Management of hepatitis C virus coinfection in HIV-infected persons.
ABSTRACT Approximately 300,000 patients in the United States are coinfected with HIV and hepatitis C virus (HCV). More rapid progression of HCV-related liver disease is seen in coinfected patients than in HCV-monoinfected patients. Since the introduction of potent antiretroviral therapy, liver disease has become a leading cause of death in HIV-infected patients. Therefore, more aggressive management of HCV-related liver disease is essential in HIV-positive patients. Recently, several trials have established the superiority of pegylated interferon alfa in combination with ribavirin to standard interferon with ribavirin for treatment of HCV infection in HIV-HCV-coinfected patients. Sustained virologic response (SVR) rates were only 14% to 29% in genotype 1 and 43% to 73% in genotype 2 and 3 HCV with 48 weeks of combination therapy. Absence of an early virologic response determined at 12 weeks can limit treatment exposure in patients destined not to achieve an SVR. The risk of interactions between drugs used to treat hepatitis C and those for HIV, such as between ribavirin and didanosine, needs to be considered before initiating treatment in HIV-HCV-coinfected patients.
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ABSTRACT: Non-adherence to treatment and risk-reduction measures not only leads to increased morbidity and mortality in patients with HIV/AIDS but is also a major public health hazard. While there are multiple determinants of non-adherence, one that is particularly complex and refractory to intervention appears to be the history of childhood trauma and the development of post-traumatic stress disorder (PTSD). While behavioral intervention is occasionally helpful in increasing a patient's commitment to self-care, it is our view that the use of a more psychoanalytic framework, as well as the development of a psychodynamic understanding of the patient's history and struggles, may provide both patient and clinician with a more profound understanding of the forces that perpetuate non-adherence, thus facilitating a more cohesive and empathic approach to treatment. It is the aim of this article to explore, from a psychodynamic perspective, the possible connections between early childhood trauma resulting in PTSD and non-adherence to risk reduction and HIV treatment.The journal of the American Academy of Psychoanalysis and Dynamic Psychiatry. 12/2011; 39(4):633-50.
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ABSTRACT: To determine the seroprevalence of hepatitis C virus (HCV) and its co-infection with hepatitis B virus (HBV), hepatitis delta agent (HDV) and human immunodeficiency virus (HIV) among liver disease patients of south Tamil Nadu. A total of 1012 samples comprising 512 clinically diagnosed cases of liver disease patients and 500 apparently healthy age and sex matched individuals were screened for Hepatitis C virus (anti HCV and HCV RNA), Hepatitis B virus (HBsAg), Hepatitis delta agent (anti HDV) and Human immuno virus (antibodies to HIV-1 and HIV-2) using commercially available enzyme linked immunosorbent assay kits. HCV RNA was detected by RT-PCR. Liver function tests like ALT, AST, GGT, ALP, bilirubin and albumin were also studied. The seroprevalence of HCV was found to be 5.6% among liver disease patients by ELISA. 27/512, 49/512 and 12/512 patients were positive for HIV, HBV & HDV respectively. Co-infection of HCV & HBV was found in 8 patients, with 6 for HCV & HIV and 4 for HCV, HBV & HIV co-infections. Sex-wise analysis showed that HIV, HCV & HBV and HCV & HIV co-infection was high among females whereas for HBV it was high in males. The mean ALT and AST in HCV positive cases were 42.1 ± 8.3 and 49 ± 10.1. In people co-infected with HCV & HBV or HCV & HIV or HCV, HBV & HIV the mean ALT of 58.0 ± 03.16, 56.78 ± 4.401 and 64.37 ± 4.01 respectively. We strongly recommend routine test of the blood for HCV in addition to HBV and HIV. We also recommend individualized counseling to identify those at risk and testing for those who want it. Improved surveillance and periodic epidemiological studies will have to be undertaken to monitor and prevent these blood-borne viruses.World journal of hepatology. 01/2010; 2(1):42-8.
- Gastroenterology and Hepatology 06/2007; 3(6 Suppl 20):4-32.