevalence/incidence. RESULTS Very few studies estimated the incidence of TB in HIV positive prisoners, with most simply reporting prevalence of co-infection. Co-infection is rarely explicitly measured, with studies simply reporting HIV status in prisoners with TB, or a cross-sectional survey of TB prevalence amongst prisoners with HIV. Estimates of co-infection prevalence ranged from 2.4 to 73.1% and relative risks for one, given the other, ranged from 2.0 to 10.75, although some studies reported no significant association between HIV and TB. Few studies provided a comparison with the risk of co-infection in the general population. CONCLUSIONS Prisoners infected with HIV are at high risk of developing TB. However, the magnitude of risk varies between different prisons and countries. There is little evidence on treatment outcomes in co-infected prisoners, and the existing evidence is conflicting in regards to HIV status influence on prisoner treatment outcomes.PROSPERO Number: CRD42016034068.
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Affiliation(s)
- Chantal L Edge
- London School of Hygiene and Tropical Medicine, London, England;
| | - Emma J King
- Brighton and Hove City Council, Brighton and Hove, England
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Martin McKee
- ECOHOST, London School of Hygiene and Tropical Medicine, London, England
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Alemu YM, Awoke W, Wilder-Smith A. Determinants for tuberculosis in HIV-infected adults in Northwest Ethiopia: a multicentre case-control study. BMJ Open 2016; 6:e009058. [PMID: 27084271 PMCID: PMC4838743 DOI: 10.1136/bmjopen-2015-009058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify determinants for tuberculosis (TB) among HIV-infected adults in Northwest Ethiopia. DESIGN Case-control study. SETTING Three hospitals and 10 health centres in Northwest Ethiopia. PARTICIPANTS A total of 446 individuals consented to participate in the study (150 cases and 296 controls). Cases were HIV-infected adults diagnosed with active TB, and controls were HIV-infected adults without active TB. MAIN OUTCOME MEASURE The link between TB and determinants was assessed using logistic regression. Determinants were categorised as sociodemographic, host-related, clinical and environmental. RESULTS Smoking (adjusted OR (AOR) 5.47; 95% CI 2.26 to 13.22), presence of a TB patient in the family (AOR 2.66; 95% CI 1.25 to 5.66), alcohol consumption (AOR 2.49; 95% CI 1.29 to 4.80) and chewing khat (AOR 2.22; 95% CI 1.11 to 4.41) were independent determinants for increased occurrence of TB. Highly active antiretroviral therapy (HAART) (AOR 0.25; 95% CI 0.13 to 0.51), isoniazid preventive therapy (IPT) (AOR 0.22; 95% CI 0.11 to 0.41) and cotrimoxazole preventive therapy (AOR 0.32; 95% CI 0.19 to 0.55) had a protective effect against TB. CONCLUSIONS HIV-infected adults with substance abuse (tobacco smoking, khat chewing and alcohol) should be prioritised for TB screening. This study reaffirmed that HAART and IPT are some of the best strategies for reducing TB occurrence in HIV-infected adults. These findings provide impetus to intensify tracing of TB household contacts.
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Affiliation(s)
- Yihun Mulugeta Alemu
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Worku Awoke
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Annalies Wilder-Smith
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Motamedifar M, Ebrahim-Saraie HS, Abadi ARH, Moghadam MN. First Outcome of MDR-TB among Co-Infected HIV/TB Patients from South-West Iran. Tuberc Respir Dis (Seoul) 2015; 78:253-7. [PMID: 26175780 PMCID: PMC4499594 DOI: 10.4046/trd.2015.78.3.253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 11/16/2014] [Accepted: 11/25/2014] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) is the leading cause of mortality among human immunodeficiency virus (HIV) patients and the majority of them occur in developing countries. The aims of the present study were to determine the frequency of HIV/TB co-infection and other probable associated factors. Methods This 10 year retrospective study was conducted on 824 HIV patients in the south-west of Iran. HIV infection was diagnosed by the enzyme linked immunosorbent assay and confirmed by Western blot. TB diagnosis was based on consistency of the clinical manifestations, chest X-ray, and microscopic examination. Drug susceptibility testing was done by the proportional method on Löwenstein-Jensen media. Results Of 824 HIV patients, 59 (7.2%) were identified as TB co-infected and the majority (86.4%) of them were male. Of the overall TB infected patients, 6 cases (10.2%) showed multidrug-resistant with the mean CD4+ lymphocyte count of 163±166 cells/mm3. The main clinical forms of TB were pulmonary (73%). There was a significant (p<0.05) correlation between TB infection and CD4+ lymphocyte counts ≤200 cells/mm3, gender, prison history, addiction history, and highly active anti-retroviral therapy. Conclusion We reported novel information on frequency of HIV/TB co-infection and multidrug resistant-TB outcome among co-infected patients that could facilitate better management of such infections on a global scale.
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Affiliation(s)
- Mohammad Motamedifar
- Department of Bacteriology & Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. ; Shiraz HIV/AIDS Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Hadi Sedigh Ebrahim-Saraie
- Department of Bacteriology & Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahboube Nakhzari Moghadam
- Department of Bacteriology & Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Incidence and Predictors of Tuberculosis among HIV Positive Children at University of Gondar Referral Hospital, Northwest Ethiopia: A Retrospective Follow-Up Study. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2015; 2015:307810. [PMID: 27347516 PMCID: PMC4897326 DOI: 10.1155/2015/307810] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 04/09/2015] [Accepted: 04/21/2015] [Indexed: 02/05/2023]
Abstract
Background. The aim of this study was to determine the incidence of tuberculosis and its predictors among HIV positive children. Methods. A six-year retrospective follow-up study was conducted among HIV infected children aged less than 15 years. Life table was used to estimate the cumulative probability of tuberculosis free survival. Cox proportional hazards model was used to identify predictors of tuberculosis. Results. A total of 271 HIV positive children were followed for six years and produced 1100.50 person-years of observation. During the follow-up period 52 new TB cases occurred. The overall incidence density of TB was 4.9 per 100 PY. Inappropriate vaccination [AHR: 8.03 (95% CI; 4.61–13.97)], ambulatory functional status [AHR: 1.99 (95% CI; 1.04–3.81)], and having baseline anemia [AHR: 2.23 (95% CI; 1.19–4.15)] were important predictors of time to TB occurrence. Conclusion. TB incidence rate was high. Early diagnosis and treatment of anemia and strengthening immunization program would reduce the risk of TB occurrence.
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Alimohamadi Y, Tabatabaee H, AfsarKazerooni P, Vahedi S, Enaami M, Teimourizad A. Epidemiologic characteristics of HIV-positive patients referring to behavioral diseases consultation center in Shiraz, Iran. Med J Islam Repub Iran 2014; 28:147. [PMID: 25695005 PMCID: PMC4322336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/04/2014] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Acquired immune deficiency syndrome (AIDS) was firstly reported from California and soon became a pandemic in the world. This disease poses serious threats to humans' health. In this study, we intended to examine the characteristics of HIV-positive patients who referred to the Behavioral Diseases Consultation Center (BDCC) in Shiraz, Iran. METHODS This was a cross-sectional descriptive study. HIV-positive patients, referring toBDCC of Shiraz University of Medical Scienceswere the population under the study. The data, collected through a checklist, were encoded and entered in to the SPSS 19. Then descriptive statistics such as mean, median, standard deviation and range were used to describe the variables. Also, the relationships between the variables were tested using X2 test. RESULTS The mean and median age of the HIV-positive patients were 39 + 8.7 and 38years, respectively.Nearly327 (65.4%) of the studied population were male and 173 (34.6%) were female. With respect to marital status, 225 (45%) participants were married, 133 (27%) were single, 91 (18.2%) were divorced and 49 (9.8%) were widowed. Also, 265(53%) of the participants were infected through injection drug use, 198 (39.6%) through sexual route, 7 (1.4%) through blood and blood products, 6 (1.2%) through tattoos and 21 (4.2%) by other routes. Most of the participants had a HIV-positive history in their family, and 145 (29%) mentioned that their wives were HIV-positive. Moreover, 320 (62.7%) of the participants had a positive history of drug use, 176 (35.2%) did not have a history of drug abuse, and the status of 10 (2%) participants was not recognized. CONCLUSION Although the results of this study highlighted that injection addiction remains the major transmission route inIran, the role of sexual transmission should be acknowledged in the future.
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Affiliation(s)
- Yousef Alimohamadi
- 1. MSc of Epidemiology, Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hamidreza Tabatabaee
- 2. Professor Assistant of Epidemiology, Department of Epidemiology, School of Healthand Nutrition, Shiraz University of Medical sciences, Shiraz, Iran.
| | - Parvin AfsarKazerooni
- 3. Medical Doctor, Master of Public Health, HIV Research Center, Shiraz University of Medical sciences, Shiraz, Iran.
| | - Sajad Vahedi
- 4. MSc of Health Economics, Department of Health Economics, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Meysam Enaami
- 5. MSc of Health Economics, Department of Health Economics, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abedin Teimourizad
- 6. MSc of Health Economics, Department of Health Economics, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
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Ande A, McArthur C, Kumar A, Kumar S. Tobacco smoking effect on HIV-1 pathogenesis: role of cytochrome P450 isozymes. Expert Opin Drug Metab Toxicol 2013; 9:1453-64. [PMID: 23822755 PMCID: PMC4007120 DOI: 10.1517/17425255.2013.816285] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Tobacco smoking is highly prevalent among the HIV-1-infected population. In addition to diminished immune response, smoking has been shown to increase HIV-1 replication and decrease response to antiretroviral therapy, perhaps through drug-drug interaction. However, the mechanism by which tobacco/nicotine increases HIV-1 replication and mediates drug-drug interaction is poorly understood. AREAS COVERED In this review, the authors discuss the effects of smoking on HIV-1 pathogenesis. Since they propose a role for the cytochrome P450 (CYP) pathway in smoking-mediated HIV-1 pathogenesis, the authors briefly converse the role of CYP enzymes in tobacco-mediated oxidative stress and toxicity. Finally, the authors focus on the role of CYP enzymes, especially CYP2A6, in tobacco/nicotine metabolism and oxidative stress in HIV-1 model systems monocytes/macrophages, lymphocytes, astrocytes and neurons, which may be responsible for HIV-1 pathogenesis. EXPERT OPINION Recent findings suggest that CYP-mediated oxidative stress is a novel pathway that may be involved in smoking-mediated HIV-1 pathogenesis, including HIV-1 replication and drug-drug interaction. Thus, CYP and CYP-associated oxidative stress pathways may be potential targets to develop novel pharmaceuticals for HIV-1-infected smokers. Since HIV-1/TB co-infections are common, future study involving interactions between antiretroviral and antituberculosis drugs that involve CYP pathways would also help treat HIV-1/TB co-infected smokers effectively.
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Affiliation(s)
- Anusha Ande
- University of Missouri Kansas City, School of Pharmacy, Division of Pharmacology & Toxicology, Kansas City, MO 64108, USA
| | - Carole McArthur
- Professor, University of Missouri Kansas City, School of Dentistry, Department of Oral Biology, Kansas City, MO 64108, USA
| | - Anil Kumar
- Professor and Chair, University of Missouri Kansas City, School of Pharmacy, Division of Pharmacology & Toxicology, Kansas City, MO 64108, USA
| | - Santosh Kumar
- Assistant Professor, University of Missouri Kansas City, School of Pharmacy, Division of Pharmacology & Toxicology, 2464 Charlotte St. Kansas City, MO 64108, USA Tel: +1 816 235 5494 (Off); Fax: +1 816 235 1776;
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