Background and Aim The population based incidence rate of drug induced liver injury (DILI) in the United States is not known. The Drug Induced Liver Injury Network (DILIN) accrues cases of hepatotoxicity due to medications and herbal and dietary supplements (HDS) from limited geographical areas. The current analysis was an ancillary study of DILIN aimed at determining the annual incidence of DILI in the US on a population basis, through surveillance in the state of Delaware. Methods At the outset of the study, there were 41 gastroenterologists in the state of Delaware and all agreed to participate in surveillance for DILI, which comprised active reporting of suspected cases to the DILIN. The gastroenterologists underwent training in the diagnosis of DILI and were provided with DILIN inclusion criteria. Only cases that met the DILIN laboratory inclusion criteria in 2014 were included in the incidence calculation, and these patients were invited to participate in the DILIN Prospective Study. The number of suspected cases that met inclusion criteria served as the numerator and the 2014 Delaware adult population as the denominator. Results During 2014, 23 patients were identified by the surveillance network, 20 of whom met DILIN laboratory inclusion criteria, leading to a incidence of 2.7 cases of DILI per 100,000 adult residents (95% CI: 1.5 to 3.9 per 100,000). Fourteen subjects agreed to participate in the DILIN; 6 declined. Among enrolled cases, the mean age was 51 years, 57% were women, and 71% were white. Eight cases were attributed to antibiotics (36%) and other drugs (21%) and 6 to HDS (43%). The pattern of injury was hepatocellular in all HDS cases but in only 50% of conventional drug cases (p=0.05) which more commonly presented with eosinophilia (p=0.47) and higher alkaline phosphatase levels (p=0.05). Half of patients were jaundiced, none developed liver failure and all recovered without the need for transplantation. Conclusion Prospective gastroenterologist-based surveillance for suspected DILI in Delaware yielded an incidence of 2.7 cases per 100,000 adults in 2014; this is the first prospective estimate of DILI for the US. Because surveillance was limited to subspecialists, the actual incidence of DILI is likely to be higher. These findings provide a benchmark statistic for the epidemiology of DILI in the United States, to be refined with expansion of the surveillance period.

Prior to release from the Rhode Island state prison, women at the highest risk for reincarceration and HIV infection are assigned to the Women's HIV/Prison Prevention Program (WHPPP), a discharge program designed to reduce the likelihood of reincarceration and HIV infection. Candidates for the WHPPP must meet at least one of three criteria: intravenous drug use or crack use, commercial sex work, or a history of prison recidivism with poor educational history and poor employment prospects. While incarcerated, the program participant develops a relationship with a physician and a social worker and establishes an individualized discharge plan. After release, the same physician and social worker continue to work with the client and assist an outreach worker in implementing the discharge plan. Data were collected from questionnaires administered to 78 women enrolled in the WHPPP between 1992 and 1995. The population in this program was primarily composed of ethnic minorities (55%), 25-35 years of age (55%), unmarried (90%), had children (72%), and displayed a variety of HIV risk behaviors. The WHPPP recidivism rates were compared with those of a mostly white (65%), similarly aged (51% were between 25 and 35 years of age) historical control group of all women incarcerated in Rhode Island in 1992. The intervention group demonstrated lower recidivism rates than the historical control group at 3 months (5% versus 18.5%, p = 0.0036) and at 12 months (33% versus 45%, p = 0.06). Assuming that recidivism is a marker for high-risk behavior, participation in the WHPPP was associated with a reduction in recidivism and in the risk of HIV disease in this very high risk group of women.

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Background & Aims Pernicious anemia (PA) is characterized by vitamin B12 deficiency and achlorhydria, both of which have a detrimental effect on bone strength. The principle aim of this study was to determine the risk of hip fracture in patients with PA. Methods This is a retrospective cohort study using the General Practice Research Database (GPRD) from the United Kingdom. GPRD data from May 1987 until April 2002 were utilized to identify patients between 40 and 90 years of age at the time of GPRD enrollment. The exposed group contained patients with a diagnosis of PA being treated with vitamin B12 therapy. We matched each patient having a diagnosis of PA with 4 randomly selected non-PA patients with respect to age (+/− 1 year) and sex. Cox regression analysis was used to determine the hazard ratio (HR) for hip fracture associated with PA. Results 9,506 patients with a diagnosis of PA receiving vitamin B12 injection therapy were identified and compared to 38,024 controls. Patients with PA had a greater risk of hip fracture than the controls (HR 1.74, 95% CI 1.45–2.08). The increase in hip fracture risk was even more pronounced among those patients newly diagnosed with PA during GPRD follow-up (HR 2.63, 95% CI 2.03–3.41). Conclusions Patients with a diagnosis of PA have an elevated risk of hip fracture. The increased hip fracture risk was persistent even years after vitamin B12 therapy. Chronic achlorhydria could be the mechanism contributing to the persistently elevated hip fracture risk.

We conclude that HCV/HIV coinfection is associated with worsened liver disease and higher mortality than HCV- or HIV-monoinfection without directly influencing CD4 count and HCV or HIV titers. Furthermore, we demonstrated a racial disparity in survival of HCV/HIV-coinfected patients that needs further investigation.