Hepatitis C virus infection in individuals with or without human immunodeficiency virus type 1 infection

Summary Serum specimens from 111 human immunodeficiency virus type 1 (HIV-1) infected and 183 HIV-1 seronegative patients were analysed for antibodies to hepatitis C virus (HCV), hepatitis B virus (HBV) and hepatitis A virus (HAV) by enzyme linked immunoassay (ELISA) and radioimmunoassay. Anti-HCV and anti-HBV antibodies were found in the vast majority (89 and 83%, respectively) of intravenous drug addicts (IVDA), independent of the type of drug abuse or whether the patients were HIV-1 infected or not. Anti-HAV antibodies were found in 60% of the IVDA. Anti-HCV antibodies were found in anti-HIV-1 positive homosexual men (14%) and anti-HIV-1 negative heterosexual persons (8%), but not in HIV-1 seronegative homosexual men. Also anti-HAV antibodies were found to a small extent in these groups. In contrast, anti-HBV antibodies were common in the homosexual men. The absorbance values of the positive reactions in the anti-HCV ELISA were lower for HIV-1 seropositive patients than those for HIV-1 seronegative subjects, particularly in the late stages of HIV-1 infection. These data suggest that HCV infection is transmitted as readily as HBV infection by intravenous drug abuse and that all three types of hepatitis virus infection are common in IVDA. Although transmission of HCV is primarily mediated by blood, sexual transmission may also occur. HIV-1 infection seems to be associated with unusually low levels of anti-HCV antibodies, especially in the late stages of HIV-1 infection.

---

Hepatitis C Virus Infektionen bei HIV-1 Infizierten und nicht mit HIV-Inifizierten

Zusammenfassung Serumproben von 111 mit dem menschlichen Immunschwächevirus Typ 1 (HIV-1) Infizierten und von 183 HIV-1 seronegativen Patienten wurden auf Antikörper gegen das Hepatitis C Virus (HCV), Hepatitis B Virus (HBV) und Hepatitis A Virus (HAV) mittels enzymgebundenem Immunassay (ELISA) oder Radioimmunassay untersucht. Bei der überwiegenden Mehrzahl der i. v. Drogenabhängigen fanden sich Antikörper gegen HCV (89%) und HBV (83%). Dabei fand sich keine Korrelation zur Art der Droge oder HIV-Infektion. 60% der i. v. Drogenabhängigen hatten auch HAV-Antikörper. Unter den anti-HIV-1 positiven Männern wiesen 14% Antikörper gegen HCV auf. Anti-HIV negative heterosexuelle Personen waren zu 8% anti-HCV positiv. Unter den HIV-1 seronegativen homosexuellen Männern fanden sich in keinem Fall Antikörper gegen HCV. Ein kleiner Anteil der Personen dieser Gruppen wies auch Antikörper gegen HAV auf. Anti-HBV Antikörper fanden sich häufig bei homosexuellen Männern, wobei keine Abhängigkeit vom HIV-Serumstatus bestand. Bei HIV-1 seropositiven Patienten, und zwar besonders ausgeprägt im Spätstadium der HIV-Infektionen, waren die Absorptionswerte bei positivem anti-HCV ELISA niedriger als bei HIV-1 seronegativen Personen. Daraus läßt sich schließen, daß die HCV-Infektion wie die HBV-Infektion durch intravenösen Drogenmißbrauch übertragen wird und daß alle drei Typen der Virushepatitis bei i. v. Drogenabhängigen häufig sind. Obwohl die HCV-Übertragung hauptsächlich durch Blut erfolgt, ist eine sexuelle Übertragung ebenfalls möglich. Bei HIV-1 Infizierten sind die anti-HCV Antikörperspiegel ungewöhnlich niedrig, vor allem in den Spätstadien der Infektion.

     

Feasibility of a pocket-PC based cognitive control intervention in dementia spousal caregivers

Objectives: Spousal caregivers of patients with dementia are in need of interventions to bolster their quality of life. Computer-based, self-administered cognitive training is an innovative approach to target spousal caregiver distress and coping. We tested the feasibility of administering one such intervention with minimal clinician intervention.

Methods: Twenty-seven elderly adults (>64 years old), who each were the primary caregiver for a spouse with dementia, were recruited through the Memory Disorders Clinic of the Alzheimer Disease Research Center in Pittsburgh, PA. Spousal caregivers were instructed to use a handheld computer version of the Adaptive Paced Visual Serial Attention Task (APVSAT) at least three times per week for four weeks as part of a larger caregiver intervention trial (P01 AG020677). Feasibility was explored by examining the frequency of APVSAT usage.

Results: Results suggest that self-directed cognitive training is feasible for spousal caregivers of dementia patients. The mean usage of the APVSAT was 42 (SD = 28.58). Performance increased from the beginning to the end of the trial, and usage was not affected by stress, worry, or poor sleep quality.

Conclusion: Findings suggest the potential utility of cognitive training via handheld computer for spousal caregivers of dementia patients to improve problem solving, coping and adaptation, planning, and persevering with goal-directed tasks.     

Surgical management of 234 patients with hydatid disease: the Tikur Anbessa Hospital experience

OBJECTIVE: The aim of this study was to evaluate the pattern and surgical management of hydatid disease. METHODS: A hospital based retrospective cross sectional analysis was conducted in Tikur Anbessa Hospital, department of surgery, Addis Ababa, Ethiopia. Patients' medical records and operation theater registers of 234 patients operated upon for hydatid disease between September 1995 and August 2005 were analyzed RESULTS: One hundred and twenty three patients were male and 111 female. Their age ranged from 13-69 years, with median and peak age of incidence of 30 and 21-30 years respectively. Hundred forty five (62.0%) patients were from rural population. Significant number of patients (40.6%) came from Oromiya regional state (p < 0.004). The most common presenting symptoms were pain in 206/234 (88.0%) patients with hydatidosis, mass or organomegally in 106/141(75.2%) patients with intraabdominal hydatid diseases, cough in 91.2% and expectoration in 83.3% of cases of thoracic hydatidosis. Liver and lung (79.6%) are the most commonly affected organs. More than one organ involvement was seen in 13.7% of cases. Ultrasonography and chest roentgenography were the main modalities of investigation of abdominal and thoracic hydatidosis respectively. Surgical techniques employed for removal of cysts was evacuation in 181 (67.3%). capitonnage in 167 (62.1%) and pericystectomy in 47 (17.5%) organs. In 191 (81.6%) patients the postoperative course was uneventful while 15.8% developed postoperative complications. There were six deaths. The follow up period ranged from 1 month to 3 years (mean 5.6 months). CONCLUSION: Hydatidosis is not uncommon in rural communities of Ethiopia particularly in Oromiya. Complete excision of the disease processes with maximum preservation of tissue is safe and ideal for most patients with hydatidosis.     

Knowledge, attitude and practice of home-based care for HIV/AIDS patients by their family/ caregivers at Jimma Town

BACKGROUND: About 1.5 million people are currently living with HIV/AIDS in Ethiopia-one of the largest HIV infected populations in the world. The current prevalence rate of infection is estimated at 4.4% nationally. Hospital bed occupancy rate due to AIDS has reached over 50% in urban hospitals creating a severe burden to the health service system in the country, or else US $3.4 million is needed in order to increase their bed capacity. Here arises the need to look for a better way of caring for people living with HIV/AIDS. Home care would thus offer the only feasible option for this need as it can mobilize the considerable reservoir of caring and sympathy that exists within a community beyond that of cost cutting. The study was conducted to determine the knowledge, attitude and practice of family/caregivers regarding home-based care for people living with HIV/AIDS. METHODS: This was a cross-sectional community-based study conducted among 274 family/caregivers who were giving care for people living with HIV/AIDS in urban setting of Jimma town from June - August 2005. A structured and pre-tested questionnaire was used to collect data on socio-demographic characteristics, knowledge and attitude towards home based care practice. Data collection was done by interviewing family/caregivers at their respective houses and analyzed using SPSS for windows version 11.0. RESULTS: Over three fourth of the studied subjects (91.6%) were knowledgeable about home based care and 88.7% showed favorable attitude. Ninety two point eight percent agreed that home is a better place for the care of PLWHA than hospital. Single caregivers were about four times more likely to be knowledgeable about home care as compared to their counterparts (OR = 3.98 (95% CI: 0.50, 88.08), but the finding was not statistically significant (p > 0.05). Neighbors and friends were two times more likely to have favorable attitude towards HBC as compared to family members, OR = 1.96 (95% CI: 0.74, 5.21) but, the finding is not statistically significant (p > 0.05). CONCLUSION: The study highlighted that the majority of family members/caregivers have good knowledge and favorable attitude towards HBC and over half favored this care. Therefore, appropriate use of the above promising findings and experience of innovative approaches of HBC from other countries is recommended for further, more organized and effective home-based care practice.     

Vascular reactivity changes in glucose-intolerant rat

The vascular effects of glucose-intolerance were investigated using the neonatal streptozotocin-treated (nSTZ) rat model. Glucose-intolerance was initiated by administration of STZ (90 mg/kg, IP) into 2-day-old male rats. Aortic reactivity was assessed in vitro at 3 and 6 months of age. Both the 3- and 6-month-old nSTZ rats displayed higher blood glucose levels in response to a glucose challenge. At 3 months of age, aortic responsiveness to both norepinephrine and acetylcholine was not altered. However, at 6 months of age, the responses of endothelium-denuded aortas from nSTZ rats to norepinephrine and serotonin were enhanced compared to controls. Endothelium-mediated relaxation of aortas from these animals to acetylcholine was also augmented, and this effect was linked to NO release. Although norepinephrine did not elicit enhancement of aortic contraction in calcium-free medium in 6-month-old nSTZ rats, the responses to both maximum and submaximum concentrations of the agonist after readdition of calcium were greater in these tissues than in control preparations. Pretreatment of aortas with calphostin C eliminated the difference in NE-induced contraction between the control and experimental groups. Although the concentration-response curves for phorbol 12,13-dibutyrate were not different between the 2 groups, the responses of the aortas from 6-month-old nSTZ rats to a submaximum concentration of the phorbol ester were enhanced relative to controls, and this enhancement was normalized with calphostin C. Overall, the data suggest that glucose-intolerance of sufficient duration causes increases in vascular reactivity to agonists. While these findings warrant further investigations, such vascular alterations during the prediabetes stage of glucose intolerance can be a predisposing factor for the eventual development of cardiovascular complications.