Vitamin D,selenium,and antidiabetic drugs in the treatment of type 2 diabetes mellitus with Hashimoto's thyroiditis

BACKGROUND Diabetes and thyroiditis are closely related.They occur in combination and cause significant damage to the body.There is no clear treatment for type-2 diabetes mellitus(T2DM)with Hashimoto's thyroiditis(HT).While single symptomatic drug treatment of the two diseases is less effective,combined drug treatment may improve efficacy.AIM To investigate the effect of a combination of vitamin D,selenium,and hypoglycemic agents in T2DM with HT.METHODS This retrospective study included 150 patients with T2DM and HT treated at The Central Hospital of Shaoyang from March 2020 to February 2023.Fifty patients were assigned to the control group,test group A,and test group B according to different treatment methods.The control group received low-iodine diet guidance and hypoglycemic drug treatment.Test group A received the control treatment plus vitamin D treatment.Test group B received the group A treatment plus selenium.Blood levels of markers of thyroid function[free T3(FT3),thyroid stimulating hormone(TSH),free T4(FT4)],autoantibodies[thyroid peroxidase antibody(TPOAB)and thyroid globulin antibody(TGAB)],blood lipid index[low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triacylglycerol(TG)],blood glucose index[fasting blood glucose(FBG),and hemoglobin A1c(HbA1c)]were measured pre-treatment and 3 and 6 months after treatment.The relationships between serum 25-hydroxyvitamin D3[25(OH)D3]level and each of these indices were analyzed.RESULTS The levels of 25(OH)D3,FT3,FT4,and LDL-C increased in the order of the control group,test group A,and test group B(all P<0.05).The TPOAB,TGAB,TC,TG,FBG,HbA1c,and TSH levels increased in the order of test groups B,A,and the control group(all P<0.05).All the above indices were compared after 3 and 6 months of treatment.Pre-treatment,there was no divergence in serum 25(OH)D3 level,thyroid function-related indexes,autoantibodies level,blood glucose,and blood lipid index between the control group,test groups A and B(all P>0.05).The 25(OH)D3 levels in test groups A and B were negatively correlated with FT4 and TGAB(all P<0.05).CONCLUSION The combination drug treatment for T2DM with HT significantly improved thyroid function,autoantibody,and blood glucose and lipid levels.

Association between glucose-lowering drugs and circulating insulin antibodies induced by insulin therapy in patients with type 2 diabetes

BACKGROUND Insulin antibodies(IAs)affect blood glucose control in patients receiving insulin therapy.AIM To investigate the relationship between different hypoglycemic treatments and IAs in patients with type 2 diabetes mellitus(T2DM).METHODS This cross-sectional,retrospective study included 1863 patients with T2DM who were receiving exogenous insulin therapy.All patients received stable antidiabetic therapy in the last 3 months and IA levels were measured using an iodine-125 array.RESULTS A total of 1863 patients were enrolled.There were 902(48.4%)patients who had positive IAs(IA level>5%),with a mean IA level of 11.06%(10.39%-11.72%).IA levels were positively correlated with high fasting blood glucose(odds ratio=1.069,P<0.001).The proportion of positive IAs was lowest in patients using glargine only(31.9%)and highest in patients using human insulin only(70.3%),P<0.001.The IA levels in patients using sulfonylureas/glinides(8.3%),metformin(9.6%),and dipeptidyl peptidase-4 inhibitors(8.2%)were all lower than in patients without these drugs(all P<0.05).CONCLUSION Nearly half of patients on insulin therapy have positive IA antibodies,and IA antibody levels are associated with blood glucose control.Insulin glargine and a combination of oral glucose-lowering drugs were correlated with lower IA levels.

PHLDA2 reshapes the immune microenvironment and induces drug resistance in hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is a malignancy known for its unfavorable prognosis.The dysregulation of the tumor microenvironment(TME)can affect the sensitivity to immunotherapy or chemotherapy,leading to treatment failure.The elucidation of PHLDA2’s involvement in HCC is imperative,and the clinical value of PHLDA2 is also underestimated.Here,bioinformatics analysis was performed in multiple cohorts to explore the phenotype and mechanism through which PHLDA2 may affect the progression of HCC.Then,the expression and function of PHLDA2 were examined via the qRT-PCR,Western Blot,and MTT assays.Our findings indicate a substantial upregulation of PHLDA2 in HCC,correlated with a poorer prognosis.The methylation levels of PHLDA2 were found to be lower in HCC tissues compared to normal liver tissues.Besides,noteworthy associations were observed between PHLDA2 expression and immune infiltration in HCC.In addition,PHLDA2 upregulation is closely associated with stemness features and immunotherapy or chemotherapy resistance in HCC.In vitro experiments showed that sorafenib or cisplatin significantly up-regulated PHLDA2 mRNA levels,and PHLDA2 knockdown markedly decreased the sensitivity of HCC cells to chemotherapy drugs.Meanwhile,we found that TGF-βinduced the expression of PHLDA2 in vitro.The GSEA and in vitro experiment indicated that PHLDA2 may promote the HCC progression via activating the AKT signaling pathway.Our study revealed the novel role of PHLDA2 as an independent prognostic factor,which plays an essential role in TME remodeling and treatment resistance in HCC.

Non-steroidal anti-inflammatory drugs in postoperative hand fracture management:Do they positively or negatively impact recovery?

This editorial explores the impact of non-steroidal anti-inflammatory drugs(NSAIDs)on postoperative recovery in hand fracture patients,amidst shifting pain management strategies away from opioids due to their adverse effects.With hand fractures being significantly common and postoperative pain management crucial for recovery,the potential of NSAIDs offers a non-addictive pain control alternative.However,the controversy over NSAIDs'effects on bone healing—stemming from their Cyclooxygenase-2 inhibition and associated risks of fracture non-union or delayed union—necessitates further investigation.Despite a comprehensive literature search,the study finds a lack of specific research on NSAIDs in postoperative hand fracture management,highlighting an urgent need for future studies to balance their benefits against possible risks.

Antibody-Coupled Drugs in HER2-Positive Gastric Cancer

Antibody drug conjugates (ADCs) are a new class of drugs that combine chemosynthetic drugs with antibody drugs through a linker. Antibody drug conjugates combine the targeting characteristics of traditional antibody drugs with the cytotoxic characteristics of small molecule drugs, while reducing the side effects of both drugs, making them a kind of “biological missile” and representing a relatively new and evolving class of anti-cancer drugs. Antibody-coupled drugs are currently used in many solid tumors, and this article reviews the clinical application of antibody-coupled drugs in HER2-positive gastric cancer.

2型糖尿病合并感染患者肺炎克雷伯菌分布及预后影响因素分析

目的:探讨2型糖尿病(T2DM)合并感染患者肺炎克雷伯菌(KP)分布及预后影响因素分析。方法:选择226例T2DM患者为研究对象,根据是否合并KP感染分为未感染组(n=170)和感染组(n=56),分析T2DM患者感染的危险因素。收集T2DM合并感染患者KP标本,记录标本来源并进行菌种鉴定和药敏试验,并对所有菌株进行多位点序列(MLST)分型,记录预后情况。结果:基础疾病、抗生素使用、侵入性操作、血清白蛋白(ALB)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)为影响T2DM发生感染的危险因素(均P<0.05)。T2DM合并感染患者体内分离56株肺炎克雷伯菌,肺炎克雷伯菌在痰液中的占比最高为44.62%,其次为尿液19.64%,血液中占比16.07%,脓液中占比12.5%,其他标本占比7.14%。56株KP总耐药率最高为氨苄西林,最低为亚胺培南,痰液标本中KP对头孢呋辛、头孢哌酮、庆大霉素耐药率高于非痰液标本,非痰液标本中KP对头孢他啶高于痰液标本(均P<0.05)。56株肺炎克雷伯菌MLST分型共发现42个ST型,ST-20型、36型、65型、347型、660型各2株,分别占3.57%,23型4株占7.14%,ST-17、25、29、35、37、45、86、189、208、211、218、322、355、412、490、519、557、595、726、776、1049、1092、1103、1319、1569、1916、2059、3014、3140、3536、4023、4194、4262、4412、4857型各1株,分别占1.78%,其他ST型7株占比12.5%。56例T2DM合并KP感染患者预后良好患者52例,预后不良患者4例,预后良好率为92.86%。结论:T2DM合并感染患者KP主要分布在痰液和尿液中,基础疾病、抗生素使用、侵入性操作、ALB、HbA1c、FPG是影响KP感染发生危险因素,T2DM合并KP感染患者根据药敏结果选择用药,有利于患者预后。

基于WHO/HAI标准调查法的湖北省SGLT-2抑制剂类药物可及性研究

目的了解湖北省钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂的可及性现状,为药品临床使用和政策制定提供参考依据。方法依据世界卫生组织/健康行动国际组织(WHO/HAI)的标准调查法,调查湖北省医疗机构SGLT-2抑制剂的可及性,采取关键人物访谈法分析影响SGLT-2抑制剂可获得性及可负担性的关键因素。结果2018—2023年期间湖北省医疗机构SGLT-2抑制剂的配备数量和可获得性呈递增趋势,三级医院普遍高于二级医院。其中达格列净可获得性最好,由2018年可获得性差(<25%)增加为2023年的可获得性好(>75%),其次为恩格列净,其他药物可获得性相对较差。影响可获得性因素主要为药品价格、药品是否纳入医保和药品是否集采等。从药品可负担性出发,此类药物总体较差(药物30 d治疗费用均大于最低日薪1倍),卡格列净、艾托格列净和恩格列净部分仿制药国内价格低于国际参考价,影响可负担性因素主要为医保覆盖情况及报销比例、药品价格和患者及家庭收入等。结论SGLT-2抑制剂在湖北省内的药品价格、可获得性及可负担性均有待进一步改善。随着这类药物治疗地位提升及临床需求增加,期望相关部门可从集采、医保、基本药物及药品研发生产等政策方面促进调整。

甘精胰岛素生物仿制药与原研药治疗2型糖尿病临床有效性及安全性的Meta分析

目的系统性评价甘精胰岛素生物仿制药与原研药治疗2型糖尿病的临床有效性与安全性。方法检索国内外相关文献,系统分析甘精胰岛素生物仿制药与原研药治疗2型糖尿病人群的有效性和安全性的区别。结果Meta分析结果显示,甘精胰岛素生物仿制药与原研品种在降低空腹血糖、糖化血红蛋白(HbA1c)水平及HbA1c达标率方面差异无统计学意义;在低血糖发生率及总体不良事件报告率方面差异无统计学意义。结论本研究结果显示,从有效性和安全性方面考虑,甘精胰岛素生物仿制药与原研药并无明显差异。但因纳入文献质量和数量有限,仍需大样本、多中心的随机对照试验来进一步证实该结论。

转录因子7-like 2在宫颈癌中表达水平及其与顺铂化疗敏感性关系研究

目的:探究转录因子7-like 2(TCF7L2)在宫颈癌患者中表达水平及其与顺铂化疗敏感性的相关性。方法:收集68例宫颈癌患者(观察组)和68例体检正常者(对照组)为研究对象。留取两组晨起静脉血样用于血清TCF7L2和β-catenin表达水平测定。分析血清中TCF7L2和β-catenin与患者临床特征及顺铂化疗敏感性的关系。结果:观察组患者血清TCF7L2和β-catenin表达水平显著高于对照组(均P<0.05)。观察组患者FIGO分期Ⅳa期、肿瘤低分化者血清中TCF7L2、β-catenin表达水平明显高于FIGO分期Ⅱb期、Ⅲ期和肿瘤高分化者,FIGO分期Ⅲ期明显高于FIGO分期Ⅱb期,出现淋巴转移者高于无淋巴转移者(均P<0.05);同时顺铂化疗不敏感者血清TCF7L2、β-catenin表达水平明显高于敏感者(均P<0.05)。Logistic回归分析显示,血清中TCF7L2、β-catenin高表达是顺铂化疗不敏感的危险因素(均P<0.05)。结论:宫颈癌患者中TCF7L2异常高表达,且其高表达可能是导致患者顺铂化疗耐药的原因之一。

选择性COX-2抑制剂引起心血管风险的研究进展

非甾体抗炎药(non-steroid anti-inflammatory drugs,NSAIDs)是一种有效的、广泛使用的抗炎镇痛药物,其对环氧合酶(cyclo-oxygenase,COX)亚型(COX-1、COX-2)的抑制作用将引起不同的反应,选择性COX-2抑制剂将显著增加不良心血管事件的风险,随着此类药物使用的增加和临床循证证据的积累,其带来的心血管风险引起了越来越多学者的关注。笔者通过归纳分析最新发表文献对选择性COX-2抑制剂引起心血管风险的研究进行综述,以期辅助临床合理用药,减少不良反应,提高用药安全性。

双靶向新辅助药物联合不同化疗治疗HER-2阳性乳腺癌临床疗效比较

目的探讨双靶向新辅助药物联合不同化学药物治疗(简称化疗)的方案治疗人类表皮生长因子受体-2(HER-2)阳性乳腺癌的临床疗效。方法选取凉山彝族自治州第一人民医院2019年1月至2022年12月收治的HER-2阳性乳腺癌患者110例,按治疗方案的不同分为TcbHP组和AC-THP组,各55例。TcbHP组患者予曲妥珠单抗和帕妥珠单抗联合紫杉类(多西他赛或紫杉醇)和卡铂治疗,以21 d为1个周期,共治疗6个周期;AC-THP组患者予曲妥珠单抗和帕妥珠单抗联合蒽环类药物(吡柔比星或表柔比星)和环磷酰胺治疗,以21 d为1个周期,曲妥珠单抗和帕妥珠单抗及其他药物分别治疗4个周期,共8个周期。结果TcbHP组患者病理完全缓解率为61.80%,稍高于AC-THP组的50.90%(P>0.05)。治疗后,TcbHP组恶心,呕吐,腹泻,心脏毒性及手足综合征程度均显著低于AC-THP组(P<0.05);各肿瘤标志物[糖类抗原(CA19-9,CA125,CA153),癌胚抗原(CEA)]水平均显著低于AC-THP组(P<0.05);左心室射血分数(LVEF)及血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)、氨基末端脑钠肽前体(NT-proBNP)水平均无明显变化(P>0.05),且均显著优于AC-THP组(P<0.05)。结论TcbHP方案治疗HER-2阳性乳腺癌的疗效与AC-THP方案相当,但前者降低肿瘤标志物生成的作用更明显,且心脏毒性风险相对更低。

老年2型糖尿病合并动脉粥样硬化性心血管疾病多重用药管理规范

2型糖尿病(T2DM)是老年人常见的慢性病之一,持续的高血糖易损伤全身血管,影响心、肾、眼和神经等器官组织,导致各种并发症的出现。其中,动脉粥样硬化性心血管疾病(ASCVD)是T2DM患者死亡的主要原因,此类患者需要进行降糖、调脂、降压、抗血小板和降低尿蛋白等综合治疗。多重用药对合并多种并发症的老年人有较好的疾病控制作用,但如果应用不合理、不科学,也会带来潜在的药物相互作用和药物不良反应等问题。本文针对老年T2DM合并ASCVD患者多重用药管理进行分析,重点阐述降糖药、降压药、调脂药和抗血小板药等之间的相互作用和注意事项,保证药物使用有效性的前提下提高患者用药的合理性、安全性和规范性,减少不良反应的发生,为临床医师用药提供参考。

冠心病合并2型糖尿病患者的血糖管理专家共识

我国冠心病合并糖尿病患者的比例较高,即使接受降压、降脂、抗栓等常规治疗仍存在残余心血管风险。近年的研究证明,一些降糖药物对2型糖尿病患者具有明确的心血管获益。但调研显示,目前心内科医师对2型糖尿病筛查时机、指标和诊断标准仍不熟悉,对具有明确心血管获益的新型降糖药物如胰高糖素样肽-1受体激动剂/钠-葡萄糖共转运蛋白2抑制剂的认知程度不够、规范应用率低。在此背景下,根据国内外指南/共识和最新的循证医学证据,本共识旨在规范急性冠状动脉综合征、慢性冠状动脉综合征以及经皮冠状动脉介入治疗围术期冠心病患者的血糖管理方案,不涉及糖尿病急性并发症,对冠心病患者中2型糖尿病的筛查和诊断、心血管风险综合管理等内容总结了要点,明确具有心血管获益的降糖药物的临床应用实践,促进上述药物在心血管及其他相关专业领域规范应用,同时也关注患者的非降糖治疗,以全面降低其心血管风险。

Transduction of Fas gene or Bcl-2 antisense RNA sensitizes cultured drug resistant gastric cancer cells to chemotherapeutic drugs

AIM To compare the expression level of Fas gene and Bcl-2 gene in gastric cancer cells SGC7901 and gastric cancer MDR (multidrug resistant) cells SGC7901/VCR, to transduce Fas cDNA and Bcl-2 antisense nucleic acid into SGC7901/VCR cells respectively, and to observe the expression of two genes in transfectants and non-transfectants as well as their drug sensitivity.METHODS Eukaryotic expression vector pBK-Fas cDNA and pDOR-anti Bcl-2 were constructed and transfected into SGC7901/VCR cells by lipofectamine, respectively. Northern blot and Western blot were used to detect the expression of mRNA and protein in SGC7901/VCR and SGC7901 cells and transfectants, and drug sensitivity of transfectants for VCR, CDDP and 5-FU was analyzed with MTT assay.RESULTS After gene transfection, 80 for Fas and 120 for antisense Bcl-2 drug-resistant clones were selected from 2×105 cells, transfection rate being 0.04% and 0.06%. Two clones of SGC7901 Fas/VCR cells and SGC7901 anti Bcl-2/VCR cells were randomly selected for further incubation. Hybridization results showed that the expression level of Fas mRNA and protein in SGC7901/VCR cells was much lower, but that of Bcl-2 mRNA and protein was higher than that in SGC7901 cells. The expression of Fas mRNA and protein in SGC7901 Fas/VCR cells was higher, and of Bcl-2 mRNA and protein was lower in SGC7901 anti Bcl-2/VCR cells than that in non-transfectants. MTT assay showed that transfectants were more sensitive to VCR, CDDP, 5-FU than non-transfectants.CONCLUSION Bcl-2 gene displayed high expression while Fas gene had low expression in drug resistant gastric cancer cells. Expression of Bcl-2 protein was effectively blocked in SGC7901 anti Bcl-2/VCR cells by gene transfection. In contrast, the expression of Fas mRNA and protein in SGC7901 Fas/VCR cells increased. Fas gene and Bcl-2 antisense nucleic acid transfection sensitized drug resistant gastric cancer cells to chemotherapeutic drugs. These results suggest cell apoptosis plays an important role in the mechanism of MDR, and enhancing apoptosis might reverse MDR.

2型糖尿病患者二线用药偏好研究:基于离散选择实验

背景随着糖尿病防治策略的不断完善,临床指南推荐一线降糖药物的同时强调“以患者为中心”,根据患者的临床特征及其偏好选择适当的二线降糖药物进行治疗。目的利用离散选择实验定量分析2型糖尿病(T2DM)患者二线降糖药物选择偏好,为T2DM患者的临床诊治提供参考。方法本研究于2021年10月—2022年1月,采取多阶段分层随机抽样的方式,选取海南省和山西省T2DM患者进行问卷调查。问卷包括被调查者的个人基本信息、疾病治疗相关信息和离散选择实验选择集(通过文献研究、焦点小组讨论和预试验,纳入血糖控制效果、发生低血糖事件的风险、发生胃肠道不良反应的风险、半年内体重变化、能否保护心血管、服药方式和自付费用/月7个属性,每个属性又包括若干水平)。采用混合Logit回归模型量化T2DM患者对二线降糖药物相关属性偏好程度,回归系数反映T2DM患者对二线降糖药物各属性水平偏好的方向和大小。采用支付意愿(WTP)反映不同属性水平变动后患者愿意支付或获得补偿的货币值。结果本次调查共发放问卷1443份,回收有效问卷1388份,有效回收率为96.2%。7个属性对T2DM患者用药偏好均有影响(P<0.05),对用药偏好影响排在前三的分别为血糖控制效果、发生胃肠道不良反应的风险和发生低血糖事件的风险,排在最后的是半年内体重变化。当血糖降低幅度由0.5%升高为2.5%时,T2DM患者每月愿意支付411.16元;而当半年内体重变化由增加3000 g转换为降低2000 g时,T2DM患者每月仅愿意支付96.78元。结论T2DM患者选择二线降糖药物更偏好血糖控制效果好、无胃肠道不良反应风险、无低血糖事件的风险、保护心血管、服药方式为口服和半年内体重降低2000 g的二线降糖药物。

老年2型糖尿病并发肌少症的相关研究及降糖药物选择

随着预期寿命增加,衰老过程中出现的肌肉无力逐渐引起关注。作为老年人口主要的健康负担的糖尿病,其神经血管并发症只能部分解释病人日渐出现的肌肉无力、耐力下降、活动障碍及身体残疾等表现,肌少症的提出进一步解释了这种身体机能的减退。该文对老年糖尿病病人并发肌少症的发病机制、危险因素进行归纳总结,突出强调对于肌少症的早期预防以及各类降糖药物对于骨骼肌的影响,为降糖药物选择提供新思路。

曲妥珠单抗生物仿制药对比原研药治疗复发或转移性HER-2阳性乳腺癌的药物经济学评价

目的从卫生体系角度评估曲妥珠单抗生物仿制药(汉曲优)与原研药(赫赛汀)治疗复发或转移性人表皮生长因子受体2(HER-2)阳性乳腺癌的经济性。方法根据NCT03084237试验数据构建分区生存模型,模拟周期为3周,模拟时限为10年。以成本和质量调整生命年(QALY)为产出指标,采用成本-效用分析法评价上述2种方案的经济性。采用单因素敏感性分析和概率敏感性分析检验模型的稳健性。结果曲妥珠单抗生物仿制药组与原研药组的成本分别为111516.72、111122.30元,效用分别为1.52、1.36 QALYs,增量成本-效果比(ICER)为2465.12元/QALY,小于以3倍中国2023年人均国内生产总值(GDP)作为的意愿支付(WTP)阈值(268200元/QALY)。单因素敏感性分析结果表明,曲妥珠单抗生物仿制药费用与曲妥珠单抗原研药费用对ICER有较大影响。概率敏感性分析结果显示,当WTP阈值大于14902元/QALY时,曲妥珠单抗生物仿制药组具有经济性的概率为100%。结论当WTP阈值为3倍中国2023年人均GDP(268200元/QALY)时,与曲妥珠单抗原研药相比,曲妥珠单抗生物仿制药治疗复发或转移性HER-2阳性乳腺癌具有较好的经济性。

角质形成细胞与2型炎症互作在特应性皮炎发病机制中的作用

特应性皮炎(AD)患者皮肤屏障功能受损,与角质形成细胞(KC)异常密切相关。在外界因素的刺激下,KC释放炎症因子、趋化因子等炎症介质,作用于2型免疫细胞,进而引起皮肤免疫向2型炎症方向偏移。反之,2型炎症进一步加剧皮肤屏障破坏,故而形成恶性循环。因此,KC和2型炎症之间的互作是促进AD发生发展、加剧炎症反应与瘙痒的重要因素。目前,AD治疗领域的靶向创新药物如生物制剂和小分子药的抗炎作用已逐步得到证实,部分研究表明他们还具有修复皮肤屏障的作用。针对KC与2型炎症互作的研究不仅有助于理解AD的发病机制,也有望优化疾病的治疗方案,提供更多治疗参考。

2型糖尿病与骨质疏松症药物治疗间相关性研究进展

2型糖尿病是目前世界上最为常见的慢性疾病之一,这些患者并发骨质疏松症的概率远高于非糖尿病患者。另外,糖尿病合并骨质疏松症出现的致残率与死亡率极高,严重影响人类生活健康。不少研究发现2型糖尿病与骨质疏松症有许多共同的高危发病因素以及发病机制,但二者药物治疗之间的相关性仍存在较大争议,未能给予临床用药准确的参考价值。因此,笔者通过归纳分析总结近些年最新参考文献,发现两者在药物治疗方面的关联性十分密切,如某些抗2型糖尿病药物不仅可以改善血糖水平而且还能调节骨平衡,某些抗骨质疏松症药物对降低血糖又具有一定的价值,不过两者药物治疗之间的关联性还需要更进一步的研究探索。因此,笔者探讨了2型糖尿病与骨质疏松症两者药物治疗之间的相关性并作一综述,以期能够为临床治疗提供一些参考价值。

Hepatitis C virus/human T lymphotropic virus 1/2 coinfection:Regional burden and virological outcomes in people who inject drugs

This review analyses current data concerning co-infection with hepatitis C virus(HCV) and human T lymphotropic virus(HTLV)-1/2 in people who inject drugs(PWID), with a particular focus on disease burden and global implications for virological outcome. In addition, the available treatment options for HTLV-1/2 are summarized and the on-going and likely future research challenges are discussed. The data in this review was obtained from 34 articles on HCV/HTLV-1/2 co-infection in PWID retrieved from the Pub Med literature database and published between 1997 and 2015. Despite unavailable estimates of the burden of HCV/HTLV-1/2 co-infection in general, the epidemiologic constellation of HTLV-1/2 shows high incidence in PWID with history of migration, incarceration, and other blood-borne infectious diseases such as HCV or human immunodeficiency virus. The most recent research data strongly suggest that HTLV-1 co-infection can influence HCV viral load, HCV sustained virological response to α-interferon treatment, and HCV-related liver disease progression. In short, outcome of HCV infection is worse in the context of HTLV-1 co-infection, yet more studies are needed to gain accurate estimations of the burden of HCV/HTLV-1/2 co-infections. Moreover, in the current era of new direct-acting antiviral treatments for HCV and proven HTLV-1/2 treatment options, prospective clinical and treatment studies should be carried out, with particular focus on the PWID patient population, with the aim of improving virological outcomes.