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Eisner J, Harvey D, Dunn D, Jones J, Byars A, Fastenau P, Austin J, Hermann B, Oyegbile-Chidi T. Long-term characterization of cognitive phenotypes in children with seizures over 36 months. Epilepsy Behav 2024; 154:109742. [PMID: 38554647 DOI: 10.1016/j.yebeh.2024.109742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/19/2024] [Accepted: 03/10/2024] [Indexed: 04/02/2024]
Abstract
RATIONALE Children with new-onset epilepsies often exhibit co-morbidities including cognitive dysfunction, which adversely affects academic performance. Application of unsupervised machine learning techniques has demonstrated the presence of discrete cognitive phenotypes at or near the time of diagnosis, but there is limited knowledge of their longitudinal trajectories. Here we investigate longitudinally the presence and progression of cognitive phenotypes and academic status in youth with new-onset seizures as sibling controls. METHODS 282 subjects (6-16 years) were recruited within 6 weeks of their first recognized seizure along with 167 unaffected siblings. Each child underwent a comprehensive neuropsychological assessment at baseline, 18 and 36 months later. Factor analysis of the neuropsychological tests revealed four underlying domains - language, processing speed, executive function, and verbal memory. Latent trajectory analysis of the mean factor scores over 36 months identified clusters with prototypical cognitive trajectories. RESULTS Three unique phenotypic groups with distinct cognitive trajectories over the 36-month period were identified: Resilient, Average, and Impaired phenotypes. The Resilient phenotype exhibited the highest neuropsychological factor scores and academic performance that were all similar to controls; while the Impaired phenotype showed the polar opposite with the worst performances across all test metrics. These findings remained significant and stable over 36 months. Multivariate logistic regression indicated that age of onset, EEG, neurological examination, and sociodemographic disadvantage were associated with phenotype classification. CONCLUSIONS This study demonstrates the presence of diverse latent cognitive trajectory phenotypes over 36 months in youth with new-onset seizures that are associated with a stable neuropsychological and academic performance longitudinally.
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Affiliation(s)
- Jordan Eisner
- Department of Neurology, University of California Davis, Sacramento, CA 95817, USA
| | - Danielle Harvey
- Department of Public Health Sciences, University of California Davis, Davis, CA 95616, USA
| | - David Dunn
- Departments of Psychiatry and Neurology, Indiana University, Indianapolis, IN 46202, USA
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, Cincinnati, OH 45229, USA
| | - Philip Fastenau
- Department of Neurology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Joan Austin
- Distinguished Professor Emerita, School of Nursing, Indiana University, Indianapolis, IN 46202, USA
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
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Moore AE, Burns JE, Sally D, Milinkovic A, Krokos G, John J, Rookyard C, Borca A, Pool ER, Tostevin A, Harman A, Dulnoan DS, Gilson R, Arenas-Pinto A, Cook GJ, Saunders J, Dunn D, Blake GM, Pett SL. Bone turnover change after randomized switch from tenofovir disoproxil to tenofovir alafenamide fumarate in men with HIV. AIDS 2024; 38:521-529. [PMID: 38061030 PMCID: PMC10906193 DOI: 10.1097/qad.0000000000003811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/24/2023] [Accepted: 10/05/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Bone loss in people with HIV (PWH) is poorly understood. Switching tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) has yielded bone mineral density (BMD) increases. PETRAM (NCT#:03405012) investigated whether BMD and bone turnover changes correlate. DESIGN Open-label, randomized controlled trial. SETTING Single-site, outpatient, secondary care. PARTICIPANTS Nonosteoporotic, virologically suppressed, cis-male PWH taking TDF/emtricitabine (FTC)/rilpivirine (RPV) for more than 24 weeks. INTERVENTION Continuing TDF/FTC/RPV versus switching to TAF/FTC/RPV (1 : 1 randomization). MAIN OUTCOME MEASURES :[ 18 F]NaF-PET/CT for bone turnover (standardized uptake values, SUV mean ) and dual-energy x-ray absorptiometry for lumbar spine and total hip BMD. RESULTS Thirty-two men, median age 51 years, 76% white, median duration TDF/FTC/RPV 49 months, were randomized between 31 August 2018 and 09 March 2020. Sixteen TAF:11 TDF were analyzed. Baseline-final scan range was 23-103 (median 55) weeks. LS-SUV mean decreased for both groups (TAF -7.9% [95% confidence interval -14.4, -1.5], TDF -5.3% [-12.1,1.5], P = 0.57). TH-SUV mean showed minimal changes (TAF +0.3% [-12.2,12.8], TDF +2.9% [-11.1,16.9], P = 0.77). LS-BMD changes were slightly more favorable with TAF but failed to reach significance (TAF +1.7% [0.3,3.1], TDF -0.3 [-1.8,1.2], P = 0.06). Bone turnover markers decreased more with TAF ([CTX -35.3% [-45.7, -24.9], P1NP -17.6% [-26.2, -8.5]) than TDF (-11.6% [-28.8, +5.6] and -6.9% [-19.2, +5.4] respectively); statistical significance was only observed for CTX ( P = 0.02, P1NP, P = 0.17). CONCLUSION Contrary to our hypothesis, lumbar spine and total hip regional bone formation (SUV mean ) and BMD did not differ postswitch to TAF. However, improved LS-BMD and CTX echo other TAF-switch studies. The lack of difference in SUV mean may be due to inadequate power.
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Affiliation(s)
- Amelia E.B. Moore
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
- Osteoporosis Unit, Guy's and St Thomas’ NHS Foundation Trust
| | - James E. Burns
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Deirdre Sally
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Ana Milinkovic
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Georgios Krokos
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - Joemon John
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - Christopher Rookyard
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - Alessandro Borca
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Erica R.M. Pool
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Anna Tostevin
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
| | - Alyss Harman
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | | | - Richard Gilson
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Alejandro Arenas-Pinto
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Gary J.R. Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - John Saunders
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - David Dunn
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
| | - Glen M. Blake
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital, London, UK
| | - Sarah L. Pett
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
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Cozzi-Lepri A, Dunn D, Tostevin A, Marvig RL, Bennedbaek M, Sharma S, Kozal MJ, Gompels M, Pinto AN, Lundgren J, Baxter JD. Rate of response to initial antiretroviral therapy according to level of pre-existing HIV-1 drug resistance detected by next-generation sequencing in the strategic timing of antiretroviral treatment (START) study. HIV Med 2024; 25:212-222. [PMID: 37775947 PMCID: PMC10872720 DOI: 10.1111/hiv.13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES The main objective of this analysis was to evaluate the impact of pre-existing drug resistance by next-generation sequencing (NGS) on the risk of treatment failure (TF) of first-line regimens in participants enrolled in the START study. METHODS Stored plasma from participants with entry HIV RNA >1000 copies/mL were analysed using NGS (llumina MiSeq). Pre-existing drug resistance was defined using the mutations considered by the Stanford HIV Drug Resistance Database (HIVDB v8.6) to calculate the genotypic susceptibility score (GSS, estimating the number of active drugs) for the first-line regimen at the detection threshold windows of >20%, >5%, and >2% of the viral population. Survival analysis was conducted to evaluate the association between the GSS and risk of TF (viral load >200 copies/mL plus treatment change). RESULTS Baseline NGS data were available for 1380 antiretroviral therapy (ART)-naïve participants enrolled over 2009-2013. First-line ART included a non-nucleoside reverse transcriptase inhibitor (NNRTI) in 976 (71%), a boosted protease inhibitor in 297 (22%), or an integrase strand transfer inhibitor in 107 (8%). The proportions of participants with GSS <3 were 7% for >20%, 10% for >5%, and 17% for the >2% thresholds, respectively. The adjusted hazard ratio of TF associated with a GSS of 0-2.75 versus 3 in the subset of participants with mutations detected at the >2% threshold was 1.66 (95% confidence interval 1.01-2.74; p = 0.05) and 2.32 (95% confidence interval 1.32-4.09; p = 0.003) after restricting the analysis to participants who started an NNRTI-based regimen. CONCLUSIONS Up to 17% of participants initiated ART with a GSS <3 on the basis of NGS data. Minority variants were predictive of TF, especially for participants starting NNRTI-based regimens.
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Affiliation(s)
| | - David Dunn
- Institute for Global Health, UCL, London, UK
| | | | - Rasmus L Marvig
- Center for Genomic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marc Bennedbaek
- Virus Research and Development Laboratory, Virus and Microbiological Special Diagnostics, Statens Serum Institute, Copenhagen, Denmark
| | - Shweta Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | - Angie N Pinto
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Jens Lundgren
- Copenhagen HIV Programme, Rigs Hospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John D Baxter
- Cooper Medical School of Rowan University and Cooper University Health Care, Camden, New Jersey, USA
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Witzel TC, Nicholls EJ, McCabe L, Weatherburn P, McCormack S, Bonell C, Gafos M, Lampe FC, Speakman A, Dunn D, Ward D, Phillips AN, Pebody R, Gabriel MM, Collaco-Moraes Y, Rodger AJ, Burns FM. Understanding experiences of potential harm among MSM (cis and trans) using HIV self-testing in the SELPHI randomised controlled trial in England and Wales: a mixed-methods study. Sex Transm Infect 2023; 99:534-540. [PMID: 37607814 PMCID: PMC10715485 DOI: 10.1136/sextrans-2023-055840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/15/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The potential of HIV self-testing (HIVST) to cause harm is a concern hindering widespread implementation. The aim of this paper is to understand the relationship between HIVST and harm in SELPHI (An HIV Self-testing Public Health Intervention), the largest randomised trial of HIVST in a high-income country to date. METHODS 10 111 cis and trans men who have sex with men (MSM) recruited online (geolocation social/sexual networking apps, social media), aged 16+, reporting previous anal intercourse and resident in England or Wales were first randomised 60/40 to baseline HIVST (baseline testing, BT) or not (no baseline testing, nBT) (randomisation A). BT participants reporting negative baseline test, sexual risk at 3 months and interest in further HIVST were randomised to three-monthly HIVST (repeat testing, RT) or not (no repeat testing, nRT) (randomisation B). All received an exit survey collecting data on harms (to relationships, well-being, false results or being pressured/persuaded to test). Nine participants reporting harm were interviewed in-depth about their experiences in an exploratory substudy; qualitative data were analysed narratively. RESULTS Baseline: predominantly cis MSM, 90% white, 88% gay, 47% university educated and 7% current/former pre-exposure prophylaxis (PrEP) users. Final survey response rate was: nBT=26% (1056/4062), BT=45% (1674/3741), nRT=41% (471/1147), RT=50% (581/1161).Harms were rare and reported by 4% (n=138/3691) in exit surveys, with an additional two false positive results captured in other study surveys. 1% reported harm to relationships and to well-being in BT, nRT and RT combined. In all arms combined, being pressured or persuaded to test was reported by 1% (n=54/3678) and false positive results in 0.7% (n=34/4665).Qualitative analysis revealed harms arose from the kit itself (technological harms), the intervention (intervention harms) or from the social context of the participant (socially emergent harms). Intervention and socially emergent harms did not reduce HIVST acceptability, whereas technological harms did. DISCUSSION HIVST harms were rare but strategies to link individuals experiencing harms with psychosocial support should be considered for HIVST scale-up. TRIAL REGISTRATION NUMBER ISRCTN20312003.
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Affiliation(s)
- T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
| | | | - Leanne McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Peter Weatherburn
- Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Christopher Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Mitzy Gafos
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | - David Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | | | - Michelle M Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
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Oyegbile-Chidi T, Harvey D, Dunn D, Jones J, Byars A, Fastenau P, Austin J, Hermann B. The Impact of Sociodemographic Disadvantage on Cognitive Outcomes in Children With Newly Diagnosed Seizures and Their Unaffected Siblings Over 36 Months. Pediatr Neurol 2023; 148:178-188. [PMID: 37742443 DOI: 10.1016/j.pediatrneurol.2023.08.028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Accumulating evidence indicates that children with newly diagnosed epilepsy have comorbidities including cognitive challenges. Research investigating comorbidities has focused on clinical epilepsy characteristics and neurobiological/genetic correlates. The role that sociodemographic disadvantage (SD) may play has received less attention. We investigated the role of SD in cognitive status in youth with newly diagnosed epilepsy over a follow-up of 36 months to determine the degree, extent, and duration of the role of disadvantage. METHODS A total of 289 children (six to 16 years) within six weeks of their first seizure along with 167 siblings underwent comprehensive neuropsychological assessments (intelligence, language, memory, executive function, processing speed, and academic achievement) at baseline, 18 months later, and at 36 months from baseline. Baseline demographic information (race, caregivers education, household income, and parental marital status), clinical epilepsy characteristics (e.g., age of onset), and magnetic resonance imaging (MRI) and electroencephalographic (EEG) information was collected. RESULTS An SD index was computed for each family and categorized into four groups by level of disadvantage. In children and siblings, the least disadvantaged group exhibited the highest Full-Scale IQ, neuropsychological factor scores, and academic performances, whereas the most disadvantaged showed the polar opposite with the worst performances across all tests. Findings remained stable and significant over 36 months. Linear regression analyses indicated that disadvantage was a more constant and stable predictor of cognitive and academic performance over time compared with clinical epilepsy characteristics and MRI/EEG abnormalities. CONCLUSIONS This study indicates the strong association between SD and cognitive/academic performance in children with newly diagnosed epilepsy and their siblings is significant and predictive of three-year cognitive outcomes.
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Affiliation(s)
| | - Danielle Harvey
- Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - David Dunn
- Departments of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, Cincinnati, Ohio
| | - Philip Fastenau
- Department of Neurology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joan Austin
- Distinguished Professor Emerita, School of Nursing, Indiana University, Indianapolis, Indiana
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Oyegbile-Chidi T, Harvey D, Jones J, Byars A, Austin J, Hermann B, Dunn D. Impact of sociodemographic disadvantage on neurobehavioral outcomes in children with newly diagnosed seizures and their unaffected siblings over 36 months. Epilepsia 2023; 64:2172-2185. [PMID: 37264778 PMCID: PMC10526637 DOI: 10.1111/epi.17672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study was undertaken to determine the short-term and longer term impact of sociodemographic disadvantage on the emotional-behavioral status of youths with new onset epilepsy and their unaffected siblings at the time of diagnosis and the subsequent 3 years. METHODS Three hundred twelve youths with newly diagnosed epilepsies and 223 unaffected siblings, aged 6-16 years, were independently assessed regarding their emotional and behavioral status by their parents and teachers at baseline, and at 18 at 36 months later; youths with seizures also completed self-report measures of depression, anxiety, and hostility at those three time points. A sociodemographic disadvantage score was computed for each family (children with newly diagnosed seizures and their siblings), and families were separated into four categories from most disadvantaged to least disadvantaged. RESULTS In both children and siblings, the least disadvantaged group exhibited the lowest level of neurobehavioral problems, whereas the most disadvantaged group showed a higher level of neurobehavioral problems across all the same behavior metrics. Findings remained stable and significant across all informants (parent, teacher, child) and across all time periods (throughout the 3-year period). Furthermore, both corrected and uncorrected linear regression analyses indicated that disadvantage was a more constant and stable predictor of behavioral and emotional problems over time compared to clinical seizure characteristics and abnormalities in magnetic resonance imaging and electroencephalographic testing. SIGNIFICANCE Sociodemographic disadvantage bears a strong relationship to youths with emotional and behavioral problems both at the time of diagnosis as well as prospectively. The relationship is robust and reflected in reports from multiple informants (parent, teacher, child self-report), evident in siblings as well, and possibly more explanatory than traditional clinical seizure variables. Future studies will be needed to determine whether this disadvantage factor is modifiable with early intervention.
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Affiliation(s)
| | - Danielle Harvey
- Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Anna Byars
- Department of Neurology, Cincinnati, Cincinnati Children's Hospital, University of Cincinnati, Ohio, USA
| | - Joan Austin
- Department of Environments for Health, Indiana University, Indianapolis, Indiana, USA
| | - Bruce Hermann
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David Dunn
- Department of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana, USA
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Zhukova A, Dunn D, Gascuel O. Modeling Drug Resistance Emergence and Transmission in HIV-1 in the UK. Viruses 2023; 15:1244. [PMID: 37376544 DOI: 10.3390/v15061244] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
A deeper understanding of HIV-1 transmission and drug resistance mechanisms can lead to improvements in current treatment policies. However, the rates at which HIV-1 drug resistance mutations (DRMs) are acquired and which transmitted DRMs persist are multi-factorial and vary considerably between different mutations. We develop a method for the estimation of drug resistance acquisition and transmission patterns. The method uses maximum likelihood ancestral character reconstruction informed by treatment roll-out dates and allows for the analysis of very large datasets. We apply our method to transmission trees reconstructed on the data obtained from the UK HIV Drug Resistance Database to make predictions for known DRMs. Our results show important differences between DRMs, in particular between polymorphic and non-polymorphic DRMs and between the B and C subtypes. Our estimates of reversion times, based on a very large number of sequences, are compatible but more accurate than those already available in the literature, with narrower confidence intervals. We consistently find that large resistance clusters are associated with polymorphic DRMs and DRMs with long loss times, which require special surveillance. As in other high-income countries (e.g., Switzerland), the prevalence of sequences with DRMs is decreasing, but among these, the fraction of transmitted resistance is clearly increasing compared to the fraction of acquired resistance mutations. All this indicates that efforts to monitor these mutations and the emergence of resistance clusters in the population must be maintained in the long term.
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Affiliation(s)
- Anna Zhukova
- Bioinformatics and Biostatistics Hub, Institut Pasteur, Université Paris Cité, 75015 Paris, France
| | - David Dunn
- UK MRC Clinical Trials Unit, University College London, London WC1V 6LJ, UK
| | - Olivier Gascuel
- Institut de Systématique, Evolution, Biodiversité (ISYEB)-URM 7205 CNRS, Muséum National d'Histoire Naturelle, SU, EPHE & UA, 75005 Paris, France
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Dunn D, McCabe L, White E, Delpech V, Kirwan PD, Khawam J, Croxford S, Ward D, Brodnicki E, Rodger A, McCormack S. Electronic health records to capture primary outcome measures: two case studies in HIV prevention research. Trials 2023; 24:244. [PMID: 36997941 PMCID: PMC10063429 DOI: 10.1186/s13063-023-07264-6] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND There is increasing interest in the use of electronic health records (EHRs) to improve the efficiency and cost-effectiveness of clinical trials, including the capture of outcome measures. MAIN TEXT We describe our experience of using EHRs to capture the primary outcome measure - HIV infection or the diagnosis of HIV infection - in two randomised HIV prevention trials conducted in the UK. PROUD was a clinic-based trial evaluating pre-exposure prophylaxis (PrEP), and SELPHI was an internet-based trial evaluating HIV self-testing kits. The EHR was the national database of HIV diagnoses in the UK, curated by the UK Health Security Agency (UKHSA). In PROUD, linkage to the UKHSA database was performed at the end of the trial and identified five primary outcomes in addition to the 30 outcomes diagnosed by the participating clinics. Linkage also produced an additional 345 person-years follow-up, an increase of 27% over clinic-based follow-up. In SELPHI, new HIV diagnoses were primarily identified via UKHSA linkage, complemented by participant self-report through internet surveys. Rates of survey completion were low, and only 14 of the 33 new diagnoses recorded in the UKHSA database were also self-reported. Thus UKHSA linkage was essential for capturing HIV diagnoses and the successful conduct of the trial. CONCLUSIONS Our experience of using the UKHSA database of HIV diagnoses as a source of primary outcomes in two randomised trials in the field of HIV prevention was highly favourable and encourages the use of a similar approach in future trials in this disease area.
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Affiliation(s)
- David Dunn
- MRC Clinical Trials Unit at UCL, London, UK.
- Institute for Global Health, University College London, London, UK.
| | | | | | | | | | | | | | | | | | - Alison Rodger
- Institute for Global Health, University College London, London, UK
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9
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Waters L, Winston A, Reeves I, Boffito M, Churchill D, Cromarty B, Dunn D, Fink D, Fidler S, Foster C, Fox J, Gupta R, Hilton A, Khoo S, Leen C, Mackie N, Naous N, Ogbonmwan D, Orkin C, Panton L, Post F, Pozniak A, Sabin C, Walsh J, Walsh J. BHIVA guidelines on antiretroviral treatment for adults living with HIV-1 2022. HIV Med 2022; 23 Suppl 5:3-115. [PMID: 36504313 DOI: 10.1111/hiv.13446] [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] [Accepted: 10/25/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Laura Waters
- Central and North West London NHS Foundation Trust
| | - Alan Winston
- Imperial College London and Imperial College Healthcare NHS Trust, London
| | | | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London
| | | | - Ben Cromarty
- UK Community Advisory Board and Yorkshire Mesmac
| | | | | | - Sarah Fidler
- Imperial College London and Imperial College Healthcare NHS Trust, London
| | | | - Julie Fox
- Guys and St Thomas’ NHS Foundation Trust and Kings College London
| | | | | | | | | | | | - Nadia Naous
- Chelsea and Westminster Hospital NHS Foundation Trust, London
| | | | | | | | - Frank Post
- King's College Hospital NHS Foundation Trust, London
| | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London
| | | | - John Walsh
- Imperial College Healthcare NHS Trust, London
| | - John Walsh
- Imperial College Healthcare NHS Trust, London
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Rodger AJ, McCabe L, Phillips AN, Lampe FC, Burns F, Ward D, Delpech V, Weatherburn P, Witzel TC, Pebody R, Kirwan P, Gabriel M, Khawam J, Brady M, Fenton KA, Trevelion R, Collaco-Moraes Y, McCormack S, Dunn D. Free HIV self-test for identification and linkage to care of previously undetected HIV infection in men who have sex with men in England and Wales (SELPHI): an open-label, internet-based, randomised controlled trial. Lancet HIV 2022; 9:e838-e847. [PMID: 36460023 DOI: 10.1016/s2352-3018(22)00266-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND High levels of HIV testing in men who have sex with men remain key to reducing the incidence of HIV. We aimed to assess whether the offer of a single, free HIV self-testing kit led to increased HIV diagnoses with linkage to care. METHODS SELPHI was an internet-based, open-label, randomised controlled trial that recruited participants via sexual and social networking sites. Eligibility criteria included being a man or trans woman (although trans women are reported separately); being resident in England or Wales, UK; being aged 16 years or older; having had anal intercourse with a man; not having a positive HIV diagnosis; and being willing to provide name, email address, date of birth, and consent to link to national HIV databases. Participants were randomly allocated (3:2) by computer-generated number sequence to receive a free HIV self-test kit (BT group) or to not receive this free kit (nBT group). Online surveys collected data at baseline, 2 weeks after enrolment (BT group only), 3 months after enrolment, and at the end of the study. The primary outcome was confirmed (linked to care) new HIV diagnosis within 3 months of enrolment, analysed by intention to treat. Those assessing the primary outcome were masked to allocation. This study is registered with the ISRCTN Clinical Trials Register, number ISRCTN20312003. FINDINGS 10 111 participants (6049 in BT group and 4062 in nBT group) enrolled between Feb 16, 2017, and March 1, 2018. The median age of participants was 33 years (IQR 26-44 years); 9000 (89%) participants were White; 8118 (80%) participants were born in the UK; 81 (1%) participants were transgender men; 4706 (47%) participants were university educated; 1537 (15%) participants had never been tested for HIV; and 389 (4%) participants were taking pre-exposure prophylaxis. At enrolment, 7282 (72%) participants reported condomless anal sex with at least one male partner in the previous 3 months. In the BT group, of the 4511 participants for whom HIV testing information was available, 4263 (95%) reported having used the free HIV self-test kit within 3 months.Within 3 months of enrolment there were 19 confirmed new HIV diagnoses (0·31%) in 6049 participants in the BT group and 15 (0·37%) of 4062 in the nBT group (p=0·64). INTERPRETATION The offer of a single, free HIV self-test did not lead to increased rates of new HIV diagnoses, which could reflect decreasing HIV incidence rates in the UK. Nonetheless, the offer of a free HIV self-testing kit resulted in high HIV testing rates, indicating that self-testing is an attractive testing option for a large group of men who have sex with men. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- Alison J Rodger
- Institute for Global Health, University College London, London, UK.
| | - Leanne McCabe
- UK MRC Clinical Trials Unit, University College London, London, UK
| | | | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | - Denise Ward
- UK MRC Clinical Trials Unit, University College London, London, UK
| | - Valerie Delpech
- National Infection Service, UK Health Security Agency, London, UK
| | - Peter Weatherburn
- Department of Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - T Charles Witzel
- Institute for Global Health, University College London, London, UK
| | | | - Peter Kirwan
- National Infection Service, UK Health Security Agency, London, UK
| | - Michelle Gabriel
- UK MRC Clinical Trials Unit, University College London, London, UK
| | - Jameel Khawam
- National Infection Service, UK Health Security Agency, London, UK
| | - Michael Brady
- Department of Sexual Health and HIV, King's College Hospital, London, UK
| | | | | | | | - Sheena McCormack
- UK MRC Clinical Trials Unit, University College London, London, UK
| | - David Dunn
- UK MRC Clinical Trials Unit, University College London, London, UK
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11
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Oyegbile-Chidi T, Harvey D, Dunn D, Jones J, Hermann B, Byars A, Austin J. Characterizing Sleep Phenotypes in Children With Newly Diagnosed Epilepsy. Pediatr Neurol 2022; 137:34-40. [PMID: 36215818 PMCID: PMC9970008 DOI: 10.1016/j.pediatrneurol.2022.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/21/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children with epilepsy frequently have sleep, behavior, and cognitive problems at the time of or before the epilepsy diagnosis. The primary goal of this study was to determine if specific sleep disturbance phenotypes exist in a large cohort of children with new-onset epilepsy and if these phenotypes are associated with specific cognitive and behavioral signatures. METHODS A total of354 children with new-onset epilepsy, aged six to 16 years, were recruited within six weeks of initial seizure onset. Each child underwent evaluation of their sleep along with self, parent, and teacher ratings of emotional-behavioral status. Two-step clustering using sleep disturbance (Sleep Behavior Questionnaire), naps, and sleep latency was employed to determine phenotype clusters. RESULTS Analysis showed three distinct sleep disturbance phenotypes-minimal sleep disturbance, moderate sleep disturbance, and severe sleep disturbance phenotypes. Children who fell into the minimal sleep disturbance phenotype had an older age of onset with the best cognitive performance compared with the other phenotypes and the lowest levels of emotional-behavioral problems. In contrast, children who fell into the severe sleep disturbance phenotype had the youngest age of onset of epilepsy with poor cognitive performance and highest levels of emotional-behavioral problems. CONCLUSIONS This study indicates that there are indeed specific sleep disturbance phenotypes that are apparent in children with newly diagnosed epilepsy and are associated with specific comorbidities. Future research should determine if these phenotypic groups persist over time and are predictive of long-term difficulties, as these subgroups may benefit from targeted therapy and intervention.
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Affiliation(s)
| | - Danielle Harvey
- Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - David Dunn
- Departments of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, Cincinnati, Ohio
| | - Joan Austin
- Distinguished Professor Emerita, School of Nursing, Indiana University, Indianapolis, Indiana
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12
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Stirrup O, Tostevin A, Ragonnet-Cronin M, Volz E, Burns F, Delpech V, Dunn D. Diagnosis delays in the UK according to pre or postmigration acquisition of HIV. AIDS 2022; 36:415-422. [PMID: 35084383 PMCID: PMC7612284 DOI: 10.1097/qad.0000000000003110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether infection occurred pre or postmigration and the associated diagnosis delay in migrants diagnosed with HIV in the UK. DESIGN We analyzed a cohort of individuals diagnosed with HIV in the UK in 2014-2016 born in Africa or elsewhere in Europe. Inclusion criteria were arrival within 15 years before diagnosis, availability of HIV pol sequence, and viral subtype shared by at least 10 individuals. METHODS We examined phylogenies for evidence of infection after entry into the UK and incorporated this information into a Bayesian analysis of timing of infection using biomarkers of CD4+ cell count, avidity assays, proportion of ambiguous nucleotides in viral sequences, and last negative test dates where available. RESULTS One thousand, two hundred and fifty-six individuals were included. The final model indicated that HIV was acquired postmigration for most MSM born in Europe (posterior expectation 65%, 95% credibility interval 64-67%) or Africa (65%, 62-69%), whereas a minority (20-30%) of men and women with heterosexual transmission acquired HIV postmigration. Estimated diagnosis delays were lower for MSM than for those with heterosexual transmission, and were lower for those with postmigration infection across all subgroups. For MSM acquiring HIV postmigration, the estimated mean time to diagnosis was less than one year, but for those who acquired HIV premigration, the mean time from infection to diagnosis was more than five years for all subgroups. CONCLUSION Acquisition of HIV postmigration is common, particularly among MSM, calling for prevention efforts aimed at migrant communities. Delays in diagnosis reinforce the need for targeted testing initiatives.
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Affiliation(s)
- Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - Anna Tostevin
- Institute for Global Health, University College London, London, UK
| | - Manon Ragonnet-Cronin
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Erik Volz
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Valerie Delpech
- HIV and STI Department, National Infection Service, Public Health England, London, United Kingdom
| | - David Dunn
- Institute for Global Health, University College London, London, UK
- MRC Clinical Trials Unit, University College London, London, UK
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13
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Oyegbile-Chidi T, Harvey D, Eisner J, Dunn D, Jones J, Byars A, Hermann B, Austin J. The Relationship Between Sleep, Cognition and Behavior in Children With Newly-Diagnosed Epilepsy Over 36 Months. Front Neurol 2022; 13:903137. [PMID: 35959398 PMCID: PMC9360804 DOI: 10.3389/fneur.2022.903137] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction There is substantial evidence that children with epilepsy experience more sleep, behavior and cognitive challenges than children without epilepsy. However, the literature is limited in describing the relationship between sleep, epilepsy, cognition and behavioral challenges and the interactions amongst these factors over time. This study aims to understand the nature and strength of the relationship between sleep, cognition, mood and behavior in children with new-onset epilepsy as assessed by multiple informants at multiple time periods using multiple different dependent measures. Methods 332 participants (6-16years) were recruited within 6 weeks of their first recognized seizure. The comparison group was comprised of 266 healthy siblings. Participants underwent sleep evaluation by a parent using the Sleep Behavioral Questionnaire (SBQ), cognitive evaluation using a comprehensive neuropsychological test battery, a behavioral evaluation using the Child Behavior Checklist (CBCL from parents and TRF from teachers) and the Children's Depression Inventory (CDI). These evaluations were completed at baseline (B), at 18 months, and at 36 months. Results Compared to siblings, children with new-onset epilepsy had more sleep disturbance (SBQ), higher rates of behavioral problems (CBCL and TRF), lower cognitive testing scores, and higher rates of depression; which persisted over the 36-month study. Sleep significantly correlated with behavioral problems, cognitive scores and depression. When divided into categories based of sleep disturbance scores, 39.7% of children with epilepsy experienced "Persistently Abnormal Sleep", while 14.8% experienced "Persistently Normal Sleep". Children with persistently abnormal sleep experienced the highest rates of behavioral problems, depression and cognitive impairment compared to those with persistently normal sleep, regardless of epilepsy syndrome. Younger age of seizure onset, younger age at testing, and lower grade level at baseline were associated with persistently abnormal sleep. Conclusions To our knowledge, this is the first demonstration of the nature, strength, reliability, stability and persistence of the relationship between sleep, cognition, and behavioral problems over time in a large cohort of children with newly diagnosed epilepsy, as assessed by multiple informants at different timepoints. The results of this study indicate that children with epilepsy are at a high risk of significant persisting neurobehavioral multimorbidity. Therefore, early screening for these challenges may be essential for optimizing quality of life long-term.
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Affiliation(s)
- Temitayo Oyegbile-Chidi
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Danielle Harvey
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Jordan Eisner
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - David Dunn
- Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, University of Cincinnati, Cincinnati, OH, United States
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Joan Austin
- School of Nursing, Indiana University, Indianapolis, IN, United States
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14
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Barratt S, Bielicki JA, Dunn D, Faust SN, Finn A, Harper L, Jackson P, Lyttle MD, Powell CV, Rogers L, Roland D, Stöhr W, Sturgeon K, Vitale E, Wan M, Gibb DM, Sharland M. Amoxicillin duration and dose for community-acquired pneumonia in children: the CAP-IT factorial non-inferiority RCT. Health Technol Assess 2021; 25:1-72. [PMID: 34738518 DOI: 10.3310/hta25600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Data are limited regarding the optimal dose and duration of amoxicillin treatment for community-acquired pneumonia in children. OBJECTIVES To determine the efficacy, safety and impact on antimicrobial resistance of shorter (3-day) and longer (7-day) treatment with amoxicillin at both a lower and a higher dose at hospital discharge in children with uncomplicated community-acquired pneumonia. DESIGN A multicentre randomised double-blind 2 × 2 factorial non-inferiority trial in secondary care in the UK and Ireland. SETTING Paediatric emergency departments, paediatric assessment/observation units and inpatient wards. PARTICIPANTS Children aged > 6 months, weighing 6-24 kg, with a clinical diagnosis of community-acquired pneumonia, in whom treatment with amoxicillin as the sole antibiotic was planned on discharge. INTERVENTIONS Oral amoxicillin syrup at a dose of 35-50 mg/kg/day compared with a dose of 70-90 mg/kg/day, and 3 compared with 7 days' duration. Children were randomised simultaneously to each of the two factorial arms in a 1 : 1 ratio. MAIN OUTCOME MEASURES The primary outcome was clinically indicated systemic antibacterial treatment prescribed for respiratory tract infection (including community-acquired pneumonia), other than trial medication, up to 28 days after randomisation. Secondary outcomes included severity and duration of parent/guardian-reported community-acquired pneumonia symptoms, drug-related adverse events (including thrush, skin rashes and diarrhoea), antimicrobial resistance and adherence to trial medication. RESULTS A total of 824 children were recruited from 29 hospitals. Ten participants received no trial medication and were excluded. Participants [median age 2.5 (interquartile range 1.6-2.7) years; 52% male] were randomised to either 3 (n = 413) or 7 days (n = 401) of trial medication at either lower (n = 410) or higher (n = 404) doses. There were 51 (12.5%) and 49 (12.5%) primary end points in the 3- and 7-day arms, respectively (difference 0.1%, 90% confidence interval -3.8% to 3.9%) and 51 (12.6%) and 49 (12.4%) primary end points in the low- and high-dose arms, respectively (difference 0.2%, 90% confidence interval -3.7% to 4.0%), both demonstrating non-inferiority. Resolution of cough was faster in the 7-day arm than in the 3-day arm for cough (10 days vs. 12 days) (p = 0.040), with no difference in time to resolution of other symptoms. The type and frequency of adverse events and rate of colonisation by penicillin-non-susceptible pneumococci were comparable between arms. LIMITATIONS End-of-treatment swabs were not taken, and 28-day swabs were collected in only 53% of children. We focused on phenotypic penicillin resistance testing in pneumococci in the nasopharynx, which does not describe the global impact on the microflora. Although 21% of children did not attend the final 28-day visit, we obtained data from general practitioners for the primary end point on all but 3% of children. CONCLUSIONS Antibiotic retreatment, adverse events and nasopharyngeal colonisation by penicillin-non-susceptible pneumococci were similar with the higher and lower amoxicillin doses and the 3- and 7-day treatments. Time to resolution of cough and sleep disturbance was slightly longer in children taking 3 days' amoxicillin, but time to resolution of all other symptoms was similar in both arms. FUTURE WORK Antimicrobial resistance genotypic studies are ongoing, including whole-genome sequencing and shotgun metagenomics, to fully characterise the effect of amoxicillin dose and duration on antimicrobial resistance. The analysis of a randomised substudy comparing parental electronic and paper diary entry is also ongoing. TRIAL REGISTRATION Current Controlled Trials ISRCTN76888927, EudraCT 2016-000809-36 and CTA 00316/0246/001-0006. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 60. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sam Barratt
- MRC Clinical Trials Unit, University College London, London, UK
| | - Julia A Bielicki
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - David Dunn
- MRC Clinical Trials Unit, University College London, London, UK
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Adam Finn
- Bristol Children's Vaccine Centre, School of Population Health Sciences/School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Lynda Harper
- MRC Clinical Trials Unit, University College London, London, UK
| | - Pauline Jackson
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Colin Ve Powell
- Paediatric Emergency Medicine Department, Sidra Medicine, Doha, The State of Qatar.,School of Medicine, Cardiff University, Cardiff, UK
| | - Louise Rogers
- Research and Development Nursing Team, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK.,SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK
| | - Wolfgang Stöhr
- MRC Clinical Trials Unit, University College London, London, UK
| | - Kate Sturgeon
- MRC Clinical Trials Unit, University College London, London, UK
| | - Elia Vitale
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Mandy Wan
- Evelina Pharmacy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Diana M Gibb
- MRC Clinical Trials Unit, University College London, London, UK
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
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15
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Bielicki JA, Stöhr W, Barratt S, Dunn D, Naufal N, Roland D, Sturgeon K, Finn A, Rodriguez-Ruiz JP, Malhotra-Kumar S, Powell C, Faust SN, Alcock AE, Hall D, Robinson G, Hawcutt DB, Lyttle MD, Gibb DM, Sharland M. Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial. JAMA 2021; 326:1713-1724. [PMID: 34726708 PMCID: PMC8564579 DOI: 10.1001/jama.2021.17843] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE The optimal dose and duration of oral amoxicillin for children with community-acquired pneumonia (CAP) are unclear. OBJECTIVE To determine whether lower-dose amoxicillin is noninferior to higher dose and whether 3-day treatment is noninferior to 7 days. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, 2 × 2 factorial noninferiority trial enrolling 824 children, aged 6 months and older, with clinically diagnosed CAP, treated with amoxicillin on discharge from emergency departments and inpatient wards of 28 hospitals in the UK and 1 in Ireland between February 2017 and April 2019, with last trial visit on May 21, 2019. INTERVENTIONS Children were randomized 1:1 to receive oral amoxicillin at a lower dose (35-50 mg/kg/d; n = 410) or higher dose (70-90 mg/kg/d; n = 404), for a shorter duration (3 days; n = 413) or a longer duration (7 days; n = 401). MAIN OUTCOMES AND MEASURES The primary outcome was clinically indicated antibiotic re-treatment for respiratory infection within 28 days after randomization. The noninferiority margin was 8%. Secondary outcomes included severity/duration of 9 parent-reported CAP symptoms, 3 antibiotic-related adverse events, and phenotypic resistance in colonizing Streptococcus pneumoniae isolates. RESULTS Of 824 participants randomized into 1 of the 4 groups, 814 received at least 1 dose of trial medication (median [IQR] age, 2.5 years [1.6-2.7]; 421 [52%] males and 393 [48%] females), and the primary outcome was available for 789 (97%). For lower vs higher dose, the primary outcome occurred in 12.6% with lower dose vs 12.4% with higher dose (difference, 0.2% [1-sided 95% CI -∞ to 4.0%]), and in 12.5% with 3-day treatment vs 12.5% with 7-day treatment (difference, 0.1% [1-sided 95% CI -∞ to 3.9]). Both groups demonstrated noninferiority with no significant interaction between dose and duration (P = .63). Of the 14 prespecified secondary end points, the only significant differences were 3-day vs 7-day treatment for cough duration (median 12 days vs 10 days; hazard ratio [HR], 1.2 [95% CI, 1.0 to 1.4]; P = .04) and sleep disturbed by cough (median, 4 days vs 4 days; HR, 1.2 [95% CI, 1.0 to 1.4]; P = .03). Among the subgroup of children with severe CAP, the primary end point occurred in 17.3% of lower-dose recipients vs 13.5% of higher-dose recipients (difference, 3.8% [1-sided 95% CI, -∞ to10%]; P value for interaction = .18) and in 16.0% with 3-day treatment vs 14.8% with 7-day treatment (difference, 1.2% [1-sided 95% CI, -∞ to 7.4%]; P value for interaction = .73). CONCLUSIONS AND RELEVANCE Among children with CAP discharged from an emergency department or hospital ward (within 48 hours), lower-dose outpatient oral amoxicillin was noninferior to higher dose, and 3-day duration was noninferior to 7 days, with regard to need for antibiotic re-treatment. However, disease severity, treatment setting, prior antibiotics received, and acceptability of the noninferiority margin require consideration when interpreting the findings. TRIAL REGISTRATION ISRCTN Identifier: ISRCTN76888927.
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Affiliation(s)
- Julia A. Bielicki
- Pediatric Infectious Diseases Research Group, Medical Research Council Clinical Trial Unit at University College London, Institute for Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Wolfgang Stöhr
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Sam Barratt
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - David Dunn
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Nishdha Naufal
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Damian Roland
- Pediatric Emergency Medicine Leicester Academic (PEMLA) Group, Emergency Department, Leicester, United Kingdom
- SAPPHIRE Group, University of Leicester, Department of Health Sciences, Leicester, United Kingdom
| | - Kate Sturgeon
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Adam Finn
- Bristol Children’s Vaccine Centre, Schools of Population Sciences and Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Juan Pablo Rodriguez-Ruiz
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Colin Powell
- Emergency Medicine, Sidra Medical and Research Center, Doha, Qatar
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Saul N. Faust
- National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Anastasia E. Alcock
- Pediatric Emergency Medicine, Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Dani Hall
- Pediatric Emergency Medicine, Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Pediatric Emergency Medicine, Children’s Health Ireland at Crumlin, Ireland
| | - Gisela Robinson
- Pediatric Emergency Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Daniel B. Hawcutt
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Pediatric Medicines Research Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Mark D. Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, United Kingdom
- Faculty of Health and Applied Science, University of the West of England, Bristol, United Kingdom
| | - Diana M. Gibb
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Mike Sharland
- Pediatric Infectious Diseases Research Group, Medical Research Council Clinical Trial Unit at University College London, Institute for Infection and Immunity, St George’s University of London, London, United Kingdom
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16
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Burns JE, Stirrup O, Waters L, Dunn D, Gilson R, Pett SL. No overall impact on rate of weight gain with integrase inhibitor-containing regimens in antiretroviral-naïve adults. HIV Med 2021; 23:294-300. [PMID: 34634168 DOI: 10.1111/hiv.13186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Integrase strand transfer inhibitors (INSTIs) are commonplace in modern antiretroviral therapy (ART). Increased weight gain with their use is increasingly scrutinized. We evaluated weight changes in treatment-naïve adults with HIV-1 attending a UK centre who started regimens including raltegravir or dolutegravir. METHODS A retrospective cohort study of adults prescribed an INSTI between January 2015 and March 2020 were categorized as having started an ART regimen containing raltegravir, dolutegravir, a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor. Individuals with one or more weight measurement ≤ 5 years both pre- and post-ART initiation, who started a three-drug regimen with ≥ 6 months duration and achieved virological suppression (< 50 copies/mL) within 6 months were included. A random effects model with linear slope pre- and post-ART was used, adjusting for age, gender, ethnicity, ART regimen, backbone and year of initiation. RESULTS The cohort included 390 adults; 88.7% were male, 66.4% were of white ethnicity, their median age was 40 years, there was a median of six weight measurements, 2.2 years from diagnosis to ART initiation, 2.9 years from ART to the last weight measurement, and weight and body mass index at initiation were 75 kg and 24.1 kg/m2 respectively. Of these, 254 (65%) started an INSTI. The average pre-ART rate of weight gain was 0.44 kg/year [95% confidence interval (CI): 0.19-0.70], increasing to 0.88 kg/year (0.63-1.10, p = 0.04) after ART initiation. Our adjusted model found no evidence of an association between ART regimen and rate of weight gain. CONCLUSIONS Weight increased in the cohort both pre- and post-ART. We found no evidence of a higher rate of weight gain following ART initiation with an INSTI compared with other regimens.
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Affiliation(s)
- James E Burns
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,Central and North West London NHS Foundation Trust, London, UK
| | - Oliver Stirrup
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - Laura Waters
- Central and North West London NHS Foundation Trust, London, UK
| | - David Dunn
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Richard Gilson
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,Central and North West London NHS Foundation Trust, London, UK
| | - Sarah L Pett
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,Central and North West London NHS Foundation Trust, London, UK.,Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
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Baxter JD, Dunn D, Tostevin A, Marvig RL, Bennedbaek M, Cozzi-Lepri A, Sharma S, Kozal MJ, Gompels M, Pinto AN, Lundgren J. Transmitted HIV-1 drug resistance in a large international cohort using next-generation sequencing: results from the Strategic Timing of Antiretroviral Treatment (START) study. HIV Med 2021; 22:360-371. [PMID: 33369017 PMCID: PMC8049964 DOI: 10.1111/hiv.13038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/11/2020] [Accepted: 11/10/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The aim of this analysis was to characterize transmitted drug resistance (TDR) in Strategic Timing of Antiretroviral Treatment (START) study participants by next-generation sequencing (NGS), a sensitive assay capable of detecting low-frequency variants. METHODS Stored plasma from participants with entry HIV RNA > 1000 copies/mL were analysed by NGS (Illumina MiSeq). TDR was based on the WHO 2009 surveillance definition with the addition of reverse transcriptase (RT) mutations T215N and E138K, and integrase strand transfer inhibitor (INSTI) surveillance mutations (Stanford HIVdb). Drug resistance mutations (DRMs) detected at three thresholds are reported: > 2%, 5% and 20% of the viral population. RESULTS Between 2009 and 2013, START enrolled 4684 antiretroviral therapy (ART)-naïve individuals in 35 countries. Baseline NGS data at study entry were available for 2902 participants. Overall prevalence rates of TDR using a detection threshold of 2%/5%/20% were 9.2%/5.6%/3.2% for nucleoside reverse transcriptase inhibitors (NRTIs), 9.2%/6.6%/4.9% for non-NRTIs, 11.4%/5.5%/2.4% for protease inhibitors (PIs) and 3.5%/1.6%/0.1% for INSTI DRMs and varied by geographic region. Using the 2% detection threshold, individual DRMs with the highest prevalence were: PI M46IL (5.5%), RT K103NS (3.5%), RT G190ASE (3.1%), T215ISCDVEN (2.5%), RT M41L (2.2%), RT K219QENR (1.7%) and PI D30N (1.6%). INSTI DRMs were detected almost exclusively below the 20% detection threshold, most commonly Y143H (0.4%), Q148R (0.4%) and T66I (0.4%). CONCLUSIONS Use of NGS in this study population resulted in the detection of a large proportion of low-level variants which would not have been detected by traditional Sanger sequencing. Global surveillance studies utilizing NGS should provide a more comprehensive assessment of TDR prevalence in different regions of the world.
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Affiliation(s)
- J D Baxter
- Cooper University Hospital/Cooper Medical School of Rowan University, Camden, NJ, USA
| | - D Dunn
- Institute for Global Health, UCL, London, UK
| | - A Tostevin
- Institute for Global Health, UCL, London, UK
| | - R L Marvig
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - M Bennedbaek
- Copenhagen HIV Programme, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - S Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - M J Kozal
- Yale University School of Medicine, New Haven, CT, USA
| | - M Gompels
- North Bristol NHS Trust, Westbury on Trym, UK
| | - A N Pinto
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - J Lundgren
- Copenhagen HIV Programme, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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18
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Patel H, Blake H, Dunn D. Psychogenic Nonepileptic Seizures in Children and Adolescents. Indian Pediatr 2021; 58:259-265. [PMID: 33713062] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CONTEXT Though psychogenic non-epileptic seizures (PNES) are seen commonly during evaluation of children and adolescents with epilepsy, the literature regarding developmental changes in PNES is limited. EVIDENCE ACQUISITION Literature search was conducted in PubMed. Key search terms included: Pseudoseizure* OR PNES OR [(non-epileptic or nonepileptic or psychogenic or non-epileptic attack disorder) AND (seizure*)], resulting in 3,236 articles. Filters included human, ages 1-18 years, English language and last 15 years (2004-2019), resulting in 533 articles. We reviewed 33 articles, which included 19 articles that involved children (1-18 years), with 10 or more children with PNES in their study group. 21 articles obtained in cross references that were outside the filter setting (including time frame and age range) were also reviewed, for a total of 54 articles. RESULTS Majority of the studies were retrospective. We detail clinical features, predisposing factors and appropriate workup for children and adolescents with possible PNES. There is no consensus regarding frequency of psychiatric comorbidities in children with PNES. No controlled trials of treatment of PNES in children are available, but cognitive behavioral therapy is the consensus for adult PNES. Outcome appears to be better in children with PNES. CONCLUSION There is a need for be long-term prospective studies to document various clinical features and outcome of pediatric and adolescent PNES, and also the comorbid conditions.
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Affiliation(s)
- Hema Patel
- Department of Neurology, Section of Pediatric Neurology, Children's Wisconsin, Medical College of Wisconsin, USA. Correspondence to: Dr Hema Patel, Professor, Clinical Neurology, Department of Pediatric Neurology, 999, North 92nd Street, Suite 540, Milwaukee, WI 53226, USA.
| | - Hillary Blake
- Department of Clinical Psychiatry, Section of Child Psychology, Indiana University School of Medicine, USA
| | - David Dunn
- Department of Psychiatry and Neurology, Riley Hospital for Children, Indiana University Medical Center, USA
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19
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Dunn D, Price H, Vudriko T, Kityo C, Musoro G, Hakim J, Gilks C, Kaleebu P, Pillay D, Gilson R. New Insights on Long-Term Hepatitis B Virus Responses in HIV-Hepatitis B virus Co-infected Patients: Implications for Antiretroviral Management in Hepatitis B virus-Endemic Settings. J Acquir Immune Defic Syndr 2021; 86:98-103. [PMID: 33306565 DOI: 10.1097/qai.0000000000002517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND WHO treatment guidelines recommend tenofovir plus lamivudine or emtricitabine as the nucleoside reverse transcriptase inhibitor backbone in first-line regimens for HIV-infected adults. Lamivudine alone is not recommended, because of the risk of hepatitis B virus (HBV) resistance. We studied HBV responses in a large cohort of co-infected patients in a resource-limited setting. SETTING Clinical centers in Uganda and Zimbabwe. METHODS DART was a randomized trial of monitoring practices in HIV-infected adults starting antiretroviral therapy. Baseline samples were tested retrospectively for HBV serological markers and HBV DNA. Longitudinal HBV DNA testing at 48 weeks and the last available sample before HBV-relevant modification of antiretroviral therapy was performed on patients with detectable HBV DNA at baseline. RESULTS Two hundred twenty-four hepatitis B surface antigen-positive patients were followed for up to 4.8 years. Of the drugs with anti-HBV activity, 166 were prescribed lamivudine-tenofovir and 58 lamivudine alone. Ninety-eight percent (96/98) patients with baseline HBV DNA <6 log10 IU/mL achieved viral suppression at 48 weeks (HBV DNA <48 IU/mL), regardless of regimen, compared with 50%(26/52) for HBV DNA >6 log10 IU/mL. Of the 83 patients suppressed at 48 weeks and with follow-up data, only 7(8%) experienced viral rebound (range 200-3460 IU/mL). Of the 20 patients not suppressed at 48 weeks and with follow-up data, HBV DNA levels generally declined with lamivudine-tenofovir, but increased with lamivudine alone. Alanine transaminase flares were not observed in any patient who experienced viral rebound. CONCLUSIONS The suppressive effect of lamivudine alone was highly durable (up to 5 years) in HIV-HBV co-infected patients with baseline HBV DNA <6 log10 IU/mL. It may be feasible to develop stratified approaches using lamivudine as the only drug with anti-HBV activity.
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Affiliation(s)
- David Dunn
- Institute for Global Health, University College London, London, United Kingdom
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Huw Price
- Institute for Global Health, University College London, London, United Kingdom
| | - Tobias Vudriko
- MRC/UVRI & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Godfrey Musoro
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - James Hakim
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Charles Gilks
- School of Public Health, University of Queensland, Brisbane, Australia; and
| | - Pontiano Kaleebu
- MRC/UVRI & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Deenan Pillay
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Richard Gilson
- Institute for Global Health, University College London, London, United Kingdom
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20
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James EC, Dunn D, Cook AD, Clamp AR, Sydes MR. Overlap between adverse events (AEs) and serious adverse events (SAEs): a case study of a phase III cancer clinical trial. Trials 2020; 21:802. [PMID: 32943106 PMCID: PMC7495966 DOI: 10.1186/s13063-020-04718-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Safety data is required to be collected in all clinical trials and can be separated into two types of data, adverse events and serious adverse events. Often, these types of safety data are collected as two discrete data sets, where adverse events that also meet the criteria for seriousness should be reported in both datasets. Safety analyses are often conducted using only the adverse event dataset, which should feature all safety events reported. We investigated whether the reporting of safety in both datasets was systematically followed and explored the impact of this on safety analyses in ICON8, an ovarian cancer clinical trial. METHODS Text searches of serious adverse event data identified events that could potentially match the data reported in the adverse event dataset (looking at pre-specified AE terms only). These serious adverse events were then mapped to adverse event data according to predefined criteria: (a) event term matches, (b) date of onset and date of assessment within 30 days of each other, (c) date of assessment lies between date of onset and date of resolution and (d) events confirmed to occur in the same chemotherapy cycle. A combined dataset of all unique safety events (whether originally reported in the adverse event or serious adverse event dataset) was created and safety analyses re-performed. RESULTS 51,019 adverse events were reported in ICON8, of which 42,410 were included in the mapping exercise. One thousand five hundred six serious adverse event elements were reported, of which 668 were included in the mapping exercise. Sixty-one percent of serious adverse event elements was matched to an already-reported adverse event. Supplementing these additional safety events and re-performing safety analyses increased the proportion of patients with at least one grade 3 or worse safety events in all arms from 42 to 47% in the control arm and 61 to 65% and 52 to 59% in the research arms. The difference in proportions of grade 3 or worse event in the research arms compared to the control arm changed by 18% (95% confidence interval [CI] 12 to 24%) and 12% (95% CI 6 to 18%), respectively. CONCLUSIONS There was low agreement in mapping serious adverse events to already reported adverse events, with nearly 40% of serious adverse events included in the mapping exercise not mapped to an already reported adverse event. Any analyses of safety data that use only adverse event datasets or do not clearly account for serious adverse event data will likely be missing important safety information. Reporting standards should make clear which datasets were used for analyses.
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Affiliation(s)
- Elizabeth C James
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCL, London, UK.
| | - David Dunn
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCL, London, UK
| | - Adrian D Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCL, London, UK
| | - Andrew R Clamp
- The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCL, London, UK
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21
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Rodger AJ, Dunn D, McCabe L, Weatherburn P, Lampe FC, Witzel TC, Burns F, Ward D, Pebody R, Trevelion R, Brady M, Kirwan PD, Khawam J, Delpech VC, Gabriel M, Collaco-Moraes Y, Phillips AN, McCormack S. Sexual risk and HIV testing disconnect in men who have sex with men (MSM) recruited to an online HIV self-testing trial. HIV Med 2020; 21:588-598. [PMID: 32776431 DOI: 10.1111/hiv.12919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 04/21/2020] [Accepted: 06/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We report the frequency of previous HIV testing at baseline in men who have sex with men (MSM) who enrolled in an HIV self-testing (HIVST) randomized controlled trial [an HIV self-testing public health intervention (SELPHI)]. METHODS Criteria for enrolment were age ≥ 16 years, being a man (including trans men) who ever had anal intercourse (AI) with a man, not being known to be HIV positive and having consented to national HIV database linkage. Using online survey baseline data (2017-2018), we assessed associations with never having tested for HIV and not testing in the previous 6 months, among men who reported at least two recent condomless AI (CAI) partners. RESULTS A total of 10 111 men were randomized; the median age was 33 years [interquartile range (IQR) 26-44 years], 89% were white, 20% were born outside the UK, 0.8% were trans men, 47% were degree educated, and 8% and 4% had ever used and were currently using pre-exposure prophylaxis (PrEP), respectively. In the previous 3 months, 89% reported AI and 72% reported CAI with at least one male partner. Overall, 17%, 33%, 54%, and 72% had tested for HIV in the last 3 months, 6 months, 12 months and 2 years, respectively; 13% had tested more than 2 years ago and 15% had never tested. Among 3972 men reporting at least two recent CAI partners, only 22% had tested in the previous 3 months. Region of residence and education level were independently associated with recent HIV testing. Among current PrEP users, 15% had not tested in the previous 6 months. CONCLUSIONS Most men in SELPHI, particularly those reporting at least two CAI partners and current PrEP users, were not testing in line with current UK recommendations. The results of the trial will inform whether online promotion of HIVST addresses ongoing testing barriers.
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Affiliation(s)
- A J Rodger
- Institute for Global Health, University College London, London, UK
| | - D Dunn
- MRC Clinical Trials Unit at UCL, London, UK
| | - L McCabe
- MRC Clinical Trials Unit at UCL, London, UK
| | - P Weatherburn
- London School of Hygiene & Tropical Medicine, London, UK
| | - F C Lampe
- Institute for Global Health, University College London, London, UK
| | - T C Witzel
- London School of Hygiene & Tropical Medicine, London, UK
| | - F Burns
- Institute for Global Health, University College London, London, UK
| | - D Ward
- MRC Clinical Trials Unit at UCL, London, UK
| | | | | | - M Brady
- King's College Hospital NHS Foundation Trust, London, UK
| | - P D Kirwan
- National Infection Service, Public Health England, London, UK
| | - J Khawam
- National Infection Service, Public Health England, London, UK
| | - V C Delpech
- National Infection Service, Public Health England, London, UK
| | - M Gabriel
- MRC Clinical Trials Unit at UCL, London, UK
| | | | - A N Phillips
- Institute for Global Health, University College London, London, UK
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22
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Thompson JA, Kityo C, Dunn D, Hoppe A, Ndashimye E, Hakim J, Kambugu A, van Oosterhout JJ, Arribas J, Mugyenyi P, Walker AS, Paton NI. Evolution of Protease Inhibitor Resistance in Human Immunodeficiency Virus Type 1 Infected Patients Failing Protease Inhibitor Monotherapy as Second-line Therapy in Low-income Countries: An Observational Analysis Within the EARNEST Randomized Trial. Clin Infect Dis 2020; 68:1184-1192. [PMID: 30060027 DOI: 10.1093/cid/ciy589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/24/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Limited viral load (VL) testing in human immunodeficiency virus (HIV) treatment programs in low-income countries often delays detection of treatment failure. The impact of remaining on failing protease inhibitor (PI)-containing regimens is unclear. METHODS We retrospectively tested VL in 2164 stored plasma samples from 386 patients randomized to receive lopinavir monotherapy (after initial raltegravir induction) in the Europe-Africa Research Network for Evaluation of Second-line Therapy (EARNEST) trial. Protease genotypic resistance testing was performed when VL >1000 copies/mL. We assessed evolution of PI resistance mutations from virological failure (confirmed VL >1000 copies/mL) until PI monotherapy discontinuation and examined associations using mixed-effects models. RESULTS Median post-failure follow-up (in 118 patients) was 68 (interquartile range, 48-88) weeks. At failure, 20% had intermediate/high-level resistance to lopinavir. At 40-48 weeks post-failure, 68% and 51% had intermediate/high-level resistance to lopinavir and atazanavir; 17% had intermediate-level resistance (none high) to darunavir. Common PI mutations were M46I, I54V, and V82A. On average, 1.7 (95% confidence interval 1.5-2.0) PI mutations developed per year; increasing after the first mutation; decreasing with subsequent mutations (P < .0001). VL changes were modest, mainly driven by nonadherence (P = .006) and PI mutation development (P = .0002); I47A was associated with a larger increase in VL than other mutations (P = .05). CONCLUSIONS Most patients develop intermediate/high-level lopinavir resistance within 1 year of ongoing viral replication on monotherapy but retain susceptibility to darunavir. Viral load increased slowly after failure, driven by non-adherence and PI mutation development. CLINICAL TRIALS REGISTRATION NCT00988039.
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Affiliation(s)
- Jennifer A Thompson
- Medical Research Council Clinical Trials Unit at University College London, United Kingdom.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - David Dunn
- Medical Research Council Clinical Trials Unit at University College London, United Kingdom
| | - Anne Hoppe
- Medical Research Council Clinical Trials Unit at University College London, United Kingdom.,Division of Infection and Immunity, University College London, United Kingdom
| | - Emmanuel Ndashimye
- Joint Clinical Research Centre, Kampala, Uganda.,Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
| | - James Hakim
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Joep J van Oosterhout
- Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi.,Dignitas International, Zomba, Malawi
| | | | | | - A Sarah Walker
- Medical Research Council Clinical Trials Unit at University College London, United Kingdom
| | - Nicholas I Paton
- Medical Research Council Clinical Trials Unit at University College London, United Kingdom.,Yong Loo Lin School of Medicine, National University of Singapore
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23
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Rahman F, Dunn D, Baneman E, Sullivan T, Fuller R, Jacobs S, Pinney S, Barghash M, Rana M, Taimur S. Strongyloides Screening in Heart Transplant Candidates. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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24
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Arenas-Pinto A, Stöhr W, Khoo S, Clarke A, Beeching N, Warwick Z, Lee V, Else L, Wiggins R, Ferns B, Nastouli E, Dunn D, Lacey CJ, Paton NI. Genital secretion HIV RNA shedding in HIV-positive patients on ritonavir-boosted protease inhibitor monotherapy or standard combination ART: a cross-sectional sub-study from the PIVOT Trial. Antivir Ther 2020; 25:55-59. [PMID: 32202510 DOI: 10.3851/imp3340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND Protease inhibitors (PI) have relatively low penetration into the genital tract, raising concerns about the potential for genital HIV RNA shedding in patients taking PI-based regimens, particularly PI monotherapy (PI-mono). METHODS We measured HIV RNA and PI drug concentrations in samples of semen, cervico-vaginal and rectal mucosa secretions, and plasma in patients after 48-96 weeks on PI-mono or standard triple therapy. RESULTS A total of 85 participants were recruited. Of the 43 participants on PI-mono (70% on darunavir [DRV]/ritonavir [r]), 3 had detectable virus in semen or vaginal secretions (all below quantification limit), and none in rectal mucosa or plasma. Among those taking triple therapy, five had detectable virus in semen or vaginal secretions (HIV RNA >50 copies/ml in one), none in rectal mucosa and one in plasma. The median (IQR) concentration of DRV and atazanavir in semen (659.7 [339-1,089] and 128.8 [63-368] ng/ml, respectively) and cervico-vaginal samples (2,768 [312-7,879] and 1,836 [359-3,314] ng/ml, respectively) exceeded their protein adjusted median inhibition concentration (MIC50). DRV concentration in rectal secretions showed higher variability compared with concentration in the other sites, with particularly high rectal secretion/blood ratios (median 8.4, IQR 2.6-68.7:1). CONCLUSIONS We found no substantive evidence of HIV shedding in patients taking PI-mono, suggesting that PIs provide adequate control of virus in the genital compartment and are unlikely to lead to ongoing sexual transmission.
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Affiliation(s)
- Alejandro Arenas-Pinto
- MRC-Clinical Trials Unit at UCL, London, UK.,UCL Institute for Global Health, London, UK
| | | | - Saye Khoo
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Royal Liverpool University Hospital, Liverpool, UK
| | - Amanda Clarke
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK.,Sussex Medical School, Brighton, UK
| | | | | | | | - Laura Else
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Rebecca Wiggins
- York Biomedical Research Institute, University of York, York, UK
| | - Bridget Ferns
- Department of Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eleni Nastouli
- Department of Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Dunn
- MRC-Clinical Trials Unit at UCL, London, UK.,UCL Institute for Global Health, London, UK
| | - Charles J Lacey
- York Biomedical Research Institute, University of York, York, UK
| | - Nicholas I Paton
- MRC-Clinical Trials Unit at UCL, London, UK.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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25
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Pavlos R, Deshpande P, Chopra A, Leary S, Strautins K, Nolan D, Thorborn D, Shaefer M, Rauch A, Dunn D, Montaner J, Rachlis A, Almeida CA, Choo L, James I, Redwood AJ, Li Y, Gaudieri S, Mallal SA, Phillips EJ. New genetic predictors for abacavir tolerance in HLA-B*57:01 positive individuals. Hum Immunol 2020; 81:300-304. [PMID: 32173028 DOI: 10.1016/j.humimm.2020.02.011] [Citation(s) in RCA: 17] [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] [Received: 11/28/2019] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 01/11/2023]
Abstract
Abacavir hypersensitivity syndrome (ABC HSS) is strongly associated with carriage of human leukocyte antigen (HLA)-B*57:01, which has a 100% negative predictive value for the development of ABC HSS. However, 45% of individuals who carry HLA-B*57:01 can tolerate ABC. We investigated immune and non-immune related genes in ABC HSS (n = 95) and ABC tolerant (n = 43) HLA-B*57:01 + patients to determine other factors required for the development of ABC HSS. Assignment of phenotype showed that ABC HSS subjects were significantly less likely than tolerants to carry only ERAP1 hypoactive trimming allotypes (p = 0.02). An altered self-peptide repertoire model by which abacavir activates T cells is in keeping with observation that endoplasmic reticulum aminopeptidase 1 (ERAP1) allotypes that favour efficient peptide trimming are more common in ABC HSS patients compared to patients who tolerate ABC. Independently, non-specific immune activation via soluble cluster of differentiation antigen 14 (sCD14) may also influence susceptibility to ABC HSS.
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Affiliation(s)
- Rebecca Pavlos
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia; Telethon Kids Institute, Western Australia, Australia
| | - Pooja Deshpande
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia; School of Human Sciences, University of Western Australia, Western Australia, Australia
| | - Abha Chopra
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia
| | - Shay Leary
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia
| | - Kaija Strautins
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia
| | - David Nolan
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia; Department of Clinical Immunology, Royal Perth Hospital, Western Australia, Australia
| | | | - Mark Shaefer
- ViiV Healthcare at Research Triangle Park, NC, USA
| | | | - David Dunn
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver British Columbia, Canada
| | - Anita Rachlis
- Sunnybrook Health Sciences Centre, Toronto, Canada; University of Toronto,Toronto, Canada
| | - Coral-Ann Almeida
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia; Department of Haematology, Fiona Stanley Hospital, Western Australia, Australia
| | - Linda Choo
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia
| | - Ian James
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia
| | - Alec J Redwood
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia; Institute for Respiratory Health, University of Western Australia, Western Australia, Australia
| | - Yueran Li
- School of Human Sciences, University of Western Australia, Western Australia, Australia
| | - Silvana Gaudieri
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia; School of Human Sciences, University of Western Australia, Western Australia, Australia; Vanderbilt University Medical Centre, Nashville, USA
| | - Simon A Mallal
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia; Vanderbilt University Medical Centre, Nashville, USA
| | - Elizabeth J Phillips
- Institute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia; Vanderbilt University Medical Centre, Nashville, USA.
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26
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Miltz A, Lampe F, McCormack S, Dunn D, White E, Rodger A, Phillips A, Sherr L, Sullivan AK, Reeves I, Clarke A, Gafos M. Prevalence and correlates of depressive symptoms among gay, bisexual and other men who have sex with men in the PROUD randomised clinical trial of HIV pre-exposure prophylaxis. BMJ Open 2019; 9:e031085. [PMID: 31826890 PMCID: PMC6924847 DOI: 10.1136/bmjopen-2019-031085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The aim of this analysis is to: (i) assess the prevalence of clinically significant depressive symptoms at baseline and follow-up for participants in the PROUD trial of HIV pre-exposure prophylaxis (PrEP), examining changes in prevalence over time and (ii) investigate the association of socioeconomic and psychosocial factors with depression. METHODS PROUD was an open label randomised trial evaluating the benefit of PrEP for 544 HIV-negative gay, bisexual and other men who have sex with men (GBMSM) in England. Enrolment was between 2012 and 2014, with at least 2 years follow-up. Prevalence of depression (score ≥10 on Patient Health Questionnaire-9) was assessed and compared across time-points (using McNemar's χ2 tests) and between trial arms (using χ2 tests). Cross-sectional associations with socioeconomic and psychosocial factors were examined using baseline data in modified Poisson regression models and combined 12 and 24 month follow-up data in generalised estimating equations (GEEs). Prevalence ratios (PRs) were presented as unadjusted PR and adjusted PR (aPR) for age, UK birth, sexual identity, university education, London study clinic site and calendar time (and follow-up time-point in GEEs). RESULTS Depression increased significantly from baseline (9.1%; 49/540) to the 12 month (14.4%; 59/410) and 24 month (14.4%; 48/333) follow-ups, possibly explained by underreporting at baseline. The prevalence of depression did not differ by study trial arm, at any time-point. In the baseline analysis, younger age, unemployment and crystal methamphetamine use, was associated with depression. In combined analysis of 12 and 24 month data, measures of intimate partner violence (IPV) (lifetime IPV victimisation aPR 2.57 (95% CI: 1.71 to 3.86)), internalised homophobia (aPR 1.91 (95% CI: 1.29 to 2.83)) and concealment of sexual identity (aPR 1.75 (95% CI: 1.16 to 2.65)), were strongly associated with depression. CONCLUSIONS There is a high concomitant burden of psychosocial factors with depression among GBMSM. TRIAL REGISTRATION NUMBER ISRCTN (ISRCTN94465371) and ClinicalTrials.gov (NCT02065986).
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Affiliation(s)
- Ada Miltz
- Institute for Global Health, University College London, London, UK
| | - Fiona Lampe
- Institute for Global Health, University College London, London, UK
| | | | - David Dunn
- MRC CTU, University College London, London, UK
| | - Ellen White
- MRC CTU, University College London, London, UK
| | - Alison Rodger
- Institute for Global Health, University College London, London, UK
| | - Andrew Phillips
- Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Ann K Sullivan
- Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Iain Reeves
- Homerton University Hospital NHS Trust, London, UK
| | - Amanda Clarke
- Brighton & Sussex University Hospital NHS Trust, Brighton & Sussex Medical School, Brighton, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Lodi S, Günthard HF, Gill J, Phillips AN, Dunn D, Vu Q, Siemieniuk R, Garcia F, Logan R, Jose S, Bucher HC, Scherrer AU, Reiss P, van Sighem A, Boender TS, Porter K, Gilson R, Paraskevis D, Simeon M, Vourli G, Moreno S, Jarrin I, Sabin C, Hernán MA. Effectiveness of Transmitted Drug Resistance Testing Before Initiation of Antiretroviral Therapy in HIV-Positive Individuals. J Acquir Immune Defic Syndr 2019; 82:314-320. [PMID: 31609929 PMCID: PMC7830777 DOI: 10.1097/qai.0000000000002135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND For people living with HIV, major guidelines in high-income countries recommend testing for transmitted drug resistance (TDR) to guide the choice of first-line antiretroviral therapy (ART). However, individuals who fail a first-line regimen can now be switched to one of several effective regimens. Therefore, the virological and clinical benefit of TDR testing needs to be evaluated. METHODS We included individuals from the HIV-CAUSAL Collaboration who enrolled <6 months of HIV diagnosis between 2006 and 2015, were ART-naive, and had measured CD4 count and HIV-RNA. Follow-up started at the date when all inclusion criteria were first met (baseline). We compared 2 strategies: (1) TDR testing within 3 months of baseline versus (2) no TDR testing. We used inverse probability weighting to estimate the 5-year proportion and hazard ratios (HRs) of virological suppression (confirmed HIV-RNA <50 copies/mL), and of AIDS or death under both strategies. RESULTS Of 25,672 eligible individuals (82% males, 52% diagnosed in 2010 or later), 17,189 (67%) were tested for TDR within 3 months of baseline. Of these, 6% had intermediate- or high-level TDR to any antiretroviral drug. The estimated 5-year proportion virologically suppressed was 77% under TDR testing and 74% under no TDR testing; HR 1.06 (95% confidence interval: 1.03 to 1.19). The estimated 5-year risk of AIDS or death was 6% under both strategies; HR 1.03 (95% confidence interval: 0.95 to 1.12). CONCLUSIONS TDR prevalence was low. Although TDR testing improved virological response, we found no evidence that it reduced the incidence of AIDS or death in first 5 years after diagnosis.
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Affiliation(s)
- Sara Lodi
- Boston University School of Public Health, Boston, MA
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Zürich, Switzerland
| | - John Gill
- University of Calgary, Calgary, Alberta, Canada
- Southern Alberta Clinic, Calgary, Alberta, Canada
| | - Andrew N Phillips
- Institute for Global Health, University College London, London, United Kingdom
| | - David Dunn
- Institute for Global Health, University College London, London, United Kingdom
| | - Quang Vu
- University of Calgary, Calgary, Alberta, Canada
| | - Reed Siemieniuk
- Southern Alberta Clinic, Calgary, Alberta, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Roger Logan
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sophie Jose
- Institute for Global Health, University College London, London, United Kingdom
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandra U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Zürich, Switzerland
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, the Netherlands
- Division of Infectious Diseases, Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | | | | | - Kholoud Porter
- Institute for Global Health, University College London, London, United Kingdom
| | - Richard Gilson
- Institute for Global Health, University College London, London, United Kingdom
| | | | | | - Georgia Vourli
- National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Santiago Moreno
- Ramón y Cajal Hospital, IRYCIS, Madrid, Spain
- University of Alcalá de Henares, Madrid, Spain
| | - Inmaculada Jarrin
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Caroline Sabin
- Institute for Global Health, University College London, London, United Kingdom
| | - Miguel A Hernán
- Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard-MIT Division of Health Sciences and Technology, Boston, MA
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28
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Stirrup OT, Sabin CA, Phillips AN, Williams I, Churchill D, Tostevin A, Hill T, Dunn DT, Asboe D, Pozniak A, Cane P, Chadwick D, Churchill D, Clark D, Collins S, Delpech V, Douthwaite S, Dunn D, Fearnhill E, Porter K, Tostevin A, Stirrup O, Fraser C, Geretti AM, Gunson R, Hale A, Hué S, Lazarus L, Leigh-Brown A, Mbisa T, Mackie N, Orkin C, Nastouli E, Pillay D, Phillips A, Sabin C, Smit E, Templeton K, Tilston P, Volz E, Williams I, Zhang H, Fairbrother K, Dawkins J, O’Shea S, Mullen J, Cox A, Tandy R, Fawcett T, Hopkins M, Booth C, Renwick L, Renwick L, Schmid ML, Payne B, Hubb J, Dustan S, Kirk S, Bradley-Stewart A, Hill T, Jose S, Thornton A, Huntington S, Glabay A, Shidfar S, Lynch J, Hand J, de Souza C, Perry N, Tilbury S, Youssef E, Gazzard B, Nelson M, Mabika T, Mandalia S, Anderson J, Munshi S, Post F, Adefisan A, Taylor C, Gleisner Z, Ibrahim F, Campbell L, Baillie K, Gilson R, Brima N, Ainsworth J, Schwenk A, Miller S, Wood C, Johnson M, Youle M, Lampe F, Smith C, Tsintas R, Chaloner C, Hutchinson S, Walsh J, Mackie N, Winston A, Weber J, Ramzan F, Carder M, Leen C, Wilson A, Morris S, Gompels M, Allan S, Palfreeman A, Lewszuk A, Kegg S, Faleye A, Ogunbiyi V, Mitchell S, Hay P, Kemble C, Martin F, Russell-Sharpe S, Gravely J, Allan S, Harte A, Tariq A, Spencer H, Jones R, Pritchard J, Cumming S, Atkinson C, Mital D, Edgell V, Allen J, Ustianowski A, Murphy C, Gunder I, Trevelion R, Babiker A. Associations between baseline characteristics, CD4 cell count response and virological failure on first-line efavirenz + tenofovir + emtricitabine for HIV. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30037-6] [Citation(s) in RCA: 4] [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] [Indexed: 10/23/2022] Open
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29
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Schultze A, Paredes R, Sabin C, Phillips AN, Pillay D, Mackie N, Castagna A, Chadwick D, Falconer K, Geretti AM, Post FA, Hill T, Kirk O, Pozniak A, Nelson M, Tostevin A, Dunn D, Lundgren J, Cozzi-Lepri A. The association between detected drug resistance mutations and CD4 + T-cell decline in HIV-positive individuals maintained on a failing treatment regimen. Antivir Ther 2019. [PMID: 28627486 DOI: 10.3851/imp3178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND To analyse the effect of drug resistance mutations (DRM) on CD4+ T-cell (CD4) trends in HIV-positive people maintained on virologically failing antiretroviral therapy (ART). METHODS Individuals from two large cohorts experiencing virological failure (VF) while maintained on ART with ≥1 CD4 count and ≥1 resistance test were included. CD4 slopes were estimated using linear mixed models. Principal component analysis (PCA) was used to assess the effect of clusters of mutations, defined using extracted component based scores from the PCA, on CD4 decline. RESULTS 5,357 individuals contributing 7,661 VF episodes were included: any DRM were detected in 88.8% of episodes. After adjustment, CD4 counts declined less steeply during episodes where DRM were detected compared to episodes with no DRM (difference =28 cells/mm3/year, 95% CI =18, 39; P<0.001). Among individuals with at least one DRM, we found evidence that any nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) resistance, the reverse transcriptase (RT) mutations M184V, D67N and T215Y as well as the protease mutations V82A and I54V were associated with reduced CD4 declines. The detection of any non-nucleoside reverse transcriptase inhibitor resistance, the RT mutations V179D and L74V were associated with steeper CD4 declines. The presence of some mutation patterns similar to the clusters identified by the PCA also affected the CD4 decline. CONCLUSIONS Detection of resistance and of certain DRM during VF of ART has a small but significant favourable effect on CD4 decline.
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Affiliation(s)
- Anna Schultze
- Department of Infection and Population Health, UCL, London, UK
| | - Roger Paredes
- Institut de Recerca de la SIDA-IrsiCaixa, Badalona, Spain
| | - Caroline Sabin
- Department of Infection and Population Health, UCL, London, UK
| | | | - Deenan Pillay
- Division of Infection and Immunity, UCL, London, UK.,Africa Centre for Population Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Nicola Mackie
- Department of HIV, Sexual Health and Infections, Imperial College Healthcare NHS Trust, London, UK
| | | | - David Chadwick
- Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, UK
| | - Karolin Falconer
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Frank A Post
- Department of Sexual Health and HIV, King's College Hospital, London, UK
| | - Teresa Hill
- Department of Infection and Population Health, UCL, London, UK
| | - Ole Kirk
- Department of Infectious Diseases, CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anton Pozniak
- St Stephens AIDS Trust, Chelsea and Westminster Hospital, London, UK
| | - Mark Nelson
- St Stephens AIDS Trust, Chelsea and Westminster Hospital, London, UK
| | - Anna Tostevin
- Department of Infection and Population Health, UCL, London, UK
| | - David Dunn
- Department of Infection and Population Health, UCL, London, UK.,MRC Clinical Trials Unit, UCL, London, UK
| | - Jens Lundgren
- Department of Infectious Diseases, CHIP, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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30
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Volz EM, Le Vu S, Ratmann O, Tostevin A, Dunn D, Orkin C, O'Shea S, Delpech V, Brown A, Gill N, Fraser C. Molecular Epidemiology of HIV-1 Subtype B Reveals Heterogeneous Transmission Risk: Implications for Intervention and Control. J Infect Dis 2019; 217:1522-1529. [PMID: 29506269 PMCID: PMC5913615 DOI: 10.1093/infdis/jiy044] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/22/2018] [Indexed: 11/25/2022] Open
Abstract
Background The impact of HIV pre-exposure prophylaxis (PrEP) depends on infections averted by protecting vulnerable individuals as well as infections averted by preventing transmission by those who would have been infected if not receiving PrEP. Analysis of HIV phylogenies reveals risk factors for transmission, which we examine as potential criteria for allocating PrEP. Methods We analyzed 6912 HIV-1 partial pol sequences from men who have sex with men (MSM) in the United Kingdom combined with global reference sequences and patient-level metadata. Population genetic models were developed that adjust for stage of infection, global migration of HIV lineages, and changing incidence of infection through time. Models were extended to simulate the effects of providing susceptible MSM with PrEP. Results We found that young age <25 years confers higher risk of HIV transmission (relative risk = 2.52 [95% confidence interval, 2.32–2.73]) and that young MSM are more likely to transmit to one another than expected by chance. Simulated interventions indicate that 4-fold more infections can be averted over 5 years by focusing PrEP on young MSM. Conclusions Concentrating PrEP doses on young individuals can avert more infections than random allocation.
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Affiliation(s)
- Erik M Volz
- Department of Infectious Disease Epidemiology and the National Institute for Health Research Health Protection Research Unit on Modeling Methodology, Imperial College London
| | - Stephane Le Vu
- Department of Infectious Disease Epidemiology and the National Institute for Health Research Health Protection Research Unit on Modeling Methodology, Imperial College London
| | - Oliver Ratmann
- Department of Infectious Disease Epidemiology and the National Institute for Health Research Health Protection Research Unit on Modeling Methodology, Imperial College London
| | - Anna Tostevin
- Institute for Global Health, University College London
| | - David Dunn
- Institute for Global Health, University College London
| | | | - Siobhan O'Shea
- Infection Sciences, Viapath Analytics, Guy's and St Thomas' NHS Foundation Trust, London
| | | | | | | | - Christophe Fraser
- Li Ka Shing Centre for Health Information and Discovery, Oxford University, United Kingdom
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31
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Banerjee E, Griffith J, Kenyon C, Christianson B, Strain A, Martin K, McMahon M, Bagstad E, Laine E, Hardy K, Grilli G, Walters J, Dunn D, Roddy M, Ehresmann K. Containing a measles outbreak in Minnesota, 2017: methods and challenges. Perspect Public Health 2019; 140:162-171. [PMID: 31480896 DOI: 10.1177/1757913919871072] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS We report on a measles outbreak largely occurring in Minnesota's under-vaccinated Somali community in the spring of 2017. The outbreak was already into its third generation when the first two cases were confirmed, and rapid public health actions were needed. The aim of our response was to quickly end transmission and contain the outbreak. METHODS The state public health department performed laboratory testing on suspect cases and activated an Incident Command staffed by subject matter experts that was operational within 2 h of case confirmation. Epidemiologic interviews identified exposures in settings where risk of transmission was high, that is, healthcare, childcare, and school settings. Vaccination status of exposed persons was assessed, and postexposure prophylaxis (PEP) was offered, if applicable. Exposed persons who did not receive PEP were excluded from childcare centers or schools for 21 days. An accelerated statewide measles, mumps, and rubella (MMR) recommendation was made for Somali Minnesota children and children in affected outbreak counties. Partnerships with the Somali Minnesota community were deepened, building off outreach work done with the community since 2008. RESULTS Public health identified 75 measles cases from 30 March to 25 August 2017: 43% were female, 81% Somali Minnesotan, 91% unvaccinated, and 28% hospitalized. The median age of cases was 2 years (range: 3 months-57 years). Most transmission (78%) occurred in childcare centers and households. A secondary attack rate of 91% was calculated for unvaccinated household contacts. Over 51,000 doses of MMR were administered during the outbreak above expected baseline. At least 8490 individuals were exposed to measles; 155 individuals received PEP; and over 500 persons were excluded from childcare and school. State and key public health partners spent an estimated $2.3 million on response. CONCLUSION This outbreak demonstrates the necessity of immediate, targeted disease control actions and strong public health, healthcare, and community partnerships to end a measles outbreak.
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Affiliation(s)
- E Banerjee
- Infectious Disease Epidemiology, Prevention and Control, Minnesota Department of Health, 625 Robert St. N., St. Paul, MN 55164, USA
| | - J Griffith
- Minnesota Department of Health, St. Paul, MN, USA
| | - C Kenyon
- Minnesota Department of Health, St. Paul, MN, USA
| | | | - A Strain
- Minnesota Department of Health, St. Paul, MN, USA
| | - K Martin
- Minnesota Department of Health, St. Paul, MN, USA
| | - M McMahon
- Minnesota Department of Health, St. Paul, MN, USA
| | - E Bagstad
- Hennepin County Human Services and Public Health, Hopkins, MN, USA
| | - E Laine
- Minnesota Department of Health, St. Paul, MN, USA
| | - K Hardy
- Minnesota Department of Health, St. Paul, MN, USA
| | - G Grilli
- Minnesota Department of Health, St. Paul, MN, USA
| | - J Walters
- Minnesota Department of Health, St. Paul, MN, USA
| | - D Dunn
- Minnesota Department of Health, St. Paul, MN, USA
| | - M Roddy
- Minnesota Department of Health, St. Paul, MN, USA
| | - K Ehresmann
- Minnesota Department of Health, St. Paul, MN, USA
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32
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Le Vu S, Ratmann O, Delpech V, Brown AE, Gill ON, Tostevin A, Dunn D, Fraser C, Volz EM. HIV-1 Transmission Patterns in Men Who Have Sex with Men: Insights from Genetic Source Attribution Analysis. AIDS Res Hum Retroviruses 2019; 35:805-813. [PMID: 31280593 PMCID: PMC6735327 DOI: 10.1089/aid.2018.0236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Near 60% of new HIV infections in the United Kingdom are estimated to occur in men who have sex with men (MSM). Age-disassortative partnerships in MSM have been suggested to spread the HIV epidemics in many Western developed countries and to contribute to ethnic disparities in infection rates. Understanding these mixing patterns in transmission can help to determine which groups are at a greater risk and guide public health interventions. We analyzed combined epidemiological data and viral sequences from MSM diagnosed with HIV at the national level. We applied a phylodynamic source attribution model to infer patterns of transmission between groups of patients. From pair probabilities of transmission between 14,603 MSM patients, we found that potential transmitters of HIV subtype B were on average 8 months older than recipients. We also found a moderate overall assortativity of transmission by ethnic group and a stronger assortativity by region. Our findings suggest that there is only a modest net flow of transmissions from older to young MSM in subtype B epidemics and that young MSM, both for Black or White groups, are more likely to be infected by one another than expected in a sexual network with random mixing.
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Affiliation(s)
- Stéphane Le Vu
- Department of Infectious Disease Epidemiology, National Institute for Health Research Health Protection Research Unit on Modeling Methodology, Imperial College London, London, United Kingdom
| | - Oliver Ratmann
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Valerie Delpech
- HIV and STI Department of Public Health England's Center for Infectious Disease Surveillance and Control, London, United Kingdom
| | - Alison E. Brown
- HIV and STI Department of Public Health England's Center for Infectious Disease Surveillance and Control, London, United Kingdom
| | - O. Noel Gill
- HIV and STI Department of Public Health England's Center for Infectious Disease Surveillance and Control, London, United Kingdom
| | - Anna Tostevin
- Institute for Global Health, University College London, London, United Kingdom
| | - David Dunn
- Institute for Global Health, University College London, London, United Kingdom
| | - Christophe Fraser
- Nuffield Department of Medicine, Big Data Institute, Li Ka Shing Center for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Erik M. Volz
- Department of Infectious Disease Epidemiology, National Institute for Health Research Health Protection Research Unit on Modeling Methodology, Imperial College London, London, United Kingdom
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Lyttle MD, Bielicki JA, Barratt S, Dunn D, Finn A, Harper L, Jackson P, Powell CVE, Roland D, Stohr W, Sturgeon K, Wan M, Little P, Faust SN, Robotham J, Hay AD, Gibb DM, Sharland M. Efficacy, safety and impact on antimicrobial resistance of duration and dose of amoxicillin treatment for young children with Community-Acquired Pneumonia: a protocol for a randomIsed controlled Trial (CAP-IT). BMJ Open 2019; 9:e029875. [PMID: 31123008 PMCID: PMC6538022 DOI: 10.1136/bmjopen-2019-029875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is a common indication for antibiotic treatment in young children. Data are limited regarding the ideal dose and duration of amoxicillin, leading to practice variation which may impact on treatment failure and antimicrobial resistance (AMR). Community-Acquired Pneumonia: a randomIsed controlled Trial (CAP-IT) aims to determine the optimal amoxicillin treatment strategies for CAP in young children in relation to efficacy and AMR. METHODS AND ANALYSIS The CAP-IT trial is a multicentre, randomised, double-blind, placebo-controlled 2×2 factorial non-inferiority trial of amoxicillin dose and duration. Children are enrolled in paediatric emergency and inpatient environments, and randomised to receive amoxicillin 70-90 or 35-50 mg/kg/day for 3 or 7 days following hospital discharge. The primary outcome is systemic antibacterial treatment for respiratory tract infection (including CAP) other than trial medication up to 4 weeks after randomisation. Secondary outcomes include adverse events, severity and duration of parent-reported CAP symptoms, adherence and antibiotic resistance. The primary analysis will be by intention to treat. Assuming a 15% primary outcome event rate, 8% non-inferiority margin assessed against an upper one-sided 95% CI, 90% power and 15% loss to follow-up, 800 children will be enrolled to demonstrate non-inferiority for the primary outcome for each of duration and dose. ETHICS AND DISSEMINATION The CAP-IT trial and relevant materials were approved by the National Research Ethics Service (reference: 16/LO/0831; 30 June 2016). The CAP-IT trial results will be published in peer-reviewed journals, and in a report published by the National Institute for Health Research Health Technology Assessment programme. Oral and poster presentations will be given to national and international conferences, and participating families will be notified of the results if they so wish. Key messages will be constructed in partnership with families, and social media will be used in their dissemination. TRIAL REGISTRATION NUMBER ISRCTN76888927, EudraCT2016-000809-36.
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Affiliation(s)
- Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Faculty of Health and Applied Science, University of the West of England, Bristol, UK
| | - Julia A Bielicki
- Paediatric Infectious Diseases Research Group, MRC Clinical Trial Unit at UCL, Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - David Dunn
- MRC Clinical Trials Unit at UCL, London, UK
| | - Adam Finn
- Bristol Children's Vaccine Centre, Schools of Population Sciences and Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | | | - Pauline Jackson
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Colin V E Powell
- Paediatric Emergency Medicine Department, Sidra Medicine, Doha, Qatar
- School of Medicine, Cardiff University, Cardiff, UK
| | - Damian Roland
- Emergency Department, Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester, UK
- SAPPHIRE group, University of Leicester Department of Health Sciences, Leicester, UK
| | | | | | - Mandy Wan
- NIHR CRN: Children, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Little
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Saul N Faust
- Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Julie Robotham
- HCAI and AMR Division, National Infection Service, Public Health England, London, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | | | - Mike Sharland
- Paediatric Infectious Diseases Research Group, MRC Clinical Trial Unit at UCL, Institute for Infection and Immunity, St George's University of London, London, UK
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Ragonnet-Cronin M, Hué S, Hodcroft EB, Tostevin A, Dunn D, Fawcett T, Pozniak A, Brown AE, Delpech V, Brown AJL. Non-disclosed men who have sex with men in UK HIV transmission networks: phylogenetic analysis of surveillance data. Lancet HIV 2019; 5:e309-e316. [PMID: 29893244 DOI: 10.1016/s2352-3018(18)30062-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients who do not disclose their sexuality, including men who do not disclose same-sex behaviour, are difficult to characterise through traditional epidemiological approaches such as interviews. Using a recently developed method to detect large networks of viral sequences from time-resolved trees, we localised non-disclosed men who have sex with men (MSM) in UK transmission networks, gaining crucial insight into the behaviour of this group. METHODS For this phylogenetic analysis, we obtained HIV pol sequences from the UK HIV Drug Resistance Database (UKRDB), a central repository for resistance tests done as part of routine clinical care throughout the UK. Sequence data are linked to demographic and clinical data held by the UK Collaborative HIV Cohort study and the national HIV/AIDS reporting system database. Initially, we reconstructed maximum likelihood phylogenies from these sequences, then sequences were selected for time-resolved analysis in BEAST if they were clustered with at least one other sequence at a genetic distance of 4·5% or less with support of at least 90%. We used time-resolved phylogenies to create networks by linking together nodes if sequences shared a common ancestor within the previous 5 years. We identified potential non-disclosed MSM (pnMSM), defined as self-reported heterosexual men who clustered only with men. We measured the network position of pnMSM, including betweenness (a measure of connectedness and importance) and assortativity (the propensity for nodes sharing attributes to link). FINDINGS 14 405 individuals were in the network, including 8452 MSM, 1743 heterosexual women and 1341 heterosexual men. 249 pnMSM were identified (18·6% of all clustered heterosexual men) in the network. pnMSM were more likely to be black African (p<0·0001), less likely to be infected with subtype B (p=0·006), and were slightly older (p=0·002) than the MSM they clustered with. Mean betweenness centrality was lower for pnMSM than for MSM (1·31, 95% CI 0·48-2·15 in pnMSM vs 2·24, 0·98-3·51 in MSM; p=0·002), indicating that pnMSM were in peripheral positions in MSM clusters. Assortativity by risk group was higher than expected (0·037 vs -0·037, p=0·01) signifying that pnMSM were linked to each other. We found that self-reported heterosexual men were more likely to link MSM and heterosexual women than heterosexual women were to link MSM and heterosexual men (Fisher's exact test p=0·0004; OR 2·24) but the number of such transmission chains was small (only 54 in total vs 32 in women). INTERPRETATION pnMSM are a subgroup distinct from both MSM and from heterosexual men. They are more likely to choose sexual partners who are also pnMSM and might exhibit lower-risk sexual behaviour than MSM (eg, choosing low-risk partners or consistently using condoms). Heterosexual men are the group most likely to be diagnosed with late-stage disease (ie, low CD4 counts) and non-disclosed MSM might put female partners at higher risk than heterosexual men because non-disclosed MSM have male partners. Hence, pnMSM require specific consideration to ensure they are included in public health interventions. FUNDING National Institutes of Health.
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Affiliation(s)
| | - Stéphane Hué
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma B Hodcroft
- Institute of Evolutionary Biology, Ashworth Laboratories, University of Edinburgh, Edinburgh, UK
| | - Anna Tostevin
- Institute for Global Health, University College London, London, UK
| | - David Dunn
- Institute for Global Health, University College London, London, UK
| | - Tracy Fawcett
- Virology, Old Medical School, Leeds General Infirmary, Leeds, UK
| | | | | | | | - Andrew J Leigh Brown
- Institute of Evolutionary Biology, Ashworth Laboratories, University of Edinburgh, Edinburgh, UK
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Do TD, Vuong TD, Dunn D, Clubb M, Valliyodan B, Patil G, Chen P, Xu D, Nguyen HT, Shannon JG. Identification of new loci for salt tolerance in soybean by high-resolution genome-wide association mapping. BMC Genomics 2019; 20:318. [PMID: 31023240 PMCID: PMC6485111 DOI: 10.1186/s12864-019-5662-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/31/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Salinity is an abiotic stress that negatively affects soybean [Glycine max (L.) Merr.] seed yield. Although a major gene for salt tolerance was identified and consistently mapped to chromosome (Chr.) 3 by linkage mapping studies, it does not fully explain genetic variability for tolerance in soybean germplasm. In this study, a genome-wide association study (GWAS) was performed to map genomic regions for salt tolerance in a diverse panel of 305 soybean accessions using a single nucleotide polymorphism (SNP) dataset derived from the SoySNP50K iSelect BeadChip. A second GWAS was also conducted in a subset of 234 accessions using another 3.7 M SNP dataset derived from a whole-genome resequencing (WGRS) study. In addition, three gene-based markers (GBM) of the known gene, Glyma03g32900, on Chr. 3 were also integrated into the two datasets. Salt tolerance among soybean lines was evaluated by leaf scorch score (LSS), chlorophyll content ratio (CCR), leaf sodium content (LSC), and leaf chloride content (LCC). RESULTS For both association studies, a major locus for salt tolerance on Chr. 3 was confirmed by a number of significant SNPs, of which three gene-based SNP markers, Salt-20, Salt14056 and Salt11655, had the highest association with all four traits studied. Also, additional genomic regions on Chrs. 1, 8, and 18 were found to be associated with various traits measured in the second GWAS using the WGRS-derived SNP dataset. CONCLUSIONS A region identified on Chr. 8 was identified to be associated with all four traits and predicted as a new minor locus for salt tolerance in soybean. The candidate genes harbored in this minor locus may help reveal the molecular mechanism involved in salt tolerance and to improve tolerance in soybean cultivars. The significant SNPs will be useful for marker-assisted selection for salt tolerance in soybean breeding programs.
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Affiliation(s)
- Tuyen D. Do
- Division of Plant Sciences, University of Missouri, Columbia, MO 65211 USA
- Present address: The Cuu Long Delta Rice Research Institute, Thoi Lai District, Can Tho City, Vietnam
| | - Tri D. Vuong
- Division of Plant Sciences, University of Missouri, Columbia, MO 65211 USA
| | - David Dunn
- Division of Plant Sciences, University of Missouri, Portageville, MO 63873 USA
| | - Michael Clubb
- Division of Plant Sciences, University of Missouri, Portageville, MO 63873 USA
| | - Babu Valliyodan
- Division of Plant Sciences, University of Missouri, Columbia, MO 65211 USA
| | - Gunvant Patil
- Division of Plant Sciences, University of Missouri, Columbia, MO 65211 USA
- Present Address: Department Agronomy and Plant Genetics, University of Minnesota, St. Paul, MN 55108 USA
| | - Pengyin Chen
- Division of Plant Sciences, University of Missouri, Portageville, MO 63873 USA
| | - Dong Xu
- Department of Electric Engineering and Computer Science, Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO 65211 USA
| | - Henry T. Nguyen
- Division of Plant Sciences, University of Missouri, Columbia, MO 65211 USA
| | - J. Grover Shannon
- Division of Plant Sciences, University of Missouri, Portageville, MO 63873 USA
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Miltz AR, Lampe FC, Bacchus LJ, McCormack S, Dunn D, White E, Rodger A, Phillips AN, Sherr L, Clarke A, McOwan A, Sullivan A, Gafos M. Intimate partner violence, depression, and sexual behaviour among gay, bisexual and other men who have sex with men in the PROUD trial. BMC Public Health 2019; 19:431. [PMID: 31023281 PMCID: PMC6482482 DOI: 10.1186/s12889-019-6757-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about the prevalence and correlates of intimate partner violence (IPV) among gay, bisexual and other men who have sex with men (GBMSM) in the UK. The aim of this study was to investigate the prevalence of IPV, associations of socio-economic and psychosocial factors with IPV, and the association of IPV with depression and sexual behaviour, among GBMSM in the PROUD trial of pre-exposure prophylaxis (PrEP). Methods PROUD enrolled 544 HIV-negative participants in England from 2012 to 2014; participants were randomised to immediate or deferred PrEP. This analysis included 436 GBMSM who had IPV data at month-12 and/or 24. Prevalence of IPV victimization and perpetration (lifetime, and in the past year) was assessed at these time-points. Generalized estimating equations were used to investigate associations with IPV, using pooled data from both time-points. Results At month-12 (N = 410), 44.9% of men reported ever being a victim of IPV, 15.6% in the last year, and 19.5% reported ever perpetrating IPV, 7.8% in the last year. At month-24 (N = 333), the corresponding prevalence was 40.2 and 14.7% for lifetime and past year IPV victimization and 18.0 and 6.9% for lifetime and past year IPV perpetration. IPV prevalence did not differ by randomised arm. Men reporting internalized homophobia and sexualized drug use were more likely to report IPV. Lifetime and last year experience of IPV victimization and perpetration were strongly associated with depressive symptoms (PHQ-9 ≥ 10) (adjusted for socio-demographics: lifetime IPV victimization PR 2.57 [95% CI: 1.71, 3.86]; past year IPV victimization PR 2.93 [95% CI: 1.96, 4.40]; lifetime IPV perpetration PR 2.87 [95% CI: 1.91, 4.32]; past year IPV perpetration PR 3.47 [95% CI: 2.13, 5.64], p < 0.001 for all); IPV was not consistently associated with measures of condomless anal sex or high partner numbers. Conclusions GBMSM at high-risk of HIV who are seeking/taking PrEP may experience a high burden of IPV, which may be linked to depression. Training on awareness of and enquiry for IPV among GBMSM in sexual health clinics is recommended. Trial registration ClinicalTrials.gov identifier: NCT02065986. Registered 19 February 2014 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12889-019-6757-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ada R Miltz
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK.
| | - Fiona C Lampe
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Loraine J Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - David Dunn
- MRC Clinical Trials Unit, University College London, London, UK
| | - Ellen White
- MRC Clinical Trials Unit, University College London, London, UK
| | - Alison Rodger
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Andrew N Phillips
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | | | | | - Ann Sullivan
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
AbstractAnxiety is a common comorbidity in children with epilepsy, though often overlooked and undertreated. Fear and worry are common reactions of children with epilepsy and their parents. Risk factors are multiple and include demographical, epilepsy-related, genetic, and family variables. Anxiety negatively affects health-related quality of life (QOL) and may contribute to poor seizure control. Appropriate treatment of anxiety in children with epilepsy should follow practice guidelines developed for treatment of anxiety in children without epilepsy and consist of education, counseling, and potentially psychopharmacology.
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Affiliation(s)
- Kelda Walsh
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - David Dunn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, United States
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Chakravarthula P, Dunn D, Aksit K, Fuchs H. FocusAR: Auto-focus Augmented Reality Eyeglasses for both Real World and Virtual Imagery. IEEE Trans Vis Comput Graph 2018; 24:2906-2916. [PMID: 30207958 DOI: 10.1109/tvcg.2018.2868532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We describe a system which corrects dynamically for the focus of the real world surrounding the near-eye display of the user and simultaneously the internal display for augmented synthetic imagery, with an aim of completely replacing the user prescription eyeglasses. The ability to adjust focus for both real and virtual stimuli will be useful for a wide variety of users, but especially for users over 40 years of age who have limited accommodation range. Our proposed solution employs a tunable-focus lens for dynamic prescription vision correction, and a varifocal internal display for setting the virtual imagery at appropriate spatially registered depths. We also demonstrate a proof of concept prototype to verify our design and discuss the challenges to building an auto-focus augmented reality eyeglasses for both real and virtual.
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Churchill D, Waters L, Ahmed N, Angus B, Boffito M, Bower M, Dunn D, Edwards S, Emerson C, Fidler S, Fisher M, Horne R, Khoo S, Leen C, Mackie N, Marshall N, Monteiro F, Nelson M, Orkin C, Palfreeman A, Pett S, Phillips A, Post F, Pozniak A, Reeves I, Sabin C, Trevelion R, Walsh J, Wilkins E, Williams I, Winston A. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015. HIV Med 2018; 17 Suppl 4:s2-s104. [PMID: 27568911 DOI: 10.1111/hiv.12426] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | - Mark Bower
- Chelsea and Westminster Hospital, London, UK
| | | | - Simon Edwards
- Central and North West London NHS Foundation Trust, UK
| | | | - Sarah Fidler
- Imperial College School of Medicine at St Mary's, London, UK
| | | | | | | | | | | | | | | | - Mark Nelson
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Caroline Sabin
- Royal Free and University College Medical School, London, UK
| | | | - John Walsh
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Ian Williams
- Royal Free and University College Medical School, London, UK
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40
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Auvin S, Wirrell E, Donald KA, Berl M, Hartmann H, Valente KD, Van Bogaert P, Cross JH, Osawa M, Kanemura H, Aihara M, Guerreiro MM, Samia P, Vinayan KP, Smith ML, Carmant L, Kerr M, Hermann B, Dunn D, Wilmshurst JM. Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission. Epilepsia 2018; 59:1867-1880. [DOI: 10.1111/epi.14549] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/28/2018] [Accepted: 07/31/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Stéphane Auvin
- Department of Pediatric Neurology; Robert-Debré University Hospital; APHP; Paris France
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy; Mayo Clinic; Rochester Minnesota
| | - Kirsten A. Donald
- Division of Developmental Paediatrics; Department of Paediatrics and Child Health; Neurosciences Institute; Red Cross War Memorial Children’s Hospital; University of Cape Town; Cape Town South Africa
| | - Madison Berl
- Division of Pediatric Neuropsychology; Children’s National Medical Center; Washington District of Columbia
| | - Hans Hartmann
- Clinic for Pediatric Kidney, Liver and Metabolic Disorders; Hannover Medical School; Hannover Germany
| | - Kette D. Valente
- Division of Clinical Neurophysiology, Institute and Department of Psychiatry; Clinics Hospital (HCFMUSP); Faculty of Medicine; University of São Paulo; São Paulo Brazil
| | - Patrick Van Bogaert
- Department of Pediatric Neurology and Neurosurgery; University Hospital of Angers; Angers France
| | - J. Helen Cross
- Developmental Neurosciences Programme; UCl Great Ormond Street Institute of Child Health, London & Young Epilepsy; Lingfield UK
| | - Makiko Osawa
- Department of Pediatrics; Tokyo Women’s Medical University; Tokyo Japan
| | - Hideaki Kanemura
- Department of Pediatrics; Faculty of Medicine; University of Yamanashi; Yamanashi Japan
| | - Masao Aihara
- Graduate Faculty of Interdisciplinary Research; Graduate School; University of Amanashi; Yamanashi Japan
| | | | - Pauline Samia
- Department of Paediatrics and Child Health; Aga Khan University; Nairobi Kenya
| | | | - Mary Lou Smith
- Department of Psychology; The Hospital for Sick Children; University of Toronto Mississauga; Toronto Canada
| | - Lionel Carmant
- Department of Neurosciences and Pediatrics; CHU Sainte-Justine; University of Montreal; Montreal Canada
| | - Michael Kerr
- Division of Psychological Medicine and Clinical Neuroscience; Cardiff University; Cardiff Wales UK
| | - Bruce Hermann
- Department of Neurology; School of Medicine and Public Health; University of Wisconsin; Madison Wisconsin
| | - David Dunn
- Section of Child and Adolescent Psychiatry; Departments of Psychiatry and Neurology; Indiana University School of Medicine; Indianapolis Indiana
| | - Jo M. Wilmshurst
- Division of Paediatric Neurology; Neuroscience Institute; Department of Paediatrics and Child Health; Red Cross War Memorial Children’s Hospital; University of Cape Town; Cape Town South Africa
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Do TD, Vuong TD, Dunn D, Smothers S, Patil G, Yungbluth DC, Chen P, Scaboo A, Xu D, Carter TE, Nguyen HT, Grover Shannon J. Mapping and confirmation of loci for salt tolerance in a novel soybean germplasm, Fiskeby III. Theor Appl Genet 2018; 131:513-524. [PMID: 29151146 DOI: 10.1007/s00122-017-3015-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/04/2017] [Indexed: 05/02/2023]
Abstract
KEY MESSAGE The confirmation of a major locus associated with salt tolerance and mapping of a new locus, which could be beneficial for improving salt tolerance in soybean. Breeding soybean for tolerance to high salt conditions is important in some regions of the USA and world. Soybean cultivar Fiskeby III (PI 438471) in maturity group 000 has been reported to be highly tolerant to multiple abiotic stress conditions, including salinity. In this study, a mapping population of 132 F2 families derived from a cross of cultivar Williams 82 (PI 518671, moderately salt sensitive) and Fiskeby III (salt tolerant) was analyzed to map salt tolerance genes. The evaluation for salt tolerance was performed by analyzing leaf scorch score (LSS), chlorophyll content ratio (CCR), leaf sodium content (LSC), and leaf chloride content (LCC) after treatment with 120 mM NaCl under greenhouse conditions. Genotypic data for the F2 population were obtained using the SoySNP6K Illumina Infinium BeadChip assay. A major allele from Fiskeby III was significantly associated with LSS, CCR, LSC, and LCC on chromosome (Chr.) 03 with LOD scores of 19.1, 11.0, 7.7 and 25.6, respectively. In addition, a second locus associated with salt tolerance for LSC was detected and mapped on Chr. 13 with an LOD score of 4.6 and an R 2 of 0.115. Three gene-based polymorphic molecular markers (Salt-20, Salt14056 and Salt11655) on Chr.03 showed a strong predictive association with phenotypic salt tolerance in the present mapping population. These molecular markers will be useful for marker-assisted selection to improve salt tolerance in soybean.
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Affiliation(s)
- Tuyen D Do
- Division of Plant Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - Tri D Vuong
- Division of Plant Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - David Dunn
- Division of Plant Sciences, University of Missouri, Delta Research Center, Portageville, MO, 63873, USA
| | - Scotty Smothers
- Division of Plant Sciences, University of Missouri, Delta Research Center, Portageville, MO, 63873, USA
| | - Gunvant Patil
- Division of Plant Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - Dennis C Yungbluth
- Division of Plant Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - Pengyin Chen
- Division of Plant Sciences, University of Missouri, Delta Research Center, Portageville, MO, 63873, USA
| | - Andrew Scaboo
- Division of Plant Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - Dong Xu
- Department of Electric Engineering and Computer Science, Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO, 65211, USA
| | - Thomas E Carter
- Soybean and Nitrogen Fixation Unit, USDA-ARS, Raleigh, NC, 27607, USA
| | - Henry T Nguyen
- Division of Plant Sciences, University of Missouri, Columbia, MO, 65211, USA.
| | - J Grover Shannon
- Division of Plant Sciences, University of Missouri, Delta Research Center, Portageville, MO, 63873, USA.
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Wiggs KK, Chang Z, Quinn PD, Hur K, Gibbons R, Dunn D, Brikell I, Larsson H, D'Onofrio BM. Attention-deficit/hyperactivity disorder medication and seizures. Neurology 2018; 90:e1104-e1110. [PMID: 29476037 DOI: 10.1212/wnl.0000000000005213] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/12/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of seizures, but there is uncertainty about whether ADHD medication treatment increases risk among patients with and without preexisting seizures. METHODS We followed a sample of 801,838 patients with ADHD who had prescribed drug claims from the Truven Health MarketScan Commercial Claims and Encounters databases to examine whether ADHD medication increases the likelihood of seizures among ADHD patients with and without a history of seizures. First, we assessed overall risk of seizures among patients with ADHD. Second, within-individual concurrent analyses assessed odds of seizure events during months when a patient with ADHD received ADHD medication compared with when the same individual did not, while adjusting for antiepileptic medications. Third, within-individual long-term analyses examined odds of seizure events in relation to the duration of months over the previous 2 years patients received medication. RESULTS Patients with ADHD were at higher odds for any seizure compared with non-ADHD controls (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 2.24-2.42 males; OR = 2.31, 95% CI = 2.22-2.42 females). In adjusted within-individual comparisons, ADHD medication was associated with lower odds of seizures among patients with (OR = 0.71, 95% CI = 0.60-0.85) and without (OR = 0.71, 95% CI = 0.62-0.82) prior seizures. Long-term within-individual comparisons suggested no evidence of an association between medication use and seizures among individuals with (OR = 0.87, 95% CI = 0.59-1.30) and without (OR = 1.01, 95% CI = 0.80-1.28) a seizure history. CONCLUSIONS Results reaffirm that patients with ADHD are at higher risk of seizures. However, ADHD medication was associated with lower risk of seizures within individuals while they were dispensed medication, which is not consistent with the hypothesis that ADHD medication increases risk of seizures.
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Affiliation(s)
- Kelsey K Wiggs
- From the Department of Psychological and Brain Sciences (K.K.W., P.D.Q., B.M.D.), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics (Z.C., I.B., H.L.), Karolinska Institutet, Stockholm, Sweden; Center for Health Statistics (Z.C., P.D.Q., K.H., R.G.) and Departments of Medicine (R.G.) and Public Health Sciences (R.G.), University of Chicago, IL; Departments of Psychiatry (D.D.) and Neurology (D.D.), Indiana University School of Medicine, Indianapolis; and School of Medical Sciences (H.L.), Orebro University, Sweden.
| | - Zheng Chang
- From the Department of Psychological and Brain Sciences (K.K.W., P.D.Q., B.M.D.), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics (Z.C., I.B., H.L.), Karolinska Institutet, Stockholm, Sweden; Center for Health Statistics (Z.C., P.D.Q., K.H., R.G.) and Departments of Medicine (R.G.) and Public Health Sciences (R.G.), University of Chicago, IL; Departments of Psychiatry (D.D.) and Neurology (D.D.), Indiana University School of Medicine, Indianapolis; and School of Medical Sciences (H.L.), Orebro University, Sweden
| | - Patrick D Quinn
- From the Department of Psychological and Brain Sciences (K.K.W., P.D.Q., B.M.D.), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics (Z.C., I.B., H.L.), Karolinska Institutet, Stockholm, Sweden; Center for Health Statistics (Z.C., P.D.Q., K.H., R.G.) and Departments of Medicine (R.G.) and Public Health Sciences (R.G.), University of Chicago, IL; Departments of Psychiatry (D.D.) and Neurology (D.D.), Indiana University School of Medicine, Indianapolis; and School of Medical Sciences (H.L.), Orebro University, Sweden
| | - Kwan Hur
- From the Department of Psychological and Brain Sciences (K.K.W., P.D.Q., B.M.D.), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics (Z.C., I.B., H.L.), Karolinska Institutet, Stockholm, Sweden; Center for Health Statistics (Z.C., P.D.Q., K.H., R.G.) and Departments of Medicine (R.G.) and Public Health Sciences (R.G.), University of Chicago, IL; Departments of Psychiatry (D.D.) and Neurology (D.D.), Indiana University School of Medicine, Indianapolis; and School of Medical Sciences (H.L.), Orebro University, Sweden
| | - Robert Gibbons
- From the Department of Psychological and Brain Sciences (K.K.W., P.D.Q., B.M.D.), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics (Z.C., I.B., H.L.), Karolinska Institutet, Stockholm, Sweden; Center for Health Statistics (Z.C., P.D.Q., K.H., R.G.) and Departments of Medicine (R.G.) and Public Health Sciences (R.G.), University of Chicago, IL; Departments of Psychiatry (D.D.) and Neurology (D.D.), Indiana University School of Medicine, Indianapolis; and School of Medical Sciences (H.L.), Orebro University, Sweden
| | - David Dunn
- From the Department of Psychological and Brain Sciences (K.K.W., P.D.Q., B.M.D.), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics (Z.C., I.B., H.L.), Karolinska Institutet, Stockholm, Sweden; Center for Health Statistics (Z.C., P.D.Q., K.H., R.G.) and Departments of Medicine (R.G.) and Public Health Sciences (R.G.), University of Chicago, IL; Departments of Psychiatry (D.D.) and Neurology (D.D.), Indiana University School of Medicine, Indianapolis; and School of Medical Sciences (H.L.), Orebro University, Sweden
| | - Isabell Brikell
- From the Department of Psychological and Brain Sciences (K.K.W., P.D.Q., B.M.D.), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics (Z.C., I.B., H.L.), Karolinska Institutet, Stockholm, Sweden; Center for Health Statistics (Z.C., P.D.Q., K.H., R.G.) and Departments of Medicine (R.G.) and Public Health Sciences (R.G.), University of Chicago, IL; Departments of Psychiatry (D.D.) and Neurology (D.D.), Indiana University School of Medicine, Indianapolis; and School of Medical Sciences (H.L.), Orebro University, Sweden
| | - Henrik Larsson
- From the Department of Psychological and Brain Sciences (K.K.W., P.D.Q., B.M.D.), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics (Z.C., I.B., H.L.), Karolinska Institutet, Stockholm, Sweden; Center for Health Statistics (Z.C., P.D.Q., K.H., R.G.) and Departments of Medicine (R.G.) and Public Health Sciences (R.G.), University of Chicago, IL; Departments of Psychiatry (D.D.) and Neurology (D.D.), Indiana University School of Medicine, Indianapolis; and School of Medical Sciences (H.L.), Orebro University, Sweden
| | - Brian M D'Onofrio
- From the Department of Psychological and Brain Sciences (K.K.W., P.D.Q., B.M.D.), Indiana University, Bloomington; Department of Medical Epidemiology and Biostatistics (Z.C., I.B., H.L.), Karolinska Institutet, Stockholm, Sweden; Center for Health Statistics (Z.C., P.D.Q., K.H., R.G.) and Departments of Medicine (R.G.) and Public Health Sciences (R.G.), University of Chicago, IL; Departments of Psychiatry (D.D.) and Neurology (D.D.), Indiana University School of Medicine, Indianapolis; and School of Medical Sciences (H.L.), Orebro University, Sweden
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Cambiano V, Miners A, Dunn D, McCormack S, Ong KJ, Gill ON, Nardone A, Desai M, Field N, Hart G, Delpech V, Cairns G, Rodger A, Phillips AN. Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation. Lancet Infect Dis 2017; 18:85-94. [PMID: 29054789 DOI: 10.1016/s1473-3099(17)30540-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/01/2017] [Accepted: 08/29/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND In the UK, HIV incidence among men who have sex with men (MSM) has remained high for several years, despite widespread use of antiretroviral therapy and high rates of virological suppression. Pre-exposure prophylaxis (PrEP) has been shown to be highly effective in preventing further infections in MSM, but its cost-effectiveness is uncertain. METHODS In this modelling study and economic evaluation, we calibrated a dynamic, individual-based stochastic model, the HIV Synthesis Model, to multiple data sources (surveillance data provided by Public Health England and data from a large, nationally representative survey, Natsal-3) on HIV among MSM in the UK. We did a probabilistic sensitivity analysis (sampling 22 key parameters) along with a range of univariate sensitivity analyses to evaluate the introduction of a PrEP programme with sexual event-based use of emtricitabine and tenofovir for MSM who had condomless anal sexual intercourse in the previous 3 months, a negative HIV test at baseline, and a negative HIV test in the preceding year. The main model outcomes were the number of HIV infections, quality-adjusted life-years (QALYs), and costs. FINDINGS Introduction of such a PrEP programme, with around 4000 MSM initiated on PrEP by the end of the first year and almost 40 000 by the end of the 15th year, would result in a total cost saving (£1·0 billion discounted), avert 25% of HIV infections (42% of which would be directly because of PrEP), and lead to a gain of 40 000 discounted QALYs over an 80-year time horizon. This result was particularly sensitive to the time horizon chosen, the cost of antiretroviral drugs (for treatment and PrEP), and the underlying trend in condomless sex. INTERPRETATION This analysis suggests that the introduction of a PrEP programme for MSM in the UK is cost-effective and possibly cost-saving in the long term. A reduction in the cost of antiretroviral drugs (including the drugs used for PrEP) would substantially shorten the time for cost savings to be realised. FUNDING National Institute for Health Research.
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Affiliation(s)
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Dunn
- MRC Clinical Trials Unit at UCL, London, UK
| | | | - Koh Jun Ong
- HIV and STI Department, Public Health England, London, UK
| | - O Noel Gill
- HIV and STI Department, Public Health England, London, UK
| | | | - Monica Desai
- HIV and STI Department, Public Health England, London, UK
| | - Nigel Field
- Institute for Global Health, University College London, London, UK
| | - Graham Hart
- Faculty of Population Health Sciences, University College London, London, UK
| | | | | | - Alison Rodger
- Institute for Global Health, University College London, London, UK
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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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O'Connor J, Smith C, Lampe FC, Johnson MA, Chadwick DR, Nelson M, Dunn D, Winston A, Post FA, Sabin C, Phillips AN. Durability of viral suppression with first-line antiretroviral therapy in patients with HIV in the UK: an observational cohort study. Lancet HIV 2017; 4:e295-e302. [PMID: 28479492 PMCID: PMC5489695 DOI: 10.1016/s2352-3018(17)30053-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/04/2017] [Accepted: 02/28/2017] [Indexed: 12/04/2022]
Abstract
BACKGROUND The length of time that people with HIV on antiretroviral therapy (ART) with viral load suppression will be able to continue before developing viral rebound is unknown. We aimed to investigate the rate of first viral rebound in people that have achieved initial suppression with ART, to determine factors associated with viral rebound, and to use these estimates to predict long-term durability of viral suppression. METHODS The UK Collaborative HIV Cohort (UK CHIC) Study is an ongoing multicentre cohort study that brings together in a standardised format data on people with HIV attending clinics around the UK. We included participants who started ART with three or more drugs and who had achieved viral suppression (≤50 copies per mL) by 9 months after the start of ART (baseline). Viral rebound was defined as the first single viral load of more than 200 copies per mL or treatment interruption (for ≥1 month). We investigated factors associated with viral rebound with Poisson regression. These results were used to calculate the rate of viral rebound according to several key factors, including age, calendar year at start of ART, and time since baseline. RESULTS Of the 16 101 people included, 4519 had a first viral rebound over 58 038 person-years (7·8 per 100 person-years, 95% CI 7·6-8·0). Of the 4519 viral rebounds, 3105 (69%) were defined by measurement of a single viral load of more than 200 copies per mL, and 1414 (31%) by a documented treatment interruption. The rate of first viral rebound declined substantially over time until 7 years from baseline. The other factors associated with viral rebound were current age at follow-up and calendar year at ART initiation (p<0·0001) and HIV risk group (p<0·0001); higher pre-ART CD4 count (p=0·0008) and pre-ART viral load (p=0·0003) were associated with viral rebound in the multivariate analysis only. For 1322 (29%) of the 3105 people with observed viral rebound, the next viral load value after rebound was 50 copies per mL or less with no regimen change. For HIV-positive men who have sex with men, our estimates suggest that the probability of first viral rebound reaches a plateau of 1·4% per year after 45 years of age, and 1·0% when accounting for the fact that 29% of viral rebounds are temporary elevations. INTERPRETATION A substantial proportion of people on ART will not have viral rebound over their lifetime, which has implications for people with HIV and the planning of future drug development. FUNDING UK Medical Research Council.
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Affiliation(s)
- Jemma O'Connor
- Research Department of Infection and Population Health, UCL, London, UK
| | - Colette Smith
- Research Department of Infection and Population Health, UCL, London, UK
| | - Fiona C Lampe
- Research Department of Infection and Population Health, UCL, London, UK
| | | | - David R Chadwick
- Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, UK
| | - Mark Nelson
- Department of Sexual Health and HIV, Chelsea and Westminster Hospital, London, UK
| | - David Dunn
- Research Department of Infection and Population Health, UCL, London, UK
| | - Alan Winston
- Department of Medicine, Imperial College and St Mary's Hospital, London, UK
| | - Frank A Post
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, UK
| | - Caroline Sabin
- Research Department of Infection and Population Health, UCL, London, UK
| | - Andrew N Phillips
- Research Department of Infection and Population Health, UCL, London, UK.
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Gafos M, Brodnicki E, Desai M, McCormack S, Nutland W, Wayal S, White E, Wood G, Barber T, Bell G, Clarke A, Dolling D, Dunn D, Fox J, Haddow L, Lacey C, Nardone A, Quinn K, Rae C, Reeves I, Rayment M, White D, Apea V, Ayap W, Dewsnap C, Collaco-Moraes Y, Schembri G, Sowunmi Y, Horne R. Acceptability of an open-label wait-listed trial design: Experiences from the PROUD PrEP study. PLoS One 2017; 12:e0175596. [PMID: 28426834 PMCID: PMC5398545 DOI: 10.1371/journal.pone.0175596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/28/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND PROUD participants were randomly assigned to receive pre-exposure prophylaxis (PrEP) immediately or after a deferred period of one-year. We report on the acceptability of this open-label wait-listed trial design. METHODS Participants completed an acceptability questionnaire, which included categorical study acceptability data and free-text data on most and least liked aspects of the study. We also conducted in-depth interviews (IDI) with a purposely selected sub-sample of participants. RESULTS Acceptability questionnaires were completed by 76% (415/544) of participants. After controlling for age, immediate-group participants were almost twice as likely as deferred-group participants to complete the questionnaire (AOR:1.86;95%CI:1.24,2.81). In quantitative data, the majority of participants in both groups found the wait-listed design acceptable when measured by satisfaction of joining the study, intention to remain in the study, and interest in joining a subsequent study. However, three-quarters thought that the chance of being in the deferred-group might put other volunteers off joining the study. In free-text responses, data collection tools were the most frequently reported least liked aspect of the study. A fifth of deferred participants reported 'being deferred' as the thing they least liked about the study. However, more deferred participants disliked the data collection tools than the fact that they had to wait a year to access PrEP. Participants in the IDIs had a good understanding of the rationale for the open-label wait-listed study design. Most accepted the design but acknowledged they were, or would have been, disappointed to be randomised to the deferred group. Five of the 25 participants interviewed reported some objection to the wait-listed design. CONCLUSION The quantitative and qualitative findings suggest that in an environment where PrEP was not available, the rationale for the wait-listed trial design was well understood and generally acceptable to most participants in this study.
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Affiliation(s)
- Mitzy Gafos
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Elizabeth Brodnicki
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Monica Desai
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Will Nutland
- Sigma research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sonali Wayal
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
| | - Ellen White
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gemma Wood
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Tristan Barber
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Gill Bell
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Amanda Clarke
- Claude Nichol Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - David Dolling
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - David Dunn
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Julie Fox
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lewis Haddow
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Charles Lacey
- York Hospitals NHS Foundation Trust, York, United Kingdom
| | - Anthony Nardone
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Killian Quinn
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline Rae
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Iain Reeves
- Department of Sexual Health, Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - Michael Rayment
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - David White
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Vanessa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, United Kingdom
| | - Wilbert Ayap
- St Mary’s Hospital, Imperial College NHS Foundation Trust, London, United Kingdom
| | - Claire Dewsnap
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Yolanda Collaco-Moraes
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Yinka Sowunmi
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Rob Horne
- School of Pharmacy, University College London, London, United Kingdom
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Collins IJ, Foster C, Tostevin A, Tookey P, Riordan A, Dunn D, Gibb DM, Judd A. Clinical Status of Adolescents with Perinatal HIV at Transfer to Adult Care in the UK/Ireland. Clin Infect Dis 2017; 64:1105-1112. [PMID: 28329212 PMCID: PMC5714266 DOI: 10.1093/cid/cix063] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/15/2016] [Indexed: 12/15/2022] Open
Abstract
Background Increasing numbers of children infected perinatally with human immunodeficiency virus (HIV) are surviving to adolescence and transitioning to adult care, yet there are scarce data on their clinical status at transfer. Methods We analyzed prospective cohort data from the UK/Ireland national Collaborative HIV Pediatric Study (CHIPS). Clinical status at last pediatric clinic visit prior to transfer was described. Factors associated with higher CD4 cell count and viral load (VL) suppression<400 c/mL among patients on antiretroviral therapy (ART) at transfer were assessed using linear and logistic regression, respectively. Data were matched with the UK HIV Drug Resistance Database (UKHIVDRB) to assess cumulative resistance profiles at transfer. Results Of 1,907 children followed in CHIPS from 1996 to November 2014, 644 (34%) transferred to adult care: 53% were female, 62% born outside the UK/Ireland, 75% black African. At last pediatric follow-up, median age was 17.4 years [interquartile range 16.5,18.1], 27% had previous AIDS diagnosis, CD4 was 444 cells/mm3 [280, 643], 76% were on ART, 13% off-ART, and 11% ART-naive. Among patients on ART, 74% had VL<400 c/mL. In multivariable analysis, higher CD4 at transfer was associated with younger age, higher CD4 at ART initiation and lower VL at transfer (P ≤ .001). Predictors of viral suppression include no AIDS diagnosis and later year of transfer (P ≤ .05). Of 291 patients with resistance data, 82% had resistance to ≥1 drug class, 56% to ≥2 classes and 12% had triple-class resistance. Conclusion Three-quarters of adolescents were on stable ART at transfer, of whom 74% were virologically suppressed. The prevalence of triple-class resistance was relatively low at 12%.
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Affiliation(s)
- Intira Jeannie Collins
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK
| | | | - Anna Tostevin
- Research Department of Infection and Population Health, University College London, UK
| | - Pat Tookey
- Institute of Child Health, University College London, London, UK
| | - Andrew Riordan
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - David Dunn
- Research Department of Infection and Population Health, University College London, UK
| | - D M Gibb
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK
| | - Ali Judd
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK
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Dunn D, Tippets C, Torell K, Kellnhofer P, Aksit K, Didyk P, Myszkowski K, Luebke D, Fuchs H. Wide Field Of View Varifocal Near-Eye Display Using See-Through Deformable Membrane Mirrors. IEEE Trans Vis Comput Graph 2017; 23:1322-1331. [PMID: 28129167 DOI: 10.1109/tvcg.2017.2657058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Accommodative depth cues, a wide field of view, and ever-higher resolutions all present major hardware design challenges for near-eye displays. Optimizing a design to overcome one of these challenges typically leads to a trade-off in the others. We tackle this problem by introducing an all-in-one solution - a new wide field of view, gaze-tracked near-eye display for augmented reality applications. The key component of our solution is the use of a single see-through, varifocal deformable membrane mirror for each eye reflecting a display. They are controlled by airtight cavities and change the effective focal power to present a virtual image at a target depth plane which is determined by the gaze tracker. The benefits of using the membranes include wide field of view (100° diagonal) and fast depth switching (from 20 cm to infinity within 300 ms). Our subjective experiment verifies the prototype and demonstrates its potential benefits for near-eye see-through displays.
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Tostevin A, White E, Dunn D, Croxford S, Delpech V, Williams I, Asboe D, Pozniak A, Churchill D, Geretti AM, Pillay D, Sabin C, Leigh‐Brown A, Smit E. Recent trends and patterns in HIV-1 transmitted drug resistance in the United Kingdom. HIV Med 2017; 18:204-213. [PMID: 27476929 PMCID: PMC5297994 DOI: 10.1111/hiv.12414] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Transmission of drug-resistant HIV-1 has decreased in the UK since the early 2000s. This analysis reports recent trends and characteristics of transmitted drug resistance (TDR) in the UK from 2010 to 2013. METHODS Resistance tests conducted in antiretroviral treatment (ART)-naïve individuals between 2010 and 2013 were analysed for the presence of transmitted drug resistance mutations (TDRMs), defined as any mutations from a modified 2009 World Health Organization surveillance list, or a modified 2013 International Antiviral Society-USA list for integrase tests. Logistic regression was used to examine associations between demographics and the prevalence of TDRMs. RESULTS TDRMs were observed in 1223 (7.5%) of 16 425 individuals; prevalence declined from 8.1% in 2010 to 6.6% in 2013 (P = 0.02). The prevalence of TDRMs was higher among men who have sex with men (MSM) compared with heterosexual men and women (8.7% versus 6.4%, respectively) with a trend for decreasing TDRMs among MSM (P = 0.008) driven by a reduction in nucleoside reverse transcriptase inhibitor (NRTI)-related mutations. The most frequently detected TDRMs were K103N (2.2%), T215 revertants (1.6%), M41L (0.9%) and L90M (0.7%). Predicted phenotypic resistance to first-line ART was highest to the nonnucleoside reverse transcriptase inhibitors (NNRTIs) rilpivirine and efavirenz (6.2% and 3.4%, respectively) but minimal to NRTIs, including tenofovir, and protease inhibitors (PIs). No major integrase TDRMs were detected among 101 individuals tested while ART-naïve. CONCLUSIONS We observed a decrease in TDRMs in recent years. However, this was confined to the MSM population and rates remained stable in those with heterosexually acquired HIV infection. Resistance to currently recommended first-line ART, including integrase inhibitors, remained reassuringly low.
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Affiliation(s)
- A Tostevin
- MRC Clinical Trials Unit at UCLUniversity College LondonLondonUK
| | - E White
- MRC Clinical Trials Unit at UCLUniversity College LondonLondonUK
| | - D Dunn
- MRC Clinical Trials Unit at UCLUniversity College LondonLondonUK
| | - S Croxford
- Centre for Infectious Disease Surveillance and Control (CIDSC)Public Health EnglandLondonUK
| | - V Delpech
- Centre for Infectious Disease Surveillance and Control (CIDSC)Public Health EnglandLondonUK
| | - I Williams
- Mortimer Market CentreUniversity College London Hospitals NHS TrustLondonUK
| | - D Asboe
- Chelsea & Westminster HospitalLondonUK
| | - A Pozniak
- Chelsea & Westminster HospitalLondonUK
| | - D Churchill
- Brighton and Sussex University Hospitals NHS TrustBrightonUK
| | | | - D Pillay
- Division of Infection and ImmunityUniversity College LondonLondonUK
- Africa Centre for Health and Population StudiesUniversity of KwaZulu‐NatalMtubatubaSouth Africa
| | - C Sabin
- Research Department of Infection and Population HealthUniversity College LondonLondonUK
| | | | - E Smit
- Public Health EnglandBirmingham Heartlands HospitalBirminghamUK
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Butterfield R, Dunn D, Hu Y, Bonnemann C, Weiss R. Transcriptome profiling identifies key pathways important in collagen VI related muscular dystrophies including differences between patients with dominant negative vs. null mutations. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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