Prevalent and Incident Hepatitis C Virus Infection Among HIV-Infected Men Who Have Sex With Men Engaged in Primary Care in a Boston Community Health Center.

Prevalent and Incident Hepatitis C Virus Infection among HIV-Infected Men Who Have Sex with Men Engaged in Primary Care in a Boston Community Health Center.

Filed under: Drug and Alcohol Rehabilitation

Clin Infect Dis. 2013 Feb 5;
Garg S, Taylor LE, Grasso C, Mayer KH

Background.?Sexually transmitted hepatitis C virus (HCV) infection is an emerging epidemic among HIV-infected men who have sex with men (MSM). HCV may be under-recognized in this population, historically thought to be at low risk.Methods.?We determined the prevalence and incidence of HCV among HIV-infected men at Fenway Health between 1997 and 2009. We describe characteristics associated with HCV.Results.?Of 1171 HIV-infected men, of whom 96% identify as MSM, 1068 (91%) were screened for HCV and 64 (6%) had a positive HCV antibody (Ab) result at initial screening. Among the 995 men whose initial HCV Ab was negative, 62% received no further HCV Ab testing. Among the 377 men who had ?1 additional HCV Ab test, 23 (6%) seroconverted over 1,408 person-years, for an annualized incidence of 1.63/100 person-years (95% CI 0.97-2.30). Among the 87 HIV-infected MSM diagnosed with prevalent or incident HCV, 33% reported history of injection drug use, 46% non-injection drug use (NIDU) and 70% sexually transmitted infections (STI). Sixty-four (74%) of HCV-infected MSM developed chronic HCV; 22 (34%) initiated HCV treatment and 13 (59%) of treated persons achieved a sustained virologic response (SVR).Conclusion.?Prevalent and incident HCV, primarily acquired through non-parenteral means, was common in this HIV-infected population despite engagement in care. STIs and NIDU were common among HIV/HCV coinfected MSM. SVR rates were high among those who underwent HCV treatment. All sexually active and/or substance-using HIV-infected MSM should receive routine and repeated HCV screening to allow for early diagnosis and treatment of HCV.
HubMed – drug

Methylprednisolone sodium succinate-associated macroglossia in a critically ill patient.

Filed under: Drug and Alcohol Rehabilitation

Pharmacotherapy. 2013 Feb; 33(2): e14-8
Igneri LA, Czosnowski QA, Whitman CB

Allergic hypersensitivity reactions are a rare adverse effect of corticosteroids. Previous reports have identified patients who developed symptoms of urticaria, dyspnea, hypotension, bronchospasm, and angioedema occurring within minutes to an hour after corticosteroid administration. A 35-year-old woman is described who developed an atypical reaction of isolated macroglossia after receiving intravenous methylprednisolone sodium succinate for myasthenic crisis. Macroglossia was identified on day 2 of therapy and worsened through day 5. On day 5, she was transitioned to prednisone 50 mg daily administered by feeding tube. Tongue swelling improved by day 7 and on day 10, the patient was extubated. The patient required reintubation due to stridor, but received a tracheostomy and was weaned off mechanical ventilation by day 15. The reaction was not confirmed with skin-prick tests, intradermal tests, or a drug rechallenge; however, she had previously received and tolerated all other drugs administered during this time. Due to the timing of administration and onset of symptoms, we feel this adverse drug reaction was likely due to administration of methylprednisolone. Applying the Naranjo adverse drug reaction probability scale to this case, a score of six was obtained, indicating a probable association between the administration of methylprednisolone and the development of macroglossia. As intravenous corticosteroids are often used in the treatment of allergic reactions, they may be overlooked as a cause of macroglossia and other allergic reactions; therefore, practitioners need to be aware of the possibility of this adverse effect secondary to corticosteroid administration. In the event of methylprednisolone sodium succinate-induced macroglossia, alternative nonesterified corticosteroids, such as dexamethasone or prednisone, should be considered if continuation of therapy is required.
HubMed – drug

The role of human carboxylesterases in drug metabolism: have we overlooked their importance?

Filed under: Drug and Alcohol Rehabilitation

Pharmacotherapy. 2013 Feb; 33(2): 210-22
Casey Laizure S, Herring V, Hu Z, Witbrodt K, Parker RB

Carboxylesterases are a multigene family of mammalian enzymes widely distributed throughout the body that catalyze the hydrolysis of esters, amides, thioesters, and carbamates. In humans, two carboxylesterases, hCE1 and hCE2, are important mediators of drug metabolism. Both are expressed in the liver, but hCE1 greatly exceeds hCE2. In the intestine, only hCE2 is present and highly expressed. The most common drug substrates of these enzymes are ester prodrugs specifically designed to enhance oral bioavailability by hydrolysis to the active carboxylic acid after absorption from the gastrointestinal tract. Carboxylesterases also play an important role in the hydrolysis of some drugs to inactive metabolites. It has been widely believed that drugs undergoing hydrolysis by hCE1 and hCE2 are not subject to clinically significant alterations in their disposition, but evidence exists that genetic polymorphisms, drug-drug interactions, drug-disease interactions and other factors are important determinants of the variability in the therapeutic response to carboxylesterase-substrate drugs. The implications for drug therapy are far-reaching, as substrate drugs include numerous examples from widely prescribed therapeutic classes. Representative drugs include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, antiplatelet drugs, statins, antivirals, and central nervous system agents. As research interest increases in the carboxylesterases, evidence is accumulating of their important role in drug metabolism and, therefore, the outcomes of pharmacotherapy.
HubMed – drug

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