MELD SCORE CORRELATION WITH LABORATORY FINDINGS AND COMPLICATIONS OF HEPATITIS C CAUSED LIVER CIRRHOSIS.

Introduction: Model for End-Stage Liver Disease (MELD) is a scoring system used to estimate the severity of chronic liver disease. Score is based on objective variables and predicts survival among different populations of patients. Study Aim. The aim of the study was to retrospectively analyze potential connection between MELD score and laboratory findings and complications of hepatitis C caused liver cirrhosis. Materials and Methods: A retrospective cross-sectional study based on data from Riga East Clinical University Hospital from the time period of 2010 to 2014 was performed. Original protocol and database were developed with consequential data statistical analysis using IBM SPSS Statistics ver.20.0. Results: In total 221 cirrhosis cases were enrolled in the study. 128 (58%) cases were male and 93 (42%) female. Mean age was 52.7 ± 13.4 years. Statistically significant correlation was found between leukocytes (r = 0.4, p < 0.001), blood urea (r = 0.4, p < 0.001), serum albumin (r = -0.4, p < 0.001), C-reactive protein (r = 0.4, p < 0.001) and MELD score. Higher leukocytes, higher urea, C-reactive protein and lower serum albumin rates give higher MELD score. At the time of hospitalization 208 (94%) of the patients had different complications of liver cirrhosis. Correlation between MELD score varied significantly with esophageal varices (r = 0.2, p < 0.05) and esophageal vein bleeding (r = 0.2, p < 0.05). Results show, if patient is present with esophageal varices and esophageal vein bleeding, MELD score is higher. Conclusion: Patients with higher leukocytes, blood urea nitrogen and lower serum albumin level are presenting higher MELD score. In patients who presented with esophageal varices and esophageal vein bleeding, higher MELD score was observed.

Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe.

OBJECTIVES: The aim of the study was to investigate the organization and delivery of HIV and tuberculosis (TB) health care and to analyse potential differences between treatment centres in Eastern (EE) and Western Europe (WE). METHODS: Thirty-eight European HIV and TB treatment centres participating in the TB:HIV study within EuroCoord completed a survey on health care management for coinfected patients in 2013 (EE: 17 respondents; WE:21; 76% of all TB:HIV centres). Descriptive statistics were obtained for regional comparisons. The reported data on health care strategies were compared with actual clinical practice at patient level via data derived from the TB:HIV study. RESULTS: Respondent centres in EE comprised: Belarus (n = 3), Estonia (1), Georgia (1), Latvia (1), Lithuania (1), Poland (4), Romania (1), the Russian Federation (4) and Ukraine (1); those in WE comprised: Belgium (1), Denmark (1), France (1), Italy (7), Spain (2), Switzerland (1) and UK (8). Compared with WE, treatment of HIV and TB in EE are less often located at the same site (47% in EE versus 100% in WE; P < 0.001) and less often provided by the same doctors (41% versus 90%, respectively; P = 0.002), whereas regular screening of HIV-infected patients for TB (80% versus 40%, respectively; P = 0.037) and directly observed treatment (88% versus 20%, respectively; P < 0.001) were more common in EE. The reported availability of rifabutin and second- and third-line anti-TB drugs was lower, and opioid substitution therapy (OST) was available at fewer centres in EE compared with WE (53% versus 100%, respectively; P < 0.001). CONCLUSIONS: Major differences exist between EE and WE in relation to the organization and delivery of health care for HIV/TB-coinfected patients and the availability of anti-TB drugs and OST. Significant discrepancies between reported and actual clinical practices were found in EE.

Changing utilization of Stavudine (d4T) in HIV-positive people in 2006-2013 in the EuroSIDA study.

OBJECTIVES: The long-term side effects of stavudine (d4T) led to recommendations in 2009 to phase out use of this drug. We aimed to describe temporal patterns of d4T use across Europe. METHODS: Patients taking combination antiretroviral therapy (cART) in EuroSIDA with follow-up after 1 January 2006 were included in the study. cART was defined as d4T-containing [d4T plus at least two other antiretrovirals (ARVs) from any class] or non-d4T-containing (at least three ARVs from any class, excluding d4T). Poisson regression was used to describe temporal changes in the prevalence of d4T use and factors associated with initiating d4T. RESULTS: A total of 5850 patients receiving cART on 1 January 2006 were included in the current analysis, rising to 7768 patients on January 1 2013. During this time, the prevalence of d4T use fell from 11.2% to 0.7%, with an overall decline of 19% per 6 months [95% confidence interval (CI) 19-20%]. d4T use declined fastest in Northern Europe [26% (95% CI 23-29%) per 6 months], and slowest in Eastern Europe [17% (95% CI 16-19%) per 6 months]. In multivariable Poisson regression models, new d4T initiations decreased by 14% per 6 months [adjusted incidence rate ratio (aIRR) 0.86; 95% CI 0.80-0.91]. Factors associated with initiating d4T were residence in Eastern Europe (aIRR 4.31; 95% CI 2.17-9.98) versus other European regions and HIV RNA > 400 copies/mL (aIRR 3.11; 95% CI 1.60-6.02) versus HIV RNA < 400 copies/mL. CONCLUSIONS: d4T use has declined sharply since 2006 to low levels in most regions; however, a low but persistent level of d4T use remains in Eastern Europe, where new d4T initiations post 2006 are also more common. The reasons for the regional differences may be multifactorial, but it is important to ensure that all clinicians treating HIV-positive patients are aware of the potential harmful effects associated with d4T.