Hepatic adverse events during highly active antiretroviral therapy containing nevirapine: a case report

BACKGROUND: Hepatotoxicity is one of the most serious complications of highly active antiretroviral therapy (HAART). The aim of this report is to analyse an HIV infected patient on HAART including nevirapine and taking antidepressive agents, with acute toxic hepatitis. CASE PRESENTATION: A 39 year old patient diagnosed as HIV positive one month ago administered to the clinical ward of the Department of Infectious Diseases and Clinical Microbiology in Ege University Medical School with high fever, malaise, nausea, diarrheae and elevated liver enzymes (ALT 1558 U/L, AST 4288 U/L). He has been using HAART including zidovudine+lamivudine (2 × 1/day) and nevirapine (2 × 200 mg/day, following dose escalation) for 22 days, sertralin and diazepam for 12 days and lithium for 10 days. The patient was hospitalized. Antiretroviral and antidepressant treatments were stopped. The day after admission, his fever dropped and his symptoms improved. Clinical improvement continued on the following days. The patient was discharged upon his request on the 14(th) day of hospitalization. The liver function tests returned to normal levels in two weeks following discharge. CONCLUSION: Close monitoring of liver enzymes during the first 12 weeks of nevirapine therapy is critical to prevent life threatening events

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

Response to letter to the editor re ‘HIV Trends: Defining “The Middle East’

WOS: 000378046700031PubMed ID: 2710910

SARS-CoV-2 epidemiology and control, different scenarios for Turkey

Background/aim: Coronavirus Infectious Disease 2019 (COVID-19) is now a pandemic spreading in most countries including Turkey. Materials and methods: the current knowledge of COVID-19 and the virus causing it, SARS-CoV-2, was reviewed. the epidemiology and control in different countries was compared and the differences discussed. Results: the population attack rates and case fatality rates vary from country to country with Lombardy in northern Italy reporting an attack rate in the general population of 0.37% compared to 0.004% in Hong Kong. the differences are caused by different testing strategies and reporting systems. Conclusion: Turkey is early in the outbreak. Different control strategies are available with South Korea, Hong Kong and Singapore being models to follow

Türkiye'de HIV'le İlgili Damgalama ve Ayrımcılığın Analizi: HIV'le Yaşayan Kişiler İçin Damgalama Göstergesi Sonuçları

Objective: HIV-related stigma is a devastating problem with severe negative consequences in terms of further spread of the epidemic as well as the health status and social and psychological well-being of people living with HIV. The present study aimed to determine the current situation of HIV-related stigma and discrimination in Turkey.Methods: Data were gathered through the People Living with HIV Stigma Index, which was developed by a group of international organizations and was administered in Turkey in 2011. One hundred people living with HIV including 21 females, 4 transsexual women and 75 men were included in the study using the purposive sampling technique. Results: The rates of HIV-related stigma/discrimination and violation of human rights were 23.1% and 30% respectively. Being gossiped about (69%), being subject to verbal abuse, threats and injury (46%) were the most common forms of stigma. Thirty percent of the participants lost their jobs due to HIV-related stigma and 20% were denied healthcare services because of HIV positivity. Disclosure of HIV status to third parties by healthcare professionals without the consent of the patients appeared as another major problem. The respondents identified the fear of transmission through casual contact due to lack of knowledge on the transmission routes of HIV as the major reason for stigma. The survey also revealed high levels of internalized stigma among the participants. Conclusions: The findings suggested an urgent need to develop national policies for protecting people living with HIV from stigma and discrimination in Turkey. Klimik Dergisi 2017; 30(1): 15-21.Amaç: HIV ile ilgili stigma, salgının daha hızlı yayılmasının yanı sıra, HIV ile yaşayan insanların sağlık durumu ve sosyal ve psikolojik iyiliği açısından ciddi olumsuz sonuçları olan çarpıcı bir sorundur. Bu çalışmanın amacı, Türkiye'deki HIV ile ilişkili damgalanma ve ayrımcılığın mevcut durumunu belirlemektir. Yöntemler: Veriler, uluslararası kuruluşlardan oluşan bir grup tarafından geliştirilen ve Türkiye'de 2011 yılında uygulanan HIV ile Yaşayan Kişiler İçin Damgalama Göstergesi gereci kullanılarak toplanmıştır. Amaçlı örnekleme tekniğiyle HIV ile yaşayan 100 kişi çalışmaya dahil edilmiştir; bunların 21'i kadın, dördü transseksüel ve 75'i erkektir.Bulgular: HIV ile ilgili damgalama/ayrımcılık ve insan hakları ihlali oranı sırasıyla %23.1 ve %30 bulunmuştur. En yaygın damgalama şeklinin, hakkında dedikodu yapılması (%69) ve sözel taciz, tehdit ve incitilme (%46) olduğu belirlenmiştir. Katılımcıların %30'u HIV ile ilgili damgalama nedeniyle işini kaybetmiş ve %20'sine sağlık hizmeti verilmesi reddedilmiştir. Hastaların rızası olmadan sağlık profesyonelleri tarafından üçüncü şahıslara HIV durumunun açıklanması da bir başka önemli sorun olarak ortaya çıkmıştır. HIV'in bulaşma yolları konusunda yeterli bilgi olmaması nedeniyle gündelik temas yoluyla bulaşma korkusunun, damgalamanın en önemli nedeni olduğu belirlenmiştir. Ayrıca, katılımcılar arasında içselleştirilmiş damgalama eğiliminin de yüksek olduğu saptanmıştır. Sonuçlar: Bulgular, Türkiye'de HIV ile yaşayan kişilere önemli ölçüde damgalama ve ayrımcılığın uygulandığını ve bunu önlemek için acil ulusal politikalar geliştirmek gerektiğini ortaya koymaktadır. Klimik Dergisi 2017; 30(1): 15-21