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Rodriguez CA, Natukunda E, Strehlau R, Venter EL, Rungmaitree S, Cunningham CK, Lalloo U, Kosalaraksa P, HellstrÖm E, Liberty A, McGrath EJ, Kaur M, Leisegang R, Hindman JT, Vieira VA, Kersey K, Cotton MF, Rakhmanina N, Gaur AH. Pharmacokinetics and safety of coformulated bictegravir, emtricitabine, and tenofovir alafenamide in children aged 2 years and older with virologically suppressed HIV: a phase 2/3, open-label, single-arm study. Lancet HIV 2024; 11:e300-e308. [PMID: 38621393 DOI: 10.1016/s2352-3018(23)00327-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/03/2023] [Accepted: 11/28/2023] [Indexed: 04/17/2024]
Abstract
BACKGROUND Coformulated bictegravir, emtricitabine, and tenofovir alafenamide is a single-tablet regimen and was efficacious and well tolerated in children and adolescents with HIV (aged 6 years to <18 years) in a 48-week phase 2/3 trial. In this study, we report data from children aged at least 2 years and weighing 14 kg to less than 25 kg. METHODS We conducted this open-label, multicentre, multicohort, single-arm study in South Africa, Thailand, Uganda, and the USA. Participants were virologically suppressed children with HIV, aged at least 2 years, weighing 14 kg to less than 25 kg. Participants received bictegravir (30 mg), emtricitabine (120 mg), and tenofovir alafenamide (15 mg) once daily, switching to bictegravir (50 mg), emtricitabine (200 mg), and tenofovir alafenamide (25 mg) upon attaining a bodyweight of at least 25 kg. The study included pharmacokinetic evaluation at week 2 to confirm the dose of coformulated bictegravir, emtricitabine, and tenofovir alafenamide for this weight band by comparing with previous adult data. Primary outcomes were bictegravir area under the curve over the dosing interval (AUCtau) and concentration at the end of the dosing interval (Ctau) at week 2, and incidence of treatment-emergent adverse events and laboratory abnormalities until the end of week 24 in all participants who received at least one dose of bictegravir, emtricitabine, and tenofovir alafenamide. This study is registered with ClinicalTrials.gov, NCT02881320. FINDINGS Overall, 22 participants were screened (from Nov 14, 2018, to Jan 11, 2020), completed treatment with bictegravir, emtricitabine, and tenofovir alafenamide (until week 48), and entered an extension phase. The geometric least squares mean (GLSM) ratio for AUCtau for bictegravir was 7·6% higher than adults (GLSM ratio 107·6%, 90% CI 96·7-119·7); Ctau was 34·6% lower than adults (65·4%, 49·1-87·2). Both parameters were within the target exposure range previously found in adults, children, or both". Grade 3-4 laboratory abnormalities occurred in four (18%) participants by the end week 24 and six (27%) by the end of week 48. Drug-related adverse events occurred in three participants (14%) by the end of week 24 and week 48; none were severe. No Grade 3-4 adverse events, serious adverse events, or adverse events leading to discontinuation occurred by the end of week 24 and week 48. INTERPRETATION Data support the use of single-tablet coformulated bictegravir (30 mg), emtricitabine (120 mg), and tenofovir alafenamide (15 mg) for treatment of HIV in children aged at least 2 years and weighing 14 kg to less than 25 kg. FUNDING Gilead Sciences.
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Affiliation(s)
- Carina A Rodriguez
- Department of Pediatrics, Division of Infectious Diseases, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Renate Strehlau
- VIDA-Nkanyezi Research Unit, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Supattra Rungmaitree
- Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Coleen K Cunningham
- School of Medicine, University of California Irvine (UCI), Irvine, CA, USA; Children's Hospital of Orange County, Orange, CA, USA
| | - Umesh Lalloo
- Durban International Clinical Research Site, Durban University of Technology, Durban, South Africa
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Afaaf Liberty
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Eric J McGrath
- Division of Infectious Diseases & Prevention, Wayne State University School of Medicine, Detroit, MI, USA
| | | | | | | | | | | | - Mark F Cotton
- Department of Paediatrics and Child Health, Family Centre for Research with Ubuntu (FAMCRU), Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Natella Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA; School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Aditya H Gaur
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA.
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Leavitt SV, Rodriguez CA, Bouton TC, Horsburgh CR, Abel Zur Wiesch P, Nichols BE, White LF, Jenkins HE. Outcomes for people with TB by disease severity at presentation. Int J Tuberc Lung Dis 2024; 28:142-147. [PMID: 38454178 DOI: 10.5588/ijtld.23.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND There is substantial heterogeneity in disease presentation for individuals with TB disease, which may correlate with disease outcomes. We estimated disease outcomes by disease severity at presentation among individuals with TB during the pre-chemotherapy era.METHODS We extracted data on people with TB enrolled between 1917 and 1948 in the USA, stratified by three disease severity categories at presentation using the U.S. National Tuberculosis Association diagnostic criteria. These criteria were based largely on radiographic findings ("minimal", "moderately advanced", and "far advanced"). We used Bayesian parametric survival analysis to model the survival distribution overall, and by disease severity and Bayesian logistic regression to estimate the severity-level specific natural recovery odds within 3 years.RESULTS People with minimal TB at presentation had a 2% (95% CrI 0-11%) probability of TB death within 5 years vs. 40% (95% CrI 15-68) for those with far advanced disease. Individuals with minimal disease had 13.62 times the odds (95% CrI 9.87-19.10) of natural recovery within 3 years vs. those with far advanced disease.CONCLUSION Mortality and natural recovery vary by disease severity at presentation. This supports continued work to evaluate individualized (e.g., shortened or longer) regimens based on disease severity at presentation, identified using radiography..
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Affiliation(s)
| | - C A Rodriguez
- Departments of Epidemiology, Boston University School of Public Health, Boston, MA
| | - T C Bouton
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, Boston University School of Medicine, Boston, MA
| | - C R Horsburgh
- Departments of Biostatistics and, Departments of Epidemiology, Boston University School of Public Health, Boston, MA, Boston University School of Medicine, Boston, MA, Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - P Abel Zur Wiesch
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Norway;, Center of Infectious Disease Dynamics, Pennsylvania State University, Philadelphia, PA, USA
| | - B E Nichols
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Rodriguez CA, Horsburgh CR, Jenkins HE, White LF. Reply to 'Estimating TB survival - mind the immortal-time gap'. Int J Tuberc Lung Dis 2024; 28:66-67. [PMID: 38178287 DOI: 10.5588/ijtld.23.0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Affiliation(s)
- C A Rodriguez
- Departments of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - C R Horsburgh
- Departments of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - H E Jenkins
- Departments of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - L F White
- Departments of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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Rick AM, Laurens MB, Huang Y, Yu C, Martin TCS, Rodriguez CA, Rostad CA, Maboa RM, Baden LR, El Sahly HM, Grinsztejn B, Gray GE, Gay CL, Gilbert PB, Janes HE, Kublin JG, Huang Y, Leav B, Hirsch I, Struyf F, Dunkle LM, Neuzil KM, Corey L, Goepfert PA, Walsh SR, Follmann D, Kotloff KL. Risk of COVID-19 after natural infection or vaccination. EBioMedicine 2023; 96:104799. [PMID: 37738833 PMCID: PMC10518569 DOI: 10.1016/j.ebiom.2023.104799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. METHODS In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7-15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. FINDINGS Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05-0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01-0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. INTERPRETATION Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. FUNDING National Institutes of Health.
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Affiliation(s)
- Anne-Marie Rick
- Department of Pediatrics, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Matthew B Laurens
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ying Huang
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Chenchen Yu
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Thomas C S Martin
- Department of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Carina A Rodriguez
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Christina A Rostad
- Department of Pediatrics, Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Glenda E Gray
- South African Medical Research Council, Cape Town, South Africa
| | - Cynthia L Gay
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | | | | | - Yunda Huang
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Ian Hirsch
- AstraZeneca BioPharmaceuticals, Cambridge, UK
| | | | | | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Paul A Goepfert
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Stephen R Walsh
- Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Dean Follmann
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Rodriguez CA, Leavitt SV, Bouton TC, Horsburgh CR, Zur Wiesch PA, Nichols B, Jenkins HE, White LF. Survival of people with untreated TB: effects of time, geography and setting. Int J Tuberc Lung Dis 2023; 27:694-702. [PMID: 37608480 PMCID: PMC10443783 DOI: 10.5588/ijtld.22.0668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/30/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: An estimated 40% of people who developed TB in 2021 were not diagnosed or treated. Pre-chemotherapy era data are a rich resource on survival of people with untreated TB. We aimed to identify heterogeneities in these data to inform their more precise use.METHODS: We extracted survival data from pre-chemotherapy era papers reporting TB-specific mortality and/or natural recovery data. We used Bayesian parametric survival analysis to model the survival distribution, stratifying by geography (North America vs. Europe), time (pre-1930 vs. post-1930), and setting (sanitoria vs. non-sanitoria).RESULTS: We found 12 studies with TB-specific mortality data. Ten-year survival was 69% in North America (95% CI 54-81) and 36% in Europe (95% CI 10-71). Only 38% (95% CI 18-63) of non-sanitorium individuals survived to 10 years compared to 69% (95% CI 41-87) of sanitoria/hospitalized patients. There were no significant differences between people diagnosed pre-1930 and post-1930 (5-year survival pre-1930: 65%, 95% CI 44-88 vs. post-1930: 72%, 95% CI 41-94).CONCLUSIONS: Mortality and natural recovery risks vary substantially by location and setting. These heterogeneities need to be considered when using pre-chemotherapy data to make inferences about expected survival of people with undiagnosed TB.
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Affiliation(s)
| | - S V Leavitt
- Departments of Biostatistics, Boston University School of Public Health, Boston, MA
| | - T C Bouton
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, Boston University School of Medicine, Boston, MA, USA
| | - C R Horsburgh
- Departments of Epidemiology, and, Departments of Biostatistics, Boston University School of Public Health, Boston, MA
| | - P Abel Zur Wiesch
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway, Center of Infectious Disease Dynamics, Pennsylvania State University, Philadelphia, PA
| | - B Nichols
- Department of Global Health, Boston University School of Public Health, Boston, MA USA
| | - H E Jenkins
- Departments of Biostatistics, Boston University School of Public Health, Boston, MA
| | - L F White
- Departments of Biostatistics, Boston University School of Public Health, Boston, MA
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DiGiovanni LK, Lim AC, Kosyluk K, Loecher N, Lewald DL, Rodriguez CA, Sanders LJ. Novel Application of Dot Survey Methodology at a Youth Health Clinic: A Pilot Study. J Adolesc Health 2023; 72:616-622. [PMID: 36543632 DOI: 10.1016/j.jadohealth.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE We tested a novel dot survey methodology at our clinic that provides sexual health services to youth ages 13 to 24. We conducted two interactive dot surveys to assess their feasibility and acceptability while gaining insight into patients' attitudes about mental health. METHODS We adapted a dot survey approach to assess youths' familiarity with mental health and attitudes toward related services. We also assessed their attitudes toward participating in this survey method. All patients with scheduled appointments were eligible to participate. Participants used dot stickers to indicate their responses on survey posters displayed in the waiting room. RESULTS Three hundred patients participated between June and September 2021 (150 participants/survey). About 95% of participants liked seeing others' responses to the dot surveys, and over 70% reported that the surveys made them think more about mental health. Over 90% would participate in future dot surveys at the clinic. Survey items with the most consensus among participants included that 74.5% "really agree" youth face barriers to accessing mental health services (n = 141, mean = 4.61, standard deviation = 0.79) and 87.1% "really agree" primary care providers should ask youth about their mental health (n = 139, mean = 4.81, standard deviation = 0.59). DISCUSSION The dot surveys were effective at assessing patients' attitudes about mental health and feasible to conduct in our waiting room. Results confirmed that this survey method was well received among patients. Dot surveys can be adapted by other clinical settings to engage youth regarding their health-related attitudes.
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Affiliation(s)
- Lauren K DiGiovanni
- Department of Pediatrics, University of South Florida Health, Morsani College of Medicine, Tampa, Florida
| | - Andrew C Lim
- Department of Pediatrics, University of South Florida Health, Morsani College of Medicine, Tampa, Florida
| | - Kristin Kosyluk
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida
| | - Nele Loecher
- Department of Mental Health Law & Policy, University of South Florida, Tampa, Florida
| | | | - Carina A Rodriguez
- Department of Pediatrics, University of South Florida Health, Morsani College of Medicine, Tampa, Florida
| | - Lisa J Sanders
- Department of Pediatrics, University of South Florida Health, Morsani College of Medicine, Tampa, Florida.
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Rodriguez CA, Fustes OJH, Arteaga CBT. A novel Notch 3 mutation (pathogenic variant c.1565G>C) in CADASIL. Neurologia (Engl Ed) 2022; 37:235-236. [PMID: 35465915 DOI: 10.1016/j.nrleng.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/22/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - O J H Fustes
- Complexo Hospital de Clínicas da Universidade Federal do Paraná, Serviço de Neurologia, Hospital de Clínicas, Curitiba, Brazil.
| | - C B T Arteaga
- Estudante de Medicina, UNAERP, Ribeirão Preto, Brazil
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Rodriguez CA, Fustes OJH, Arteaga CBT. A novel Notch 3 mutation (pathogenic variant c.1565G>C) in CADASIL. Neurologia 2022; 37:235-236. [PMID: 34074565 DOI: 10.1016/j.nrl.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - O J H Fustes
- Complexo Hospital de Clínicas da Universidade Federal do Paraná, Serviço de Neurologia, Hospital de Clínicas, Curitiba, Brazil.
| | - C B T Arteaga
- Estudante de Medicina, UNAERP, Ribeirão Preto, Brazil
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Mohr-Holland E, Daniels J, Reuter A, Rodriguez CA, Mitnick C, Kock Y, Cox V, Furin J, Cox H. Early mortality during rifampicin-resistant TB treatment. Int J Tuberc Lung Dis 2022; 26:150-157. [PMID: 35086627 PMCID: PMC8802559 DOI: 10.5588/ijtld.21.0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND: Data suggest that treatment with newer TB drugs (linezolid [LZD], bedaquiline [BDQ] and delamanid [DLM]), used in Khayelitsha, South Africa, since 2012, reduces mortality due to rifampicin-resistant TB (RR-TB).METHODS: This was a retrospective cohort study to assess 6-month mortality among RR-TB patients diagnosed between 2008 and 2019.RESULTS: By 6 months, 236/2,008 (12%) patients died; 12% (78/651) among those diagnosed in 2008-2011, and respectively 8% (49/619) and 15% (109/738) with and without LZD/BDQ/DLM in 2012-2019. Multivariable analysis showed a small, non-significant mortality reduction with LZD/BDQ/DLM use compared to the 2008-2011 period (aOR 0.79, 95% CI 0.5-1.2). Inpatient treatment initiation (aOR 3.2, 95% CI 2.4-4.4), fluoroquinolone (FQ) resistance (aOR 2.7, 95% CI 1.8-4.2) and female sex (aOR 1.5, 95% CI 1.1-2.0) were also associated with mortality. When restricted to 2012-2019, use of LZD/BDQ/DLM was associated with lower mortality (aOR 0.58, 95% CI 0.39-0.87).CONCLUSIONS: While LZD/BDQ/DLM reduced 6-month mortality between 2012 and 2019, there was no significant effect overall. These findings may be due to initially restricted LZD/BDQ/DLM use for those with high-level resistance or treatment failure. Additional contributors include increased treatment initiation among individuals who would have otherwise died before treatment due to universal drug susceptibility testing from 2012, an effect that also likely contributed to higher mortality among females (survival through to care-seeking).
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Affiliation(s)
- E Mohr-Holland
- Khayelitsha Project, Médecins Sans Frontières (MSF), Cape Town, South Africa, Southern Africa Medical Unit, MSF, Cape Town, South Africa
| | - J Daniels
- Khayelitsha Project, Médecins Sans Frontières (MSF), Cape Town, South Africa
| | - A Reuter
- Khayelitsha Project, Médecins Sans Frontières (MSF), Cape Town, South Africa
| | - C A Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - C Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Y Kock
- National Department of Health, Pretoria, South Africa
| | - V Cox
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - H Cox
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape Town, South Africa, Institute for Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa
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Rodriguez CA, Brooks MB, Aibana O, Mitnick CD, Franke MF. Sputum culture conversion definitions and analytic practices for multidrug-resistant TB. Int J Tuberc Lung Dis 2021; 25:596-598. [PMID: 34183109 PMCID: PMC8259120 DOI: 10.5588/ijtld.21.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- C A Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - M B Brooks
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - O Aibana
- Department of Internal Medicine, University of Texas Health Science Center - Houston, McGovern Medical School, Houston, TX, USA
| | - C D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - M F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
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Gaur AH, Cotton MF, Rodriguez CA, McGrath EJ, Helström E, Liberty A, Natukunda E, Kosalaraksa P, Chokephaibulkit K, Maxwell H, Wong P, Porter D, Majeed S, Yue MS, Graham H, Martin H, Brainard DM, Pikora C. Fixed-dose combination bictegravir, emtricitabine, and tenofovir alafenamide in adolescents and children with HIV: week 48 results of a single-arm, open-label, multicentre, phase 2/3 trial. Lancet Child Adolesc Health 2021; 5:642-651. [PMID: 34302760 DOI: 10.1016/s2352-4642(21)00165-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Bictegravir is a potent integrase strand-transfer inhibitor (INSTI) with a high genetic barrier to resistance. Bictegravir, coformulated with emtricitabine and tenofovir alafenamide, is recommended by key European and US HIV treatment guidelines as the preferred single-tablet regimen for adults and adolescents. The aim of this study was to assess the pharmacokinetics, safety, and efficacy of switching to this regimen in virologically suppressed children and adolescents with HIV. METHODS In this single-arm, open-label trial, we enrolled virologically suppressed children and adolescents (aged 6 to <18 years) with HIV at 22 hospital clinics in South Africa, Thailand, Uganda, and the USA. Eligible participants had a bodyweight of at least 25 kg, were virologically suppressed (HIV-1 RNA <50 copies per mL) on a stable ART regimen for at least 6 months before screening, had a CD4 count of at least 200 cells per μL, and an estimated glomerular filtration rate of at least 90 mL/min per 1·73 m2 by the Schwartz formula at screening. All participants received the fixed-dose regimen of coformulated bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafenamide 25 mg once daily. Pharmacokinetic analysis was used for dosing confirmation, and results compared with adult values. The primary outcomes were area under the curve at the end of the dosing interval (AUCtau) and concentration at the end of the dosing interval (Ctau) of bictegravir, and incidence of treatment-emergent adverse events and laboratory abnormalities at week 24. Efficacy and safety analyses included all participants who received at least one dose of study drug. We report the 48-week results. This study is registered with ClinicalTrials.gov, NCT02881320. FINDINGS Between Sept 29, 2016 and Feb 16, 2018, we enrolled 102 participants. 100 participants received bictegravir, emtricitabine, and tenofovir alafenamide (cohort 1 [adolescents aged 12 to <18 years], n=50; cohort 2 [children aged 6 to <12 years], n=50). The mean bictegravir AUCtau was 89 100 ng × h/mL (coefficient of variation 31·0%) in adolescents (cohort 1) and 128 000 ng × h/mL (27·8%) in children (cohort 2). Compared with adults, bictegravir Ctau was 35% lower in adolescents and 11% lower in children. The 90% CIs of both parameters were within the predefined pharmacokinetic equivalence boundary and within overall range of exposures observed in adults and deemed to be safe and efficacious (geometric least-squares mean ratio [GLSM] 86·3% [90% CI 80·0-93·0] for AUCtau and 65·4% [58·3-73·3] for Ctau in adolescents; GLSM 125% [90% CI 117-134] for AUCtau and 88·9% [80·6-98·0] for Ctau for children). Bictegravir, emtricitabine, and tenofovir alafenamide was well tolerated; most adverse events were grade 2 or less in severity and no study drug-related serious adverse events were reported. One participant discontinued study drug due to adverse events (grade 2 insomnia and anxiety). Virological suppression (HIV-1 RNA <50 copies per mL) was maintained by all 100 participants at week 24 and by 98 (98%) of 100 at week 48; no participants had treatment-emergent resistance. INTERPRETATION In adolescents and children with HIV, the bictegravir, emtricitabine, and tenofovir alafenamide single-tablet regimen was well tolerated and maintained virological suppression. Our data support the treatment of HIV in adolescents and children with this single-tablet regimen. At present, the single-tablet regimen is recommended as first-line treatment in the USA for adolescents and as an alternative regimen in children and has the potential to represent an important regimen in the paediatric population. FUNDING Gilead Sciences.
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Affiliation(s)
- Aditya H Gaur
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Mark F Cotton
- Department of Paediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Carina A Rodriguez
- Department of Pediatrics, Division of Infectious Diseases, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Eric J McGrath
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
| | | | - Afaaf Liberty
- Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | | | | | - Kulkanya Chokephaibulkit
- Department of Pediatrics and Siriraj Institute of Clinical Research, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Heather Maxwell
- Department of Portfolio Project Management, Gilead Sciences, Foster City, CA, USA
| | - Pamela Wong
- Department of Biometrics, Gilead Sciences, Foster City, CA, USA
| | - Danielle Porter
- Department of Virology, Gilead Sciences, Foster City, CA, USA
| | - Sophia Majeed
- Department of Clinical Pharmacology, Gilead Sciences, Foster City, CA, USA
| | - Mun Sang Yue
- Department of Clinical Pharmacology, Gilead Sciences, Foster City, CA, USA
| | - Hiba Graham
- Department of Virology Clinical Research, Gilead Sciences, Foster City, CA, USA
| | - Hal Martin
- Department of Virology Clinical Research, Gilead Sciences, Foster City, CA, USA
| | - Diana M Brainard
- Department of Virology Clinical Research, Gilead Sciences, Foster City, CA, USA
| | - Cheryl Pikora
- Department of Virology Clinical Research, Gilead Sciences, Foster City, CA, USA
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Franke MF, Rodriguez CA, Mitnick CD. Causal inference in tuberculosis treatment studies: bias considerations and data needs. Int J Tuberc Lung Dis 2019; 23:960-961. [PMID: 31533889 DOI: 10.5588/ijtld.19.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- M F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA molly_,
| | - C A Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA molly_,
| | - C D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA molly_,
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Lynn C, Chenneville T, Bradley-Klug K, Walsh ASJ, Dedrick RF, Rodriguez CA. Depression, anxiety, and posttraumatic stress as predictors of immune functioning: differences between youth with behaviorally and perinatally acquired HIV. AIDS Care 2019; 31:1261-1270. [PMID: 30829044 DOI: 10.1080/09540121.2019.1587354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Youth living with HIV (YLWH) face significant mental health problems, namely depression, anxiety, and PTSD with rates of these disorders higher than in the general population. This study explored the relationship between symptoms of depression, anxiety, and PTSD and biological markers among a sample of 145 YLWH ages 13-25 years. Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder-7 Item Scale (GAD-7), and Primary Care-Posttraumatic Stress Disorder Screen (PC-PTSD). Biological markers included CD4 count and viral load (VL) abstracted from medical records. Findings revealed a relationship between depression and anxiety and CD4 count as well as anxiety and VL. The relationship between depression and anxiety and CD4 count and anxiety and VL was moderated by transmission mode (i.e., behavioral versus perinatal). For youth perinatally infected, greater psychological symptoms of depression and anxiety were associated with a decline in CD4 count and increase in VL, but this was not true for youth with behaviorally acquired HIV. These findings point to the need for individualized mental health prevention and intervention services for YLWH.
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Affiliation(s)
- Courtney Lynn
- a Department of Educational and Psychological Studies, University of South Florida , Tampa , FL , USA
| | - Tiffany Chenneville
- b Department of Psychology, University of South Florida St. Petersburg , St. Petersburg , FL , USA
| | - Kathy Bradley-Klug
- a Department of Educational and Psychological Studies, University of South Florida , Tampa , FL , USA
| | - Audra St John Walsh
- c Department of Pediatrics, University of South Florida , St. Petersburg , FL , USA
| | - Robert F Dedrick
- a Department of Educational and Psychological Studies, University of South Florida , Tampa , FL , USA
| | - Carina A Rodriguez
- d Department of Pediatrics, University of South Florida , Tampa , FL , USA
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Rodriguez CA, Garcia-Gomez J, Ribelles N, Gavila J, Pernas S, Rodriguez-Lescure A, Urrutikoetxea A, Pernaut C, Lopez A, Garcia-Mata J. Abstract P2-13-04: Impact of the adjuvant treatment with trastuzumab in HER2 positive breast cancer in the real-world setting. Analysis of two cohorts (1997-2005/2006-2015) in 1970 patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-13-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION: Although large randomized trials assessing the benefit of adjuvant trastuzumab in HER2-positive (HER2+) breast cancer have clearly demonstrated a significant improvement in long-term survival, it is necessary to know the impact of the use of trastuzumab adjuvant in the real life population, which includes patients frequently excluded from clinical trials, such as those with very small tumors without node involvement, or advanced age. The objective of this study is to describe the outcomes of women who received adjuvant trastuzumab for HER2+ cáncer since it was approved in 2006, compared with a previous cohort of HER2+ patients not treated with trastuzumab in 7 Spanish centers.
METHODS: Women with newly diagnosed stage I-III, HER2+ breast cancer, between 1997 and 2015 were included in the study. Two cohorts were considered: The No-Trastuzumab cohort (No-T), between 1997 and 2005, and the Trastuzumab cohort (T) with trastuzumab-treated women between 2006 and 2015. Kaplan-Meier estimates were used to evaluate DFS and OS. Additionally, cohorts were analyzed by pathologic tumour size, lymph node involvement and hormonal receptor status to stratify outcome measures.
RESULTS: A total of 2134 patients were identified. In 164 cases, data were insufficient or the follow-up incomplete. Therefore, the final analysis included 1970 patients, of whom 539 belong to the "No-T" cohort and 1431 to the "T" cohort. The median follow-up was 81 months. Median age: 53 years [22-98]. A total of 699 patients had T1 tumors [43% in the "No-T" cohort vs 33% in the "T" cohort]. 55% of the cases were N0 [58% and 54% in the "No-T" and "T" cohorts respectively]. The status of the hormonal receptors was well balanced between groups [36% ER negative in both]. Regarding the type of adjuvant treatment administered, in the "T" cohort more patients received adjuvant chemotherapy [65% vs 97%] and also in the “T” group combinations of taxanes and anthracyclines were more frequent [14% vs 72%]. The proportion of adjuvant endocrine therapy was similar in both groups [37% vs 34%].
In the “T” cohort, median Disease Free Survival (DFS) was not-reached, compared with 149 months in the “No-T” group. 5-year DFS was 83% vs 65% respectively [p<0.001]. 5-year DFS was also superior and statistically significant in all the subgroups analyzed, including patients with T1 tumors (87% vs 57%), N0 (87% vs 78%), patients T1N0 (88% vs 74%) and HR positive (86% vs 71%) or negative (78% vs 50%). Similarly, Overall Survival (OS) was increased in patients treated with Trastuzumab (median: 224 months vs not-reached, 5-year OS: 92% vs 75% [p <0.001].) 5-year OS was also statistically superior in the T1 subgroup (92% vs 72%), and N0 (95% vs 88%). [p<0.001 in all subanalysis].
CONCLUSIONS: Adjuvant treatment with Trastuzumab under conditions of real clinical practice in HER2+ early breast cancer, shows a highly significant benefit in terms of DFS and OS, regardless of the stage of the disease or other clinical variables. A very important benefit was reached in patients with small tumors, node-negative disease, or both conditions (T1N0). The benefit was also obtained regardless of the expression of hormonal receptors.
Citation Format: Rodriguez CA, Garcia-Gomez J, Ribelles N, Gavila J, Pernas S, Rodriguez-Lescure A, Urrutikoetxea A, Pernaut C, Lopez A, Garcia-Mata J. Impact of the adjuvant treatment with trastuzumab in HER2 positive breast cancer in the real-world setting. Analysis of two cohorts (1997-2005/2006-2015) in 1970 patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-13-04.
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Affiliation(s)
- CA Rodriguez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - J Garcia-Gomez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - N Ribelles
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - J Gavila
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - S Pernas
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - A Rodriguez-Lescure
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - A Urrutikoetxea
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - C Pernaut
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - A Lopez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
| | - J Garcia-Mata
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain; Complejo Hospitalario de Orense, Orense, Spain; Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto Valenciano de Oncología, Valencia, Spain; Instituto Catalan de Oncologia, L'Hospitalet, Barcelona, Spain; Hospital General Universitario de Elche, Elche, Alicante, Spain; Onkologikoa, San Sebastian, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Complejo Asistencial Universitario de Leon, Leon, Spain
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15
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Rodriguez CA, Guillen C, Garcia M, Sancho M, Gomez A, Ludena D, Cruz JJ. Abstract P4-08-07: Discordance between surrogated intrinsic subtypes defined by immunohistochemistry compared with PAM50 in ER positive / HER2 negative early breast cancer. Analysis of value of the status of the progesterone receptor and Ki67. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-08-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Classification by intrinsic subtypes by gene expression profiles of early-stage breast cancer (EBC) provides information of prognostic value and constitutes a tool to help in making therapeutic decisions. Several authors have proposed surrogated classifications based on immunohistochemistry results (IHC) in order to facilitate a classification with identical prognostic and predictive value. However, there is evidence that suggests a lack of correlation between these classifications.
The aim of this study was to evaluate the correlation between classification by intrinsic subtypes in patients with EBC ER+/ HER2neg, obtained by PAM50 and the surrogated classification proposed by St. Gallen 2013.
Methods: Samples from 12 centers from the spanish region of Castilla y León were analyzed by PAM50 (nCounterTM / Nanostring) at the University Hospital of Salamanca. The results obtained were compared with the surrogate classification of St.Gallen'13 from local reports. Tumors of patients pre and post-menopausal tests T1-2, N0-N1mi, grade I-II that met criteria for inclusion of the regional evaluation program through ProsignaTM were included.
Results: Between August'15 and December'17, 264 samples were analyzed. All patients were classified by IHC as lum-A or lum-B. In total 113 cases were reclassified by PAM50 (43%). The change of LumA by IHC to Lum-B by PAM50 was 18%, while Lum-B by IHC to Lum-A by PAM50 was 58% (n = 89). In those cases considered Lum-B by IHC based only in a value of Ki67>14% (n = 93), 54% was reclassified to Lum-A. Conversely, when low expression (negative or <20%) of Progesterone Receptor (PR) was used as the single criterion of Lum-B by IHC (n = 44), PAM50 reclassified 33 cases as Lum-A (75%). Applying the Kappa test to analyze the concordance between the 2 tests, a coefficient of 0.203 (low agreement) was obtained, statistically significant (0.000).
Conclusion: The surrogated classification by IHC of intrinsic subtypes in EBC ER+/HER2neg shows a low concordance with PAM50 analysis, and cannot be considered adequate. In particular, the presence of negative or <20% PR as the only criterion seems the least appropriate and should not be recommended for a surrogated classification of a tumor as Lum-B, overestimating the real risk of numerous patients. PAM50 allowed the reclassification in more than 40% of cases, especially csaes considered Lum-B by IHC.
Citation Format: Rodriguez CA, Guillen C, Garcia M, Sancho M, Gomez A, Ludena D, Cruz JJ. Discordance between surrogated intrinsic subtypes defined by immunohistochemistry compared with PAM50 in ER positive / HER2 negative early breast cancer. Analysis of value of the status of the progesterone receptor and Ki67 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-07.
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Affiliation(s)
- CA Rodriguez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - C Guillen
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - M Garcia
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - M Sancho
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - A Gomez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - D Ludena
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - JJ Cruz
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
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Carmone A, Rodriguez CA, Frank TD, Kiromat M, Bongi PW, Kuno RG, Palou T, Franke MF. Increasing isoniazid preventive therapy uptake in an HIV program in rural Papua New Guinea. Public Health Action 2017; 7:193-198. [PMID: 29201654 DOI: 10.5588/pha.17.0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 06/07/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Tuberculosis (TB) is the leading cause of death among people living with the human immunodeficiency virus (PLHIV) in Papua New Guinea. Despite a policy for isoniazid preventive therapy (IPT) among PLHIV, implementation has been slow. Objective: We prospectively evaluated a standardized guided screening process, including TB diagnostic support, to increase IPT initiation in adult PLHIV on antiretro-viral treatment. Design: The guided process included a paper-based IPT screening tool that prompted review of patient history and TB symptoms and sputum analysis by smear microscopy and Xpert® MTB/RIF. Chest X-ray was performed at the provider's discretion. We quantified the yield of this guided process on IPT initiation and detection of TB and rifampicin resistance, and examined the contributions of each diagnostic modality. Results: Among 532 patients, TB was ruled out and IPT initiated in 450 (84%). TB was diagnosed and treatment was started in 82 (15%) patients. Xpert detected rifampicin resistance in one of 21 patients (5%, 95%CI 0.24-21.3) with a positive Xpert result. All TB cases were diagnosed by chest X-ray and/or Xpert. No cases were diagnosed by sputum smear alone. Conclusion: A standardized guided process, including TB diagnostic support, successfully enabled IPT initiation and identified a large burden of undetected TB.
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Affiliation(s)
- A Carmone
- Clinton Health Access Initiative, Port Moresby, Goroka, Mount Hagen, Papua New Guinea
| | - C A Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - T D Frank
- Clinton Health Access Initiative, Port Moresby, Goroka, Mount Hagen, Papua New Guinea
| | - M Kiromat
- Clinton Health Access Initiative, Port Moresby, Goroka, Mount Hagen, Papua New Guinea
| | - P W Bongi
- Clinton Health Access Initiative, Port Moresby, Goroka, Mount Hagen, Papua New Guinea
| | - R G Kuno
- Eastern Highlands Provincial Health Authority, Goroka, Eastern Highlands, Papua New Guinea
| | - T Palou
- Clinton Health Access Initiative, Port Moresby, Goroka, Mount Hagen, Papua New Guinea
| | - M F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Rivera F, Andres R, Felip E, Garcia-Campelo R, Lianes P, Llombart A, Piera JM, Puente J, Rodriguez CA, Vera R, Virizuela JA, Martin M, Garrido P. Medical oncology future plan of the Spanish Society of Medical Oncology: challenges and future needs of the Spanish oncologists. Clin Transl Oncol 2017; 19:508-518. [PMID: 28005259 PMCID: PMC5346109 DOI: 10.1007/s12094-016-1595-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The SEOM Future Plan is aimed at identifying the main challenges, trends and needs of the medical oncology speciality over the next years, including potential oncologist workforce shortages, and proposing recommendations to overcome them. METHODS The estimations of the required medical oncologists workforce are based on an updated Medical Oncologist Register in Spain, Medical Oncology Departments activity data, dedication times and projected cancer incidence. Challenges, needs and future recommendations were drawn from an opinion survey and an advisory board. RESULTS A shortage of 211 FTE medical oncologist specialists has been established. To maintain an optimal ratio of 158 new cases/FTE, medical oncology workforce should reach 1881 FTE by 2035. CONCLUSIONS Main recommendations to face the growing demand and complexity of oncology services include a yearly growth of 2.5% of medical oncologist's workforce until 2035, and development and application of more accurate quality indicators for cancer care and health outcomes measure.
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Affiliation(s)
- F Rivera
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
- Sociedad Española de Oncología Médica (SEOM), C/ Velázquez, 7-3º planta, 28001, Madrid, Spain.
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain.
| | - R Andres
- Medical Oncology Department, Hospital Clínico Lozano Blesa, Zaragoza, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - E Felip
- Institut d'Oncologia, Vall d'Hebron University Hospital, Barcelona, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - R Garcia-Campelo
- Medical Oncology Department, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - P Lianes
- Medical Oncology Department, Hospital de Mataró, Mataró, Barcelona, Spain
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - A Llombart
- Medical Oncology Department, Hospital Universitàri Arnau de Vilanova, Lleida, Spain
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - J M Piera
- Medical Oncology Department, University Hospital Donostia, Donostia/San Sebastián, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - J Puente
- Medical Oncology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
- SEOM Future Plan Advisory Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - C A Rodriguez
- Medical Oncology Department, Hospital Clínico Universitario, Salamanca, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - R Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - J A Virizuela
- Medical Oncology Department, Complejo Hospitalario Regional Virgen Macarena, Sevilla, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - M Martin
- Department of Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- 2015-2017 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
| | - P Garrido
- Department of Medical Oncology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
- 2013-2015 SEOM Executive Board, C/ Velázquez, 7-3º planta, 28001, Madrid, Spain
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Walsh ASJ, Wesley KL, Tan SY, Lynn C, O'Leary K, Wang Y, Nguyen D, Chenneville T, Rodriguez CA. Screening for depression among youth with HIV in an integrated care setting. AIDS Care 2017; 29:851-857. [PMID: 28278567 DOI: 10.1080/09540121.2017.1281878] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Youth living with HIV (YLWH) are at risk for depression. Depressive symptoms can impact treatment engagement, health outcomes, and quality of life. Early identification of symptoms can guide treatment planning. This study aimed to identify trends in depressive symptoms for YLWH in a specialty-care clinic and follow-up clinical treatment procedures. An archival review of a clinical database provided depression screening information for a sample of 130 YLWH between 11 and 25 years old in the southeastern United States. Findings indicated that approximately 24% of the sample screened positive for depression-risk. Most commonly endorsed symptoms included fatigue (54.3%) and sleep difficulties (48.5%). Depressive symptoms did not differ significantly by age, gender, race, ethnicity, or sexual orientation. Youth who acquired HIV behaviorally were more likely to endorse the critical item (i.e., self-harm and/or suicidal ideation) than youth who acquired HIV perinatally. Forty-percent of the sample (i.e., 51 youth) had a follow-up treatment plan. YLWH who endorsed the critical item were more likely to receive follow-up action when compared to those who did not endorse the item. Despite limitations of the study, findings have important implications for clinical care and future research.
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Affiliation(s)
| | - Katherine L Wesley
- b Department of Educational and Psychological Studies , University of South Florida , Tampa , FL , USA
| | - Sim Yin Tan
- a Department of Pediatrics , University of South Florida , Tampa , FL , USA
| | - Courtney Lynn
- b Department of Educational and Psychological Studies , University of South Florida , Tampa , FL , USA
| | - Kimberly O'Leary
- c Department of Psychology , University of South Florida , Tampa , FL , USA
| | - Yan Wang
- b Department of Educational and Psychological Studies , University of South Florida , Tampa , FL , USA
| | - Diep Nguyen
- b Department of Educational and Psychological Studies , University of South Florida , Tampa , FL , USA
| | - Tiffany Chenneville
- d Department of Psychology , University of South Florida St. Petersburg , St. Petersburg , FL , USA
| | - Carina A Rodriguez
- a Department of Pediatrics , University of South Florida , Tampa , FL , USA
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19
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Garcia-Saenz JA, Bermejo B, Estevez LG, Palomo AG, Gonzalez-Farre X, Margeli M, Pernas S, Servitja S, Rodriguez CA, Ciruelos E. SEOM clinical guidelines in early-stage breast cancer 2015. Clin Transl Oncol 2015; 17:939-45. [PMID: 26497356 PMCID: PMC4689767 DOI: 10.1007/s12094-015-1427-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 12/18/2022]
Abstract
Breast cancer is a major public health problem. Despite remarkable advances in early diagnosis and treatment, one in three women may have metastases since diagnosis. Better understanding of prognostic and predictive factors allows us to select the most appropriate adjuvant therapy in each patient. In these guidelines, we summarize current evidence for the medical management of early-stage breast cancer.
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Affiliation(s)
| | - B Bermejo
- Hospital Clínico Universitario, Valencia, Spain
| | - L G Estevez
- CIOCC Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - A G Palomo
- Complejo Asistencial Universitario de León, León, Spain
| | | | - M Margeli
- Hospital Universitari Germans Trias I Pujol de Badalona (ICO-Badalona), Barcelona, Spain
| | - S Pernas
- Hospital Durán i Reynals (ICO), Barcelona, Spain
| | - S Servitja
- Hospital del Mar - Parc de Salut Mar, Barcelona, Spain
| | - C A Rodriguez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - E Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
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20
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Murphy TK, Patel PD, McGuire JF, Kennel A, Mutch PJ, Parker-Athill EC, Hanks CE, Lewin AB, Storch EA, Toufexis MD, Dadlani GH, Rodriguez CA. Characterization of the pediatric acute-onset neuropsychiatric syndrome phenotype. J Child Adolesc Psychopharmacol 2015; 25:14-25. [PMID: 25314221 PMCID: PMC4340632 DOI: 10.1089/cap.2014.0062] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pediatric acute-onset neuropsychiatric syndrome (PANS) is a subtype of obsessive compulsive disorder (OCD) marked by an abrupt onset or exacerbation of neuropsychiatric symptoms. We aim to characterize the phenotypic presentation of youth with PANS. METHODS Forty-three youth (ages 4-14 years) meeting criteria for PANS were assessed using self-report and clinician-administered measures, medical record reviews, comprehensive clinical evaluation, and laboratory measures. RESULTS Youth with PANS presented with an early age of OCD onset (mean=7.84 years) and exhibited moderate to severe obsessive compulsive symptoms upon evaluation. All had comorbid anxiety and emotional lability, and scored well below normative means on all quality of life subscales. Youth with elevated streptococcal antibody titers trended toward having higher OCD severity, and presented more frequently with dilated pupils relative to youth without elevated titers. A cluster analysis of core PANS symptoms revealed three distinct symptom clusters that included core characteristic PANS symptoms, streptococcal-related symptoms, and cytokine-driven/physiological symptoms. Youth with PANS who had comorbid tics were more likely to exhibit a decline in school performance, visuomotor impairment, food restriction symptoms, and handwriting deterioration, and they reported lower quality of life relative to youth without tics. CONCLUSIONS The sudden, acute onset of neuropsychiatric symptoms, high frequency of comorbidities (i.e., anxiety, behavioral regression, depression, and suicidality), and poor quality of life capture the PANS subgroup as suddenly and severely impaired youth. Identifying clinical characteristics of youth with PANS will allow clinicians to diagnose and treat this subtype of OCD with a more strategized and effective approach.
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Affiliation(s)
- Tanya K. Murphy
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida.,Department of Psychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Priyal D. Patel
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Joseph F. McGuire
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida.,Department of Psychology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Allison Kennel
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - P. Jane Mutch
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - E. Carla Parker-Athill
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Camille E. Hanks
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Adam B. Lewin
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida.,Department of Psychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida.,Department of Psychology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Eric A. Storch
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida.,Department of Psychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida.,Department of Psychology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Megan D. Toufexis
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Gul H. Dadlani
- Department of Pediatrics, All Children's Heart Institute, St. Petersburg, Florida
| | - Carina A. Rodriguez
- Department of Pediatrics, Division of Infectious Diseases, University of South Florida Morsani College of Medicine, Tampa, Florida
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21
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Rodriguez CA, Koch S, Goodenow M, Sleasman JW. Clinical implications of discordant viral and immune outcomes following protease inhibitor containing antiretroviral therapy for HIV-infected children. Immunol Res 2008; 40:271-86. [PMID: 17952387 DOI: 10.1007/s12026-007-0031-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many HIV-infected children treated with protease inhibitors (PI) reconstitute immunity despite viral breakthrough predicting disease progression. We studied a unique cohort of PI treated children with advanced disease who demonstrated sustained CD4 T cell counts but median post therapy viral load rebounded to >4.0 log(10) copies/ml. Phylogenetic relationships between pre- and post-therapy viruses reveals significant bottlenecks for quasispecies with natural polymorphisms mapping outside of protease active site providing selective advantage for emergence. Among discordant subjects post-therapy viruses fell into two phenotypes; high viral loads (median >5.0 log(10) copies/ml) and attenuated post-therapy replication (median <4.0 log(10) copies/ml). Both groups showed similar degrees of CD4 T cell immune reconstitution and were similar to children who optimally suppressed virus to <400 copies/ml. Both high fit and low fit discordant response groups showed high reconstitution of naïve CD4 CD45RA T cells (median 388 and 357 cells/microl, respectively). Naïve T cells increases suggest virus replicating under PI selective pressure do not impair thymic output. If therapeutic options are limited, selection of therapy which allows immune reconstitution despite suboptimal viral control may be beneficial. This novel paradigm for virus/host interactions may lead to therapeutic approaches to attenuate viral pathogenesis.
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Affiliation(s)
- Carina A Rodriguez
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of South Florida, College of Medicine, All Children's Hospital, St. Petersburg, FL 33701-4899, USA
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Abstract
The diagnosis of HIV-1 infection in infants and children continues to present challenges. Currently available virologic assays are sensitive and specific and allow early detection of perinatally acquired HIV infection. Identification soon after birth allows for the rapid initiation of antiretroviral therapy and preservation of the infant's immune system. Serologic diagnostic methods, including HIV-ELISA, Western blot, and immunofluorescence Assay can be used to make the diagnosis of HIV infection in infants older than 18 months of age, children, and adolescents. Recently developed rapid tests allow for testing outside clinical sites, provide results in a short period of time, and allow for prompt initiation of effective prophylaxis in cases of exposure particularly maternal to child transmission. We discuss here the diagnostic management of HIV-exposed infants and HIV-infected children.
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Affiliation(s)
- Jorge Lujan-Zilbermann
- Division of Infectious Diseases, Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida, USA.
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Abstract
Advances in laboratory methods have driven improvements in the management and treatment of HIV infection. The methods to accurately and rapidly diagnose HIV infection in infants and children have been outlined in the previous article. In this review, the laboratory evaluation of infected children is described and methods to monitor progression of disease and response to therapy outlined.
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Affiliation(s)
- Carina A Rodriguez
- Division of Infectious Diseases, Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida, USA
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24
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Avadhanula V, Rodriguez CA, Devincenzo JP, Wang Y, Webby RJ, Ulett GC, Adderson EE. Respiratory viruses augment the adhesion of bacterial pathogens to respiratory epithelium in a viral species- and cell type-dependent manner. J Virol 2006; 80:1629-36. [PMID: 16439519 PMCID: PMC1367158 DOI: 10.1128/jvi.80.4.1629-1636.2006] [Citation(s) in RCA: 254] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Secondary bacterial infections often complicate respiratory viral infections, but the mechanisms whereby viruses predispose to bacterial disease are not completely understood. We determined the effects of infection with respiratory syncytial virus (RSV), human parainfluenza virus 3 (HPIV-3), and influenza virus on the abilities of nontypeable Haemophilus influenzae and Streptococcus pneumoniae to adhere to respiratory epithelial cells and how these viruses alter the expression of known receptors for these bacteria. All viruses enhanced bacterial adhesion to primary and immortalized cell lines. RSV and HPIV-3 infection increased the expression of several known receptors for pathogenic bacteria by primary bronchial epithelial cells and A549 cells but not by primary small airway epithelial cells. Influenza virus infection did not alter receptor expression. Paramyxoviruses augmented bacterial adherence to primary bronchial epithelial cells and immortalized cell lines by up-regulating eukaryotic cell receptors for these pathogens, whereas this mechanism was less significant in primary small airway epithelial cells and in influenza virus infections. Respiratory viruses promote bacterial adhesion to respiratory epithelial cells, a process that may increase bacterial colonization and contribute to disease. These studies highlight the distinct responses of different cell types to viral infection and the need to consider this variation when interpreting studies of the interactions between respiratory cells and viral pathogens.
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Affiliation(s)
- Vasanthi Avadhanula
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Mailstop 320, 332 N. Lauderdale St., Memphis, TN 38105, USA
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25
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Avadhanula V, Rodriguez CA, Ulett GC, Bakaletz LO, Adderson EE. Nontypeable Haemophilus influenzae adheres to intercellular adhesion molecule 1 (ICAM-1) on respiratory epithelial cells and upregulates ICAM-1 expression. Infect Immun 2006; 74:830-8. [PMID: 16428725 PMCID: PMC1360337 DOI: 10.1128/iai.74.2.830-838.2006] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nontypeable Haemophilus influenzae (NTHI) is an important respiratory pathogen. NTHI initiates infection by adhering to the airway epithelium. Here, we report that NTHI interacts with intracellular adhesion molecule 1 (ICAM-1) expressed by respiratory epithelial cells. A fourfold-higher number of NTHI bacteria adhered to Chinese hamster ovary (CHO) cells transfected with human ICAM-1 (CHO-ICAM-1) than to control CHO cells (P < or = 0.005). Blocking cell surface ICAM-1 with specific antibody reduced the adhesion of NTHI to A549 respiratory epithelial cells by 37% (P = 0.001) and to CHO-ICAM-1 cells by 69% (P = 0.005). Preincubating the bacteria with recombinant ICAM-1 reduced adhesion by 69% (P = 0.003). The adherence to CHO-ICAM-1 cells of NTHI strains deficient in the adhesins P5, P2, HMW1/2, and Hap or expressing a truncated lipooligosaccharide was compared to that of parental strains. Only strain 1128f-, which lacks the outer membrane protein (OMP) P5-homologous adhesin (P5 fimbriae), adhered less well than its parental strain. The numbers of NTHI cells adhering to CHO-ICAM-1 cells were reduced by 67% (P = 0.009) following preincubation with anti-P5 antisera. Furthermore, recombinant ICAM bound to an OMP preparation from strain 1128f+, which expresses P5, but not to that from its P5-deficient mutant, confirming a specific interaction between ICAM-1 and P5 fimbriae. Incubation of respiratory epithelial cells with NTHI increased ICAM-1 expression fourfold (P=0.001). Adhesion of NTHI to the respiratory epithelium, therefore, upregulates the expression of its own receptor. Blocking interactions between NTHI P5 fimbriae and ICAM-1 may reduce respiratory colonization by NTHI and limit the frequency and severity of NTHI infection.
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Affiliation(s)
- Vasanthi Avadhanula
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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26
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Rodriguez CA, Atkinson R, Bitar W, Whitney CG, Edwards KM, Mitchell L, Li J, Sublett J, Li CS, Liu T, Chesney PJ, Tuomanen EI. Tolerance to vancomycin in pneumococci: detection with a molecular marker and assessment of clinical impact. J Infect Dis 2004; 190:1481-7. [PMID: 15378442 DOI: 10.1086/424467] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 04/14/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Vancomycin is often added to therapy for meningitis caused by Streptococcus pneumoniae. Tolerant bacteria without classic resistance that escape killing by multiple antibiotics have been reported sporadically. We determined the prevalence of tolerance to vancomycin in pneumococci and its effect on the outcome of meningitis. METHODS Archival samples of 215 nasopharyngeal (NP) and 113 meningitis isolates were tested for the killing efficacy of vancomycin. Specific DNA sequence changes in a transporter locus were identified for tolerant isolates. Similar tests were conducted prospectively on 517 NP isolates from healthy children. RESULTS In archival isolates, tolerance to vancomycin was detected in 3.7% of NP and 10.6% of invasive isolates. Patients with meningitis caused by tolerant isolates had a worse estimated 30-day survival than did patients with meningitis caused by nontolerant isolates (49% vs. 86%; P = .048); 62.5% of tolerant archival NP isolates harbored a specific sequence change for pep27 and vex2 (P = .021). Prospective analysis of 517 carriage isolates indicated that 8.1% were tolerant to vancomycin and that 82.1% of tolerant isolates harbored the specified marker gene sequences (P = .001). CONCLUSIONS Tolerance to vancomycin exists in the population of pneumococci. Tolerant isolates are associated with meningitis of increased mortality, and these isolates can be tracked by specific marker sequences in 2 genes.
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Affiliation(s)
- Carina A Rodriguez
- Department of Infectious Diseases , St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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27
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Abstract
Study of the epidemiology of invasive infections caused by encapsulated Haemophilus influenzae has been complicated by the poor sensitivity and specificity of the serologic assays used to identify specific capsular polysaccharides. The population structure of these bacteria is highly clonal, however, and serotype is highly correlated with other genetic characteristics. We sought to determine if alleles of the highly conserved phosphoglucose isomerase (pgi) gene correspond to the serotypes of encapsulated H. influenzae strains. pgi alleles of 52 well-characterized encapsulated H. influenzae isolates were amplified by PCR, sequenced, and compared to one another and to additional previously reported H. influenzae pgi alleles. Overall, 83% of the strains possessed pgi alleles associated with the major serotype a, b, e, and f clonotypes that cause the most invasive disease in the United States. Six strains (four type a and two type f) had unusual pgi alleles, which suggested that these strains belonged to less common clonotypes of encapsulated bacteria or were actually nontypeable strains. pgi genotyping may provide a simple and stable surrogate for capsular serotyping. Further studies correlating pgi typing with the expression of capsule are likely to increase our understanding of the epidemiology and pathogenesis of these infections.
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Affiliation(s)
- Juliana N Anyanwu
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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28
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Rodriguez CA, Avadhanula V, Buscher A, Smith AL, St Geme JW, Adderson EE. Prevalence and distribution of adhesins in invasive non-type b encapsulated Haemophilus influenzae. Infect Immun 2003; 71:1635-42. [PMID: 12654775 PMCID: PMC152026 DOI: 10.1128/iai.71.4.1635-1642.2003] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Adhesion to the respiratory epithelium plays an important role in Haemophilus influenzae infection. The distribution of H. influenzae adhesins in type b and nontypeable strains has been characterized, but little is known about the prevalence of these factors in non-type b encapsulated strains. We analyzed 53 invasive type a, type e, and type f strains for the presence of hap, hia, hmw, and hif genes; Hap, Hia, and HMW1/2 adhesins; and hemagglutinating pili. The hap gene was ubiquitous, and homologs of hmw and hia were present in 7 of 53 (13.2%) and 45 of 53 (84.9%) strains, respectively. Hap was detected in 28 of 45 (62.2%) hap(+) strains, HMW1/2 was detected in 5 of 7 (71.4%) hmw(+) strains, and Hia was detected in 31 of 45 (68.8%) hia(+) strains. The hif gene cluster was present in 26 of 53 strains (49.1%), and 21 of 26 hif(+) strains (80.8%) agglutinated (HA) red blood cells. Nine isolates exhibited HA but lacked the hif gene cluster. The distribution of adhesin genes correlated with the genetic relatedness of the strains. Strains belonging to one type a clonotype and the major type e clonotype possessed hia but lacked the hif cluster. Strains belonging to the second type a clonotype possessed both hia and hif genes. All type f strains belonging to the major type f clonotype possessed hia and lacked hifB. Although the specific complement of adhesin genes in non-type b encapsulated H. influenzae varies, most invasive strains express Hap and Hia, suggesting these adhesins may be especially important to the virulence of these organisms.
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Affiliation(s)
- Carina A Rodriguez
- Department of Infectious Diseases, St. Jude Children's Research Hospital, 332 N. Lauderdale Street, Memphis, TN 38105, USA
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Omikunle A, Takahashi S, Ogilvie CL, Wang Y, Rodriguez CA, St Geme JW, Adderson EE. Limited genetic diversity of recent invasive isolates of non-serotype b encapsulated Haemophilus influenzae. J Clin Microbiol 2002; 40:1264-70. [PMID: 11923343 PMCID: PMC140381 DOI: 10.1128/jcm.40.4.1264-1270.2002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Invasive infections caused by non-type b encapsulated Haemophilus influenzae have increased in frequency in the last decade. This change prompted us to characterize the genetic relationships of 48 recently isolated invasive H. influenzae type a (Hia), e (Hie), and f (Hif) strains by comparison of restriction digest patterns (RDPs). Recent Hia isolates exhibited moderate genetic diversity, with the majority segregating into two major clonotypes. Recent Hie and, especially, Hif strains displayed considerably restricted genetic diversity. In particular, all but one Hif strain segregated into a single clonotype, and half of these isolates had identical RDPs. These results are consistent with the hypothesis that the increased incidence of disease due to non-type b encapsulated H. influenzae reflects the emergence of hypervirulent clones, especially in the case of Hif. Alternatively, it is possible that non-type b encapsulated H. influenzae strains have limited overall genetic diversity.
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Affiliation(s)
- Adebomi Omikunle
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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31
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Ogilvie C, Omikunle A, Wang Y, St Geme III JW, Rodriguez CA, Adderson EE. Capsulation loci of non-serotype b encapsulated Haemophilus influenzae. J Infect Dis 2001; 184:144-9. [PMID: 11424010 DOI: 10.1086/322001] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2001] [Revised: 04/03/2001] [Indexed: 11/03/2022] Open
Abstract
Invasive infections caused by non-type b encapsulated Haemophilus influenzae have increased recently. Because capsule is a major virulence factor, capsulation of 62 recently isolated non-serotype b encapsulated strains was examined. Repeated serotyping confirmed only 69.0% of isolates. The combination of slide agglutination and cap genotyping confirmed 78.9% of type a, 100% of type e, and 86.4% of type f strains. Seven nonencapsulated strains may have lost capsulation through homologous recombination. Three strains that could not be serotyped or genotyped failed to hybridize with any cap probe and are probably nontypeable H. influenzae. Of isolates that retained an intact cap locus, 62.2% had evidence of cap amplification. The epidemiology of non-type b encapsulated H. influenzae infections is complicated by the poor specificity of available serologic reagents and by spontaneous capsule loss. Recently isolated invasive non-type b encapsulated H. influenzae frequently have cap amplification, which may contribute to their virulence.
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Affiliation(s)
- C Ogilvie
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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32
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Preston AM, Bercovitch FB, Rodriguez CA, Lebron MR, Rivera CE. Plasma ascorbic acid concentrations in a population of rhesus monkeys (Macaca mulatta). Contemp Top Lab Anim Sci 2001; 40:30-2. [PMID: 11353522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Although monkeys frequently are used as animal models for ascorbic acid studies whose results are extrapolated to humans, little information is available on the normal levels of this vitamin in large populations of animals classified by sex, age, or physiologic state such as pregnancy or lactation. The purpose of this report is to provide these values and compare them to the same parameters in humans, pointing out similar and dissimilar trends. Plasma samples were obtained from a troop of 167 rhesus monkeys (Macaca mulatta) and analyzed for ascorbic acid by using the 2,4-dinitrophenyl hydrazine method. Results obtained for ascorbic acid concentrations in plasma showed no differences between sexes. A significant (P< 0.0001) lowering effect was observed in aging versus young animals. Pregnant and nonpregnant females had similar ascorbate values, and lactating monkeys had slightly elevated levels. We conclude that rhesus monkeys and humans exhibit some of the same characteristics of ascorbic acid metabolism, such as an age-related decrease in ascorbate and the maintenance of these levels during lactation. However, a difference between species was noted with gender. Women maintain higher ascorbate concentrations than do men, whereas no differences in concentrations of this vitamin were observed between female and male monkeys.
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Affiliation(s)
- A M Preston
- Department of Biochemistry, University of Puerto Rico Medical School, San Juan
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Affiliation(s)
- C A Rodriguez
- St Jude Children's Research Hospital, Memphis, TN, USA
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Hansen SB, Slater AD, Rodriguez CA, Spinale FG, Santamore WP. Examination of epimysial leads used to stimulate the latissimus dorsi muscle. IEEE Trans Biomed Eng 1996; 43:653-7. [PMID: 8987270 DOI: 10.1109/10.495285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cardiomyoplasty is a new surgical treatment for heart failure in which the patient's latissimus dorsi muscle (LDM) is isolated, wrapped around the heart, and electrically stimulated to provide cardiac assistance. At present, long term stimulation of the LDM is achieved with intramuscular electrodes, which produce minimal nerve damage. This study examined the use of epimysial electrodes by measuring the epimysial lead characteristics during a four-week LDM training. Lead resistance started at 463 +/- 41 omega after implantation, decreased during the following week (251 +/- 16 omega), and remained less than the initial value during the last three weeks (weeks two: 282 +/- 19 omega and week four: 341 +/- 28 omega). The recruitment properties were similar to nervecuff electrodes: low threshold voltages (week one: 0.75 +/- 0.12, week two: 0.90 +/- 0.33, week four: 0.52 +/- 0.10 V) and a very steep recruitment curve with low saturation voltages. Histological examination revealed normal muscle fibers with no inflammatory response. Epimysial leads may be more convenient for most surgeons because the design does not require any free-dissection of the nerve nor guiding a needle around the nerve with the risk of perforating vessels or nerve branches. These results indicate that epimysial leads are worthy of further investigation.
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Affiliation(s)
- S B Hansen
- Department of Surgery, University of Louisville School of Medicine, KY 40292, USA
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Holohean AM, Rodriguez CA, Hackman JC, Davidoff RA. Voltage-gated calcium currents in whole-cell patch-clamped bullfrog dorsal root ganglion cells: effects of cell size and intracellular solutions. Brain Res 1996; 711:138-45. [PMID: 8680856 DOI: 10.1016/0006-8993(95)01414-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Acutely dissociated bullfrog dorsal root ganglion (DRG) cells could be divided into two classes by measurement of cell capacitance. A bimodal distribution of cell capacitance was found and a value of 75 pF was used to divide frog DRG cells into 'small' and 'large' types. Two distinct voltage-activated Ca2+ currents were evoked in both classes of cells: a rapidly inactivating, low-voltage-activated current and a slowly-inactivating, high-voltage-activated current. When the recording pipette contained CsCl, greater peak inward current values and densities were seen in large cells compared to small cells. No significant differences were observed in the distribution of low-and high-voltage-activated currents in small and large cells. Replacement of pipette solutions containing CsCl with solutions containing equimolar concentrations of Cs glutamate, L-arginine Cl, or N-methyl-D-glucamine significantly increased both the reversal potential and the maximum amplitude of the Ca2+ currents in both small and large DRG cells. These increases indicate that internal substitutions with organic ions suppresses outward currents more effectively than does CsCl. In contrast to findings with CsCl, when organic ions were used in the pipette solution a significantly higher proportion of low-threshold Ca2+ channels was observed in small cells compared to large cells. These observations indicate that when organic solutions were used internally, significant differences in the proportion of low-threshold to high-threshold Ca2+ channels were observed in small and large cells. The composition of the internal solution is a critical variable when determining the type and amount of inward Ca2+ current in different types of neurons.
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Affiliation(s)
- A M Holohean
- Neurophysiology Laboratory, Veteran's Administration Medical Center, Miami, FL, USA
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Rodriguez CA, Smith DE. Influence of the unbound concentration of cefonicid on its renal elimination in isolated perfused rat kidneys. Antimicrob Agents Chemother 1991; 35:2395-400. [PMID: 1804013 PMCID: PMC245391 DOI: 10.1128/aac.35.11.2395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The effect of variations in plasma protein binding on the renal excretion of cefonicid was assessed by using isolated perfused rat kidneys. Cefonicid exhibits preferential binding ex vivo to human serum albumin (HSA), as opposed to bovine serum albumin (BSA), and is eliminated mainly by tubular secretion, a process that was reported to be dependent on the total drug concentration. This contradicts previous studies with antimicrobial compounds and other drugs of low renal extraction in which the unbound drug concentration was shown to be the driving force for carrier-mediated tubular transport. To clarify this discrepancy, we performed perfusion studies by using 6% BSA at initial concentrations of 200 micrograms/ml (n = 6) and 20 micrograms/ml (n = 9) and in a combination of 4% BSA plus 2% HSA at initial concentrations of 200 micrograms/ml (n = 4). The excretion ratio [ER = CLR/(fu x GFR)] of cefonicid decreased with increasing unbound concentrations, whereas no apparent relationship with the total concentration was evident. At similar total concentrations of cefonicid, the renal clearance remained unchanged; the secretion clearance increased significantly in the 4% BSA-2% HSA experiments, reflecting the reduced unbound fraction and unbound drug concentration of cefonicid. The excretion ratio data were compatible with a model in which Michaelis-Menten kinetics were required to describe active transport and secretion was dependent on the unbound cefonicid concentration. As a result, changes in plasma protein binding as a result of drug interactions or disease states could significantly influence the tubular transport capability of compounds with low renal extraction.
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Affiliation(s)
- C A Rodriguez
- College of Pharmacy, University of Michigan, Ann Arbor 48109-1065
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Borowitz JL, Mayer PR, Rodriguez CA, Antoun M. Increased kidney glucose utilization induced by cyclosporine: lack of relation to magnesium excretion. Fundam Appl Toxicol 1989; 12:158-62. [PMID: 2925014 DOI: 10.1016/0272-0590(89)90071-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cyclosporine enhances D-[5-3H]glucose utilization in homogenates of rat kidney medulla but not kidney cortex or liver. This is true whether cyclosporine is added to fresh tissue homogenates or is given to rats prior to sacrifice. Through the use of isolated perfused rat kidneys, an attempt was made to relate increased glucose utilization by cyclosporine to a possible consequence of cyclosporine nephrotoxicity, viz., loss of magnesium in urine. Although an enhanced rate of glucose utilization by cyclosporine was evident in isolated kidneys, glucose consumption was not related to urinary magnesium loss. In fact, kidneys from cyclosporine-treated rats actually showed a normal or even diminished urinary magnesium loss. The data suggest that cyclosporine-induced magnesium imbalance may be extrarenal in origin and that the kidney medulla may be a primary site of the nephrotoxic action of cyclosporine since the drug increases glucose utilization at this site.
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Affiliation(s)
- J L Borowitz
- Department of Pharmacology, School of Pharmacy and Pharmacal Sciences, Purdue University, West Lafayette, Indiana 47907
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Salmerón De Diego J, Rodriguez CA, Orlando AS, Cervigon PS, Mutazzi EC, Mateos JM. Syndrome of 'inappropriate secretion of thyroid-stimulating hormone' by partial target organ resistance to thyroid hormones. Acta Endocrinol (Copenh) 1981; 97:361-8. [PMID: 6789594 DOI: 10.1530/acta.0.0970361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A 74 year old woman was found to have elevated serum thyroid-stimulating hormone (TSH) levels and elevated serum thyroid hormone levels, with clinical euthyroidism. There was no evidence of a pituitary tumor. TSH levels increased substantially during methimazole therapy. Administration of dexamethasone was followed by a prompt fall in serum TSH levels. Triiodothyronine (T3) was administered over a period of 20 days in doses from 25 micrograms to as much as 100 micrograms daily causing a rise in serum T3 above 700 ng/100 ml, a decline of T4 and a blunting of the response to thyrotrophin-releasing hormone (TRH), with normal metabolic responses (pulse rate, photomotogram, cholesterol). These results suggest that the patient's disorder is due to partial target organ resistance to thyroid hormones.
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Rodriguez CA, Buskop A, Johnson J, Fromowitz F, Koss LG. Renal oncocytoma: preoperative diagnosis by aspiration biopsy. Acta Cytol 1980; 24:355-9. [PMID: 6932150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The cytologic, histologic and ultrastructural features of an oncocytoma of the right kidney with the primary diagnosis by thin needle aspiration biopsy are presented. These uncommon tumors are generally considered to be of renal tubular origin and are thought to be benign. In the case reported below, two separate tumor masses were present within the diseased kidney; one of them extended to the perirenal adipose tissue and was accompanied by satellite tumor nodules. This presentation of oncocytoma, associated with focal cellular atypia, suggests that malignant behavior of at least some of these tumors may be anticipated.
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Von Harnack GA, Tanner JM, Whitehouse RH, Rodriguez CA. Catch-up in height and skeletal maturity in children on long-term treatment for hypothyroidism. Z Kinderheilkd 1972; 112:1-17. [PMID: 4336263 DOI: 10.1007/bf00491961] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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