Effectiveness of highly active antiretroviral therapy among HIV-1 infected women

STUDY OBJECTIVE: To describe the impact of highly active antiretroviral therapy (HAART) on mortality, morbidity, and markers of HIV disease progression in HIV infected women. DESIGN: Data collected from the Women's Interagency HIV Study, a prospective cohort study that enrolled women between October 1994 and November 1995. SETTING: Six clinical consortia based in five cities in the United States (New York, NY; Washington, DC; Los Angeles, CA; San Francisco, CA; and Chicago, IL). PARTICIPANTS: A total of 1691 HIV seropositive women with a study visit after April 1996. MAIN RESULTS: Beginning in April 1996, the self reported use of HAART increased over time, with more than 50% of the cohort reporting HAART use in 1999. There was a 23% decline per semester in the incidence of AIDS from April 1996 (95% confidence intervals (CI) -29% to -16%). Furthermore, there was a 21% decline of the semiannual mortality rates among those with AIDS at baseline (95% CI -27% to -14%) and an 11% decline among those AIDS free at baseline (95% CI -3% to -18%). CD4+ lymphocyte counts either increased (women with baseline AIDS) or stabilised (women without baseline AIDS) after April 1996, and HIV RNA levels dramatically declined in both groups, although the percentage of women with HIV RNA above 4000 cps/ml remained stable at approximately 40% since mid-1997. CONCLUSIONS: Despite concerns regarding the use of antiretroviral therapies in this population, the use of therapies led to improved immunological function, suppressed HIV disease activity, and dramatic declines in morbidity and mortality.     

HIV-1感染者抗病毒治疗后HIV-1 DNA载量动力学变化及影响因素分析

目的:分析云南省德宏傣族景颇族自治州（德宏州）HIV感染者抗病毒治疗后HIV-1 DNA载量的动力学变化及影响因素,为HIV-1 DNA定量检测的临床应用提供参考依据。方法:研究对象来源于德宏州CDC建立的2009-2018年HIV新发感染队列,构建HIV-1 DNA载量随抗病毒治疗时间动力学变化曲线图。采用logis...     

The addition of depression to the Framingham Risk Equation model for predicting coronary heart disease risk in women

BackgroundDepression is widely considered to be an independent and robust predictor of Coronary Heart Disease (CHD), however is seldom considered in the context of formal risk assessment. We assessed whether the addition of depression to the Framingham Risk Equation (FRE) improved accuracy for predicting 10-year CHD in a sample of women.DesignA prospective, longitudinal design comprising an age-stratified, population-based sample of Australian women collected between 1993 and 2011 (n = 862).MethodsClinical depressive disorder was assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-I/NP), using retrospective age-of-onset data. A composite measure of CHD included non-fatal myocardial infarction, unstable angina coronary intervention or cardiac death. Cox proportional-hazards regression models were conducted and overall accuracy assessed using area under receiver operating characteristic (ROC) curve analysis.ResultsROC curve analyses revealed that the addition of baseline depression status to the FRE model improved its overall accuracy (AUC:0.77, Specificity:0.70, Sensitivity:0.75) when compared to the original FRE model (AUC:0.75, Specificity:0.73, Sensitivity:0.67). However, when calibrated against the original model, the predicted number of events generated by the augmented version marginally over-estimated the true number observed.ConclusionsThe addition of a depression variable to the FRE equation improves the overall accuracy of the model for predicting 10-year CHD events in women, however may over-estimate the number of events that actually occur. This model now requires validation in larger samples as it could form a new CHD risk equation for women.     

Prognostic model for HIV-1 disease progression in patients starting antiretroviral therapy was validated using independent data

SETTING AND OBJECTIVE: The Antiretroviral Therapy (ART) Cohort Collaboration published models predicting progression to AIDS or death (the complement of AIDS-free survival) and death (the complement of absolute survival). The objective is to validate the model on independent data from CASCADE. STUDY DESIGN: Discrimination was assessed using concordance statistics, and calibration was examined by comparing predicted survival curves with the corresponding Kaplan-Meier estimates. Accuracy was assessed by comparing predicted percentage probability of survival with the Kaplan-Meier estimate at yearly intervals after start of therapy. RESULTS: There was little loss of model discrimination when applying the model to CASCADE. Overall predicted calibration curves agreed with Kaplan-Meier survival curves. Predicted probabilities of AIDS or death at 3 years after starting HAART ranged from 4.3% in the low-risk group to 20.5% in high-risk patients, with corresponding Kaplan-Meier estimates ranging from 4.0% to 18.3%; for death predictions, the probabilities ranged from 1.2% to 7.3% and estimates from 1.1% to 8.6%. CONCLUSION: The predictions from the model agree with observed outcomes in CASCADE to within the 95% upper and lower Kaplan-Meier estimates. The prognostic model appears to be accurate in terms of discrimination and calibration, giving reliable and transportable predictions up to 3 years after the start of HAART.     

Mycoplasmas in the urine of HIV-1 infected men

The aim of this study was determine the prevalence of Mycoplasma hominis, M. genitalium, M. fermentans, M. pirum, M. penetrans and Ureaplasma urealyticum in HIV-infected patients. Culture and PCR were used to detect six species of Mycoplasma in first-void urine of HIV-1 infected men. A total of 497 HIV/AIDS patients (age range 5-75 years, mean 37 years) were screened in the study. All presented positive for at least one kind of mycoplasma, especially U. urealyticum and M. hominis. Six mycoplasmas were significant in the homosexual contact and heterosexual contact groups. The distribution of M. hominis, M. penetrans, and M. pirum were significantly different in this four-transmission category. CD4+ cell count levels were lower in the AIDS-associated Mycoplasma-positive group than in the Mycoplasma-negative group (P<0.01). This study indicates that U. urealyticum, M. hominis and M. fermentans are prevalent in HIV-1-infected male patients. This may be an indication of whether mycoplasmas are co-factors in the progression of HIV disease.     

On the use of a logistic risk score in predicting risk of coronary heart disease

Many studies over the last 20 years have used logistic regression to model the relationship between the risk of developing coronary heart disease (CHD) and the levels of risk factors such as high blood pressure, high serum cholesterol, and cigarette smoking. Subsequently, several investigators have proposed the use of some of the published estimated logistic risk functions to predict risk in new populations. Because of great variation in definition of event, duration of follow-up, population characteristics, definition of risk variables, and selection of other variables in the logistic functions, direct use of such established functions would generally not have validity for the prediction of absolute risk levels. A review of fifteen of these studies indicates on the one hand generally similar results in direction and order of magnitude of effects of the major risk factors, confirming the importance of these risk factors of CHD. On the other hand the reviews indicate sufficient variation to suggest that extrapolation to new populations even to predict relative risk is not justified.     

Magnesium intake and risk of coronary heart disease among men

OBJECTIVE: Our aim in this study was to assess the relationship between magnesium intake and risk of coronary heart disease (CHD) among men. METHODS: A total of 39,633 men in the Health Professionals Follow-up Study who returned a dietary questionnaire in 1986 were followed up for 12 years. Intakes of magnesium, zinc and potassium and other nutrients were assessed in 1986, 1990 and 1994. Total CHD incidence (nonfatal myocardial infarction (MI) and fatal CHD) was ascertained by biennial questionnaire and mortality surveillance confirmed by medical record review. Standard CHD risk factors were recorded biennially. RESULTS: During 12 years of follow-up (414,285 person-years), we documented 1,449 cases of total CHD (1,021 non-fatal MI cases, and 428 fatal CHD). The age-adjusted relative risk (RR) of developing CHD in the highest quintile (median intake = 457 mg/day) compared with the lowest quintile (median intake = 269 mg/day) was 0.73 (95% CI 0.62-0.87, p for trend <0.0001). After controlling for standard CHD risk factors and dietary factors, the RR for developing CHD among men in the highest total magnesium intake quintile compared with those in the lowest was 0.82 (95% CI 0.65-1.05, p for trend = 0.08). For supplemental magnesium intake, the RR comparing the highest quintile to non-supplement users was 0.77 (95% CI 0.56-1.06, p for trend = 0.14). CONCLUSIONS: These results suggest that intake of magnesium may have a modest inverse association with risk of CHD among men.     

Evaluation of coronary heart disease risk model by carotid ultrasonography in the occupational setting--intima-media thickness and coronary heart disease risk]

Recently, because of an increase in aged workers with high risk health conditions in Japan, it is becoming necessary to have a preventive control system for work-related diseases, such as coronary heart disease. We have already built a system by applying the prediction model of Framingham's risk equation for management after an annual check-up since 1999. At that time, we considered the relationship between CHD risk and intimamedia thickness (IMT) as an index of actual atherosclerosis. Correlation coefficients among max IMT, CHD risk and the several health factors in the corporate annual health check-up were obtained by Spearman's method. Significant associations with max IMT were only for CHD risk and systolic blood pressure. Correlation coefficients were 0.30 and 0.21 for CHD risk and systolic blood pressure, respectively. Furthermore, when we divided findings into those for the atherosclerotic and non-atherosclerotic groups defined by a max IMT over 1.1 mm or less, the difference between the two groups in CHD risks was investigated by t-test. The CHD risk for the atherosclerotic group was revealed to be significantly higher than that for the non-atherosclerotic group, with the means +/- SD in the two groups being 21.4 +/- 9.4% and 17.0 +/- 7.7%, respectively. CHD risk was therefore concluded to be important for the objective index of atherosclerosis from the viewpoint of high-risk-strategy in the worksite.     

The effect of a home-based walking program on risk factors for coronary heart disease in hypercholesterolaemic men. A randomized controlled trial

BACKGROUND: Hypercholesterolaemia and physical inactivity significantly contribute towards risk of coronary heart disease. Increased physical activity may be an effective way to improve lipid profiles in hypercholesterolaemic individuals. The aim of this study was to investigate whether a home-based physical activity program meeting current guidelines improved the lipid profile of hypercholesterolaemic men. METHODS: Sixty-seven hypercholesterolaemic men (55.1 (4.9) years), from Bristol England, recruited between 2002-2004, were randomized to either 12 weeks of brisk walking sufficient to expend at least 300 kcal each walk or control condition. Fasting lipids including total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), glucose, insulin, blood pressure and anthropometric characteristics were measured at baseline and follow-up. Compliance was monitored using accelerometers and activity logs. RESULTS: After controlling for baseline differences, TC/HDL-C was significantly lower in the intervention group at follow-up (-0.28, 95% CI: -0.52, -0.03, p=0.03). An increase in HDL-C (0.07 mmol/l: -0.01, 0.12, p=0.07) and reduction in TG (-0.30 mmol/l: -0.64, 0.03, p=0.07) in intervention participants were of borderline statistical significance. Weight significantly decreased in intervention participants (-1.40 kg: -2.43, -0.38, p<0.01). No other significant between group effects were found. Compliance to the walking program was 97.6%. CONCLUSIONS: Twelve weeks of moderate intensity walking was sufficient to improve TC/HDL-C in hypercholesterolaemic men, primarily through improvement in HDL-C.     

Role of metabolic syndrome and antiretroviral therapy in adiponectin levels and oxidative stress in HIV-1 infected patients

ObjectiveHIV-1 infection is accompanied by severe metabolic and immune dysfunction. The aim of this study was to evaluate the role of metabolic syndrome (MetS) and antiretroviral therapy (ART) utilization on the adiponectin levels and oxidative stress in patients infected with HIV-1.MethodsWe allocated 285 patients into four groups: group 1: patients without MetS who were not using ART; group 2: patients without MetS using ART; group 3: patients with MetS who were not using ART; and group 4: patients with MetS using ART. Biochemical, immunologic, and oxidative stress parameters were measured.ResultsGroup 4 exhibited higher lipoperoxides when compared with group 1 (P < 0.0001) and higher advanced oxidation protein products (AOPP) compared with group 2 or group 1 (P < 0.0001). Group 3 also presented higher AOPP than group 2 (P < 0.05). Group 4 showed lower adiponectin levels compared with groups 1 or 2 (P < 0.0001). Similarly, group 3 presented lower adiponectin levels compared with group 2 (P < 0.05) or group 1 (P < 0.0001). Multivariate analysis showed that both an increase in AOPP and a decrease in total radical-trapping antioxidant parameter/uric acid were independently associated with MetS in HIV-1 patients. Regarding immunologic markers of HIV-1 disease progression and viral replication, group 4 exhibited significantly higher CD45⁺, CD3⁺, and CD4⁺ T cells count compared with group 2 (P < 0.01).ConclusionHIV-1–infected patients with MetS exhibited hypoadiponectinemia and increased oxidative stress, and these findings were not influenced by ART use. The findings of the present study allow the suggestion that MetS and inflammation might be mainly responsible for the aforementioned features. More studies are needed to verify whether drugs or food, which yield increased adiponectinemia and decreased oxidative stress, could reduce cardiovascular risk in HIV-infected patients.     

Prospective study of major dietary patterns and risk of coronary heart disease in men

BACKGROUND: Previous studies on diet and coronary heart disease (CHD) focused primarily on individual nutrients or foods. OBJECTIVE: We examined whether overall dietary patterns derived from a food-frequency questionnaire (FFQ) predict risk of CHD in men. DESIGN: This was a prospective cohort study of 44875 men aged 40-75 y without diagnosed cardiovascular disease or cancer at baseline in 1986. RESULTS: During 8 y of follow-up, we documented 1089 cases of CHD (nonfatal myocardial infarction and fatal CHD). Using factor analysis, we identified 2 major dietary patterns using dietary data collected through a 131-item FFQ. The first factor, which we labeled the "prudent pattern," was characterized by higher intake of vegetables, fruit, legumes, whole grains, fish, and poultry, whereas the second factor, the "Western pattern," was characterized by higher intake of red meat, processed meat, refined grains, sweets and dessert, French fries, and high-fat dairy products. After adjustment for age and CHD risk factors, the relative risks from the lowest to highest quintiles of the prudent pattern score were 1.0, 0. 87, 0.79, 0.75, and 0.70 (95% CI: 0.56, 0.86; P: for trend = 0.0009). In contrast, the relative risks across increasing quintiles of the Western pattern score were 1.0, 1.21, 1.36, 1.40, and 1.64 (95% CI: 1.24, 2.17; P: for trend < 0.0001). These associations persisted in subgroup analyses according to cigarette smoking, body mass index, and parental history of myocardial infarction. CONCLUSIONS: These data suggest that major dietary patterns derived from the FFQ predict risk of CHD, independent of other lifestyle variables.     

The utility of the international child and adolescent overweight guidelines for predicting coronary heart disease risk factors

The purpose of this study was to assess the association between the international overweight cutoffs for children and youth and coronary heart disease risk factors. The sample included 410 boys and 337 girls 9-18 years of age from the Québec Family Study. Participants were classified as normal weight or overweight using the international BMI cutoffs, and into normal and elevated risk groups based on the 90th percentile of sex-specific age-adjusted risk factors [blood pressure, fasting total cholesterol (CHOL), LDL-C, HDL-C, CHOL/HDL-C, triglycerides, glucose, and physical work capacity]. Overweight participants had between 1.6 and 9.1 times the risk of elevated risk factors compared to normal-weight participants. Further, boys and girls with four or more risk factors were 19 and 43 times more likely to be overweight, respectively, compared to participants with no risk factors. The results add evidence that the international cutoffs are related to health risks in youth, supporting the adoption of the guidelines.     

Serum triglycerides and risk of coronary heart disease among Japanese men and women

To examine the relation of triglycerides with coronary heart disease among populations with low mean total cholesterol, the authors conducted a 15.5-year prospective study ending in 1997 of 11,068 Japanese aged 40-69 years (4,452 men and 6,616 women with mean total cholesterol = 4.73 mmol/liter and 5.03 mmol/liter, respectively), initially free of coronary heart disease or stroke. There were 236 coronary heart disease events comprising 133 myocardial infarctions, 68 angina pectoris events, and 44 sudden cardiac deaths. The coronary heart disease incidence was greater in a dose-response manner across increasing quartiles of nonfasting triglycerides for both sexes. The multivariate relative risk of coronary heart disease adjusting for coronary risk factors and time since last meal associated with a 1-mmol/liter increase in triglycerides was 1.29 (95% confidence interval (CI): 1.09, 1.53; p = 0.004) for men and 1.42 (95% CI: 1.15, 1.75; p = 0.001) for women. The trend was similar for myocardial infarction, angina pectoris, and sudden cardiac death. The relation of triglycerides with coronary heart disease was not influenced materially by total cholesterol levels or, in a subsample analysis (51% of total sample), by high density lipoprotein cholesterol levels. Nonfasting serum triglycerides predict the incidence of coronary heart disease among Japanese men and women who possess low mean values of total cholesterol. Further adjustment for high density lipoprotein cholesterol suggests an independent role of triglycerides on the coronary heart disease risk.     

Dietary magnesium intake and risk of incident coronary heart disease in men: A prospective cohort study

We studied 85,975 Japanese subjects by questionnaire at baseline (age 45–65 years, no histories of CVD or cancer) in 1995 and 1998, and were followed until the end of 2009 and 2010 in Cohorts I and II, respectively. Dietary magnesium intake was estimated from a self-administered 138 item food-frequency questionnaire. Confounding variables were used for age, smoking, alcohol, body mass index, history of diabetes, medication of antihypertensive drug and anti-lipidemic drug users, regular exercise, public health centers, foods (vegetables and fish), dietary energy and minerals (salt, calcium, and potassium).

1. Download high-res image (179KB)
2. Download full-size image

     

Long-term effect of occupational noise on the risk of coronary heart disease

OBJECTIVES: The aim of the study was to investigate the short- and long-term effects of occupational exposure to continuous and impulse noise on the risk of CHD. METHODS: The effect of noise on CHD was studied among 6005 Finnish middle-aged industrially employed men (part of the screeners in the Helsinki Heart Study) in a prospective 18-year follow-up study. The CHD end points (codes 410-414 in the ninth revision of the International Classification of Diseases and codes I20-I25 in the tenth revision) were obtained from official Finnish registers. The Finnish job-exposure matrix FINJEM provided estimates of the proportion of exposed persons and the mean level of exposure among those exposed by occupation. The relative risks (RR) of CHD and the 95% confidence intervals (95% CI) for noise exposure were calculated from Cox's proportional hazard models with adjustment for some other risk factors of CHD. RESULTS: The short-term (9-year follow-up) relative risk of CHD for the combined noise (continuous noise exceeding 80 decibels and impulse noise) was 1.38 (95% CI 1.04-1.82), and the long-term (18-year follow-up) RR was 1.54 (95% CI 1.28-1.86). For blue-collar workers the corresponding estimates were 1.11 (95% CI 0.82-1.51) and 1.29 (95% CI 1.05-1.57). Adjustment for other relevant risk factors did not materially change the results. CONCLUSIONS: In our long-term follow-up of industrially employed men, exposure to noise, especially to impulse noise, was associated with a moderate, but statistically significant increase in CHD risk that persisted even after the workers had passed the age of retirement.     

Prospective study of selenium levels in toenails and risk of coronary heart disease in men

Selenium is a trace mineral that plays a role in antioxidant defenses as a component of glutathione peroxidase. Epidemiologic findings on the relation of selenium status to risk of heart disease are inconsistent. Therefore, the authors investigated prospectively the association between toenail selenium levels and risk of coronary heart disease (CHD) in a case-control study nested within the Health Professionals Follow-up Study. Between 1987 and 1992, 470 CHD cases were newly diagnosed. A control matched to each case on age, smoking status, and date of toenail return was chosen. Toenail selenium levels analyzed by neutron activation were not associated with risk of total CHD after adjustment for age and smoking and other CHD risk factors (highest quintile vs. lowest: odds ratio (OR) = 0.86, 95% confidence interval (CI): 0.55, 1.32; p-trend = 0.75). Selenium level was inversely associated with risk of nonfatal myocardial infarction for extreme quintiles (OR = 0.54, 95% CI: 0.31, 0.93; p-trend = 0.07), was less so for fatal CHD (OR = 0.79, 95% CI: 0.39, 1.60; p-trend = 0.61), and was directly associated with coronary revascularization procedures (OR = 2.38, 95% CI: 1.11, 5.09; p-trend = 0.02). Although these findings suggest no overall relation between selenium status and CHD, a specific protective role for myocardial infarction cannot be excluded.