Hospital pharmacists’ knowledge about and attitude toward HIV/AIDS and patients living with HIV/AIDS in Kedah,Malaysia

Introduction

The current study aims to explore the knowledge, attitude, and perception of hospital pharmacists towards HIV/AIDS and patients living with HIV/AIDS (PLWHA) in the state of Kedah, Malaysia.

Material and methods

This was a cross-sectional study conducted among the hospital pharmacists in three government hospitals in Kedah, using a self-administered 43-item questionnaire. Data analysis was done using non-parametric and multinomial regression.

Results

A total of 75 respondents participated in this study, resulting in a response rate of 60.8%. The majority were found to be well aware of the causes of HIV/AIDS. However, about 34 (45.3%) believed erroneously that HIV/AIDS cannot be transmitted through tattooing or body piercing. Nearly 25 (33.3%) of the respondents believed that preventing the use of intravenous drugs may not be effective to prevent HIV/AIDS and endorsed social isolation as a measure to prevent HIV/AIDS. The majority (66.6%) had negative attitudes and about 20% held extremely negative attitudes. Findings from regression modelling revealed that hospital (–2 log likelihood = 215.182, χ² = 18.060, Df = 8, p = 0.021) and gender (–2 log likelihood = 213.643, χ² = 16.521, Df = 8, p = 0.035) were more likely to affect the attitudes of respondents.

Conclusions

Overall, more than one third of the respondents were found to have negative attitudes towards PLWHA. Gender, job experience, and hospitals with more HIV/AIDS patient visits were the main factors affecting attitudes.     

Lipoprotein profile of patients infected with HIV in C?te d'Ivoire]

Aids is a cachexysing disease which is striking Africa. C?te d'Ivoire with its 12% seroprevalence is paying a heavy tribute to this pandemia. The course of the disease is characterized by the occurrence of immunological and biochemical disorders. The aim of this study is to offer African practitioners, clinicians and biologists some biochimical parameters that would help them to follow up people infected with HIV. The authors determined the lipoprotein profile in 204 people (112 Aids patients, 61 HIV infected asymptomatics and 31 controls seronegative to HIV), of both sexes aged 17 to 70 years old. The results show a relatively high level of triglyceridemia, a decreased level of total cholesterol, apoproteins A1 and B and a hypergammaglobulinemia with concomitant and significant increase in the level of orosomucoide as a stigmate of inflammation. These data could help practitioners who lack CD4/CD8 count and viral load monitoring in the follow up of their AIDS patients.     

Globulin–platelet model predicts significant fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase levels

The globulin–platelet model (GP) is a new noninvasive liver fibrosis model developed in chronic hepatitis B (CHB) patients. This study aimed to evaluate the diagnostic performance of GP model for liver fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase (ALT) levels. We enrolled 316 CHB patients with HBV DNA ≥ 4 log 10 copies/mL and 40 IU/L < ALT ≤ 80 IU/L. The GP, aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) were calculated. Using liver histology as a gold standard, the diagnostic performances of noninvasive fibrosis models were compared by the area under receiver operating characteristic curves (AUROCs). Of 316 patients, 146 (46.2%), 64 (20.3%) and 40 (12.7%) were classified as having significant fibrosis, severe fibrosis and cirrhosis, respectively. To predict significant fibrosis, the AUROC of GP was lower than APRI (0.64 vs 0.76, p < 0.001) and equivalent to FIB-4 (0.64 vs 0.66, p = 0.366). To predict severe fibrosis, the AUROC of GP was equivalent to APRI (0.82 vs 0.79, p = 0.409) and FIB-4 (0.82 vs 0.77, p = 0.224). To predict cirrhosis, the AUROC of GP was higher than APRI (0.91 vs 0.84, p = 0.033) and FIB-4 (0.91 vs 0.80, p = 0.004). GP is a more accurate noninvasive fibrosis model than APRI and FIB-4 to diagnose cirrhosis in CHB patients with high HBV DNA and mildly elevated ALT levels. The clinical application of GP model may reduce the need for liver biopsy in CHB patients.     

Erythropoiesis in patients with aggressive and indolent non-Hodgkin’s lymphomas

Parameters of the erythroid, granulocytic, and megakaryocytic hemopoietic stems were compared in 87 patients with aggressive and indolent non-Hodgkins lymphomas before and 6 months after the start cytostatic therapy. Before chemotherapy anemia was detected in 46% patients with aggressive and 49% patients with indolent lymphomas. Hemoglobin content, peripheral blood erythrocyte count, and total count of erythroid cells in the bone marrow increased during chemotherapy in the indolent lymphoma group. Increased count of erythroid cells in the myelogram was due to decreased count of lymphoid cells in the bone marrow, which was associated with complete or partial remission. In aggressive lymphoma chemotherapy decreased the mean level of hemoglobin and mean erythrocyte count in the peripheral blood, but the total count of erythroid cells in the bone marrow increased; no relationship was detected between lymphocyte count in the bone marrow and erythropoiesis characteristics. Lymphocytosis >50% in the myelogram before chemotherapy was less frequent in this group in comparison with indolent non-Hodgkins lymphomas.Translated from Byulleten Eksperimentalnoi Biologii i Meditsiny, Vol. 138, No. 12, pp. 668–673, December, 2004This revised version was published online in April 2005 with a corrected cover date.     

Clinical experience with dolutegravir/abacavir/lamivudine in HIV–HCV co-infected patients treated with a sofosbuvir-based regimen—safety and efficacy

Background: There is no known reason to suspect an adverse drug interaction between dolutegravir-based antiretroviral therapy and sofosbuvir, simeprevir, or ledipasvir. There is a paucity of clinical data for this combination.

Methods: Prospective, open-label study of patients with HIV well controlled on dolutegravir, abacavir, and lamivudine, who were co-infected with HCV genotype 1, and required therapy with simeprevir plus sofosbuvir or sofosbuvir/ledipasvir single-tablet regimen (STR) for 12 weeks. The two primary endpoints were percentage of patients achieving sustained virologic response (SVR) at 12 weeks post-treatment and percentage of patients with a HIV-1 viral load <50 copies/ml at end of the combination therapy.

Results: Twenty-eight subjects were enrolled from August 2014 to September 2015. Thirteen patients were treated with simprevir plus sofosbuvir, and 15 subjects were treated with sofosbuvir/ledipasvir. 23 genotype 1a, and 5 genotype 1b were included. Nineteen were treatment naïve, and 2 patients had compensated cirrhosis. The mean age was 59 years (95% CI 58.21–59.78 years). The mean age was 59 years (95% CI: 58.21–59.78 years), and 25 patients were black. Out of the 28 patients who completed this study, SVR 12 was achieved in 27 of 28 patients (96%, 95% CI 89.6–100.0%), and all patients had an HIV virus load <50 copies/ml at week 12 of therapy, for an intent-to-treat rate of 100%. No patients ended therapy secondary to adverse events.

Conclusion: Our study suggests a good safety and efficacy for the combination of a dolutegravir, abacavir, and lamivudine with sofosbuvir-based DAA therapy.     

Anti-myeloperoxidase and anti-lactoferrin antibodies in patients with IgA nephropathy and Henoch-Schönlein purpura

Antineutrophil cytoplasmic antibodies (ANCA) for two antigens, i.e. myeloperoxidase (MPO) and lactoferrin (LF) in sera from 19 IgA nephropathy (IgAN), 3 adult Henoch-Sch?nlein purpura (HSP) and 8 child HSP patients were examined by enzyme-linked immunoabsorbent assay (ELISA) for immunoglobulin isotypes. All of child HSP patients showed negative ANCA. On the other hand, one IgAN patient and two adult HSP patients showed weak positivity for IgA class anti-MPO antibody. There was no patients who showed positivity for IgG and IgM class anti-MPO antibody. In anti-LF antibody, one IgAN and one adult HSP showed positivity in IgG class; 2 IgAN and 2 HSP in IgA class and 2 IgAN and one HSP in IgM class. These results indicate that adult HSP patients have higher prevalence of IgA class anti-MPO antibody and anti-LF antibody than IgAN or child HSP.     

Verbal and nonverbal short‐term memory in patients with Alzheimer's disease and in healthy elderly subjects

Short‐term memory (STM) deteriorates with the progression of Alzheimer's disease (AD). The purpose of the present study was to characterize this decline by examining component processes of STM. Accordingly, AD patients whose dementia ranged from mild to severe and healthy, age‐matched subjects received the Brown‐Peterson distractor task, in which class of material (verbal and nonverbal), number of memoranda (one, two, and three), and agent of forgetting (time and distraction) were manipulated. Healthy elderly subjects showed the expected pattern of performance: When distraction was present, forgetting was greater with longer retention intervals and larger memory loads; when distraction was absent, recall was perfect. AD patients showed significant forgetting at shorter intervals and with smaller memory loads than healthy elderly subjects when distraction was present; without distraction, AD patients' recall of nonverbal (but not verbal) material was impaired, which may be attributable to the greater difficulty of the nonverbal task over the verbal one and to a diminished rehearsal capacity of AD patients for nonverbal material. Data from individual patients suggest that the verbal and nonverbal systems can deteriorate independently.     

Prevalence and impact of hepatitis B and C virus co-infections in antiretroviral treatment naïve patients with HIV infection at a major treatment center in Ghana

Data on the effects of the presence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in patients co‐infected with these viruses and HIV in West Africa are conflicting and little information is available in Ghana. A cohort of 138 treatment naïve individuals infected with HIV was screened for HBV and HCV serologic markers; HBsAg positive patients were tested for HBeAg, anti‐HBe, and anti‐HBc IgM. The viral load of HIV‐1 in the plasma was determined in 81 patients. Eighteen of the 138 patients (13%) and 5 (3.6%) had HBsAg and anti‐HCV, respectively. None of the patients had anti‐HBc IgM, but 10 (55.6%) and 8 (44.4%) of the 18 patients who were HBsAg positive had HBeAg and anti‐HBe, respectively. In patients with measurement of CD4⁺ undertaken within 1 month (n = 83), CD4⁺ count was significantly lower in patients with HBeAg (median [IQR], 81 [22–144]) as compared to those with anti‐HBe (median [IQR], 210 [197–222]) (P = 0.002, CI: ?96.46 to 51.21). However, those with HIV mono‐infection had similar CD4⁺ counts (median [IQR], 57 [14–159]) compared to those with HBeAg (P = 1.0, CI: ?71.75 to 73.66). Similar results were obtained if CD4⁺ count was measured within 2 months prior to initiation of HAART (n = 119). Generally, HBV and anti‐HCV did not affect CD4⁺ and viral loads of HIV‐1 in plasma but patients with HIV and HBV co‐infection who had HBeAg had more severe immune suppression as compared to those with anti‐HBe. This may have implication for initiating HAART in HBV endemic areas. J. Med. Virol. 84:6–10, 2011. © 2011 Wiley Periodicals, Inc.     

Hormonal changes in patients with mumps orchitis

目的：检测不同年龄感染腮腺炎性睾丸炎患者的激素水平改变。方法：应用放射免疫法测定３组患者的ＦＳＨ、ＬＨ、催乳素、雌二醇和睾酮水平。结果：３组患者均存在不同程度的激素紊乱，尤其以青春期发生感染的组Ⅱ有显著激素水平改变。与对照组比较，组Ⅱ的ＦＳＨ、ＬＨ、催乳素和雌二醇分别升高２８７、１９７、１８１和１９８倍，睾酮减少６４１倍。结论：感染腮腺炎性睾丸炎患者的生殖激素有明显改变，且与感染时患者的年龄有关。     

CA-125 concentration in serum and peritoneal fluid in patients with endometriosis – preliminary results

Introduction

Cancer antigen 125 (CA-125), known as a biomarker for women genital tract malignancies, could be also useful in detecting and monitoring endometriosis. The aim of this study was to evaluate CA-125 in serum and peritoneal fluid (PF) as an indicator of endometriosis.

Material and methods

Fifty-six patients admitted to the First Department of Obstetrics and Gynaecology for diagnostic or therapeutic laparoscopy conducted for infertility, pelvic pain, suspected endometriosis or ovarian cysts entered the study. Those with laparoscopically confirmed endometriosis were assigned to group A, those without this condition to group B. Blood for CA-125 was taken prior to surgery, centrifuged and assayed in accordance with the manufacturer''s instructions (VIDAS CA-125 II). Peritoneal fluid and an endometrial biopsy were taken during laparoscopy. Statistical comparisons were performed using Statistica 7.1.

Results

Group A consisted of 44 women with laparoscopically confirmed diagnosis; 15 patients served as a control group. The mean value of CA-125 concentration in the endometriosis group was 33.98 U/ml, vs. 9.3 U/ml in the control group. The mean value of CA-125 in peritoneal fluid was 1241.88 U/ml in the non-endometriosis group versus 2640.23 U/ml in the study group; both results were statistically significant (p < 0.05). There was a significant correlation between the stage of endometriosis and CA-125 plasma concentration (R = 0.5993, p < 0.001). Cancer antigen 125 concentration in serum was a moderate predictor to distinguish between patients with and without endometriosis (AUC 0.794; 95% CI 0.668-0.921; p = 0.001).

Conclusions

Cancer antigen 125 is a well-known biomarker for endometriosis and helpful in daily clinical practice when endometriosis is suspected. The cut-off value in serum suggesting endometriosis with 68% sensitivity is 11 U/ml. This value is normal range for Ca-125 concentration.     

Hepatitis B precore/core promoter mutations in isolates from HBV-monoinfected and HBV–HIV coinfected patients: A 3-yr prospective study

BackgroundThe course of chronic HBV infection is modified by HIV-coexistence.ObjectiveTo analyze the role of HBV genomic heterogeneity in basal core promoter (BCP) and precore (Pc) genomic regions.Study designIn a 3-yr prospective study, 39 HBV infected patients (20 monoinfected and 19 HIV-coinfected) were included. Eighty-two HBV isolates were studied at quasispecies level in the BCP/Pc genomic region. Clinical records obtained include data on lamivudine therapy and resistance mutations, HBV and HIV-viral load.ResultsHBV isolates were predominantly ascribed to genotype (Gt) A2 among HBV-monoinfected and HIV-coinfected patients. BCP mutations in isolates from monoinfected patients were significantly more frequent than in those from coinfected ones, irrespective of the HBe expression pattern (p < 0.0001).Regardless of the HIV-coexistence, the Pc mutation at G1896A only barely appeared among clone-derived sequences of GtF1 isolates, mainly from HBe(?) HBV-monoinfected patients.ConclusionsHBV isolates characterized from HIV-coinfected patients seem to be more prone to exhibit a wild type genomic pattern at BCP regulatory region with respect to those from HBV-monoinfected ones. Besides, mutations at Pc region might be genotype-dependent in their frequency but not on HIV co-presence related.     

Down-regulation of Z39Ig on macrophages by IFN-γ in patients with chronic HBV infection

Co-inhibitory signals from the B7 superfamily have been demonstrated to induce T cell dysfunction in chronic HBV infection (CHB). However, the expression and function of Z39Ig, a new inhibitor of the B7 superfamily, is still unclear in CHB. Here immunohistochemical staining showed that Z39Ig was restricted to macrophages and that its level was decreased significantly in CHB patients compared to healthy controls. Moreover, reduced Z39Ig expression was positively correlated with plasma HBV load but was inversely related to serum alanine aminotransaminase levels. Further, Z39Ig mRNA had a negative relation to IFN-γ in vivo, and IFN-γ also down-regulated Z39Ig expression on monocyte-derived macrophages (MDMs) in a time- and dose-dependent manner in vitro. Interestingly, Z39Ig expression on MDMs was restored when IFN-γ neutralizing antibodies were added to the T cell/MDM co-culture system, indicating that the IFN-γ derived from activated-T cells may contribute to the reduction of Z39Ig in the CHB environment. Our results suggest that T cells can opposite T cell hyporesponsiveness through dampening Z39Ig inhibitory signals from macrophages and thus maintain their anti-viral function in CHB. Therefore, decreasing Z39Ig signals from macrophages could contribute to CHB clinical therapy.     

Cardiac and autonomic function in patients with Crohn’s disease during remission

Purpose

The aim of the study was to assess cardiac and autonomic function in patients with Crohn’s disease and explore their relation to disease duration using cardiovascular reflex tests.

Prevalence and correlates of overweight in drug-naïve patients with bipolar disorder

BACKGROUND: Patients with bipolar disorder may be at greater risk for overweight and obesity than individuals in the general population. This risk may be due to the illness itself, to mediating factors (diet, life style) and/or to medications used to treat the disorder. This investigation explores the association between body weight and bipolar illness in drug-na?ve patients. METHODS: Weight and height were retrospectively obtained from 76 clinical charts of drug-na?ve patients with bipolar disorder (DSM-IV-TR). A reference group for comparison was then selected from another psychiatric population (65 patients with obsessive-compulsive disorder) and investigated with the same methodology to estimate their BMI. A second focus was to examine the differences in baseline demographic and clinical characteristics between overweight and non-overweight bipolar patients. RESULTS: A total of 40.8% of the patients with bipolar disorder met criteria for obesity or overweight with significant difference in comparison with obsessive-compulsive patients (10.8%). The highest proportions of depression at index episode were in the overweight group (83.3%) with significant difference with the non-overweight patients (58.1%). LIMITATIONS: Retrospective study. Weight measurement not in euthymic period. CONCLUSIONS: Overweight is significantly more prevalent in drug-na?ve patients with bipolar disorder than in another drug-na?ve psychiatric patients (OCD). In agreement with previous studies, the number of patients experiencing a depressive episode was significantly higher in the overweight than in the non-overweight group. These results suggest that the prevalence of overweight in bipolar patients is also influenced by the illness itself or mediating factors such as diet and life style than by pharmacologic treatment.     

Increased annexin-V and decreased TNF-α serum levels in chronic-medicated patients with schizophrenia

Schizophrenia (SZ) is a chronic severe mental disorder. Increased inflammatory processes have been shown in acute and chronic SZ. Apoptotic processes may alter the neuronal network and are involved in the pathogenesis of several neurodegenerative diseases, such as SZ. Annexin-V seems to have a role on inhibition of pro-inflammatory activities during apoptosis. Tumor necrosis factor (TNF-alpha) is a cytokine involved in systemic inflammation and is a member of a group of cytokines which stimulate acute phase reactions. A chronic immune activation in SZ has been shown. The aim of this study was to compare annexin-V and TNF-alpha serum levels in chronic medicated patients with SZ and healthy controls. Thirty-eight outpatients from the HCPA Schizophrenia Program and 38 healthy controls were enrolled to this study protocol. Annexin-V and TNF-alpha serum levels were measured with ELISA. Serum annexin-V levels were significantly higher in patients with SZ than in controls (p < 0.001) and TNF-alpha significantly lower (p < 0.001). The present result of increased annexin-V and decreased serum levels of TNF-alpha compared to controls may be a result of the stabilization phase of psychosis and a reduction in metabolic brain aggression. In this complex picture, increased levels of annexin-V and decreased levels of TNF-alpha in our sample would be explained by illness stability and chronic treatment. Our findings support the hypothesis of a state dependant process of inflammation in SZ. Further prospective studies to clarify the findings described in this paper are needed.     

Interferon-α therapy in patients with Kaposi's Sarcoma and the acquired immunodeficiency syndrome

High dose IFN-α is an effective treatment for a subset of patients with Kaposi's Sarcoma, that is, those who lack systemic symptoms (e.g. fever, weight loss), and co-existing HIV-associated conditions (e.g. opportunistic infections), and whose cell-mediated immunity system is only mildly or moderately impaired. There is little evidence that the addition of chemotherapeutic agents to IFN-α improves treatment outcome. Response rates in excess of 40% have been reported with the addition of AZT to IFN-α, and may prove active in patients with more severely impaired T-cell immunity. There is evidence that in responding patients, IFN-α also suppresses HIV replication, and in vitro studies indicate synergistic suppression of HIV by the IFN-α-AZT combination; evidence for in vitro synergy is being sought.     

Delphinidin diminishes in vitro interferon-γ and interleukin-17 producing cells in patients with psoriatic disease

The anthocyanidin delphinidin reduces psoriasiform lesions and inflammatory mediators in human cell culture systems. Its role in psoriatic disease has not yet been investigated. We assessed delphinidin’s in vitro immunomodulatory effect on ex vivo stimulated peripheral blood mononuclear cells (PBMCs) from 50 individuals [26 with psoriasis, 10 with psoriatic arthritis (PsA) and 14 healthy controls (HCs)]. Cells were either left untreated or stimulated with PMA plus ionomycin in the presence or absence of delphinidin. Intracellular production of interferon-γ (IFNγ), interleukin-17A (IL-17A), and interleukin-10 (IL-10) was measured flow cytometrically. Delphinidin dose-dependently reduced IFNγ⁺ T cells from patients and HCs. The mean IFNγ decrease in CD4⁺ T subpopulations was 42.5?±?28% for psoriasis patients, 51.8?±?21.5% for PsA patients and 49?±?17% for HCs (p?<?0.001 for all). Similarly, IFNγ reduction in CD8⁺ T cells was 34?±?21.6% for psoriasis patients, 47.1?±?22.8% for PsA and 44.8?±?14.3% for HCs (P <?0.001 for all). An inhibitory effect of delphinidin was also noted in IFNγ producing NKs and NKTs from psoriasis individuals. Delphinidin also significantly decreased IL-17⁺ CD4⁺ T cells in all tested subjects, with marginal effect on the increase of IL-10-producing T regulatory subsets. In conclusion, delphinidin exerts a profound in vitro anti-inflammatory effect in psoriasis and psoriatic arthritis by inhibiting IFNγ⁺ innate and adaptive cells and T helper (Th) 17 cells. If this effect is also exerted in vivo, delphinidin may be regarded as a nutraceutical with immunosuppressive potential.