Antibody and markers of T-cell activation illuminate the pathogenesis of HCV immune restoration disease in HIV/HCV co-infected patients commencing ART.

Some HIV/hepatitis C virus co-infected patients beginning ART experience Immune Restoration Disease (IRD) manifested as a rise in serum alanine transaminase. This was investigated in HIV/HCV co-infected individuals (n=50) commencing ART in Jakarta (Indonesia). Samples were collected at weeks 0, 4, 8, 12, 24 and at HCV IRD. Nine patients experienced HCV IRD (incidence=9.2 per 1000 person-weeks). These resolved without changing treatment. Markers of T-cell activation (sCD26, sCD30) and immune recruitment (CXCL10) increased in many HCV IRD cases, so T-cells may mediate HCV IRD. Total anti-HCV antibody (core, NS3, NS4) remained lower in HCV IRD cases, but levels of antibody to core were not lower in HCV IRD cases. Rises in HCV RNA on ART were independent of HCV IRD, but there was a negative correlation between baseline HCV RNA and total anti-HCV antibody. High levels of antibody may protect against HCV IRD, via lower HCV antigen loads.

Grade 3-4 liver enzyme elevation during HAART in HIV and hepatitis C co-infected adults.

AIM: To evaluate the incidence of grade 3-4 LEE in HIV/HCV co-infected patients after the introduction of HAART, the clinical significance to the patients and to determine any factors that could predict its development. METHODS: A retrospective cohort study of HIV/HCV co-infected adults in Pokdisus AIDS Clinic Cipto Mangunkusumo Hospital was conducted. All patients were antiretroviral naive and had never had interferon therapy before. Patients who started taking fist line combination therapy in Indonesia (NNRTI based regimen) from January 2004 to August 2006 and who were followed up for at least 6 months later were included in this study. RESULTS: A total of 59 grade 3-4 LEE (any ALT increase by > 5 times ULN or any increase of 100 U/L from baseline) developed in 284 patients during the follow up (20.8%). The median onset of grade 3-4 LEE was 20 weeks (min-max 2-80). Only 27.1% accompanied with symptoms. Two patients developed decompensated liver diseases, one of them ended with death. In 5 patients, grade 3-4 LEE coincided with nevirapine or efavirenz-related rashes. Fifty-two patients (88.1%) continued their antiretroviral regimen throughout the entire episode of grade 3-4 LEE. The median peak level of ALT was 2311 IU/L (IQR, 174-327). CONCLUSION: Lower baseline ALT was the only factor significantly correlated with grade 3-4 LEE in this study.

Anaphylaxis: lesson learned from five cases.

Anaphylaxis is a severe hypersensitivity reaction. Its clinical manifestations vary, affecting several organs at once. Skin symptom is the most frequent manifestation; however, diagnosis of anaphylaxis will only be established when involving one or both vital organs, which are cardiovascular and respiratory system. Other symptom, such as that involving central nervous system or gastrointestinal tract, may accompany. We present five cases of anaphylaxis which vary in onset of symptoms, allergen, degree of severity, therapeutic response and clinical manifestation. Anaphylactic reaction to drugs in these cases is mainly manifested as anaphylactic shock and reaction to food allergen causing obstruction of respiratory tract. Four anaphylactic events occurred at home and only one occurred in a hospital, thus education on anaphylaxis to general community is very important, especially for the patients and their families. Prompt medical assistance in patients with anaphylactic symptoms determines their therapeutic response. Skin test prior to administration of cephalosporin does not give negative predictive value toward anaphylactic event.

Latex allergen sensitization due to glove use among hospital staff in Jakarta and related factors.

AIM: To know whether latex sensitization risk among nurses is higher than among administration staff and whether latex sensitization risk among operating room nurses is higher than among ward room nurses and also whether there is a correlation between sensitization and sex, age, duration-frequency of exposure, smoking, or atopic status. METHODS: A cross-sectional study has been conducted in 830 persons from 6 hospitals in Jakarta consisting of 271 operating room nurses, 287 ward room nurses, and 272 administration staff. Subjects completed a guided questionnaire to determine the subject's age, sex, work setting, duration and frequency of exposure or smoking habits and then the subjects underwent an allergy skin prick test with allergens Der p, Der f, Fel d and latex to determine atopic status and latex sensitization. RESULTS: The proportion of latex sensitization among nurses was 6.1% and among administration staff 1.5%; there was a significant difference (p=0.002). The proportion between operating room nurses was 6.3% and among ward room nurses 5.9%; there was no significant difference (p=0.974). There was a significant correlation between sensitization and mild or severe exposure or atopic status, but no significant correlation between sensitization and sex, age, duration of exposure, or smoking. CONCLUSION: The risk of latex sensitization among nurses is higher than among administration staff, but the risk among operating room nurses was similar to ward room nurses. Atopic status and frequency of exposure were both associated with latex sensitization.