Antiretroviral Adherence, Drug Resistance, and the Impact of Social Determinants of Health in HIV-1 Patients in the US

Adherence to antiretroviral therapy (ART) is critical to achieving viral suppression. However, social determinants of health (SDoH) can undermine patient adherence to ART, resulting in drug resistance that compromises future treatment options. We assessed ART adherence and HIV-1 drug resistance at the national and state levels in the US and investigated their associations with SDoH and other HIV-related outcomes. Data were obtained from Symphony Health's Integrated Dataverse (IDV), Monogram/LabCorp Database, as well as national and publicly available databases, including Centers for Disease Control and Prevention (CDC), American Community Survey (ACS), and J. Kaiser Family Foundation (KFF). Inferential analyses were performed to investigate associations using patient-level data, and the results were reported by state and overall within the nation. Correlations between continuous variables were estimated by the Spearman's test, and that between continuous variable and categorical variable were estimated using one-way analysis of variance (ANOVA). State-level rates of poor adherence and resistance ranged from 26 to 55% and 20 to 54%, respectively. Female gender, non-white race, low education, poverty, and unemployment were associated with poor adherence; female gender was associated with drug resistance. Both adherence and resistance were correlated to HIV prevalence rates. Our findings suggest that US patients living with HIV face great challenges associated with poor ART adherence and HIV-1 drug resistance.

[Current Nomina Anatomica for oral and maxillofacial surgery]

Using the international organonymy is mandatory as well for daily clinical practice as for research and teaching our students. The international organonymy, Nomina Anatomica, is in Latin. A rather unsuccessful attempt at using a French version of the international organonymy in clinical practice has been made in France. Eponyms have been systematically contraindicated; the definitions of general anatomy are applied, as well as a systematic Gallicization of the Latin terminology. Despite a stringent observance of these rules, some terms remain inappropriate because they are misleading or inaccurate. Furthermore, using this language used worldwide remains uneasy in daily clinical practice. We had for objective to focus on the main anatomical terms used routinely in oral and maxillofacial surgery, and to justify their use in clinical practice, research, and education.

[Can one harvest a long bone stick in the radial forearm flap? Original radioanatomical and NanoSPECT-CT Bioscan microvascular study]

OBJECTIVES

The composite radial forearm flap is a surgical option in the reconstruction of large traumatic or oncologic orofacial defects. Nevertheless, it has been criticized for its poor bone transport faculties that would make this flap insufficient in large osseous mandibular reconstructions, or for oral prosthetic rehabilitation with dental implants. What is more, the morbidity of the donor site has often been pointed. The aim of this radioanatomic study was to revisit the vascularization of the composite radial forearm flap, focusing on the bone stick.

METHODS

A radioanatomic study was performed on seven upper limbs taken from fresh cadavers. First, the vessels were washed with a 40°C solution of potassium acetate. Then an intra-arterial injection of a mixture of lead oxide and agar-agar was performed. 3D-CT-scan examinations of the anatomical pieces were performed. In a second step, the flaps were harvested and analyzed with a Microscan examination (NanoSPECT-CT Bioscan(®), voxel 220 microns). Collateral branches of the radial artery to the bone and the skin were counted and classified.

RESULTS

One radial diaphyseal artery was present in all the cases. The nutrient foramen took place at the anteromedial aspect of the diaphysis, between 45 and 65 % of the length of the bone. A dense anastomotic periosteal network was highlightened, supplied by one to four musculoperiosteal branches, and one to six fascio-periosteal arteries arising from the radial artery. A total of mean five osseous branches, and 12 cutaneous branches have been observed.

CONCLUSIONS

The results of the present preclinical study suggested that a 16-cm bone stick could be harvested with an optimal vascular safety, without consideration for the morbidity at the donor site. The original approach in this study, relating anatomy to the preclinical imaging, allowed a precise visualization of the microvascularization of the soft and hard tissues. It opened a field of innovative research in plastic and reconstructive surgery.

Simultaneous demonstration of horseradish peroxidase and acetylcholinesterase

Simultaneous demonstration of acetylcholinesterase (AChE) and horseradish peroxidase (HRP) has been achieved by staining frozen sections with a modified Koelle-Friedenwald thiocholine method for AChE followed directly by the Graham-Karnovsky procedure for HRP. By using sodium sulfite instead of sodium sulfide in the AChE procedure, the final reaction product appears as black AChE granules that contrast sharply with the yellowish-brown HRP granules.

[An update on focal infection of oral origin]

Focal infection of oral origin means that an oral infectious focus may have widespread effects. This concept remains controversial since it is difficult to prove the oral origin of germs responsible for an extra-oral infection. Experiments on animal models and clinical studies suggested several physiopathological mechanisms: bacteremia, toxinic and immunological mechanisms. Various operations induce the passage of bacterial flora (transcytosis) and its toxins into the bloodstream: oral care, chewing, or tooth brushing. Bacteremia is worsened by poor oral hygiene or an infection. The germs are usually destroyed by the host's reticuloendothelial system in a few minutes, but the presence of a valvular disease or a weak immune system favors focal infection. Besides infectious endocarditis, this may concern cardiovascular diseases, lung infections, prematurity and hypotrophy, diabetes, prosthetic infections, cerebral abscesses, etc. This update is based on literature review, selected according to its high level of scientific proof, as well as on a selected choice of consensus conferences. The current recommendation is to limit antibiotic prophylaxis to the high bacteremia risk procedures and to patients highly at risk of developing a focal infection.

[Mixed odontogenic tumours]

Mixed odontogenic tumors include all tumors of the teeth both epithelial and mesenchymatous. Most of these tumors are rare (ameloblastic fibroma, ameloblastic fibro-odontoma and fibrodentinoma, odontoameloblastoma, calcified odontogenic cyst). Other tumors such as odontoma are frequent. They have in common a benign aspect, their often-fortuitous observation, a higher rate in the young adult and surgical treatment by complete exeresis preventing recurrence. They present a radiolucent lacuna but appear different depending on the presence or not of intralesional calcifications revealing the production of more or less mature dental tissue. The diagnosis may be confirmed only by an anatomopathological examination, along with clinical and radiological observations.

Web database of molecular genetic data from fish stocks

Much research at the national and international level has been devoted to the development of several genetic methods for use in the characterization of fish stocks. We have developed a database that collates data from population genetic studies of fish. This database is accessible to researchers and control authorities on the Internet and should serve as a repository for genetic information of commercially important fish species. The prototype database has been developed in such a way that the new information can easily be updated by researchers in the field, who can submit their own data. The site can be found at http://fishgen.jrc.it.

Bactericidal effect of a whey protein concentrate with anti-Helicobacter pylori activity

AIMS

To investigate the effect of whey protein concentrate (WPC) enriched in anti-Helicobacter pylori antibodies on growth of the organism in vitro.

METHODS AND RESULTS

A WPC rich in H. pylori-specific antibodies was produced by immunizing lactating cows against H. pylori and processing pooled bulk milk samples into whey powder. The antibodies bound several proteins within the bacterial homogenate and were active at pH 5. In a complement-dependent reaction, the immune WPC was highly bactericidal against four H. pylori strains tested in vitro.

CONCLUSION

WPC produced with milk from H. pylori-immunized cows contains antibodies that are active at the pH of the stomach, and bactericidal against H. pylori in vitro, via the classical complement pathway.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study has demonstrated the potential for use of WPC in the prevention/treatment of H. pylori infections.

Glucose disorders associated with HIV and its drug therapy

OBJECTIVE

To review the impact that factors such as HIV infection, antiretrovirals, and other commonly used drug therapies have on glucose metabolism in HIV-infected patients.

DATA SOURCES

Pertinent literature was identified via a MEDLINE search from 1980 to April 2000 and through secondary sources (abstracts presented at recent scientific meetings, manufacturers' package inserts). The key words used were antiretroviral therapy, HIV infection, insulin resistance, and metabolic abnormalities. All information deemed relevant to evaluate the impact that HIV infection and drug therapy have on glucose metabolism in HIV-infected patients was included.

DATA SYNTHESIS

The viral burden and stress that are present in HIV-infected patients elicit a complex hormonal and immunologic response that may alter various biochemical pathways, including glucose metabolism. Although rare before the era of potent antiretroviral therapy, insulin resistance has now been described as an important component of the lipodystrophy syndrome. The complex and multifactorial nature of glucose metabolism dysregulation makes management of hyperglycemia or diabetes mellitus challenging in HIV-infected patients. In such a context, a set of recommendations was developed to guide practitioners in assessing, treating, and monitoring hyperglycemia or diabetes mellitus in HIV-infected patients.

CONCLUSIONS

Alterations of glucose metabolism observed in HIV-infected patients are more frequent since the introduction of potent antiretroviral therapy. Although the etiology of such abnormalities remains unknown, protease inhibitors and, to a lesser extent, nucleoside reverse transcriptase inhibitors are believed to participate in their pathogenic mechanisms. Because of similarities to the pathogenesis of diabetes mellitus, management of antiretroviral-induced hyperglycemia could follow that the recommendations of the American Diabetes Association, with special considerations for monitoring patients with HIV infection. Future studies of altered glucose metabolism in HIV-infected patients should focus on understanding the precise mechanism or causes of this complication so that preventive and therapeutic guidelines can be further evaluated.

Lack of acute cyclosporine nephrotoxicity in late heart-transplant recipients

BACKGROUND

Cyclosporine induces daily renal hypoperfusion in subjects with normal atrial natriuretic peptide (ANP) levels, but its acute effects in heart transplant patients with increased ANP remain to be determined.

METHODS

Cyclosporinemia and creatinine clearance were monitored during 7 hours following cyclosporine administration in 6 heart transplant patients.

RESULTS

CONCLUSIONS

No acute cyclosporine-induced decrease in creatinine clearance was observed after heart transplantation. These data suggest that maintenance cyclosporine dose may be less nephrotoxic than suspected and that increased ANP might protect the renal function late after heart transplantation.

Enhanced natriuretic response to neutral endopeptidase inhibition in heart-transplant recipients

Heart-transplant recipients (Htx) generally present with body fluid and sodium handling abnormalities and hypertension. To investigate whether neutral endopeptidase inhibition (NEP-I) increases endogenous atrial natriuretic peptide (ANP) and enhances natriuresis and diuresis after heart transplantation, ecadotril was given orally to 8 control subjects and 8 matched Htx, and levels of volume-regulating hormones and renal water, electrolyte, and cyclic guanosine monophosphate (cGMP) excretions were monitored for 210 minutes. Baseline plasma ANP, brain natriuretic peptide (BNP), and cGMP were elevated in Htx, but renin and aldosterone, like urinary parameters, did not differ between groups. NEP-I increased plasma ANP (Htx, 20.6+/-2.3 to 33.2+/-5.9 pmol/L, P<0.01; controls, 7.7+/-1. 2 to 10.6+/-2.6 pmol/L) and cGMP, but not BNP. Renin decreased similarly in both groups, whereas aldosterone decreased significantly only in Htx. Enhanced urinary sodium (1650+/-370% versus 450+/-150%, P=0.01), cGMP, and water excretions were observed in Htx and urinary cGMP positively correlated with natriuresis in 6 of the Htx subjects. Consistent with a normal circadian rhythm of blood pressure, without excluding a possible effect of NEP-I, mean systemic blood pressure increased similarly in both groups at the end of the study (6.9+/-2.0% versus 7.4+/-2.8% in controls and Htx). Thus, systemic hypertension, mild renal impairment, and raised plasma ANP levels are possible contributory factors in the enhanced natriuresis and diuresis with NEP-I in Htx. These results support a physiological role for the cardiac hormone after heart transplantation and suggest that long-term studies may be useful to determine the potential of NEP-I in the treatment of sodium retention and water retention after heart transplantation.

The afferent connections of the main and the accessory olfactory bulb formations in the rat: an experimental HRP-study

The afferent connections of the main and accessory olfactory bulbs in the rat were examined by injecting horseradish peroxidase (HRP) into one or the other of these structures either by microelectrophoresis or by hydraulic pressure. Alternate sections were stained with newly developed HRP-procedures using either benzidine dihydrochloride (de Olmos and Heimer, '77) or tetramethyl-benzidine. Eighteen to twenty-four hours after unilateral HRP injections confined to the main olfactory bulb, a large number of HRP-labeled perikaria appeared in the following telencephalic structures on the ipsilateral side: All portions of the anterior olfactory nucleus (AON) except its external part, the lateral transitional field (LT) between AON and the paleocortex, the whole extent of the primary olfactory cortex (POC); the medial forebrain bundle area deep to the olfactory tubercle, the nucleus of the horizontal limb of the diagonal band (NHDB) and the nucleus of the lateral olfactory tract (NLOT). A moderate to small number of labeled cells, furthermore, were seen in the dorsal (DT) and medial (MT) transition fields, the ventral praecommissural hippocampus (tt2), the ventral superficial part of the nucleus of the vertical limb of the diagonal band (NVDB), the sublenticular part of the substantia innominata (SI), the anterior amygdaloid area, the posterolateral cortical amygdaloid nucleus (C2) and the transition region (28 L') between the olfactory cortex and the lateral entorhinal area proper. On the contralateral side a large number of labeled cells were found in all parts of the AON, with especially heavy labeling in its external part. A moderate number of labeled cells could also be detected in the lateral transition field (LT) and the NLOT. In the diencephalon and the brain stem a moderate number of HRP-labeled perikaria were observed in the dorsal, perifornical, and lateral hypothalamus, as well as in locus coeruleus and the dorsal and medial raphae nuclei. Following large HRP injections in the main olfactory bulb a moderate to small number of labeled cells were seen also in the posterior and premammillary hypothalamus and in field CA1 of the retrocommissural hippocampus on the ipsilateral side, as well as in POC on the contralateral side. It is possible, however, that the uptake of label took place in an undetected pool of HRP in the very rostal part of AON rather than in the olfactory bulb. HRP injections in the accessory olfactory bulb resulted in labeled neurons in the posterior ventro-lateral part of the bed nucleus of the stria terminalis, the nucleus of the accessory olfactory tract, the rostrodorsal portions of the medial amygdaloid nucleus, and the whole extent of the posteromedial cortical amygdaloid nucleus (C3) on the ipsilateral side. A few lightly labeled cells were seen also in the contralateral C3.