Human Deficiency Virus Research Articles

Prevalence and determinants to COVID-19 vaccine hesitancy among people living with HIV in Bench Sheko zone, Southwest Ethiopia: A multi-center study

IntroductionIn 2019, the World Health Organization (WHO) identified coronavirus disease-2019 (COVID-19) as one of the top 10 threats to global health. Currently, vaccine hesitancy is the most common obstacle to reducing COVID-19 incidence and achieving herd immunity worldwide. Understanding the factors influencing vaccine hesitancy in this specific population is crucial for developing targeted interventions to improve vaccine uptake and protect vulnerable communities. Therefore, this study aimed to evaluate the prevalence and determinants of COVID-19 vaccine hesitancy among people living with human immunodeficiency virus (HIV) who receive care at public health facilities in Bench Sheko Zone, Southwest Ethiopia. MethodsA multi-center study was employed, involving multiple healthcare facilities within the Bench Sheko Zone from January 1 to 30 February 2023 to assess the prevalence and determinants of hesitancy to COVID-19 vaccination among people living with human deficiency virus (PLHIV). Data were collected by using pre-tested interviewer administered questionnaires and document review, and entered into Epi-data version 3.1 then exported to and analyzed by using SPSS version 24. Statistical significance was assessed by using multivariable logistic regression analysis by determining odds ratios and 95% confidence interval. Multi-Collinearity and model fitness were also checked. ResultsAccording to the study, the prevalence of COVID-19 vaccine hesitancy was found to be 47.9%, [95% CI, 43.8–52.0]. One significant finding was that younger individuals (age ≤25years) [AOR = 2.30, 95%CI, 1.15–4.57] exhibited a higher level of hesitancy compared to their older counterparts. Additionally, the study identified monthly income≤3000 birr [AOR = 0.57, 95%CI, 0.31–0.92], urban residence [AOR = 0.61, 95%CI, 0.42–0.91], HIV stage one [AOR = 0.44, 95%CI, 0.27–0.73] and human immunodeficiency virus (HIV) clinical stage two of HIV [AOR = 0.60, 95CI, 0.39–0.93] as determinants of vaccine hesitancy. ConclusionAccording to our study finding in southwest Ethiopia, individuals living with HIV were found to have a higher level of hesitancy towards receiving the COVID-19 vaccine as compared with center for disease control and prevention estimate of vaccine hesitancy. The study also identified several factors that contribute to vaccine hesitancy, including age, urban of residence, income level, and HIV clinical stage. Addressing the identified factors in this specific population could decrease the hesitancy. To ensure the success of vaccination campaigns in the region, policymakers and stakeholders should take steps to address these underlying factors and promote greater acceptance of the COVID-19 vaccine among the population.

Increased prevalence of pretreatment drug resistance mutations in treatment-naïve people living with HIV-1 in Henan Province, China (2022/23)

Human deficiency virus type 1 (HIV-1) harboring drug resistance mutations (DRMs) before the initiation of antiretroviral therapy (ART) poses a serious threat to the efficacy of current ART regimens. Currently, the prevalence of pre-treatment drug resistance mutations (PDRMs) including transmitted DRMs (TDRMs) is not completely clear. Understanding this prevalence better should offer valuable data for clinical- and government-level decision-making. To closely monitor the PDRM trend in treatment-naïve people living with HIV/AIDS (PLWHA) in Henan Province, China, plasma samples from the patients seeking treatments at our hospital from January 2022 to February 2023 were collected for genotypic drug resistance testing. From the 645 patients whose samples were collected, partial pol and integrase gene sequences were obtained from 637 patients. Subtyping analysis indicated that the top-three most common subtypes, in descending order, were CRF07_BC (41.76%, 266/637), CRF01_AE (28.26%, 180/637), and B (20.41%, 130/637). PDRMs were observed in 5.18% (33/637), 6.28% (40/637), 0.31% (2/637), and 2.83% (18/637) cases for nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs), respectively; all these medications contributed to an overall PDRM prevalence of 11.93% (76/637). On analyzing individual PDRMs, we noted that the most commonly observed mutation(s) were K103S/N (3.77%, 24/637), M184I/V (3.14%, 20/637), followed by K65R (1.26%, 8/637), and V106A/M (1.10%, 7/637). PDRM prevalence in ART-naïve PLWHA of Henan Province is high and increased compared with that noted in previous years. However, evidence of cluster-linked outbreaks of PDRMs is lacking, suggesting that measures such as education about adherence and improved treatment strategies with a low incidence of failure can effectively reduce PDRM prevalence.

Characteristics of rectal chlamydia among men who have sex with men in southern Taiwan, 2020-2022: An emerging threat of rectal lymphogranuloma venereum L2b.

The prevalence of rectal chlamydia among men who have sex with men (MSM) without human deficiency virus infection (non-HIV) remains uncertain in Taiwan, and rectal lymphogranuloma venereum (LGV) among MSM has never been reported in the Far East. From January 2020 to April 2022, MSM coming for anonymous voluntary counseling and testing, for pre-exposure prophylaxis, and for antiretroviral therapy were enrolled. All participants submitted his fecal samples and completed a QR-code questionnaire. Medical records of those who took regular medical visits for HIV were recorded. Multiplex polymerase chain reaction (PCR) was performed for all fecal samples, and ompA gene sequencing was therefore performed for each Chlamydia-positive fecal sample. Among 341 MSM during 2020-2022 in southern Taiwan, 21 (6.2%) had rectal chlamydia infection. Risk factors of rectal chlamydia included co-infection with rectal gonorrhea (adjusted odds ratio [AOR] 6.78, 95% confidence interval [CI] 1.44-31.91, P=0.015) and multiple sexual partners (AOR 1.373, 95% CI 1.002-1.882, P=0.048). Further ompA gene sequencing from 19 Chlamydia-positive fecal samples revealed that the prevalent genotypes or genovariants were Da (26.3%) and L2b (26.3%), followed by B (21.1%), J (14.3%), and G (9.5%). All cases of rectal LGV genovariant L2b presented as acute proctitis with diarrhea, anal pain, or discharge and were treated successfully with prolonged treatment of doxycycline. Rectal gonorrhea and multiplex sexual partners are risk factors for rectal chlamydia. Clinicians in Taiwan should be aware of the emerging threat of rectal LGV among MSM with acute proctitis.

Stem cell therapy: a novel approach against emerging and re-emerging viral infections with special reference to SARS-CoV-2.

The past several decades have witnessed the emergence and re-emergence of many infectious viral agents, flaviviruses, influenza, filoviruses, alphaviruses, and coronaviruses since the advent of human deficiency virus (HIV). Some of them even become serious threats to public health and have raised major global health concerns. Several different medicinal compounds such as anti-viral, anti-malarial, and anti-inflammatory agents, are under investigation for the treatment of these viral diseases. These therapies are effective improving recovery rates and overall survival of patients but are unable to heal lung damage caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, there is a critical need to identify effective treatments to combat this unmet clinical need. Due to its antioxidant and immunomodulatory properties, stem cell therapy is considered a novel approach to regenerate damaged lungs and reduce inflammation. Stem cell therapy uses a heterogeneous subset of regenerative cells that can be harvested from various adult tissue types and is gaining popularity due to its prodigious regenerative potential as well as immunomodulatory and anti-inflammatory properties. These cells retain expression of cluster of differentiation markers (CD markers), interferon-stimulated gene (ISG), reduce expression of pro-inflammatory cytokines and, show a rapid proliferation rate, which makes them an attractive tool for cellular therapies and to treat various inflammatory and viral-induced injuries. By examining various clinical studies, this review demonstrates positive considerations for the implications of stem cell therapy and presents a necessary approach for treating virally induced infections in patients.

Professional commitment and willingness to care for people living with HIV among undergraduate nursing students: The mediating role of empathy

BackgroundAs future registered nurses, undergraduate students play a vital role in integrated care for acquired immunodeficiency syndrome; hence, there is a need to examine factors that can increase their willingness to care for persons with such conditions. ObjectiveThis study examined the relationship among nursing professional commitment, empathy, and willingness to care for people living with human immunodeficiency virus and acquired immunodeficiency syndrome among undergraduate student nurses, and the mediating role of empathy in this relationship. DesignQuantitative, cross-sectional design. SettingsNursing schools from five provinces of China, including Hunan, Jiangxi, Guangxi, Henan, and Hebei. ParticipantsA total of 747 undergraduate student nurses were recruited via cluster sampling. MethodsOnline survey was used to collect data. Nursing Willingness Questionnaire, Professional Commitment Scale, and Jefferson Scale of Empathy were the scales used to measure the variables. Structural equation modeling was used to determine significant relationships. ResultsRespondents' professional commitment and empathy demonstrated moderate positive associations with willingness to care. Empathy demonstrated a 21 % mediating effect on the effect of professional commitment and willingness to care (p < 0.05). ConclusionsFindings highlight the enabling role of professional commitment and empathy in improving undergraduate student nurses' willingness to care for persons living with human deficiency virus. Nurse educators can help improve the impact of students' professional commitment on their willingness by using educational strategies that enhance their empathy.

Knowledge and Risk factors of Cervical cancer among women in towns of Pune Division - Maharashtra

Cervical cancer (CC) is a worldwide disease with 97000 of new cases per year occurring in most populated country, India. The objective of this study was to find possible factors which could affect knowledge about CC and, some CC risk factors in our community. A community-based cross-sectional study was carried out in Maharashtra, State of India. Knowledge about CC is modulated by the level of education and the young age of women. Risk factors although universal seem to vary according to the geographical area and the socio-cultural environment where one lives. Some risk factors identified are early onset of sexual intercourse, polygamous marriages, multiple sexual partners, the sexual behavior of the male partner, Human papilloma virus (HPV) infections, sexually transmitted diseases (STDs), Human Deficiency Virus (HIV), and history of genital warts. No enhancement of lifestyle as the voluntary refusal of cervical cancer screening and CC vaccination have also be found to be risky attitudes for CC.

Seizure as Initial Presentation of HIV: A Case Report of Cerebral Toxoplasmosis

This paper reports a case of a previously healthy patient who presented with a generalised tonic-clonic seizure due to cerebral edema. Investigations revealed he had human Deficiency Virus (HIV) with cerebral toxoplasmosis and was co-infected with Hepatitis C. He was immediately placed on a toxoplasmosis treatment regime which, 4 weeks later, showed improvement in his clinical condition and computed tomography (CT) brain imaging. He was then put on antiretroviral therapy (ART). This case describes the management of a patient with newly diagnosed HIV with opportunistic and co-infections.

Primary Sternal Osteomyelitis Caused by Methicillin-Sensitive Staphylococcus aureus: A Diagnosis Rare in Healthy Adults

Primary sternal osteomyelitis (PSO) is a rare clinical entity, and usually, it is associated with predisposing factors such as intravenous drug use, diabetes mellitus, or human deficiency virus infection. In an otherwise healthy adult, it becomes an even rarer entity. Early diagnosis and treatment minimize associated morbidity, like the need for surgical debridement, longer courses of medication, and length of in-hospital stay.We describe the case of a 54-year-old man without any predisposing risk factors for PSO, who presented with chest pain, erythema, tenderness, and warmth at the right parasternal region. A non-enhanced thoracic tomography showed a 33 mm suspicious pulmonary nodule and no signs of sternum abnormalities. To better evaluate this finding, a positron emission tomography with fluorine-18 fluorodeoxyglucose was performed, showing abnormal uptake of the radionuclide at the sternomanubrial synchondrosis and no abnormal uptake at the lung parenchyma. The presence of Staphylococcus aureus in blood cultures, in conjunction with these results, supported the diagnosis of PSO. The patient completed six weeks of microbiologically oriented antibacterial therapy with complete recovery.

Black in Immuno ‐ amplifying, celebrating, and supporting Black voices in immunology

Black in Immuno ‐ amplifying, celebrating, and supporting Black voices in immunology

Particular Aspects on Applying Nanocarbon Quantum Dots for HIV Inhibition and Theranostics: a Review

Viral infection is a globally leading health issue, causing significantly unfavourable mortality with an adversely decreasing socio-economic growth. To solve those infections of global pandemic HIV specifically, the current utilization of highly active antiretroviral therapy (HAART) in human deficiency virus (HIV) theranostics has remarkably improved the life’s duration of patients infected by human immunodeficiency virus (HIV); however, the unfortunate drawbacks in combination with prolonged HAART therapy need to be used continuously along patient’s lifetime. Additionally, RNA virus of COVID-19 is also associated with viral pneumonia and acute respiratory distress syndrome causing significant morbidity and mortality. Meanwhile, many scientific researchers have explored the successive novelty of carbon quantum dots (CQDs) as alternative to HIV or other related viruses theranostics in the field of antiviral drugs research, but the attempt has been still challenging to introduce perfect antiviral CQDs with excellent biocompatibility, drug resistance, and safety at several areas in the virus’s life cycle. On the contrary, CQDs-based nano-therapy is currently promising because those carbon quantum dots had multiple favourable properties, including significant antiviral response effects, water-soluble activity, color-tunable fluorescence, high yield, low cytotoxic behaviour, and promising biocompatibility. In this review, some effectively recent progress of promising CQDs forviral inhibition and theranostics explored by many studies are systematically summarized.

Particular Aspects on Applying Nanocarbon Quantum Dots for HIV Inhibition and Theranostics: a Review

Viral infection is a globally leading health issue, causing significantly unfavourable mortality with an adversely decreasing socio-economic growth. To solve those infections of global pandemic HIV specifically, the current utilization of highly active antiretroviral therapy (HAART) in human deficiency virus (HIV) theranostics has remarkably improved the life’s duration of patients infected by human immunodeficiency virus (HIV); however, the unfortunate drawbacks in combination with prolonged HAART therapy need to be used continuously along patient’s lifetime. Additionally, RNA virus of COVID-19 is also associated with viral pneumonia and acute respiratory distress syndrome causing significant morbidity and mortality. Meanwhile, many scientific researchers have explored the successive novelty of carbon quantum dots (CQDs) as alternative to HIV or other related viruses theranostics in the field of antiviral drugs research, but the attempt has been still challenging to introduce perfect antiviral CQDs with excellent biocompatibility, drug resistance, and safety at several areas in the virus’s life cycle. On the contrary, CQDs-based nano-therapy is currently promising because those carbon quantum dots had multiple favourable properties, including significant antiviral response effects, water-soluble activity, color-tunable fluorescence, high yield, low cytotoxic behaviour, and promising biocompatibility. In this review, some effectively recent progress of promising CQDs forviral inhibition and theranostics explored by many studies are systematically summarized.

PS-062-The increasing importance of non-alcoholic fatty liver disease in human deficiency virus (HIV) positive patients

PS-062-The increasing importance of non-alcoholic fatty liver disease in human deficiency virus (HIV) positive patients

Quality of life among HIV-tuberculosis co-infected patients.

Background:India is the world's third leading country in terms of people living with human deficiency virus (HIV) (2.1 million) with 0.4 million deaths due to HIV-associated tuberculosis (TB). Physical and mental stress degrades the quality of life (QOL) in these patients. Studies have been done in HIV patients but very few on HIV-TB co-infected patients. Our study aims at assessing and comparing the QOL in HIV patients with and without TB.Materials and Methods:It was a cross-sectional study done at Antiretroviral Treatment Center of KMC, Mangalore and District Wenlock Hospital, Mangalore, over 6 months. A sample size was 104. Semi-structured questionnaire to collect clinico-demographic data, World Health Organization QOL (WHOQOL)-HIV BREF to assess the QoL, and Beck's Depression Inventory Scale (Physical health, psychological well-being, social relationship, environmental health, level of independence, and spiritual health) to identify depression were used. The Cronbach's alpha was used to measure the internal consistency for each domain of the WHOQOL-HIV instrument.Results:HIV-TB co-infected patients had a lower mean score in all domains as compare to only HIV patients, suggesting that HIV-TB co-infected patients had a poor QOL (P < 0.05). Internal consistency of each domain was good (α >0.7).Conclusion:To improve the QOL in HIV patients, it is important to identify the determinants of QOL and work toward its improvement.

Clinical and demographic profile of catatonic patients who received electroconvulsive therapy in a South African setting.

BackgroundCatatonia is a psychomotor dysregulation syndrome seen in several illnesses. Uncertainties exist regarding its prevalence and causes. While some research shows a strong association with mood disorders, other data show catatonia to be strongly associated with schizophrenia. Data from low- and middle-income countries are required.AimTo determine the clinical and demographic profile of patients with catatonia that received electroconvulsive therapy (ECT) between 01 January 2012 and 31 December 2014.SettingThe study was conducted at Elizabeth Donkin Psychiatric Hospital in Port Elizabeth, Eastern Cape. The hospital has mostly patients admitted under the Mental Health Care Act 17 of 2002 as Involuntary Mental Health Care Users.MethodA retrospective chart review was conducted. Using the hospital ECT database, all files of patients who received ECT for catatonia were identified. Demographics, psychiatric and medical diagnoses, signs of catatonia and other data were abstracted from these files.ResultsForty-two patients received ECT for catatonia, of whom 34 (80.95%) were diagnosed with a psychotic illness. Schizophrenia was the most common diagnosis (n = 19; 45.24%), followed by psychotic disorder owing to a general medical condition (n = 8; 19.05). Human immunodeficiency deficiency virus was the cause in 75.00% of the patients whose medical conditions caused catatonia. Seven (16.67%) patients had mood disorders, with bipolar I disorder accounting for 6 (14.29%) of these.ConclusionPsychotic disorders were more frequent than mood disorders in the sample. Schizophrenia was the most common diagnosis, followed by psychotic disorder owing to a general medical condition.

The relationship between hemoglobin A1C levels and sputum conversion time in indonesian patients with new cases of pulmonary tuberculosis

Background: Hemoglobin A1c (HbA1c) is a glycated form of hemoglobin and is associated with increased susceptibility to tuberculosis (TB), severity, and resistance to therapy. We aimed to determine the impact of HbA1c levels on sputum conversion time among Indonesian patients with pulmonary TB under the intensive phase of TB treatment. Methods: This prospective cohort study was conducted in patients with new cases of pulmonary TB patients aged ≥15-year-old and had never been diagnosed with type 2 diabetes mellitus (T2DM). The exclusion criteria of this study are pulmonary TB accompanied by T2DM, pregnancy, or coinfected with human deficiency virus. Statistical analysis was performed using Fisher's exact test to find the relative risk of all variables. We also performed power analysis to check the sample sufficiency. Results: One hundred and twenty-three patients of new cases of pulmonary TB were included in this study; of which 63 females and 60 males. There were 12 patients who had HbA1c levels ≥47.5 mmol/mol. More than half (56.1%) of patients had smear-positive acid-fast bacilli and duration of sputum smear conversion time for more than 2 months was recorded in 11 patients (8.9%). There was a significant relationship between HbA1c levels >47.5 mmol/mol and sputum conversion time >2 months with a relative risk of 6.3 (1.9–39.6), value of P = 0.01. Conclusion: HbA1c levels played an important role toward sputum smear conversion time in patients with new cases of pulmonary TB, and therefore, HbA1c should be considered as an important factor for the outcome in patients receiving anti-TB drugs.

Prevalence and Pattern of Sexually Transmitted Infections/HIV among the High Risk Groups in Dakshina Kannada District (Rural), India

Introduction: Human Deficiency Virus and other sexually transmitted infections (STIs) often coexist and share common modes of transmission. High risk groups (HRGs) under National AIDS Control Programme in India include Female Sex Workers (FSWs), Men having Sex with Men (MSMs) and Intravenous Drug Users (IDUs). Objectives: This study assessed the pattern of Sexually Transmitted Infections (STIs) among the high risk groups including Female Sex Workers (FSWs) and Men Having Sex with Men (MSMs) using the syndromic management approach. Methodology: STI clinics were conducted on a monthly basis by a NGO working in 100 high risk villages in Dakshina Kannada district. These HRGs were treated using syndromic management for STIs and also provided referral to Integrated Counseling and Testing Centres (ICTCs) for HIV/ AIDS. Syndromic management is a comprehensive approach for STI/RTI control endorsed by the World Health Organization. A questionnaire was used to include the socio-demographic characteristics of HRGs and the diagnoses made. The data sheet did not contain any personal details, maintaining complete anonymity of the study participants. Statistical tests used were proportions to assess proportion and patterns; t-test for difference in proportions among the subgroups of HRGs. Results: The most common diagnosis was vaginitis followed by urethritis, cervicitis, PID and inguinal bubo. The prevalence of STIs was significantly higher among FSWs than MSMs. Conclusion: Sexually transmitted infections continue to persist in high risk groups and hence require sustained strategies for prevention under the framework of existing national programmes.

Modulation of gene expression in CD4+ T lymphocytes following in vitro HIV infection: a comparison between human and chimpanzee.

Chimpanzees are susceptible to experimental infection by human deficiency virus (HIV)-1, but unlike humans, they exceptionally develop an immunodeficiency syndrome after HIV-1 inoculation. To explore the difference between human and chimpanzee, we analyzed the expression of 1547 genes of various functions in human or chimpanzee CD4+ lymphoblasts inoculated in vitro with HIV-1. We observed that, 1day after HIV inoculation, fifty-eight genes were up-regulated in lymphoblasts of the three humans while their expression remained unchanged in lymphoblasts of the three chimpanzees. One gene is involved in adhesion of HIV (catenin-alpha), three in the immune response (semaphorin 4D, placental growth factor, IL-6), three in apoptosis (deleted in colorectal carcinoma, caspase 9 and FOXO1A). No difference between species was revealed for the expression of 373 genes related to glycosylation pathways. The in vitro human/chimpanzee comparison reveals new candidate genes up-regulated after inoculation with HIV-1 only in human lymphoblasts and which could be related to the higher sensitivity of human to HIV-induced AIDS.

The value of flow cytometry in the measurement of platelet activation and aggregation in human immunodeficiency virus infection

Human immunodeficiency deficiency virus (HIV) infection is associated with chronic inflammation and an increased risk of thrombotic events. Activated platelets (PLTs) play an important role in both thrombosis and inflammation, and HIV has been shown to induce PLT activation by both direct and indirect mechanisms. P-selectin (CD62P) is a well-described marker of PLT activation, and PLT glycoprotein (GP) IV (CD36) has been identified as a marker of PLT aggregation. Data on PLT function in the context of HIV infection remain inconclusive. Laboratory techniques, such as flow cytometry, enable the assessment of PLTs in their physiological state and environment, with minimal artifactual in vitro activation and aggregation. In this study, we describe a novel flow cytometry PLT assay, which enabled the measurement of PLT function in HIV infection. Forty-one antiretroviral-naïve HIV-positive individuals and 41 HIV-negative controls were recruited from a clinic in the Western Cape. Platelet function was evaluated by assessing the response of platelets to adenosine diphosphate (ADP) at two concentrations (0.04 mM, 0.2 mM). The percentage expression and mean fluorescence intensity (MFI) of CD62P and CD36 was used to evaluate platelet function. These were then correlated with platelet (PLT) count; CD4 count; % CD38/8; viral load and D-dimers. The % CD62P levels were higher in HIV-positive patients (HIV % CD62P 11.33[5.96–29.36] vs. control 2.48[1.56–6.04]; p < 0.0001). In addition, the HIV group showed higher CD62P MFI levels (HIV CD62P MFI 3.25 ± 7.23 vs. control 2.35 ± 1.31, p = 0.0292). Baseline levels of %CD36 expression were significantly higher in HIV-positive patients (%CD36 12.41[6.31–21.83] vs. control 6.04[1.34–13.15]; p = 0.0091). However, the baseline CD36MFI showed no significant difference between the two groups (HIV CD36 MFI 3.09 ± 0.64 vs. control 2.44 ± 0.11, p = 0.4591). The HIV group showed higher levels of % CD36 expression post stimulation with 0.04 mM ADP 43.32 ± 27.41 vs. control 27.47 ± 12.95; p < 0.0214) and no significant difference at 0.2 mM ADP (HIV % CD36 39.06 ± 17.91 vs. control 44.61 ± 18.76; p = 0.3277). Furthermore, the HIV group showed a single phase response to ADP as compared to the control group, which showed a normal biphasic response. We concluded that PLT flow cytometry is valuable in the assessment of levels of PLT activation, and further, that the addition of an endogenous agonist, such as ADP, enabled the measurement of PLT function in HIV infection. We were able to show that, although PLTs are significantly activated in HIV compared to uninfected controls, they retain their functional capacity.

Alcoholic liver disease: a synopsis of the Charles Lieber's Memorial Symposia 2009-2012.

This paper is based upon the 'Charles Lieber Satellite Symposia' organized by Manuela G. Neuman at each of the 2009-2012 Research Society on Alcoholism (RSA) Annual Meetings. The presentations represent a broad spectrum dealing with alcoholic liver disease (ALD). In addition, a literature search (2008-2013) in the discussed area was performed in order to obtain updated data. The presentations are focused on genetic polymorphisms of ethanol metabolizing enzymes and the role of cytochrome P4502E1 (CYP2E1) in ALD. In addition, alcohol-mediated hepatocarcinogenesis, immune response to alcohol and fibrogenesis in alcoholic hepatitis as well as its co-morbidities with chronic viral hepatitis infections in the presence or absence of human deficiency virus are discussed. Finally, emphasis was led on alcohol and drug interactions as well as liver transplantation for end-stage ALD.

Adrenal Enzyme Impairment in Neonates and Adolescents Treated with Ritonavir and Protease Inhibitors for HIV Exposure or Infection

Background: Human deficiency virus (HIV) protease inhibitors (PIs) are widely used drugs whose effects are pharmacologically enhanced by ritonavir, a potent cytochrome P450 inhibitor. We reported previously that prophylactic postnatal ritonavir-PI therapy in HIV-exposed neonates was associated with increases in plasma 17-hydroxyprogesterone (17-OHP) and dehydroepiandrosterone sulfate (DHEA-S). Aims: To further investigate adrenal function in neonates and adolescents given ritonavir-PI. Methods: Adrenal function was assessed prospectively in 3 HIV-exposed neonates given short-term prophylactic treatment and 3 HIV-infected adolescents given long-term treatment. Plasma cortisol, 17-OHP, 17-OH-pregnenolone, DHEA-S, and androstenedione were measured before and after ACTH administration. Results: None of the patients had clinical signs of adrenal dysfunction. The only neonate exposed to ritonavir-PI in utero had up to 3-fold increases in plasma 17-OHP. Increases in 17-OH-pregnenolone of up to 3.1-fold were noted in 4 of the 6 patients, and all 6 patients had elevations in DHEA-S (up to 20.4-fold increase) and/or DHEA (up to 4.7-fold) and/or androstenedione (up to 5.2-fold). All these parameters improved after treatment completion. Conclusion: Neonates and adolescents given ritonavir-PI exhibit a similar adrenal dysfunction profile consistent with an impact on multiple adrenal enzymes. These abnormalities require evaluation, given the potentially long exposure times.