There are 13.2 million HIV infected persons addicted to intravenous drugs (AIDs) and 80% of them live to developing countries. Highly Active Antiretroviral Therapy (HAART) is provided to 15% of AIDs persons. Improper provision of HAART to AIDs persons was described both to Europe and to the USA. The factor which is responsible to HAART is adherence. The patients on substitutive treatment can achieve quite often the level of adherence and HAART eff ectiveness similar to persons not addicted to drugs. But not all addicted patients can follow medically advised treatment and live in good social position and that infl uences inappropriate results of provided support. Many investigators do confi rm that there is no diff erence for activity of HIV infection to general population comparing to AIDs patients. Still there is some data that HAART can be provided to patients even in once daily mode. There are many infections which are infl uencing drug users history – i.e. tuberculosis, abscesses or STDs. About 95% of patients do suff er from HCV infection world wide. Adherence is very important to the treatment provided to drug users and sometimes drugs could be provided as Directly Observed Therapy – DOT. Antireroviral drugs thanks to the infl uence of cytochrome P450 (mainly CYP3A4) can develop interactions and should be properly medically adapted. Patients from the substitutive programs who are receiving antiretrovirals should be prepared for increased requirement of opioids and signs of the drugs defi ciency to the patients.
PL
Na świecie zakażenie HIV u osób przyjmujących dożylne środki uzależniające (OPDŚU) może wynosić 13,2 mln osób, a 80% z nich żyje w krajach rozwijających się. Wysoce aktywną terapię antyretrowirusową (HAART) przyjmuje ok. 15% OPDŚU. Złe wykorzystanie HAART u OPDŚU zostało opisane zarówno w krajach europejskich jak i w USA. Czynnikiem, który warunkuje powodzenie terapii antyretrowirusowej jest adherencja. Pacjenci programów substytucyjnych często osiągają poziom adherencji i skuteczność HAART zbliżoną do uzyskiwanej u osób nigdy nieuzależnionych. Nie wszystkie osoby przyjmujące dożylne środki uzależniające mają możliwość stosować się do zaleceń terapeutycznych i mieć dobre warunki socjalno-ekonomiczne. Natomiast wiele badań wskazują, że HAART stosowane jeden raz dziennie jest równie efektywne, jak leczenie stosowane dwa razy dziennie. Większość badaczy zwraca uwagę na brak różnicy w postępie zakażenia HIV pomiędzy OPDŚU a osobami, które nabyły zakażenie w inny sposób. Znacznie częstsze jest występowanie chorób, które nie należą do schorzeń defi niujących AIDS, natomiast w istotny sposób wpływają na losy narkomanów dożylnych zakażonych HIV. Ważnym elementem jest współzakażenie wirusem HCV, które może dotyczyć ponad 95% OPDŚU. U osób leczonych HAART sposobem na poprawienie adherencji jest tzw. leczenie bezpośrednio obserwowane – Directly Observed Therapy. Leki antyretrowirusowe poprzez wpływ na układ cytochromu P450 (głównie na CYP3A4) wchodzą w interakcje, które muszą być właściwie diagnozowane. Pacjenci programów substytucyjnych, u których wdraża się HAART z udziałem leków antyretrowirusowych powinni być przygotowani na wzrost zapotrzebowania na opioidy i ewentualne objawy niedoboru.
Malignancies were one of the earliest diagnosed manifestations that resulted in the description of acquired immunodeficiency syndrome (AIDS). Most cancers in AIDS patients are associated with coinfection with oncogenic viruses. Knowledge and public awareness about HIV infectious materials are important elements in preventing the spread of HIV infections. The aim of the study was to assess the knowledge about HIV infectious materials among three populations in Poland. A Poland-wide on-line survey was conducted and 2205 anonymous answers were analysed. Almost half of the answers came from students, of which 40% were medical students.
In 2005, 440 patients infected with HIV were registered in the AIDS center in Lodz, Poland. The aim of our study was to analyze the causes of death in 70 fatal cases. We analyzed the data from 70 fatal cases from 1995 through 2005. Of the fatal cases we investigated, 10 were in women and 60 in men. The most common route of HIV transmission was intravenous drug use (50%). At the time of death, the mean age of patients was 36,48 years, and the mean CD4 count was 115,14 cells per microliter. The mean time from HIV diagnosis to death was 3,75 years. The leading cause of death in the group from 1995 through 2004 was AIDS. In 2002, liver diseases resulting from hepatitis C virus (HCV) infection were the cause of death in two patients. In 2005, two patients died as a result of myocardial infarction. The prevalence of fatal cases decreased from 9,09 % in 1995 to 1,59 % in 2005. Hepatitis B surface antigen (HBsAg) was found in 4 of 62 patients (6,45%), anti-HCV in 28 patients (45,16%), and both hepatitis B virus (HBV) and HCV infection in 5 patients (8,07%). Coinfections occurred most frequently in intravenous drug users (IDUs). In conclusions: (1) AIDS is still the leading cause of death in HIV-positive patients in the Lodz region; (2) the emerging cause of death in HIV-positive patients is liver disease as the sequel of HBV and HCV coinfections; (3) heart disease is becoming an important cause of death in HIV-positive patients.
Human immunodeficiency virus (HIV) infection still is a worldwide public health concern, but especially so in Cameroon. Still, the health of HIV-infected people has greatly improved following the introduction of highly active antiretroviral therapy (HAART). Conversely, some authors reported the occurrence of side effects. Unfortunately, data on the topic are scarce in Cameroon. This study aimed at investigating the impact of HAART on liver function in newly diagnosed HIV-infected people. An 18-month longitudinal study was carried out in a health facility in the town of Douala, Cameroon. Investigative methods relied on a questionnaire approach, clinical and biological analyses and medical records exploitation. A total of 107 patients aged 18-45 years old were included in the study. Most participants were females (94, 87.9%) and aged 30-40 years (60, 56.1%). A higher significant fraction of patients had CD4 lymphocytes counts less than 200 cells/mm3 (42, 39.3%) at baseline. We recorded a 1.5-fold increment in the CD4 lymphocytes counts over the follow up period (P-value < 0.0001). Indeed, globally, a significant increasing in ALT level was recorded over follow up. There is a critical need for paying attention to liver function in people living with HIV/AIDS and under therapy.
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