In resource-limited settings, illness can impose a major financial burden on patients and their families. With the advent and increasing accessibility of antiretroviral therapy, HIV/AIDS has now become a fundamentally chronic treatable disease with far reaching economic and social consequences, and hence it is crucial to also examine the long-term financial impact of HIV healthcare. Beyond the direct costs of medications, monitoring, and medical care, additional costs include the long-term lost earnings of HIV-infected individuals as well as of their household members who also provide care. A clearer understanding of the financial burden of healthcare for HIV-infected Indians can allow policy makers and planners to better allocate limited resources. This article reviews the financial consequences of HIV care and treatment on individuals and their households by examining current treatment options, HIV monitoring, the clinical course of HIV disease, and the roles of the private and public sector in providing HIV care in India. Future studies should more thoroughly examine the financial impact of HIV-related costs incurred by households over time and examine household responses to these costs.

Occupational and environmental exposures to lead (Pb), one of the toxic metal pollutants, is of global concern. Health risks are increasingly associated with environmental exposures to Pb emissions from, for example, the widespread use of leaded gasoline in developing countries. Exposure occurs mainly through the respiratory and gastrointestinal systems, and the ingested and absorbed Pb is stored primarily in soft tissues and bone. Autopsy studies of Pb-exposed patients have shown a large amount (approximately 33%) of the absorbed Pb in soft tissue stored in liver. In addition to neuronal encephalopathy observed in persons after exposure to very high concentrations of Pb, gastrointestinal colic (abdominal pain, constipation, intestinal paralysis) is a consistent early symptom of Pb poisoning in humans. Such severe gastrointestinal effects are consistently observed in patients with a blood Pb range of 30 to 80 microg/dl. Ingestion of Pb is one of the primary causes of its hepatotoxic effects. Hepatocarcinogenic effects of Pb reported in animal toxicology studies have led to new research into the biochemical and molecular aspects of Pb toxicology. Gains in the molecular understanding of Pb effects on hepatic drug metabolizing enzymes, cholesterol metabolism, oxidative stress, and hepatic hyperplasia suggest a potential role for Pb in damaging extrahepatic systems, including the cardiovascular system. This review also discusses the therapeutic potential of chelation therapy in treating Pb-induced hepatotoxicity in animals.