ABSTRACT
OBJECTIVES: The aim of the study was to determine the relationship between alcohol consumption and liver fibrosis as assessed by aspartate aminotransferase to platelet ratio index (APRI) in HIV-infected adults and to explore the relative contributions of alcohol and hepatitis C virus (HCV) to APRI among HIV/HCV-coinfected adults. METHODS: We performed a cross-sectional analysis of data from an observational clinical cohort. Alcohol consumption was categorized according to National Institute on Alcohol Abuse and Alcoholism guidelines. We defined significant liver disease as APRI>1.5, and used multinomial logistic regression to identify correlates of increased APRI. RESULTS: Among 1358 participants, 10.4% reported hazardous drinking. It was found that 11.6% had APRI>1.5, indicating liver fibrosis. Hazardous drinking was associated with increased APRI [adjusted relative risk ratio (RRR) 2.30; 95% confidence interval (CI) 1.26-4.17]. Other factors associated with increased APRI were male gender, viral hepatitis, and HIV transmission category of injecting drug use. Among coinfected individuals, 18.3% had APRI>1.5, and hazardous drinking was not associated with APRI. Among non-HCV-infected individuals, 5.3% had APRI>1.5 and hazardous drinking was associated with increased APRI (adjusted RRR 3.72; 95% CI 1.40-9.87). CONCLUSIONS: Hazardous drinking is an important modifiable risk factor for liver fibrosis, particularly among non-HCV-infected patients. Clinicians and researchers must address alcohol use as the burden of liver disease increases among HIV-positive individuals.
Subject(s)
Alcohol-Related Disorders/enzymology , Aspartate Aminotransferases/metabolism , HIV Infections/enzymology , Hepatitis B/enzymology , Liver Cirrhosis, Alcoholic/enzymology , Platelet Count , Adult , Alcohol-Related Disorders/blood , Alcohol-Related Disorders/complications , Biomarkers/metabolism , Cross-Sectional Studies , Female , HIV Infections/blood , HIV Infections/complications , Hepatitis B/blood , Hepatitis B/complications , Hepatitis C, Chronic/blood , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/enzymology , Humans , Liver Cirrhosis, Alcoholic/blood , Liver Cirrhosis, Alcoholic/complications , Logistic Models , Male , Prognosis , Urban HealthABSTRACT
A patient with features suggesting pulmonary haemosiderosis was found to have a myxoma. The pulmonary lesion cleared after excision of the tumour.
Subject(s)
Heart Neoplasms/complications , Hemosiderosis/etiology , Myxoma/complications , Female , Heart Atria/pathology , Hemosiderosis/pathology , Humans , Lung/pathology , Middle Aged , Myxoma/pathologyABSTRACT
Cytotoxic chemotherapy often induces sustained, severe granulocytopenia in patients with leukemic reticuloendotheliosis. Many of the patients so treated subsequently develop serious infections. Poor marrow reserve has been implicated but lacks supporting evidence as the cause of the granulocytopenia. In six patients we studied with leukemic reticuloendotheliosis, bone marrow showed severe granulocytopenia, blood neutrophil response after intravenous hydrocortisone injection was poor, and leukocyte migration to the site of inflammation showed suboptimal neutrophilia and poor or no mononuclear response. Splenic hypersequestration and pooling were probably not important factors in causing neutropenia, since similar results were seen in patients without spleens. These findings suggest that in this disease the marrow granulocyte reserve and leukocyte mobilization are impaired and the neutropenia is due to poor granulocyte production and not to increased migration of leukocytes to tissues. Cytotoxic chemotherapy should be used with caution in patients with this disease.
