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Aili, K., Arvidsson, S., Olsson, M., Jarfelt, M., Nygren, J.
BMJ Open, 7.01.2022
Tilføjet 9.01.2022
Introduction
Acute lymphoblastic leukaemia (ALL) is the most common form of cancer in children. Although treatment methods have improved and resulted in significant improvement of survival and reduction in late effects and late mortality risk, the health-related quality of life (HRQOL) of survivors might be affected. To introduce new interventions in clinical practice with the potential to support positive HRQOL outcomes, more knowledge is needed on how HRQOL in this group is constructed and stimulated. The purpose of this study is to investigate how HRQOL is affected in adults treated for paediatric ALL, in a long-term perspective and possible factors influencing this relationship.
Methods and analysis
This cohort of young adult ALL survivors allows for investigations of factors influencing HRQOL outcomes on a national level. Eligible participants are obtained from the Swedish Childhood Cancer quality registry. Data collection includes both a follow-up of data collected in 2012 (n=224) and recruitment of new eligible participants to the cohort (n=601). The cohort will cover survivors of paediatric ALL, diagnosed between 1985 and 2007, at an age between 0 and 15 years. Data will be collected using validated, multidimensional, self-administered instruments, designed to measure HRQOL (SF-36), social support, sense of coherence and resilience.
Ethics and dissemination
The study will be carried out in accordance with the ethics permit obtained from the Swedish ethics review authority (Dnr 2019-05181). Dissemination of study results will take place through research articles and reports to the national patient organisation and the national network for consultancy nurses for this target group and to the working group for the Swedish national long-term care programme for childhood cancer. Results will also reach practical application within the follow-up clinic for adult childhood cancer survivors at Sahlgrenska Hospital in Gothenburg.
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Du, S., Su, Y., Zhang, D., Wu, J., Zheng, H., Wang, X.
BMJ Open, 7.01.2022
Tilføjet 9.01.2022
Objectives
Modifiable physical activity (PA) plays an important role in dyslipidaemia risk in middle-aged women with sleep problems, especially perimenopausal women. We aimed to explore the joint effects of sleep and PA on the risk of dyslipidaemia in women aged 45–55 years, and the extent to which PA moderated the effect of sleep on the risk of dyslipidaemia.
Design
A cross-sectional study.
Setting
This study was based on the survey of Chronic Disease and Nutrition Monitoring in Adults in Inner Mongolia in 2015.
Participants
721 women aged 45–55 years were included.
Outcome measurement
PA was measured by the Global Physical Activity Questionnaire. Sleep was measured by questionnaire formulated by the Chinese Center for Disease Control and Prevention. Multivariate logistic regression analyses were performed to determine the joint effects of sleep and PA on dyslipidaemia risk. OR and 95% CI were reported.
Results
Among all participants, 60.6% had sleep problems, 29.0% had low PA and 41.1% had dyslipidaemia. Women with sleep problems had higher dyslipidaemia risk than women without sleep problems, irrespective of low, moderate or high PA, with OR (95% CI) of 4.24 (2.40 to 7.49), 3.14 (1.80 to 5.49) and 2.04 (1.20 to 3.48), respectively. PA could not completely attenuate the negative association between sleep and dyslipidaemia risk. With PA increased from low to high, the OR of dyslipidaemia decreased by 2.20. Women with sleep problems and low PA had higher risks of high total cholesterol, high triglyceride, low high-density lipoprotein cholesterol and high low-density lipoprotein cholesterol than women without sleep problems and high PA, with OR (95% CI) of 2.51 (1.18 to 5.35), 2.42 (1.23 to 4.74), 2.88 (1.44 to 5.74) and 2.52 (1.12 to 5.70), respectively.
Conclusions
Among women aged 45–55 years, the joint effects of self-reported sleep and PA on dyslipidaemia risk were more marked for sleep than for PA. Modifiable PA is a widely accessible and effective intervention to reduce the dyslipidaemia risk in women with sleep problems, particularly among perimenopausal women.
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Fox, K. A. A., Virdone, S., Bassand, J.-P., Camm, A. J., Goto, S., Goldhaber, S. Z., Haas, S., Kayani, G., Koretsune, Y., Misselwitz, F., Oh, S., Piccini, J. P., Parkhomenko, A., Sawhney, J. P. S., Stepinska, J., Turpie, A. G. G., Verheugt, F. W. A., Kakkar, A. K., GARFIELD-AF investigators*
BMJ Open, 7.01.2022
Tilføjet 9.01.2022
Objective
In patients with newly diagnosed atrial fibrillation (AF), do baseline risk factors and stroke prevention strategies account for the geographically diverse outcomes.
Design
Global Anticoagulant Registry in the FIELD-Atrial Fibrillation is a prospective multinational non-interventional registry of patients with newly diagnosed AF (n=52 018 patients).
Setting
Investigator sites (n=1317) were representative of the care settings/locations in each of the 35 participating countries. Treatment decisions were all determined by the local responsible clinicians.
Participants
The patients (18 years and over) with newly diagnosed AF had at least 1 investigator-determined stroke risk factor and patients were not required to meet specific thresholds of risk score for anticoagulant treatment.
Main outcomes and measures
Observed 1-year event rates and risk-standardised rates were derived.
Results
Rates of death, non-haemorrhagic stroke/systemic embolism and major bleeding varied more than three-to-four fold across countries even after adjustment for baseline factors and antithrombotic treatments. Rates of anticoagulation and antithrombotic treatment varied widely. Patients from countries with the highest rates of cardiovascular mortality and stroke were among the least likely to receive oral anticoagulants. Beyond anticoagulant treatment, variations in the treatment of comorbidities and lifestyle factors may have contributed to the variations in outcomes. Countries with the lowest healthcare Access and Quality indices (India, Ukraine, Argentina, Brazil) had the highest risk-standardised mortality.
Conclusion
The variability in outcomes across countries for patients with newly diagnosed AF is not accounted for by baseline characteristics and antithrombotic treatments. Residual mortality rates were correlated with Healthcare Access and Quality indices. The findings suggest the management of patients with AF needs to not only address guideline indicated and sustained anticoagulation, but also the treatment of comorbidities and lifestyle factors.
Trial registration number
NCT01090362.
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Kreniske, Philip; Nalugoda, Fred; Chen, Ivy; Huang, Rui; Wei, Ying; Chang, Larry; Ssekubugu, Robert; Lutalo, Tom; Kigozi, Godfrey; Kagaayi, Joseph; Sewankambo, Nelson; Grabowski, M. Kate; Gray, Ronald; Serwadda, David; Santelli, John
Journal of Acquired Immune Deficiency Syndromes, 24.12.2021
Tilføjet 9.01.2022
Background:
Sub-Saharan Africa has the highest HIV incidence and prevalence in the world. In the past decade mobile phone ownership has doubled – impacting social and sexual practices. Using longitudinal follow-up data, this study examined if mobile phone ownership was associated with sexual behaviors and HIV incidence for youth and adults.
Methods:
The Rakai Community Cohort Study gathers demographic and sexual health information and conducts HIV testing among an open cohort in southcentral Uganda every 12-18 months.
Results:
Of the 10,618 participants, 58% owned a mobile phone, 69% lived in rural locations and 77% were sexually active. Analyses were adjusted for time, location, religion and socioeconomic status. Phone ownership was associated with increased odds of ever having had sex for 15-19-year-olds (men AOR 2.12, 95% CI 1.78-2.52; women AOR 3.20, 95% CI 2.45-4.17). Among sexually active participants, owning a phone was associated with increased odds of having 2 or more concurrent sex partners (15-24-year-old men AOR 1.76, 95% CI 1.34-2.32; 25-49-year-old men AOR 1.81, 95% CI 1.54–2.13; 25-49-year-old women AOR 1.81, 95% CI 1.32-2.49). For men, phone ownership was associated with increased odds of circumcision (15-24-year-old men AOR 1.24, 95% CI 1.08-1.41; 25-49-year-old men AOR 1.12, 95% CI 1.01-1.24). Phone ownership was not associated with HIV incidence.
Conclusion:
Although mobile phone ownership was associated with sexual risk behaviors, it was not associated with increased risk of HIV acquisition. Research should continue exploring how phones can be used for reducing sexual health risk.
Corresponding Author and Request for Reprints: Philip Kreniske, HIV Center for Clinical and Behavioral Studies New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive # 15, New York, NY 10032, Phone: 001-646-774-7001, Division Fax number: (646) 774-6955
Conflict of Interest and Source of Funding: This project was supported by a grant from the National Institute of Child Health and Human Development (R01HD091003, Principal Investigator John Santelli, MD, MPH). In addition, Philip Kreniske’s contribution was also supported by grants from the National Institute of Mental Health (K01MH122319, Principal Investigator Philip Kreniske, PhD; T32 MH019139 Principal Investigator, Theodorus Sandfort, PhD) and an award to the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University (P30MH43520, Principal Investigator: Robert Remien, PhD).
* Co-first authors contributed equally to this manuscript.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedChan, Carrie T.; Ming, Kristin; Camp, Christina; Saberi, Parya
Journal of Acquired Immune Deficiency Syndromes, 24.12.2021
Tilføjet 9.01.2022
Hetta, Gouse; Jane, Masson; Michelle, Henry; Anna, Dreyer; Reuben, Robbins; Greg, Kew; Andre, Joska John; Leslie, London; Thomas, Marcotte; Kevin GF, Thomas
Journal of Acquired Immune Deficiency Syndromes, 24.12.2021
Tilføjet 9.01.2022
Background:
The intellectually demanding modern workplace is often dependent on good cognitive health, yet there is little understanding of how neurocognitive dysfunction related to HIV presents in employed individuals working in high risk vocations like driving. HIV-associated neurocognitive impairment is also associated with poorer long term cognitive, health and employment outcomes.
Setting:
This study, set in Cape Town, South Africa, assessed the effects of HIV on neuropsychological test performance in employed male professional drivers.
Method:
We administered a neuropsychological test battery spanning seven cognitive domains and obtained behavioral data, anthropometry, and medical biomarkers from three groups of professional drivers (68 men with HIV, 55 men with cardiovascular risk, and 81 controls). We compared the drivers’ cognitive profiles, and used multiple regression modelling to investigate whether between-group differences persisted after considering potentially confounding sociodemographic and clinical variables (i.e., income, home language, depression, and Framingham Risk Score).
Results:
Relative to other study participants, professional drivers with HIV performed significantly more poorly on tests assessing processing speed (p
Læs mere Tjek på PubMedSack, Daniel E.; Gange, Stephen J.; Althoff, Keri N.; Pettit, April C.; Kheshti, Asghar N.; Ransby, Imani S.; Nelson, Jeff J.; Turner, Megan M.; Sterling, Timothy R.; Rebeiro, Peter F.
Journal of Acquired Immune Deficiency Syndromes, 24.12.2021
Tilføjet 9.01.2022
Background:
Maps are potent tools for describing the spatial distribution of population and disease characteristics, and thereby, for appropriately targeting public health interventions. People with HIV (PWH) cluster in geographically compact and densely populated areas, which does not easily lend itself to maps that use unadjusted geographic or political borders.
Setting:
To illustrate these challenges, we used geographic data from adult PWH at the Vanderbilt Comprehensive Care Clinic (VCCC), in Nashville, Tennessee, and aggregated data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from 1998-2015.
Methods:
We compared choropleth maps, which use differential shading of political/geographic boundaries, and density-adjusted cartograms, which allow for shading and deformed boundaries according to a variable of interest, such as PWH.
Results:
Cartograms enlarged high-burden areas and shrank low-burden areas of PWH, improving visual interpretation of where to focus HIV prevention and mitigation efforts compared to choropleth maps. Cartograms may also demonstrate cohort representativeness of underlying populations (e.g., Tennessee for VCCC or the United States for NA-ACCORD), which can guide efforts to assess external validity and improve generalizability.
Conclusion:
Choropleth maps and cartograms offer powerful visual evidence of the geographic distribution of HIV disease and cohort representation and should be used to guide targeted public health interventions.
Corresponding Author: Daniel E. Sack, 2525 West End Ave, Suite 750, Nashville, TN, 37203, Email: daniel.e.sack@vanderbilt.edu, Tel: 615-343-8351, Fax: 615-343-8350
Conflicts of Interest and Sources of Funding: PFR received an honorarium from Gilead in 2020.KNA is a consultant to the All of Us Research Program (NIH) and serves on the scientific advisory board for TrioHealth., All other authors declare no competing interests beyond NIH funding (money paid to institutions, described below for individual authors and the cohorts with data included in the manuscript), The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Support was provided by NIAID (K01AI131895; PFR), NIMH (F30MH123219; DES; R01MH113438; ACP), and by the National Institute of General Medical Sciences (T32GM007347; DES).This work was further supported by National Institutes of Health grants U01AI069918, F31AI124794, F31DA037788, G12MD007583, K01AI093197, K01AI131895, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050409, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01DA011602, R01DA012568, R01AG053100, R24AI067039, U01AA013566, U01AA020790, U01AI038855, U01AI038858, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01DA03629, U01DA036935, U10EY008057, U10EY008052, U10EY008067, U01HL146192, U01HL146193, U01HL146194, U01HL146201, U01HL146202, U01HL146203, U01HL146204, U01HL146205, U01HL146208, U01HL146240, U01HL146241, U01HL146242, U01HL146245, U01HL146333, U24AA020794,U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, Z01CP010214 and Z01CP010176; contracts CDC-200-2006-18797 and CDC-200-2015-63931 from the Centers for Disease Control and Prevention, USA; contract 90047713 from the Agency for Healthcare Research and Quality, USA; contract 90051652 from the Health Resources and Services Administration, USA; grants CBR-86906, CBR-94036, HCP-97105 and TGF-96118 from the Canadian Institutes of Health Research, Canada; Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Additional support was provided by the National Institute Of Allergy And Infectious Diseases (NIAID), National Cancer Institute (NCI), National Heart, Lung, and Blood Institute (NHLBI), Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Human Genome Research Institute (NHGRI), National Institute for Mental Health (NIMH) and National Institute on Drug Abuse (NIDA), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Nursing Research (NINR), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedGolden, Matthew R.; AugsJoost, Brett; Bender, Melverta; Brady, Kathleen A.; Collins, Lyell S.; Dombrowski, Julia D.; Ealey, Jamila; Garcia, Christopher; George, Dan; Gilliard, Bernard; Harris, Terrainia; Johnson, Cynthia; Khosropour, Christine M.; Rumanes, Sophia F.; Surita, Karen; Tabidze, Irina; Udeagu, Chi-Chi N.; Walker-Baban, Cherie; Cramer, Natalie O.
Journal of Acquired Immune Deficiency Syndromes, 24.12.2021
Tilføjet 9.01.2022
Background:
The contemporary effectiveness of assisted partner notification services (APS) in the U.S. is uncertain.
Setting:
State and local jurisdictions in the U.S. that reported >300 new HIV diagnoses in 2018 and were
participating in the Ending the Epidemic Initiative
Methods:
The study surveyed health departments to collect data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS), and estimated staff case- finding productivity.
Results:
Sixteen (84%) of 19 jurisdictions responded to the survey, providing APS outcome data for 14 (74%) areas. Most health departments routinely integrated APS with linkage of cases and partners to HIV care (88%) and pre-exposure prophylaxis (88%). A total of 19,164 persons were newly diagnosed with HIV in the 14 areas. Staff initiated APS investigations on 14,203 (74%) cases and provided APS to 9,937 (52%) cases. Cases named 6,799 partners (contact index=0.68), of whom 1,841 (27%) had
previously diagnosed HIV, 2,202 (32%) tested HIV-negative, 541 (8% of named and 20% of tested partners) were newly diagnosed with HIV, and 2,215 (33%) were not known to have tested. Across jurisdictions, the case-finding index was 0.054 (median=0.05, range 0.015-0.12). Health departments employed 292 full-time equivalent staff to provide APS. These staff identified a median of 2.0 new HIV infections per staff per year. APS accounted for 2.8% of new diagnoses in 2019.
Conclusions:
HIV case-finding resulting from APS in the U.S. is low.
Corresponding author: Matthew R. Golden MD, MPH Phone: (206) 744-6829, Fax: (206) 744-4151, Email:golden@uw.edu Address: Harborbview Medical Center Box 359777 325 9th Ave, Seattle, WA 98125
The authors report no conflicts of interest related to this work.
Funding: Research reported in this publication was supported by the University of Washington / Fred Hutch Center for AIDS Research, an NIH-funded program under award number AI027757 which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, NIDDK.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedViolette, Lauren R; Cornelius-Hudson, Andy; Snidarich, Madison; Niemann, Lisa A; Assennato, Sonny Michael; Ritchie, Allyson; Goel, Neha; Chavez, Pollyanna R; Ethridge, Steven F; Katz, David A.; Lee, Helen; Delaney, Kevin P; Stekler, Joanne D
Journal of Acquired Immune Deficiency Syndromes, 24.12.2021
Tilføjet 9.01.2022
Abstract:
Background:
Point-of-care (POC) nucleic acid tests (NAT) have potential to diagnose acute HIV infection and monitor persons taking pre-exposure prophylaxis (PrEP) or antiretroviral treatment (ART). POC NATs have not yet been evaluated in the US.
Methods:
From June 2018-March 2019, we conducted a cross-sectional evaluation of the SAMBA II POC NAT. PWH and persons testing for HIV were tested with the SAMBA II qualitative (Qual) whole blood (WB) test. From April-September 2019, the Qual test was used on persons who were ART-naïve, and SAMBA II semi-quantitative (Semi-Q) WB was used with ART-experienced PWH. Both were performed on unprocessed venipuncture (VP) and, when indicated by protocol, fingerstick (FS) WB and plasma. SAMBA results were compared to Abbott RealTime HIV-1 PCR results on plasma. We calculated sensitivity, specificity, and concordance between tests.
Results:
SAMBA was used in 330 visits among 280 participants: 202 (61.2%) visits from PWH, and 128 (38.8%) from HIV-negative persons. Qual test sensitivity with ART-naïve participants was 91.4% (32/35, 95% CI: 77.6-97.0%) using VP WB and 100% (27/27, 95% CI: 87.5-100%) using FS WB. Specificity was 100% using both specimen types. Concordance between the gold standard and Semi-Q at 1000 copies/mL among PWH on ART was 97.7% (86/88, 95% CI: 92.1-99.4%) and 100% (30/30, 95% CI: 88.7-100%) using VP and FS WB, respectively. Conclusion: The SAMBA II POC NATs showed high sensitivity, specificity, and concordance with the gold-standard assay, indicating its potential use in diagnostics and monitoring. Future work will evaluate POC NAT implementation in the US.
Corresponding author: Lauren R Violette, Mailing: 325 Ninth Avenue, Box 359931, Seattle, WA 98104, Phone: 206-616-1054, Fax: 206-744-3693, Email: lvio@uw.edu
Conflicts of Interest and Source of Funding: [Authors Sonny Michael Assennato, Allyson Ritchie, Neha Goel, and Helen Lee are employed by Diagnostics for the Real World (DRW), the creators of the SAMBA II test. DRW provided two SAMBA II machines for investigational use. For the remaining authors, none were declared.] This study was funded by the CDC through a federal contract (# 200-2014-61285). Additional support was provided by the UW/Fred Hutchinson Center for AIDS Research, a National Institutes of Health–funded program (P30 AI027757).
Meetings at which parts of the data were presented: 2019 HIV Diagnostics Conference, Atlanta, GA, March 25-28, 2019; Conference on Retroviruses and Opportunistic Infections 2020, Boston, MA/virtual, March 8-11, 2020.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedWang, Yan; Karver, Tahilin Sanchez; Barrington, Clare; Donastorg, Yeycy; Perez, Martha; Gomez, Hoisex; Davis, Wendy; Galai, Noya; Kerrigan, Deanna
Journal of Acquired Immune Deficiency Syndromes, 24.12.2021
Tilføjet 9.01.2022
Background.
The COVID-19 pandemic and its associated socio-economic disruptions has disproportionally affected marginalized populations including people living with HIV (PLHIV). Little is known about how the pandemic has impacted populations experiencing multiple forms of stigma, discrimination and violence such as female sex workers (FSW) living with HIV.
Methods.
We conducted a cross-sectional survey between August and December 2020 among 187 FSW living with HIV in the Dominican Republic (DR) to examine the impact of COVID-19. Using multivariable logistic regression, we examined associations between COVID-19-related financial concerns, mental health, substance use and partner abuse on engagement in HIV care and ART adherence. We conducted mediation analysis to assess whether mental health challenges mediated the impact of partner abuse or substance use on HIV outcomes.
Results.
Most participants reported no income (72%) or a substantial decline in income (25%) since the COVID-19 pandemic. Approximately one third (34%) reported COVID-19 had an impact on their HIV care and treatment. Greater COVID-19 financial concerns (aOR=1.14, 95% CI: 1.02-1.27), mental health challenges (aOR=1.38, 95% CI: 1.06-1.79) and partner emotional abuse (aOR=2.62, 95% CI: 1.01-6.79) were associated with higher odds of negatively impacted HIV care, respectively. The relationship between increased emotional partner abuse and negatively impacted HIV care was mediated by greater COVID-19-related mental health challenges.
Conclusion.
FSW living with HIV in the DR have been significantly impacted by the COVID-19 pandemic. Targeted interventions that address structural (financial security, partner abuse) and psychosocial (mental health) factors are needed to sustain HIV outcomes and well-being.
Correspondence: Yan Wang, MD, DrPH, Associate professor, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA, Phone #: (202) 994-7400 Fax #: (202) 994-3773 Email address: yanwang20@gwu.edu
Conflicts of Interest and Source of Funding: Dr. Kerrigan received an R01 grant from NIH as a PI (R01MH110158). Dr. Wang received a pilot award (PI: Y. Wang) from the District of Columbia Center for AIDS Research, an NIH funded program (P30AI117970), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIMHD, NIDCR, NINR, FIC and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. For the remaining authors none were declare
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedKilgore, Collin B.; Strain, Jeremy F.; Nelson, Brittany; Cooley, Sarah A.; Rosenow, Alexander; Glans, Michelle; Cade, W. Todd; Reeds, Dominic N.; Paul, Robert H.; Ances, Beau M.
Journal of Acquired Immune Deficiency Syndromes, 24.12.2021
Tilføjet 9.01.2022
Background:
Despite improved survival rates, neurocognitive impairment persists in persons living with HIV (PLWH). An active lifestyle is linked to improved cognition among PLWH, yet the neural substrates remain unclear. Diffusion tensor imaging (DTI) and diffusion-basis spectrum imaging (DBSI) measure HIV-related changes in brain white matter integrity. We used these measures of structural brain integrity to assess white matter changes, physical fitness, and cognition in a cross-sectional study of PLWH.
Methods:
Forty-four virologically well-controlled PLWH were recruited (average age of 56 years old, median recent CD4+ count of 682 cells/mm3). DTI-derived fractional anisotropy (FA) and DBSI-derived axonal density were calculated. Cardiorespiratory fitness (maximal volume of oxygen consumption or VO2 max) was measured by performing indirect calorimetry during exercise to volitional exhaustion. Cardiovascular risk was assessed by the Framingham risk score. Neuropsychological performance (NP) testing evaluated learning, memory, psychomotor/processing speed, and executive function. Partial correlations assessed the relationships among cardiorespiratory fitness, neuroimaging, NP, and HIV clinical metrics (CD4+ count, time since diagnosis).
Results:
Higher VO2 max was associated with higher FA and higher axonal density in multiple white matter tracts including the corticospinal tract and superior longitudinal fasciculus. Better NP in the motor/psychomotor domain was positively associated with FA and axonal density in diverse tracts including those associated with motor and visuospatial processing. However, higher VO2 max was not associated with NP or HIV clinical metrics.
Conclusion:
An active lifestyle promoting cardiorespiratory fitness may lead to better white matter integrity and decreased susceptibility to cognitive decline in virologically well-controlled PLWH.
Address Correspondence to: Dr. Jeremy Strain, Department of Neurology, Box 8111, 660 South Euclid Ave, St. Louis, MO 63110, (phone) (314) 747-8423 (fax) (314) 747-8423, (email) jstrain@wustl.edu
Potential conflicts of interest: The authors have no conflicts of interest to report.
Financial Support: This work was supported by the National Institute for Nursing Research [R01NR015738], National Institute of Mental Health [R01MH118031], and the Washington University Institute of Clinical and Translational Sciences [UL1TR000448 from the National Center for Advancing Translational Sciences].
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedJiang, He; Lan, Guanghua; Zhu, Qiuying; Feng, Yi; Liang, Shujia; Li, Jianjun; Zhou, Xinjuan; Lin, Mei; Shao, Yiming
Journal of Acquired Immune Deficiency Syndromes, 24.12.2021
Tilføjet 9.01.2022
Background:
Comprehensively estimating the impacts of HIV-1 subtype diversity on long-term clinical outcomes during antiretroviral therapy (ART) can help inform programme recommendations.
Methods:
The HIV-1 sequences data and clinical records of 5950 patients from all 14 prefectures in Guangxi, China during 2008–2020 were included. Evolutional trends of CD4+ T-lymphocyte count and viral load were explored and the effects of HIV-1 subtypes on clinical outcomes were estimated by Cox’s proportional hazards model. The polymorphisms involved in drug resistance mutation were analyzed.
Results:
Compared with patients with CRF07_BC, patients with CRF01_AE and CRF08_BC showed poor immunologic and virologic responses to antiretroviral therapy. Although the median expected time from ART initiation to virologic suppression for all patients was approximately 12 months, patients with CRF01_AE and CRF08_BC had a long time to achieve immune recovery and a short time to occur immunologic failure, compared with patients with CRF07_BC. Adjusted analysis showed that both CRF01_AE and CRF08_BC were the negative factors in immune recovery and long-term mortality. Additionally, CRF08_BC was a negative factor in virologic suppression and a risk factor of virologic failure. This poor virologic response might result from the high prevalence of drug resistance mutation in CRF08_BC.
Conclusions:
Compared with patients with CRF07_BC, patients with CRF01_AE could benefit more from immediate ART, and patients with CRF08_BC are more suitable for PI-based regimens. These data emphasize the importance of routine HIV-1 genotyping before ART, immediate ART, and personalized ART regimens to improve the prognosis for patients undergoing ART.
Correspondence to: Yiming Shao: Division of Research on Virology and Immunology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206, People’s Republic of China. Phone: +86-10-58900982, Fax: Phone: +86-10-58900982, E-mail: yshao@bjmu.edu.cn.
Potential conflict of interest: H.J., G.L., Q.Z., Y.F., S.L., J.L., X.Z., M.L., and Y.S. declare that there are no potential conflicts of interest.
* H.J., G.L., and Q.Z. contributed equally.
# M.L. and Y.S. contributed equally.
Funding sources: This work was supported by the Guangxi Bagui Honor Scholarship grant and the project of Health Commission of Guangxi (Z2016440) and the National Natural Science Foundation of China (82160636).
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedArimide, Dawit Assefa; Amogne, Minilik Demissie; Kebede, Yenew; Balcha, Taye T.; Adugna, Fekadu; Ramos, Artur; DeVos, Joshua; Zeh, Clement; Agardh, Anette; Chih-Wei Chang, Joy; Björkman, Per; Medstrand, Patrik
Journal of Acquired Immune Deficiency Syndromes, 24.12.2021
Tilføjet 9.01.2022
Objective:
To determine viral load non-suppression (VLN) rates, HIV drug resistance (HIVDR) prevalence and associated factors among female sex workers (FSWs) in Ethiopia.
Methods:
A cross-sectional biobehavioural survey was conducted among FSWs in 11 cities in Ethiopia in 2014. Whole blood was collected and HIVDR genotyping was done. Logistic regression analysis was used to identify factors associated with VLN and HIVDR.
Results:
Among 4900 participants, 1172 (23.9%) were HIV-positive, and 1154 (98.5%) had a VL result. Participants were categorized into ART (n=239) and ART-naïve (n=915) groups based on self-report. From the 521 specimens (ART, 59; ART-naïve, 462) with VL ≥1000 copies/mL, genotyping was successful for 420 (80.6%), and 92 (21.9%) had drug resistance mutations (DRMs). Pre-treatment drug resistance (PDR) was detected in (63/381) 16.5% ART-naïve participants. Nucleoside, non-nucleoside reverse transcriptase inhibitors (NRTIs, NNRTI), and dual-class DRMs were detected in 40 (10.5%), 55 (14.4%), and 35 (9.2%) of the participants, respectively. Among 239 on ART, 59 (24.7%) had VLN. Genotyping was successfully performed for 39 (66.1%). DRMs were detected in 29 (74.4%). All 29 had NNRTI, 23 (79.3%) had NRTI or dual-class DRMs. VLN was associated with age ≥35 years, CD4+ T-cell count
Læs mere Tjek på PubMedDijkstra, Suzan; Hofstra, L. Marije; Mudrikova, Tania; Wensing, Annemarie M.J.; Oomen, Patrick G.A.; Hoepelman, Andy I.M.; van Welzen, Berend J.
Journal of Acquired Immune Deficiency Syndromes, 24.12.2021
Tilføjet 9.01.2022
Background:
As the nature of viral blips remains unclear, their occurrence often leads to uncertainty. This study compares blip incidence rates during treatment with different combination antiretroviral therapy anchors.
Setting:
Retrospective cohort study in a tertiary hospital.
Methods:
All antiretroviral regimens between 2010-2020 containing two nucleos(-t)ide reverse transcriptase inhibitors plus one anchor in virologically suppressed people living with HIV (PLWH) from our center were evaluated for the occurrence of blips (isolated viral loads [VLs] 50-499 copies/mL between measurements
Læs mere Tjek på PubMedHuang Y, Zhu W, Carnes N, et al.
Clinical Infectious Diseases, 8.01.2022
Tilføjet 9.01.2022
AbstractWe analyzed a national pharmacy database to estimate the annual number of persons who abandoned their PrEP prescription and assessed the associated factors. About 9% of persons prescribed PrEP abandoned it in 2019, and PrEP abandonment was associated with sex, age, insurance type, black race/ethnicity, and drug copayment amount.
Læs mere Tjek på PubMedTodd Fojo A, Wallengren E, Schnure M, et al.
Clinical Infectious Diseases, 7.01.2022
Tilføjet 9.01.2022
AbstractBackgroundThe degree to which the 2019 novel coronavirus disease (COVID-19) pandemic will affect the US human immunodeficiency virus (HIV) epidemic is unclear.MethodsWe used the Johns Hopkins Epidemiologic and Economic Model to project HIV infections from 2020 to 2025 in 32 US metropolitan statistical areas (MSAs). We sampled a range of effects of the pandemic on sexual transmission (0–50% reduction), viral suppression among people with HIV (0–40% reduction), HIV testing (0–50% reduction), and pre-exposure prophylaxis use (0–30% reduction), and indexed reductions over time to Google Community Mobility Reports.ResultsSimulations projected reported diagnoses would drop in 2020 and rebound in 2021 or 2022, regardless of underlying incidence. If sexual transmission normalized by July 2021 and HIV care normalized by January 2022, we projected 1,161 (1%) more infections from 2020 to 2025 across all 32 cities than if COVID had not occurred. Among “optimistic” simulations in which sexual transmission was sharply reduced and viral suppression was maintained we projected 8% lower incidence (95% credible interval: 14% lower to no change). Among “pessimistic” simulations where sexual transmission was largely unchanged but viral suppression fell, we projected 11% higher incidence (1% to 21% higher). MSA-specific projections are available at jheem.org?covid.ConclusionsThe effects of COVID-19 on HIV transmission remain uncertain and differ between cities. Reported diagnoses of HIV in 2020–2021 are likely to correlate poorly with underlying incidence. Minimizing disruptions to HIV care is critical to mitigating negative effects of the COVID-19 pandemic on HIV transmission.
Læs mere Tjek på PubMedHeftdal L, Schultz M, Lange T, et al.
Clinical Infectious Diseases, 7.01.2022
Tilføjet 9.01.2022
AbstractBackgroundCOVID-19 vaccines are implemented worldwide in efforts to curb the pandemic. This study investigates the risk of a positive SARS-CoV-2 RT-PCR test following BNT162b2 vaccination in a large real-life population in Denmark.MethodsVaccination status and positive SARS-CoV-2 RT-PCR results from adults in the Capital Region of Denmark (n=1,549,488) were obtained from national registries. PCR testing was free and widely available. The number of positive PCR tests per individual at risk were calculated as weekly rates. Time to positive PCR test was modelled using Kaplan-Meier methods and hazard ratios (HR) were calculated using Cox regression.Results1,119,574 individuals received first dose of BNT162b2 and 1,088,879 received a second dose of BNT162b2. Individuals were followed up to 8.7 months after first dose (median: 5.5 months, IQR:4.1-8.7). Rates of PCR-confirmed SARS-CoV-2 infection two to four months after the second dose were 0.21, 0.33 and 0.36 per 1000 individuals per week at risk for July, August and September, respectively. Four or more months after the second dose, the rates were 0.56, 0.76 and 0.53 per 1000 individuals per week at risk for July, August and September, respectively. HR of SARS-CoV-2 infection after the second dose was 0.2 (95% CI: 0.05-0.48, p=0.001) for individuals with eight months follow-up.ConclusionIndividuals who received two doses of the BNT162b2 COVID-19 vaccine had a low risk of breakthrough-infection after up to 8 months of follow-up. However, there was a tendency towards higher rates with longer follow-up.
Læs mere Tjek på PubMedJani I, Peter T.
Clinical Infectious Diseases, 7.01.2022
Tilføjet 9.01.2022
AbstractTesting programs for SARS-CoV-2 have relied on high-throughput PCR laboratories and rapid antigen assays to meet diagnostic needs. Both technologies are essential, however issues of cost, accessibility, manufacturing delays and performance have limited their use in low resource settings and contributed to the global inequity in Covid-19 testing. Emerging low-cost, multi-disease point-of-care nucleic acid tests may address these limitations and strengthen pandemic preparedness, especially within primary healthcare where most cases of disease first present. Widespread deployment of these novel technologies will also help close long-standing test access gaps for other diseases, including tuberculosis, HIV, cervical cancer, viral hepatitis and sexually transmitted infections. We propose a more optimized testing framework based on greater use of point-of-care nucleic acid tests together with rapid immunologic assays and high-throughput laboratory molecular tests to improve the diagnosis of priority endemic and epidemic diseases, as well as strengthen the overall delivery of primary healthcare services.
Læs mere Tjek på PubMedPalmer M, Gunasekera K, van der Zalm M, et al.
Clinical Infectious Diseases, 7.01.2022
Tilføjet 9.01.2022
AbstractIntroductionThe chest radiograph (CR) remains a key tool in the diagnosis of pediatric tuberculosis (TB). In children with presumptive intrathoracic TB, we aimed to identify CR features which had high specificity for, and were strongly associated with, bacteriologically confirmed TB.MethodsWe analyzed CR data from children with presumptive intrathoracic TB prospectively enrolled in a cohort study in a high-TB burden setting and who were classified using standard clinical case definitions as confirmed, unconfirmed or unlikely TB. We report the CR features and inter-reader agreement between expert readers who interpreted the CRs. We calculated the sensitivity and specificity of the CR features with at least moderate inter-reader agreement and analyzed the relationship between these CR features and the classification of TB in a multivariable regression model.ResultsOf features with at least moderate inter-reader agreement, enlargement of perihilar and/or paratracheal lymph nodes, bronchial deviation/compression, cavities, expansile pneumonia and pleural effusion had a specificity of >90% for confirmed TB, compared to unlikely TB. Enlargement of perihilar (adjusted odds ratio [aOR]: 6.6; 95% confidence interval [CI] 3.80-11.72) and/or paratracheal lymph nodes (aOR: 5.14; 95%CI: 2.25-12.58), bronchial deviation/compression (aOR: 6.22; 95%CI: 2.70-15.69), pleural effusion (aOR: 2.27; 95%CI: 1.04-4.78) and cavities (aOR: 7.45; 95%CI: 3.38-17.45) were associated with confirmed TB in the multivariate regression model while alveolar opacification (aOR: 1.16; 95%CI: 0.76-1.77) and expansile pneumonia (aOR: 4.16; 95%CI: 0.93-22.34) were not.ConclusionsIn children investigated for intrathoracic TB enlargement of perihilar or paratracheal lymph nodes, bronchial compression/deviation, pleural effusion, or cavities on CR strongly support the diagnosis.
Læs mere Tjek på PubMedKaipilyawar V, Zhao Y, Wang X, et al.
Clinical Infectious Diseases, 7.01.2022
Tilføjet 9.01.2022
AbstractRationaleBlood-based biomarkers for diagnosis of active tuberculosis (TB), monitoring treatment response and predicting risk of progression to TB disease have been reported. However, validation of the biomarkers across multiple independent cohorts is scarce. A robust platform to validate TB biomarkers in different populations with clinical endpoints is essential to the development of a point-of-care clinical test.ObjectivesNanoString nCounter technology is an amplification-free digital detection platform that directly measures mRNA transcripts with high specificity. Here, we investigated whether NanoString could serve as a platform for extensive validation of candidate TB biomarkers.MethodsThe NanoString platform was employed for performance evaluation of existing TB gene signatures in a cohort in which signatures were previously evaluated on RNA-seq dataset. A NanoString Codeset that probes 107 genes comprising twelve TB signatures and six house-keeping genes (NS-TB107) was developed and applied to total RNA derived from whole blood samples of TB patients and individuals with latent TB infection (LTBI) from South India. The TBSignatureProfiler tool was used to score samples for each signature. An ensemble of machine learning algorithms was used to derive a parsimonious biomarker.Measurements and Main ResultsGene signatures present in NS-TB107 had statistically significant discriminative power for segregating TB from LTBI. Further analysis of the data yielded a six-gene set (NANO6) that when tested on ten published datasets was highly diagnostic for active TB.ConclusionsThe NanoString nCounter system provides a robust platform to validate existing TB biomarkers and to derive a parsimonious gene signature with enhanced diagnostic performance.
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