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Langhorne C, McMichael L, Hoy J, Kopp S, Murray P. Haematology and serum biochemistry results for anaesthetised northern brown bandicoots (Isoodon macrourus) in south east Queensland. Aust Vet J 2021; 99:408-411. [PMID: 34169506 DOI: 10.1111/avj.13098] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/04/2020] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
Bandicoots are terrestrial marsupials, endemic to Australia and Papua New Guinea. Despite drastic declines in several bandicoot species since European settlement, the northern brown bandicoot (Isoodon macrourus) remains common in many areas of Australia. It inhabits native environments as well as anthropogenic landscapes. This study presents comprehensive haematologic and serum biochemical results for 39 anaesthetised, clinically healthy, wild-caught, adult northern brown bandicoots in south east Queensland, Australia. The bloodwork profile of a single animal with chronic prostatic abscessation highlights that haematology and clinical chemistry can provide useful biomarkers for identifying clinical disease in bandicoots. Comparisons of haematologic and biochemical values between sexes of the northern brown bandicoot revealed significant differences for eosinophils, alkaline phosphatase and total bilirubin. At the individual animal level, the ranges established in this study are a guide for monitoring health and disease status; however, they also have much wider applications in population health and ecological research.
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Affiliation(s)
- C Langhorne
- School of Veterinary Science, The University of Queensland, Gatton Campus, Gatton, Queensland, 4343, Australia.,Hidden Vale Wildlife Centre, Grandchester, Queensland, 4340, Australia
| | - L McMichael
- School of Veterinary Science, The University of Queensland, Gatton Campus, Gatton, Queensland, 4343, Australia
| | - J Hoy
- Hidden Vale Wildlife Centre, Grandchester, Queensland, 4340, Australia
| | - S Kopp
- School of Veterinary Science, The University of Queensland, Gatton Campus, Gatton, Queensland, 4343, Australia
| | - P Murray
- School of Veterinary Science, The University of Queensland, Gatton Campus, Gatton, Queensland, 4343, Australia.,School of Sciences, University of Southern Queensland, Darling Heights, Queensland, 4350, Australia
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2
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Sanderson WM, Hoy J, Morrison C, Wang F, Wang Y, Morrison PJ, Buhro WE, Loomis RA. Excitation Energy Dependence of Photoluminescence Quantum Yields in Semiconductor Nanomaterials with Varying Dimensionalities. J Phys Chem Lett 2020; 11:3249-3256. [PMID: 32255643 DOI: 10.1021/acs.jpclett.0c00489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The excitation energy dependence (EED) of the photoluminescence quantum yield (ΦPL) of semiconductor nanoparticles with varying dimensionalities is reported. Specifically, the EEDs of CdSe quantum dots, CdSe quantum platelets, CdSe quantum belts, and CdTe quantum wires were determined via measurements of individual ΦPL values and photoluminescence efficiency (PLEff(E)) spectra. There is a general trend of overall decreasing efficiency for radiative recombination with increasing excitation energy. In addition, there are often local minima in the PLEff(E) spectra that are most often at energies between quantum-confinement transitions. The average PL lifetimes of the samples do not depend on the excitation energy, suggesting that the EED of ΦPL arises from charge carrier trapping that competes efficiently with intraband carrier relaxation to the band edge. The local minima in the PLEff(E) spectra are attributed to excitation into optically coupled states that results in the loss of carriers in the semiconductor. The EED data suggest that the PLEff(E) spectra depend on the sample synthesis, preparation, surface passivation, and environment.
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Affiliation(s)
- William M Sanderson
- Department of Chemistry and Institute of Materials Science and Engineering, Washington University in St. Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
| | - Jessica Hoy
- Department of Chemistry and Institute of Materials Science and Engineering, Washington University in St. Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
| | - Calynn Morrison
- Department of Chemistry and Institute of Materials Science and Engineering, Washington University in St. Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
| | - Fudong Wang
- Department of Chemistry and Institute of Materials Science and Engineering, Washington University in St. Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
| | - Yuanyuan Wang
- Department of Chemistry and Institute of Materials Science and Engineering, Washington University in St. Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
| | - Paul J Morrison
- Department of Chemistry and Institute of Materials Science and Engineering, Washington University in St. Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
| | - William E Buhro
- Department of Chemistry and Institute of Materials Science and Engineering, Washington University in St. Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
| | - Richard A Loomis
- Department of Chemistry and Institute of Materials Science and Engineering, Washington University in St. Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
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3
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Hoy J, Nishimura H, Yaoita E, Gomez RA, Sequiera‐Lopez MLS. Ontogeny of renin gene expression and juxtaglomerular apparatus in birds. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.729.4] [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: 11/11/2022]
Affiliation(s)
- Jessica Hoy
- Child Health Research CenterUniversity of VirginiaCharlottesvilleVA
| | - Hiroko Nishimura
- Child Health Research CenterUniversity of VirginiaCharlottesvilleVA
- Kidney Research CenterNiigata University Graduate School of Medical & Dental SciencesNiigataJapan
| | - Eishin Yaoita
- Kidney Research CenterNiigata University Graduate School of Medical & Dental SciencesNiigataJapan
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4
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Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, Schomaker M, Smit C, Sterne J, Thiebaut R, Thorne C, Torti C, van der Valk M, Wittkop L, Tanser F, Vinikoor M, Macete E, Wood R, Stinson K, Garone D, Fatti G, Giddy J, Malisita K, Eley B, Fritz C, Hobbins M, Kamenova K, Fox M, Prozesky H, Technau K, Sawry S, Benson CA, Bosch RJ, Kirk GD, Boswell S, Mayer KH, Grasso C, Hogg RS, Richard Harrigan P, Montaner JSG, Yip B, Zhu J, Salters K, Gabler K, Buchacz K, Brooks JT, Gebo KA, Moore RD, Moore RD, Rodriguez B, Horberg MA, Silverberg MJ, Thorne JE, Rabkin C, Margolick JB, Jacobson LP, D’Souza G, Klein MB, Rourke SB, Rachlis AR, Cupido P, Hunter-Mellado RF, Mayor AM, John Gill M, Deeks SG, Martin JN, Patel P, Brooks JT, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Rebeiro P, Turner M, Bebawy S, Rogers B, Justice AC, Dubrow R, Fiellin D, Gange SJ, Anastos K, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, Horberg MA, Klein MB, McKaig RG, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing J, Modur S, Wong C, Hogan B, Desir F, Liu B, You B, Cahn P, Cesar C, Fink V, Sued O, Dell’Isola E, Perez H, Valiente J, Yamamoto C, Grinsztejn B, Veloso V, Luz P, de Boni R, Cardoso Wagner S, Friedman R, Moreira R, Pinto J, Ferreira F, Maia M, Célia de Menezes Succi R, Maria Machado D, de Fátima Barbosa Gouvêa A, Wolff M, Cortes C, Fernanda Rodriguez M, Allendes G, William Pape J, Rouzier V, Marcelin A, Perodin C, Tulio Luque M, Padgett D, Sierra Madero J, Crabtree Ramirez B, Belaunzaran P, Caro Vega Y, Gotuzzo E, Mejia F, Carriquiry G, McGowan CC, Shepherd BE, Sterling T, Jayathilake K, Person AK, Rebeiro PF, Giganti M, Castilho J, Duda SN, Maruri F, Vansell H, Ly PS, Khol V, Zhang FJ, Zhao HX, Han N, Lee MP, Li PCK, Lam W, Chan YT, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Gaikwad S, Chitalikar A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Tanuma J, Oka S, Nishijima T, Na S, Choi JY, Kim JM, Sim BLH, Gani YM, David R, Kamarulzaman A, Syed Omar SF, Ponnampalavanar S, Azwa I, Ditangco R, Uy E, Bantique R, Wong WW, Ku WW, Wu PC, Ng OT, Lim PL, Lee LS, Ohnmar PS, Avihingsanon A, Gatechompol S, Phanuphak P, Phadungphon C, Kiertiburanakul S, Sungkanuparph S, Chumla L, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Praparattanapan J, Kantipong P, Kambua P, Ratanasuwan W, Sriondee R, Nguyen KV, Bui HV, Nguyen DTH, Nguyen DT, Cuong DD, An NV, Luan NT, Sohn AH, Ross JL, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Ellis D, Bloch M, Agrawal S, Vincent T, Allen D, Smith D, Rankin A, Baker D, Templeton DJ, O’Connor CC, Thackeray O, Jackson E, McCallum K, Ryder N, Sweeney G, Cooper D, Carr A, Macrae K, Hesse K, Finlayson R, Gupta S, Langton-Lockton J, Shakeshaft J, Brown K, Idle S, Arvela N, Varma R, Lu H, Couldwell D, Eswarappa S, Smith DE, Furner V, Smith D, Cabrera G, Fernando S, Cogle A, Lawrence C, Mulhall B, Boyd M, Law M, Petoumenos K, Puhr R, Huang R, Han A, Gunathilake M, Payne R, O’Sullivan M, Croydon A, Russell D, Cashman C, Roberts C, Sowden D, Taing K, Marshall P, Orth D, Youds D, Rowling D, Latch N, Warzywoda E, Dickson B, Donohue W, Moore R, Edwards S, Boyd S, Roth NJ, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Allen A, Guelfi G, Mills G, Wharry C, Raymond N, Bargh K, Templeton D, Giles M, Brown K, Hoy J. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clin Infect Dis 2017; 65:1316-1326. [PMID: 28531260 PMCID: PMC5850623 DOI: 10.1093/cid/cix480] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). RESULTS We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. CONCLUSIONS Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
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Fazio SB, Demasi M, Farren E, Frankl S, Gottlieb B, Hoy J, Johnson A, Kasper J, Lee P, McCarthy C, Miller K, Morris J, O'Hare K, Rosales R, Simmons L, Smith B, Treadway K, Goodell K, Ogur B. Blueprint for an Undergraduate Primary Care Curriculum. Acad Med 2016; 91:1628-1637. [PMID: 27415445 DOI: 10.1097/acm.0000000000001302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In light of the increasing demand for primary care services and the changing scope of health care, it is important to consider how the principles of primary care are taught in medical school. While the majority of schools have increased students' exposure to primary care, they have not developed a standardized primary care curriculum for undergraduate medical education. In 2013, the authors convened a group of educators from primary care internal medicine, pediatrics, family medicine, and medicine-pediatrics, as well as five medical students to create a blueprint for a primary care curriculum that could be integrated into a longitudinal primary care experience spanning undergraduate medical education and delivered to all students regardless of their eventual career choice.The authors organized this blueprint into three domains: care management, specific areas of content expertise, and understanding the role of primary care in the health care system. Within each domain, they described specific curriculum content, including longitudinality, generalism, central responsibility for managing care, therapeutic alliance/communication, approach to acute and chronic care, wellness and prevention, mental and behavioral health, systems improvement, interprofessional training, and population health, as well as competencies that all medical students should attain by graduation.The proposed curriculum incorporates important core features of doctoring, which are often affirmed by all disciplines but owned by none. The authors argue that primary care educators are natural stewards of this curriculum content and can ensure that it complements and strengthens all aspects of undergraduate medical education.
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Affiliation(s)
- Sara B Fazio
- S.B. Fazio is associate professor, Department of Internal Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts. M. Demasi is instructor of population health (family medicine), Cambridge Health Alliance, and Harvard Medical School, Boston, Massachusetts. E. Farren is education program director, Center for Primary Care, Harvard Medical School, Boston, Massachusetts. S. Frankl is assistant professor, Department of Internal Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts. B. Gottlieb is associate professor, Department of Internal Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts. J. Hoy is resident physician, Department of Internal Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts. A. Johnson is resident physician, Department of Internal Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. J. Kasper is instructor, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. P. Lee is assistant professor, Department of Internal Medicine, Cambridge Health Alliance, and Harvard Medical School, Boston, Massachusetts. C. McCarthy is assistant professor, Department of Pediatrics, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts. K. Miller is assistant professor of population medicine (family medicine), Cambridge Health Alliance, and Harvard Medical School, Boston, Massachusetts. J. Morris is resident physician, Department of Family & Community Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. K. O'Hare is assistant professor, Department of Internal Medicine, Brigham and Women's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. R. Rosales is a medical student, Harvard Medical School, Boston, Massachusetts. L. Simmons is assistant professor, Department of Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts. B. Smith is resident physician, Fort Collins Family Medicine Residency, Fort Collins, Colorado. K. Treadway is associate professor, Department of Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts. K. Goodell is director for innovation in medical education (family medicine), Center for Primary Care, Harvard Medical School, Boston, Massachusetts. B. Ogur is associate professor of medicine, Department of Internal Medicine, Cambridge Health Alliance, and Harvard Medical School, Boston, Massachusetts
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6
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Lee FJ, Monteiro P, Baker D, Bloch M, Roth N, Finlayson R, Moore R, Hoy J, Martinez E, Carr A. Rosuvastatin vs. protease inhibitor switching for hypercholesterolaemia: a randomized trial. HIV Med 2016; 17:605-14. [PMID: 26987376 DOI: 10.1111/hiv.12362] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 10/18/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to compare the efficacy and safety of rosuvastatin initiation with those of switching of ritonavir-boosted protease inhibitors (PI/rs) in HIV-1-infected adults with hypercholesterolaemia and increased cardiovascular risk scores. METHODS In this open-label, multicentre study, HIV-1-infected adults on PI/r-based therapy with viral load < 50 HIV-1 RNA copies/mL, fasting total cholesterol ≥ 5.5 mmol/L (both for ≥ 6 months) and elevated cardiovascular risk (Framingham score ≥ 8% or diabetes or family history), and not on lipid-lowering therapy, were randomized to open-label rosuvastatin 10 mg/day or to PI/r switching, both with standardized diet/exercise advice. The primary endpoint was change in total cholesterol at week 12 (intention to treat). RESULTS There were 43 participants (23 on rosuvastatin). Baseline characteristics were: mean [± standard deviation (SD)] age 55 (8.5) years, 42 (98%) male, 41 (95%) white race, and mean (± SD) total cholesterol 6.2 (1.2) mmol/L. At enrolment, PI/rs were lopinavir/ritonavir (n = 22; 51%), atazanavir/ritonavir (n = 12; 28%) and darunavir/ritonavir (n = 9; 21%). The commonest PI/r substitutes were raltegravir (n = 9; 45%) and rilpivirine (n = 4; 20%). All participants were adherent through to week 12. Rosuvastatin yielded greater declines than PI/r switching in total (- 21.4% vs. - 8.7%, respectively; P = 0.003) and low-density lipoprotein (- 29.9% vs. - 1.0%, respectively; P < 0.001) cholesterol, but smaller declines in very low-density lipoprotein cholesterol and triglycerides (P < 0.01). Cholesterol lowering was greater in participants on atazanavir/ritonavir or once-daily darunavir/ritonavir (vs. lopinavir/ritonavir). More study drug-related adverse events (mostly grade 1 nausea/diarrhoea; 10 vs. one, respectively; P = 0.001) occurred with PI/r switching than with rosuvastatin. CONCLUSIONS In adults receiving a PI/r, rosuvastatin 10 mg/day for 12 weeks yielded larger decreases in total and low-density lipoprotein cholesterol than PI/r switching, and was better tolerated.
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Affiliation(s)
- F J Lee
- Clinical Research Program, Centre for Applied Medical Research, St Vincent's Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - P Monteiro
- Infectious Diseases Unit, Hospital Cliníc, University of Barcelona, Barcelona, Spain
| | - D Baker
- East Sydney Doctors, Sydney, NSW, Australia
| | - M Bloch
- Holdsworth House Medical Practice, Sydney, NSW, Australia
| | - N Roth
- Prahran Market Clinic, Melbourne, Vic., Australia
| | - R Finlayson
- Taylor Square Private Clinic, Sydney, NSW, Australia
| | - R Moore
- Northside Clinic, Melbourne, Vic., Australia
| | - J Hoy
- Department of Infectious Diseases, The Alfred Hospital & Monash University, Melbourne, Vic., Australia
| | - E Martinez
- Infectious Diseases Unit, Hospital Cliníc, University of Barcelona, Barcelona, Spain
| | - A Carr
- Clinical Research Program, Centre for Applied Medical Research, St Vincent's Hospital, Sydney, NSW, Australia
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Carr A, Grund B, Neuhaus J, Schwartz A, Bernardino JI, White D, Badel-Faesen S, Avihingsanon A, Ensrud K, Hoy J. Prevalence of and risk factors for low bone mineral density in untreated HIV infection: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:137-46. [PMID: 25711332 DOI: 10.1111/hiv.12242] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 11/21/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES HIV infection is associated with a higher prevalence of low bone mineral density (BMD) and fractures than that found in the general population. There are limited data in HIV-positive adults, naïve to antiretroviral therapy (ART), with which to estimate the relative contribution of untreated HIV infection to bone loss. METHODS The primary objective of the Strategic Timing of AntiRetroviral Treatment (START) Bone Mineral Density Substudy is to compare the effect of immediate versus deferred initial ART on bone. We evaluated traditional, demographic, HIV-related and immunological factors for their associations with baseline hip and lumbar spine BMD, measured by dual-energy X-ray absorptiometry, using multiple regression. RESULTS A total of 424 ART-naïve participants were enrolled at 33 sites on six continents; the mean age was 34 years [standard deviation (SD) 10.1 years], 79.0% were nonwhite, 26.0% were women, and 12.5% had a body mass index (BMI) < 20 kg/m(2) . Mean (SD) Z-scores were -0.41 (0.94) at the spine and -0.36 (0.88) for total hip; 1.9% had osteoporosis and 35.1% had low BMD (hip or spine T-score < -1.0). Factors independently associated with lower BMD at the hip and spine were female sex, Latino/Hispanic ethnicity, lower BMI and higher estimated glomerular filtration rate. Longer time since HIV diagnosis was associated with lower hip BMD. Current or nadir CD4 cell count and HIV viral load were not associated with BMD. CONCLUSIONS In this geographically and racially diverse population of ART-naïve adults with normal CD4 cell counts, low BMD was common, but osteoporosis was rare. Lower BMD was significantly associated with traditional risk factors but not with CD4 cell count or viral load.
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Affiliation(s)
- A Carr
- Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia
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8
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Wang L, Han J, Hoy J, Hu F, Liu H, Gentleman MM, Sfeir MY, Misewich JA, Wong SS. Probing differential optical and coverage behavior in nanotube-nanocrystal heterostructures synthesized by covalent versus non-covalent approaches. Dalton Trans 2015; 43:7480-90. [PMID: 24658386 DOI: 10.1039/c3dt53405g] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Double-walled carbon nanotube (DWNT)-CdSe heterostructures with the individual nanoscale building blocks linked together by 4-aminothiophenol (4-ATP) have been successfully synthesized using two different and complementary routes, i.e. covalent attachment and non-covalent π-π stacking. Specifically, using a number of characterization methods, we have probed the effects of these differential synthetic coupling approaches on the resulting CdSe quantum dot (QD) coverage on the underlying nanotube template as well as the degree of charge transfer between the CdSe QDs and the DWNTs. In general, based on microscopy and spectroscopy data collectively, we noted that heterostructures generated by non-covalent π-π stacking interactions evinced not only higher QD coverage density but also possibly more efficient charge transfer behavior as compared with their counterparts produced using covalent linker-mediated protocols.
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Affiliation(s)
- Lei Wang
- Department of Chemistry, State University of New York at Stony Brook, Stony Brook, NY 11794-3400, USA.
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Busby E, Xia J, Low JZ, Wu Q, Hoy J, Campos LM, Sfeir MY. Fast Singlet Exciton Decay in Push–Pull Molecules Containing Oxidized Thiophenes. J Phys Chem B 2015; 119:7644-50. [DOI: 10.1021/jp511704r] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Erik Busby
- Department
of Chemistry, Columbia University, 3000 Broadway, New York, New York 10027, United States
- Center
for Functional Nanomaterials, Brookhaven National Laboratory, Upton, New York 11973, United States
| | - Jianlong Xia
- Department
of Chemistry, Columbia University, 3000 Broadway, New York, New York 10027, United States
| | - Jonathan Z. Low
- Department
of Chemistry, Columbia University, 3000 Broadway, New York, New York 10027, United States
| | - Qin Wu
- Center
for Functional Nanomaterials, Brookhaven National Laboratory, Upton, New York 11973, United States
| | - Jessica Hoy
- Center
for Functional Nanomaterials, Brookhaven National Laboratory, Upton, New York 11973, United States
- Condensed
Matter Physics and Materials Science, Brookhaven National Laboratory, Upton, New York 11973, United States
| | - Luis M. Campos
- Department
of Chemistry, Columbia University, 3000 Broadway, New York, New York 10027, United States
| | - Matthew Y. Sfeir
- Center
for Functional Nanomaterials, Brookhaven National Laboratory, Upton, New York 11973, United States
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10
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Camino FE, Nam CY, Pang YT, Hoy J, Eisaman MD, Black CT, Sfeir MY. Characterization of plasmonic hole arrays as transparent electrical contacts for organic photovoltaics using high-brightness Fourier transform methods. J Mod Opt 2014; 61:1735-1742. [PMID: 25705085 PMCID: PMC4311927 DOI: 10.1080/09500340.2014.917731] [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] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/20/2014] [Indexed: 06/04/2023]
Abstract
We present a methodology for probing light-matter interactions in prototype photovoltaic devices consisting of an organic semiconductor active layer with a semitransparent metal electrical contact exhibiting surface plasmon-based enhanced optical transmission. We achieve high-spectral irradiance in a spot size of less than 100 μm using a high-brightness laser-driven light source and appropriate coupling optics. Spatially resolved Fourier transform photocurrent spectroscopy in the visible and near-infrared spectral regions allows us to measure external quantum efficiency with high sensitivity in small-area devices (<1 mm2). This allows for rapid fabrication of variable-pitch sub-wavelength hole arrays in metal films for use as transparent electrical contacts, and evaluation of the evanescent and propagating mode coupling to resonances in the active layer.
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Affiliation(s)
- Fernando E. Camino
- Center for Functional Nanomaterials, Brookhaven National Laboratory, Upton, NY, USA
| | - Chang-Yong Nam
- Center for Functional Nanomaterials, Brookhaven National Laboratory, Upton, NY, USA
| | - Yutong T. Pang
- Sustainable Energy Technologies, Brookhaven National Laboratory, Upton, NY, USA
- Department of Physics and Astronomy, Stony Brook University, Stony Brook, NY, USA
| | - Jessica Hoy
- Center for Functional Nanomaterials, Brookhaven National Laboratory, Upton, NY, USA
- Condensed Matter Physics and Materials Science, Brookhaven National Laboratory, Upton, NY, USA
| | - Matthew D. Eisaman
- Sustainable Energy Technologies, Brookhaven National Laboratory, Upton, NY, USA
- Department of Physics and Astronomy, Stony Brook University, Stony Brook, NY, USA
| | - Charles T. Black
- Center for Functional Nanomaterials, Brookhaven National Laboratory, Upton, NY, USA
| | - Matthew Y. Sfeir
- Center for Functional Nanomaterials, Brookhaven National Laboratory, Upton, NY, USA
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11
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Han N, Wright ST, O'Connor CC, Hoy J, Ponnampalavanar S, Grotowski M, Zhao HX, Kamarulzaman A. HIV and aging: insights from the Asia Pacific HIV Observational Database (APHOD). HIV Med 2014; 16:152-60. [PMID: 25407085 DOI: 10.1111/hiv.12188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 05/24/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The proportion of people living with HIV/AIDS in the ageing population (>50 years old) is increasing. We aimed to explore the relationship between older age and treatment outcomes in HIV-positive persons from the Asia Pacific region. METHODS Patients from the Australian HIV Observational Database (AHOD) and the TREAT Asia HIV Observational Database (TAHOD) were included in the analysis. We used survival methods to assess the association between older age and all-cause mortality, as well as time to treatment modification. We used regression analyses to evaluate changes in CD4 counts after combination antiretroviral therapy (cART) initiation and determined the odds of detectable viral load, up to 24 months of treatment. RESULTS A total of 7142 patients were included in these analyses (60% in TAHOD and 40% in AHOD), of whom 25% were >50 years old. In multivariable analyses, those aged > 50 years were at least twice as likely to die as those aged 30-39 years [hazard ratio (HR) for 50-59 years: 2.27; 95% confidence interval (CI) 1.34-3.83; HR for > 60 years: 4.28; 95% CI 2.42-7.55]. The effect of older age on CD4 count changes was insignificant (p-trend=0.06). The odds of detectable viral load after cART initiation decreased with age (p-trend=< 0.0001). The effect of older age on time to first treatment modification was insignificant (p-trend=0.21). We found no statistically significant differences in outcomes between AHOD and TAHOD participants for all endpoints examined. CONCLUSIONS The associations between older age and typical patient outcomes in HIV-positive patients from the Asia Pacific region are similar in AHOD and TAHOD. Our data indicate that 'age effects' traverse the resource-rich and resource-limited divide and that future ageing-related findings might be applicable to each setting.
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Affiliation(s)
- N Han
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
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12
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Emery S, Kelleher A, Workman C, Puls R, Bloch M, Baker D, Anderson J, Hoy J, Ip S, Nalliah K, Ward L, Law M, Cooper D. Influence of IFNγ Co-Expression on the Safety and Antiviral Efficacy of Recombinant Fowlpox Virus HIV Therapeutic Vaccines Following Interruption of Antiretroviral Therapy. Human Vaccines 2014; 3:260-7. [DOI: 10.4161/hv.4627] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Wang Y, Zhang Y, Wang F, Giblin DE, Hoy J, Rohrs HW, Loomis RA, Buhro WE. The Magic-Size Nanocluster (CdSe) 34 as a Low-Temperature Nucleant for Cadmium Selenide Nanocrystals; Room-Temperature Growth of Crystalline Quantum Platelets. Chem Mater 2014; 26:2233-2243. [PMID: 24803726 PMCID: PMC3985485 DOI: 10.1021/cm404068e] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 03/04/2014] [Indexed: 05/20/2023]
Abstract
Reaction of Cd(OAc)2·2H2O and selenourea in primary-amine/secondary-amine cosolvent mixtures affords crystalline CdSe quantum platelets at room temperature. Their crystallinity is established by X-ray diffraction analysis (XRD), high-resolution transmission electron microscopy (TEM), and their sharp extinction and photoluminescence spectra. Reaction monitoring establishes the magic-size nanocluster (CdSe)34 to be a key intermediate in the growth process, which converts to CdSe quantum platelets by first-order kinetics with no induction period. The results are interpreted to indicate that the critical crystal-nucleus size for CdSe under these conditions is in the range of (CdSe)34 to (CdSe)68. The nanocluster is obtained in isolated form as [(CdSe)34(n-octylamine)16(di-n-pentylamine)2], which is proposed to function as crystal nuclei that may be stored in a bottle.
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Affiliation(s)
- Yuanyuan Wang
- Department of Chemistry, Washington University, St. Louis, Missouri 63130-4899, United States
| | - Ying Zhang
- Department of Chemistry, Washington University, St. Louis, Missouri 63130-4899, United States
| | - Fudong Wang
- Department of Chemistry, Washington University, St. Louis, Missouri 63130-4899, United States
| | - Daryl E. Giblin
- Department of Chemistry, Washington University, St. Louis, Missouri 63130-4899, United States
| | - Jessica Hoy
- Department of Chemistry, Washington University, St. Louis, Missouri 63130-4899, United States
| | - Henry W. Rohrs
- Department of Chemistry, Washington University, St. Louis, Missouri 63130-4899, United States
| | - Richard A. Loomis
- Department of Chemistry, Washington University, St. Louis, Missouri 63130-4899, United States
| | - William E. Buhro
- Department of Chemistry, Washington University, St. Louis, Missouri 63130-4899, United States
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14
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Bloch M, Tong WWY, Hoy J, Baker D, Lee FJ, Richardson R, Carr A. Switch from tenofovir to raltegravir increases low bone mineral density and decreases markers of bone turnover over 48 weeks. HIV Med 2014; 15:373-80. [DOI: 10.1111/hiv.12123] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 11/28/2022]
Affiliation(s)
- M Bloch
- Holdsworth House Medical Practice; Sydney NSW Australia
| | - WWY Tong
- St Vincent's Hospital and University of New South Wales; Sydney NSW Australia
| | - J Hoy
- The Alfred Hospital and Monash University; Melbourne Vic. Australia
| | - D Baker
- East Sydney Doctors; Sydney NSW Australia
| | - FJ Lee
- St Vincent's Hospital and University of New South Wales; Sydney NSW Australia
| | - R Richardson
- St Vincent's Hospital and University of New South Wales; Sydney NSW Australia
| | - A Carr
- St Vincent's Hospital and University of New South Wales; Sydney NSW Australia
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15
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Hoy J, Morrison PJ, Steinberg LK, Buhro WE, Loomis RA. Excitation Energy Dependence of the Photoluminescence Quantum Yields of Core and Core/Shell Quantum Dots. J Phys Chem Lett 2013; 4:2053-60. [PMID: 26283252 DOI: 10.1021/jz4004735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The photoluminescence (PL) intensity of semiconductor quantum dots (QDs) is routinely monitored to track the chemical and physical properties within a sample or device incorporating the QDs. A dependence of the PL quantum yields (QYs) on the excitation energy could lead to erroneous conclusions but is commonly not considered. We summarize previous evidence and present results from two methodologies that confirm the possibility of a dependence of the PL QYs on the excitation energy. The data presented indicate that PL QYs of CdSe and CdSe/ZnS QDs suspended in toluene are highest for excitation just above the band gap, Eg, of each. The PL QYs decrease with increasing excitation energies up to 1 eV above Eg. The PL intensity decay profiles recorded for these samples at varying emission and excitation energies indicate that the changes in the PL QYs result from the nonradiative relaxation pathways sampled as the charge carriers relax down to the band edge.
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Affiliation(s)
- Jessica Hoy
- Department of Chemistry and Center for Materials Innovation, Washington University in Saint Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
| | - Paul J Morrison
- Department of Chemistry and Center for Materials Innovation, Washington University in Saint Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
| | - Lindsey K Steinberg
- Department of Chemistry and Center for Materials Innovation, Washington University in Saint Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
| | - William E Buhro
- Department of Chemistry and Center for Materials Innovation, Washington University in Saint Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
| | - Richard A Loomis
- Department of Chemistry and Center for Materials Innovation, Washington University in Saint Louis, One Brookings Drive, CB 1134, Saint Louis, Missouri 63130, United States
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16
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Abstract
Colloidal CdTe quantum wires are reported having ensemble photoluminescence efficiencies as high as 25% under low excitation-power densities. High photoluminescence efficiencies are achieved by formation of a monolayer CdS shell on the CdTe quantum wires. Like other semiconductor nanowires, the CdTe quantum wires may contain frequent wurtzite-zinc-blende structural alternations along their lengths. The present results demonstrate that the optical properties, emission-peak shape and photoluminescence efficiencies, are independent of the presence or absence of such structural alternations.
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Affiliation(s)
- Yi-Hsin Liu
- Department of Chemistry, Washington University, Saint Louis, Missouri 63130-4899
| | - Fudong Wang
- Department of Chemistry, Washington University, Saint Louis, Missouri 63130-4899
| | - Jessica Hoy
- Department of Chemistry, Washington University, Saint Louis, Missouri 63130-4899
| | - Virginia L. Wayman
- Department of Chemistry, Washington University, Saint Louis, Missouri 63130-4899
| | - Lindsey K. Steinberg
- Department of Chemistry, Washington University, Saint Louis, Missouri 63130-4899
| | - Richard A. Loomis
- Department of Chemistry, Washington University, Saint Louis, Missouri 63130-4899
| | - William E. Buhro
- Department of Chemistry, Washington University, Saint Louis, Missouri 63130-4899
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17
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Rotty J, Anderson D, Garcia M, Diaz J, Van de Waarsenburg S, Howard T, Dennison A, Lewin SR, Elliott JH, Hoy J. Preliminary assessment of Treponema pallidum-specific IgM antibody detection and a new rapid point-of-care assay for the diagnosis of syphilis in human immunodeficiency virus-1-infected patients. Int J STD AIDS 2011; 21:758-64. [PMID: 21187358 DOI: 10.1258/ijsa.2010.010237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aims of the study were to assess whether Treponema pallidum-specific IgM may provide a useful marker of infectious syphilis in human immunodeficiency virus (HIV)-infected patients, and to compare the performance of a prototype IgM-rapid point-of-care test (PoCT) with a standard IgM-enzyme immunoassay (EIA). Twenty samples from HIV-infected patients with untreated syphilis (n = 4 primary syphilis, n = 11 secondary and n = 5 early latent) and 51 follow-up samples at three, six or 12 months after treatment were tested for the presence of IgM with the Mercia-EIA (Microgen Bioproducts Ltd, Camberley, UK) and a prototype PoCT (Select Vaccines Ltd, Melbourne, Australia). Although sample numbers were small, IgM detection by EIA appears to be a reliable marker for untreated syphilis in HIV-infected patients with primary (4/4 IgM-positive) or secondary syphilis (10/11 IgM-positive, 1/11 equivocal). After treatment, IgM was no longer detected after three months in the majority of patients (87%) and was either negative or equivocal in all patients after six and 12 months. The overall sensitivity of the IgM-PoCT was 82% and varied with clinical stage, being highest in secondary (10/10 EIA positives) but lower in primary (2/4 EIA positives) and early latent syphilis (2/3 EIA positives). Overall specificity was 95%. Rapid detection of IgM would enable clinicians to distinguish between past-treated and infectious syphilis and allow for diagnosis and treatment in a single visit.
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Affiliation(s)
- J Rotty
- Infectious Diseases Unit, Alfred Hospital, Victoria 3181,Australia.
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18
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Wright EJ, Grund B, Robertson K, Brew BJ, Roediger M, Bain MP, Drummond F, Vjecha MJ, Hoy J, Miller C, Penalva de Oliveira AC, Pumpradit W, Shlay JC, El-Sadr W, Price RW. Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons. Neurology 2010; 75:864-73. [PMID: 20702792 DOI: 10.1212/wnl.0b013e3181f11bd8] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To determine factors associated with baseline neurocognitive performance in HIV-infected participants enrolled in the Strategies for Management of Antiretroviral Therapy (SMART) neurology substudy. METHODS Participants from Australia, North America, Brazil, and Thailand were administered a 5-test neurocognitive battery. Z scores and the neurocognitive performance outcome measure, the quantitative neurocognitive performance z score (QNPZ-5), were calculated using US norms. Neurocognitive impairment was defined as z scores <-2 in two or more cognitive domains. Associations of test scores, the QNPZ-5, and impairment with baseline factors including demographics and risk factors for HIV-associated dementia (HAD) and cardiovascular disease (CVD) were determined in multiple regression. RESULTS The 292 participants had a median CD4 cell count of 536 cells/mm(3), 88% had an HIV viral load < or =400 copies/mL, and 92% were taking antiretrovirals. Demographics, HIV, and clinical factors differed between locations. The mean QNPZ-5 score was -0.72; 14% of participants had neurocognitive impairment. For most tests, scores and z scores differed significantly between locations, with and without adjustment for age, sex, education, and race. Prior CVD was associated with neurocognitive impairment. Prior CVD, hypercholesterolemia, and hypertension were associated with poorer neurocognitive performance but conventional HAD risk factors and the CNS penetration effectiveness rank of antiretroviral regimens were not. CONCLUSIONS In this HIV-positive population with high CD4 cell counts, neurocognitive impairment was associated with prior CVD. Lower neurocognitive performance was associated with prior CVD, hypertension, and hypercholesterolemia, but not conventional HAD risk factors. The contribution of CVD and cardiovascular risk factors to the neurocognition of HIV-positive populations warrants further investigation.
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Affiliation(s)
- E J Wright
- Infectious Diseases Unit, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.
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19
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Bloch M, Hoy J, Cunningham N, Roth N, Andrianopoulos N, Rayner C, Carr A. Adherence to HIV treatment guidelines for initiation of antiretroviral therapy in Australia. J Int AIDS Soc 2010. [PMCID: PMC3112952 DOI: 10.1186/1758-2652-13-s4-p172] [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: 11/24/2022] Open
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20
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Gavrila A, Robinson B, Hoy J, Stewart J, Bhargava A, Amir S. Double-stranded RNA-mediated suppression of Period2 expression in the suprachiasmatic nucleus disrupts circadian locomotor activity in rats. Neuroscience 2008; 154:409-14. [DOI: 10.1016/j.neuroscience.2008.04.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 04/15/2008] [Accepted: 04/16/2008] [Indexed: 10/22/2022]
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21
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Anderson J, Hoy J, Hillman R, Gittleson C, Hartel G, Medley G, Basser R. Abnormal anal cytology in high-risk human papilloma virus infection in HIV-infected Australians. Sex Transm Infect 2008; 84:94-6. [PMID: 17881414 DOI: 10.1136/sti.2007.027250] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 11/04/2022] Open
Abstract
OBJECTIVE To assess the prevalence of abnormal anal cytology and high-risk human papilloma virus (HPV)-type infection in HIV-infected people with a CD4 cell count >300 cells/microl. METHODS The clinic-based patient population included 126 HIV-infected people: 124 men who have sex with men, and two women (median age 45 years; CD4 cell count >300 cells/microl). Anal cytology swabs were placed into liquid-based medium for HPV typing by Hybrid Capture-2 assay and cytological assessment, by a single cytopathologist. RESULTS 106 (84%) participants were infected with high-risk HPV; 17 (14%) had no high-risk types of HPV detected; three (2%) had no HPV assay result because of an inadequate sample. Sixteen (13%) participants had cytological evidence of high-grade squamous intraepithelial (HGSIL) changes, 100% of whom had high-risk HPV types detected, and 13 (10%) had atypical squamous cells of undetermined significance with possible high-grade changes (ASCUS-H), 92% of whom had high-risk HPV types detected. Low-grade changes (LSIL) were detected in 24 (19%) participants, 96% of whom had high-risk HPV types, 32 (25%) had ASCUS with 88% high-risk HPV types, 30 (24%) had normal cytology with 73% high-risk HPV types, and 11 (9%) samples were inadequate for cytological assessment. The odds ratio of participants with high-risk HPV having abnormal anal cytology on anal swab was 5.03 (95% CI 1.45 to 17.39). DISCUSSION High-risk HPV types are common in this HIV+ population with a CD4 cell count >300 cells/microl. The presence of high-risk HPV types was associated with abnormal anal cytology such as HGSIL and ASCUS-H.
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Affiliation(s)
- J Anderson
- Carlton Clinic, 88 Rathdowne St, Carlton, Melbourne, Vic 3053, Australia
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22
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Singh KP, Howard JL, Wild SP, Jones SL, Hoy J, Lewin SR. Human cytomegalovirus (CMV)-specific CD8+ T cell responses are reduced in HIV-infected individuals with a history of CMV disease despite CD4+ T cell recovery. Clin Immunol 2007; 124:200-6. [PMID: 17574925 DOI: 10.1016/j.clim.2007.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 04/22/2007] [Accepted: 04/28/2007] [Indexed: 11/17/2022]
Abstract
Cytomegalovirus (CMV)-specific immunity was investigated in human immunodeficiency virus (HIV)-infected individuals. A case-control (1:2) study was performed with cases defined as having a history of CMV end-organ disease (n=15) and controls (n=30) matched by current CD4(+) T cell count. CMV-specific CD8(+) T cells responses were quantified using the high throughput Quantiferon-CMV test (Cellestis, Melbourne, Australia). 40/44 (91%) had a positive Quantiferon-CMV test and the magnitude of response to CMV peptides correlated significantly with response to mitogen (p<0.0001) but not with CD4(+) T cell count at the time of testing, CD4(+) T cell nadir or HIV viral load. Cases had a significantly lower Quantiferon-CMV test than controls but there was no significant difference in response to mitogen or other antigens. In individuals with a history of CMV disease, CMV-specific CD8(+) T cell responses are reduced even in the setting of CD4(+) T cell reconstitution.
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Affiliation(s)
- K P Singh
- Infectious Diseases Unit, Alfred Hospital, Australia
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23
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El-Sadr WM, Lundgren JD, Neaton JD, Gordin F, Abrams D, Arduino RC, Babiker A, Burman W, Clumeck N, Cohen CJ, Cohn D, Cooper D, Darbyshire J, Emery S, Fätkenheuer G, Gazzard B, Grund B, Hoy J, Klingman K, Losso M, Markowitz N, Neuhaus J, Phillips A, Rappoport C. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med 2006; 355:2283-96. [PMID: 17135583 DOI: 10.1056/nejmoa062360] [Citation(s) in RCA: 1648] [Impact Index Per Article: 91.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite declines in morbidity and mortality with the use of combination antiretroviral therapy, its effectiveness is limited by adverse events, problems with adherence, and resistance of the human immunodeficiency virus (HIV). METHODS We randomly assigned persons infected with HIV who had a CD4+ cell count of more than 350 per cubic millimeter to the continuous use of antiretroviral therapy (the viral suppression group) or the episodic use of antiretroviral therapy (the drug conservation group). Episodic use involved the deferral of therapy until the CD4+ count decreased to less than 250 per cubic millimeter and then the use of therapy until the CD4+ count increased to more than 350 per cubic millimeter. The primary end point was the development of an opportunistic disease or death from any cause. An important secondary end point was major cardiovascular, renal, or hepatic disease. RESULTS A total of 5472 participants (2720 assigned to drug conservation and 2752 to viral suppression) were followed for an average of 16 months before the protocol was modified for the drug conservation group. At baseline, the median and nadir CD4+ counts were 597 per cubic millimeter and 250 per cubic millimeter, respectively, and 71.7% of participants had plasma HIV RNA levels of 400 copies or less per milliliter. Opportunistic disease or death from any cause occurred in 120 participants (3.3 events per 100 person-years) in the drug conservation group and 47 participants (1.3 per 100 person-years) in the viral suppression group (hazard ratio for the drug conservation group vs. the viral suppression group, 2.6; 95% confidence interval [CI], 1.9 to 3.7; P<0.001). Hazard ratios for death from any cause and for major cardiovascular, renal, and hepatic disease were 1.8 (95% CI, 1.2 to 2.9; P=0.007) and 1.7 (95% CI, 1.1 to 2.5; P=0.009), respectively. Adjustment for the latest CD4+ count and HIV RNA level (as time-updated covariates) reduced the hazard ratio for the primary end point from 2.6 to 1.5 (95% CI, 1.0 to 2.1). CONCLUSIONS Episodic antiretroviral therapy guided by the CD4+ count, as used in our study, significantly increased the risk of opportunistic disease or death from any cause, as compared with continuous antiretroviral therapy, largely as a consequence of lowering the CD4+ cell count and increasing the viral load. Episodic antiretroviral therapy does not reduce the risk of adverse events that have been associated with antiretroviral therapy. (ClinicalTrials.gov number, NCT00027352 [ClinicalTrials.gov].).
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Mijch A, Burgess P, Judd F, Grech P, Komiti A, Hoy J, Lloyd JH, Gibbie T, Street A. Increased health care utilization and increased antiretroviral use in HIV-infected individuals with mental health disorders. HIV Med 2006; 7:205-12. [PMID: 16630032 DOI: 10.1111/j.1468-1293.2006.00359.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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: 11/28/2022]
Abstract
OBJECTIVES The aims of the study were to describe the prevalence and associations of mental health disorder (MHD) among a cohort of HIV-infected patients attending the Victorian HIV/AIDS Service between 1984 and 2000, and to examine whether antiretroviral therapy use or mortality was influenced by MHD (defined as a record of service provision by psychiatric services on the Victorian Psychiatric Case Register). It was hypothesized that HIV-positive individuals with MHD would have poorer treatment outcomes, reduced responses to highly active antiretroviral therapy (HAART) and increased mortality compared with those without MHD. METHODS This is a retrospective cohort of 2981 individuals (73% of the Victorian population diagnosed with HIV infection) captured on an HIV database which was electronically matched with the public Victorian Psychiatric Case Register (VPCR) (accounting for 95% of public system psychiatry service provision). The prevalence, dates and recorded specifics of mental health disorders at the time of the electronic match on 1 June 2000 are described. The association with recorded MHD, gender, age, AIDS illness, HIV exposure category, duration and type of antiviral therapy, treatment era (prior to 1986, post-1987 and pre-HAART, and post-HAART) on hospitalization and mortality at 1 September 2001 was assessed. RESULTS Five hundred and twenty-five individuals (17.6% of the Victorian HIV-positive population) were recorded with MHD, most frequently coded as attributable to substance dependence/abuse or affective disorder. MHD was diagnosed prior to HIV in 33% and, of those diagnosed after HIV, 93.8% were recorded more than 1 year after the HIV diagnosis. Schizophrenia was recorded in 6% of the population with MHD. Hospitalizations for both psychiatric and nonpsychiatric illness were more frequent in those with MHD (relative risk 5.4; 95% confidence interval 3.7, 8.2). The total number of antiretrovirals used (median 6.4 agents vs 5.5 agents) was greater in those with MHD. When adjusted for antiretroviral treatment era, HIV exposure category, CD4 cell count and antiretroviral therapy, survival was not affected by MHD. CONCLUSIONS MHD is frequent in this population with HIV infection and is associated with increased healthcare utilization but not with reduced survival.
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Affiliation(s)
- A Mijch
- Victorian HIV Psychiatry Consortium, Melbourne, Australia.
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Gibbie T, Mijch A, Ellen S, Hoy J, Hutchison C, Wright E, Chua P, Judd F. Depression and neurocognitive performance in individuals with HIV/AIDS: 2-year follow-up. HIV Med 2006; 7:112-21. [PMID: 16420256 DOI: 10.1111/j.1468-1293.2006.00350.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [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: 11/28/2022]
Abstract
OBJECTIVES The aims of this study were to follow a cohort of HIV-infected individuals for 2 years to assess changes in depression and neuropsychological performance over time, to explore the relationship between depression, HIV illness and neuropsychological performance, and to examine the natural history of the effect of highly active antiretroviral therapy (HAART) on depression and neurocognitive performance. METHODS HIV-seropositive out-patients were assessed at baseline and at 2-year follow-up. At each assessment, patients were assessed for depression [using the Beck Depression Inventory (BDI) and Structured Clinical Interview (SCID-CV)] and completed a battery of neuropsychological tests including the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Hopkins HIV Dementia Scale (HDS). RESULTS At baseline, 34.8% scored > or =14 on the BDI [> or =14 suggests depressive symptoms (DS)]. The SCID-CV revealed that 27% of participants met the criteria for current mood disorder. Seven per cent of the participants' scores on the HDS indicated HIV-associated cognitive changes. Eighty participants were re-tested at 2-year follow-up and were split into two groups based on BDI scores at baseline. CANTAB results revealed that the cohort were significantly impaired on nine of 10 measures compared with age-matched normative data. Neurocognitive performance significantly improved for participants with no DS at baseline, whereas participants with DS at baseline did not show as much improvement. Multivariate analysis revealed that 40% of the change in cognitive performance was attributable to the variables age, AIDS and HAART regimen. CONCLUSION These results suggest a significant decline in depression scores and an improvement in several neurocognitive domains over time, with a relationship between HIV illness, HAART, symptoms of depression and neurocognitive performance.
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Affiliation(s)
- T Gibbie
- Victorian HIV Service, The Alfred Hospital, Victoria, Australia
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Emery S, Workman C, Puls RL, Bloch M, Baker D, Bodsworth N, Anderson J, Crowe SM, French MAH, Hoy J, Aichelburg A, Ward LD, Boyle DB, Law MG, Kelleher AD, Cooper DA. Randomized, placebo-controlled, phase I/IIa evaluation of the safety and immunogenicity of fowlpox virus expressing HIV gag-pol and interferon-gamma in HIV-1 infected subjects. Hum Vaccin 2005; 1:232-8. [PMID: 17012863 DOI: 10.4161/hv.1.6.2342] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We conducted a randomized, placebo-controlled double-blind trial to examine the safety and immunogenicity of a candidate HIV therapeutic vaccine based upon a recombinant fowl pox virus capable of coexpressing the human cytokine interferon-gamma and/or genes from HIV-1. Thirty-five eligible subjects were randomized (12 placebo, 11 fowlpox + HIV genes, 12 fowl pox + HIV genes + interferon gamma). All but one subject (placebo group) received three immunizations (by intramuscular injection on day 0, week 4 and week 12) and all completed 52 weeks of follow-up. All subjects continued to take combination antiretroviral therapy for the duration of study. There were no significant toxicity or safety concerns and the distribution of adverse events and their severity was consistent across each randomly assigned vaccine group. Comparison of placebo recipients with the combined recipients of the two vaccine constructs, in terms of anti-HIV gag ELISpot or lymphoproliferative responses, tended to favour the placebo group, but were not significantly different (difference in time-weighted mean change from baseline = 56 Spot forming units (sfu)/10(6) PBMC; p = 0.062 and 4.4 SI; p = 0.337). There were no significant changes in CTL responses by standard Cr(51) release assay. Anti-FPV antibodies were detected by week 14 in 0 placebo and 20 (87%) vaccine recipients. Although safe, neither vaccine construct appeared to possess detectable T-cell mediated anti-HIV immunogenic properties in HIV infected individuals, as measured by standard T cell assays.
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Affiliation(s)
- S Emery
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
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Abstract
OBJECTIVES To describe, retrospectively, the Australian experience of multi-centric Castleman's disease (MCD) in the setting of HIV infection, specifically with the advent of HAART, and newer chemotherapeutic agents. PATIENTS AND METHODS HIV-infected patients diagnosed with MCD since 1994, were identified from three major HIV treatment centres in Australia. Demographic and disease characteristic variables were collated by the National Centre in HIV Epidemiology and Clinical Research. RESULTS Eleven patients were identified with MCD. Medial follow up was 46 (18-57) months. All had CD4 cell counts less than 500 cells/microL. All but one patient was receiving HAART at the time of diagnosis. Nine of the 11 patients had Kaposi's sarcoma (KS) and two patients also developed non-Hodgkin's Lymphoma (NHL). All patients received chemotherapy for MCD. The response rate from Chemotherapy was 64%. Only two patients achieved sustained remissions. The median survival was 21.9 (1-52) months. The mortality was 45% from MCD and its related complications. CONCLUSION MCD in HIV infected patients is a rare and life-threatening disorder. There is limited recent information on optimal treatment for MCD. MCD in our series appeared to be a chemo-responsive disease. In our experience, treatment with liposomal anthracycline was associated with good response rates and acceptable toxicity in several patients, and therefore merits further exploration to establish its role. Treatment in the future may concentrate on novel agents such as anti-interleukin 6, anti-CD20 antibodies, thalidomide and viral ablation.
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Affiliation(s)
- S Loi
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Becket Street, East Melbourne, Victoria 8006, Australia.
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Ioannidis JPA, Trikalinos TA, Law M, Carr A, Carr A, Barr D, Cooper DA, Emery S, Grinspoon S, Ioannidis J, Lewis R, Law M, Lichtenstein K, Murray J, Pizzuti D, Powderly WG, Rozenbaum W, Schambelan M, Puls R, Emery S, Moore A, Miller J, Carr A, Belloso WH, Ivalo SA, Clara LO, Barcan LA, Stern LD, Galich AM, Perman MI, Losso M, Duran A, Toibaro J, Baker D, Vale R, McFarlane R, MacLeod H, Kidd J, Genn B, Carr A, Fielden R, Mallal S, French M, Cain A, Skett J, Maxwell D, Mijch A, Hoy J, Pierce A, McCormick C, De Graaf B, Falutz J, Vatistas J, Dion L, Montaner J, Harris M, Phillips P, Montessori V, Valyi M, Stewart W, Walmsley S, Casciaro L, Lundgren J, Andersen O, Gronholdt A, Beguinot I, Mercié P, Chêne G, Reynes J, Cotte L, Rozenbaum W, Nait-Ighil L, Slama L, Nguyen TH, Rousselle C, Viard JP, Roudière L, Maignan A, Burgard M, Mauss S, Schmutz G, Scholten S, Oka S, Fraser H, Ishihara M, Itoh K, Reiss P, van der Valk M, Leunissen P, Nievaard M, van EckSmit B, Kujik CC, Paton N, Peperstraete B, Karim F, Khim CY, Ong S, Gatell J, Martinez E, Milinkovic A, Churchill D, Timaeus C, Maher T, Perry N, Bray A, Moyle G, Baldwin C, Higgs C, Reynolds B, Carpenter C, Bausserman L, Fiore T, DiSpigno M, Cohen C, Hellinger J, Foy K, Hubka S, Riccio B, El-Sadr W, Raghavan S, Chowdury N, de Vries B, Miller S, Hammer S, Crawford M, Chang S, Dobkin J, Quagliarello B, Gallagher D, Punyanitya M, Kessler H, Tenorio A, Kjos S, Falloon J, Lane HC, Rock D, Ehler L, Lichtenstein K, McClain T, Murphy R, Milne P, Powderly W, Aberg J, Klebert M, Conklin M, Ward D, Green L, Stearn B. HIV Lipodystrophy Case Definition using Artificial Neural Network Modelling. Antivir Ther 2003. [DOI: 10.1177/135965350300800511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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
Objective A case definition of HIV lipodystrophy has recently been developed from a combination of clinical, metabolic and imaging/body composition variables using logistic regression methods. We aimed to evaluate whether artificial neural networks could improve the diagnostic accuracy. Methods The database of the case-control Lipodystrophy Case Definition Study was split into 504 subjects (265 with and 239 without lipodystrophy) used for training and 284 independent subjects (152 with and 132 without lipodystrophy) used for validation. Back-propagation neural networks with one or two middle layers were trained and validated. Results were compared against logistic regression models using the same information. Results Neural networks using clinical variables only (41 items) achieved consistently superior performance than logistic regression in terms of specificity, overall accuracy and area under the ROC curve. Their average sensitivity and specificity were 72.4 and 71.2%, as compared with 73.0 and 62.9% for logistic regression, respectively (area under the ROC curve, 0.784 vs 0.748). The discriminating performance of the neural networks was largely unaffected when built excluding 13 parameters that patients may not have readily available. The average sensitivity and specificity of the neural networks remained the same when metabolic variables were also considered (total 60 items) without a clear advantage against logistic regression (overall accuracy 71.8%). The performance of networks considering also body composition variables was similar to that of logistic regression (overall accuracy 78.5% for both). Conclusions Neural networks may offer a means to improve the discriminating performance for HIV lipodystrophy, when only clinical data are available and a rapid approximate diagnostic decision is needed. In this context, information on metabolic parameters is apparently not helpful in improving the diagnosis of HIV lipodystrophy, unless imaging and body composition studies are also obtained.
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Affiliation(s)
- John PA Ioannidis
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Thomas A Trikalinos
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Matthew Law
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
| | - Andrew Carr
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
- HIV, Immunology and Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Australia
| | - A Carr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - D Barr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - DA Cooper
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (Massachusetts General Hospital, Boston, Mass., USA)
| | - S Grinspoon
- (Massachusetts General Hospital, Boston, Mass., USA)
| | | | - R Lewis
- (Agouron Pharmaceuticals, San Diego, Calif., USA)
| | - M Law
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - K Lichtenstein
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - J Murray
- (US Department of Health and Human Services Food and Drug Administration, Washington, DC, USA)
| | - D Pizzuti
- (Bristol-Myers Squibb, Princeton, NJ, USA, representing the European Medicines Evaluation Agency Oversight Committee)
| | - WG Powderly
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - W Rozenbaum
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - M Schambelan
- (University of California, San Francisco, Calif., USA; to September 2000)
| | - R Puls
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Moore
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - J Miller
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Carr
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - WH Belloso
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - SA Ivalo
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LO Clara
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LA Barcan
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LD Stern
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - AM Galich
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - MI Perman
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - M Losso
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - A Duran
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - J Toibaro
- (Hospital J M Ramos Mejía, Buenos Aires)
| | | | | | | | | | | | | | - A Carr
- (St Vincent's Hospital, Sydney)
| | | | | | | | - A Cain
- (Royal Perth Hospital, Perth)
| | - J Skett
- (Royal Perth Hospital, Perth)
| | | | - A Mijch
- (Alfred Hospital and Monash University, Melbourne)
| | - J Hoy
- (Alfred Hospital and Monash University, Melbourne)
| | - A Pierce
- (Alfred Hospital and Monash University, Melbourne)
| | - C McCormick
- (Alfred Hospital and Monash University, Melbourne)
| | - B De Graaf
- (Alfred Hospital and Monash University, Melbourne)
| | - J Falutz
- (Montreal General Hospital, Montreal)
| | | | - L Dion
- (Montreal General Hospital, Montreal)
| | | | | | | | | | - M Valyi
- (St Paul's Hospital, Vancouver)
| | | | | | | | - J Lundgren
- (Hvidovre University Hospital, Copenhagen)
| | - O Andersen
- (Hvidovre University Hospital, Copenhagen)
| | | | | | - P Mercié
- (Hôpital Haut-Lévêque, Bordeaux)
| | - G Chêne
- (Hôpital Haut-Lévêque, Bordeaux)
| | - J Reynes
- (Hôpital Gui de Chauliac, Montpellier)
| | - L Cotte
- (Hôpital Gui de Chauliac, Montpellier)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - P Reiss
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M van der Valk
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - P Leunissen
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M Nievaard
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - B van EckSmit
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - C can Kujik
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - N Paton
- (Tan Tock Seng Hospital, Singapore)
| | | | - F Karim
- (Tan Tock Seng Hospital, Singapore)
| | - C Y Khim
- (Tan Tock Seng Hospital, Singapore)
| | - S Ong
- (Tan Tock Seng Hospital, Singapore)
| | - J Gatell
- (Hospital Clinic Provincial de Barcelona)
| | - E Martinez
- (Hospital Clinic Provincial de Barcelona)
| | | | | | | | | | | | - A Bray
- (Sussex Hospital, Brighton)
| | - G Moyle
- (Chelsea and Westminster Hospital, London)
| | - C Baldwin
- (Chelsea and Westminster Hospital, London)
| | - C Higgs
- (Chelsea and Westminster Hospital, London)
| | - B Reynolds
- (Chelsea and Westminster Hospital, London)
| | | | | | - T Fiore
- (Miriam Hospital, Providence, RI)
| | | | - C Cohen
- (Community Research Initiative of New England, Brookline, Mass.)
| | - J Hellinger
- (Community Research Initiative of New England, Brookline, Mass.)
| | - K Foy
- (Community Research Initiative of New England, Brookline, Mass.)
| | - S Hubka
- (Community Research Initiative of New England, Brookline, Mass.)
| | - B Riccio
- (Community Research Initiative of New England, Brookline, Mass.)
| | - W El-Sadr
- (Harlem Hospital Center, New York, NY)
| | | | | | | | - S Miller
- (Harlem Hospital Center, New York, NY)
| | - S Hammer
- (Columbia University, New York, NY)
| | | | - S Chang
- (Columbia University, New York, NY)
| | - J Dobkin
- (Columbia University, New York, NY)
| | | | | | | | - H Kessler
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - A Tenorio
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - S Kjos
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - J Falloon
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - HC Lane
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - D Rock
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - L Ehler
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | | | - T McClain
- (Denver Infectious Disease Consultants, Denver, Col.)
| | - R Murphy
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - P Milne
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - W Powderly
- (Washington University School of Medicine, St Louis, Mo.)
| | - J Aberg
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Klebert
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Conklin
- (Washington University School of Medicine, St Louis, Mo.)
| | - D Ward
- (Dupont Circle Physician's Group, Washington, DC)
| | - L Green
- (Dupont Circle Physician's Group, Washington, DC)
| | - B Stearn
- (Dupont Circle Physician's Group, Washington, DC)
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Abstract
OBJECTIVE To review the existing literature on suicidal behaviour in people with HIV/AIDS infection. METHOD A search on the Index Medicus/MEDLINE database was performed, for articles that investigated and/or reviewed suicidal behaviour in people with HIV at any stage of the illness. Only articles written in English were used in this review. RESULTS Most studies have been done on homosexual/bisexual groups, with little data available for heterosexual populations or women. Studies show an increased rate of suicidal ideation, suicide attempts and completed suicide in individuals with HIV/AIDS. Of note, there is a high prevalence of psychiatric illness and substance abuse in those with suicidal behaviour. CONCLUSIONS The increased rate of suicidal behaviour in HIV-infected persons is consistent with findings in other medically ill groups with chronic, life-threatening disorders. However, assessment of any possible direct effect of HIV/AIDS on suicidal behaviour is confounded by methodological limitations of many of the studies. More longitudinal studies encompassing other affected groups including heterosexual populations and women are needed to elucidate the relationship between suicidal behaviour and HIV/AIDS.
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Affiliation(s)
- A Komiti
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
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Mijch AM, Hoy J, Watson K, Dunne A, Crowe S, Wesselingh SL. Does plasma HIV RNA predict outcome in a cohort of treated HIV-infected individuals followed over 3 years? J Clin Virol 2001; 22:271-8. [PMID: 11564592 DOI: 10.1016/s1386-6532(01)00199-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 10/17/2022]
Abstract
BACKGROUND Despite reductions in AIDS illness and mortality, it is increasingly apparent that a significant proportion of individuals treated with combination antiretroviral (cARV) therapy have continuing or recrudescent HIV RNA in plasma. The predictive value of plasma HIV RNA in treated individual remains uncertain and rates of and risk factors for adverse outcomes such as hospitalisation, opportunistic infections and deaths are needed. OBJECTIVES The objectives of this study were to establish a retrospective cohort of individuals treated with cARVs, to assess factors associated with detectable HIV RNA and to determine rates of and risk factors for hospitalisation, opportunistic infection and mortality over 3 years of follow-up. STUDY DESIGN All individuals treated at The Alfred Hospital, Melbourne, Victoria between January and June 1997 who had had plasma HIV RNA measured were included in the retrospective cohort. Clinical, virological and hospitalisation data were recorded and validated by cross-reference with electronically stored laboratory, hospital activity and state notification databases. Outcome was assessed at October 2000. RESULTS Amongst the 555 individuals tested, 438 (60.7%) had detectable (>500 copies/ml) HIV RNA (bDNA assay, version 2) at baseline. The overall mortality rate was 5.5 per 100 person years; the AIDS rate 1.99 per 100 person years and hospitalisation rate 16.4 per 100 person years. Risk factors for death in this population identified by univariate analysis were HIV RNA concentration at baseline and at follow-up October 2000, nadir and most recent CD4 lymphocyte number, not receiving cARV as initial treatment, total number of ARV agents and number of changes in ARV per year, developing AIDS and being hospitalised during follow-up. In a multivariate model, the most recent CD4 lymphocyte number, the number of different ARVs per year and having more than one hospitalisation remained predictive of death. CONCLUSIONS HIV RNA remained detectable in the majority (60.7%) of this treatment-experienced population over 3 years, yet mortality rate remained relatively low at 5.5 per 100 person years. Factors associated with death were immunological (CD4 lymphocyte number) and treatment related (numbers of changes of ARV and hospitalisation) rather than virological (HIV RNA) in this cohort. We believe hospitalisation rates may be a useful marker of HIV disease in cARV treated populations and may identify groups at risk of poorer outcome and in need of intervention.
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Affiliation(s)
- A M Mijch
- Infectious Diseases Unit, Alfred Hospital, Monash University, Prahran, Vic. 3181, Australia.
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Carr A, Hudson J, Chuah J, Mallal S, Law M, Hoy J, Doong N, French M, Smith D, Cooper DA. HIV protease inhibitor substitution in patients with lipodystrophy: a randomized, controlled, open-label, multicentre study. AIDS 2001; 15:1811-22. [PMID: 11579243 DOI: 10.1097/00002030-200109280-00010] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lipodystrophy, dyslipidaemia and insulin resistance often complicate protease inhibitor-containing antiretroviral therapy. The aims of this study were to determine if these are reversible with continued HIV suppression following protease inhibitor substitution. METHODS Eighty-one HIV protease inhibitor recipients (78 male; mean antiretroviral therapy, 55 months) with predominant peripheral lipoatrophy, HIV RNA < 400 copies/ml plasma for at least the preceding 6 months, and no prior abacavir, non-nucleoside analogue or adefovir therapy were randomized 3 : 2 to continue nucleoside analogues and substitute protease inhibitor(s) with abacavir, nevirapine, adefovir and hydroxyurea (n = 49) or to continue all therapy (n = 32) with an option to switch at week 24. The primary endpoints were total body fat and HIV RNA at week 24. Other assessments were regimen safety, regional body composition, metabolic parameters, quality of life, and CD4 T-lymphocyte counts to week 48. RESULTS There was a greater decline in total body fat in the switch group than in the continue group (-1.6 and -0.4 kg, respectively at week 24; P = 0.006). This comprised greater declines in limb and subcutaneous abdominal fat, and in intra-abdominal fat of patients with moderate or severe abdominal fat accumulation. Viral suppression was similar, despite 18 (37%) switch group patients ceasing at least one study drug by week 24 because of adverse events. Total cholesterol and triglycerides declined more in the switch group (both P < 0.002). High density lipoprotein cholesterol increased significantly in both groups at week 48 (P < 0.02). There was no change for any glycaemic parameter. CONCLUSIONS In predominantly lipoatrophic patients, switching from HIV protease inhibitor therapy lead to improved lipids and less intra-abdominal fat, but also to less peripheral fat, and had minimal effect on insulin resistance. Virological control in these heavily pretreated patients was unaffected, despite frequent switch drug cessations.
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Affiliation(s)
- A Carr
- HIV, Immunology and Infectious Disease Clinical Services Unit, St. Vincent's Hospital, Sydney, Australia
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Dunne AL, Mitchell FM, Coberly SK, Hellmann NS, Hoy J, Mijch A, Petropoulos CJ, Mills J, Crowe SM. Comparison of genotyping and phenotyping methods for determining susceptibility of HIV-1 to antiretroviral drugs. AIDS 2001; 15:1471-5. [PMID: 11504978 DOI: 10.1097/00002030-200108170-00003] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [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(S) To compare antiretroviral resistance susceptibility testing of patient HIV-1 strains using genotype and phenotype methods. DESIGN Eighteen plasma samples with viral load > 2000 HIV-1 RNA copies/ml were randomly selected for testing by both methods. Disease and treatment data were available for all patients. METHODS Samples were analysed genotypically using a kit assay (HIV-1 Genotyping Systems, Applied Biosystems), performed by the Clinical Research Laboratory at Macfarlane Burnet Centre for Medical Research. Samples were analysed phenotypically using a rapid phenotypic assay (PhenoSenseTM HIV, ViroLogic), performed by the manufacturer. Results from both methods were interpreted using a defined protocol. Each susceptibility assay was performed and interpreted by individuals unaware of either the clinical data or the results of the other susceptibility assay. Concordance was defined categorically as either the presence of reduced susceptibility (> 2.5-fold change) in the phenotypic assay and resistance associated mutations in the genotypic assay, or the absence of these findings in both assays. RESULTS Concordance between phenotypic and genotypic susceptibility testing was 81% for nucleoside reverse transcriptase inhibitors, 91% for non-nucleoside reverse transcriptase inhibitors and 90% for protease inhibitors. Complete concordance between phenotype and genotype for all 14 drugs evaluated was observed in three (17%) patient samples. CONCLUSIONS Phenotypic and genotypic susceptibility appear to provide similar results. However, interpretation of genotypic results can be complicated, and both methods still require clinical validation.
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Affiliation(s)
- A L Dunne
- Macfarlane Burnet Centre for Medical Research, Fairfield, Victoria, Australia
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Judd FK, Cockram AM, Komiti A, Mijch AM, Hoy J, Bell R. Depressive symptoms reduced in individuals with HIV/AIDS treated with highly active antiretroviral therapy: a longitudinal study. Aust N Z J Psychiatry 2000; 34:1015-21. [PMID: 11127611 DOI: 10.1080/000486700278] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aims of this study were to investigate the stability of depressive symptoms over time, explore possible reasons for the genesis of depressive symptoms, examine psychosocial adjustment over time and examine the effects of the introduction of highly active antiretroviral therapy (HAART) in a group of HIV infected patients. METHOD HIV seropositive outpatients were assessed at 6 monthly intervals over a 2-year period. At each assessment patients completed the Beck Depression Inventory, the Life Event Inventory, the Core Bereavement Item questionnaire and the Psychosocial Adjustment to Illness Scale. Details regarding HIV illness progression and antiretroviral treatment were recorded for each follow-up assessment. RESULTS One hundred and sixty-three patients completed the baseline assessment and proceeded to the 2-year follow-up study. Most patients remained well over the 2-year follow-up period; mean CD4 count for the group increased over the study period. Ten patients developed AIDS and 18 patients died. Antiretroviral medications changed significantly during the follow-up, with most patients changing to combination (triple) therapy, which included the use of a protease inhibitor. Psychosocial stressors (life event distress and number of bereavements) reduced as the study progressed. Reported depressive symptoms decreased over time and psychosocial adjustment to illness tended to improve over the 2-year period. CONCLUSIONS Over a 2-year follow-up period HIV/AIDS symptoms and illness markers and psychosocial adjustment to illness improved, psychological stressors and depressive symptoms decreased, with a temporal relationship to changes in antiretroviral therapy.
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Affiliation(s)
- F K Judd
- Department of Psychiatry, The University of Melbourne, Royal Melbourne Hospital, Australia.
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Carr A, Chuah J, Hudson J, French M, Hoy J, Law M, Sayer D, Emery S, Cooper DA. A randomised, open-label comparison of three highly active antiretroviral therapy regimens including two nucleoside analogues and indinavir for previously untreated HIV-1 infection: the OzCombo1 study. AIDS 2000; 14:1171-80. [PMID: 10894281 DOI: 10.1097/00002030-200006160-00014] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [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: 11/25/2022]
Abstract
BACKGROUND Highly active antiretroviral therapy (HAART) including two nucleoside analogues and a potent protease inhibitor is standard of care initial therapy for HIV-infected adults. The best-tolerated and most potent initial HAART regimen is unknown and was investigated in this study. METHODS One hundred and nine HIV-infected adults with no prior antiretroviral therapy, and CD4 lymphocyte counts < 500 x 10(6) cells/l or plasma HIV RNA > 30,000 copies/ml were randomized to zidovudine-lamivudine-indinavir (ZDV-3TC-IDV), stavudine-lamivudine-indinavir (d4T-3TC-IDV) or stavudine-didanosine-indinavir (d4T-ddI-IDV) for 52 weeks. The primary endpoints were plasma HIV RNA and drug-related adverse events. Other assessments were overall safety, adherence and adverse events, CD4 lymphocyte counts, cutaneous delayed type hypersensitivity (DTH) responses and quality of life (Euroqol). RESULTS Only 58% patients had HIV RNA < 50 copies/ml plasma at 12 months, with no significant difference between the three regimes (P = 0.34). Drug-related adverse events sufficiently severe to warrant drug discontinuation were less common (P = 0.06) in patients receiving d4T-3TC-IDV (18%) than in those receiving ZDV-3TC-IDV (34%) or d4T-ddI-IDV (41%). The percentages of patients who remained on their assigned therapy with plasma HIV RNA < 50 copies/ml at 52 weeks were 60% with d4T-3TC-IDV, 53% with ZDV-3TC-IDV and 35% with d4T-ddI-IDV. Virological failure at 52 weeks was more likely in those whose adherence was estimated to be < 100% in the first 4 weeks of therapy (P = 0.02), but not in those who developed grade 3 or 4 drug-related adverse events. At 52 weeks, the mean CD4 lymphocyte count increase was 200 x 10(6) cells/l with only 7% of patients having counts lower than at baseline; DTH responses improved but remained clinically impaired in most patients. Quality of life improved significantly in all groups. CONCLUSIONS Initial HAART regimens including IDV failed to suppress plasma HIV RNA to < 50 copies/ml in > 40% patients after only 12 months of therapy although there was significant overall improvement immunologically and in quality of life. The type of dual nucleoside combination used was less important in predicting virological failure than was imperfect adherence early in therapy. Consideration should be given to modifying a HAART regimen relatively early in non-adherent patients.
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Affiliation(s)
- A Carr
- HIV, Immunology and Infectious Disease Clinical Services Unit, St. Vincent's Hospital, Sydney, Australia.
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Affiliation(s)
- J Hoy
- Clinical Research Section, Alfred Hospital, Melbourne, Victoria, Australia
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Hoy J, Venn A, Halliday J, Kovacs G, Waalwyk K. Perinatal and obstetric outcomes of donor insemination using cryopreserved semen in Victoria, Australia. Hum Reprod 1999; 14:1760-4. [PMID: 10402384 DOI: 10.1093/humrep/14.7.1760] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [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: 11/14/2022] Open
Abstract
This study compared the perinatal and obstetric outcomes of 1552 donor insemination pregnancies in Victoria, Australia, with a control group of 7717 normally conceived pregnancies from the general population. Data on the outcomes of pregnancies of at least 20 weeks gestation, for both groups, were obtained from the same population-based birth registry. The study showed that there were no significant differences between the donor insemination and control groups in the incidence of preterm birth, low birthweight, multiple birth, perinatal death and birth defects, or in the sex ratio. Pregnancies conceived by donor insemination were significantly more likely than controls to have an induced labour (OR = 1.6, 95% CI 1. 4-1.8), a forceps delivery (OR = 1.5, 95% CI 1.3-1.8) and/or a Caesarean section (OR = 1.6, 95% CI 1.4-1.9) and to develop pre-eclampsia (OR = 1.4, 95% CI 1.2-1.8) after adjusting for maternal age, multiple birth, parity and presentation. Reasons for the higher rate of induced and operative deliveries are not clear. Overall, the study's findings are reassuring for couples considering infertility treatment with donor insemination. The study illustrates the importance of complete follow-up in studies of pregnancy outcomes after assisted conception and the use of appropriate population-based control groups with comparable ascertainment of outcomes.
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Affiliation(s)
- J Hoy
- Perinatal Data Collection Unit, Department of Human Services, Victoria 3001, Australia
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Carr A, Emery S, Lloyd A, Hoy J, Garsia R, French M, Stewart G, Fyfe G, Cooper DA. Outpatient continuous intravenous interleukin-2 or subcutaneous, polyethylene glycol-modified interleukin-2 in human immunodeficiency virus-infected patients: a randomized, controlled, multicenter study. Australian IL-2 Study Group. J Infect Dis 1998; 178:992-9. [PMID: 9806026 DOI: 10.1086/515653] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [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: 11/03/2022] Open
Abstract
The safety and activity of outpatient-based continuous intravenous interleukin-2 (CIV IL-2) or a slow-release, polyethylene glycol (PEG)-modified IL-2 were studied in human immunodeficiency virus (HIV)-infected persons with CD4 cell counts between 200 and 500/mm3. One hundred fifteen patients were randomized to antiretroviral therapy plus cyclical CIV IL-2 (n = 27), subcutaneous PEG IL-2 (n = 58), or no IL-2 (n = 30). Toxicity withdrawal rates were low (4% for CIV IL-2 and 7% for PEG IL-2). There were median CD4 cell count increases of 359 and 44 cells/mm3 and a decline of 46 cells/mm3 in the 3 groups, respectively, over 1 year (P < .0001 for each intergroup comparison). CD4 cell count increases were greatest in those with lower HIV RNA load. Delayed-type hypersensitivity scores increased and HLA-DR expression on CD8 cells decreased significantly with IL-2 therapy. HIV RNA levels were unaffected. IL-2 therapy may expand the existing immune repertoire but not immediately reconstitute lost immune function.
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Affiliation(s)
- A Carr
- HIV Medicine Unit, St Vincent's Hospital, Sydney, Australia.
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Crowe S, Hoy J, Mills J. Book Reviews. AIDS Care 1997. [DOI: 10.1080/09540129750124768] [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: 10/16/2022]
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Leenders AC, Reiss P, Portegies P, Clezy K, Hop WC, Hoy J, Borleffs JC, Allworth T, Kauffmann RH, Jones P, Kroon FP, Verbrugh HA, de Marie S. Liposomal amphotericin B (AmBisome) compared with amphotericin B both followed by oral fluconazole in the treatment of AIDS-associated cryptococcal meningitis. AIDS 1997; 11:1463-71. [PMID: 9342068 DOI: 10.1097/00002030-199712000-00010] [Citation(s) in RCA: 220] [Impact Index Per Article: 8.1] [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: 02/05/2023]
Abstract
OBJECTIVE Amphotericin B deoxycholate initial therapy and fluconazole maintenance therapy is the treatment of choice for AIDS-associated cryptococcal meningitis. However, the administration of amphotericin B is associated with considerable toxicity. A potential strategy for reducing the toxicity and increasing the therapeutic index of amphotericin B is the use of lipid formulations of this drug. DESIGN AND METHODS HIV-infected patients with cryptococcal meningitis were randomized to treatment with either liposomal amphotericin B (AmBisome) 4 mg/kg daily or standard amphotericin B 0.7 mg/kg daily for 3 weeks, each followed by fluconazole 400 mg daily for 7 weeks. During the first 3 weeks, clinical efficacy was assessed daily. Mycological response was primarily evaluated by cerebrospinal fluid (CSF) cultures at days 7, 14, 21 and 70. RESULTS Of the 28 evaluable patients, 15 were assigned to receive AmBisome and 13 to receive amphotericin B. Baseline characteristics were comparable. The time to and the rate of clinical response were the same in both arms. AmBisome therapy resulted in a CSF culture conversion within 7 days in six out of 15 patients versus one out of 12 amphotericin B-treated patients (P = 0.09), within 14 days in 10 out of 15 AmBisome patients versus one out of nine amphotericin B patients (P = 0.01), and within 21 days in 11 out of 15 AmBisome patients versus three out of eight amphotericin B patients (P = 0.19). When Kaplan-Meier estimates were used to compare time to CSF culture conversion, AmBisome was more effective (P < 0.05; median time between 7 and 14 days for AmBisome versus > 21 days for amphotericin B). AmBisome was significantly less nephrotoxic. CONCLUSIONS A 3-week course of 4 mg/kg AmBisome resulted in a significantly earlier CSF culture conversion than 0.7 mg/kg amphotericin B, had equal clinical efficacy and was significantly less nephrotoxic when used for the treatment of primary episodes of AIDS-associated cryptococcal meningitis.
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Stuart RL, Hellard ME, Jolley D, Spelman D, Hoy J, Stevenson EM, Yates MT, Ryan NJ, Fairley CK. Cryptosporidiosis in patients with AIDS. Int J STD AIDS 1997; 8:339-41. [PMID: 9175659 DOI: 10.1258/0956462971920064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cases of cryptosporidiosis in patients with the acquired immunodeficiency syndrome (AIDS) residing in Melbourne over a 6-year period (1990-1995) are described. During this period 85 cases occurred, while 979 new AIDS diagnoses were notified. Over this period temporal clustering in cryptosporidial detection was evident (P=0.007), but the pattern was not statistically associated with the season, rainfall (P=0.88), mean average maximal temperature (P=0.15) or mean average minimal temperature. Further studies should identify these risk factors and provide an opportunity to prevent this devastating disease.
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Affiliation(s)
- R L Stuart
- Department of Epidemiology & Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran, Victoria, Australia
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de Jong MD, Vella S, Carr A, Boucher CA, Imrie A, French M, Hoy J, Sorice S, Pauluzzi S, Chiodo F, Weverling GJ, van der Ende ME, Frissen PJ, Weigel HM, Kauffmann RH, Lange JM, Yoon R, Moroni M, Hoenderdos E, Leitz G, Cooper DA, Hall D, Reiss P. High-dose nevirapine in previously untreated human immunodeficiency virus type 1-infected persons does not result in sustained suppression of viral replication. J Infect Dis 1997; 175:966-70. [PMID: 9086161 DOI: 10.1086/514002] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
High-dose nevirapine treatment has been reported to confer sustained antiretroviral effects, despite a rapid development of resistance. The use of this strategy was evaluated in 20 previously untreated human immunodeficiency virus type 1 (HIV-1) p24 antigenemic persons with CD4 cell counts between 100 and 500/mm3. Treatment consisted of 400 mg of nevirapine, after a 2-week lead-in dose of 200 mg. Rash was the most frequently reported adverse event, occurring in 25%. While sustained declines in p24 antigen levels were observed in the majority, serum HIV-1 RNA load and CD4 cell counts returned to baseline values within 12 weeks in virtually all subjects. The resistance-conferring tyrosine-to-cysteine substitution at reverse transcriptase position 181 was detected after 4 weeks in most subjects. These observations suggest that plasma drug levels attained with high-dose nevirapine were not sufficient to inhibit nevirapine-resistant virus, although they were approximately 2-fold higher than reported IC50 values of resistant virus.
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Affiliation(s)
- M D de Jong
- National AIDS Therapy Evaluation Centre, Department of Infectious Diseases, University of Amsterdam, Netherlands
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Newell M, Goldstein D, Milliken S, Lewis C, Hoy J, Thomson B, Cooper D. Phase I/II trial of filgrastim (r-metHuG-CSF), CEOP chemotherapy and antiretroviral therapy in HIV-related non-Hodgkin's lymphoma. Ann Oncol 1996; 7:1029-36. [PMID: 9037361 DOI: 10.1093/oxfordjournals.annonc.a010495] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A phase I/II trial determined the maximum tolerated dose (MTD) of CEOP for AIDS-related non-Hodgkin's lymphoma (NHL) with concurrent filgrastim and antiretroviral therapy. PATIENTS AND METHODS Fourteen AIDS-NHL patients, chemotherapy naïve and ECOG performance status < 2 received filgrastim 1.0 microgram/kg s.c. daily for 3-7 days to assess neutrophil response, followed by CEOP with filgrastim support 10 micrograms/kg s.c. daily, day 2-14, continued if the absolute neutrophil count (ANC) < 1.2 x 10(9)/l. Two CEOP dose cohorts were used: cohort 1 (5 patients) - cyclophosphamide (C) 500 mg/m2, epirubicin (E) 37.5 mg/m2, vincristine (O) 2 mg and prednisolone (P) 75 mg/m2 daily on days 1-5; cohort 2 (9 patients) - C 750 mg/m2, E 50 mg/m2, same doses of O and P. Antiretroviral therapy was maintained (zidovudine-10, ddI-3, both-1). RESULTS In cohort 1, 4/5 patients received at least 3 courses of CEOP with one complete response after five cycles and four progressions. Four have died (3-21 months after entry) with 1 alive at 40 months. Dose limiting toxicity (DLT - grade IV febrile neutropenia in cycle 1) occurred in 1 patient. In cohort 2, 5/9 completed > or = 5 cycles with 6 complete responses, 1 partial response and 2 progressions, 6 deaths and 3 alive at > 33 months. DLT (evaluable in 8 patients) occurred in two patients. Median survival for both cohorts was 17 months. Mean relative dose intensity was > 85%. CONCLUSIONS The dosages of CEOP in cohort 1 defined the MTD however, the cohort 2 doses with filgrastim and antiretroviral therapy gave an encouraging response, acceptable toxicities and merit further study.
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Affiliation(s)
- M Newell
- National Center in HIV Epidemiology and Clinical Research, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Abstract
A patient who developed an acute brainstem syndrome following Mycoplasma pneumoniae respiratory infection is reported. MRI showed changes consistent with brainstem demyelination. Clinical features and laboratory investigations support an immune mediated mechanism with no evidence of direction CNS invasion. On the basis of this case and a review of the literature, we postulate two mechanisms for the development of M. pneumoniae associated CNS disease: direct CNS invasion causing meningitis and an immune-mediated acute disseminated encephalomyelitis (ADEM). This has obvious therapeutic implications.
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Affiliation(s)
- M Pellegrini
- Department of Clinical Neurosciences, St. Vincent's Hospital, Victoria, Australia
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Hurley SF, Kaldor JM, Carlin JB, Gardiner S, Evans DB, Chondros P, Hoy J, Spelman D, Spicer WJ, Wraight H. The usage and costs of health services for HIV infection in Australia. AIDS 1995; 9:777-85. [PMID: 7546424 DOI: 10.1097/00002030-199507000-00016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [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: 01/25/2023]
Abstract
OBJECTIVE To describe patterns of health-service usage and the resulting costs in 1992-1993 for Australian men. DESIGN A prospective survey, stratified by phase of illness. SETTING Hospital and community-based care. PATIENTS A total of 128 homosexual men: 20 in phase 1 (CD4+ count > or = 500 x 10(6)/l), 31 in phase 2 (CD4+ count < 500 and > or = 200 x 10(6)/l), 30 in phase 3 (CD4+ count < 200 x 10(6)/l), and 47 in phase 4 (AIDS). MAIN OUTCOME MEASURES Mean monthly service usage rates and costs. RESULTS Health-service utilization increased and became more hospital-based as illness worsened; the main exception was use of antiretroviral drugs, which peaked in phases 2 and 3. Hospital admission was rare before diagnosis of AIDS. Hospital bed-days per patient per month averaged 3.3 for AIDS patients until the final 3 months of life increasing to 15.8 in the 3 months before death. Mean monthly costs (in 1992-1993 Australian dollars) were $331 [95% confidence interval (CI), 218-455] in phase 1, $667 (95% CI, 540-836) in phase 2, $1372 (95% CI, 1044-1776) in phase 3, and $4615 (95% CI, 3456-5985) for AIDS patients until the last 3 months of life and $13,308 (95% CI, 10,538-16,516) in the 3 months before death. Drugs comprised 57% of total costs in phase 1, but only 30% of costs for patients with AIDS, whereas hospital bed-days comprised 10% of phase 1 costs and 60% of AIDS costs. CONCLUSIONS Health-care utilization and resulting costs increased with severity of illness, and were particularly high for AIDS patients in the 3 months before death. Service-utilization patterns and components of costs varied between each phase.
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Affiliation(s)
- S F Hurley
- Department of Public Health and Community Medicine, University of Melbourne, Victoria, Australia
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Lewin SR, Hoy J, Crowe SM, McDonald CF. The role of bronchoscopy in the diagnosis and treatment of pulmonary disease in HIV-infected patients. Aust N Z J Med 1995; 25:133-9. [PMID: 7605295 DOI: 10.1111/j.1445-5994.1995.tb02825.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Pulmonary disease is the most common reason for presentation and the major cause of death in HIV-infected patients. There has been an evolution in the optimal approach to the investigation of a pulmonary infiltrate in HIV-infected patients since the introduction of induced sputum for the diagnosis of Pneumocystis carinii pneumonia (PCP). AIMS To evaluate the usefulness of flexible fibreoptic bronchoscopy (FFB), bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) and bronchial brushings (BB) in the diagnosis of pulmonary disease in HIV-infected patients and to examine the effect of FFB on changes in therapy and survival. METHODS The histories of all HIV-infected patients referred to Fairfield Hospital for FFB between January 1990 and June 1993 were examined retrospectively. RESULTS Forty-two FFB were performed on 41 patients (40 male and one female). Definitive diagnoses made at FFB included Kaposi's sarcoma (KS) (n = 9), invasive aspergillosis (n = 5), PCP (n = 4), Mycobacterium avium complex (MAC) pneumonia (n = 2), cytomegalovirus (CMV) pneumonia (n = 1), Cryptococcus neoformans pneumonia (n = 1), microsporidium (n = 1) and Pseudomonas aeruginosa pneumonia (n = 1). TBB and BB did not provide a diagnosis for diseases not seen macroscopically at FFB or diagnosed by BAL. FFB findings altered diagnosis in 21/42 (50%) presentations and changed therapy in 26/42 (62%) cases. CONCLUSIONS FFB together with BAL altered the working diagnosis and changed therapy in a significant number of patients. TBB and BB should not be routinely performed in all patients as these procedures are of limited value in this setting.
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Tachedjian G, Hoy J, McGavin K, Birch C. Long-term foscarnet therapy not associated with the development of foscarnet-resistant human immunodeficiency virus type 1 in an acquired immunodeficiency syndrome patient. J Med Virol 1994; 42:207-11. [PMID: 7512615 DOI: 10.1002/jmv.1890420220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Sequential human-immunodeficiency virus type 1 (HIV-1) isolates from an acquired immunodeficiency syndrome (AIDS) patient on long-term foscarnet and zidovudine therapy were examined for the emergence of foscarnet resistance. One isolate obtained before therapy, and three post-foscarnet therapy HIV isolates had similar foscarnet sensitivity profiles, despite the emergence of foscarnet-resistant herpes simplex virus type 2 (HSV-2) during the period of therapy. Virion reverse transcriptases from these isolates were also equally inhibited by foscarnet. In contrast, sequential HIV isolates taken pre- and postzidovudine therapy showed a gradual increase in IC50 to this drug. In this patient, long-term foscarnet and zidovudine therapy selected foscarnet-resistant HSV and zidovudine-resistant HIV; in contrast, HIV remained susceptible to foscarnet. Concurrent administration of other anti-HIV drugs (zidovudine and interferon-alpha) may have hindered the development of foscarnet resistant HIV-1 in vivo.
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Affiliation(s)
- G Tachedjian
- Macfarlane Burnet Centre for Medical Research, Fairfield Hospital, Victoria, Australia
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Dixon PS, Flanigan TP, DeBuono BA, Laurie JJ, De Ciantis ML, Hoy J, Stein M, Scott HD, Carpenter CC. Infection with the human immunodeficiency virus in prisoners: meeting the health care challenge. Am J Med 1993; 95:629-35. [PMID: 8259780 DOI: 10.1016/0002-9343(93)90359-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The magnitude and the scope of health care problems posed by human prison inmates seropositive for the human immunodeficiency virus (HIV) are enormous. Prisoners represent a substantial proportion of HIV-infected individuals in North America. A high proportion of prisoners are intravenous drug users who often have not received appropriate health care or HIV-directed services prior to incarceration. Health care of HIV-seropositive prisoners and follow-up medical care after prison release has often been less than optimal. Among inmates at the prison facility in Rhode Island, 4% of the men and 12% of the women are HIV seropositive. The Brown University medical community, in conjunction with the Rhode Island Department of Health and Corrections, has developed an effective program for the health care of such prisoners, both during incarceration and after release from prison. Academic medical centers are uniquely poised to assume the leading role in meeting this obligation. We believe that this general approach, with region-specific modifications, may be effectively applied in many correctional institutions in North America.
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Abstract
BACKGROUND Malignant mesothelioma reportedly shows different epidemiology and pathology in females, and a proportion are believed to arise spontaneously. METHODS One hundred and seventy seven cases of malignant mesothelioma in females were reviewed, examined by histochemistry and immunohistochemistry, assessed for asbestosis and lung fibre burden by transmission electron microscopy with energy dispersive x ray analysis, and compared with 31 female controls. RESULTS Two of one hundred and three cases tested for carcinoembryonic antigen were positive and were excluded from further analysis. Tumour cases showed increased amphibole burdens; in those in whom exposure information was known, 74 (80%) of 93 patients had a history of exposure to asbestos. Seventy two (47%) of 152 patients had lung fibrosis. Tumour site and histological type were little different from those reported in adult males. Mixed type histological pattern, lung fibrosis, and peritoneal site were associated with heavier lung asbestos burdens, but not exclusively. Thirty five (30%) of 117 patients had amphibole burdens of less than 2 x 10(6) fibres/g; the sites affected and the histological pattern of tumours in this group were similar to those in cases with amphibole fibre counts of > or = 2 x 10(6)/g lung. A higher lung amphibole burden than the mean burden in control females was found in 115 (98%) of 117 patients tested. CONCLUSIONS The pathology of malignant mesothelioma appears to be similar in women and in men, and in cases associated and unassociated with asbestos.
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Affiliation(s)
- A Dawson
- Department of Histopathology, Llandough Hospital, Penarth, South Glamorgan, UK
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Abstract
OBJECTIVE To determine the relationship between the development of hepatitis C antibody (anti-HCV) and the clinical symptoms in acute hepatitis C. DESIGN Retrospective analysis of sera from patients with acute non-A non-B hepatitis. SETTING AND PATIENTS Patients admitted to Fairfield Hospital with the diagnosis of acute non-A non-B hepatitis between 1979 and 1989. Inclusion criteria included a typical clinical illness, accompanied by an alanine aminotransferase level of more than 2.5 times the upper limit of normal (normal, less than or equal to 40 U/L) and negative serological test results for acute hepatitis A and B. MAIN OUTCOME MEASURE Time to develop anti-HCV after the onset of symptoms in patients with acute hepatitis C. RESULTS Seroconversion was demonstrated in 26 of the 128 patients who fulfilled the inclusion criteria. In these patients, antibody was detected between one week and 32 weeks after the onset of dark urine; more than half the patients (54%) had seroconverted by four weeks and a third (34%) developed antibodies within two weeks. Of 20 patients who had sera collected within four weeks of the onset of dark urine, 14 (70%) had developed antibody. CONCLUSION These results suggest that in patients with community-acquired hepatitis C, seroconversion occurs significantly earlier than is observed in patients who have been infected by blood transfusion. Sera taken shortly after the onset of symptomatic hepatitis C may be useful in the diagnosis of this condition.
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