ABSTRACT
BACKGROUND: Marijuana smoking is prevalent among hepatitis C virus-infected patients. The literature assessing the influence of marijuana on liver disease progression and hepatitis C virus antiviral treatment outcomes is conflicting. METHODS: The authors evaluated hepatitis C virus RNA-positive patients followed at The Ottawa Hospital Viral Hepatitis Clinic (Ottawa, Ontario) from 2000 to 2009. Using The Ottawa Hospital Viral Hepatitis Clinic database and charts, information regarding demographics, HIV coinfection, alcohol use, liver biopsy results, treatment outcomes and self-reported marijuana use was extracted. Biopsy characteristics and hepatitis C virus antiviral treatment outcomes were assessed for association with categorized marijuana use by adjusted logistic regression; covariates were specified according to clinical relevance a priori. RESULTS: Information regarding marijuana use was available for 550 patients, 159 (28.9%) of whom were using marijuana at the time of first assessment. Biopsy fibrosis stage and marijuana use data were available for 377 of these 550 (F0-2 = 72.3%). Overall, marijuana use did not predict fibrosis stage, inflammation grade or steatosis. Sustained virological response and marijuana use data were available for 359 of the 550 cohort participants; a total of 211 (58.8%) achieved a sustained virological response. Marijuana use was not associated with premature interruption of therapy for side effects, the likelihood of completing a full course of therapy or sustained virological response. CONCLUSION: Marijuana use did not influence biopsy histology or alter key hard outcomes of hepatitis C virus antiviral therapy.
Subject(s)
Antiviral Agents/administration & dosage , Hepatitis C, Chronic/epidemiology , Marijuana Smoking , Adult , Biopsy , Cohort Studies , Female , Hepacivirus/isolation & purification , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/pathology , Humans , Male , Middle Aged , Ontario/epidemiology , RNA, Viral/analysis , Treatment OutcomeABSTRACT
UNLABELLED: Despite the South African antiretroviral therapy rollout, which should reduce the incidence of HIV-associated tuberculosis (TB), the number of TB-attributable deaths in KwaZuluNatal (KZN) remains high. TB is often diagnosed clinically, without microbiologic confirmation, leading to inaccurate estimates of TB-attributed deaths. This may contribute to avoidable deaths, and impact population-based TB mortality estimates. OBJECTIVES: (1) To measure the number of cases with microbiologically confirmed TB in a retrospective cohort of deceased inpatients with TB-attributed hospital deaths. (2) To estimate the rates of multi-drug resistant (MDR) and extensively drug resistant (XDR) TB in this cohort. RESULTS: Of 2752 deaths at EDH between September 2006 and March 2007, 403 (15%) were attributed to TB on the death certificate. 176 of the TB-attributed deaths (44%) had a specimen sent for smear or culture; only 64 (36%) had a TB diagnosis confirmed by either test. Of the 39 culture-confirmed cases, 27/39 (69%) had fully susceptible TB and 27/39 (69%) had smear-negative culture-positive TB (SNTB). Two patients had drug monoresistance, three patients had MDR-TB, and one had XDR-TB. CONCLUSIONS: Most TB-attributed deaths in this cohort were not microbiologically confirmed. Of confirmed cases, most were smear-negative, culture positive and were susceptible to all first line drugs.
Subject(s)
Diagnostic Errors , HIV Infections , HIV-1 , Tuberculosis, Pulmonary/diagnosis , Adult , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/therapeutic use , Antitubercular Agents/administration & dosage , Antitubercular Agents/therapeutic use , Bacterial Load , CD4 Lymphocyte Count , Coinfection , Death Certificates , Female , HIV Infections/drug therapy , HIV Infections/mortality , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , South Africa/epidemiology , Treatment Outcome , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/mortality , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/mortalityABSTRACT
Cardiac device infections (CDIs) are recognized complications of device implantation. Most CDIs are caused by skin flora but can also result from hematogenous seeding of the device. A case involving Streptococcus pneumoniae CDI, which is rare, potentially vaccine preventable and may not be associated with overt antecedent pneumococcal infection, is reported.
Les infections associées à des dispositifs cardiaques (IDC) sont des complications connues des implants cardiaques. La plupart des IDC sont causées par la flore cutanée, mais elles peuvent aussi résulter d'un ensemencement hématogène. Les auteurs présentent une occurrence rare d'IDC à Streptococcus pneumoniae, qui aurait peut-être pu être évitée par la vaccination et qui ne s'associerait pas à une infection pneumococcique antérieure manifeste.
Subject(s)
Acute Kidney Injury/chemically induced , Antitubercular Agents/adverse effects , Disseminated Intravascular Coagulation/chemically induced , Rifampin/adverse effects , Acute Kidney Injury/therapy , Antitubercular Agents/therapeutic use , Drug Therapy, Combination , Female , Humans , Renal Dialysis , Rifampin/therapeutic use , Tuberculosis, Pulmonary/drug therapy , Young AdultABSTRACT
A 55-year-old man who was recently diagnosed with HIV/AIDS developed multiple bilateral pulmonary nodules after starting highly active antiretroviral therapy. Workup confirmed the diagnosis of pulmonary hyalinizing granuloma. This is the first described case of pulmonary hyalinizing granuloma in HIV/AIDS, and may represent a rare form of immune reconstitution inflammatory syndrome.
