Prevalence and Risk Factors for Aspirin Resistance in Elderly Patients With Type 2 Diabetes

Background

Aspirin resistance in patients with diabetes is recognized. However, the prevalence and related risk factors for aspirin resistance in elderly patients with Type 2 diabetes have not been reported, which is why we undertook this study.

Methods

One hundred and forty elderly patients (age, 73.84 ± 8.02 years) with Type 2 diabetes receiving daily aspirin therapy (≥75 mg) over 1 month were recruited. Platelet aggregation was measured by light transmission aggregometry (LTA) and thrombelastography (TEG) platelet mapping assay. The definitions of aspirin resistance were 20% or greater arachidonic acid-induced and 70% or greater adenosine diphosphate-induced aggregation by LTA. Aspirin semiresponders were defined as meeting one (but not both) of these criteria. Aspirin resistance by TEG was defined as 50% or greater aggregation induced by arachidonic acid.

Results

By LTA, 6 (4.3%) patients with Type 2 diabetes were found to be resistant to aspirin therapy; 44 (31.4%) patients were semiresponders. By TEG, 31 patients (22.1%) were aspirin resistant. Of the 31 patients who were aspirin-resistant by TEG, 3 were aspirin-resistant by LTA. Eight of 44 semiresponders by LTA were aspirin-resistant by TEG. In the multivariate logistic regression analysis, being female (odds ratio: 5.54, 95% confidence interval: 1.17–27.47, p = 0.036) and homocysteine levels (odds ratio: 1.15, 95% confidence interval: 1.00–1.31, p = 0.043) were significant risk factors for aspirin resistance by TEG.

Conclusion

The prevalence of aspirin resistance in elderly patients with Type 2 diabetes was considerably higher in female patients and in patients with higher serum levels of homocysteine.     

Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania

Background

HIV-associated anemia is common and associated with poor prognosis. However, its response to antiretroviral treatment (ART) in rural Africa is poorly understood.

Methods

HIV-infected adults (≥15 years) who enrolled in HIV care at Haydom Lutheran Hospital in northern Tanzania were included in the study. The effect of ART (zidovudine/stavudine + lamivudine + efavirenz/nevirapine) on HIV-associated anemia was studied in a subset of patients who were anemic at the time they started ART and had a follow-up hemoglobin measurement 12 months later. Pregnant women were excluded from the study, as were women who had given birth within the past 6 weeks. Anemia was defined as hemoglobin <12 g/dL in women and <13 g/dL in men. We applied paired sample T-tests to compare hemoglobin levels before and one year after ART initiation, and logistic regression models to identify predictors of persistent anemia.

Results

At enrollment, mean hemoglobin was 10.3 g/dL, and 649 of 838 patients (77.4%) were anemic. Of the anemic patients, 254 (39.1%) had microcytosis and hypochromia. Among 102 patients who were anemic at ART initiation and had a follow-up hemoglobin measurement after 12 months, the mean hemoglobin increased by 2.5 g/dL (P < 0.001); however, 39 patients (38.2%) were still anemic after 12 months of ART. Independent predictors of persistent anemia were mean cell volume in the lower quartile (<76.0 fL; Odds Ratio [OR] 4.34; 95% confidence interval [CI] 1.22-15.5) and a zidovudine-containing initial regimen (OR 2.91; 95% CI 1.03-8.19).

Conclusions

Most patients had anemia at enrollment, of whom nearly 40% had microcytosis and hypochromia suggestive of iron deficiency. The mean hemoglobin increased significantly in patients who received ART, but one third were still anemic 12 months after ART initiation indicating that additional interventions to treat HIV-associated anemia in rural Africa might be warranted, particularly in patients with microcytosis and those treated with zidovudine.

     

Prevalence of gestational diabetes mellitus in urban and rural Tanzania

Aim

To estimate prevalence of gestational diabetes mellitus (GDM) and associated determinants in urban and rural Tanzania.

Methods

A cross-sectional study was conducted from 2011 through 2012 in selected urban and rural communities. Pregnant women (609 urban, 301 rural), who were not previously known to have diabetes, participated during usual ante-natal clinic visits. Capillary blood samples were collected at fasting and 2 h after 75 g glucose load and were measured using HemoCue. Diagnosis of GDM was made using 1999 World Health Organization (WHO) criteria.

Results

Women in rural areas were younger (26.6 years) than in urban areas (27.5 years). Mean gestational age, height, and mid-upper arm circumference (MUAC) were similar for the two areas. Overall prevalence of GDM averaged 5.9%, with 8.4% in urban area and 1.0% in rural area. Prevalence of GDM was higher for women who had a previous stillbirth (OR 2.8, 95% CI 1.5–5.4), family history of type 2 diabetes (OR 2.1, 95% CI 1.1–4.2), and MUAC above 28 cm (OR 1.9, 95% CI 1.1–3.3), and lower for women with normal hemoglobin compared with anemia (OR 0.45, 95% CI 0.22–0.93).

Conclusions

Prevalence of GDM is higher than expected in urban areas in Tanzania, indicating an increasing population who are at risk for delivery complications and type 2 diabetes in Sub-Saharan Africa.     

Portfolios of Biomedical HIV Interventions in South Africa: A Cost-Effectiveness Analysis

BACKGROUND

Recent clinical trials of male circumcision, oral pre-exposure prophylaxis (PrEP), and a vaginal microbicide gel have shown partial effectiveness at reducing HIV transmission, stimulating interest in implementing portfolios of biomedical prevention programs.

OBJECTIVE

To evaluate the effectiveness and cost-effectiveness of combination biomedical HIV prevention and treatment scale-up in South Africa, given uncertainty in program effectiveness.

DESIGN

Dynamic HIV transmission and disease progression model with Monte Carlo simulation and cost-effectiveness analysis.

PARTICIPANTS

Men and women aged 15 to 49 years in South Africa.

INTERVENTIONS

HIV screening and counseling, antiretroviral therapy (ART), male circumcision, PrEP, microbicide, and select combinations.

MAIN MEASURES

HIV incidence, prevalence, discounted costs, discounted quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios.

KEY RESULTS

Providing half of all uninfected persons with PrEP averts 28 % of future HIV infections for $9,000/QALY gained, but the affordability of such a program is questionable. Given limited resources, annual HIV screening and ART utilization by 75 % of eligible infected persons could avert one-third of new HIV infections, for approximately $1,000/QALY gained. Male circumcision is more cost-effective, but disproportionately benefits men. A comprehensive portfolio of expanded screening, ART, male circumcision, microbicides, and PrEP could avert 62 % of new HIV infections, reducing HIV prevalence from a projected 14 % to 10 % after 10 years. This strategy doubles treatment initiation and adds 31 million QALYs to the population. Despite uncertainty in program effectiveness, a comprehensive portfolio costs less than $10,000/QALY gained in 33 % of simulation iterations and less than $30,000/QALY gained in 90 % of iterations, assuming an annual microbicide cost of $100.

CONCLUSIONS

A portfolio of modestly-effective biomedical HIV prevention programs, including male circumcision, vaginal microbicides, and oral PrEP, could substantially reduce HIV incidence and prevalence in South Africa and be likely cost-effective. Given limited resources, PrEP is the least cost-effective intervention of those considered.     

The relationship of insulin resistance and extracoronary calcification in the multi-ethnic study of atherosclerosis

Objective

We hypothesized that insulin resistance, measured by the homeostasis model assessment of insulin resistance (HOMA), is independently associated with prevalent and incident extra-coronary calcification (ECC).

Methods

We studied calcium scores of the aortic valve calcification (AVC), mitral valve calcification (MVC), thoracic aorta calcification (TAC) and aortic valve root calcification (AVR) in 6104 MESA participants not on diabetes medication who had baseline cardiac CT scans; 5312 had follow-up scans (mean 2.4 years). Relative-risk regression modeled prevalent and incident ECC adjusted for baseline demographics (model 1), and additionally for CVD risk factors (model 2).

Results

In model 1, prevalence and incidence risk-ratios for the highest versus lowest quartile of HOMA were 20–30% higher in all ECC locations (p-value for trend ≤0.05 for all but incident-AVC). In model 2, all associations were attenuated, primarily by adjustment for metabolic syndrome components.

Conclusions

HOMA has a positive and graded association with ECC, but not independently of cardiovascular risk factors—particularly metabolic syndrome components.     

Prevalence of insulin resistance and cardiometabolic risk in Korean children and adolescents: A population-based study

Aims

We aimed to establish normal reference values of serum insulin and the homeostasis model assessment of insulin resistance (HOMA-IR). We also aimed to verify HOMA-IR “cut-off values” in predicting cardiometabolic risk among Korean children and adolescents.

Methods

Data from 2716 Korean subjects (1421 male and 1295 female, aged 10–20 years) were evaluated. Insulin resistance was defined as HOMA-IR >95th percentile. The odds ratios of cardiometabolic risk were assessed based on the state of insulin resistance.

Results

Reference values of insulin and HOMA-IR were determined according to sex and age, based on data obtained from normal-weight subjects with normal fasting glucose levels. HOMA-IR values appeared to peak at the age of 14–15 years in male subjects and at the age of 12–13 years in female subjects. The prevalence of insulin resistance in the subjects was 9.8% (male = 10.9%, female = 8.6%). The prevalence of insulin resistance in normal-weight, overweight, and obese subjects were 4.7%, 25.6%, and 47.1% respectively. Subjects with insulin resistance had a higher prevalence of metabolic syndrome (odds ratios = 18.33; 95% confidence interval, 9.62–34.94) and its components, especially hyperglycemia and hypertriglyceridemia.

Conclusion

We established reference values of serum insulin and HOMA-IR according to age and sex. Obesity is the most important risk factor for insulin resistance and metabolic syndrome. However, insulin resistance independently increases cardiometabolic risk. This information may be useful for Korean as well as other Asian in planning programs for the prevention of type 2 diabetes.     

Echocardiographic screening in a resource poor setting: Borderline rheumatic heart disease could be a normal variant

Objective

To estimate the echocardiography confirmed prevalence of rheumatic heart disease (RHD) in school children in Fiji.

Design

Cross-sectional observational study.

Setting

Ten primary schools in Fiji.

Patients

School children aged 5–14 years.

Interventions

Each child had an echocardiogram performed by an echocardiographic technician subsequently read by a paediatric cardiologist not involved with field screening, and auscultation performed by a paediatrician.

Main outcome measures

Echocardiographic criteria for RHD diagnosis were based on those previously published by the National Institutes of Health (NIH) and World Health Organization (WHO), and data were also analyzed using the new World Heart Federation (WHF) criteria. Prevalence figures were calculated with binomial 95% confidence intervals.

Results

Using the modified NIH/WHO criteria the prevalence of definite RHD prevalence was 7.2 cases per 1000 (95% CI 3.7–12.5), and the prevalence of probable RHD 28.2 cases per 1000 (95% CI 20.8–37.3). By applying the WHF criteria the prevalence of definite and borderline RHD was 8.4 cases per 1000 (95% CI 4.6–14.1) and 10.8 cases per 1000 (95% CI 6.4–17.0) respectively. Definite RHD was more common in females (OR 5.1, 95% CI 1.1–48.3) and in children who attended school in a rural location (OR 2.3, 95% CI 0.6–13.50). Auscultation was poorly sensitive compared to echocardiography (30%).

Conclusion

There is a high burden of undiagnosed RHD in Fiji. Auscultation is poorly sensitive when compared to echocardiography in the detection of asymptomatic RHD. The results of this study highlight the importance of the use of highly sensitive and specific diagnostic criteria for echocardiography diagnosis of RHD.     

Serum low-density lipoprotein cholesterol level is strong risk factor for acquired color vision impairment in young to middle-aged Japanese men: The Okubo Color Study Report 2

Objective

To investigate associations between blood low-density lipoprotein cholesterol (LDL-C) levels and the prevalence of acquired color vision impairment (ACVI) in middle-aged Japanese men.

Methods

Participants in this cross-sectional study underwent color vision testing, ophthalmic examination, a standardized interview and examination of venous blood samples. Ishihara plates, a Lanthony 15-hue desaturated panel, and Standard pseudoisochromatic Plates part 2 were used to examine color vision ability. The Farnsworth–Munsell 100-hue test was performed to define ACVI. Smoking status and alcohol intake were recorded during the interview. We performed logistic regression analysis adjusted for age, LDL-C level, systemic hypertension, diabetes, cataract, glaucoma, overweight, smoking status, and alcohol intake. Adjusted odds ratios for four LDL-C levels were calculated.

Results

A total of 1042 men were enrolled, 872 participants were eligible for the study, and 31 subjects were diagnosed with ACVI. As compared to the lowest LDL-C category level (<100 mg/dl), the crude OR of ACVI was 3.85 (95% confidence interval [CI], 1.24–11.00) for the 2nd highest category (130–159 mg/dl), and 4.84 (95% CI, 1.42–16.43) for the highest level (≥160 mg/dl). The multiple-adjusted ORs were 2.91 (95% CI, 0.87–9.70) for the 2nd highest category and 3.81 (95% CI, 1.03–14.05) for the highest level. Tests for trend were significant (P < 0.05) in both analyses.

Conclusions

These findings suggested that the prevalence of ACVI is higher among middle-aged Japanese men with elevated LDL-C levels. These changes might be related to deteriorated neurologic function associated with lipid metabolite abnormalities.     

Review of epidemiology and management of atrial fibrillation in developing countries

Background

Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia. In developing countries, AF is a growing public health problem with the epidemiologic transition from communicable to non-communicable diseases. However, relatively little is known about AF in the developing world. The aim of this review is to examine in developing countries the prevalence, associated medical conditions and management of AF.

Methods

A literature search was conducted via MEDLINE and EMBASE (1990–2012).

Results

Seventy studies were included in the review. The prevalence of AF in the general population ranged from 0.03% to 1.25%, while the prevalence of AF in hospital-based studies varied from 0.7% to 55.7%. Prevalence of AF in Africa was lower than in other regions. The most common conditions associated with AF were hypertension (10.3%–71.9%) and valvular heart disease (5.6%–66.3%). The prevalence of stroke in patients with AF ranged from 6.7% to 27%. The utilization of anticoagulants was highly variable (2.7%–72.7%). Approximately half of the patients with AF using warfarin had therapeutic International Normalized Ratios (INR). There was a high prevalence of use of rate control therapies (55.3%–87.3%).

Conclusions

The limited studies available suggest that in the developing world there is a significant prevalence of AF, which is predominantly associated with hypertension and valvular heart disease, and carries a risk of stroke. Highly variable use of anticoagulants may be related to different health care and socioeconomic settings. More studies are needed to improve understanding of the epidemiology and management of AF in developing countries.     

Global rural diabetes prevalence: A systematic review and meta-analysis covering 1990–2012

Aim

To investigate diabetes prevalence in rural areas globally and how it has changed over time in high-income countries (HIC) and low-middle income countries (LMIC).

Methods

We systematically searched four electronic databases (MEDLINE, EMBASE, Cochrane Library, and CINAHL) for studies reporting rural prevalence of diabetes between January 1990 and January 2012. We used random effect meta-analysis to estimate pooled prevalence and metaregression to identify factors that may be associated with our estimates.

Findings

We included 109 population-based surveys involving 1,100,746 individuals. Pooled global rural prevalence of diabetes was 6.8% (95% confidence intervals: 6.1–7.6) with no gender difference. Considering five-year increments between 1985 and 2011, when studies were conducted, global rural prevalence was 5.7% (3.5–7.9) during 1985–1989 and 8.7% (6.8–10.7) during 2005–2011. In LMICs, rural diabetes prevalence was 1.8% (1.0–2.6) during 1985–1989 and 7.5% (5.6–9.5) during 2005–2011. In HICs, rural diabetes prevalence was 8.2% (6.0–10.4) during 1985–1989 and 14.3% (8.7–20) in the most recent period.

Conclusion

Diabetes prevalence has increased in all rural areas globally but relative growth was faster in LMIC than HIC rural areas. These data suggest a need to expand diabetes surveillance to rural areas using standardized measures, as well as the need to devise and deploy appropriate prevention and control interventions.     

Relationship between white blood cell count and nonalcoholic fatty liver disease

Background

Higher levels of white blood cell (WBC) count are known to be associated with metabolic syndrome and insulin resistance. Nonalcoholic fatty liver disease (NAFLD) is also considered a hepatic manifestation of insulin resistance.

Aims

The present study aimed to determine the relation between WBC count and the presence of NAFLD based on abdominal sonographic findings.

Methods

A cross-sectional study with 3681 healthy subjects (2066 men, 1615 women) undergoing medical check-up was conducted. The odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD were calculated using multivariate logistic regression analyses across WBC quartiles.

Results

A graded independent relationship between higher levels of WBC count and the prevalence risk of NAFLD was observed. After adjusting for age, smoking status, regular exercise, body mass index (BMI), blood pressure, fasting plasma glucose, triglyceride, and HDL-cholesterol, the ORs (95% CIs) for NAFLD according to WBC quartiles were 1.00, 1.48 (1.10–1.98), 1.59 (1.18–2.14), and 1.84 (1.35–2.51) for men and 1.00, 1.15 (0.67–1.96), 1.88 (1.13–3.11), and 2.74 (1.68–4.46) for women.

Conclusions

WBC count was found to be independently associated with the presence of NAFLD regardless of classical cardiovascular risk factors and other components of metabolic syndrome.     

Who is at low risk for cardiovascular disease? An assessment of different definitions

Background

There is little information regarding the determinants and trends of the prevalence of low cardiovascular risk factor (RF) profile in the general population. The aim of this study was to assess the prevalence and trends of low RF profile in the Swiss population according to different definitions.

Methods

Population-based cross-sectional studies conducted in 1984–1986 (N = 3300), 1988–1989 (N = 3331), 1992–1993 (N = 3133) and 2003–2006 (N = 6170) and restricted to age group 35–75 years. Seven different definitions of low RF profile were used to assess determinants, while two definitions were used to assess trends.

Results

Prevalence of low RF profile varied between 6.5% (95% confidence interval: 5.9–7.1) and 9.7% (9.0–10.5) depending on the definition used. This prevalence was higher than in other countries. Irrespective of the definition used, the prevalence of low RF profile was higher in women and in physically active participants, and decreased with increasing age or in the presence of a family history of cardiovascular disease. Using one definition, the prevalence of low RF profile increased from 3.8% (3.1–4.5) in 1984–1986 to 6.7% (6.1–7.3) in 2003–2006; using another definition, the results were 5.9% (5.1–6.8) and 9.7% (9.0–10.5), respectively.

Conclusion

Switzerland is characterized by a high and increasing prevalence of low RF profile within the age group 35 to 75, irrespective of the criteria used. This high prevalence might partly explain the low and decreasing trend in cardiovascular mortality rates.     

Worldwide risk factors for heart failure: A systematic review and pooled analysis

Background

Heart failure risk factors are diverse and likely to vary among world regions. Systematic review and pooled analysis were used to describe contributions of major underlying risk factors for heart failure in six world regions.

Methods

Electronic databases were systematically searched, and 37 clinic-based studies representing 40 countries published in 1980–2008 and reporting underlying risk factors for heart failure were included. Risk factors were classified as ischemic heart disease (IHD), hypertension, rheumatic/other valvular heart disease, cardiopulmonary disease, cardiomyopathy, and “other”. Crude and age- and sex-adjusted risk factor prevalences were estimated for each region using a regression analysis, under specifications of overlapping as well as additive contributions.

Results

Many heart failure cases were assigned multiple underlying risk factors, leading to a considerable overlap. Crude IHD prevalence among heart failure patients was > 50% in Europe and North America, approximately 30–40% in East Asia and Latin America and the Caribbean, and < 10% in Sub-Saharan Africa. Age and sex adjustment attenuated regional differences in IHD-as-risk factor but IHD remained rare in Sub-Saharan Africa. Hypertension prevalence was high in heart failure patients of all regions but the highest in Eastern and Central Europe and Sub-Saharan Africa (age- and sex-adjusted, 35.0% and 32.6%, respectively). Cardiomyopathy was most common in Latin America, the Caribbean and Sub-Saharan Africa (age- and sex-adjusted, 19.8% and 25.7%).

Conclusions

Heart failure risk factors vary substantially among world regions. More detailed regional heart failure epidemiology studies are needed in order to quantify the global burden of heart failure and identify regional prevention and treatment strategies.     

Changing aetiological factors of hepatocellular carcinoma and their potential impact on the effectiveness of surveillance

Background

The aetiological factors of hepatocellular carcinoma may vary over time.

Aims

The study assessed the potential impact of the aetiological factors on the effectiveness of surveillance in real-world patients.

Methods

Multicentre, cross-sectional study enrolling consecutive hepatocellular carcinoma cases during a six month period.

Results

1733 cases (1311 prevalent and 422 incident) were recruited (mean age 68.6 years; 46.1% cases over 70 years; 73.9% males; 95.3% with cirrhosis); 63.0% were hepatitis C virus positive and 23.7% were virus negative. Amongst incident HCCs, 34.5% were single ≤3 cm and 54.4% met the Milan criteria; 61.6% were diagnosed during surveillance; virus negative patients showed the lowest rate of surveillance (51.0%). Surveillance was an independent predictor of detecting single HCCs ≤2 cm (O.R. = 5.4; 95% C.I. = 2.4–12.4) or HCCs meeting the Milan criteria (O.R. = 3.1; 95% C.I. = 1.9–5.2). Compared with an earlier Italian survey, there was a higher proportion of elderly subjects (P < 0.01), Child-Pugh class A cases (P < 0.01), of virus-negative patients (P < 0.01) and with single tumours ≤3 cm (P < 0.01) and a lower prevalence of hepatitis C virus positive individuals (P < 0.01).

Conclusion

HCC is characterised by a growing prevalence of elderly patients and cases unrelated to hepatitis virus infections. The application of surveillance must be implemented, particularly amongst non-viral patients.     

Aerobic and resistance training effects compared to aerobic training alone in obese type 2 diabetic patients on diet treatment

Aims

The study was designed to compare a combined aerobic and resistance training (ART) with an aerobic training (AT) over hemodynamic, glucose metabolism and endothelial factors, adipokines and pro-inflammatory marker release in a population of obese type 2 diabetic patients.

Methods

Forty-seven patients were randomly assigned to aerobic (27 patients) or aerobic plus resistance (20 patients) exercise trainings, on the top of a diet regime. Anthropometric, metabolic, hormonal and inflammatory variables were measured at hospitalization and discharge.

Results

Both exercise programs equally improved body weight and fructosamine levels however ART only partially decreased HOMA index compared with AT (ART: −25% vs AT: −54%, p < 0.01). Mean blood pressure (AT: −3.6 mmHg vs ART: +0.6 mmHg, p < 0.05) and endothelin-1 (ET-1) incremental areas during walking test (AT: −11% vs ART: +30%, p < 0.001) decreased after AT while increased after ART. Adiponectin levels increased by 54% after AT while decreased by 13% after ART (p < 0.0001) and matrix metalloproteinase-2 (MMP-2), tumor necrosis factor-alpha (TNF-alpha) and monocyte chemoattractan protein-1 (MCP-1) levels significantly decreased in AT while increased in ART group.

Conclusions

Compared with AT, ART similarly enhanced body weight loss but exerted less positive effects on insulin sensitivity and endothelial factors, adipokines and pro-inflammatory marker release.     

HOMA-IR and the risk of hyperuricemia: A prospective study in non-diabetic Japanese men

Aims

To examine the relation of insulin resistant status determined by homeostasis model assessment of insulin resistance (HOMA-IR) with the risk of incident hyperuricemia.

Methods

The study participants included 2071 Japanese men without hyperuricemia and diabetes, aged 35–54 years. The participants had undergone annual heath examinations for 6 years to compare incident hyperuricemia (serum uric acid >416.4 μmol/L (7.0 mg/dL) and/or taking medication for hyperuricemia) in four groups based on quartiles of baseline HOMA-IR.

Results

During follow-up there were 331 incident cases of hyperuricemia. The hazard ratios for hyperuricemia, compared with HOMA-IR ≤0.66, were 1.42 (95% confidence interval 1.02–1.98) for HOMA-IR 0.67–0.98, 1.20 (0.86–1.68) for HOMA-IR 0.99–1.49 and 1.44 (1.04–1.98) for HOMA-IR ≥1.50 after adjustment for baseline serum uric acid, creatinine, hypercholesterolemia and hypertension status, age, alcohol intake, and smoking and exercise habits. The hazard ratio associated with an increase of one standard deviation in lnHOMA-IR (1.85 as one geometric standard deviation of HOMA-IR) was 1.14 (1.03–1.28) (p for trend = 0.02).

Conclusions

Increased HOMA-IR independently predicted the subsequent development of hyperuricemia. Insulin resistance itself or compensatory hyperinsulinemia may contribute to the development of hyperuricemia.     

Virological suppression in children and adolescents is not influenced by genotyping,but depends on optimal adherence to antiretroviral therapy

Objective

To evaluate the virological outcomes in children and adolescents infected with HIV-1 in Salvador, Bahia according to genotyping results.