Current Issue : January - March Volume : 2012 Issue Number : 1 Articles : 8 Articles
Background: Separately, chronic alcohol ingestion and HIV-1 infection are associated with severe skeletal muscle\r\nderangements, including atrophy and wasting, weakness, and fatigue. One prospective cohort study reported that\r\n41% of HIV-infected patients met the criteria for alcoholism, however; few reports exist on the co-morbid effects of\r\nthese two disease processes on skeletal muscle homeostasis. Thus, we analyzed the atrophic effects of chronic\r\nalcohol ingestion in HIV-1 transgenic rats and identified alterations to several catabolic and anabolic factors.\r\nFindings: Relative plantaris mass, total protein content, and fiber cross-sectional area were reduced in each\r\nexperimental group compared to healthy, control-fed rats. Alcohol abuse further reduced plantaris fiber area in\r\nHIV-1 transgenic rats. Consistent with previous reports, gene levels of myostatin and its receptor activin IIB were\r\nnot increased in HIV-1 transgenic rat muscle. However, myostatin and activin IIB were induced in healthy and HIV-1\r\ntransgenic rats fed alcohol for 12 weeks. Catabolic signaling factors such as TGFb1, TNFa, and phospho-p38/totalp38\r\nwere increased in all groups compared to controls. There was no effect on IL-6, leukemia inhibitory factor (LIF),\r\ncardiotrophin-1 (CT-1), or ciliary neurotrophic factor (CNTF) in control-fed, transgenic rats. However, the comorbidity\r\nof chronic alcohol abuse and HIV-1-related protein expression decreased expression of the two anabolic\r\nfactors, CT-1 and CNTF.\r\nConclusions: Consistent with previous reports, alcohol abuse accentuated skeletal muscle atrophy in an animal\r\nmodel of HIV/AIDS. While some catabolic pathways known to drive alcoholic or HIV-1-associated myopathies were\r\nalso elevated in this co-morbid model (e.g., TGFb1), consistent expression patterns were not apparent. Thus, specific\r\nalterations to signaling mechanisms such as the induction of the myostatin/activin IIB system or reductions in\r\ngrowth factor signaling via CT-1- and CNTF-dependent mechanisms may play larger roles in the regulation of\r\nmuscle mass in alcoholic, HIV-1 models....
Background: Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to\r\nmake decisions about treatment options. However, they are rarely utilised to help those with chronic or age\r\nrelated conditions to make decisions about care services. Decision aids should also be useful for carers of people\r\nwith decreased decisional capacity. These carers� choices must balance health outcomes for themselves and for\r\nsalient others with relational and value-based concerns, while relying on information from health professionals. This\r\npaper reports on a study that both developed and pilot tested a decision aid aimed at assisting carers to make\r\nevaluative judgements of community services, particularly respite care.\r\nMethods: A mixed method sequential study, involving qualitative development and a pilot randomised controlled\r\ntrial, was conducted in Tasmania, Australia. We undertook 13 semi-structured interviews and three focus groups to\r\ninform the development of the decision aid. For the randomised control trial we randomly assigned 31 carers of\r\npeople with dementia to either receive the service decision aid at the start or end of the study. The primary\r\noutcome was measured by comparing the difference in carer burden between the two groups three months after\r\nthe intervention group received the decision aid. Pilot data was collected from carers using intervieweradministered\r\nquestionnaires at the commencement of the project, two weeks and 12 weeks later.\r\nResults: The qualitative data strongly suggest that the intervention provides carers with needed decision support.\r\nMost carers felt that the decision aid was useful. The trial data demonstrated that, using the mean change\r\nbetween baseline and three month follow-up, the intervention group had less increase in burden, a decrease in\r\ndecisional conflict and increased knowledge compared to control group participants.\r\nConclusions: While these results must be interpreted with caution due to the small sample size, all intervention\r\nresults trend in a direction that is beneficial for carers and their decisional ability. Mixed method data suggest the\r\ndecision aid provides decisional support that carers do not otherwise receive. Decision aids may prove useful in a\r\ncommunity health services context....
Background: Effective interventions to prevent mother-to-child HIV transmission (PMTCT) exist and when properly\r\napplied reduce the risk of vertical HIV transmission. As part of optimizing PMTCT in the Dutch Caribbean we\r\ndeveloped a set of valid and applicable indicators in order to assess the quality of care in HIV-infected (pregnant)\r\nwomen and their newborns.\r\nMethods: A multidisciplinary expert panel of 19 experts reviewed and prioritized recommendations extracted from\r\nlocally used international PMTCT guidelines according to a 3-step-modified-Delphi procedure. Subsequently, the\r\nfeasibility, sample size, inter-observer reliability, sensitivity to change and case mixed stability of the potential\r\nindicators were tested for a data set of 153 HIV-infected women, 108 pregnancies of HIV-infected women and 79\r\nnewborns of HIV-infected women in Aruba, CuraÃ?§ao and St Maarten from 2000 to 2010.\r\nResults: The panel selected and prioritized 13 potential indicators. Applicability could not be tested for 4 indicators\r\nregarding HIV-screening in pregnant women because of lack of data. Four indicators performed satisfactorily for\r\nCuraÃ?§ao (ââ?¬â?¢monitoring CD4-cell countââ?¬â?¢, ââ?¬Ë?monitoring HIV-RNA levelsââ?¬â?¢, ââ?¬Ë?intrapartum antiretroviral therapy and infant\r\nprophylaxis if antepartum antiretroviral therapy was not receivedââ?¬â?¢, ââ?¬Ë?scheduled caesarean deliveryââ?¬â?¢) and 3 for St\r\nMaarten (ââ?¬â?¢monitoring CD4-cell countââ?¬â?¢, ââ?¬Ë?monitoring HIV-RNA levelsââ?¬â?¢, ââ?¬Ë?discuss and provide combined antiretroviral\r\ntherapy to all HIV-infected pregnant womenââ?¬â?¢) whilst none for Aruba.\r\nConclusions: A systemic evidence-and consensus-based approach was used to develop quality indicators in 3\r\nDutch Caribbean settings. The varying results of the applicability testing accentuate the necessity of applicability\r\ntesting even in, at first, comparable settings....
Background: Antiretroviral therapy (ART) requires high-level (> 95%) adherence. Kenya is rolling out ART access\r\nprogrammes and, issue of adherence to therapy is therefore imperative. However, published data on adherence to\r\nART in Kenya is limited. This study assessed adherence to ART and identified factors responsible for non adherence\r\nin Nairobi.\r\nMethods: This is a multiple facility-based cross-sectional study, where 416 patients aged over 18 years were\r\nsystematically selected and interviewed using a structured questionnaire about their experience taking ART.\r\nAdditional data was extracted from hospital records. Patients were grouped into adherent and non-adherent based\r\non a composite score derived from a three questions adherence tool developed by Center for Adherence Support\r\nEvaluation (CASE). Multivariate regression model was used to determine predictors of non-adherence.\r\nResults: Overall, 403 patients responded; 35% males and 65% females, 18% were non-adherent, and main (38%)\r\nreason for missing therapy were being busy and forgetting. Accessing ART in a clinic within walking distance from\r\nhome (OR = 2.387, CI.95 = 1.155-4.931; p = 0.019) and difficulty with dosing schedule (OR = 2.310, CI.95 = 1.211-\r\n4.408, p = 0.011) predicted non-adherence.\r\nConclusions: The study found better adherence to HAART in Nairobi compared to previous studies in Kenya.\r\nHowever, this can be improved further by employing fitting strategies to improve patients� ability to fit therapy in\r\nown lifestyle and cue-dose training to impact forgetfulness. Further work to determine why patients accessing\r\ntherapy from ARV clinics within walking distance from their residence did not adhere is recommended....
Background: Data on lipid profile derangements induced by antiretroviral treatment in Africa are scarce. The aim of this\r\nstudy was to determine the prevalence and characteristics of lipid profile derangements associated with first-line highly\r\nactive antiretroviral therapy (ART) among Cameroonians living with human immunodeficiency virus (HIV) infection.\r\nMethods: This cross-sectional study was conducted between November 2009 and January 2010, and involved 138\r\nHIV patients who had never received ART (ART-naive group) and 138 others treated for at least 12 months with\r\nfirst line triple ART regimens that included nevirapine or efavirenz (ART group). Lipid profile was determined after\r\novernight fast and dyslipidemia diagnosed according to the US National Cholesterol Education Program III criteria.\r\nData comparison used chi-square test, Student t-test and logistic regressions.\r\nResults: The prevalence of total cholesterol = 200 mg/dl was 37.6% and 24.6% respectively in ART group and ARTnaive\r\ngroups (p = 0.019). The equivalents for LDL-cholesterol = 130 mg/dl were 46.4% and 21% (p = 0.001). Proportions\r\nof patients with total cholesterol/HDL-cholesterol ratio = 5 was 35.5% in ART group and 18.6% in ART-naive group (p =\r\n0.001). The distribution of HDL-cholesterol and triglycerides was similar between the two groups. In multivariable\r\nanalysis adjusted for age, sex, body mass index, CD4 count and co-infection with tuberculosis, being on ART was\r\nsignificantly and positively associated with raised total cholesterol, LDL-cholesterol and TC/HDL cholesterol. The\r\nadjusted odd ratios (95% confidence interval, p-value) ART-treated vs. ART-na�¯ve was 1.82 (1.06-1.12, p = 0.02) for TC =\r\n200 mg/dl; 2.99 (1.74-5.15), p < 0.0001) for LDL-cholesterol = 130 mg/dl and 1.73 (1.04-2.89, p = 0.03) for TC/HDLcholesterol\r\n= 5.\r\nConclusions: First-line antiretroviral therapy that includes nonnucleoside reverse transcriptase inhibitors is\r\nassociated with pro-atherogenic adverse lipid profile in people with HIV-1 infection compared to untreated HIVinfected\r\nsubjects in Yaounde. Lipid profile and other cardiovascular risk factors should be monitored in patients on\r\nsuch therapy so that any untoward effects of treatments can be optimally managed....
Background: Highly effective antiviral treatment can suppress HIV-1 infection, but the chronic effects of HIV-1-\r\nrelated viral proteins, including gp120 and Tat, on organs such as the lungs can be damaging. HIV-1 transgenic\r\nrodent models are useful for studying the systemic effects of these proteins independently of viral infection. We\r\nhave previously shown that HIV-1 transgene expression (and therefore, HIV-1-related protein expression) in rats\r\ndecreases alveolar macrophage zinc levels and phagocytic capacity by unknown mechanisms. We hypothesized\r\nthat HIV-1 transgene expression induces chronic inflammation and zinc sequestration within the liver and thereby\r\ndecreases zinc bioavailability in the lung. We examined the expression of the pro-inflammatory cytokine, tumor\r\nnecrosis factor alpha (TNFa), the zinc storage protein, metallothionein (MT1), and the zinc exporter, ZNT1 in the\r\nlivers and the lungs of wild type and HIV-1 transgenic rats �± dietary zinc supplementation. In addition, we\r\nmeasured zinc levels, the zinc importing protein ZIP1, and the phagocytic capacity in the alveolar macrophages.\r\nResults: HIV-1 transgene expression increased the liver-specific expression of TNFa, suggesting a chronic\r\ninflammatory response within the liver in response to HIV-1-related protein expression. In parallel, HIV-1 transgene\r\nexpression significantly increased MT1 and ZNT1 expression in the liver as compared to the lung, a pattern that is\r\nconsistent with zinc sequestration in the liver as occurs during systemic inflammation. Further, HIV-1 transgene\r\nexpression decreased intracellular zinc levels and increased expression of ZIP1 in the alveolar macrophages, a\r\npattern consistent with zinc deficiency, and decreased their bacterial phagocytic capacity. Interestingly, dietary zinc\r\nsupplementation in HIV-1 transgenic rats decreased gene expression of TNFa, MT1, and ZNT1 in the liver while\r\nsimultaneously increasing their expression in the lung. In parallel, zinc supplementation increased alveolar\r\nmacrophage intracellular zinc levels and bacterial phagocytic capacity in HIV-1 transgenic rats.\r\nConclusion: Taken together, these findings suggest that chronic HIV-1-related protein expression causes liver\r\ninflammation and zinc sequestration, which in turn limits zinc bioavailability in the lung and thereby impairs\r\nalveolar macrophage phagocytic function. Importantly, dietary zinc supplementation decreases liver inflammation\r\nand zinc sequestration and restores alveolar macrophage phagocytic function in HIV-1 transgenic rats, a result with\r\npotential clinical implications for improving lung health in HIV-1-infected individuals....
Background: A wide range of preventive, treatment, and care programs for HIV/AIDS are currently available and\r\nsome of them have been implemented in Thailand. Policy makers are now facing challenges on how the scarce\r\nresources for HIV/AIDS control can be spent more wisely. Although effectiveness and cost-effectiveness information\r\nis useful for guiding policy decisions, empirical evidence indicates the importance of other criteria, such as equity\r\nand the characteristics of the target population, also play important roles in priority setting. This study aims to\r\nexperiment with the use of multi-criteria decision analysis (MCDA) to prioritise interventions in HIV/AIDS control in\r\nThailand.\r\nMethods: We used MCDA to rank 40 HIV/AIDS interventions on the basis of the priority setting criteria put forward\r\nby three groups of stakeholders including policy makers, people living with HIV/AIDs (PLWHA), and village health\r\nvolunteers (VHVs). MCDA incorporated an explicit component of deliberation to let stakeholders reflect on the rank\r\nordering, and adapt where necessary.\r\nResults: Upon deliberation, policy makers expressed a preference for programs that target high risk groups such as\r\nmen who have sex with men, injecting drug users, and female sex workers. The VHVs preferred interventions that\r\ntarget the youth or the general population, and gave lower priority to programs that target high risk groups.\r\nPLWHA gave all interventions the same priority. The rank order correlation between the priorities as expressed\r\nbefore and after deliberation was 37% among the policy makers and 46% among the VHVs.\r\nConclusion: This study documented the feasibility of MCDA to prioritize HIV/AIDS interventions in Thailand, and\r\nhas shown the usefulness of a deliberative process as an integrated component of MCDA. MCDA holds potential\r\nto contribute to a more transparent and accountable priority setting process, and further application of this\r\napproach in the prioritisation of health interventions is warranted....
Background: We examined trends in AIDS-defining illnesses (ADIs) among individuals receiving highly active\r\nantiretroviral therapy (HAART) in British Columbia (BC), Canada to determine whether declines in ADIs could be\r\ncontributing to previously observed improvements in life-expectancy among HAART patients in BC since 1996.\r\nMethods: HAART-na�¯ve individuals aged = 18 years who initiated treatment in BC each of the following timeperiods\r\n1996 - 1998; 1999 - 2001; 2002 - 2004; 2005 - 2007 were included. The proportion of participants with\r\nreported ADIs were examined for each time period and trends were analyzed using the Cochran-Armitage Trend\r\nTest. Cox proportional hazards models were used to examine factors associated with ADIs.\r\nResults: A total of 3721 individuals (81% male) initiated HAART during the study period. A total of 251 reports of\r\nADIs were received from 214 unique patients. These occurred in a median of 4 months (IQR = 1-19 months) from\r\nHAART initiation. The proportion of individuals with a reported ADI did not change significantly from 4.6% in the\r\nearliest time period to 5.8% in the latest period (p = 0.181 for test of trend). There were no significant declines in\r\nany specific ADI over the study period. Multivariable Cox models found that individuals initiating HAART during\r\n2002-04 were at an increased risk of ADIs (AHR = 1.55; 95% CI 1.04-2.32) in comparison to 1996 - 98, but there\r\nwere no significant differences in other time periods.\r\nConclusions: Trends in reported ADIs among individuals receiving HAART since 1996 in BC do not appear to\r\nparallel improvements in life-expectancy over the same period....
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