Insight on the hepatitis B virus and host immune mechanisms in the context of occult hepatitis.

Hepatitis B virus infection is the 10th leading cause of death around the world. Occult HBV infection (OBI) represents those with a viral load of < 104 IU/ml. Among permanent blood recipients, OBI appears to be the most common cause of posttransfusion hepatitis. Moreover, OBI may reduce hepatitis C virus (HCV) treatment responsiveness in people with chronic HCV infection, and OBI may become acutely reactivated when on immunosuppression or potentially contribute to chronic liver disease. Since most previous studies used either small sample sizes, diverse populations, or were cross-sectional in design, it is possible that using multiple techniques with varying sensitivity for HBV DNA measurement in the liver or serum will shed light on discrepancies in the impact of OBI in cases with chronic liver disease. The purpose of this research is to review many elements of OBI, such as its prevalence, the hepatitis B virus and host immune mechanisms, diagnostic procedures, clinical implications, therapy, and prevention strategies.

The outcome of prevention of mother-to-child transmission of HIV infection at King Abdulaziz University Hospital, Western Region of Saudi Arabia: A Descriptive Study.

OBJECTIVES: To describe the effectiveness of HIV guidelines in prevention of mother-to-child transmission (PMTCT). METHODS: A retrospective review from January 2009 to December 2018 at the King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. The main outcome measures were characteristics of HIV-exposed patients and transmission rate. RESULTS: A total of 18 HIV-positive mothers and their 26 infants were included. The mean age of mothers at delivery was 31.69 years, and 50% were under 30 years old. All mothers received lifelong ART, except one who was not diagnosed until the 27th week of gestation. Among the mothers, 83% complied with treatment regimens, and 11% had ART resistance. Human immunodeficiency virus polymerase chain reaction (PCR) was undetectable in 19 pregnancies. Seven mothers had opportunistic infections and treatment was immediately initiated. After reviewing the infants' HIV PCR tests, the transmission rates of HIV were 0% for both spontaneous vaginal delivery and cesarean section. CONCLUSION: Many challenges face the efforts to decrease vertical HIV transmission, and a particular focus on the transitions between stages of care is needed. We believe that early screening, counseling, and regular follow-up have contributed to MTCT elimination.

Efficacy and safety of eravacycline: A meta-analysis.

OBJECTIVES: This study was conducted to evaluate the efficacy and safety of eravacycline, a recently approved fluorocycline for treatment of complicated intra-abdominal infections (cIAIs). METHODS: PubMed, EMBASE and three trial registries were searched for randomised controlled trials (RCTs) comparing the efficacy and safety of eravacycline versus comparators. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using random-effects models. The study outcomes included clinical response, all-cause mortality and adverse events (AEs). RESULTS: Three RCTs (1128 patients) with cIAIs were included. There were no significant differences in clinical response in the modified intention-to-treat (ITT) (OR, 0.91, 95% CI 0.62-1.35; I2 = 0%), microbiological ITT (OR, 0.93, 95% CI 0.61-1.41; I2 = 0%) and clinically evaluable (OR, 0.98, 95% CI 0.55-1.75; I2 = 0%) populations or in all-cause mortality (OR, 1.18, 95% CI 0.16-8.94; I2 = 0%). Eravacycline was associated with significantly greater odds of total AEs (OR, 1.55, 95% CI 1.20-1.99; I2 = 0%) and nausea (OR, 5.29, 95% CI 1.77-15.78; I2 = 1.70%) but the increase in vomiting was non-significant (OR, 1.44, 95% CI 0.73-2.86; I2 = 1.70%). There were no significant differences in serious AEs or discontinuation due to AEs. CONCLUSION: This meta-analysis of RCTs found similar clinical efficacy and mortality for eravacycline compared with carbapenems for treatment of cIAIs. However, the odds of total AEs and specifically nausea was higher with eravacycline, while no significant differences were observed in vomiting (although numerically higher), serious AEs or discontinuation due to AEs.

Improving HCV cure rates in HIV-coinfected patients - a real-world perspective.

OBJECTIVES: To study rates and predictors of hepatitis C virus (HCV) cure among human immunodeficiency virus (HIV)/HCV-coinfected patients, and then to evaluate the effect of attendance at clinic visits on HCV cure. METHODS: Retrospective cohort study of adult HIV/HCV-coinfected patients who initiated and completed treatment for HCV with direct-acting antivirals (DAAs) between January 1, 2014, and June 30, 2015. RESULTS: Eighty-four participants reported completing treatment. The median age was 58 years (interquartile ratio, 50-66); 88% were male and 50% were black. One-third were cirrhotic and half were HCV-treatment-experienced. The most commonly used regimen was sofosbuvir/ledipasvir (40%) followed by simeprevir/sofosbuvir (30%). Cure was achieved in 83.3%, 11.9% relapsed, and 2.3% experienced virological breakthrough. Two patients (2.3%) did not complete treatment based on pill counts and follow-up visit documentation. In multivariable analysis, cure was associated with attendance at follow-up clinic visits (odds ratio [OR], 9.0; 95% CI, 2.91-163) and with use of an integrase-based HIV regimen versus other non-integrase regimens, such as non-nucleoside analogues or protease inhibitors (OR, 6.22; 95% CI 1.81-141). Age, race, genotype, presence of cirrhosis, prior HCV treatment, HCV regimen, and pre-treatment CD4 counts were not associated with cure. CONCLUSIONS: Real-world HCV cure rates with DAAs in HCV/HIV coinfection are lower than those seen in clinical trials. Cure is associated with attendance at follow-up clinic visits and with use of an integrase-based HIV regimen. Future studies should evaluate best antiretroviral regimens, predictors of attendance at follow-up visits, impact of different monitoring protocols on medication adherence, and interventions to ensure adequate models of HIV/HCV care.