Background: Acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) is an important health concern worldwide, and AIDS-related morbidity and mortality have seen a sharp decline due to the introduction of highly active antiretroviral therapy (HAART). To address the problems of high cost, poor compliance, lack of awareness, social stigma, and occurrence of adverse effects in India, National AIDS Control Organization (NACO) has organized a simplified drug regimen with regular monitoring, counseling, and follow-up by specially trained personnel with necessary laboratory facilities and infrastructure. Objectives: The present study was taken up to assess the efficacy of the NACO-recommended HAART regimen in subjects with HIV in the south Indian population. Materials and Methods: HAART, consisting of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor, was instituted in 158 properly selected subjects. The initial therapy in most of the subjects was zidovudine (AZT)+lamivudine (3TC)+nevirapine (NVP). AZT was substituted by stavudine (d4T) in patients with Hb %o8 g, whereas NVP was substituted by efavirenz (EFV) in the event of non-availability, adverse effects, or possible interactions. All subjects received cotrimoxazole prophylaxis. Patients were monitored at regular intervals for 24 weeks. Efficacy was assessed by response based on CD4 count; total lymphocyte count; and improvement assessed in terms of general health, weight gain, functional status, and improvement in WHO clinical staging. Results: There was good clinical improvement with increase in CD4 count in the majority of the subjects. Antiretrovirals were well tolerated, with only mild, tolerable, and controllable adverse events, and death occurred only in 5.71% the subjects. Conclusion: The NACO-sponsored HAART regimen was found to be effective and well tolerated in the majority of the subjects, with minimum and tolerable adverse effects.

Background: Alcohol abuse is a chronic behavioral problem that can further develop as a progressive disease. Disulfiram is the most extensively used deterrent drug for clinical management of alcoholism. A supervised disulfiram-ethanol reaction (DER) test is carried out in patients who are willing for it, and who are skeptical of the effect of disulfiram in causing a DER. Objective: The aim of this work was to study the possible cardiovascular changes and complications during disulfiramethanol reaction in persons fulfilling the inclusion and exclusion criteria. Materials and Methods: After written informed consent was obtained, 60 subjects underwent alcohol detoxification and received disulfiram 250 mg BD orally for 5 days. On 5th day, alcohol challenge was carried out with constant monitoring of all the vital parameters. Cardiovascular changes were monitored and recorded during the DER. Results: Disulfiram was generally well tolerated and DER started to occur within 10-15 minutes and lasted for 90-240 minutes. Cardiovascular changes observed were blood pressure changes [hypotension (n=16, 26.67%) and hypertension (n=3, 5%)] and ECG changes [sinus tachycardia (n=22, 36.67%), transient ischemic changes (n=13, 21.67%), occasional atrial ectopics (n=1, 1.67%) and junctional rhythm (n=1, 1.67%)]. Only 23 subjects (38.33%) did not show any significant ECG changes. All subjects recovered with no residual ECG changes except those who developed hypotension (n=16) who required intervention with IV fluids. Conclusion: Cardiovascular complications can occur even in properly selected subjects having no baseline cardiovascular impairment, which could be serious and potentially life threatening. Based on the results of the present study, disulfiram-ethanol challenge test appears to be a relatively safe procedure if carried out under standardized conditions and using a safe maintenance dose of disulfiram.