ALTHOUGH MAY'S GENERAL ELECTION IN ISRAEL REPRESENTS A HIATUS IN THE MIDDLE EAST PEACE PROCESS, WHICH HAS BEEN STALLED SINCE THE 1996 ELECTIONS BROUGHT BENJAMIN NETANYAHU'S LIKUD COALITION GOVERNMENT TO POWER, 1999 MAY MARK A NEW STAGE IN THE QUEST FOR STABILITY. THE NETANYAHU GOVERNMENT, EVEN THOUGH IT ACCEPTED THE LETTER OF THE OSLO ACCORDS BETWEEN ISRAEL AND THE PALESTINE LIBERATION ORGANIZATION, THWARTED THEM IN SPIRIT, DRAGGING OUT THE NEGOTIATIONS WITH THE PALESTINE AUTHORITY AND CONTINUING WITH THE EXPANSION OF SETTLEMENTS ON THE WEST BANK. THE WYE PLANTATION ON OCTOBER 1998 REPRESENTED A RE-STARTING OF THE TALKS, SOME TWO-AND-A-HALF YEARS BEHIND SCHEDULE.
TURKEY IS, AND IS DETERMINED TO REMAIN, A DEMOCATIC, SECULAR REPUBLIC IN ACCORDANCE WITH THE IDEALS OF MUSTAFA KEMAL ATATURK. TURKEY'S LEADERS SEE THEIR DEMOCRATIC/SECULAR SYSTEM AS A MODEL FOR OTHER STATES IN THEIR REGION. THIS ARTICLE EXPLORES SOME OBSTACLES IN THE WAY OF ACHIEVING THIS ASPIRATION BY ANALYZING TURKEY'S RELATIONS WITH ITS NEIGHBORS. IT FINDS IT DIFFICULT TO BE WHOLLY OPTIMISTIC AND NOTES THAT TURKEY IS AT PRESENT SWIMMING AGAINST THE TIDES IN ITS FOREIGN POLICY ENDEAVORS.
IN THIS ARTICLE, THE AUTHOR RECALLS THE HISTORICAL AND POLITICAL CIRCUMSTANCES WHICH GAVE RISE TO THE EUROPEAN ECONOMIC COMMUNITY, AND DESCRIBES THE PRICIPLE ACHIEVEMENTS OF THAT ORGANIZATION OVER THE LAST THIRTY YEARS. PERHAPS THE FOREMOST ACHIEVEMENT HAS BEEN A VERY SUBSTANTIAL RISE IN THE GENERAL STANDARD OF LIVING OF CITIZENS OF THE MEMBER STATES. ALSO, OVER THE YEARS, EEC HAS GREATLY EXPANDED ITS MEMBERSHIP, AND HAS REACHED CONSENSUS ON A NUMBER OF COMMON POLICIES WHICH HAS HARMONIZED EEC TO VARYING DEGREES. THESE ACHIEVEMENTS CAN HELP BOLSTER COOPERATION TO ADDRESS THE SERIOUS PROBLEMS CONFRONTING THE EEC AT THE DAWN OF THE 21ST CENTURY.
Hepatitis C (HCV) and HIV share common transmission pathways and the acquisition of both viruses are relatively common. Concurrent treatment for HCV with highly active anti‐retroviral therapy (HAART) should be considered in HIV co‐infected individuals to decrease the progression of liver damage. Adverse effects and less satisfactory treatment outcomes are often concerns when treating co‐infected individuals. Although, direct acting antivirals (DAAs) may increase SVR, they may not be possible because of drug‐drug interactions. he objective of this study is to investigate the difference in response rates of HCV treatment in HIV co‐infected inmates with varying doses of ribavirin. Retrospective medical chart reviews of 52 HCV/HIV co‐infected inmates who underwent HCV therapy between 2003 and 2010. All received standard doses of pegylated interferon alpha 2a or 2b and 800–1600 mg of ribavirin depending on weight. The recommended dosage for genotypes 2 and 3 is 800 mg/day. For other genotypes, if weight is<75 kg, the recommended ribavirin dose is 1000 mg/day or 1200 mg/day if>75 kg. Efficacy was defined as attaining sustained virological response (SVR) six months post treatment. Univariate analyses was performed using SPSS‐18; Chi‐square test with p‐value<0.05 was defined significant. 52 co‐infected (3 females & 49 males) were identified. Mean age was 40±7 years. Caucasians accounted for 84.6%; First Nations for 13.5% and Asians 1.9%. 36 were concurrently on HAART. The genotype distribution was: geno 1, 66.0%; geno 2, 7.5%; geno 3, 26.4%. SVR by ribavirin dosage ratio (actual dosage/recommended dosage):=1.0; 41.2% (14/34),>1.0; 58.8% (20/34). Doses greater than 1.5 times were associated with higher adverse events and lower SVR. Suboptimal doses of weight‐based ribavirin may be contributing to a lower treatment response in HCV/HIV co‐infectants. In our experience, the optimal dose of ribavirin is between 1 and 1.2 times the current recommended dose. We recommend that ribavirin dose be individualized in co‐infected in order to enhance the likelihood of achieving SVR. Dual therapy is more practical in many of our population because of chaotic lifestyle. Therefore optimizing the ribavirin dose should be initially undertaken.
Hepatitis C (HCV) and HIV are commonly acquired through intravenous drug use (IDU). Treatment of HCV is beneficial in reducing hepatic complications and likely decelerating the rate of progression of HIV. HCV therapy in HCV/HIV co‐infected individuals is increasingly being reported to be feasible. However, re‐infection is emerging as an important concern, especially in the prison population where likely related to surreptitious IDU. In this study, we report the re‐infection rate of inmates in the Pacific region of Canada who have HCV/HIV and were successfully treated for HCV. Retrospective medical chart reviews of 57 co‐infected inmates with a history of IDU who received HCV therapy between April 2003 and June 2012. All received standard doses of pegylated interferon alpha 2a or 2b and weight‐base ribavirin for durations of 24–48 weeks depending on genotypes. After successfully attaining SVR, inmates are routinely monitored for re‐infection every 6–12 months with HCV RNA qualitative analysis. Of the 57 inmates with HCV/HIV, 48 (82.8%) were Caucasians and 10 (17.2%) were First Nations. 94.7% (54) of the study population were males. The mean age at the start of treatment was 39.6±7.5 years. 100% (inclusion criteria) admitted to IDU before treatment and 7 (12.1%) admitted IDU after treatment. Genotype 1 made up 56.1% (32), followed by genotype 3 at 35.1% (20) and genotype 2 at 8.8% (5). Treatment was discontinued due to adverse side effects in 4 (6.9%) and discontinued due to no response in 9 (15.5%) inmates. 2 (3.7%) were lost to follow up due to discharge to community. SVR was attained in 33 (56.9%) inmates and of those 30.3% (10) were re‐infected. These re‐infected cases were noted mainly in genotype 3 (60%) and genotype 1 (40%). Six had viral relapsed. SVR results are pending for three. Achieving a SVR is encouraging in HCV/HIV co‐infected. Our study revealed that 30.3 % of the inmate population became re‐infected after treatment. Of note, these numbers are relatively small. However, it is important that counseling regarding harm reduction and strategies should be provided before, during and after treatment to help reduce the rate of re‐infection.
