Introduction: Liver disease caused by hepatitis C virus (HCV) is a major cause of morbidity in HIV patients. This study investigates the possibility that chronic HCV increases the risk of hepatotoxicity after highly active antiretroviral therapy (HAART) initiation. Methodology: The data from 30 coinfected HIV/HCV and 35 HIV monoinfected patients between August 2008 and August 2010, since the start of HAART, were analyzed along with data from every three months, with clinical/laboratory evaluation until the end of twelve months. The aim of this study was to assess risk and incidence of hepatotoxicity in both groups. Results: Before the introduction of HAART, coinfected patients had higher average levels of transaminases than did the monoinfected group (p < 0.001). After initiation of HAART, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were higher in coinfected patients, regardless of type of HAART they received. Twenty-two (73%) of the coinfected patients had some degree of hepatotoxicity versus only seven (20%) of the monoinfected patients. No patient had severe hepatotoxicity. Risk of hepatotoxicity after HAART in a coinfected patient was 3.7 times higher than in a monoinfected patient .4], p < 0.001).Conclusions: This study demonstrates that coinfected patients are at an increased risk for developing hepatotoxicity, but the clinical and immunological benefits of HAART are higher than the risk of hepatotoxicity and rarely justify discontinuation of therapy.

Objective: To evaluate caesarean section (CS) rates in women with and without HIV and frequency of mother-to-child HIV transmission. Design: Retrospective cohort study. Setting: Tertiary hospital in south Brazil, epicenter of the country’s HIV epidemic. Population or Sample: Women-infant pairs delivering at one institution between 1/1/2008 to 12/31/2018 Methods: Data was extracted from hospital records CS frequencies were compared using Pearson’s chi-squared test. CS predictors were evaluated by multivariate log-linear Poisson regression using a generalized estimating equations approach. HIV viral suppression (VS) was defined as virus load (VL) of <1000 copies/ml at delivery. HIV MTCT was determined according to national guidelines. Main Outcome Measures: C-section, HIV mother-to-child transmission (MTCT). Results: Over 11 years, 48,688 pregnancies occurred in 40,375 women; HIV seroprevalence was 2.7%; 18,886 (38.8%) CS were performed; 47.7% of WLH and 38.6% of women without HIV (WWOH) had CS, p<0.001. Although HIV was a risk factor for CS (aRR: 1.17 [1.05-1.29]), WLH with VS achieved similar CS rates (36.7%) as WWOH (39.8%) by 2018. CS in WLH with unknown VL at delivery (42.6%) did not increase over time. HIV MTCT rate was 2.2%, highest in WLH with unknown VL (8.4%) versus WLH without VS (4.1%) and WLH with VS (0.5%; p<0.001). Conclusion: In the HIV epicenter of Brazil, WLH with VS had less surgical deliveries, likely due to potent combination antiretroviral use. Nearly half of WLH with unknown VL, did not undergo CS, a potential missed opportunity for HIV PMTCT.