A pilot study assessing the safety and latency-reversing activity of disulfiram in HIV-1-infected adults on antiretroviral therapy

BACKGROUND

Transcriptionally silent human immunodeficiency virus type 1 (HIV-1) DNA persists in resting memory CD4(+) T cells despite antiretroviral therapy. In a primary cell model, the antialcoholism drug disulfiram has been shown to induce HIV-1 transcription in latently infected resting memory CD4(+) T cells at concentrations achieved in vivo.

METHODS

We conducted a single-arm pilot study to evaluate whether 500 mg of disulfiram administered daily for 14 days to HIV-1-infected individuals on stable suppressive antiretroviral therapy would result in reversal of HIV-1 latency with a concomitant transient increase in residual viremia or depletion of the latent reservoir in resting memory CD4(+) T cells.

RESULTS

Disulfiram was safe and well tolerated. There was a high level of subject-to-subject variability in plasma disulfiram levels. The latent reservoir did not change significantly (1.16-fold change; 95% confidence interval [CI], .70- to 1.92-fold; P = .56). During disulfiram administration, residual viremia did not change significantly compared to baseline (1.53-fold; 95% CI, .88- to 2.69-fold; P = .13), although residual viremia was estimated to increase by 1.88-fold compared to baseline during the postdosing period (95% CI, 1.03- to 3.43-fold; P = .04). In a post hoc analysis, a rapid and transient increase in viremia was noted in a subset of individuals (n = 6) with immediate postdose sampling (HIV-1 RNA increase, 2.96-fold; 95% CI, 1.29- to 6.81-fold; P = .01).

CONCLUSIONS

Administration of disulfiram to patients on antiretroviral therapy does not reduce the size of the latent reservoir. A possible dose-related effect on residual viremia supports future studies assessing the impact of higher doses on HIV-1 production. Disulfiram affects relevant signaling pathways and can be safely administered, supporting future studies of this drug.

Three distinct phases of HIV-1 RNA decay in treatment-naive patients receiving raltegravir-based antiretroviral therapy: ACTG A5248

OBJECTIVE

The goal of this study was to define viral kinetics after initiation of raltegravir (RAL)-based antiretroviral therapy (ART).

METHODS

ART-naive patients received RAL, tenofovir disoproxil fumarate, and emtricitabine for 72 weeks. Human immunodeficiency virus type 1 (HIV-1) RNA were measured by ultrasensitive and single-copy assays, and first (d1)-, second (d2)-, and, third (d3)-phase decay rates were estimated by mixed-effects models. Decay data were compared to historical estimates for efavirenz (EFV)- and ritonavir/lopinavir (LPV/r)-based regimens.

RESULTS

Bi- and tri-exponential models for ultrasensitive assay (n = 38) and single-copy assay (n = 8) data, respectively, provided the best fits over 8 and 72 weeks. The median d1 with ultrasensitive data was 0.563/day (interquartile range [IQR], 0.501-0.610/day), significantly slower than d1 for EFV-based regimens [P < .001]). The median duration of d1 was 15.1 days, transitioning to d2 at an HIV-1 RNA of 91 copies/mL, indicating a longer duration of d1 and a d2 transition at lower viremia levels than with EFV. Median patient-specific decay estimates with the single-copy assay were 0.607/day (IQR, 0.582-0.653) for d1, 0.070/day (IQR, 0.042-0.079) for d2, and 0.0016/day (IQR, 0.0005-0.0022) for d3; the median d1 duration was 16.1 days, transitioning to d2 at 69 copies/mL. d3 transition occurred at 110 days, at 2.6 copies/mL, similar to values for LPV/r-based regimens.

CONCLUSIONS

Models using single-copy assay data revealed 3 phases of decay with RAL-containing ART, with a longer duration of first-phase decay consistent with RAL-mediated blockade of productive infection from preintegration complexes.

Desempenho, carcaça e cortes de frangos caipira francês barré (gris barré cou plumé)

Objetivou-se analisar os efeitos dos níveis de energia metabolizável e da idade de abate sobre o desempenho zootécnico, rendimento de carcaça e cortes de frangos da linhagem Caipira Francês Barré. O experimento foi conduzido em galpão experimental localizado em Parauapebas, PA. Foram utilizados 192 pintos, mistos, de 1 dia, criados em sistema intensivo. O delineamento experimental utilizado foi inteiramente casualizado, com 3 tratamentos. Cada tratamento foi formado de 4 repetições, sendo a unidade experimental 1 box de 16 aves. Os tratamentos foram definidos de acordo com os níveis de energia metabolizável das rações inicial (1 a 28 dias) e final (29 a 90 dias), respectivamente: T1 - 3000 e 3100 kcal de EM/kg; T2 - 3100 e 3200 kcal de EM/kg; T3 - 3200 e 3300 kcal de EM/kg. As variáveis estudadas foram peso inicial, peso final, consumo de ração e conversão alimentar, proteína bruta consumida, proteína metabolizada consumida, eficiência energética e eficiência protéica. As características de carcaças das aves, analisadas com 77, 84 e 91 dias de idade, foram o rendimento de carcaça, peito, coxas, sobrecoxas, asa, dorso, asas, pés, cabeça e pescoço. A análise estatística dos dados foi realizada utilizando o procedimento ANOVA, para um modelo inteiramente casualizado, com o programa Sistema para análise estatística e genética (SAEG, 2007). As diferenças entre as médias das variáveis estudadas foram realizadas pelo Teste de Tukey a um nível de 5%. Os níveis de energia nas dietas não interferiram no desempenho zootécnico e no rendimento de carcaça, peito, coxas, sobrecoxas, asas, pés e cabeça + pescoço das aves. O nível de 3200 kcal de EM/kg proporcionou melhor rendimento de dorso. A proteína bruta e a energia metabolizada consumida pelas aves melhoraram com o incremento energético da ração, durante a fase de engorda. A idade de abate não influenciou no rendimento de carcaça, entretanto as aves abatidas aos 90 dias de idade apresentaram maior rendimento de peito.

Functional brain connectivity and deactivation in new onset schizophrenia: A pilot study

There has been previous evidence of aberrant functional connectivity in the so-called “default-mode” network (DMN) in patients with schizophrenia.

Objective

The purpose of this study was to test whether such aberrant connectivity, if existent, can be modulated by a task involving the challenge of attention, working memory and executive functioning.

Methods

A functional magnetic resonance imaging (fMRI) experiment alternating between periods of “rest” and periods of visual stimulation with successive series of pictures extracted from the Wechsler Adult Intelligence Scale-III was carried out in seven patients with new onset schizophrenia according to the DSM-IV criteria and in six healthy control subjects matched for sex, age, and education. The DMN was extracted by using independent component analysis (ICA). The degree of deactivation during periods of stimulation was tested by means of a correlation analysis. To determine the existence of differences in deactivation between patients and controls, we used a non-parametric statistical test.

Results

An overall increased activation of the DMN in patients with schizophrenia relative to control subjects seems to occur. There was also an almost significant difference in the degree of deactivation between the two groups (controls>patients, p = 0.05).

Conclusions

Aberrant connectivity of the DMN is indeed a consistent feature in schizophrenia. An altered deactivation of the DMN during a highly demanding task in patients with schizophrenia confirms previous results suggesting an abnormal behaviour of networks in the transition from “rest” to goal-directed activity.

Alezzandrini syndrome: report of a sixth clinical case

The aim of this article is to describe an additional clinical case of a patient with Alezzandrini syndrome. Clinically the patient presented with unilateral vitiligo on the left cheek, with partial loss of hearing and vision on the same side.

Expression of Xylella fastidiosa fimbrial and afimbrial proteins during biofilm formation

Complete sequencing of the Xylella fastidiosa genome revealed characteristics that have not been described previously for a phytopathogen. One characteristic of this genome was the abundance of genes encoding proteins with adhesion functions related to biofilm formation, an essential step for colonization of a plant host or an insect vector. We examined four of the proteins belonging to this class encoded by genes in the genome of X. fastidiosa: the PilA2 and PilC fimbrial proteins, which are components of the type IV pili, and XadA1 and XadA2, which are afimbrial adhesins. Polyclonal antibodies were raised against these four proteins, and their behavior during biofilm development was assessed by Western blotting and immunofluorescence assays. In addition, immunogold electron microscopy was used to detect these proteins in bacteria present in xylem vessels of three different hosts (citrus, periwinkle, and hibiscus). We verified that these proteins are present in X. fastidiosa biofilms but have differential regulation since the amounts varied temporally during biofilm formation, as well as spatially within the biofilms. The proteins were also detected in bacteria colonizing the xylem vessels of infected plants.

Comparison of once-daily versus twice-daily combination antiretroviral therapy in treatment-naive patients: results of AIDS clinical trials group (ACTG) A5073, a 48-week randomized controlled trial

BACKGROUND

Dosing frequency is an important determinant of regimen effectiveness. Methods. To compare efficacy of once-daily (QD) versus twice-daily (BID) antiretroviral therapy, we randomized human immunodeficiency virus (HIV)-positive, treatment-naive patients to lopinavir-ritonavir (LPV/r) administered at a dosage of 400 mg of lopinavir and 100 mg of ritonavir BID (n = 160) or 800 mg of lopinavir and 200 mg of ritonavir QD (n = 161), plus either emtricitabine 200 mg QD and extended-release stavudine at a dosage of 100 mg QD or tenofovir at a dosage of 300 mg QD. Randomization was stratified by screening HIV RNA level <100,000 copies/mL versus > or = 100,000 copies/mL. The primary efficacy end point was sustained virologic response (SVR; defined as reaching and maintaining an HIV RNA level <200 copies/mL) through week 48.

RESULTS

Subjects were 78% male, 33% Hispanic, and 34% black. A total of 82% of subjects completed the study, and 71% continued to receive the initially assigned dosage schedule. The probability of SVR did not differ significantly for the BID versus QD comparison, with an absolute proportional difference of 0.03 (95% confidence interval [CI], -0.07 to 0.12). The comparison depended on the screening RNA stratum (P=.038); in the higher RNA stratum, the probability of SVR was significantly better in the BID arm than in the QD arm: 0.89 (95% CI, 0.79-0.94) versus 0.76 (95% CI, 0.64-0.84), a difference of 0.13 (95% CI, 0.01-0.25). Lopinavir trough plasma concentrations were higher with BID dosing. Adherence to prescribed doses of LPV/r was 90.6% in the QD arm versus 79.9% in the BID arm (P<.001). Conclusions. Although subjects assigned to QD regimens had better adherence, overall treatment outcomes were similar in the QD and BID arms. Subjects with HIV RNA levels > or =100,000 copies/mL had better SVR with BID regimens at 48 weeks, which suggests a possible advantage in this setting for more frequent dosing. Clinical trial registration. ClinicalTrials.gov registration number: NCT00036452.

Expression of progranulin (Acrogranin/PCDGF/Granulin-Epithelin Precursor) in benign and malignant ovarian tumors and activation of MAPK signaling in ovarian cancer cell line

It has been recently demonstrated that progranulin is overexpressed in ovarian cancer and that this protein is involved in the stimulation of cell proliferation, malignancy, and chemoresistance in ovarian cancer. The goal of the present study was to establish the differences in progranulin expression among normal, benign, and malignant ovarian tissues and to identify the signal transduction pathways activated by progranulin in an ovarian cancer cell line. Compared with benign tumors and normal ovarian tissue, progranulin mRNA and protein were overexpressed in malignant tumors. Survival analysis by the Kaplan-Meier method showed a correlation between high mRNA expression levels with poor survival outcome. Progranulin activated the MAPK-signaling pathway in NIH-OVCAR-3 cells. Progranulin expression may be potentially involved in the pathogenesis and malignant progression of ovarian cancer, and thus may represent a therapeutic target for this particular malignancy.

Screening of obstructive sleep apnea using Hilbert-Huang decomposition of oronasal airway pressure recordings

Polysomnographic signals are usually recorded from patients exhibiting symptoms related to sleep disorders such as obstructive sleep apnea (OSA). Analysis of polysomnographic data allows for the determination of the type and severity of sleep apnea or other sleep-related disorders by a specialist or technician. The usual procedure entails an overnight recording several hours long. This paper presents a methodology to help with the screening of OSA using a 5-min oronasal airway pressure signal emanating from a polysomnographic recording during the awake period, eschewing the need for an overnight recording. The clinical sample consisted of a total of 41 subjects, 20 non-OSA individuals and 21 individuals with OSA. A signal analysis technique based on the Hilbert-Huang transform was used to extract intrinsic oscillatory modes from the signals. The frequency distribution of both the first mode and second mode and their sum were shown to differ significantly between non-OSA subjects and OSA patients. An index measure based on the distribution frequencies of the oscillatory modes yielded a sensitivity of 81.0% (for 95% specificity) for the detection of OSA. Two other index measures based on the relation between the area and the maximum of the 1st and 2nd halves of the frequency histogram both yielded a sensitivity of 76.2% (for 95% specificity). Although further tests will be needed to test the reproducibility of these results, the proposed measures seem to provide a fast method to screen OSA patients, thus reducing the costs and the waiting time for diagnosis.

Review of clinical experience with the frameless LNG-IUS for contraception and treatment of heavy menstrual bleeding

OBJECTIVE

Review the clinical experience with the frameless FibroPlant levonorgestrel intrauterine system (FP-LNG-IUS).

STUDY DESIGN

An open, prospective non-comparative contraceptive 5-year study; a 1-year MBL study in women with heavy menstrual bleeding (HMB), using a PBAC and a 2-year MBL study in women with HMB and with normal menstruation using the quantitative alkaline hematin method. A literature review on perforation rate with the frameless GyneFix and FibroPlant.

RESULTS

304 insertions were performed with the FP-LNG-IUS. The total observation period was 11,299 woman-months. Only one pregnancy occurred. There were two expulsions and two uterine perforations at insertion during the first year. In the first 1-year MBL study, the median MBL decreased by more than 90%. In the second 2-year MBL study, MBL reduced drastically and 80% had amenorrhoea after 24 months. The ferritin values increased significantly. On a total of approximately 17,000 insertions, the perforation rate was between 1.2 and 2.0/1000 insertions.

CONCLUSION

The frameless FP-LNG-IUS is an effective and well-tolerated long-acting reversible contraceptive and is also highly effective for the treatment of HMB. The perforation rate is similar to traditional copper and levonorgestrel-releasing intrauterine devices and systems. Strict adherence to the manufacturer's insertion instructions is recommended.

Modified directly observed antiretroviral therapy compared with self-administered therapy in treatment-naive HIV-1-infected patients: a randomized trial

BACKGROUND

Success of antiretroviral therapy depends on high rates of adherence, but few interventions are effective. Our objective was to determine if modified directly observed therapy (mDOT) improves initial antiretroviral success.

METHODS

In an open-label, randomized trial comparing mDOT (Monday-Friday for 24 weeks) and self-administered therapy with lopinavir/ritonavir soft gel capsules (800 mg/200 mg), emtricitabine (200 mg), and either extended-release stavudine (100 mg) or tenofovir (300 mg), all taken once daily, 82 participants received mDOT and 161, self-administered therapy. Participant eligibility included a plasma human immunodeficiency virus RNA level higher than 2000 copies/mL and being naïve to antiretroviral therapy. A total of 243 participants were predominantly male (79%) (median age, 38 years), with 84 Latinos (35%), 74 non-Latino blacks (30%), and 79 non-Latino whites (33%). The study was conducted at 23 AIDS Clinical Trials Group (ACTG) sites in the United States and 1 site in South Africa between October 2002 and January 2006. The primary outcome was virologic success at week 24 and secondary outcomes were virologic success, clinical progression, and adherence at week 48.

RESULTS

Over 24 weeks, mDOT had greater virologic success (0.91; 95% confidence interval [CI], 0.81 to 0.95) than self-administered therapy (0.84; 95% CI, 0.77 to 0.89), but the difference (0.07; lower bound 95% CI, -0.01) did not reach the prespecified threshold of 0.075. Over 48 weeks, virologic success was not significantly different between mDOT (0.72; 95% CI, 0.61 to 0.81) and self-administered therapy (0.78; 95% CI, 0.70 to 0.84) (difference, -0.06; 95% CI, -0.18 to 0.07 [P = .19]).

CONCLUSIONS

The potential benefit of mDOT was marginal and not sustained after discontinuation. Modified DOT should not be incorporated routinely for care of treatment-naïve human immunodeficiency virus type 1-infected patients.