Highly Active Antiretroviral Therapy Drugs Research Articles

Hodgkin’s Lymphoma in HIV-Infected Patients

Aim. To assess clinical and laboratory characteristics of the unique category of HIV-positive patients with hepatitis C or B co-infection combined with Hodgkin’s lymphoma (HL). Materials & Methods. The paper provides data on 85 HIV-positive patients with HL followed-up at the Department of Hematology and Secondary Immunodeficiencies of the AS Loginov Moscow Clinical Scientific Center from 2002 to 2019 (data on 2008-2010 are not available). The distribution of patients by sex was approximately equal, median age was 35 years (range 20-74 years). Results. Histological HL variant is predominantly mixedcell with many positive tests for Epstein-Barr virus. More than 80 % of patients with concomitant HIV infection were admitted to the AS Loginov Center with HL stage III/IV. Most of them received highly active anti-retroviral therapy (HAART) before HL diagnosis. The distinguishing feature of HIV-positive patients with HL appeared to be high (as compared to HIV patients with other lymphoma variants) CD4+ lymphocyte count. This phenomenon is considered within the framework of immune reconstitution inflammatory syndrome (IRIS). A clue to this phenomenon may lay the foundation in addressing the issue of lymphoma genesis and development. Viral load was moderate and undetectable. Hepatitis C and/or B co-infection was identified in 95 % of patients. Antiviral therapy for concomitant hepatitis C was administered concurrent with HAART. All patients received АBVD, BEACOPP-14, BEACOPP-escalat-ed, DHAP, ESHAP antitumor regimens. Radiotherapy was used if necessary. In hepatitis C HAART and direct-acting drugs were administered concurrent with chemotherapy. No severe adverse reactions were observed. Even before starting antitumor treatment of HL patients with concomitant HIV and/or hepatitis viral infections, mortality was 8 %. But in the group of patients with the same co-infections who received HL chemotherapy, mortality was 10 %. The cause of death was HL stage IVB with viral liver cirrhosis, agranulocytosis, and sepsis. Conclusion. Diseases considered incurable in the past, such as HL and hepatitis C, can be healed today. Compromised immunity of HIV-positive patients can be successfully stabilized with HAART.

Efavirenz-Associated Retinal Toxicity Presenting with Night Vision Defects in Patients with Human Immunodeficiency Virus

ABSTRACT Ocular lesions in patients with human immunodeficiency virus (HIV) are commonly due to underlying opportunistic infections. With highly active antiretroviral therapy (HAART), infectious lesions have reduced and noninfectious ocular manifestations including drug-related side effects have been noted. While retinal toxicity has been noted with few other HAART drugs, there are not many on the same with Efavirenz usage. We report a series of five patients with possible efavirenz-related retinal toxicity, visual function abnormalities, and its management. Efavirenz was replaced with alternate anti-retroviral drug. Reversal of ocular side effects were noted subjectively in the form of symptom amelioration of the patients. Objectively, it could be documented with electroretinogram changes and other visual function tests reverting back to normal after change in HAART regime. Early identification of this uncommon side effect in select patients can prevent irreversible vision loss due to efavirenz-associated retinal toxicity.

Astrocyte Senescence and Metabolic Changes in Response to HIV Antiretroviral Therapy Drugs.

With the advent of highly active antiretroviral therapy (HAART) survival rates among patients infected by HIV have increased. However, even though survival has increased HIV-associated neurocognitive disorders (HAND) still persist, suggesting that HAART-drugs may play a role in the neurocognitive impairment observed in HIV-infected patients. Given previous data demonstrating that astrocyte senescence plays a role in neurocognitive disorders such as Alzheimer’s disease (AD), we examined the role of HAART on markers of senescence in primary cultures of human astrocytes (HAs). Our results indicate HAART treatment induces cell cycle arrest, senescence-associated beta-galactosidase, and the cell cycle inhibitor p21. Highly active antiretroviral therapy treatment is also associated with the induction of reactive oxygen species and upregulation of mitochondrial oxygen consumption. These changes in mitochondria correlate with increased glycolysis in HAART drug treated astrocytes. Taken together these results indicate that HAART drugs induce the senescence program in HAs, which is associated with oxidative and metabolic changes that could play a role in the development of HAND.

PREVALENCE OF ADVERSE DRUG REACTIONS AMONG HIV/AIDS PATIENTS ON HAART IN UNIVERSITY OF MAIDUGURI TEACHING HOSPITAL (UMTH), NIGERIA: A FOUR-YEAR RETROSPECTIVE STUDY

BackgroundCurrent evidence on highly active antiretroviral therapy (HAART) indicates that each person will have to take the drugs for life [1]. Since 2000, the prevalence of HIV in Nigeria has...

Explaining Adherence to HAART among Patients Living with HIV/AIDS in Nigeria: Behavioral Theory Analysis

Background: The number of Nigerians infected with the HIV infection in 2016 was about 3 million, which was the second highest burden globally and accounted for 9% of the worldwide burden of the HIV/AIDS. The country ART (antiretroviral therapy) programme which commenced in 2001 had adult coverage of 48.3% in 2014. Effectiveness of the antiretroviral drug regimens requires a very good level of adherence (95%) to suppress viral replication. Despite all the strategies to address the adherence barriers to HAART (highly active antiretroviral therapy), the problems of poor adherence are ever-present. Factors determining adherence to HAART drug regimens have been studied in various population but little is known on this subject among PLHIV (people living with HIV) in Nigeria. Identifying and overcoming the factors that reduce adherence to combination antiretroviral agents is of utmost importance for prolonged viral load suppression. Very few of the strategies developed to mitigate the challenges of non-adherence were based on the theories of health behavior. However, behavioural theories, if adopted, could assist in the development of more effective interventions to improve treatment adherence. This cross-sectional study was conducted to explain the dynamics of HAART adherence among Nigerians living with HIV/AIDS; using behaviour change theories such as the Theory of Planned Behavior (TPB) and Health Belief Model (HBM). Methods: This was a questionnaire-based study using closed ended-questionnaires administered by the on the 225 participants. Findings: There were more female (181, 80.40%) than male (19.6%) living with HIV infection among the respondents. More than half, (139, 61.7%), of the respondents were married while less than a fifth (66; 29%) were singles About 96% of the respondents were literate with 2.7% illiteracy rate. Employment rate was also more than half (59%) while the unemployed rate was about 31.6%. Most (202, 89.8%) were of the Christianity faith TPB model factors such as the ability to set realistic goals and objectives with respect to medication adherence and meet such goals did not have any significant association with adherence (P 0.001) among the PLHIV. Likewise other TPB factors like determination and self-discipline to adhere to medications (HAART) did not have statistical association with HAART adherence. On the other hand, Health Believe Model (HBM) components such as the believes that adherence to HAART improves HIV patent's health condition (P=0.004),adherence to HIV medication is feasible in the Nigerian context (P=0.00), refusal to adhere to HAART is a serious health risk for the HIV patient (P=0.00), non-adherence to HAART is life threatening for the HIV patient(P=0.00), non-adherence to HAART can lead to AIDS faster (P=0.00) and the consequences of non-adherence to HAART are severe (P=0.00) all show significant statistical association with HAART adherence .Also significant statistical association was found between HAART adherence and other health believes like adherence to HAART is beneficial (P=0.00). Conclusion: Unlike the theory of planned behaviour, health believes Model was most suited to explaining or predicting patterns of HAART adherence behaviour among Nigerians PLHIV. However, for the model to be most effective it would need to be integrated with other models that take into account the environmental context and recommend strategies for change.

Efavirenz treatment causes arterial stiffening in apolipoprotein E-null mice

The development of highly active antiretroviral therapy (HAART) has transformed HIV-1 infection from a terminal diagnosis to a chronic, yet manageable disease. However, people living with HIV-1 exhibit a host of non-AIDS-related co-morbidities including cardiovascular disease (CVD). Several HAART drugs have been implicated in the development of CVD; however, the role of efavirenz (EFV), a highly prescribed HAART drug, in early-onset CVD is poorly understood. We treated apolipoprotein E-null (ApoE-/-) mice with EFV (75mg/kg/day) or vehicle, via oral gavage, for 35 days and quantified commonly measured preclinical markers of CVD (intima-media thickening, arterial stiffening) and plaque area. Suprarenal abdominal aortas were subjected to cylindrical biaxial biomechanical testing and standard histology. Aortas from EFV-treated mice demonstrated decreased compliance (i.e., increased arterial stiffness) and decreased axial force and a trend toward decreased in vivo axial stretch, but EFV treatment had no effect on intima-media thickness of the aortic wall or plaque coverage in thoracic aortas and aortic arches. Taken together, these data suggest that EFV leads to arterial stiffening but, for the dose and duration tested, did not lead to elevated plaque progression in ApoE-/- mice.

Colorimetric Detection of Azidothymidine Using an Alkyne-Modified Dextran Substrate.

Monitoring the adherence of patients taking highly active antiretroviral therapy (HAART) is a key step in treating an HIV infection, especially in resource-limited settings in the developing world. For most regimens, when patients are not at least 95% adherent to their drug schedule, there is a loss of effectiveness in treatment resulting in increases in health care costs, increases in the rate of transmission, and reduction of positive patient outcomes. Currently, subjective methods such as pill counting, electronic drug monitoring, and patient self-reporting are the only ways clinicians can track adherence and intervene in cases of noncompliance. We address this issue by developing a dipstick-based point-of-care azide-alkyne click chemistry assay with colorimetric read-out that directly tests for the presence of one common HAART drug in patient urine. An alkyne-modified dextran was synthesized and characterized by NMR and then used to colorimetrically report the presence of azidothymidine, an azide-containing HAART drug, in urine samples. The assay is specific to azide-containing molecules that are not naturally present in the urine and is sensitive to physiologically relevant urine concentrations as low as 750 uM. This point-of-care device is a strong alternative in resource-limited settings over current direct measurement techniques that are expensive and require trained users such as HPLC.

Acrolein Exacerbates HAART–Induced Apoptotic Death in Hepatocytes by Enhancing Transcriptionally Permissive Epigenetic Modifications at FasL Promoter

Highly active antiretroviral therapy (HAART) ‐ associated hepatotoxicity is becoming a major clinical problem leading to morbidity, mortality and treatment discontinuation in HIV patient. Environmental/dietary factors are known to significantly impact general health as well as therapeutic outcomes. Acrolein is one such common dietary and environmental pollutant and is also generated endogenously by cellular metabolism. The present study examines the hepatotoxic interactions of acrolein with HAART drug, azidothymidine (AZT).Human hepatoma cells (HepG2) as well as rat primary hepatocytes were used to examine the cytotoxic effects of acrolein (ACR) and AZT treatment either individually or in combination (AZT+ACR). Data showed that acrolein enhances expression of FasL gene, leading to increased apoptosis in AZT treated cells. Chromatin immunoprecipitation (ChIP) analysis revealed that ACR+AZT induced enhanced FasL transcription was mediated by increased in promoter histone H3K9 acetylation allowing recruitment of NFkB and RNA Polymerase II at the FasL promoter. Notably, acrolein scavenger, hydralazine significantly attenuated acrolein induced transcriptionally permissive modifications at the FasL promoter preventing FasL expression and hepatocyte cell death. Overall, the data suggest that environmental and/or dietary exposure to acrolein can induce chromatin modifications and further exacerbate the hepatotoxic effects of HAART medication affecting treatment options for HIV patients. This work was supported by NIH grants.

Effect of Calpurnia aurea Seed Extract on HAART Induced Haematotoxicity in Albino Wistar Rats

Aim: To investigate the effect of Calpurnia aurea seeds extract on highly active antiretroviral therapy (HAART), first phase regimen s ( Lamivudine + Efavirenz + Zidovudine) induced heamtotoxicity in rats. Study Design: Thirty adult healthy male albino wistar rats of weighing about 140 - 150 gms were used in the present study. They were divided into five group s six each. Group - I distilled water only; Group - II HAART drugs only; Group - III HAART drugs + 100 mg/kg of CASE (CASE: Calpurnia aurea Seed Extract); Group - IV HAART drugs + 200 mg/kg of CASE and Group - V HAART drugs + 300 mg/kg of CASE were administered orally for 35 day. Methodology: Matured dried seeds of Calpurnia aure a were collected, powdered and extracted using 70% ethanol. P reliminary phytochemical screening and in - vitro antioxidant properties of extract were done. The HAART and different doses of the Calpurnia aurea seed extract were administered orally for thirty - five days. On 35 th day, the rats were fasted overnight and the blood sample was collected by cardiac puncture after sacrificed the rats by cervical dislocation.

Cost analysis of initial highly active antiretroviral therapy regimens for managing human immunodeficiency virus-infected patients according to clinical practice in a hospital setting

ObjectiveIn the study reported here, single-tablet regimen (STR) versus (vs) multi-tablet regimen (MTR) strategies were evaluated through a cost analysis in a large cohort of patients starting their first highly active antiretroviral therapy (HAART). Adult human immunodeficiency virus (HIV) 1-naïve patients, followed at the San Raffaele Hospital, Milan, Italy, starting their first-line regimen from June 2008 to April 2012 were included in the analysis.MethodsThe most frequently used first-line HAART regimens (>10%) were grouped into two classes: 1) STR of tenofovir disoproxil fumarate (TDF) + emtricitabine (FTC) + efavirenz (EFV) and 2) MTR including TDF + FTC + EFV, TDF + FTC + atazanavir/ritonavir (ATV/r), TDF + FTC + darunavir/ritonavir (DRV/r), and TDF + FTC + lopinavir/ritoavir (LPV/r). Data were analyzed from the point of view of the Lombardy Regional Health Service. HAART, hospitalizations, visits, medical examinations, and other concomitant non-HAART drug costs were evaluated and price variations included. Descriptive statistics were calculated for baseline demographic, clinical, and laboratory characteristics; associations between categorical variables and type of antiretroviral strategy (STR vs MTR) were examined using chi-square or Fisher’s exact tests. At multivariate analysis, the generalized linear model was used to identify the predictive factors of the overall costs of the first-line HAART regimens.ResultsA total of 474 naïve patients (90% male, mean age 42.2 years, mean baseline HIV-RNA 4.50 log 10 copies/mL, and cluster of differentiation 4 [CD4+] count of 310 cells/μL, with a mean follow-up of 28 months) were included. Patients starting an STR treatment were less frequently antibody-hepatitis C virus positive (4% vs 11%, P=0.040), and had higher mean CD4+ values (351 vs 297 cells/μL, P=0.004) than MTR patients. The mean annual cost per patient in the STR group was €9,213.00 (range: €6,574.71–€33,570.00) and €14,277.00 (range: €5,908.89–€82,310.30) among MTR patients. At multivariate analysis, after adjustment for age, sex, antibody-hepatitis C virus status, HIV risk factors, baseline CD4+, and HIV-RNA, the cost analysis was significantly lower among patients starting an STR treatment than those starting an MTR (adjusted mean: €12,096.00 vs €16,106.00, P=0.0001).ConclusionSTR was associated with a lower annual cost per patient than MTR, thus can be considered a cost-saving strategy in the treatment of HIV patients. This analysis is an important tool for policy makers and health care professionals to make short- and long-term cost projections and thus assess the impact of these on available budgets.

Azidothymidine (AZT) leads to arterial stiffening and intima-media thickening in mice

HIV positive patients on highly active antiretroviral therapy (HAART) have shown elevated incidence of a number of non-AIDS defining co-morbidities, including cardiovascular disease. Given that HAART regimens contain a combination of at least three drugs, that disease management often requires adjustment of these regimens, and HIV, independent of HAART, also plays a role in development of co-morbidities, determining the role of specific HAART drugs and HIV infection itself from clinical data remains challenging. To characterize specific mediators and underlying mechanisms of disease, in vitro and in vivo animal models are required, in parallel with clinical data. Given its low cost azidothymidine (AZT) contributes to the backbone of a large proportion of HAART treated patients in the developing world where much of the global burden of HIV resides. The goal of this study was to test the hypothesis that AZT can lead to proatherogenic changes including the subclinical markers of arterial stiffening and intima-media thickening in mice. AZT (100mg/kg) or vehicle was administered to wild-type FVB/N mice via oral gavage for 35 days. Cylindrical biaxial biomechanical tests on the common carotid arteries and suprarenal aortas exhibited arterial stiffening in AZT mice compared to controls. Multiphoton microscopy and histology demonstrated that AZT led to increased intima-media thickness. These data correlated with decreased elastin content and increased protease activity as measured by cathepsin zymography; no differences were observed in collagen content or organization, in vivo axial stretch, or opening angle. Thus, this study suggests the drug AZT has significant effects on the development of subclinical markers of atherosclerosis.

Ethanol is a Significant Cofactor in HAART Induced Hepatotoxicity

Highly Active Antiretroviral Therapy (HAART) has significantly increased life expectancy of HIV patients; however, there are major side effects which include lipodystrophy and hepatotoxicity. Alcohol abuse is highly prevalent in HIV patients and can be a significant negative cofactor in HAART‐hepatotoxicity. Hence, the mechanisms underlying HAART and alcohol induced hepatotoxicity were investigated. Specifically, effects of HAART drugs (azidothymidine, and Indinavir sulphate) in combination with alcohol were examined both in vitro and in vivo. Individually, alcohol and AZT caused cytotoxicity in H4IIEC3 (a rat hepatoma) cells which was significantly increased in combination. These data indicate that alcohol can induce and further enhance HAART‐cytotoxicity.Assessment of Alcohol and HAART drug interaction and hepatotoxicity using an animal model of chronic alcohol feeding showed increased visceral adiposity compared to pair‐fed animals, suggesting disturbances in lipid metabolism. Lipodystrophy was seen as hepatic macro and microvesicular steatosis, elevated triglycerides and free fatty acids. These animals also exhibited increased inflammation and hepatic neutrophil infiltration. Overall, our data demonstrate that alcohol exacerbates HAART hepatotoxicity, and act as a significant cofactor in the development of hepatic steatosis and liver injury.

Acrolein enhances anti‐HIV‐ HAART medication‐ induced hepatotoxicity

Highly active antiretroviral therapy (HAART) has significantly increased the life expectancy of patients with HIV infection. However, HAART‐ associated hepatotoxicity is becoming a major clinical problem and can be potentially compounded by exposure to diet/environment ‐ derived reactive aldehydes, particularly acrolein. The present study investigates the combined effects of acrolein along with HAART drug, azidothymidine (AZT) in a human hepatocyte cell line (HepG2). Our results showed that exposure to either acrolein or AZT had minimal to no effect on hepatocyte survival. However acrolein in combination with AZT led to a significant increase in hepatocyte apoptotic death. The increase in apoptosis was accompanied by transcriptionally permissive H3 histone acetylation at FasL‐promoter and consequent FasL gene expression. Interestingly, concomitant with the induction of FasL and apoptotic death there was a significant attenuation of autophagy as indicated by a decrease in Beclin‐1 and an increase in LC3II/LC3I ratio. These data strongly suggest that the mechanisms underpinning acrolein‐AZT mediated hepatotoxicity involves the suppression of autophagy and induction of FasL mediated apoptosis. Overall, the data suggest that presence of diet/environment derived reactive aldehydes can play a pathogenic role in HIV patients by enhancing HAART‐hepatotoxicity. This work was supported by NIH grants.

Ginsenoside Rb1 Blocks Ritonavir-Induced Endothelial Dysfunction Through Estrogen Receptor-Beta Signaling and SOD1 Upregulation in Human Endothelial Cells

Highly active anti-retroviral therapy (HAART) is effective in controlling HIV infection and reducing the mortality and morbidity of the HIV-infected patients. However, this therapy may be associated with a higher risk of cardiovascular disease. Our previous studies demonstrated that ritonavir (RTV), one of HAART drugs, significantly increases oxidative stress and decreases endothelial nitric oxide synthase (eNOS) expression in human endothelial cells; and several antioxidants including ginsenoside Rb1 can effectively block this side effect of RTV.

HIV Co-Infections with Hepatitis B and C

With the introduction of highly active antiretroviral therapy (HAART), Human Immunodeficiency Virus (HIV) infected patients live longer and many have co-infections with chronic hepatitis B (HBV) or hepatitis C (HCV) that complicates their care. Treatment of HBV and HCV in the HIV positive co-infected patient requires careful consideration of the timing of initiation of HAART treatment, drug-drug interactions and drug and immune effects. It is an exciting era due to the introduction of new medications available to treat both HBV and HCV infections. Knowledge of the complex interactions between these viruses as well as the effect of various treatment modalities on each virus is the key to understanding and treating these patients effectively

Anti-retroviral drugs do not facilitate hepatitis C virus (HCV) infection in vitro

An estimated 4 to 5 million people are co-infected with HIV/HCV worldwide. Recently observed outbreaks of acute HCV infection among HIV-positive men who have sex with men (MSM) have been linked to behavioral factors such as high risk sexual practices and recreational drug use. However, at the molecular level, many drugs such as glucocorticoids or cyclosporine A have been found to modulate viral replication. Thus, it is conceivable that drugs used in highly active antiretroviral therapy (HAART) may heighten susceptibility to HCV infection and contribute to the recent outbreaks. We therefore performed a comprehensive screen of antiretroviral drugs covering all available drug classes both individually and in typical combinations used during HAART to probe for direct effects on HCV cell entry, replication, new particle assembly and release. Importantly, no significant enhancement or inhibition of HCV cell entry, replication or new particle production was detected. While raltegravir and ritonavir boosted atazanavir reduce HCV replication, a tenfold reduction of HCVcc entry by the CCR5 antagonist maraviroc was observed.In conclusion, commonly used HAART agents do not specifically enhance HCV replication. Thus recent epidemic outbreaks of acute HCV in HIV-infected MSM are unlikely to be related to enhancing effects of HAART drugs.

An investigation of the possible interaction between the use of Vitamin C and highly active antiretroviral therapy (HAART) adherence and effectiveness in treated HIV+ women

Our goal in this study was to examine how Vitamin C interacts with antiretroviral therapy in individuals with HIV. We specifically evaluated how Vitamin C impacts highly active antiretroviral therapy (HAART) adherence and HAART effectiveness as adjudicated by HIV viral loads and CD4 cell counts. Women served as their own controls, comparing periods of Vitamin C usage with periods of non-usage. An intra-individual, cross-sectional comparative study 'nested' in the WIHS observational cohort study. Women in the Women's Interagency HIV Study (WIHS). Adherence, CD4 count and viral load. Our study population was drawn from 2813 HIV+ participants who contributed 44,588 visits in WIHS from October, 1994 to April, 2009. Among them, there were 1122 Vitamin C users with 4954 total visits where use was reported. In the multivariate model adjusting for age, education, race, income, drug use, Vitamin C use order and depression score, there was a 44% increase in the odds of ≥ 95% HAART adherence among participants during their period of Vitamin C use compared to when they were not using Vitamin C (OR=1.44; 95% CI=1.1-1.9; P-value=0.0179). There was an association with Vitamin C usage and CD4 counts on viral loads. Vitamin C usage appears to be associated with improved adherence. Future Vitamin C studies should target specific HAART drugs, and prospective clinical outcomes.

Lipodystrophy and Associated Factors In Haart Receiving HIV Subjects In Sodo Town, Ethiopia

Ethiopia is one of the countries in Africa with a high prevalence of HIV/AIDS. Though the introduction of highly active antiretroviral therapy (HAART) improved survival and quality of life, early data from those treated, raised concerns about a possible increase in both peripheral and coronary arterial disease through lipodystrophy, diabetes mellitus and dyslipidemia. Hence an attempt was made in this study to assess the prevalence of lipodystrophy and to understand risk factors in HIV positive subjects receiving HAART. Study participants were men and women who were HIV/AIDS patients receiving HAART from Sodo government hospital, Southern Ethiopia. Data was collected on sociodemographic characteristics, HAART use, CD4 count, and subjects' status at the start of treatment, measure of body fat distribution and physical activity. In the present study the prevalence of moderate to severe clinical lipodystrophy in HIV-infected subjects receiving HAART for atleast 6 months was 15.9%, lipoatrophy was 9.1% and lipohypertrophy was 6.8%. Subjects who had been on HAART for 4 yrs or more, engaged in much lighter work intensity and who were underweight and overweight or obese had higher prevalence of lipodystrophy. In multivariate analysis, gender, duration of HAART, work intensity and recent BMI remained significantly associated with overall lipodystrophy. In multivariate analysis, for phenotypes of lipodystrophy, only work intensity remained significantly associated with lipoatrophy whereas work intensity and duration of HAART remained significantly associated with lipohypertrophy. Lipohypertrophy and lipoatrophy were positively associated with diabetes mellitus, while only lipohypertrophy was associated with hypertension. None of the HAART drugs or regimens were significantly associated with lipodystrophy and diabetes mellitus. Lipodystrophy syndrome has severe health consequences, as it may be responsible for stigma, reduced adherence to antiretroviral treatment, and increased risk of cardiovascular diseases.

Liver transplantation for patients with human immunodeficiency virus and hepatitis C virus coinfection with special reference to hemophiliac recipients in Japan

Liver transplantation for patients with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) remains challenging. The advent of highly active antiretroviral therapy (HAART) for HIV has reduced mortality from opportunistic infection related to acquired immunodeficiency syndrome dramatically, while about 50% of patients die of end-stage liver cirrhosis resulting from HCV. In Japan, liver cirrhosis frequently develops after HCV-HIV coinfection resulting from previously transfused infected blood products for hemophilia. The problems of liver transplantation for those patients arise from the need to control calcineurin inhibitor with HAART drugs, the difficulty of using interferon after liver transplantation with HAART, and the need to control intraoperative coagulopathy associated with hemophilia. We review published reports of liver transplantation for these patients in the updated world literature.

Effects of Jingyuankang Capsules ( ) on Leukocyte Level in AIDS Patients

To observe the therapeutic effects of Jingyuankang capsules for leukopenia in AIDS patients. In this randomized double-blind trial, 58 patients orally took Jingyuankang capsule, analog Leucogen tablet and the HAART (highly active anti-retroviral therapy) drugs, and the other 58 patients took Leucogen tablet, analog Jingyuankang capsule and the HAART drugs all for 6 months, during which the peripheral hemogram was periodically examined to observe the therapeutic effects of Jingyuankang capsule for leukopenia of the AIDS patients. With good therapeutic effect for leukopenia of the AIDS patients, Jingyuankang capsule can enhance leukocyte level as effective as Leucogen tablet in treating grade I and grade II leukopenia, and more effectively than Leucogen tablet in treating grade III leukopenia. No toxic side-effects and adverse reactions were found during the treatment and in the follow-up visit. Jingyuankang capsule can effectively treat leukopenia of the AIDS patients.