Contraception with subcutaneous capsules containing ST-1435. Pituitary and ovarian function and plasma levels of ST-1435

An RIA for a new progestin, ST-1435, was developed. Plasma concentrations of this steroid were measured in three women having three subcutaneous capsules, each containing 40 mg of ST-1435. Pituitary and ovarian functions were assessed by measuring plasma levels of LH, FSH, estradiol and progesterone.Plasma profiles of ST-1435 were characterized by high and irregular peaks all the way through the study period of 7–9 months. Concentrations below 100 pg/ml were not observed, whereas the highest peaks reached concentrations of 10.1 ng/ml. Plasma estradiol concentrations remained uniformly suppressed below 100 pg/ml, thus indicating a suppression in follicle development. As judged by constantly suppressed progesterone concentrations, no ovulations occurred during the treatment. Plasma FSH concentrations remained at the upper limit of the follicular phase, and those of LH at the lower limit of the luteal phase of the normal menstrual cycle. No midcycle gonadotropin peaks were observed.     

Contraception with subdermal implants releasing the progestin ST-1435: a dose-finding study.

A new modified subdermal implant releasing the potent progestin ST-1435 was studied in eleven fertile-aged women. These implants have been developed for contraception and they have a life-time of two years. Three implant lengths of 4, 6 and 8 cm were tested to find the optimal steroid dose for inhibition of ovulation. Serum samples were collected twice per week during a six-week period every six months. The concentrations of serum ST-1435, estradiol and progesterone were determined by RIA. Ovulation was inhibited by all ST-1435 doses tested. The concentration of serum progesterone was below 6 nmol/l in all samples tested showing the absence of luteinization. The concentration of serum ST-1435 increased with increasing ST-1435 dose. Serum estradiol concentrations were quite variable, showing wide range and occasional high peak values typical of progestin treatment; the mean value of serum estradiol concentrations measured did not differ with different ST-1435 doses. The results of steroid determinations led to the conclusion that a single 4 cm subdermal implant is optimal for contraception. With this dosage level, ovulation is inhibited and side effects are minimized. Bleeding control was variable. No hormonal side effects due to the progestin ST-1435 were reported. This method, using a single 4 cm subcutaneous implant releasing the progestin ST-1435 with a life-time of two years, represents a promising alternative for inhibition of ovulation and contraception.     

Unaltered lipoprotein and carbohydrate metabolism during treatment with contraceptive subdermal implants containing ST-1435

Nine healthy, fertile women were treated for six months with subdermal contraceptive implants of two different sizes containing a potent progestogen, ST-1435. Lipoprotein cholesterol and triglyceride concentrations were not influenced by the treatment. Similarly, the main apolipoproteins in low- and high-density lipoproteins were not changed, which further supports the interpretation that the lipoprotein metabolism is not affected by this type of treatment. An oral glucose tolerance test (OGTT) including insulin determinations was performed in five of the volunteers with the largest implants. Blood glucose and insulin concentrations during the OGTT remained unchanged during treatment, indicating that the treatment with ST-1435 did not affect carbohydrate metabolism.     

Contraception with levonorgestrel-releasing subdermal capsules,NorplantTM, after pregnancy termination

Six Silastic levonorgestrel-releasing capsules, Norplant^TM, were introduced subcutaneously into the ventral aspect of the left forearm or upper arm of thirty-eight patients immediately after first trimester pregnancy termination. In the control group, a Nova-T device was inserted immediately after pregnancy termination in thirty patients. Clinical examination was performed after three, six and twelve months of use. The continuation of the Norplant^TM at one year was 91.7 per cent and that of the Nova-T 73.9 per cent. No pregnancies occurred during the study period of one year. Hemoglobin concentrations and the diastolic blood pressures of the Norplant^TM users increased significantly. Dysmenorrhea and menstrual flow increased in the IUD group. Menstrual disturbances were the main side effects in the Norplant^TM group during the first five months of use.     

Milk and plasma concentrations of the progestin ST-1435 in women treated parenterally with ST-1435

A subcutaneous contraceptive capsule releasing progestin ST-1435 was used by 6 breast-feeding women. One to three paired milk and plasma samples were collected over a one-month period and the concentrations of ST-1435 were determined by radioimmunoassay. An improved and sensitive method for determination of ST-1435 in milk was developed. A column chromatographic purification of milk prior to radioimmunoassay decreased the blank and improved sensitivity. The average plasma concentration of ST-1435 was 62 +/- 20 pg/ml (mean +/- SD). The average milk concentration of ST-1435 was 38 pg/ml (ranging from 7 to 73 pg/ml), while the average milk to plasma ratio was 0.60 (ranging from 0.25 to 0.91). There was a significant correlation between ST-1435 concentrations in breast milk and plasma, indicating that the concentration in plasma is the major determinant for the amount of ST-1435 excreted into milk. Since studies with this drug have shown good contraceptive efficacy and low bioavailability after oral intake, ST-1435 is a good candidate for lactational contraception.     

Pituitary and ovarian function during contraception with one subcutaneous implant releasing a progestin, ST-1435

Three women received one subcutaneous SilasticR capsule containing 40 mg of ST-1435 for contraception. Plasma levels of ST-1435, a 19-norprogesterone derivative, were measured during the treatment period of 13-15 months. The effects of treatment on pituitary and ovarian function were determined by assaying plasma concentrations of LH, FSH, estradiol and progesterone. The mean concentrations of ST-1435 during the treatment varied from 52 to 220 pg/ml in different subjects. These low concentrations of progestin were sufficient to suppress ovulation and make the implant effective for more than one year. No mid-cycle gonadotropin peaks were observed during the treatment. The subjects showed constantly low estradiol levels, thus also indicating a suppression of follicle development. Regular cyclic activity of the pituitary and ovaries, without the occurrence of ovulation, was observed in one subject. Increasing levels of estradiol parallelled a decrease of FSH and LH. It therefore seems that the negative feedback action of estradiol on gonadotropin release is unaffected but the positive feedback action of estradiol on LH appears to be blocked by the progestin ST-1435.     

Ovarian endocrine function through five years of continuous treatment with NORPLANT subdermal contraceptive implants

Ovarian endocrine function was assessed in 88 women using NORPLANT subdermal implants during different periods of use and in a control group of 15 women using non-hormonal contraception. Blood samples for estradiol (E2) and progesterone (P) assays were obtained twice a week for five consecutive weeks. Three distinct E2 patterns were observed: one was characterized by fluctuating levels within a normal range (20 to 400 pg/ml), a second pattern corresponded to continuous low E2 levels (below 75 pg/ml in the 10 samples) and the third was characterized by high broad estradiol peaks reaching over 400 pg/ml. The proportion of sampling runs characterized by normal fluctuating levels increased from 38% in the first two years of use to 80% during the fifth year of use. Low E2 profile was only observed during the first two years of use (27%) and in only 1 case at the beginning of the third year of use (5%). The percentage of cycles with high broad estradiol peaks remained between 20-40% without a clear tendency to change in either direction with duration of use. Thirty-three percent of the observed sampling runs had luteal activity (P above 3 ng/ml). The proportion of runs with luteal activity increased from 14% during the first two years of use to 40% during the third and fourth, and 60% during the fifth year of use. All control subjects had luteal activity. The mean highest progesterone level was lower in the NORPLANT runs (8.7 +/- 3.9 ng/ml) as compared to the controls (11.3 +/- 3.8 ng/ml). NORPLANT sampling runs with luteal activity had normal fluctuating E2 levels with only one exception. However, not all cycles with normal E2 levels showed luteal activity. On the other hand, all runs with low E2 levels or high broad E2 peaks were without luteal activity. In summary, women using continuous low-dose levonorgestrel contraception through NORPLANT subdermal implants, have a variable degree of ovarian activity as compared with the more complete depression of ovarian function observed among pill or injectables' users. Ovarian activity becomes closer to normal during the third through fifth year of use.     

A contraceptive vaginal ring releasing ethinyl estradiol and the progestin ST-1435: bleeding control, serum steroid concentrations, serum lipids and serum chemistry

Four women used vaginal rings releasing the synthetic progestin ST-1435 and ethinyl estradiol for at least three 21-day cycles with a 7-day treatment-free period between intervals of use. Patterns of bleeding were evaluated and serum concentrations of ST-1435, estradiol, progesterone and ethinyl estradiol were measured by radioimmunoassay. Total serum cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and serum chemistry were determined before ring use and during the first and third treatment cycles. The women experienced no difficulties in using the vaginal ring and all continued to use the ring after the first three cycles. Bleeding control was good and hormonal side effects were minimal. Serum steroid concentrations were: ST-1435, 289 +/- 117 pmol/l (mean +/- SD); ethinyl estradiol, 172 +/- 108 pmol/l; and estradiol, 184 +/- 107 pmol/l. Concentrations of serum progesterone were low, indicating complete suppression of ovulation during treatment. Total serum cholesterol increased slightly during use of ring. However, this increase could be accounted for by an increase in serum HDL-cholesterol. Liver function tests were in the normal range during ring use and values of serum chemistry showed no significant changes. This contraceptive vaginal ring presents a good method of contraception, showing good bleeding control and no harmful metabolic effects.     

Contraception with long acting subdermal implants: II. Measured and perceived effects in international clinical trials.

Hemoglobin levels, blood pressure, body weight and the subjects' impressions of changes in various conditions have been recorded during a multicentered study of levonorgestrel and norgestrienone subdermal implants. Data from a group of women using the Copper T 200 IUD at the same clinics and admitted under the same criteria are presented for comparative purposes.A major reason for termination of use of the levonorgestrel implants was disturbance of menstrual patterns. When all subjects reported their experience with the two steroid regimens, substantially larger proportions of subjects using levonorgestrel implants noted changes in menstrual flow, duration of menses and intermenstrual bleeding and spotting than was the case of women contracepting with norgestrienone implants. Relative to the experience with implants, more users of the Copper T 200 in a control study reported increased dysmenorrhea, and an increase in the amount and duration of menstrual flow.Despite the reported increases in menstrual flow and duration of bleeding, women using subdermal implants of either contraceptive steroid, levonorgestrel and norgestrienone, showed an increase in blood hemoglobin values during the course of one year of use. In the control group using the TCu 200 IUD, no change in mean hemoglobin levels was found. Neither mean systolic nor diastolic blood pressure of the women using steroids was affected. There was a small net increase in weight among the users of steroids, but none in the Copper T controls.An increase in acne and other skin conditions was perceived by the same percentages of women using Copper IUDs as women using the steroids. A greater proportion of IUD acceptors noted increased nervousness and depression than was felt by the women contracepting with the steroid implants.     

Contraception with long acting subdermal implants: I. An effective and acceptable modality in international clinical trials.

This paper presents results of a double blind, multi-centered and multi-national study of two progestin only subdermal implants used for contraception. A regimen of six capsules of levonorgestrel (Ng) used by 492 women had a net cumulative 12-month pregnancy rate of 0.6 percent and a continuation rate of 74.6 percent. 498 women used six capsules of norgestrienone (R2010) and experienced a net cumulative 12-month pregnancy rate of 3.5 percent and a continuation rate of 79.4 percent. The difference in the pregnancy rate was significant at P less than 0.01, while there was no significant difference in the continuation rates. Menstrual problems were the principal reason for termination of the levonorgestrel regimen, accounting for approximately half of all terminations. There were significantly fewer menstrual problems among users of the norgestrienone (R2010) capsules; the net cumulative 12-month termination rate for this reason was 4.3 percent. Results are compared with continuation and termination rates for acceptors of the Copper T 200 at the same clinics. The low pregnancy rate and reasonably high continuation rate of the norgestrel implants coupled with the fact that the expected effective lifetime of a set of capsules is of the order of 3-5 years appears to warrant further development of this contraceptive regimen.     

Transdermal absorption of the progestin ST-1435: therapeutic serum steroid concentrations and high excretion of the steroid in saliva.

The synthetic progestin ST-1435 was administered transdermally to six healthy women during the late luteal phase. The steroid was applied to the periumbilical area in a commercial gel ("Progestogel"), also containing progesterone. Single doses of 2.3, 4.5 and 9.0 mg of ST-1435 were given in three experiments and repeated doses of 2.3 mg of ST-1435 for five days were given in another three experiments. Samples of serum and saliva were collected and the concentrations of ST-1435 and progesterone were determined by radioimmunoassays. Transdermal absorption of the synthetic progestin ST-1435 was shown to result in serum steroid concentrations high enough for therapeutic purposes. The concentration of ST-1435 in serum was still high 24 hours after application, reflecting sustained release of the steroid from the skin. In the five-day experiments, relatively constant serum levels were achieved in different individuals, and a single dose per day seems sufficient. High excretion of ST-1435 in saliva was found two hours after gel application. However, the concentrations of serum and salivary ST-1435 were not directly correlated in different individuals. Transdermal application of ST-1435 might offer a good alternative for systemic progestin treatment.     

吸烟对女性内分泌腺功能及相关因素的影响

目的　了解吸烟对女性内分泌腺功能及其微量元素代谢和抗氧化功能的影响。方法　点状采集北方某市郊区连续居住 5年以上 ,至今连续吸烟 2年以上 ,未服避孕药的 30～ 4 0岁女性尿和血 ,测定甲状腺体积和游离甲状腺素 (FT4、FT3 )、促甲状腺素 (TSH)和雌二醇 (E2 )等。结果　吸烟者FT4及E2 比对照减少 10 9%及 13 6 % (P均 <0 0 5 ) ;FT3 和TSH增加 34 4 % (P <0 0 1)及 10 9% (P <0 0 5 ) ,碘和谷胱苷肽过氧化物酶 (GPx)及硒减少 11 6 %和15 7% (P均 <0 0 5 )及 2 2 4 % ,铅、镉及脂质过氧化物 (LPO)增加 2 5 4 %、16 0 2 %及 31 1% (P均 <0 0 1) ;铅与碘和硒的r =- 0 6 83和 - 0 5 37(P均 <0 0 1) ;硒与FT3 和GPx的r =- 0 6 88和 - 0 5 4 6 (P均 <0 0 1) ;LPO与E2 及GPx的r =- 0 4 4 6 (P <0 0 5 )和 - 0 6 5 9(P <0 0 1)。结论　吸烟可干扰女性内分泌腺之间的协调 ,与毒物产生的自由基和抑制有关微量营养素吸收有关。     

Decreased serum selenium in alcoholics as related to liver structure and function

Serum selenium was evaluated in relation to hepatic structure and function in 46 alcoholics with diagnostic liver biopsy classified into 4 groups by hepatic histology. Their serum selenium concentration varied from 12 to 88 micrograms/l and was lower (p less than 0.001) in all groups of alcoholics, ie patients with normal liver (53.0 +/- 20.7 micrograms/l, mean +/- SD), fatty liver (55.8 +/- 21.2 micrograms/l), alcoholic hepatitis (46.0 +/- 14.1 micrograms/l), and cirrhosis (41.1 +/- 12.8 micrograms/l), than in 25 healthy controls (88.7 +/- 11.0 micrograms/l). Serum selenium level was related to the severity of liver disease, and most reduced in subjects with decompensated alcoholic cirrhosis. Their serum selenium level (29.2 +/- 13.7 micrograms/l) was below (p less than 0.05) that obtained in alcoholics with normal liver and fatty liver respectively. Both inadequate dietary selenium intake and alcohol-induced changes in hepatic structure and function may have contributed to the decrease of serum selenium in the subjects studied.     

绝经前HR+乳腺癌患者内分泌治疗相关脂肪肝预测模型的研究

目的 探索绝经前HR+乳腺癌患者内分泌治疗相关脂肪肝的影响因素。方法 回顾性收集研究对象基本信息及脂肪肝发生信息,构建列线图并进行评价。结果 294例患者纳入最后的分析,其中服用SERM类药物和服用AI类药物者分别为247例(84.0%)和47例(16.0%)。Cox单因素分析发现BMI和确诊年龄与脂肪肝的发生相关。Cox多因素分析（逐步回归法）发现使用SERM类药物(P=0.002, 95%CI:1.27~2.78)、超重(P<0.001, 95%CI:1.40~2.82)或肥胖(P<0.001, 95%CI:2.08-5.57)及确诊年龄≥46.5岁(P=0.003, 95%CI:1.20~2.45)与脂肪肝发生相关。构建列线图并进行评价,一致性指数C-index为0.668(95%CI: 0.628~0.717),列线图预测的率接近校准曲线,模型的准确度及符合度均较好。结论 绝经前HR+乳腺癌患者中,脂肪肝的发生与使用SERM类药物、超重或肥胖、确诊年龄≥46.5岁有关。列线图预测性能较好。     

Effect of etonogestrel subdermal contraceptive implant (Implanon) on liver function tests -- a randomized comparative study with Norplant implants

OBJECTIVE: The study aimed to assess the possible differences in effects of Implanon and Norplant implants on liver function over 2 years of use. METHODS: This is a 2-year open randomized study of 80 implant (Implanon and Norplant) acceptors. Selected parameters of liver function were tested in the serum before implant insertion and at 6, 12 and 24 months after implant insertion. RESULTS: In both the implant groups, the mean total and unconjugated bilirubin and the gamma-glutaryl transferase levels were significantly raised during implant use. For none of the subjects, at any sampling period, did the levels exceed the normal range in our population. There was no significant elevation of any other liver enzymes in either group. CONCLUSION: It appears that there may be mild hepatocellular dysfunction associated with the use of both Implanon and Norplant, which is possibly of no clinical significance to the healthy acceptor.     

Twenty-four-hour endocrine and metabolic profiles following consumption of high-fructose corn syrup-, sucrose-, fructose-, and glucose-sweetened beverages with meals

BACKGROUND: We have reported that, compared with glucose-sweetened beverages, consuming fructose-sweetened beverages with meals results in lower 24-h circulating glucose, insulin, and leptin concentrations and elevated triacylglycerol (TG). However, pure fructose and glucose are not commonly used as sweeteners. High-fructose corn syrup (HFCS) has replaced sucrose as the predominant sweetener in beverages in the United States. OBJECTIVE: We compared the metabolic/endocrine effects of HFCS with sucrose and, in a subset of subjects, with pure fructose and glucose. DESIGN: Thirty-four men and women consumed 3 isocaloric meals with either sucrose- or HFCS-sweetened beverages, and blood samples were collected over 24 h. Eight of the male subjects were also studied when fructose- or glucose-sweetened beverages were consumed. RESULTS: In 34 subjects, 24-h glucose, insulin, leptin, ghrelin, and TG profiles were similar between days that sucrose or HFCS was consumed. Postprandial TG excursions after HFCS or sucrose were larger in men than in women. In the men in whom the effects of 4 sweeteners were compared, the 24-h glucose and insulin responses induced by HFCS and sucrose were intermediate between the lower responses during consumption of fructose and the higher responses during glucose. Unexpectedly, postprandial TG profiles after HFCS or sucrose were not intermediate but comparably high as after pure fructose. CONCLUSIONS: Sucrose and HFCS do not have substantially different short-term endocrine/metabolic effects. In male subjects, short-term consumption of sucrose and HFCS resulted in postprandial TG responses comparable to those induced by fructose.     

人免疫球蛋白对终末期肝病合并感染患者肝功能、免疫功能及凝血功能的干预作用

目的分析人免疫球蛋白对终末期肝病合并感染患者的治疗效果及对患者肝功能、免疫功能及凝血功能的改善情况。方法选择我院2016年3月至2018年3月收治的132例终末期肝病合并感染的患者为研究对象。随机选取66位患者为观察组,在常规治疗的基础上额外给予人免疫球蛋白,同期单纯给予常规治疗的66位患者为对照组。连续治疗7 d,观察2组的免疫功能、肝功能、凝血功能、治疗有效率、并发症及二重感染发生率。结果治疗后2组的血浆总蛋白(TP)均明显高于治疗前(P<0.05),且观察组明显高于对照组(P<0.05)。治疗后2组的丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血清总胆红素(TBIL)及凝血酶原时间(PT)均明显低于治疗前(P<0.05),且观察组明显低于对照组(P<0.05)。治疗后2组的CD_3~+、CD_4~+、CD_8~+及CD_4~+/CD_8~+均明显高于治疗前(P<0.05),且观察组明显高于对照组(P<0.05)。治疗后观察组与对照组Child-pugh评分<10分的患者的治疗有效率差异无统计学意义(P>0.05)。治疗后观察组Child-pugh评分介于10～15分之间的患者的治疗有效率明显高于对照组Child-pugh评分介于10～15分之间的患者(P<0.05)。治疗期间观察组的肝性脑病发生率、肝肾综合征发生率及二重感染发生率均明显低于对照组(P<0.05)。结论对Child-pugh评分介于10～15分之间的终末期肝病合并感染患者早期使用人免疫球蛋白的抗感染疗效更佳。人免疫球蛋白能显著地改善终末期肝病的感染状态及患者的肝功能、免疫功能、凝血功能,并且减少治疗期间肝性脑病、肝肾综合征及二重感染的发生率,延缓了终末期肝病的进展。     

不同体质量指数世居藏族大学生移居平原初期肝脏功能变化

  目的  探讨不同体质量指数(BMI)的世居高原藏族大学生移居平原初期肝脏功能变化规律,为世居高原藏族脱适应研究提供科学依据和理论基础。  方法  选取从高原(西藏)初入平原(陕西)的3 035名藏族大学生为研究对象,进行脱适应症状筛查。将受试者分为体重偏轻、体重正常、超重及肥胖4组,分别于初入平原3,6,9 d检测肝脏功能指标。采用χ2检验比较各组肝功能指标异常率,采用二元Logistic回归分析BMI与肝功能指标异常的关系。  结果  超重藏族男生与肥胖藏族男女生的丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT),超重藏族男生和肥胖藏族女生的总胆汁酸(TBA)在脱适应初期均高于体重正常组(P值均 < 0.05)。在脱适应3,6,9 d,指标总体呈上升趋势的包括超重组男、女生直接胆红素(DBIL)、肥胖组女生血清总蛋白(TP)、球蛋白(GLOB)(P值均 < 0.05)。超重组男生ALT(13.9%),肥胖组男、女生ALT(34.3%,26.7%)、GGT(11.4%,13.3%)和女生AST(10.0%)肝功能指标异常率高于体重偏轻(2.8%,3.5%,0,1.0%,1.5%)、正常组(3.5%,3.4%,0.9%,3.6%,4.1%)(χ2值分别为48.07,20.55,20.55,17.93,10.23,P值均 < 0.05)。二元Logistic回归分析显示,在校正年龄和性别因素后,超重与ALT(OR=2.10,95%CI=1.20~3.62)异常呈正相关,肥胖与ALT(OR=5.50,95%CI=4.23~7.40)、GGT(OR=4.10,95%CI=2.03~6.74)异常均呈正相关(P值均 < 0.05)。  结论  世居高原藏族大学生移居平原初期,肝脏功能指标变化与BMI相关。超重肥胖者肝功能损伤指标异常率较高。肥胖高危人群从高原移居平原地区时需进行健康检查及医务监督。     

Polyunsaturated fatty acid intake is adversely related to liver function in HIV-infected subjects: the THUSA study

BACKGROUND: Dietary fat intake in the South African population is increasing. This population also has a high prevalence of HIV infection. However, information about metabolic effects of dietary fatty acids on HIV-infected subjects is lacking. OBJECTIVE: Our objective was to investigate the relation between dietary fatty acid intake and liver function in HIV-infected compared with HIV-uninfected subjects. DESIGN: This cross-sectional epidemiologic survey included a representative sample of 1854 apparently healthy black volunteers aged > or =15 y, who were recruited from 37 randomly selected sites throughout the North West province of South Africa. Data from 216 asymptomatic HIV-infected and 1604 HIV-uninfected subjects were used. RESULTS: Intakes of polyunsaturated fatty acids (PUFAs), linoleic acid (n-6), and the ratio of PUFAs to saturated fatty acids (SFAs) were positively associated with all the liver enzymes measured in HIV-infected subjects (R = 0.16-0.65). Most of these R values differed significantly from the R values for HIV-uninfected subjects. No associations were seen between liver enzymes and intakes of SFAs and monounsaturated fatty acids. Vitamin E intake was positively associated with serum gamma-glutamyl transpeptidase (R = 0.23), alanine aminotransferase (R = 0.37), and aspartate aminotransferase (R = 0.58) in HIV-infected subjects; these correlations differed significantly from those of the HIV-uninfected subjects because PUFA sources are the main carriers of vitamin E. CONCLUSIONS: The results suggest that n-6 PUFA intakes may be related to liver damage in these HIV-infected asymptomatic subjects. The reasons or mechanisms responsible are not clear, and further research is necessary to determine the optimal safe amounts for intake of n-6 PUFAs by HIV-infected subjects, especially in countries with traditionally high intakes of n-6 PUFA-rich vegetable oils.