The ABCs of HIV prevention in men: associations with HIV risk and protective behaviors

OBJECTIVE: To elucidate associations between beliefs in abstinence, fidelity, and condom use (the "ABCs" of preventing HIV and other sexually transmitted infections) and associated self-reported risk behaviors among Kenyan men. METHODS: We assessed associations of beliefs in the ABCs with sociodemographic characteristics and sexual risk behaviors in a respondent-driven sample of 500 men in Nairobi. RESULTS: Younger age, single marital status, and higher education were associated with beliefs in abstinence and condom use as "best" prevention methods; and older age and marriage were associated with belief in fidelity. Many of these and other associations persisted in multivariate models. Men citing abstinence or fidelity belief less often reported sex with a female sex worker (FSW) ever or recent concurrent partnerships less often. Belief in fidelity was negatively associated with reported use of condoms ever. Belief in condom use to prevent HIV was most common among those having recent concurrent partnerships. CONCLUSIONS: Beliefs in abstinence, fidelity ("being faithful"), or condom use were associated, in plausible directions, with life stages and other demographic factors and with corresponding risk and preventive behaviors. Context-specific and selective educational promotion of individual ABC components rather than comprehensive education from an early age in a wide repertoire of prevention strategies ignores the evolution of sexual behaviors and the relative utility of different approaches throughout the life course.     

HIV prevalence and incidence in rural Tanzania: results from 10 years of follow-up in an open-cohort study

BACKGROUND: Tanzanian antenatal clinic surveillance data suggest stabilizing HIV levels. Data from an open cohort in northern Tanzania provide robust estimates of prevalence and incidence. METHODS: Between 1994 and 2004, 19 rounds of household-based demographic surveillance and 4 rounds of individually linked HIV serologic surveys were conducted. Longitudinal knowledge of individuals' testing histories is used to allow for effects of selective participation on prevalence estimates; multiple imputation procedures allow for interval censoring effects on incidence. RESULTS: A total of 16,820 adults donated blood for HIV testing in at least 1 of 4 serologic surveys. HIV prevalence increased steadily from 6.0% in 1994/1995 to 8.3% in 2000/2001, leveling out thereafter. HIV incidence increased sharply from 0.8% in 1994 to 1997 to 1.2% per thousand in 1997 to 2000, remaining high (1.1%) in 2000 to 2003. In roadside areas, incidence fell in the last interval, especially among women, but in remote rural areas, incidence rose slightly. CONCLUSIONS: HIV spread is continuing in rural areas, suggesting a need for more intensive HIV prevention efforts and antiretroviral interventions. The leveling off in prevalence is attributable to a combination of high mortality among HIV-infected persons and a slight decrease in incidence in roadside villages.     

Snoring and vascular risk factors and disease in a low-risk Chinese population: the Guangzhou Biobank Cohort Study

STUDY OBJECTIVE: Snoring is a common condition, but data describing the relationship between snoring and vascular disease is very limited in Asian populations. We therefore describe the association between snoring and vascular disease and associated risk factors. DESIGN: Cross-sectional study of baseline data from the Guangzhou Biobank Cohort Study. SETTING: Community-based elderly association from Guangzhou, China. PARTICIPANTS: 10413 Chinese subjects (50-85 years of age). MEASUREMENTS: Self-reported snoring status and frequency and frequency of daytime tiredness were collected by questionnaire, as were demographic and socioeconomic data, disease histories, and potential confounders, such as smoking and alcohol consumption. Anthropometry, blood pressure, and fasting glucose and lipid profile were also measured. RESULTS: Self-reported snoring frequency was identified in 8325 (80.0%) subjects, with 51.6% reporting that they snored, of whom 15.5% were daily snorers. Increasing prevalence of snoring showed a clear positive relationship with cardiovascular risk factors, including age, obesity, blood pressure, and lipid levels (p < .001 for all). The prevalence of self-reported vascular-disease history was low but significantly associated with increasing snoring frequency. Logistic regression showed that snoring frequency was an independent predictor of vascular-disease history (odds ratios [95% confidence intervals] 1.68 [1.32-2.13] for daily snorers compared with the never-snorer reference group), of the metabolic syndrome (2.16 [1.88-2.49]) and each of its components (hypertension [1.37 (1.20-1.56)], and of dyslipidemia [1.22 (1.07-1.40)], central obesity [2.39 (2.08-2.76)], and diabetes [1.30 (1.09-1.56)]) after adjustment for potential confounders. CONCLUSION: Increasing snoring frequency was associated with an increasing prevalence of risk factors and self-reported vascular disease. Snoring may a useful marker for increased risk of vascular disease.     

Ecological Study of the Predictors of Successful Management of Dyslipidemia in HIV-Infected Patients on ART: the Swiss HIV Cohort Study

Abstract

Purpose: Antiretroviral therapy (ART) may induce metabolic changes and increase the risk of coronary heart disease (CHD). Based on a health care system approach, we investigated predictors for normalization of dyslipidemia in HIV–infected individuals receiving ART. Method: Individuals included in the study were registered in the Swiss HIV Cohort Study (SHCS), had dyslipidemia but were not on lipidlowering medication, were on potent ART for ≥3 months, and had ≥2 follow-up visits. Dyslipidemia was defined as two consecutive total cholesterol (TC) values above recommended levels. Predictors of achieving treatment goals for TC were assessed using Cox models. Results: Analysis included 958 individuals with median followup of 2.3 years (IQR 1.2–4.0). 454 patients (47.4%) achieved TC treatment goals. In adjusted analyses, variables significantly associated with a lower hazard of reaching TC treatment goals were as follows: older age (compared to 18–37 year olds: hazard ratio [HR] 0.62for 45–52 year olds, 95% CI 0.47–0.82; HR 0.40 for 53–85, 95% CI 0.29–0.54), diabetes (HR 0.39, 95% CI 0.26–0.59), history of coronary heart disease (HR 0.27, 95% CI 0.10–0.71), higher baseline TC (HR 0.78, 95% CI 0.71–0.85), baseline triple nucleoside regimen (HR0.12 compared to PI–only regimen, 95% CI 0.07–0.21), longer time on PI–only regimen (HR 0.39, 95% CI 0.33–0.46), longer time on NNRTI only regimen (HR 0.35, 95% CI 0.29–0.43), and longer time on PI/NNRTI regimen (HR 0.34, 95% CI 0.26–0.43). Switching ART regimen when viral load was undetectable was associated with a higher hazard of reaching TC treatment goals (HR 1.48, 95% CI 1.14–1.91). Conclusion: In SHCS participants on ART, several ART–related and not ART-related epidemiological factors were associated with insufficient control of dyslipidemia. Control of dyslipidemia in ART recipients must be further improved.     

Correlates of self-reported nonadherence to antiretroviral therapy in HIV-infected patients: the Swiss HIV Cohort Study

BACKGROUND: Adherence is one of the most crucial issues in the clinical management of HIV-infected patients receiving antiretroviral therapy (ART). METHODS: A 2-item adherence questionnaire was introduced into the Swiss HIV Cohort Study in July 2003. All 3607 eligible patients were on ART for > or =6 months and their current regimen for > or =1 month. Three definitions of nonadherence were considered: missing > or =1 dose, missing > or =2 doses, and taking <95% of doses in the past 4 weeks. RESULTS: Over 30% of patients reported missing > or =1 dose, 14.9% missed > or =2 doses, and 7.1% took <95% of doses in the previous 4 weeks. The rate of drug holidays was 5.8%. Whether using more or less conservative definitions of nonadherence, younger age, living alone, number of previous regimens, and boosted protease inhibitor regimens were independent factors associated with nonadherence. There was a significant association between optimal viral suppression and nonadherence as well as a significant linear trend in optimal viral suppression by missed doses. CONCLUSIONS: Younger age, lack of social support, and complexity of therapy are important factors that are related to nonadherence with ART. Investment in behavioral dimensions of HIV is crucial to improve adherence in ART recipients.     

The pregnancy factor: the prevalence of depression among women living with HIV enrolled in the African Cohort Study (AFRICOS) by pregnancy status

Among Sub-Saharan African women living with HIV (WLWH), pregnancy creates unique stressors that may cause depression. We describe the prevalence of depression among WLWH enrolled in the African Cohort Study (AFRICOS) by pregnancy status and describe factors associated with depression. WLWH < 45 years of age underwent six-monthly visits with depression diagnosed using the Center for Epidemiological Studies-Depression scale. Visits were categorized as “pregnant;” “postpartum” (the first visit made after the last pregnancy visit), and “non-pregnant.” The prevalence of depression was calculated for each visit type and compared using prevalence odds ratios (POR) with 95% confidence intervals (CI). Logistic regression with generalized estimating equations was used to evaluate sociodemographic factors associated with depression. From January 2013 to March 1, 2020, 1333 WLWH were enrolled, and 214 had pregnancies during follow-up. As compared to the prevalence of depression during “non-pregnant” visits (9.1%), depression was less common at “pregnant” (6.3%; POR = 0.68 [CI: 0.42, 1.09]) and “postpartum” (3.4%; POR = 0.36 [CI: 0.17, 0.76]) visits. When controlling for other factors, the visit category was not independently associated with depression. Visit number, study site, employment status, and food security were independently associated with decreased odds of depression. We observed a lower prevalence of depression during pregnancy and the postpartum period than has been previously described among WLWH during similar time points. We observed protective factors against depression which highlight the impact that holistic and consistent health care at HIV-centered clinics may have on the well-being of WLWH in AFRICOS.

     

Abnormalities of body fat distribution in HIV-infected persons treated with antiretroviral drugs: The Swiss HIV Cohort Study

We prospectively assessed the 1-month prevalence of abnormal body fat distribution in HIV-infected individuals. Of 1,359 patients treated with antiretroviral drugs, 578 (43%) had signs of abnormal fat distribution. Peripheral fat loss was observed in 382 patients (28%), whereas 412 (30%) had signs of fat accumulation. The presence of lipodystrophy (peripheral fat loss with or without fat accumulation) was found to be independently associated with increasing age (less than 35 years of age as a reference group: 35 to 41 years of age, OR = 1.5 [95% CI, 1.1-2.3]; and older than 41 years of age, OR = 2.4 [95% CI, 1.7-3.5]), current use of stavudine (OR = 2.4 [95% CI, 1.8-3.3]), current use of abacavir (OR = 2.1 [95% CI, 1.3-3.4]), and elevated lactate level (OR = 1.6 [95% CI, 1.1-2.4]). The prevalence of lipodystrophy was higher among patients who had received stavudine for a longer period (no stavudine in the current combination as a reference group: <6 months, OR = 1.1 [95% CI, 0.6-1.8]; 6-24 months, OR = 2.4 [95% CI, 1.7-3.5]; and >24 months, OR = 3.2 [95% CI, 2.4-4.3]). This study confirms the association between the use of stavudine and lipodystrophy.     

Cigarette smoking and risk of lung cancer in Korean men: the Seoul Male Cancer Cohort Study

Lung cancer is the leading cause of cancer deaths in Korea. The aim of this study was to estimate lung cancer risk of cigarette smoking in Korean men by a 10-yr follow-up prospective cohort study using the primary databases. The number of subjects was 14,272 men, who had full information of smoking habits among participants in the Seoul Male Cancer Cohort Study (SMCC). Total 125,053 person-years were calculated by determining the number of days from the start of followup, January 1, 1993, until the date of lung cancer diagnosis, death from another cause, or the end of follow-up, December 31, 2002, followed by converting the number of days to years. The information of outcome was obtained by the database of Korea Central Cancer Registry, Seoul Regional Cancer Registry, and Korea Statistical Office. The relative risk (RR) and its 95% confidence interval (CI) values of smoking were calculated using Cox proportional hazards regression stratified on potential confounders. During the follow-up periods, 78 cases of lung cancer occurred. The cigarette smoking is the major risk factor and increases the 4.18-fold risk of lung cancer in Korean men. In order to control lung cancer, intervention of quitting smoking is needed.     

缺血预处理抗缺血再灌注心肌间质损伤的实验研究

目的：观察缺血预处理（ＩＰＣ） 对大鼠缺血再灌注心肌间质胶原及心肌功能结构关系的影响,以进一步探讨ＩＰＣ 对心肌的保护作用。方法：实验采用体重（２５０ ±３０）ｇ 雄性ＳＤ 大鼠２４ 只,分３ 组,每组８ 只,即假手术对照（ＳＣ）组;缺血再灌注（Ｉ／Ｒ） 组和缺血预处理（ＩＰＣ） 组。用超微结构立体计量及羟脯氨酸浓度测定观察心肌间质胶原变化,多道记录仪测量心功能指标,透射电镜观察心肌超微结构。结果：Ｉ／Ｒ 时心肌间质胶原浓度显著低于ＳＣ 组（ Ｐ＜ ０－０１） ,心肌超微结构损伤严重,左室功能明显低于ＳＣ 组（ Ｐ＜ ０－０１） 。ＩＰＣ 组心肌超微结构破坏明显低于Ｉ／ Ｒ 组。同时,心肌间质胶原浓度、胶原纤维线密度及左室功能指标明显高于Ｉ／Ｒ 组（ Ｐ＜ ０－０５ ,Ｐ＜ ０－０１） 。结论：ＩＰＣ 的心肌保护作用不仅表现在对心肌细胞上,而且对心肌间质也有重要的保护作用。     

梓醇对谷氨酸诱导SD大鼠海马神经元损伤的保护作用

目的梓醇对谷氨酸诱导SD大鼠海马神经元损伤的影响。方法将培养7～9d的SD大鼠海马细胞进行NSE鉴定,然后随机分为:正常对照组;谷氨酸损伤组(Glu);谷氨酸损伤前予梓醇组(CAT+Glu)。采用倒置显微镜观察细胞形态学变化,噻唑蓝(MTT)法测定细胞存活率,比色法测定培养液中乳酸脱氢酶(LDH)含量,流式细胞术测定细胞凋亡率。结果与正常对照组比较,0.1mmol·L-1谷氨酸作用于海马神经元24h,出现明显细胞损伤,细胞存活率下降,培养液中LDH含量明显增加,细胞凋亡率增高(<0.01);0.2、1.0、5.0mg·L-1的梓醇可不同程度的改善谷氨酸损伤引起的神经细胞形态的改变,提高细胞存活力,减少LDH的漏出,降低细胞凋亡率,并呈一定的剂量依赖性。结论梓醇对谷氨酸诱导的海马神经细胞损伤有保护作用。     

金属硫蛋白对大鼠骨骼肌挤压缺血再灌注损伤的保护作用

目的观察大鼠挤压伤模型中骨骼肌的变化并探讨金属硫蛋白对大鼠挤压伤骨骼肌的保护作用。方法健康雌性SD大鼠随机分为对照组、挤压伤组(CI)、挤压伤+金属硫蛋白(CI+MT)组(8只/组),全自动生化分析仪检测血清中血钾、血肌酐、血尿素氮、肌酸激酶水平的变化,HE染色观察骨骼肌与肾脏形态学改变,检测挤压部位骨骼肌湿干重比、丙二醛含量和超氧化物歧化酶活力变化。结果 CI组大鼠骨骼肌组织内可见肌纤维坏死、溶解、断裂、炎症细胞浸润,肾脏组织内可见肾小管壁肿胀、小管上皮细胞水肿、管腔变细,可见少量炎细胞浸润及蛋白管型。CI+MT组与对照组有损伤改变,但损伤程度较CI组轻;CI组骨骼肌湿干比值、丙二醛含量明显高于对照组,但CI+MT组水平低于CI组(P0.05);CI组骨骼肌超氧化物歧化酶活力明显低于对照组,但CI+MT组水平高于CI组(P0.05)。结论挤压伤缺血再灌注导致骨骼肌肌纤维损伤,外源性MT对挤压伤骨骼肌缺血再灌注损伤具有保护作用。     

增加胎心监护检查频率对降低新生儿窒息率的影响

目的评价增加胎心监护检查频率方法的临床意义,探讨降低胎监假阳性率的方法,提高胎儿宫内窘迫的诊断,降低新生儿窒息率.方法取2001年在我院分娩的1087例产妇为观察组,孕37w后住院期间实行每天一次胎监检查,产时进行连续监护,1997年分娩的1091例产妇为对照组,孕37w后住院期间每周一、两次胎监检查,产时间断监护.用x2统计两组胎监假阳性率、剖宫产率、新生儿窒息率,回顾分析胎监异常与临床结局的关系.结果2001年组的因胎监异常剖宫产率为20.6%,假阳性率27.45%,新生儿窒息率6.53%,1997年组因胎监异常剖宫产率为26.4%,假阳性率为46.51%,新生儿窒息率11.73%,两组相比有显著性差异P＜0.01.结论增加胎监检查频率的方法能降低胎监的假阳性率,降低新生儿窒息率.     

Unpacking the racial disparity in HIV rates: the effect of race on risky sexual behavior among Black young men who have sex with men (YMSM)

The purpose of this study is to evaluate the large disparity in HIV prevalence rates between young Black and White Americans, including young men who have sex with men (YMSM). Research focusing on individual behaviors has proven insufficient to explain the disproportionately high rate of HIV among Black YMSM. The purpose of the present study was to gain a greater understanding of the pronounced racial disparity in HIV by evaluating whether YMSM are more likely to engage in risky sexual behaviors as a function of their partner’s race. Participants included 117 YMSM from a longitudinal study evaluating lesbian, gay, bisexual, and transgender youth (ages 16–20 at baseline), who reported characteristics and risk behaviors of up to 9 sexual partners over an 18-month period. Results indicated that participants were less likely to have unprotected sex with Black partners, and this finding was not driven by a response bias (i.e., Black YMSM did not appear to be minimizing their reports of unprotected sex). Furthermore, there was support for the hypothesis that participants’ sexual networks were partially determined by their race insofar as sexual partnerships were much more likely to be intra-racial (as opposed to interracial). It is possible that dyad- and sexual network-level factors may be needed to understand racial disparities in HIV among YMSM.     

非诺贝特对实验性糖尿病大鼠肾脏保护作用的研究

目的：探讨苯氧乙酸类降血脂药非诺贝特（fenofibrate）对实验性糖尿病大鼠肾脏的保护作用。方法：将实验用SD大鼠随机分为正常对照组（C组），糖尿病组（D组），非诺贝特治疗组（F组）。第4、6周分别随机取各组大鼠一半检测血糖、血甘油三酯、血胆固醇、血肌酐、尿白蛋白及肾脏肥大指数。应用免疫组织化学方法检测肾组织转化生长因子-β₁（TGF-β₁）、层粘连蛋白（LN）、IV型胶原蛋白的表达。用计算机图象分析系统测定肾小球平均体积（MGV）、肾小球平均面积（MGA）。结果：非诺贝特治疗组血甘油三酯、血胆固醇、尿白蛋白排泄率均低于糖尿病组（P<0.05, P<0.01）。第6周时，F组TGF-β₁、LN、IV型胶原蛋白表达低于D组（P<0.05）。结论：非诺贝特对糖尿病肾脏有部分保护作用，其机制可能部分通过降血脂、下调糖尿病大鼠TGF-β₁的表达减少细胞外基质的积聚。     

The predictive effect of insight on adverse clinical outcomes in bipolar I disorder: a two-year prospective study

Research has revealed that a lack of insight is associated with poorer clinical outcomes in schizophrenia; however, the predictive value of insight on adverse clinical outcomes among bipolar patients is quite understudied. The aim of this prospective study was to examine the impact of insight on adverse clinical outcomes among the patients with bipolar I disorder over a 2-year period. Sixty-five remitted bipolar I disorder patients received follow-up assessments at 3, 6, 9, 12, 18, and 24 months to detect the adverse clinical outcomes defined by the incidence of bipolar-related psychiatric hospitalization, emergency room visits, violent or suicidal behavior. The Schedule of Assessment of Insight was used to provide a baseline insight score. Cox regression analysis was used to examine the predictive value of insight on the adverse clinical outcomes. Impaired insight into treatment and a greater number of previous hospitalizations significantly increased the risk of adverse clinical outcomes with bipolar disorder in the 2-year period. However, insight into recognition of the illness and re-labeling of psychotic phenomena did not have any significant effect on adverse clinical outcomes. Bipolar patients' insight into treatment is an independent predictor of adverse clinical outcomes. Improving insight into treatment might be a promising target for a better outcome.