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The article discusses a research study on the association of the fibrosis marker (FIB-4) test index with hepatocellular carcinoma (HCC) among patients infected with human immunodeficiency virus (HIV). Study subjects include HIV-infected men from the Veterans Aging Cohort Study (VACS) with HCC diagnosis between 1996 and 2007 and compared intermediate FIB-4 score at 4.2 with high FIB-4 value of 13.0. Conclusions indicated that noninvasive FIB-4 tests can help in identifying high risks for HCC.

Background: Adherence to therapy with pegylated interferon and ribavirin for hepatitis C virus (HCV) infection has been incompletely examined. Objective: To evaluate the relationship between adherence to HCV therapy and early and sustained virologic response, assess changes in adherence over time, and examine risk factors for nonadherence. Design: Retrospective cohort study. Setting: National Veterans Affairs Hepatitis C Clinical Case Registry. Patients: 5706 HCV-infected patients (genotypes 1, 2, 3, or 4) with at least 1 prescription for both pegylated interferon and ribavirin between 2003 and 2006 and HCV RNA results before and after treatment initiation. Measurements: Adherence was calculated over 12-week intervals by using pharmacy refill data. End points included early virologic response (decrease of ≥2 log10 HCV RNA at 12 weeks) and sustained virologic response (undetectable HCV RNA 24 weeks after the end of treatment). Results: Early virologic response increased with higher levels of adherence to ribavirin therapy over the initial 12 weeks (patients with HCV genotype 1 or 4, 25 of 68 [37%] with ≥40% adherence vs. 1367 of 2187 [63%] with 91% to 100% adherence [P < 0.001]; patients with HCV genotype 2 or 3, 12 of 18 [67%] with ≤40% adherence vs. 651 of 713 [91%] with 91% to 100% adherence [P < 0.001]). Among patients with HCV genotype 1 or 4, sustained response increased with higher adherence to ribavirin therapy over the second, third, and fourth 12-week intervals. Results were similar for adherence to interferon therapy. Mean adherence to therapy with interferon and ribavirin decreased by 3.4 and 6.6 percentage points per 12-week interval, respectively (P for trend < 0.001 for each drug). Patients who received growth factors or thyroid medications during treatment had higher mean adherence to antiviral therapy. Limitation: This was an observational study without standardized timing for outcome measurements. Conclusion: Early and sustained virologic responses increased with higher levels of adherence to interferon and ribavirin therapy. Adherence to therapy with both antivirals decreased over time, but more so for ribavirin. [ABSTRACT FROM AUTHOR]

The article examines the incidence and risk factors for weight loss during dual HIV/Hepatitis C virus (HCV) therapy. The results indicate that the incidence of weight loss is greater in dually treated patients with HIV/HCV than in treated HCV- or HIV-monoinfected patients. Prospective studies should evaluate additional risk factors for weight loss and changes in body composition to elucidate the mechanism for this weight loss.

The article examines the prevalence, risk factors and outcomes for occult Hepatitis B virus (HBV) infection among HIV-infected patients. The results indicate that occult HBV occurred in a sizable proportion of HIV-infected patients and was associated with detectable HIV and the absence of chronic THC. It did not increase the risk of transaminitis and future studies should examine the long-term clinical implications of occult HBV in HIV-infected patients.

Advising travelers on vaccine-preventable illnesses is increasingly becoming the responsibility of primary care physicians. The approach to vaccine recommendations should be based on a thorough assessment of the risks for travel-related diseases, the time available before and current knowledge of the epidemiology of vaccine-preventable diseases. Routine childhood vaccinations should be reviewed in all travelers and updated as necessary. Yellow fever vaccination may be required for entry by countries that lie within a yellow fever zone or for travelers coming from an endemic area to prevent introduction of the disease. Immunization against hepatitis B virus should be considered in travelers who expect to have close contact with local populations that have high rates of hepatitis B transmission. Japanese encephalitis vaccine should be offered to travelers who plan prolonged trips to rural areas in southeast Asia or the Indian subcontinent during the transmission season. Typhoid fever immunization is recommended for travelers who may be exposed to potentially contaminated food and drink. Preexposure rabies vaccination should be considered in travelers who plan a prolonged duration of stay in a remote area or who engage in activities that might involve working near animals or that could attract animals. Physicians should be aware of the adverse events and contraindications associated with each travel vaccine. [ABSTRACT FROM AUTHOR]

Focuses on the major causes of malaria, enteric fever, leptospirosis, dengue fever and rickettsial infections in travellers returning from the tropics. Influence of pretravel immunizations and chemoprohylaxis taken during travel on the probability of acquiring infections; Effect of the activities of an individual during a trip on the risk of acquiring an infection; Information on various screening tests for fever.

Provides an approach to malaria prevention in travelers. Risk factors for malaria acquisition; Measures to prevent mosquito bites; Drugs approved for chemoprophylaxis.

Lyme disease is the most common vector-borne illness in the United States. It is caused by the spirochete Borrelia burgdorferi, which is transmitted by the deer tick. Deer ticks have a four-stage life cycle (egg, larva, nymph, and adult), and nymphal ticks transmit B. burgdorferi to humans more frequently than adult ticks. Transmission of this spirochete typically requires a minimum of 24 to 48 hours of tick attachment. Early stages of Lyme disease are characterized by a hallmark rash, erythema migrans. The overall risk of acquiring Lyme disease is low in a person who has a deer tick bite. If erythema migrans develops at the site of the bite, treatment may include doxycycline in persons who are at least eight years of age. Administration of amoxicillin is appropriate for pregnant women or children younger than eight years. For those who are allergic to these medications, cefuroxime axetil may be used. [ABSTRACT FROM AUTHOR]

The author discusses on study on risk for reactivation of hepatitis B virus (HBV) infection with chemotherapy for solid tumors. He states that the U.S. Food and Drug Administration has issued drug safety communication regulation urging health care providers to screen patients for HBV infection before starting treatment with B-cell depleting agents. He also mentions that risk for HBV reactivation in patient with infection receiving chemotherapy can be reduced using antiviral prophylaxis drug.

Cases of acute liver injury (ALI) have been reported among chronic HCV-infected patients receiving protease inhibitor (PI)-based direct-acting antiviral (DAA) regimens, but no analyses have compared the risk of ALI in patients receiving PI- vs. non-PI-based DAAs. Thus, we compared the risk of 3 ALI outcomes between patients (by baseline Fibrosis-4 [FIB-4] group) receiving PI-based or non-PI-based DAAs. We conducted a cohort study of 18,498 patients receiving PI-based DAA therapy (paritaprevir/ritonavir/ombitasvir±dasabuvir, elbasvir/grazoprevir, glecaprevir/pibrentasvir) matched 1:1 on propensity score to those receiving non-PI-based DAAs (sofosbuvir/ledipasvir, sofosbuvir/velpatasvir) in the 1945-1965 Veterans Birth Cohort (2014-2019). During exposure to DAA therapy, we determined development of: i) alanine aminotransferase (ALT) >200 U/L, ii) severe hepatic dysfunction (coagulopathy with hyperbilirubinemia), and iii) hepatic decompensation. We used Cox regression to determine hazard ratios (HRs) with 95% CIs for each ALI outcome within groups defined by baseline FIB-4 (≤3.25; >3.25). Among patients with baseline FIB-4 ≤3.25, those receiving PIs had a higher risk of ALT >200 U/L (HR 3.98; 95% CI 2.37-6.68), but not severe hepatic dysfunction (HR 0.67; 95% CI 0.19-2.39) or hepatic decompensation (HR 1.01; 95% CI 0.29-3.49), compared to those receiving non-PI-based regimens. For those with baseline FIB-4 >3.25, those receiving PIs had a higher risk of ALT >200 U/L (HR, 2.15; 95% CI 1.09-4.26), but not severe hepatic dysfunction (HR, 1.23 [0.64-2.38]) or hepatic decompensation (HR, 0.87; 95% CI 0.41-1.87), compared to those receiving non-PI-based regimens While risk of incident ALT elevations was increased in those receiving PI-based DAAs in both FIB-4 groups, the risk of severe hepatic dysfunction and hepatic decompensation did not differ between patients receiving PI- or non-PI-based DAAs in either FIB-4 group. Cases of liver injury have been reported among patients treated with protease inhibitor-based direct-acting antivirals for hepatitis C infection, but it is not clear if the risk of liver injury among people starting these drugs is increased compared to those starting non-protease inhibitor-based therapy. In this study, patients receiving protease inhibitor-based treatment had a higher risk of liver inflammation than those receiving a non-protease inhibitor-based treatment, regardless of the presence of pre-treatment advanced liver fibrosis/cirrhosis. However, the risk of severe liver dysfunction and decompensation were not higher for patients treated with protease inhibitor-based regimens. [Display omitted] • Comparative analysis of 18,498 initiators of PI-based DAAs matched on propensity score to 18,498 initiators of non-PI-based DAAs to assess risk of three acute liver injury endpoints, according to advanced hepatic fibrosis/cirrhosis status by FIB-4. • Propensity score-matched hazard ratios of ALT >200 U/L were higher for PI than non-PI initiators in those with and without baseline advanced hepatic fibrosis/cirrhosis (i.e., FIB-4 >3.25 and FIB-4 ≤3.25, respectively). • No differences in propensity score-matched hazard ratios of severe hepatic dysfunction or hepatic decompensation were observed between PI and non-PI-based DAA initiators, regardless of baseline advanced hepatic fibrosis/cirrhosis status by FIB-4. [ABSTRACT FROM AUTHOR]

Treating HCV infection reduces overall mortality and reduces the risk of multiple extrahepatic complications. Whether the reduction in mortality is primarily due to a reduction in liver-related causes or extrahepatic complications is unknown. We identified HCV-positive individuals treated for HCV, and propensity score-matched them to HCV-positive/untreated and HCV-uninfected individuals in ERCHIVES between 2002-2016. We extracted cause of death data from the National Center for Health Statistics' National Death Index. Viral hepatitis-associated liver-related mortality rates among treated and untreated HCV-infected persons were calculated by treatment and attainment of sustained virologic response (SVR). Among 50,674 HCV-positive/treated (Group A), 31,749 HCV-positive/untreated (Group B) and 73,526 HCV-uninfected persons (Group C), 8.6% in Group A, 35.0% in Group B, and 14.3% in Group C died. Among those who died, viral hepatitis-associated liver-related mortality rates per 100 patient-years (95% CI) were: 0.28 (0.27–0.30) for Group A; 1.44 (1.38–1.49) for Group B; and 0.06 (0.05–0.06) for Group C; (p <0.0001 for both comparisons). Among HCV-positive/treated persons, rates were 0.06 (0.05–0.06) for those with SVR vs. 0.78 (0.74–0.83) for those without SVR. In competing risks Cox proportional hazards analysis, treatment with all-oral DAA regimens (adjusted hazard ratio 0.11; 95% CI 0.09–0.14) and SVR (adjusted hazard ratio 0.10; 95% CI 0.08–0.11) were associated with reduced hazards of liver-related mortality. Treatment for HCV is associated with a significant reduction in viral hepatitis-associated liver-related mortality, which is particularly pronounced in those treated with DAA regimens and those who attain SVR. This may account for a significant proportion of the reduction in all-cause mortality reported in previous studies. Treating hepatitis C virus (HCV) infection is known to reduce overall mortality. However, whether the reduction in mortality is primarily due to a reduction in liver-related causes or extrahepatic complications was previously unknown. Herein, we show that while treating HCV with direct-acting antiviral regimens has numerous extrahepatic benefits, a significant benefit can be attributed specifically to the reduction in liver-related mortality. • Treatment of HCV with any regimen was associated with a 75% reduction in liver-related mortality. • A sustained virologic response to treatment was associated with a 90% reduction in liver-related mortality. • Compared to pegylated interferon/ribavirin, treatment with DAA regimens was associated with reduced liver-related mortality. [ABSTRACT FROM AUTHOR]

The article presents a case study of report of HIV-associated lipodystrophy accompanied by dramatic weight gain, dyslipidemia, and obstructive sleep apnea (OSA) following initiation of highly active antiretroviral therapy (HAART). Information is given on guidelines established for the management of metabolic changes induced by HAART. The case study has revealed several treatment-related metabolic changes after the initiation of antiretroviral therapy, including lipodystrophy, obesity, dyslipidemia, insulin resistance, and diabetes mellitus.

Between 2001 and 2017, 108133 persons (45.7% of diagnosed cases) were initiated on anti-hepatitis C virus treatment in the Veterans Affairs healthcare system. In 2017, nonphysician clinicians accounted for 22.2% of prescriptions, infectious diseases specialists for 14.9%, and gastroenterologists/hepatologists for 10.3%. In the pre-direct-acting antiviral era, they accounted for 7.2%, 26.7%, and 11.6%, respectively., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)