Tehran University Medical Journal

Background: Hepatitis E virus (HEV) is from Hepeviridae family and genus Hepevirus. This virus is in 4 genotypes. These 4 genotypes are classified in 2 classes. In first class there are genotypes 1 and 2 which are specific for human. Genotypes 1 and 2 are not developed to chronic hepatitis is spite to genotypes 3 and 4 which may develop to chronic hepatitis in immunocompromised patients. It should say that in middle east genotypes 3 and 4 are not frequent. One of the immunodeficiency syndrome is human immunodeficiency virus (HIV) infection in which in the late phases of the disease the power of the immunity will be severely decreased in the patients. Therefore, in patients with HIV infection, HEV (specially genotypes 3 and 4) may be a problem and it may progress to a chronic viral hepatitis which may lead to liver failure. Therefore, it may need treatment and prophylactic strategies in some areas. The aim of this study was to evaluate the frequency of HEV infection in HIV patients by molecular assay.
Methods: This descriptive, cross-sectional study was conducted on 111 random selected, known HIV infection patients in 2016 in Isfahan, Iran. This study was done under supervision of Immunodeficiency Research Center of Isfahan University of Medical Sciences. The criteria for enrolling in the study, was positivity of HIV infection, and samples were selected from all known HIV infected patients in Isfahan. After blood sampling from the selected patients, HEV RNA was surveyed by RealStar® HEV RT-PCR Kit 1.0 (Altona Diagnostics, Hamburg, Germany). At the end, after isolation of HEV RNA, the cDNA was prepared and evaluated.
Results: Patients were between 5 to 68 years old and mean of the patients age was 38.5±11.5 years. 75 (67.6%) and 36 (32.4%) of the patients were men and women respectively. Mean count of the CD4 cells in these patients was 317.2±187.8. HBsAg and HCVAb was positive in 6 (5.4%) and 39 (35.1%) of them. No one of the studied patients were positive for HEV infection.
Conclusion: On the results of this study, there is no chance for having hepatitis E infection in Iranian HIV patients. Therefore, it seems that, hepatitis E is not an important problem in this group of patients in Iran.

Background: The present study is a systematic and comparative review of the studies conducted in the field of hospice centers for patients with acute incurable diseases with a life expectancy of less than six months in the world with the aim of examining the need in Iran and the experiences of other countries, identifying candidates to receive these services, type of services provided, costs and resources in these centers. Methods: The present study was conducted as a systematic review by searching the databases: Scopus, PubMed, Elsevier, and Google Scholar search engine between 2010 and 2023. To search these databases, keywords such as hospice care centers, centers providing health services for patients with life expectancy less than six months, allocation of resources, allocation were used. After selecting the articles, the following topics were extracted from each article and compared: costs, sources of funding, candidates for receiving services, families' views, quality of near-death care, quality of life, quality of death, services provided, therapeutic interventions performed, place of death, length of stay. Results: 6 articles referred to the discussion of cost, and in all articles except one case, the use of hospice was associated with reducing the cost of patients. In one study, the source of funding was philanthropic contributions and in another study, the national budget. In all the reviewed articles, the use of hospice was associated with an increase in the quality of care, quality of end of life and quality of death, and a decrease in therapeutic interventions. The care provided by hospice was also introduced in the form of symptom assessment and management, pain relief, psychosocial support and respite care. Conclusion: Based on the findings of the present study, hospices can play an effective role in reducing treatment costs and, on the other hand, improve the quality of care, life and death in eligible people. In addition, hospices improved the end-of-life quality from the perspective of the deceased's family by reducing invasive interventions and providing physical and spiritual care.