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Al Balushi H, Watts H, Akudjedu TN. Research and evidence-based practice in clinical radiography: A systematic review of barriers and recommendations for a new direction. Radiography (Lond) 2024; 30:538-559. [PMID: 38290178 DOI: 10.1016/j.radi.2024.01.012] [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] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/28/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Existing literature provides valuable insight into the application of evidence-based practice (EBP) in Radiography; however, it primarily focuses on localised, context-specific scenarios within individual countries or institutions. This review aims to systematically explore the barriers to EBP and research implementation in clinical Radiography practice internationally. METHODOLOGY A mixed-method systematic review was implemented to obtain data from primary studies of qualitative, quantitative and mixed-methods designs. Articles were searched between June and July 2023 from the following scientific databases: PubMed, Medline, CINAHL, Science Direct and manual search dating from 2003 to July 2023. The reviewed studies were subjected to data extraction and results-based convergent synthesis. RESULTS A total of 376 articles were identified through electronic database search and citation screening after the removal of duplicates. Thirty-one studies met the predetermined inclusion criteria and were included for this review. The challenges to EBP implementation in clinical Radiography are broadly themed around professional and personal obligations, motivation and organisational culture, knowledge and skill gaps, resources and opportunities, and institutional governance. CONCLUSION Globally, clinical radiographers perceived a high level of motivation and interest towards research activities. However, numerous barriers were reported such as insufficient time allocation for research, lack of resources, lack of research culture and inadequate research-related skills and knowledge. A transition towards greater evidence-based practice precipitates the quality of clinical Radiography services, augmenting efficiency in the workflow process and enriching patient experience. IMPLICATIONS FOR PRACTICE Radiography managers must develop strategies that aim to stimulate radiographers to initiate research projects. Beyond allocation of protected time, managers should inspire staff participation in research activities through implementation of effective departmental level culture and governance for quality service delivery and improved patient care.
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Affiliation(s)
- H Al Balushi
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK; Department of Diagnostic and Interventional Imaging, Ministry of Health, Sultanate of Oman
| | - H Watts
- Radiology, James Cook University Hospital, South Tees NHS Trust, Marton Road, Middlesbrough, TS4 3BW, UK; Teesside University, School of Health & Life Sciences, Centuria Building, Tees Valley, Middlesbrough, TS1 3BX, UK
| | - T N Akudjedu
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK.
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Keogh B, Watts H. Letter to the editor regarding Saron et al. 'Communication during children's X-ray procedures and children's experiences of the procedure: A scoping review'. Radiography (Lond) 2023; 29:745. [PMID: 37210924 DOI: 10.1016/j.radi.2023.05.006] [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: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Affiliation(s)
- B Keogh
- South Tees NHS Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - H Watts
- South Tees NHS Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK; School of Health & Life Sciences, Teesside University, Middlesbrough, TS1 3BX, UK.
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Watts H. Radiographer research-what next? Radiography (Lond) 2023; 29:333. [PMID: 36709523 DOI: 10.1016/j.radi.2023.01.007] [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: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/28/2023]
Affiliation(s)
- H Watts
- Radiology, South Tees NHS Trust, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK; Visiting Scholar of Teesside University, School of Health & Life Sciences, Centuria Building, Middlesbrough, Tees Valley, TS1 3BX, UK.
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Watts H, Snaith B. Evidence based practice, research and the diagnostic radiographer role. An exploration of engagement, expectations and attitudes at a single centre. Radiography (Lond) 2023; 29:124-130. [PMID: 36351305 DOI: 10.1016/j.radi.2022.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/25/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The benefits of evidence-based practice (EBP) and research in healthcare are widely accepted for the patient, professional and organisation. However, allied health professional and radiographer activity remains lacking; this study aimed to explore this at a local level. METHODS This single centre study utilised mixed methods research methodology to triangulate findings from three parallel data collections. Document analysis of radiographer job descriptions (JDs) and appraisal frameworks, retrospective review of completed research activities, and a survey of radiographer perspectives were undertaken. Data analysis included content analysis, thematic analysis and descriptive statistics. RESULTS In three years (2018-2020), 290 EBP activities were completed; 287 were audit and three were service evaluations. There were no documented research projects and no entry level radiographer involvement. The survey response rate was 65.3% (n = 77/118). All JDs describe research engagement, but 50.6% of survey respondents did not realise this. There were inconsistencies and lack of clear progression in these expectations and no direct reference to research in the standard appraisal documentation. Radiographers demonstrated a positive attitude towards research and EBP but felt there were barriers preventing activity. Generally, they did not perceive a strong research culture in their department. CONCLUSION As part of EBP, research is a requirement for diagnostic radiographers of all levels. There is widespread enthusiasm and a positive attitude from radiographers to engage, yet activity remains low. IMPLICATIONS FOR PRACTICE A strong evidence-based culture needs to be prioritised, to embrace the current enthusiasm from radiographers to engage, and accordingly bridge the gap between aspirations of their professional body and actual clinical practice.
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Affiliation(s)
- H Watts
- Radiology, James Cook University Hospital, South Tees NHS Trust, Marton Road, Middlesbrough, TS4 3BW, UK; Visiting Scholar of Teesside University, School of Health & Life Sciences, Centuria Building, Tees Valley, Middlesbrough, TS1 3BX, UK. https://twitter.com/helenwatts91
| | - B Snaith
- Faculty of Health Studies, University of Bradford, Bradford, UK; Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK. https://twitter.com/MYradres
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Hines JZ, Sachathep K, Pals S, Davis SM, Toledo C, Bronson M, Parekh B, Carrasco M, Xaba S, Mandisarisa J, Kamobyi R, Chituwo O, Kirungi WL, Alamo S, Kabuye G, Awor AC, Mmbando S, Simbeye D, Aupokolo MA, Zemburuka B, Nyirenda R, Msungama W, Tarumbiswa T, Manda R, Nuwagaba-Biribonwoha H, Kiggundu V, Thomas AG, Watts H, Voetsch AC, Williams DB. HIV Incidence by Male Circumcision Status From the Population-Based HIV Impact Assessment Surveys-Eight Sub-Saharan African Countries, 2015-2017. J Acquir Immune Defic Syndr 2021; 87:S89-S96. [PMID: 33765683 DOI: 10.1097/qai.0000000000002658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Male circumcision (MC) offers men lifelong partial protection from heterosexually acquired HIV infection. The impact of MC on HIV incidence has not been quantified in nationally representative samples. Data from the population-based HIV impact assessments were used to compare HIV incidence by MC status in countries implementing voluntary medical MC (VMMC) programs. METHODS Data were pooled from population-based HIV impact assessments conducted in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe from 2015 to 2017. Incidence was measured using a recent infection testing algorithm and analyzed by self-reported MC status distinguishing between medical and nonmedical MC. Country, marital status, urban setting, sexual risk behaviors, and mean population HIV viral load among women as an indicator of treatment scale-up were included in a random-effects logistic regression model using pooled survey weights. Analyses were age stratified (15-34 and 35-59 years). Annualized incidence rates and 95% confidence intervals (CIs) and incidence differences were calculated between medically circumcised and uncircumcised men. RESULTS Men 15-34 years reporting medical MC had lower HIV incidence than uncircumcised men [0.04% (95% CI: 0.00% to 0.10%) versus 0.34% (95% CI: 0.10% to 0.57%), respectively; P value = 0.01]; whereas among men 35-59 years, there was no significant incidence difference [1.36% (95% CI: 0.32% to 2.39%) versus 0.55% (95% CI: 0.14% to 0.67%), respectively; P value = 0.14]. DISCUSSION Medical MC was associated with lower HIV incidence in men aged 15-34 years in nationally representative surveys in Africa. These findings are consistent with the expected ongoing VMMC program impact and highlight the importance of VMMC for the HIV response in Africa.
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Affiliation(s)
- Jonas Z Hines
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karampreet Sachathep
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York
| | - Sherri Pals
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie M Davis
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carlos Toledo
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan Bronson
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bharat Parekh
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria Carrasco
- Office of HIV and AIDS, U.S. Agency for International Development, Washington, District of Columbia
| | | | - John Mandisarisa
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | - Omega Chituwo
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Stella Alamo
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Geoffrey Kabuye
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Anna Colletar Awor
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Susan Mmbando
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Daimon Simbeye
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Mekondjo A Aupokolo
- National HIV/AIDS, STI and Hepatitis Control Program, Ministry of Health and Social Services, Windhoek, Namibia
| | - Brigitte Zemburuka
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | - Wezi Msungama
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | - Robert Manda
- U.S. Agency for International Development, Maseru, Lesotho
| | - Harriet Nuwagaba-Biribonwoha
- ICAP at Columbia University, Mbabane, Eswatini
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Valerian Kiggundu
- Office of HIV and AIDS, U.S. Agency for International Development, Washington, District of Columbia
| | - Anne G Thomas
- Defense Health Agency, U.S. Department of Defense, San Diego, California; and
| | - Heather Watts
- Office of Global AIDS Coordinator, Washington, District of Columbia
| | - Andrew C Voetsch
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dan B Williams
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Nachman S, Townsend CL, Abrams EJ, Archary M, Capparelli E, Clayden P, Lockman S, Jean-Philippe P, Mayer K, Mirochnick M, McKenzie-White J, Struble K, Watts H, Flexner C. Long-acting or extended-release antiretroviral products for HIV treatment and prevention in infants, children, adolescents, and pregnant and breastfeeding women: knowledge gaps and research priorities. Lancet HIV 2019; 6:e552-e558. [PMID: 31307946 PMCID: PMC7152795 DOI: 10.1016/s2352-3018(19)30147-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Received: 11/07/2018] [Revised: 03/14/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
Antiretroviral agents with long-acting properties have potential to improve treatment outcomes substantially for people living with HIV. In November 2017, the Long acting/Extended Release Antiretroviral Resource Program (LEAP) convened a workshop with the aim of shaping the research agenda and promoting early development of long-acting or extended release products for key populations: pregnant and lactating women, children aged up to 10 years, and adolescents aged 10-19 years. Goals included strategies and principles to ensure that the needs of children, adolescents, and pregnant and lactating women are considered when developing long-acting formulations. Research should focus not only on how best to transition long-acting products to these populations, but also on early engagement across sectors and among stakeholders. A parallel rather than sequential approach is needed when establishing adult, adolescent, and paediatric clinical trials and seeking regulatory approval. Pregnant and lactating women should be included in adult clinical trials. Adolescent-friendly trial design is needed to improve recruitment and retention of young people.
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Affiliation(s)
- Sharon Nachman
- Health Sciences Center, SUNY Stony Brook, Pediatrics, New York, NY, USA.
| | | | - Elaine J Abrams
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY, USA; Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | | | - Edmund Capparelli
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, CA, USA
| | | | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Kenneth Mayer
- School of Medicine, Harvard University, Cambridge, MA, USA
| | | | | | | | - Heather Watts
- Office of the Global AIDS Coordinator and Health Diplomacy, Washington, DC, USA
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Medley AM, Hrapcak S, Golin RA, Dziuban EJ, Watts H, Siberry GK, Rivadeneira ED, Behel S. Strategies for Identifying and Linking HIV-Infected Infants, Children, and Adolescents to HIV Treatment Services in Resource Limited Settings. J Acquir Immune Defic Syndr 2018; 78 Suppl 2:S98-S106. [PMID: 29994831 PMCID: PMC10961643 DOI: 10.1097/qai.0000000000001732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 01/12/2023]
Abstract
Many children living with HIV in resource-limited settings remain undiagnosed and at risk for HIV-related mortality and morbidity. This article describes 5 key strategies for strengthening HIV case finding and linkage to treatment for infants, children, and adolescents. These strategies result from lessons learned during the Accelerating Children's HIV/AIDS Treatment Initiative, a public-private partnership between the President's Emergency Plan for AIDS Relief (PEPFAR) and the Children's Investment Fund Foundation (CIFF). The 5 strategies include (1) implementing a targeted mix of HIV case finding approaches (eg, provider-initiated testing and counseling within health facilities, optimization of early infant diagnosis, index family testing, and integration of HIV testing within key population and orphan and vulnerable children programs); (2) addressing the unique needs of adolescents; (3) collecting and using data for program improvement; (4) fostering a supportive political and community environment; and (5) investing in health system-strengthening activities. Continued advocacy and global investments are required to eliminate AIDS-related deaths among children and adolescents.
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Affiliation(s)
- Amy M. Medley
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Susan Hrapcak
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Rachel A. Golin
- United States Agency for International Development (USAID), Office of HIV/AIDS, Washington, DC
| | - Eric J. Dziuban
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Heather Watts
- U.S. State Department, Office of the Global AIDS Coordinator, Washington, DC
| | - George K. Siberry
- U.S. State Department, Office of the Global AIDS Coordinator, Washington, DC
| | - Emilia D. Rivadeneira
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
| | - Stephanie Behel
- U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB, Atlanta, GA
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Mhlanga FG, Noguchi L, Balkus JE, Kabwigu S, Scheckter R, Piper J, Watts H, O'Rourke C, Torjesen K, Brown ER, Hillier SL, Beigi R. Implementation of a prospective pregnancy registry for antiretroviral based HIV prevention trials. HIV Clin Trials 2017; 19:8-14. [PMID: 29268654 DOI: 10.1080/15284336.2017.1411419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Safety data on pregnancy and fetal outcomes among women in HIV prevention trials are urgently needed to inform use of effective antiretroviral agents for HIV prevention. We describe an effective, efficient, and novel method to prospectively collect perinatal safety data concurrent with on-going parent clinical trials. METHODS The Microbicide Trials Network (MTN)-016 study is a multinational prospective pregnancy exposure registry designed to capture pregnancy and neonatal outcomes. Studies currently contributing data to this registry included phase I and II safety trials with planned exposures to candidate HIV prevention agents, as well as phase IIB and III efficacy trials capturing data on pregnancy and infant outcomes following inadvertent fetal exposure during study participation. RESULTS To date, participants from two phase I studies and two effectiveness trials have participated in MTN-016, resulting in 420 pregnant women and 381 infants enrolled. Infant retention has been high, with 329 of 381 (86%) infants completing the 12-month follow-up visit. CONCLUSION In a research setting context, it is feasible to establish and implement a prospective, multinational HIV chemoprophylaxis pregnancy registry that will generate pregnancy exposure data in a robust fashion.
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Affiliation(s)
- Felix G Mhlanga
- a Department of Obstetrics and Gynaecology , College of Health Sciences, University of Zimbabwe , Harare , Zimbabwe.,b UZ-UCSF Women's Collaborative Research Programme , Harare , Zimbabwe
| | - Lisa Noguchi
- c Department of Epidemiology , Johns Hopkins University , Baltimore , MD , USA
| | - Jennifer E Balkus
- d Vaccine and Infectious Disease Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA.,e Department of Epidemiology , University of Washington , Seattle , WA , USA.,f Department of Global Health , University of Washington , Seattle , WA , USA
| | - Samuel Kabwigu
- g Department of Obstetrics and Gynaecology , Makerere University - Johns Hopkins University , Uganda
| | | | - Jeanna Piper
- i Division of AIDS , National Institutes of Health (NIH) , Rockville , MD , USA
| | | | - Colin O'Rourke
- d Vaccine and Infectious Disease Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | | | - Elizabeth R Brown
- d Vaccine and Infectious Disease Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA.,k Department of Biostatistics , University of Washington , Seattle , WA , USA
| | - Sharon L Hillier
- l Department of OB/GYN/RS , Magee-Womens Hospital of UPMC , Pittsburgh , PA , USA
| | - Richard Beigi
- l Department of OB/GYN/RS , Magee-Womens Hospital of UPMC , Pittsburgh , PA , USA
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Einstein N, Okubanjo O, Alexander A, Putman M, Watts H. 158 Caring for a Critically Ill Simulated Left Ventricular Assist Device Patient With or Without a Cognitive Aid Improves Physician Comfort. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yeganeh N, Kerin T, Ank B, Watts H, Camarca M, Joao E, Pilotto JH, Veloso V, Bryson Y, Nielsen-Saines K. HIV Antiretroviral Resistance and Transmission in Mother–Infant Pairs Enrolled in a Large Perinatal Study. Open Forum Infect Dis 2017. [PMCID: PMC5632111 DOI: 10.1093/ofid/ofx162.039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Detection of antiretroviral (ARV) resistance in HIV-infected individuals is not uncommon and may be particularly problematic in HIV-infected pregnant women as it can lead to infant infection with resistant strains. To better evaluate the effect of drug resistance mutations (DRMs) on HIV mother-to-child transmission (MTCT), we determined the prevalence of DRMs in a subset of mother–infant pairs enrolled in a multi-center trial of infant prophylaxis among women not receiving ARVs during the current pregnancy. Methods A case–control design of 1:4 (1 transmitter to 4 nontransmitters) was utilized to evaluate ARV resistance as a predictor of HIV MTCT in specimens obtained from mother–infant pairs. Secondary objectives included identification of potential risk factors associated with the presence of DRMs. Viroseq HIV-1 Genotyping System was performed on mother–infant specimens to assess for mutations that might result in a substantial reduction in drug susceptibility and clinical outcome, as determined by the Stanford HIV Drug Resistance Database. Results One hundred and forty infants were infected. Of these, 123 HIV infected mother–infant pairs and 483 of 560 women who did not transmit HIV had amplifiable HIV nucleic acid enabling ARV resistance testing. A wide variety of DRMs were detected (Figure 1). Sixty (10%) of 606 women had clinically relevant DRMs; 12 (2%) had DRMs against more than 1 ARV class. Among 123 HIV− infected infants, 13 (11%) had clinically relevant DRMs with 3 (2%) harboring DRMs against more than 1 ARV class. Of 13 infants with DRMs, 10 (77%) were infected in utero. In univariate and multivariate analyses, DRMs in mothers were not associated with increased risk of HIV MTCT (AOR 0.79, 95% CI 0.38–1.5). Log HIV viral load was the only predictor of MTCT (OR 1.4, 95% CI 1.2−1.6). The presence of DRMs in mothers who transmitted was strongly associated with the presence of DRMs in infants (P < 0.001). Conclusion In infected pregnant women without ARV exposure during their current gestation, the presence of pre-existing DRMs with a wide diversity was noted. DRMs do not increase the risk of HIV MTCT. However, if women with DRMs are not virologically suppressed they are likely to transmit resistant mutations even without selective ARV pressure, thus complicating treatment options. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Nava Yeganeh
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Tara Kerin
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Bonnie Ank
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Heather Watts
- Office of the Global AIDS Coordinator and Health Diplomacy, Washington, DC
| | | | - Esau Joao
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Jose Henrique Pilotto
- Hospital Geral de Nova Iguaçu, Nova Iguaçu and Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz; (Fiocruz), Rio de Janiero, Brazil
| | - Valdilea Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Yvonne Bryson
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Karin Nielsen-Saines
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
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Albano J, Beckerman K, Mofenson L, Pikis A, Scheuerle A, Short W, Seekins D, Vannappagari V, Tilson H, Watts H. Central Nervous System and Neural Tube Birth Defects in the Antiretroviral Pregnancy Registry. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.15] [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: 11/14/2022] Open
Affiliation(s)
| | | | - Lynne Mofenson
- Research, Elizabeth Glaser Pediatric AIDS Foundation, Silver Spring, Maryland
| | - Andreas Pikis
- Division of Antiviral Drugs and Products, Food and Drug Administration, Silver Spring, Maryland
| | | | - William Short
- AAHIVS, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Hugh Tilson
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Heather Watts
- Office of the Global AIDS Coordinator and Health Diplomacy, Washington, District of Columbia
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Ezeanolue EE, Powell BJ, Patel D, Olutola A, Obiefune M, Dakum P, Okonkwo P, Gobir B, Akinmurele T, Nwandu A, Torpey K, Oyeledum B, Aina M, Eyo A, Oleribe O, Ibanga I, Oko J, Anyaike C, Idoko J, Aliyu MH, Sturke R, Watts H, Siberry G. Identifying and Prioritizing Implementation Barriers, Gaps, and Strategies Through the Nigeria Implementation Science Alliance: Getting to Zero in the Prevention of Mother-to-Child Transmission of HIV. J Acquir Immune Defic Syndr 2016; 72 Suppl 2:S161-6. [PMID: 27355504 PMCID: PMC5113249 DOI: 10.1097/qai.0000000000001066] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2013, Nigeria accounted for 15% of the 1.3 million pregnant women living with HIV in sub-Saharan Africa and 26% of new infections among children worldwide. Despite this, less than 20% of pregnant women in Nigeria received an HIV test during pregnancy, and only 23% of HIV-infected pregnant women received appropriate intervention following HIV diagnosis. This article reports findings from 2 structured group exercises conducted at the first Nigeria Implementation Science Alliance Conference to identify (1) barriers and research gaps related to prevention of mother-to-child transmission (PMTCT) and (2) potential strategies and interventions that could address PMTCT challenges. METHODS Two 1-hour structured group exercises were conducted with 10 groups of 14-15 individuals (n = 145), who were asked to brainstorm barriers and strategies and to rank their top 3 in each category. Data analysis eliminated duplicate responses and categorized each of the priorities along the HIV care continuum: HIV diagnosis, linkage to care, or retention in care. RESULTS Participating stakeholders identified 20 unique barriers and research gaps related to PMTCT across the HIV continuum. Twenty-five unique interventions and implementation strategies were identified. Similar to the barriers and research gaps, these interventions and strategies were distributed across the HIV care continuum. CONCLUSIONS The barriers and strategies identified in this study represent important pathways to progress addressing MTCT. The deliberate involvement of state and federal policy makers, program implementers, and researchers helps ensure that they are relevant and actionable.
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Affiliation(s)
- Echezona E. Ezeanolue
- Department of Epidemiology and Biostatistics, Global Health and Implementation Research Initiatives, Division of Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV
- HealthySunrise Foundation, Enugu, Nigeria
| | - Byron J. Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dina Patel
- Department of Epidemiology and Biostatistics, Global Health and Implementation Research Initiatives, Division of Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV
- HealthySunrise Foundation, Enugu, Nigeria
| | | | - Michael Obiefune
- Partners for Prevention, Education, Training, Treatment and Research, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, Baltimore, MD
| | | | - Prosper Okonkwo
- AIDS Prevention Initiative, Abuja, Nigeria
- School of Public Health, Harvard University, Cambridge, MA
| | - Bola Gobir
- Maryland Global Initiatives Corporation, Baltimore, MD
| | | | - Anthea Nwandu
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, Baltimore, MD
- Maryland Global Initiatives Corporation, Baltimore, MD
| | | | | | | | - Andy Eyo
- Excellence Community Education Welfare Scheme, Abuja, Nigeria
| | - Obinna Oleribe
- Excellence and Friends Management Consult, Abuja, Nigeria
| | | | - John Oko
- Catholic Caritas Foundation Nigeria, Abuja, Nigeria
| | | | - John Idoko
- National Agency for Control of AIDS, Abuja, Nigeria
| | - Muktar H. Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, MD
| | - Heather Watts
- Office of the US Global AIDS Coordinator, US Department of State, Washington, DC; and
| | - George Siberry
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - the Nigeria Implementation Science Alliance
- Department of Epidemiology and Biostatistics, Global Health and Implementation Research Initiatives, Division of Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV
- HealthySunrise Foundation, Enugu, Nigeria
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
- Partners for Prevention, Education, Training, Treatment and Research, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, Baltimore, MD
- Institute of Human Virology, Abuja, Nigeria
- AIDS Prevention Initiative, Abuja, Nigeria
- School of Public Health, Harvard University, Cambridge, MA
- Maryland Global Initiatives Corporation, Baltimore, MD
- Enhanced Health Access Initiatives, Abuja, Nigeria
- Family Health International, Abuja, Nigeria
- Center for Integrated Health Programs, Abuja, Nigeria
- Solina Health, Abuja, Nigeria
- Excellence Community Education Welfare Scheme, Abuja, Nigeria
- Excellence and Friends Management Consult, Abuja, Nigeria
- ProHealth International, Abuja, Nigeria
- Catholic Caritas Foundation Nigeria, Abuja, Nigeria
- Federal Ministry of Health, Abuja, Nigeria
- National Agency for Control of AIDS, Abuja, Nigeria
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN
- Fogarty International Center, National Institutes of Health, Bethesda, MD
- Office of the US Global AIDS Coordinator, US Department of State, Washington, DC; and
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, Palanee T, Nakabiito C, van der Straten A, Noguchi L, Hendrix CW, Dai JY, Ganesh S, Mkhize B, Taljaard M, Parikh UM, Piper J, Mâsse B, Grossman C, Rooney J, Schwartz JL, Watts H, Marzinke MA, Hillier SL, McGowan IM, Chirenje ZM. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med 2015; 372:509-18. [PMID: 25651245 PMCID: PMC4341965 DOI: 10.1056/nejmoa1402269] [Citation(s) in RCA: 982] [Impact Index Per Article: 109.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reproductive-age women need effective interventions to prevent the acquisition of human immunodeficiency virus type 1 (HIV-1) infection. METHODS We conducted a randomized, placebo-controlled trial to assess daily treatment with oral tenofovir disoproxil fumarate (TDF), oral tenofovir-emtricitabine (TDF-FTC), or 1% tenofovir (TFV) vaginal gel as preexposure prophylaxis against HIV-1 infection in women in South Africa, Uganda, and Zimbabwe. HIV-1 testing was performed monthly, and plasma TFV levels were assessed quarterly. RESULTS Of 12,320 women who were screened, 5029 were enrolled in the study. The rate of retention in the study was 91% during 5509 person-years of follow-up. A total of 312 HIV-1 infections occurred; the incidence of HIV-1 infection was 5.7 per 100 person-years. In the modified intention-to-treat analysis, the effectiveness was -49.0% with TDF (hazard ratio for infection, 1.49; 95% confidence interval [CI], 0.97 to 2.29), -4.4% with TDF-FTC (hazard ratio, 1.04; 95% CI, 0.73 to 1.49), and 14.5% with TFV gel (hazard ratio, 0.85; 95% CI, 0.61 to 1.21). In a random sample, TFV was detected in 30%, 29%, and 25% of available plasma samples from participants randomly assigned to receive TDF, TDF-FTC, and TFV gel, respectively. Independent predictors of TFV detection included being married, being older than 25 years of age, and being multiparous. Detection of TFV in plasma was negatively associated with characteristics predictive of HIV-1 acquisition. Elevations of serum creatinine levels were seen more frequently among participants randomly assigned to receive oral TDF-FTC than among those assigned to receive oral placebo (1.3% vs. 0.2%, P=0.004). We observed no significant differences in the frequencies of other adverse events. CONCLUSIONS None of the drug regimens we evaluated reduced the rates of HIV-1 acquisition in an intention-to-treat analysis. Adherence to study drugs was low. (Funded by the National Institutes of Health; VOICE ClinicalTrials.gov number, NCT00705679.).
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Affiliation(s)
- Jeanne M Marrazzo
- From the University of Washington (J.M.M.) and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center (B.A.R., J.Y.D., B. Mâsse) - both in Seattle; the HIV Prevention Research Unit, Medical Research Council (G.R., S.G.), and the Centre for AIDS Programme of Research in South Africa (CAPRISA), Durban (G.N.), Witwatersrand Reproductive Health and HIV Research Institute (T.P.) and Perinatal HIV Research Unit (B. Mkhize), Johannesburg, and the AURUM Institute, Klerksdorp (M.T.) - all in South Africa; FHI 360, Durham, NC (K.G.); University of Zimbabwe-University of California San Francisco Research Programme, Harare, Zimbabwe (N.M., Z.M.C.); Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda (C.N.); Women's Global Health Imperative, Research Triangle Institute (RTI) International, San Francisco (A.S.); Magee-Womens Research Institute, University of Pittsburgh Medical Center, Pittsburgh (L.N., U.M.P., S.L.H., I.M.M.); Johns Hopkins University School of Medicine, Baltimore (C.W.H., M.A.M.); Division of AIDS, National Institute of Allergy and Infectious Diseases (J.P.), National Institutes of Mental Health (C.G.), and the Eunice Shriver Kennedy National Institute of Child Health and Human Development (H.W.), National Institutes of Health - all in Bethesda, MD; Gilead Sciences, Foster City, CA (J.R.); CONRAD, Arlington, VA (J.L.S.); and Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal (B. Mâsse)
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Aweeka FT, Hu C, Huang L, Best BM, Stek A, Lizak P, Burchett SK, Read JS, Watts H, Mirochnick M, Capparelli EV. Alteration in cytochrome P450 3A4 activity as measured by a urine cortisol assay in HIV-1-infected pregnant women and relationship to antiretroviral pharmacokinetics. HIV Med 2014; 16:176-83. [PMID: 25407158 DOI: 10.1111/hiv.12195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Pregnancy results in physiological changes altering the pharmacokinetics of drugs metabolized by cytochrome P450 3A4 (CYP3A4). The urinary ratio of 6-β hydroxycortisol to cortisol (6βHF : F) is a marker of CYP3A4 induction. We sought to evaluate its change in antiretroviral (ARV)-treated HIV-1-infected women and to relate this change to ARV pharmacokinetics. METHODS Women receiving various ARVs had pharmacokinetic evaluations during the third trimester of pregnancy (>30 weeks) and postpartum with determination of 6βHF : F carried out on the same days. The Wilcoxon signed rank test was used to compare the ratio antepartum to postpartum. The relationship between the change in ratio and the change in pharmacokinetics was analysed using Kendall's tau. RESULTS 6βHF : F ratios were available for 107 women antepartum, with 54 having postpartum values. The ratio was higher antepartum (P=0.033) (median comparison 1.35; 95% confidence interval 1.01, 1.81). For 71 women taking a protease inhibitor (PI), the antepartum vs. postpartum 6βHF : F comparison was marginally significant (P=0.058). When the change in the 6βHF : F ratio was related to the change in the dose-adjusted ARV area under the plasma concentration vs. time curve (AUC) between antepartum and postpartum, the 35 subjects in the lopinavir/ritonavir (LPV/r) arms demonstrated an inverse relationship (P=0.125), albeit this correlation did not reach statistical significance. CONCLUSIONS A 35% increase in the urinary 6βHF : F ratio was measured during late pregnancy compared with postpartum, indicating that CYP3A induction occurs during pregnancy. The trend towards an inverse relationship between the change in the 6βHF : F ratio and the change in the LPV AUC antepartum vs. postpartum suggests that CYP3A induction may be one mechanism behind altered LPV exposure during pregnancy.
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Affiliation(s)
- F T Aweeka
- University of California, San Francisco, CA, USA
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Montgomery ET, Noguchi L, Dai J, Pan J, Biggio J, Isaacs K, Watts H, Schwartz J, Piper J, Beigi R. Tenofovir Gel Acceptability and Adherence among Pregnant Women in the United States. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5640.abstract] [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: 11/12/2022] Open
Affiliation(s)
| | - Lisa Noguchi
- University of Pittsburgh Medical Center and Magee-Women Research Institute, Pittsburgh, PA, United States
| | - James Dai
- SCHARP - FHCRC, Seattle, WA, United States
| | - Jason Pan
- SCHARP - FHCRC, Seattle, WA, United States
| | - Joseph Biggio
- University of Alabama at Birmingham, Birmingham, AL, United States
| | | | | | | | | | - Richard Beigi
- University of Pittsburgh Medical Center and Magee-Women Research Institute, Pittsburgh, PA, United States
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Tomkinson A, Watts H, Mackinnon AL, O'Connor RJ. Long term health consequences of a career in professional horse racing: the prevalence of pain amongst retired race jockeys. BMC Proc 2012. [PMCID: PMC3425993 DOI: 10.1186/1753-6561-6-s4-o53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vogler MA, Patterson K, Kamemoto L, Park JG, Watts H, Aweeka F, Klingman KL, Cohn SE. Contraceptive efficacy of oral and transdermal hormones when co-administered with protease inhibitors in HIV-1-infected women: pharmacokinetic results of ACTG trial A5188. J Acquir Immune Defic Syndr 2010; 55:473-82. [PMID: 20842042 PMCID: PMC4197050 DOI: 10.1097/qai.0b013e3181eb5ff5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pharmacokinetic (PK) interactions between lopinavir/ritonavir (LPV/r) and transdermally delivered ethinyl estradiol (EE) and norelgestromin (NGMN) are unknown. METHODS Using a standard noncompartmental PK analysis, we compared EE area under the time-concentration curve (AUC) and NGMN AUC during transdermal contraceptive patch administration in HIV-1-infected women on stable LPV/r to a control group of women not on highly active antiretroviral therapy (HAART). In addition, EE AUC after a single dose of a combination oral contraceptive pill including EE and norethindrone was measured before patch placement and was compared with patch EE AUC in both groups. Contraceptive effects on LPV/r PKs were estimated by measuring LPV/r AUC at baseline and during week 3 of patch administration. RESULTS Eight women on LPV/r, and 24 women in the control group were enrolled. Patch EE median AUC0-168 h was 45% lower at 6010.36 pg·h·mL in those on LPV/r versus 10911.42 pg·h·mL in those on no HAART (P = 0.064). Pill EE median AUC0-48 hours was similarly 55% lower at 344.67 pg·h·mL in those on LPV/r versus 765.38 pg·h·mL in those on no HAART (P = 0.003). Patch NGMN AUC0-168 h however, was 138.39 ng·h·mL, 83% higher in the LPV/r group compared with the control AUC of 75.63 ng·h·mL (P = 0.036). After 3 weeks on the patch, LPV AUC0-8 h decreased by 19%, (P = 0.156). CONCLUSIONS Although PKs of contraceptive EE and NGMN are significantly altered with LPV/r, the contraceptive efficacy of the patch is likely to be maintained. Larger studies are indicated to fully assess contraceptive efficacy versus risks of the transdermal contraceptive patch when co-administered with protease inhibitors.
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Affiliation(s)
- Mary A Vogler
- Department of Medicine, Division of Infectious Diseases, Weill Cornell College of Medicine, New York, NY 10011, USA.
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Watts H, Sikka R, Sweis R, Kulstad E. 69: Further Characterization of the Influence of Crowding on Medication Errors. Ann Emerg Med 2010. [DOI: 10.1016/j.annemergmed.2010.06.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tekwani K, Watts H, Sweis R, Rzechula K, Kulstad E. 8: The Effect of Etomidate on Hospital Length of Stay of Patients With Sepsis: A Prospective, Randomized Study. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Watts H, Doherty J, Kulstad E. 34: Evaluation of the Revised Trauma and Injury Severity Scores in Elderly Trauma Patients. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Melvin AJ, Kang M, Hitti J, Livingston E, Cohn SE, Stocker V, Ross AC, Watts H, McComsey GA. Cord Blood Lipids in Infants Born to HIV-1-Infected Women Treated with Combination Antiretroviral Therapy. Antivir Ther 2008. [DOI: 10.1177/135965350801300310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background To investigate the effect of exposure to protease inhibitor (PI) therapy in utero on cord blood lipids in infants born to mothers enrolled in AIDS Clinical Trials Group protocol 5084, a prospective, multi-centre, observational study of antiretroviral therapy (ART) during pregnancy. Methods Clinical outcome was determined in 80 infants born to women treated with PIs and 73 infants born to women treated with other antiretrovirals during pregnancy. Cord blood serum from 117 of these infants was assayed for total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglyceride, apolipoprotein A1 (apoA1), apolipoprotein B100 (apoB) and lipoprotein (a). Covariates considered in the analysis included race/ethnicity, gestational age, infant gender, infant birth weight, mode of delivery, maternal tobacco and alcohol use, post-partum body mass index, and ART duration. Results Cord blood total and HDL cholesterol, triglyceride, apoA1, apoB, lipoprotein (a) and apoB/apoA1 ratio were not different between the two groups. Cord blood lipid levels in these HIV-exposed infants were similar to those reported in other neonatal cohorts. Controlling for race/ethnicity, infants born to women treated with PIs had higher LDL cholesterol than those born to women not treated with PIs (29 mg/dl versus 27 mg/dl, P=0.006). Conclusion Only LDL cholesterol was significantly higher in the cord blood of PI-exposed infants versus those not exposed to PIs in utero. As the difference between the two groups was small, the clinical relevance of the effect of maternal PI treatment on infant LDL cholesterol levels at birth is not clear.
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Affiliation(s)
- Ann J Melvin
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Minhee Kang
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, USA
| | - Jane Hitti
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Elizabeth Livingston
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Susan E Cohn
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Vicki Stocker
- The AIDS Clinical Trials Group Operations Center, Rockville, MD, USA
| | - Allison C Ross
- Department of Pediatrics and Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Heather Watts
- Adolescent and Maternal AIDS Branch, National Institute of Child Health and Human Development, Rockville, MD, USA
| | - Grace A McComsey
- Department of Pediatrics and Medicine, Case Western Reserve University, Cleveland, OH, USA
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Capparelli EV, Aweeka F, Hitti J, Stek A, Hu C, Burchett SK, Best B, Smith E, Read JS, Watts H, Nachman S, Thorpe EM, Spector SA, Jimenez E, Shearer WT, Foca M, Mirochnick M. Chronic administration of nevirapine during pregnancy: impact of pregnancy on pharmacokinetics. HIV Med 2008; 9:214-20. [PMID: 18366444 PMCID: PMC2755564 DOI: 10.1111/j.1468-1293.2008.00553.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the impact of pregnancy on the pharmacokinetics (PK) of nevirapine (NVP) during chronic dosing in HIV-infected women and appropriate NVP dosing in this population. METHODS Twenty-six pregnant women participating in two open-label Pediatric AIDS Clinical Trials Group studies (P1022 and P1026S) were evaluated. Each patient received 200 mg NVP every 12 h and had PK evaluations during the second or third trimester; these evaluations were repeated postpartum. Paired maternal and cord blood NVP concentrations were collected at delivery in nine patients. Ante- and postpartum comparisons were made using paired t-tests and using a 'bioequivalence' approach to determine confidence interval (CI). RESULTS The average NVP Area Under the Curve (AUC) was 56 +/- 13 mcg(*)h/mL antepartum and 61 +/- 15 mcg(*)h/mL postpartum. The typical parameters +/- standard error were apparent clearance (CL/F)=3.51 +/- 0.18 L/h and apparent volume of distribution (Vd/F)=121 +/- 19.8 L. There were no significant differences between antepartum and postpartum AUC or pre-dose concentrations. The AUC ratio was 0.90 with a 90% CI of the mean equal to 0.80-1.02. The median (+/- standard deviation) cord blood to maternal NVP concentration ratio was 0.91 +/- 0.90. CONCLUSIONS Pregnancy does not alter NVP PK and the standard dose (200 mg every 12 h) is appropriate during pregnancy.
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Affiliation(s)
- E V Capparelli
- San Diego Schools of Medicine and Pharmacy and Pharmaceutical Sciences, University of California, San Diego, CA 92103, USA.
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Melvin AJ, Kang M, Hitti J, Livingston E, Cohn SE, Stocker V, Ross AC, Watts H, McComsey GA. Cord blood lipids in infants born to HIV-1-infected women treated with combination antiretroviral therapy. Antivir Ther 2008; 13:349-355. [PMID: 18572747] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND To investigate the effect of exposure to protease inhibitor (PI) therapy in utero on cord blood lipids in infants born to mothers enrolled in AIDS Clinical Trials Group protocol 5084, a prospective, multicentre, observational study of antiretroviral therapy (ART) during pregnancy. METHODS Clinical outcome was determined in 80 infants born to women treated with PIs and 73 infants born to women treated with other antiretrovirals during pregnancy. Cord blood serum from 117 of these infants was assayed for total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglyceride, apolipoprotein A1 (apoA1), apolipoprotein B100 (apoB) and lipoprotein (a). Covariates considered in the analysis included race/ethnicity, gestational age, infant gender, infant birth weight, mode of delivery, maternal tobacco and alcohol use, post-partum body mass index, and ART duration. RESULTS Cord blood total and HDL cholesterol, triglyceride, apoA1, apoB, lipoprotein (a) and apoB/apoA1 ratio were not different between the two groups. Cord blood lipid levels in these HIV-exposed infants were similar to those reported in other neonatal cohorts. Controlling for race/ethnicity, infants born to women treated with PIs had higher LDL cholesterol than those born to women not treated with PIs (29 mg/dl versus 27 mg/dl, P = 0.006). CONCLUSION Only LDL cholesterol was significantly higher in the cord blood of PI-exposed infants versus those not exposed to PIs in utero. As the difference between the two groups was small, the clinical relevance of the effect of maternal PI treatment on infant LDL cholesterol levels at birth is not clear.
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Affiliation(s)
- Ann J Melvin
- Department of Pediatrics, University of Washington, Seattle, WA, USA.
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Hitti J, Frenkel L, Smith L, Huang S, Stek A, Nachman S, Provisor A, Cotter A, Smith E, Watts H. 218: Comparison of venous lactate concentrations in late pregnancy and postpartum: PACTG 1022. Am J Obstet Gynecol 2007. [DOI: 10.1016/j.ajog.2007.10.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mirochnick M, Stek A, Acevedo M, Keller M, Holland D, Capparelli E, Connor J, Huang S, Hughes M, Watts H, Mofenson L, Bryson Y. Safety and pharmacokinetics of nelfinavir coadministered with zidovudine and lamivudine in infants during the first 6 weeks of life. J Acquir Immune Defic Syndr 2005; 39:189-94. [PMID: 15905735] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The safety and pharmacokinetics of nelfinavir coadministered with zidovudine and lamivudine were studied in 26 infants during the first 6 weeks of life. Cohort 1 infants (n = 7) received 10 mg/kg 3 times a day, and cohort 2 infants (n = 19) received 40 mg/kg twice a day. Two cohort 1 infants at week 1 and none at week 6 exceeded the target 24-hour area under the curve (AUC) of 30 mug.h/mL, equal to the 10th percentile of the AUC for adults receiving standard nelfinavir dosing. In cohort 2, the median 24-hour AUC was 38 mug.h/mL at both time points, with considerable variability among the infants. Three of 11 cohort 2 infants at week 1 and 4 of 11 at week 6 did not meet the AUC target. Median nelfinavir oral clearance was 2.1 L/h/kg at weeks 1 and 6. The median ratio of the plasma concentrations of the nelfinavir metabolite M8 to unchanged nelfinavir increased from 0.16 (range: 0-0.38) during week 1 to 0.56 (range: 0.4-1.47) during week 6 (P < 0.01). There were no significant differences in any of the other pharmacokinetic parameters when week 1 and week 6 results were compared. Few adverse events were attributed to nelfinavir. These data suggest that nelfinavir is well tolerated in infants at these doses, but exposure was frequently less than that seen in adults taking standard nelfinavir dosing. Further investigations of larger doses, such as 75 mg/kg twice a day, should be undertaken.
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Affiliation(s)
- Mark Mirochnick
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA.
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Massad LS, Springer G, Jacobson L, Watts H, Anastos K, Korn A, Cejtin H, Stek A, Young M, Schmidt J, Minkoff H. Pregnancy rates and predictors of conception, miscarriage and abortion in US women with HIV. AIDS 2004; 18:281-6. [PMID: 15075546 DOI: 10.1097/00002030-200401230-00018] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [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: 11/26/2022]
Abstract
OBJECTIVE To determine frequency and outcomes of pregnancy in US women with HIV before and after introduction of highly active antiretroviral therapy (HAART). DESIGN Prospective cohort study at six US centers. METHODS HIV seropositive and at-risk seronegative women reported pregnancy outcomes at 6-month intervals during the period 1 October 1994 to 31 March 2002. Outcomes were tabulated and pregnancy rates calculated. Logistic regression defined outcome correlates. RESULTS Pregnancy rates were 7.4 and 15.2 per 100 person-years in seropositive and seronegative women, respectively (P < 0.0001). Among seropositives, 119 (36%) pregnancies ended in live birth, six (2%) in stillbirth, 126 (36%) in abortion, 83 (24%) in miscarriage, 16 (5%) in ectopic pregnancy, and two (1%) in other outcomes (P = nonsignificant versus seronegatives). Independent baseline correlates of conception in seropositives included younger age [odds ratio (OR), 1.20; 95% confidence interval (CI), 1.16-1.23], prior abortion (OR, 1.79; 95% CI, 1.25-2.63), lower HIV RNA levels (OR, 1.30; 95% CI, 1.10-1.54 for each log decrease), and being unmarried (OR, 1.59; 95% CI, 1.02-2.44). Baseline antiretroviral use at baseline was linked to lower conception risk (OR, 0.34; 95% CI, 0.49-0.98 for mono- or combination therapy; OR, 0.34; 95% CI, 0.03-4.28 for HAART). Abortion was less likely during the HAART era, (OR, 0.68; 95% CI, 0.35-1.33 during the early HAART era; OR, 0.46; 95% CI, 0.23-0.90 during the later HAART era, compared with before HAART). CONCLUSIONS Women with HIV were less likely to conceive than at-risk uninfected women, but pregnancy outcomes were similar. Abortion became less common after the introduction of HAART.
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Affiliation(s)
- L Stewart Massad
- Department of Obstetrics and Gynecology, Southern Illinois University, Springfield, Illinois, 62794-9640, USA
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Beckerman K, Covington D, Watts H, Tilson H, Chavers S, Sacks S. Risk of birth defects associated with antiretroviral exposure during pregnancy. Am J Obstet Gynecol 2003. [DOI: 10.1016/j.ajog.2003.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- H Hodges
- ReNeuron Ltd., 10 Nugent Road, Surrey Research Park, Guildford, Surrey GU2 7AE, United Kingdom
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Silverberg MJ, Ahdieh L, Munoz A, Anastos K, Burk RD, Cu-Uvin S, Duerr A, Greenblatt RM, Klein RS, Massad S, Minkoff H, Muderspach L, Palefsky J, Piessens E, Schuman P, Watts H, Shah KV. The impact of HIV infection and immunodeficiency on human papillomavirus type 6 or 11 infection and on genital warts. Sex Transm Dis 2002; 29:427-35. [PMID: 12172526 DOI: 10.1097/00007435-200208000-00001] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [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: 10/26/2022]
Abstract
BACKGROUND HIV infection and associated immunodeficiency are known to alter the course of human papillomavirus (HPV) infections and of associated diseases. GOAL This study investigated the association between HIV and HPV and genital warts. STUDY DESIGN HPV testing and physical examinations were performed in two large prospective studies: the Women's Interagency HIV Study (WIHS) and the HIV Epidemiology Research Study (HERS). Statistical methods incorporating dependencies of longitudinal data were used to examine the relationship between HIV and HPV and genital warts. RESULTS A total of 1008 HIV-seronegative and 2930 HIV-seropositive women were enrolled in the two studies. The prevalence of HPV 6 or 11 was 5.6 times higher in HIV-seropositive women in the WIHS and 3.6 times higher in the HERS. Genital wart prevalence increased by a factor of 3.2 in the WIHS and 2.7 in the HERS in HIV-seropositive women. In the WIHS, infection with HPV type 6 or 11, in comparison with no HPV infection, was associated with odds of genital wart prevalence of 5.1 (95% CI: 2.9-8.8), 8.8 (95% CI: 6.1-12.8), and 12.8 (95% CI: 8.8-18.8) in HIV-seronegative women, HIV-seropositive women with > or =201 CD4 cells/microl, and HIV-seropositive women with < or =200 CD4 cells/microl, respectively. In the HERS, infection with HPV type 6 or 11 was associated with odds of 2.7 (95% CI: 1.6-4.6), 4.9 (95% CI: 3.2-7.7), and 5.3 (95% CI: 3.3-8.5) in these same groups. Other HPV types showed a similar dose-response relation, but of substantially lower magnitude and statistical significance. CONCLUSIONS HIV infection and immunodeficiency synergistically modified the relation between HPV 6 or 11 infection and genital wart prevalence.
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Clark RA, Mulligan K, Stamenovic E, Chang B, Watts H, Andersen J, Squires K, Benson C. Frequency of anovulation and early menopause among women enrolled in selected adult AIDS clinical trials group studies. J Infect Dis 2001; 184:1325-7. [PMID: 11679923 DOI: 10.1086/323999] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [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] [Received: 04/06/2001] [Revised: 06/27/2001] [Indexed: 11/03/2022] Open
Abstract
To obtain information on the prevalence of anovulation and early menopause and on pituitary-gonadal function among human immunodeficiency virus type 1-infected women, a study was undertaken that used stored serum samples from women aged 20-42 years who participated in selected Adult AIDS Clinical Trials Group protocols. Defined progesterone and follicle-stimulating hormone (FSH) levels were considered presumptive evidence of ovulation and of menopause, respectively. Anovulation occurred in 16 (48%) of 33 women for whom progesterone levels were tested; early menopause occurred in 2 (8%) of 24 women for whom FSH levels were tested. No statistically significant differences were seen in the demographic and clinical characteristics of anovulatory and ovulatory women, although women who ovulated had higher CD4 T cell counts and were less likely to have reported a recent change in menstrual periods. These data support the findings of prior studies of increased frequency of amenorrhea and/or irregular menstrual cycles, particularly among women with lower CD4 T cell counts.
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Affiliation(s)
- R A Clark
- HIV Outpatient Program, Louisiana State University Health Science Center, New Orleans, LA 70112, USA.
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Acosta EP, Zorrilla C, Van Dyke R, Bardeguez A, Smith E, Hughes M, Huang S, Pitt J, Watts H, Mofenson L. Pharmacokinetics of saquinavir-SGC in HIV-infected pregnant women. HIV Clin Trials 2001; 2:460-5. [PMID: 11742433 DOI: 10.1310/puy3-5jwl-fx2b-98vu] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate saquinavir (SQV) pharmacokinetics, tolerance, and safety in 10 HIV-infected pregnant women between 14-32 weeks gestation. METHOD This was a phase I, prospective, area-under-the-curve (AUC) targeted study. Antepartum treatment consisted of SQV 1200 mg tid, lamivudine 150 mg bid, and zidovudine 200 mg tid. The SQV targeted exposure was an 8-hour AUC (AUC(8)) of 3000 ng. h/mL; the study was to be halted if the first 4 participants did not achieve this AUC(8). Cord blood and plasma samples were collected in neonates at birth. RESULTS Four women completed the SQV pharmacokinetic assessments. Exposure in all 4 patients was below the target AUC(8). Median (range) AUC(8) and trough (C8H) were 1672 (738-2614) ng. h/mL and 60 (<15-332) ng/mL, respectively. Oral clearance (CL/F) was 9.3 (5.1-16.6) L/h/kg and C(max) was 599 (177-953) ng/mL. Cord and neonate plasma concentrations were mostly undetectable; 1 of 5 infants was HIV-infected at 24 weeks. CONCLUSION These data suggest highly variable SQV pharmacokinetics in pregnant women, and exposure at 1200 mg tid may not be adequate for longer term therapy; both the AUC(8) and C8H were considerably below average. Because ritonavir has been shown to significantly increase SQV concentrations, this combination should be further explored in this population.
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Affiliation(s)
- E P Acosta
- Division of Clinical Pharmacology, University of Alabama at Birmingham, 35294-0019, USA.
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Massad LS, Schneider M, Watts H, Darragh T, Abulafia O, Salzer E, Muderspach LI, Sidawy M, Melnick S. Correlating Papanicolaou Smear, Colposcopic Impression, and Biopsy: Results from the Women's Interagency HIV Study. J Low Genit Tract Dis 2001; 5:212-8. [PMID: 17050978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To determine associations among cervical cytology, colposcopy, and biopsy in HIV-seropositive women. MATERIALS AND METHODS HIV-seropositive women and uninfected comparison women in a multicenter prospective cohort study underwent colposcopy for protocol indications. Women were eligible if they had a cervix, satisfactory cytology, and colposcopy between October 1994 and September 1999. Cytology, colposcopic impression, and biopsy were compared using equivalent categorizations. Kappa statistics with bootstrap sampling assessed strength of associations. RESULTS Colposcopy was performed in 978/1370 HIV-seropositive women and in 154/224 seronegative women. Biopsies were performed on 603 (44%) seropositive women at least once during 1015 colposcopy visits and on 82 (37%) seronegative women at 116 visits. The positive predictive value of cytology was 72% for seropositive women and 60% for seronegative women. The positive predictive value of colposcopy was 71% for seropositive women and 55% for seronegative women. CONCLUSION The correlation between either cervical cytology or colposcopic impression and colposcopic biopsy was poor.
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Affiliation(s)
- L S Massad
- *Division of Gynecologic Oncology, Cook County Hospital and Rush Medical College, Chicago, Illinois †Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD ‡National Institute for Child Health, Bethesda, MD §Departments of Medicine and Epidemiology, University of California, San Francisco, San Francisco, CA ‖Department of Obstetrics & Gynecology, Downstate Medical Center, Brooklyn, NY ¶Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, NY **Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, CA ††Department of Pathology, George Washington University Medical Center, Washington, DC ‡‡National Cancer Institute, Bethesda, MD
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Augenbraun M, Tarwater P, Greenblatt R, Cohen M, French A, Gore ME, Watts H, Preston-Martin S, Anastos K. Opportunistic infection prophylaxis in the women's interagency HIV study (WIHS). J Acquir Immune Defic Syndr 2001; 28:195-6. [PMID: 11588516 DOI: 10.1097/00126334-200110010-00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Massad LS, Schneider M, Watts H, Darragh T, Abulafia O, Salzer E, Muderspach LI, Sidawy M, Melnick S. Correlating Papanicolaou Smear, Colposcopic Impression, and Biopsy: Results from the Women' s Interagency HIV Study. J Low Genit Tract Dis 2001. [DOI: 10.1046/j.1526-0976.2001.54005.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Al-Harthi L, Kovacs A, Coombs RW, Reichelderfer PS, Wright DJ, Cohen MH, Cohn J, Cu-Uvin S, Watts H, Lewis S, Beckner S, Landay A. A menstrual cycle pattern for cytokine levels exists in HIV-positive women: implication for HIV vaginal and plasma shedding. AIDS 2001; 15:1535-43. [PMID: 11504986 DOI: 10.1097/00002030-200108170-00011] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [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: 01/22/2023]
Abstract
OBJECTIVES To evaluate the effect of the menstrual cycle in HIV-positive women on plasma and genital cytokine levels, interrelationships between vaginal and plasma cytokines, CD4 and CD8 T cell fluctuations, and genital and plasma viral loads. METHODS Plasma and cervicovaginal lavage specimens were collected from 55 HIV-positive women with CD4 cell counts < 350 cells/microl during phases of the menstrual cycle. Samples were assayed for IL-1beta, IL-6, IL-4, IL-8, IL-10, TGFbeta, TNFalpha, INFgamma, MIP1alpha, MIP1beta, RANTES, and TNFR-II using enzyme-linked immunosorbent assays. CD4 and CD8 T cell expression was evaluated by flow cytometry. Repeated measures regression models were used to assess the effect of the menstrual cycle on cytokines and viral load. Multivariate repeated regression models were used to assess the correlation among selected cytokines and between selected cytokines and HIV viral load. RESULTS Vaginal IL-1beta, IL-4, IL-6, IL-8, IL-10, MIP1beta, RANTES, TGFbeta, and TNFR-II were significantly elevated during menses but were not altered during other phases. Plasma cytokine levels were not altered during the menstrual cycle. A positive Candida culture increased vaginal IL-8 during menses, whereas vaginal discharge was associated with a reduction in vaginal IL-4, IL-10, and RANTES. CD4 and CD8 cell numbers did not vary with the menstrual cycle. Vaginal cytokine levels correlated only with vaginal viral load, in a sampling method-dependent manner. CONCLUSION We provide evidence of elevated vaginal cytokine levels during menses, which appear to regulate vaginal and not plasma HIV shedding, suggesting that a menstrual cycle pattern exists for cytokine production in HIV-positive women impacting vaginal shedding of HIV.
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Affiliation(s)
- L Al-Harthi
- Department of Immunology/Microbiology at Rush-Presbyterian St Luke's Medical Center, Chicago, IL 60612, USA
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Massad LS, Ahdieh L, Benning L, Minkoff H, Greenblatt RM, Watts H, Miotti P, Anastos K, Moxley M, Muderspach LI, Melnick S. Evolution of cervical abnormalities among women with HIV-1: evidence from surveillance cytology in the women's interagency HIV study. J Acquir Immune Defic Syndr 2001; 27:432-42. [PMID: 11511819 DOI: 10.1097/00126334-200108150-00003] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.3] [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: 11/26/2022]
Abstract
OBJECTIVE To determine incidence, progression, and regression rates for abnormal cervical cytology and their correlates among women with HIV. METHODS In a multicenter prospective cohort study conducted October 1, 1994, through September 30, 1999 at university, public, and private medical centers and clinics, 1639 HIV-seropositive and 452 seronegative women were evaluated every 6 months for up to 5 years using history, cervical cytology, T-cell subsets, and quantitative plasma HIV RNA. Human papillomavirus (HPV) typing at baseline was determined by polymerase chain reaction. Cytology was read using the Bethesda system, with any smear showing at least atypia considered abnormal. Poisson regression identified factors associated with incident cytologic abnormalities whereas logistic regression identified those associated with progression and regression after an abnormality. RESULTS At least one abnormal smear was found during all of follow-up among 73.0% of HIV-seropositive patients and 42.3% of seronegatives (p <.001). Only 5.9% of seropositives ever developed high-grade lesions, and the proportion with high-grade findings did not rise over time. Incidence of atypical squamous cells of uncertain significance (ASCUS) or more severe lesions among HIV-seropositive patients and seronegative patients was 26.4 and 11.0/100 woman-years (rate ratio [RR], 2.4; 95% confidence interval [CI], 1.9-3.0), whereas that of at least low-grade squamous intraepithelial lesions (SIL) was 8.9 and 2.2/100 (RR, 4.0; CI, 2.6-6.1). HIV status, detection of the presence of human papillomavirus (HPV), CD4 lymphocyte count, and HIV RNA level predicted incidence of abnormal cytology (p <.05); HPV detection and HIV RNA level predicted progression (p <.01); and HPV detection, CD4 lymphocyte count, and HIV RNA level predicted regression (p <.001). Rates of incidence, progression, and regression of abnormal cytology did not differ between HIV seronegative women and seropositive women with CD4 lymphocyte counts >200/mm(3) and HIV RNA levels <4000/ml of similar HPV status. CONCLUSIONS Although HIV infected women were at high risk for abnormal cytology, high-grade changes were uncommon. HIV status, HPV detection, CD4 lymphocyte count, and HIV RNA level predicted the incidence of cervical cytologic abnormalities. Progression was significantly increased only among the most immunosuppressed women, while regression was significantly reduced in all HIV seropositive women except those with the best controlled HIV disease.
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Affiliation(s)
- L S Massad
- Division of Gynecologic Oncology, Dept. of Obstetrics & Gynecology, Cook County Hospital, 1835 West Harrison Street, Chicago, IL 60612, USA.
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Minkoff H, Ahdieh L, Watts H, Greenblatt RM, Schmidt J, Schneider M, Stek A. The relationship of pregnancy to the use of highly active antiretroviral therapy. Am J Obstet Gynecol 2001; 184:1221-7. [PMID: 11349192 DOI: 10.1067/mob.2001.113871] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [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: 11/22/2022]
Abstract
OBJECTIVE Public health agencies have recommended that the criteria for the use of highly active antiretroviral therapy should not be modified because of pregnancy. However, little information has been published with regard to the degree to which these recommendations are being followed. We report here the frequency of highly active antiretroviral therapy use among pregnant women in the Women's Interagency HIV Study and compare the frequencies of its use by pregnant women meeting published criteria for implementing highly active antiretroviral therapy and its use by nonpregnant women meeting the same criteria. STUDY DESIGN From October 1994 through November 1995, a total of 2059 human immunodeficiency virus type 1-seropositive women were enrolled in a cohort study. Participants were evaluated at baseline and at 6-month intervals with standardized interview instruments. In addition to a general physical examination at each visit, patients had a urine pregnancy test performed and were asked about current pregnancies, pregnancies since the last visit, and which antiretroviral medications they had used since the last visit. Highly active antiretroviral therapy was defined according to 1997 National Institutes of Health guidelines. RESULT At each calendar interval after October 1996, a greater proportion of nonpregnant women than pregnant women reported the use of highly active antiretroviral therapy. The use of monotherapy declined for both groups during the course of multiple calendar periods (P <.01), although the use of monotherapy remained higher among the pregnant women. In any given calendar period, pregnant women meeting published criteria for highly active antiretroviral therapy use were slightly less likely than similar nonpregnant women to receive highly active antiretroviral therapy (odds ratio, 0.28-0.98). Because of the sample size these differences reached significance in only one calendar period (P =.02). With time pregnant women did demonstrate an increase in the percentage receiving highly active antiretroviral therapy. In nearly all calendar periods a larger percentage of pregnant than nonpregnant women were receiving a regimen that included zidovudine. CONCLUSIONS Highly active antiretroviral therapy is being received by an increasing percentage of women who meet published criteria for its use, and pregnancy is a relatively small impediment to its use. Further efforts are needed to bolster the use of highly active antiretroviral therapy by all appropriate candidates and to ensure equal access to this therapy for pregnant women. Because of the increasingly frequent use of highly active antiretroviral therapy during pregnancy, ongoing efforts are needed to monitor any long-term effects of in utero exposure to multiple antiretroviral agents.
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Affiliation(s)
- H Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center and State University of New York Health Sciences, Brooklyn 11219, USA
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Levine AM, Berhane K, Masri-Lavine L, Sanchez M, Young M, Augenbraun M, Cohen M, Anastos K, Newman M, Gange SJ, Watts H. Prevalence and correlates of anemia in a large cohort of HIV-infected women: Women's Interagency HIV Study. J Acquir Immune Defic Syndr 2001; 26:28-35. [PMID: 11176266 DOI: 10.1097/00126334-200101010-00004] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [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] [Indexed: 11/26/2022]
Abstract
Anemia is a common manifestation of HIV infection, occurring in approximately 30% of patients with asymptomatic infection and in as many as 75% to 80% of those with AIDS. Anemia has been associated with decreased quality of life and decreased survival. We performed a cross-sectional study nested within a multicenter prospective cohort study to describe the prevalence of anemia in 2056 HIV-infected and 569 HIV-negative women as well as to define the demographic, clinical, immunologic, and virologic correlates of anemia among HIV-infected women. A total of 37% of HIV-positive women and 17% of HIV-negative women had hemoglobin levels < 12 g/dl (p < .001). Factors associated with anemia in HIV-positive and HIV-negative women included mean corpuscular volume (MCV) < 80 fl (p < .001) and black race (p < .001). Among HIV-infected women, multivariate logistic analyses revealed that African American race (p < .0001), MCV < 80 fl (p < .0001), CD4 count < 200 per microliter (p <.0001), higher HIV RNA in plasma (p = .02), current use of ZDV (p = .01), and history of clinical AIDS (p = .004) were all independent predictors of anemia. These data indicate that worsening parameters of HIV disease are associated with anemia among HIV-infected women. Black women and women with low MCV values are at increased risk for anemia independent of HIV status.
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Affiliation(s)
- A M Levine
- University of Southern California School of Medicine, Los Angeles, California, USA.
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Massad SL, Kirstein L, Darragh T, Bitterman P, Sidawy M, Muderspach L, Abulafia O, Salzer E, Watts H, Melnick S. Interrater Variability in Diagnosis of Cervical Biopsies from Women with HIV-1: Results from the Women's Interagency HIV Study. J Low Genit Tract Dis 2000; 4:190-4. [PMID: 25951153 DOI: 10.1046/j.1526-0976.2000.44002.x] [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: 11/20/2022]
Abstract
OBJECTIVES To determine interrater variability in classifying cervical biopsies from women with human immunodeficiency virus (HIV). MATERIALS AND METHODS Cervical biopsies performed on women participating in the Women's Interagency HIV Study (WIHS) were read at the six participating sites. A 10% random sample was retrieved and reviewed using standardized terminology by pathologists with a special interest in gynecologic pathology. Results were compared with kappa values and Mantel-Haentzel tests. RESULTS Biopsies from 288 HIV-seropositive and 24 HIV-seronegative women were reviewed. The weighted kappa value of 0.67 indicated moderate to strong agreement between original and review diagnoses, with a range of 0.54 to 0.84 across sites. No cancers were identified. Significantly more specimens showing cervical intraepithelial neoplasia (CIN) grade 2 or 3 were identified by review pathologists (p = .02). CIN2 or CIN3 was graded less severely by local pathologists in 18 (51%) of 35 cases, all from HIV-seropositive women. Local pathologists' diagnoses of CIN2 or CIN3 were downgraded by reviewers in 4 of 21 cases (19%). Discrepancies were more common among women with lower CD4 lymphocyte counts. CONCLUSIONS Although discrepancies occur, interrater correlation in the interpretation of cervical biopsies from women with HIV is moderate to strong.
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Affiliation(s)
- S L Massad
- *Division of Gynecologic Oncology, Cook County Hospital, Chicago, IL; †Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; ‡Department of Pathology, University of California, San Francisco, CA; §Department of Pathology, Rush Medical College, Chicago, IL; ∥Department of Pathology, George Washington University Medical Center, Washington, DC; **Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, CA; ††Department of Obstetrics and Gynecology, SUNY-Downstate Medical Center, Brooklyn, NY; ‡‡Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, NY; §§National Institute for Child Health and Human Development, Bethesda, MD; and ∥∥National Cancer Institute, Bethesda, MD
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Kaplan JE, Masur H, Holmes KK, Freedberg KA, Holtgrave D, Piscitelli SC, Van Dyke R, Watts H. An overview of the 1999 US Public Health Service/Infectious Diseases Society of America guidelines for preventing opportunistic infections in human immunodeficiency virus-infected persons. Clin Infect Dis 2000; 30 Suppl 1:S15-28. [PMID: 10770912 DOI: 10.1086/313844] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- J E Kaplan
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Cotton D, Watts H. Management of HIV infection during pregnancy: new options, new questions. AIDS Clin Care 1995; 7:45-7, 49. [PMID: 11362465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
MESH Headings
- AIDS Serodiagnosis
- AIDS-Related Opportunistic Infections/prevention & control
- CD4 Lymphocyte Count
- Delivery, Obstetric
- Drug Resistance, Microbial
- Female
- HIV Infections/diagnosis
- HIV Infections/drug therapy
- HIV Infections/immunology
- Health Knowledge, Attitudes, Practice
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/prevention & control
- Infectious Disease Transmission, Vertical
- Labor, Obstetric
- Mandatory Testing
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/immunology
- Pregnancy Outcome
- Pregnancy Trimester, First
- Recurrence
- Zidovudine/adverse effects
- Zidovudine/therapeutic use
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Abstract
In 1991 the roof blew off a Swindon Primary School. One child was killed. Two years later 19 of her classmates were interviewed. The parent who collected the child from school that day was also interviewed. Recalled levels of post-traumatic stress syndrome (PTSD) symptoms were assessed in both parent and child in the month following the incident. The children's symptom levels at 2 years were also assessed. Parents and children recalled significant post-traumatic stress reactions at 1 month. The level of symptoms in parents did not correlate with that of their own children.
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Affiliation(s)
- J Parker
- Department of Child & Family Psychiatry, Royal United Hospital, Bath, UK
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Abstract
We reviewed 13 pairs of conjoined twins treated at Children's Hospital of Philadelphia between 1957 and 1988. Orthopedic problems were related to the ischiopagus type. These included problems related to separation and to the correction of associated deformities. The technique for separation has evolved through improved preoperative imaging and with increased experience, resulting in preservation of a longer and more functional "shared leg." Better preservation of skin to cover both infants and enough of the "shared leg" to insure a functional knee has been possible with posterior iliac osteotomies to close the pelvic ring, as well as the use of tissue expanders.
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Affiliation(s)
- M C Albert
- Department of Orthopaedic Surgery, Wright State University, Children's Medical Center, Dayton, Ohio 45404
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Goorin AM, Perez-Atayde A, Gebhardt M, Andersen JW, Wilkinson RH, Delorey MJ, Watts H, Link M, Jaffe N, Frei E. Weekly high-dose methotrexate and doxorubicin for osteosarcoma: the Dana-Farber Cancer Institute/the Children's Hospital--study III. J Clin Oncol 1987; 5:1178-84. [PMID: 3476688 DOI: 10.1200/jco.1987.5.8.1178] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Weekly high-dose methotrexate with leucovorin rescue and vincristine (HDMTX) and doxorubicin was administered as adjuvant postoperative therapy to 46 patients with a diagnosis of conventional high-grade nonmetastatic osteosarcoma of an extremity between July 1976 and December 1981. The primary lesions were managed by wide or radical amputation (26 patients) or by limb-sparing resection in 20 selected patients. The margins of the resections were retrospectively classified as marginal in three, wide in 16, and radical in one. The 5-year relapse-free survival (RFS) for all patients is 59% (95% confidence interval [CI], 43%, 74%) and overall survival is 78% (95% CI, 65%, 91%). The RFS for patients initially having a limb resection procedure is 55% (95% CI, 32%, 77%) compared with 62% (95% CI, 43%, 81%) for those initially having amputations (P = .52). Using multivariate analysis, the only significant prognostic variables that predicted RFS of greater than or equal to 3 years, were the presence of moderate to marked lymphocytic infiltration of the primary tumor (P less than .002), primary site outside of the proximal humerus (P less than .005), and the absence of a predominance of osteoblastic pattern in the primary tumor (P less than .03).
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Belasco J, Watts H. Osteosarcoma of the proximal humerus. Med Pediatr Oncol 1983; 11:46-8. [PMID: 6220197 DOI: 10.1002/mpo.2950110110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Jaffe N, Link MP, Cohen D, Traggis D, Frei E, Watts H, Beardsley GP, Abelson HT. High-dose methotrexate in osteogenic sarcoma. Natl Cancer Inst Monogr 1981:201-6. [PMID: 6975438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
From 1972 to 1979, high-dose methotrexate (HDMTX) and 3 adjuvant regimens were used at the Sidney Farber Cancer Institute and Children's Hospital Medical Center. In the first regiment, HDMTX was used alone; the second, HDMTX and adriamycin, and the third, weekly courses of HDMTX and combination. Actuarial disease-free survival achieved with these regimens in patient with local control of the primary lesion varied from 42 to 75% at 3 years. This compared favorably with historical control patients, of whom 50% were free of disease at 6 months and only 20% at 12 months. Among 41 patients with established pulmonary metastases, 14 were alive and free of disease from more than 4 to over 60 months. The most efficacious method of administering HDMTX was a weekly schedule which produced an overall response rate of 48% in the treatment of pulmonary metastases and primary tumor in patients previously not exposed to HDMTX. Urinary alkalinization was not a standard procedure, and investigations failed to demonstrate any significant effect of alkalinization on HDMTX pharmacokinetics.
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