Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe

The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region

Role of tumor necrosis factor alpha promoter polymorphisms on severity of disease and response to antiviral medications in hbeag negative chronic hepatitis B patients

HBeAg negatif KHB enfeksiyonunun ciddiyetine ve interferon alfa + lamivudin kombinasyon tedavisine verilen yanıtın ön görülmesinde TNFalfa promotor polimorfizmlerinin rolünün belirlenmesi Hastalar: Klinik Bakteriyoloji ve Ebfeksiyon Hastalıkları kliniğinde 2002-2007 yılları arasında HBeAg negatif Kronik heptatit B tanısıyla takip edilen 43 hasta çalışmaya alındı. Karaciğer biyopsileri hastanemizde yapıldı. Hastalara 1 yıl süreyle haftada 3 kez interferon alfa2b 10MU ve lamivudin 100mg/gün tedavisi verildi. Hastalar aylık olarak polikliniğimzde takip edildi. Bulgular: Nekroinflamatuar ve fibrozis skorları yüksek olan hastalar ile nekroinflamasyon düzeyi düşük olan kişiler arasında TNF alfa promotor polimorfizmleri açısından farklılık saptanmadı. Tedaviyle birlikte, 3 ay içerisinde, hastaların AST/ALT düzeylerinde istatistiksel anlamlı azalma saptandı (p_0,000). Hastaların %16.2'sinde tedavi yanıtı elde edilemedi. Kalıcı virolojik ve biyokimyasal yanıt hastaların %67.4'ünde tespit edildi. Kalıcı yanıt veren hastalar ve kalıcı yanıt vermeyen hastalar TNFalfa promotor polimorfizmleri açısından kıyaslandığında iki grup arasında fark saptanmadı. Sonuç ve tartışma: TNF alfa promotor -238 ve -308 bölgesindeki tek baz polimorfizmleri Türk popülasyonunda KHB enfeksiyonunun ciddiyetine ve hastalığın antiviral tedaviye yanıtına etki etmemektedir.To investigate whether TNF alfa promoter polymorphisms affets disease severity and response to interferon alpha plus lamivudine combination therapy in HBeAg negative chronic hepatitis B patients. Patients and methods: 43 patients diagnosed to have HBeAg negative chronic hepatitis B between years 2002-2007 at Dept. of Clin. Bacteriology and Infectious Diseases were enrolled in this study. All patients underwent liver biopsy examination before the onset of treatment. Patients received interferon alpha2b 10MU tiw and lamivudine 100mg QD combination therapy for a year. Routine follow-ups were carried-out at out patient clinics of our department. TNF alpha promotor polymorphisms at positions -238 and -308 were studied by PCR-RFLP. Results: Patients diagnosed to have severe hepatitis as a result of higher necroinflamatory and fibrosis scores and higher AST/ALT levels were compared with patients WHO had milder disease. No statistically significant difference was found between patients with severe disease and milder disease in terms of TNFalpha promoter -238 and -308 polymorphisms.24 week after commencement of antiviral treatment AST and ALT levels were decreased significantly with respect to initial values. 16.2% of patients did not respond to treatment whereas sustained response was achieved in 67% of patients. Once again, no statistically significant difference was found between sustained responders and nonresponders in terms of TNF alfa promoter -238 and -308 polymorphisms. Discussion: TNF alpha promoter polymorphisms at position -38 and -308 do not contribute to disease severity and response to antiviral treatment in Turkish chronic hepatitis B patients

Nitroimidazole Derivative Antimicrobial Drugs and Liver Injury

Nitroimidazole derivative drugs have been widely used in clinical practice for many years. Metronidazole and ornidazole are nitroimidazole derivative antimicrobial drugs commonly used in treatment of various infections caused by anaerobic bacteria and protozoa. They are effective against many microorganisms, such as Clostridium spp., Bacteroides spp. and Trichomonas spp. These drugs are generally well-tolerated without significant adverse effects. However, It has been reported that nitroimidazole derivative drugs can rarely cause hepatotoxicity. Despite the rare occurrence of potential adverse effects on the liver associated with metronidazole and ornidazole treatments, they should not be ignored

HIV Positive Patient with Respiratory Insufficiency

HIV epidemic, itself, was first diagnosed after lung related mortality and morbidity among young men. Pneumocystis pneumonia, tuberculosis, atypical mycobacterial infections, cytomegalovirus (CMV) pneumonia and opportunistic fungal infections must be remembered in the differential diagnosis of human immunodeficiency virus (HIV) positive patients presenting with respiratory distress. A fifty-three year-old male patient with HIV associated nephropathy applied to our clinic due to fever and respiratory distress, which did not respond to broad-spectrum antibacterial treatment. HIV viral replication was suppressed for a year. His vaccination status was up-to-date against seasonal influenza and pneumococci. Massive pulmonary thromboembolism was diagnosed. The patient was put on a fibrinolytic treatment

Recreational Drugs and Antiretrovirals: Is It Worth the World or Trivial?

According to the World Health Organization, 1 out of 200 people in the world was living with Human immunodeficiency virus (HIV)/Acquired immune deficiency syndrome (AIDS) in 2015 and four new HIV infections occurred each minute. A relationship between HIV infection and recreational drug use was evident from the very beginning of the HIV epidemic. Recreational drug use is more common in patients living with HIV/AIDS compared to others. Needle-sharing activities, psychological and cognitive consequences of the abused substances facilitate new infections. It is assumed that 1.650.000 individuals were infected with HIV out of 12.190.000 intravenous drug users in 158 countries in 2013. Cytochrome isoenzymes (i.e. CYP3A4, CYP2D6) are responsible from metabolism of non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors and chemokine receptor 5 inhibitors as well as recreational drugs. Recreational and antiretroviral drugs (ARV) may share the same metabolic pathways resulting in drug interactions. Drug interactions may occur because of pharmacodynamic and pharmacokinetic properties of the drugs. Induction of CYP3A4 (due to cocaine, tobacco, chronic alcohol use, etc.) may lead to decreased antiretroviral treatment (ART) effectiveness and increased risk of metabolites-related toxicity, however, inhibition of CYP3A4 (due to marijuana, acute alcohol use, etc.) may lead to increased side effects and drug toxicity. The feeling of moving away from reality and reduction of social pressure associated with recreational drugs mean all the world to the user. However, drug interaction risk makes it challenging for the physicians, when it is time for the selection of ARV. Therefore, physicians’ awareness on the interaction of these drugs is very important. Interactions with recreational drugs should be considered when prescribing ART for these patients. Integrase inhibitors and nucleoside/nucleotide reverse transcriptase inhibitors are safe to use in these circumstances. In this paper, drug interactions between ARV and alcohol, benzodiazepines, opiates, cocaine, methamphetamine, ecstasy, lysergic acid diethylamide, ketamine, gamma hydroxylbutyrate, marihuana, and phencyclidine are reviewed

Hypophosphatemia Due to Adefovir Treatment

Adefovir dipivoxil is an orally effective prodrug excreted unchanged in urine by glomerular filtration and tubular secretion. While it effectively suppresses hepatitis B virus replication, it may cause nephrotoxicity characterized by severe hypophosphatemia. In this report, we present a case of isolated hypophosphatemia due to long-term use of adefovir dipivoxil (10 mg/day). Due to the risk of hypophosphatemia with extended use, calcium and serum levels and symptoms suggesting nephrotoxicity should be followed in patients using adefovir dipivoxil for an extended period

Cystoisospora belli infection in a renal transplant recipient: a case report and review of literature

Cystoisospora belli&nbsp;is a coccidian parasite that causes prolonged watery diarrhea especially among immunocompromised patients. Herein, we report a renal transplant patient who complaints of alternating diarrhea and review of literature related to cystoisosporiasis amongst the transplant recipients.</p

Association of Tumor Necrosis Factor Alpha -238G/A and -308G/A Promotor Polymorphisms with Clearance of Hepatitis B Virus Infection in Turkish Population

Objectives: Acute viral hepatitis B may lead to chronic hepatitis in 6% of adultpopulation. We compared the frequency of Tumor necrosis factor alpha promotor polymorphisms in chronic hepatitis B patients and people with natural immunity against hepatitis B.Materials and Methods: Chronic hepatitis B patients and age matched control cases with natural immunity to hepatitis B virus were recruited 1:1 in this study. Tumornecrosis factor alpha -238G/A and -308G/A polymorphisms were studied withPCR-RFLP. ?2 test was performed in statistical analysis.Results: A total of 101 volunteers enrolled in two study groups. Thirty-eight menand 12 women constituted the chronic hepatitis B patient group and 40 men and11 women recruited in natural immunity group. Frequency of -238G allele was87.5% and 97% in chronic hepatitis B and natural immunity groups, respectively.Frequency of -308G allel was 93% and 92.1% in chronic hepatitis B and natural im-munity groups, respectively. Frequencies of polymorphisms at positions -238 and-308 in the promotor of tumor necrosis factor alpha gene were not different be-tween chronic hepatitis B and natural immunity groups.Discussion: Tumor necrosis factor alpha promoter polymorphisms at -238 and-308 positions do not effect the outcome hepatitis B infection in Turkish population. Clearance of hepatitis B virus infection is multifactorial. Thus, further studiesneeded to identify genetic predisposition to chronic hepatitis B infection