Objective: To evaluate the virological status of ineligible HIV patients for anti-retroviral therapy based on the criterion of CD4+ T lymphocytes rate over than 350/μl of blood. Method: This is a prospective study wh...Objective: To evaluate the virological status of ineligible HIV patients for anti-retroviral therapy based on the criterion of CD4+ T lymphocytes rate over than 350/μl of blood. Method: This is a prospective study which was conducted from November 2011 to July 2012 in the tropical and infectious disease department of CHU Sylvanus Olympio of Lomé. All HIV-1 infected patients whose CD4+ T lymphocytes rate was ≥350/μl of blood were retained. The count of CD4+ T lymphocytes was made by cytometer FACSCalibur? flow of BD biosciences and the determination of viral load was achieved by NASBA laboratory method of Biomérieux. Results: We have recruited 102 PLWHA aged between 19 and 58 years with a median of 35 years. Biologically, 102 patients had a T-CD4 rate between 355 and 432/μl of blood. The determination of viral load showed a very high viral replication more than 10,000 copies/ml among all patients and 28 (27.5%) patients had a viral load > 100,000 copies/ml of blood. Conclusion: Our results argue for a reconsideration of the criteria for starting antiretroviral therapy in Togo by including virological data if necessary in patients with T-CD4 rate below 500/μl of blood.展开更多
BACKGROUND: Much evidence demonstrates that the genotypes of hepatitis B virus (HBV) present differences in pathogenicity and outcomes owing to differences in genetic structure. This study aimed to investigate the inf...BACKGROUND: Much evidence demonstrates that the genotypes of hepatitis B virus (HBV) present differences in pathogenicity and outcomes owing to differences in genetic structure. This study aimed to investigate the influences of HBV genotypes on the anti-viral therapeutic efficacy of interferon-alpha (IFN-alpha) in chronic hepatitis B patients, and to determine the relationship between HBV genotypes and levels of viral replication or gene variations. METHODS: The chronic hepatitis B patients who were treated with IFN-alpha were selected randomly. Anti-viral therapeutic efficacy was monitored in these patients. The HBV genotypes were detected by PCR microplate hybridization ELISA. The levels of serum HBV-DNA were determined by fluorescence quantitative PCR. HBV gene variation at pre-C and basic core promoter (BCP) regions were assayed by gene chip technology. RESULTS: Genotypes B and C were predominant in 94 chronic hepatitis B patients. A, E and F genotypes were not found in these patients. The HBV-DNA levels of genotype C and mixed genotypes were significantly higher than those of genotype B. The response to IFN-alpha in patients with genotype B was markedly better than in those with genotypes C and D, and the complete response to IFN-alpha was only observed in genotype B. The response to IFN-alpha in patients with mixed genotypes was the least sensitive. The negative transition of HBeAg was correlated with variations in the HBV pre-C and BCP regions in patients with partial or no response to IFN-alpha. The variation rates of HBV pre-C and BCP regions were clearly higher in genotype C than in genotype B. CONCLUSIONS: The results suggest that HBV genotype is correlated with the serum levels of HBV-DNA, HBV gene variations and therapeutic efficacy of IFN-alpha. The regular detection of HBV genotypes in the clinic will be of benefit for disease prognosis and planning of anti-viral therapeutic strategies.展开更多
Hepatic sarcoidosis is usually asymptomatic but rarely leads to adverse liver-related outcome.Co-existence of viral hepatitis and hepatic sarcoidosis is a rare,but recognised phenomenon.Obtaining a balance between imm...Hepatic sarcoidosis is usually asymptomatic but rarely leads to adverse liver-related outcome.Co-existence of viral hepatitis and hepatic sarcoidosis is a rare,but recognised phenomenon.Obtaining a balance between immune suppression and anti-viral therapy may be problematic.Immunosuppression in the presence of viral hepatitis can lead to rapid deterioration of liver disease.Similarly,anti-viral therapy may exacerbate granulomatous hepatitis.Here we present two cases of viral hepatitis co-existing with sarcoidosis that illustrate successful management strategies.In one,hepatitis B replication was suppressed with oral antiviral therapy before commencing prednisolone.In the second,remission of hepatic sarcoidosis was achieved with prednisolone,before treating hepatitis C and obtaining a sustained virological response with pegylated interferon and ribavirin therapy.展开更多
Background: Several studies indicate that depression is associated with non-viral suppression among persons living with HIV (PLWH) using antiretroviral therapy (ART) worldwide. However, among PLWH with major depressiv...Background: Several studies indicate that depression is associated with non-viral suppression among persons living with HIV (PLWH) using antiretroviral therapy (ART) worldwide. However, among PLWH with major depressive disorder, factors associated with non-viral suppression remain uncertain. We determined the prevalence and identified the factors associated with viral non-suppression among PLWH with major depressive disorder using ART in Northern Uganda. Method: A total of 30 primary care HIV clinics across three northern districts (Gulu, Kitgum, Pader) participated in the study. Using baseline data from the SEEK-GSP study, a cluster-randomized trial in northern Uganda (2016-2019) that involved 1140 PLWH with mild to moderate major depressive disorder;we examined the demographic, clinical, and psychosocial factors using standardized questionnaires. Data on viral load was abstracted from clinic records and dichotomized into suppressed (Results: We recruited 1140 PLWH. The viral non-suppression prevalence was 12.2%. In multivariable analysis, the only baseline psychosocial variable independently associated with non-viral suppression was suicide risk (PRR = 1.56, 95% CI: 1.05 - 2.32, p-value = 0.029). The prevalence odds for non-viral suppression were 56% higher among depressed PLWH with moderate to high suicide risk than those with low suicide risk. Among clinical variables, duration on ART ≥ 4 years was independently associated with non-viral suppression (PRR = 1.62, 95% CI: 1.09 - 2.32, p-value = 0.015). Conclusions: Suicide risk and longer duration on ART are associated with non-viral suppression among anti-retroviral therapy users with mild to moderate major depressive disorder in Uganda. As ART is scaled up across Sub-Saharan Africa, first-line psychological care for depression and its complications is urgently needed in established HIV treatment centers.展开更多
文摘Objective: To evaluate the virological status of ineligible HIV patients for anti-retroviral therapy based on the criterion of CD4+ T lymphocytes rate over than 350/μl of blood. Method: This is a prospective study which was conducted from November 2011 to July 2012 in the tropical and infectious disease department of CHU Sylvanus Olympio of Lomé. All HIV-1 infected patients whose CD4+ T lymphocytes rate was ≥350/μl of blood were retained. The count of CD4+ T lymphocytes was made by cytometer FACSCalibur? flow of BD biosciences and the determination of viral load was achieved by NASBA laboratory method of Biomérieux. Results: We have recruited 102 PLWHA aged between 19 and 58 years with a median of 35 years. Biologically, 102 patients had a T-CD4 rate between 355 and 432/μl of blood. The determination of viral load showed a very high viral replication more than 10,000 copies/ml among all patients and 28 (27.5%) patients had a viral load > 100,000 copies/ml of blood. Conclusion: Our results argue for a reconsideration of the criteria for starting antiretroviral therapy in Togo by including virological data if necessary in patients with T-CD4 rate below 500/μl of blood.
基金This study was supported by a grant from the Scientific and Technology Bureau of Hubei Province Foundation(No.2005AA301C26).
文摘BACKGROUND: Much evidence demonstrates that the genotypes of hepatitis B virus (HBV) present differences in pathogenicity and outcomes owing to differences in genetic structure. This study aimed to investigate the influences of HBV genotypes on the anti-viral therapeutic efficacy of interferon-alpha (IFN-alpha) in chronic hepatitis B patients, and to determine the relationship between HBV genotypes and levels of viral replication or gene variations. METHODS: The chronic hepatitis B patients who were treated with IFN-alpha were selected randomly. Anti-viral therapeutic efficacy was monitored in these patients. The HBV genotypes were detected by PCR microplate hybridization ELISA. The levels of serum HBV-DNA were determined by fluorescence quantitative PCR. HBV gene variation at pre-C and basic core promoter (BCP) regions were assayed by gene chip technology. RESULTS: Genotypes B and C were predominant in 94 chronic hepatitis B patients. A, E and F genotypes were not found in these patients. The HBV-DNA levels of genotype C and mixed genotypes were significantly higher than those of genotype B. The response to IFN-alpha in patients with genotype B was markedly better than in those with genotypes C and D, and the complete response to IFN-alpha was only observed in genotype B. The response to IFN-alpha in patients with mixed genotypes was the least sensitive. The negative transition of HBeAg was correlated with variations in the HBV pre-C and BCP regions in patients with partial or no response to IFN-alpha. The variation rates of HBV pre-C and BCP regions were clearly higher in genotype C than in genotype B. CONCLUSIONS: The results suggest that HBV genotype is correlated with the serum levels of HBV-DNA, HBV gene variations and therapeutic efficacy of IFN-alpha. The regular detection of HBV genotypes in the clinic will be of benefit for disease prognosis and planning of anti-viral therapeutic strategies.
文摘Hepatic sarcoidosis is usually asymptomatic but rarely leads to adverse liver-related outcome.Co-existence of viral hepatitis and hepatic sarcoidosis is a rare,but recognised phenomenon.Obtaining a balance between immune suppression and anti-viral therapy may be problematic.Immunosuppression in the presence of viral hepatitis can lead to rapid deterioration of liver disease.Similarly,anti-viral therapy may exacerbate granulomatous hepatitis.Here we present two cases of viral hepatitis co-existing with sarcoidosis that illustrate successful management strategies.In one,hepatitis B replication was suppressed with oral antiviral therapy before commencing prednisolone.In the second,remission of hepatic sarcoidosis was achieved with prednisolone,before treating hepatitis C and obtaining a sustained virological response with pegylated interferon and ribavirin therapy.
文摘Background: Several studies indicate that depression is associated with non-viral suppression among persons living with HIV (PLWH) using antiretroviral therapy (ART) worldwide. However, among PLWH with major depressive disorder, factors associated with non-viral suppression remain uncertain. We determined the prevalence and identified the factors associated with viral non-suppression among PLWH with major depressive disorder using ART in Northern Uganda. Method: A total of 30 primary care HIV clinics across three northern districts (Gulu, Kitgum, Pader) participated in the study. Using baseline data from the SEEK-GSP study, a cluster-randomized trial in northern Uganda (2016-2019) that involved 1140 PLWH with mild to moderate major depressive disorder;we examined the demographic, clinical, and psychosocial factors using standardized questionnaires. Data on viral load was abstracted from clinic records and dichotomized into suppressed (Results: We recruited 1140 PLWH. The viral non-suppression prevalence was 12.2%. In multivariable analysis, the only baseline psychosocial variable independently associated with non-viral suppression was suicide risk (PRR = 1.56, 95% CI: 1.05 - 2.32, p-value = 0.029). The prevalence odds for non-viral suppression were 56% higher among depressed PLWH with moderate to high suicide risk than those with low suicide risk. Among clinical variables, duration on ART ≥ 4 years was independently associated with non-viral suppression (PRR = 1.62, 95% CI: 1.09 - 2.32, p-value = 0.015). Conclusions: Suicide risk and longer duration on ART are associated with non-viral suppression among anti-retroviral therapy users with mild to moderate major depressive disorder in Uganda. As ART is scaled up across Sub-Saharan Africa, first-line psychological care for depression and its complications is urgently needed in established HIV treatment centers.
