HIV-positive men who have sex with men are at high risk of development of significant liver fibrosis after an episode of acute hepatitis C

Acute hepatitis C virus infection remains a major health concern in human immunodeficiency virus(HIV)-infected men who have sex with men (MSM). New direct-acting antiviral agent (DAA) combination therapy has not yet been approved for the treatment for acute hepatitis C virus(HCV), thereby potentially causing deferral of HCV treatment. Therefore, we aimed to study the course of liver disease after an episode of acute HCV. This study is a retrospective single-centre cohort of HIV-positive MSM with acute HCV infection. Liver fibrosis was estimated by Fibroscan^® and Fibrotest^® . Liver-related and non-liver-related outcomes were documented. Overall 213 episodes of acute HCV infection in 178 men were documented. Median follow-up for all included patients was 38.7 months. Spontaneous HCV clearance was found in 10.8% of patients, which was significantly associated with older age, lower HCV RNA levels, and higher ALT levels upon initial acute HCV diagnosis. Treatment with interferon-based therapy was initiated in 86.3% of cases, resulting in a sustained virological response(SVR) rate of 70.7%. After 3 years' follow-up, significant liver fibrosis of METAVIR F2 stage or higher was found in 39.4% of patients after first acute HCV diagnosis. Higher age, physician-declared alcoholism, and nonresponse to acute HCV therapy were independently associated with higher fibrosis stages. Ten patients died during the observation period (IR 1.4/100 patient-years) and four during interferon treatment. Significant liver fibrosis is a common finding in HIV-positive MSM following acute HCV infection despite high treatment uptake and cure rates, suggesting the need for close liver disease monitoring particularly if HCV treatment is deferred.

Efficiency of a turbidity-based, real-time control strategy applied to a retention tank: a simulation study

This paper compares several real-time control (RTC) strategies for a generic configuration consisting of a storage tank with two overflow facilities. Two of the strategies only make use of flow rate data, while the third also introduces turbidity data in order to exercise dynamic control between two overflow locations. The efficiency of each strategy is compared over a wide range of system setups, described by two parameters. This assessment is performed by simulating the application of control strategies to actual measurements time series recorded on two sites. Adding turbidity measurements into an RTC strategy leads to a significant reduction in the annual overflow pollutant load. The pollutant spills spared by such a control strategy strongly depend on the site and on the flow rate based strategy considered as a reference. With the datasets used in this study, values ranging from 5 to 50% were obtained.