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Research Article 

Hepatocellular Carcinoma in HIV-Infected Patients: Clinical Characteristics and Prognostic Factors

Antonio Diaz-Sanchez, Pilar Miralles, Ana Matilla, Teresa Aldamiz-Echevarria, OscarNunez Ana Carrero, Beatriz Merino, Cristina Diez, Rafael Banares, Gerardo Clemente and Juan Berenguer
Abstract

We analyzed 53 HIV-infected patients with hepatocellular carcinoma (HCC) diagnosed at our institution from 1998 to 2012. All patients were coinfected with hepatitis virus (77% HCV; 12% HBV; 11% HCV+HBV), and 95% had liver cirrhosis. HCC was diagnosed under surveillance in 41% of patients. Potentially curative therapy was given to 32% of patients and palliative therapy to 30% patients. Median survival was 2 months in those diagnosed from 1998 to 2005, and 11 months in those diagnosed from 2006 to 2012; P=0.16. Survival was independently associated with HCC stage, alpha-fetoprotein serum levels, MELD score, and any treatment.

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Research Article 

Modification of Antiretroviral Therapy in a Cohort Study of HIV-Infected Patients Attending an Urban Teaching Hospital in Kenya

AO Owuor, GN Lule, CF Otieno, EO Omonge, MC Maritim and P Memiah
Abstract

Objective: To determine the prevalence and factors associated with ART modification among HIV patients on 1st line therapy attending a large Teaching Hospital in Kenya. Methods: A retrospective cross-sectional clinical record review. All patients who commenced ART from January 2005 to June 2011 and had at least 1 follow-up visit were evaluated. Baseline data, including socio demographic and clinical variables was collected using a standard chart abstraction tool. Results: Out of 1,022 patients 658 (64.4%) were female and the mean age of study participants was 37.8years. The median CD4+ count at initiating ART was 149cells/ml (IQR 55-248). The most common fist-line regimens were stavudine (d4T) and zidovudine (AZT) based at 63% and 13.3% respectively. 1775 patients modified their initial ART at a rate of 36.8% (95% confidence interval [CI] 35.4-38.2%). The commonest reasons for modifying ART were toxicity accounting for 66.5%, treatment failure 12.9%, and co-morbid conditions 9.4%. The most frequent toxic effects were lipodystrophy (41.3%), peripheral neuropathy (10.6%) and anemia (5.9%). The median time to modifying therapy was 28 months (IQR 15-41). Immunological outcome of modification pre and post-modification was 335 cells/ml (IQR 8-497) to 399 cells/ ml (IQR 257-611) with p=0.001. In the multivariate analysis WHO clinical stage III (odds ratio [OR], 2.9 [95%CI 1.7-2.8]; p=0.001), and IV (5.5 [2.8-11.0]; p=0.001), CD4+ count ≤200cells/ml (2.4 [1.5- 4.0]; p=0.001) were associated with likelihood of modifying ART. Conclusion: There was a high rate of ART modification in this study. Drug toxicity was the most frequent reason for treatment modification; however it did not affect treatment success. The median duration to modification of fist-line ART was 28 months. Low CD4+ count, increasing WHO stage and longer duration of ART was associated with likelihood of ART modification.

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Research Article 

Prognostic Value of Some Acute Phase Reactants in the Management of Pulmonary Tuberculosis Disease

Akpotuzor Josephine O, Ekarika Evelyn A and Akwiwu Euphoria C
Abstract

This study was conducted to assess the relevance of serum C- reactive protein (CRP), erythrocyte sedimentation rate (ESR), relative plasma viscosity (RPV) and fibrinogen level in the management of pulmonary tuberculosis (PTB) disease. One hundred (100) PTB patients attending the TB clinic of Dr Lawrence Henshaw Memorial Specialist Hospital Calabar, and 70 age and sex-matched apparently healthy subjects between 15-65 years of age were selected and enrolled. Standard techniques were used for the assays. Results showed significantly lower PCV (p<0.05) in PTB patients (0.35 0.07L/L) when compared with control subjects (0.44 0.04L/L). CRP, ESR and RPV showed significantly higher values in PTB patients (71.09 60.34mg/L, 60.81 38.33mm/hr and 2.11 0.79 respectively) than in control subjects (2.86 0.70mg/L, 7.25 4.00mm/hr and 1.74 0.32 respectively). Among PTB patients who were smear positive, serum CRP and ESR were highest in those with AFB 3+ (140 12.30mg/L and 80.15 32.81mm/hr respectively) and least in those with AFB 1+ (18.63 31.01mg/L and 46.91 38.19mm/hr respectively). Furthermore, CRP (125.31 29.57, 44.48 40.57, 13.57 10.17 and 5.99 3.17mg/L) and ESR (87.30 28.64, 58.27 35.77, 26.70 16.47 and 18.78 8.57mm/hr) decreased significantly (p<0.05) as anti-tuberculosis therapy progressed from 0-7months. However, the rate of decline in CRP was more distinct than that of ESR. Significant lower values of ESR, RPV and CRP with significant higher PCV were observed in PTB patients without cavity lesions when compared with their counterparts with cavity lesions This study therefore concludes that among the analyzed possible markers of systemic inflammatory response in PTB, serum CRP has been observed to be the most sensitive in defining disease severity and indicating a response to treatment.

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Editorial 

Therapeutic Targeting of Structural RNA Motifs in Viral RNA Genomes

Joanna Sztuba-Solinska
Abstract

Viral RNA genomes have evolved functional motifs, which act at different stages of their life cycle. These unique structural domains, their interactions and association with host proteins and ligands, together orchestrate the multifunctionality of viral RNA genomes. Often, long-range RNA-RNA interactions bring regulatory elements into proximity, changing our view of a functional viral RNA genome from a linear molecule to one whose three-dimensional structure is an important contributor during their life cycle [1,2]. Because of their key and versatile roles in viral molecular processes, such as protein synthesis, splicing, transcriptional regulation and replication, viral genomes and virus-coded RNAs, i.e. subgenomic RNAs, pregenomic RNAs, can now be considered attractive therapeutic targets. Thus, understanding the 3D structure of viral RNAs, how their conformation correlates with disease progression, and whether this is therapeutically accessible, is a clear priority.

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