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Hepatitis

Hepatitis

Hepatitis can be caused by many different things including viral infections, parasites, bacteria, chemicals, autoimmunity, drugs or alcohol. Of these, viral infection is the most common cause of chronic (long-term) hepatitis, which can lead to severe liver damage including cirrhosis and liver cancer.

Hepatitis B and C viruses (HBV and HCV) are among the world’s most common infectious pathogens. It is estimated that 500 million people – 1 in 12 of the global population – are chronically infected with one or both of these viruses.1,2  The majority of these people live in the developing world and many of them are unaware that they are infected. Chronically infected patients are at increased risk of developing cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC), which together account for more than 1 million deaths annually.3

The hepatitis B virus is a resilient virus present in all bodily fluids of infected individuals. It is resistant to breakdown and able to survive outside the body. It can be transmitted effectively through contact with infected bodily fluids in the same way as HIV. However, HBV is 50–100 times more infectious than HIV.

Screening for HBV and HCV infection is crucial, not only to detect patients who may require treatment to reduce the risk of progression to severe sequelae, but also to reduce transmission rates.

The primary objective of therapy for chronic HBV is to achieve control of viral replication and halt disease progression/improve liver histology. This will decrease pathogenicity and infectivity and thereby stop or reduce hepatic necroinflammation.

Chronic hepatitis C infection may result in severe liver damage leading to liver failure, HCC and death. As a consequence, therapeutic intervention can arrest, and perhaps even reverse, the disease before irreversible liver damage occurs. 

Enter the Hepatitis B and C Knowledge Centre


References

1. World Health Organization. World Health Organization Hepatitis B Fact Sheet. 1998.
2. World Hepatitis Alliance. www.aminumber12.org
3. Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis B. Lancet 2003;362:2089–94

Men's Health

Men's Health

As a disease topic Men's Health covers a broad set of issues affecting men of all ages. Some of the issues requiring greater focus and more thorough dissemination of information amongst the healthcare community, are those that have the potential to go undetected in the early stages. Diseases where early detection and more regular health checks not only improve prognosis and efficacy of treatment outcomes, but also quality of life.

These include:

Erectile Dysfunction (ED)

Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. Although not considered a part of the aging process, it is associated with certain physiologic and psychological changes related to age. ED is most common in men between 40-70 years of age. However incidence is also higher amongst men with certain medical conditions which include, diabetes, heart disease, and hypertension. ED can also be a warning sign/symptom of these underlying conditions. 1

Hypogonadism (low testosterone)

Testosterone is an essential male hormone produced in the testes that plays a crucial role in the health and well being of male bodies. It is responsible for typical male sexual characteristics and is required by all men for a healthy life physically and psychologically.

Low testosterone, clinically known as hypogonadism, consists of decreased functional activity of the testes with diminished production and action of testosterone.  Although there is a progressive decline in testosterone levels as men age, hypogonadism can occur in men of any age.

Men with low testosterone are also at increased risk of cardiovascular disease, diabetes and metabolic syndrome and osteoporosis.

For your information, the Mens Health knowledge centre concentrates on the understanding, management and treatment of erectile dysfunction and hypogonadism.  The website also provides extensive details on up-coming conferences as well as an extensive library of useful resource. You can also access the knowledge centre via www.menshealthfocus.com.

Enter the Men's Health Knowledge Centre


References

1. McVary, Kevin T. Erectile. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL et al., editors. Harrison's Internal Medicine. 16th ed. New York: McGraw-Hill; 2005. p. 272-274

Clinical Case Studies

Needlestick Injuries and Post-exposure Prophylaxis Against HIV Infection

Infection: HIV Infection

Nneka Nwokolo, Consultant in Genitourinary Medicine, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK

Case History
A junior doctor is referred by the occupational health department having sustained a deep puncture wound to his left thumb 30 minutes previously. He had been attempting to resheath an arterial blood gas needle used on an unconscious patient admitted the day before with Pneumocystis jirovecii pneumonia.

Cryptococcal Disease in HIV

Infection: HIV Infection

Neil D. Ritchie, Clinical Lecturer in Infectious Diseases, Medical Faculty, University of Glasgow, Glasgow, UK

Case History
A 43-year-old Zimbabwean woman presented with headache and meningism of several weeks' duration.

Medical Videos

The Risk Factors Associated With Sexually Transmitted Diseases
The Risk Factors Associated With Sexually Transmitted Diseases

Recent Drug Updates

Medical Images

gp120 and the CCR5 co-receptor
 gp120 and the CCR5 co-receptor
HIV envelope glycoprotein
HIV envelope glycoprotein
HIV-1 genome
HIV-1 genome
Pneumocystis jirovecii pneumonia
Pneumocystis jirovecii pneumonia
HIV-1 group M subtypes and CRFs
HIV-1 group M subtypes and CRFs
Key events leading up to the era of HAART
Key events leading up to the era of HAART

Clinical Guidelines

British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012 (Updated November 2013)

Nov 2013

The overall purpose of these guidelines is to provide guidance on best clinical practice in the..

... treatment and management of adults with HIV infection with antiretroviral therapy (ART). The scope includes: (i) guidance on the initiation of ART in those previously naïve to therapy; (ii) support of patients on treatment; (iii) management of patients experiencing virological failure; and (iv) recommendations in specific patient populations where other factors need to be taken into consideration. The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection and at community advocates responsible for promoting the best interests and care of HIV-positive adults.

Guidelines on the management of erectile dysfunction

Sep 2013

The objective of this guideline is to provide healthcare professionals with recommandations on the..

... management of patients with erectile dysfunction.

Online CME

Antimicrobial-resistant gonorrhoea

This article discusses the recent problem of drug-resistant strains of gonorrhoea and how management methods have been adapted to combat this.

e-LfH eHIV-STI

eHIV-STI is an engaging and extensive e-learning programme supporting specialist training in Sexual Health & HIV. It has been developed by the British Association for Sexual Health and HIV (BASHH)...

Chlamydia infection: diagnosis and management

After completing this module you should know: the symptoms of chlamydia infections, how to test for and treat chlamydia infections, and how to manage sexual contacts of people with chlamydia...

Clinical Trials

Switch Study to Evaluate F/TAF in HIV-1 Positive Participants Who Are Virologically Suppressed on Regimens Containing FTC/TDF

22-04-2014

This study will evaluate the efficacy and safety of switching from emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) fixed dose combination (FDC) to emtricitabine/tenofovir alafenamide (F/TAF) FDC versus maintaining a treatment regimen of FTC/TDF FDC in HIV-1 positive participants who are virologically..

... suppressed on regimens containing FTC/TDF. Efficacy will be determined by the proportion of participants with HIV-1 RNA < 50 copies/mL at Week 48.

This study will consist of a 96 week double-blind treatment period. After Week 96, all participants will continue on blinded study drug treatment and attend visits every 12 weeks until treatment assignments are unblinded. All participants will return for an unblinding visit and will be given the option to receive open-label F/TAF and attend visits every 12 weeks until F/TAF is commercially available, or the sponsor terminates the F/TAF clinical development program.

A Phase IIb Study to Evaluate a Long-Acting Intramuscular Regimen for Maintenance of Virologic Suppression (Following Induction With an Oral Regimen of GSK1265744 and Abacavir/Lamivudine) in Human Immunodeficiency Virus Type 1 (HIV-1) Infected, Antiretroviral Therapy-Naive Adult Subjects

17-04-2014

This study is a Phase IIb, randomized, multicentre, parallel group, open-label, study having an overall objective to evaluate the antiviral activity, tolerability, and safety of two intramuscular (IM) dosing regimens of GSK744 LA plus TMC278 LA, relative to GSK744 30 milligram (mg) plus Abacavir/Lamivudine (ABC/3TC)..

... given orally once daily (QD), in HIV-1 infected antiretroviral-naïve subjects. GSK744 is the oral formulation of GSK1265744, GSK744 LA is the long acting injectable formulation of GSK1265744 and TMC278 LA is the long acting injectable formulation of TMC278.

The study will consist of three parts: an Induction Period, Maintenance Period and Extension Period. There is also a Long-Term Follow Up Period for subjects who withdraw from the study and have received at least one dose of GSK744 LA and / or TMC278 LA. In the Induction Period, eligible subjects will receive a combination of an oral regimen of 30 mg of GSK744 and 600/300 mg of ABC/3TC, once daily for 20 weeks. In the Maintenance Period, eligible subjects will be randomized 2:2:1 at Day 1 to receive an IM regimen of GSK744 LA 400 mg + TMC278 LA 600 mg every 4 weeks for 96 weeks (Q4W), an IM regimen of GSK744 LA 600 mg + TMC278 LA 900 mg every 8 weeks for 96 weeks (Q8W), or to continue on the oral Induction Period regimen of GSK744 30 mg + ABC/3TC once daily for 96 weeks (or 104 weeks if continuing on to the Extension Period). The Extension Period will allow for a collection of longer term efficacy and safety and tolerability data from subjects receiving GSK744 LA and TMC278 LA.

The study will involve sufficient subjects at screening in order to ensure a total of approximately 265 subjects at the beginning of the Induction Period and approximately 225 subjects randomized into the Maintenance Period.

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