HCV evolution and positive selection sites of HCV NS5B region among intravenous drug users in Guangdong / 中国输血杂志

【Objective】 To learn the situation of the evolution process of HCV virus population and the selection pressure of HCV NS5B in intravenous drug users (IDUs) in Guangdong. 【Methods】 141 blood samples from hepatitis C virus (HCV) RNA-positive blood donors and 58 from HCV patients in Guangdong were randomly collected for HCV NS5B sequence amplification, combined with HCV NS5B sequences from blood donors and IDUs obtained by sequencing previously(between 2009 and 2011). Homology analysis was performed by Molecular Evolutionary Genetics Analysis (MEGA) software, evolutionary analysis were performed by Bayesian Evolutionary Analysis Sampling Trees (BEAST) software package. Selection pressure analysis was performed on sequences isolated from IDUs by Datamonkey online software package with Mixed Effects Model Evolution (MEME) method, and the population expansion of species were analyzed using Tajima and Fu neutrality test by Arlequin software. 【Results】 The comparison results of internal homology among different subtypes of IDUs in this group were as follows : HCV-3b had the highest homology (97%), followed by HCV-3a (96%), HCV-6a (95%) and HCV-1b (94%); HCV evolution rate analysis showed that HCV-1b had the fastest evolution rate [2.17E-03 substitutions/site/year (y/y/y)], followed by HCV-3b (2.12E-0 y/y/y), HCV-3a (1.58E-03 y/y/y) and HCV-6a (1.28E-03 y/y/y). The analysis on effective population of HCV: 1980~1990 was rapid growth period for HCV-6a, 1990~1995 period for HCV-1b, and 2000~2007 period for HCV-3a. HCV population genetic characteristics was as follows: HCV-1b, 3a, 3b and 6a experienced population expansion, among which 3a and 3b were the most obvious. As to the analysis of HCV selection pressure, two positive selection sites (235 and 243)were found in the 339 nucleotide fragment of the NS5B sequence in injecting drug users, but mutation only occurred at position 316 [mutation rate 1.24% (14/1 130)] among 5 direct antiviral drug (DAA) sites in this gene. 【Conclusion】 The evolution of HCV-3b in Guangdong has showed an obvious trend of population expansion, with a high proportion and homology especially in the local IDUs. HCV-3b should be the focus of HCV prevention and control in this region. Given that the positively selected sites of the HCV NS5B gene region of IDUs in Guangdong are non-DAA binding sites, DAA is expected to demonstrate a good effect on these patients.

Neuropsychological functioning in methadone maintenance patients with HIV / Función neuropsicológica en el tratamiento de mantenimiento con metadona en pacientes con VIH

Although highly active antiretroviral therapy (HAART) has improved survival rates of HIV patients, HIV-associated neurocognitive disorders (HAND) still exist in a highly prevalent group of persons with this disease. In this study we seek to evaluate the influence of drug use in the neuropsychological performance of seropositive drug users. We carried out an extensive neuropsychological evaluation and compared the performance of seropositive drug users (n = 90) with that of a control group of seronegative drug users (n = 48). The results reveal that methadone maintenance programmes can make the seropositive subject neuropsychologically vulnerable. Likewise, we found that giving up drugs have a protective effect in the presence of neuropsychological alterations associated with HIV. These findings lead us to suggest that seropositivity is not sufficient to explain the neuropsychological alterations of seropositive drug users, noting that these alterations are multifactorial.

Aunque la terapia antirretroviral de gran actividad (TARGA) ha mejorado los índices de supervivencia de los pacientes infectados por el VIH, los trastornos neurocognitivos asociados con el VIH (TNAV) todavía existen en un grupo de personas altamente prevalente a esta enfermedad. En este estudio buscamos evaluar la influencia del consumo de drogas en el rendimiento neuropsicológico de los usuarios de drogas seropositivos. Llevamos a cabo una amplia evaluación neuropsicológica, y el rendimiento de los usuarios de drogas seropositivos (n = 90) se comparó con la de un grupo control de usuarios de drogas seronegativos (n = 48). Los resultados demuestran que los programas de tratamiento de mantenimiento con metadona pueden convertir en vulnerable a nivel neuropsicológico al individuo seropositivo. Asimismo, descubrimos que abandonar las drogas provoca un efecto protector frente a la existencia de alteraciones neuropsicológicas asociadas con el VIH. Estos resultados nos llevan a sugerir que la seropositividad no basta para explicar las alteraciones neuropsicológicas de los usuarios de drogas seropositivos, ya que estas alteraciones al parecer son multifactoriales.

Estimation of the Frequency of Intravenous Drug Users in Hamadan City, Iran, Using the Capture-recapture Method / 한국역학회지

OBJECTIVES: The number of illicit drug users is prone to underestimation. This study aimed to use the capture-recapture method as a statistical procedure for measuring the prevalence of intravenous drug users (IDUs) by estimating the number of unknown IDUs not registered by any of the registry centers. METHODS: This study was conducted in Hamadan City, the west of Iran, in 2012. Three incomplete data sources of IDUs, with partial overlapping data, were assessed including: (a) Volunteer Counseling and Testing Centers (VCTCs); (b) Drop in Centers (DICs); and (c) Outreach Teams (ORTs). A log-linear model was applied for the analysis of three-sample capture-recapture results. Two information criteria were used for model selection including Akaike's Information Criterion and the Bayesian Information Criterion. RESULTS: Out of 1,478 IDUs registered by three centers, 48% were identified by VCTCs, 32% by DICs, and 20% by ORTs. After exclusion of duplicates, 1,369 IDUs remained. According to our findings, there were 9,964 (95% CI, 6,088 to 17,636) IDUs not identified by any of the centers. Hence, the real number of IDUs is expected to be 11,333. Based on these findings, the overall completeness of the three data sources was around 12% (95% CI, 7% to 18%). CONCLUSION: There was a considerable number of IDUs not identified by any of the centers. Although the capture-recapture method is a useful and practical approach for estimating unknown populations, due to the assumptions and limitations of the method, the results must be interpreted with caution.

The Effectiveness of Methadone Maintenance Therapy Among Opiate - Dependants Registered with Hospital Raja Perempuan Zainab II Kota Bharu, Kelantan

Background: The objective of this study was to determine the effectiveness of MMT program among injecting drug users (IDUs) in Kota Bharu , Kelantan. Methods: The study was a retrospective study based on the records of injecting drug users (IDUs) involved in the MMT program from November 2005 to 31st January 2008, registered at the Psychiatric Clinic of Hospital Raja Perempuan Zainab II. Opiate Treatment Index (OTI) was used as the research instrument. Repeated measures ANCOVA was used to compare the mean scores during the entry period and after completing twelve months of MMT program after adjusted for age, marital status and level of education. Results: A total of 117 file records were reviewed. There was significant reduction in the mean scores after 12 months of heroin Q score , HIV Risk-taking Behavior Scale and health scale after adjusted for age, marital status and level of education. For Heroin Q score, mean difference was 2.01 (95% CI: 1.45, 2.56), for HIV Risk-taking Behavior Scale, mean difference was 7.64 (95% CI: 6.03, 9.26); and for health scale, mean difference was 5.35(95% CI: 3.90, 6.79). Conclusion: This study supports the evidence that MMT program is effective in treating heroin and opiate dependence.

HIV/AIDS-associated visceral leishmaniasis in patients from an endemic area in Central-west Brazil

An increase in morbidity associated with visceral leishmaniasis (VL) in human immunodeficiency virus (HIV)/AIDS patients has been described in Africa and the Mediterranean. Despite the high endemicity of VL and HIV-1/AIDS in Brazil, this association has not been thoroughly investigated. Our aim was to evaluate the epidemiologic and clinical characteristics of VL-HIV-1/AIDS cases from Central-west [Mato Grosso do Sul (MS)] Brazil. Medical records of 23 VL-HIV-1/AIDS patients were reviewed. Patients were predominantly adult males (87 percent) and 34.8 percent of the patients were intravenous drug users (IVDU). Leishmaniasis was the first opportunistic infection in 60 percent of the HIV-1 patients. Fever occurred in all patients, although splenomegaly and hepatomegaly were absent in 21.7 percent of the cases. CD4+ T-cell counts were below 200 cells/mm³ in 80 percent of the cases and the counts did not increase after clinical remission despite antiretroviral therapy. The first drug chosen to treat the cases was antimonial, but the therapeutic regimen was altered to amphotericin B in 12 of 17 cases due to side effects. Relapses were reported in 56.5 percent of the patients. IVDU may constitute an important risk factor for the transmission of both diseases in MS. VL-HIV-1/AIDS patients in MS share similar clinical characteristics as those from other endemic regions worldwide. Thus, these findings are critical for improving the surveillance of VL-HIV/AIDS patients.

Redução de danos e saúde da família: conhecimento de profissionais de saúde em três regionais do DF/Brasil / Harm reduction and family health: knowledge of health professionals in three regions of Brazil’s Federal District

Introdução: Redução de Danos é uma estratégia da saúde pública que busca reduzir os danos à saúde em consequência de práticas de risco. Estas ações são desenvolvidas pelo Projeto de Redução de Danos (PRD) do Distrito Federal desde 1999. O Programa de Saúde da Família (PSF) visa reorganizar a prática da atenção à saúde em novas bases voltadas à comunidade, levando, assim, a atenção à saúde para mais perto da família. Objetivos: Avaliar o grau de conhecimento dos profissionais do Programa Saúde da Família de três Regionais de Saúde, quanto às ações de redução de danos em grupos de risco. Método: Estudo transversal, descritivo e observacional com 143 profissionais do Programa Saúde da Família das regionais do Gama, Guará e Recanto das Emas, utilizando para isso um questionário como instrumento de coleta de dados. Resultados: Destaca-se que a maioria dos entrevistados (77,6 por cento) desconhece o PRD; mais de 65 por cento nunca tiveram contato com os redutores de danos e mais de dois terços não procuram informações sobre esta estratégia. Conclusão: Os profissionais que trabalham no PSF carecem de informações sobre redução de danos. A atuação mais integrada entre estas práticas de saúde pode contribuir para minimizar danos em populações de risco no Distrito Federal. Palavras-chave: Redução de danos; Saúde da família; Usuários de drogas injetáveis.

Introduction: Harm Reduction is a public health strategy that aims to minimize adverse outcomes caused by high risk behaviors. These activities have been developed as part of the Harm Reduction Project (HRP) of Brasília, Federal District of Brazil since 1999. The Family Health Program (FHP) intends to reorganize the way health care is delivered, with a strong focus on the community. Its goal is to bring health care closer to each family. Objective: The purpose of this study was to evaluate the degree of knowledge of the FHP professionals regarding harm reduction activities among groups presenting high risk behaviors in three regions of the Federal District. Method: A questionnaire was used as the data collection tool. The study population comprised 143 professionals working at the Family Health Program in the regions of Gama, Guará and Recanto das Emas. Results: The majority of the professionals (77.6 percent) were not aware of the Harm Reduction Project; more than 65 percent of them have never had any contact with those involved in the Project and more than two thirds of the interviewees don’t look for information about this public health strategy. Conclusion: The FHP professionals need more information about harm reduction activities. These two health actions may be in a better position to minimize the occurrence of adverse health outcomes among groups presenting higher risk behaviors if they work in an integrated and complementary way.

Epidemiology of Hepatitis B, C, D and G Viruses and Cytokine Levels among Intravenous Drug Users / 华中科技大学学报（医学）（英德文版）

To investigate the features of various hepatitis virus infection in intravenous drug users (IVDU), we conducted an epidemiological survey of hepatitis viruses including hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis G virus (HGV) in IVDU. The correlation of TH lymphocyte cytokine and hepatitis virus infection was examined. A study population of 406 IVDU consisted of 383 males and 23 females. HBV-DNA and HCV-RNA were detected by fluorescence quantitative polymerase chain reaction. HBsAg, HBeAg, anti-HBc,anti-HCV, HDV-Ag and anti-HGV were assayed by ELISA. The levels of cytokines of TH 1 and TH2 were measured by ELISA. The similar indices taken from 102 healthy persons served as controls. The infection-rate of each virus among IVDU was 36.45 % for HBV, 69. 7 % for HCV,2.22 % for HDV, and 1. 97 % for HGV, respectively. The co-infection rate of HBV and HCV was detected in 113 of 406 (27. 83%). In contrast, among controls, the infection rate was 17.65 % for HBV and 0% for the other hepatitis viruses. The levels of PHA-induced cytokines (IFN-γ and IL-4) and the level of serum IL 2 were obviously decreased in IVDU. On the other hand, the level of serum IL-4 was increased. The IFN-γ level was continuously decreased when the IVDU was infected with HBV/HCV. In conclusion, HBV and HCV infection were common in this population ofIVDU and they had led to a high incidence of impaired TH 1 cytokine levels.

Observation on Peg-IFN alpha-2? Combined with Capsule Ribavirin in Treatment Drug Addicts with Chronic Hepatitis C / 医学研究杂志

0.05).Conclusions Compared with the patients with Chronic Hepatitis C related to transfusionem,the efficiency of peg-IFN alpha-2b combined with ribavirin in treatment of IVDU with Chronic Hepatitis C was similar,and the therapy is a effective choice in treatment of IVDU with Chronic Hepatitis C.

Prevalence of Hepatitis C, B and Human Immunodeficiency Virus among Drug Users and Chronic Alcoholic Patients in Korea / 대한내과학회지

OBJECTIVES: After introduction of anti-HCV assay as screening test of blood donors, the proportion of trasfusion-associated hepatitis C declined, but the proportion of hepatitis C patients with a history of parenteral drug use increased, HCV, HRV, and H1V share similiar modes of transmission and prevalent among intravenous drug users in America. Recently the number of drug users in Korea has been increasing. Therefore we investigated the prevalence of HCV, HBV, and HIV among drug users in our country. In addition several recent reports showed that anti-HCV were freguently positive in the chronic alcoholics and HCV might play a role in the development of severe liver disease in these patients. We assessed the prevalence of anti-HCV and its re1ationship to the severity of liver disease in chronic alcoholic patients. METHODS: The prevalence of anti-HCV, HHsAg, and anti-HIV among 185 drug users who were admitted at Taegu Medical Center from January 1994 to December 1995 has been studied using ELISA and the history of drug use including sort, route, and duration investigated. In addition, We studied the prevalence of anti-HCV and its relationship to the severity of liver disease in 73 chronic alcoholics. RESULTS: 1) Among 176 methamphetamine intravenous users, the prevalence of anti-HCV was 80%, that of HBsAg was 4%, and there was none with anti-HIV positive in 131 cases tested. Of the 9 marihuana smokers, all of them were negative in anti-HCV or anti-HIV, and only 1 caese(11%) was HBsAg positive. 2) Longer duration of intravenous drug use was significantly associated with anti-HCV seropositivity, Elevated ALT level was found in 80 cases(57%) of the anti-HCV seropositive 140 cases and their mean was 971U/L. 3) The group with higher optical density of anti-HCV showed inclination of elevated ALT level; however there was no significant correlation between anti-HCV optical density and ALT level. 4) The prevalence of anti-HCV was 11% in 73 chronic alcoholic patients, and that of HBsAg was 4%. The seropositivity of anti-HCV correlated with the severity of liver disease: none in patients with no liver problem or fatty liver, 12.5% in patients with chronic liver disease, 1996 in patients with cirrhosis classified by clinical, biochemical, and ultrasonographic findings, However the presence of anti-HCV was not associated with impaired liver function tests in chronic liver disease and cirrhosis groups. CONCLUSION: The prevalence of anti-HCV among intravenous drug users in Korea was 80%, similiar to that in America, By contrast the prevalence of HBsAg was only 4%, lower than that of general population. And there was no HIV-infected cases among intravenous drug users in our study. The seropositivity of anti-HCV among chronic alcoholic patients was 11%. And increased prevalence of anti-HCV in alcoholic patients with severe liver disease might suggest that hepatitis C virus is involved in liver damage in these patients.