HIV incidence among men who have sex with men (MSM) in Metro Manila,the Philippines: A prospective cohort study 2014–2018

The human immunodeficiency virus (HIV) epidemic in the Philippines has been driven by sexual transmission among men who have sex with men (MSM) over the past 2 decades. As the incidence of HIV infection among MSM has not been extensively evaluated, this study aimed to determine the incidence of HIV infections and the associated risk factors among MSM in Metro Manila, Philippines.This prospective cohort study was conducted in 2 community centers in Metro Manila, the Philippines, between March 2014 and December 2018. MSM who had anal or oral sex in the past 12 months, aged ≥18 years, and confirmed HIV-negative status were enrolled. Participants were followed up every 3 months with repeat HIV testing and assessment of HIV-related practices.Of the 708 MSM included in this study, a total of 59 HIV seroconversions occurred during the follow-up, resulting in an incidence of 2.7 (95% confidence interval: 2.1–3.5) per 100 patient-years. Multivariate risk regression analysis indicated that age (P = .002) and anal sex with a consensual male partner in the past 3 months (P = .039) were significantly associated with HIV infection.Our study has shown high rates of incident HIV infection among Filipino MSM. This demonstrates the need for effective HIV prevention, surveillance, treatment, and intervention strategies targeting this population.     

Rationale and design of the Early Chronic Obstructive Pulmonary Disease (ECOPD) study in Guangdong,China: a prospective observational cohort study

BackgroundChronic obstructive pulmonary disease (COPD) is a heterogeneous disease and its clinically relevant subtypes are not well understood. Which clinical characteristics are more likely to be present among individuals who develop COPD remains to be studied in depth. Therefore, we designed a prospective observational cohort study, entitled the Early Chronic Obstructive Pulmonary Disease (ECOPD) study, to fill this evidence gap. The ECOPD study has four specific aims: (I) identification of characteristics, parameters, and biomarkers that may predict the development of airflow obstruction and annual decline in lung function with normal spirometry; (II) identification of clinically relevant early COPD subtypes; (III) identification of characteristics, parameters, and biomarkers that may predict disease progression in these early COPD subtypes; (IV) development and validation of machine learning models to predict development of airflow obstruction and disease progression.MethodsWe will recruit approximately 2,000 participants aged 40–80 years, including approximately 1,000 with COPD [post-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <0.7] and approximately 1,000 without COPD, using a population-based survey for COPD. We will assess all participants using standard respiratory epidemiological questionnaires, pulmonary function tests [pre-bronchodilator and post-bronchodilator spirometry, and impulse oscillometry (IOS)], health outcomes [modified British Medical Research Council (mMRC) dyspnea scale, COPD assessment test (CAT), COPD clinical questionnaire (CCQ)], inspiratory and expiratory chest computed tomography (CT), and biomarker measurements (blood and urine), as well as satellite remote sensing pollutant exposure measures. Subgroup will additionally complete induced sputum, exercise capacity tests [6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET)] and home monitoring/personal sampling as pollutant exposure measures. Study procedures will be performed at baseline and every 1 year thereafter.DiscussionThe ECOPD study will provide insight into many aspects of early COPD and improve our understanding of COPD development, which may facilitate therapeutic interventions with the potential to modify the course of disease.Trial RegistrationChinese Clinical Trial Registry, ChiCTR1900024643. Registered on 19 July, 2019.     

Determinants of suboptimal blood pressure control in a multi‐ethnic population: The Healthy Life in an Urban Setting (HELIUS) study

Among ethnic minority groups in Europe, blood pressure (BP) control is often suboptimal. We aimed to identify determinants of suboptimal BP control in a multi‐ethnic population. We analyzed cross‐sectional data of the Healthy Life in an Urban Setting (HELIUS) study, including 3571 participants aged 18‐70 with prescribed antihypertensive medication, of various ethnic backgrounds (500 Dutch, 1052 African Surinamese, 656 South‐Asian Surinamese, 637 Ghanaian, 433 Turkish, and 293 Moroccan) living in Amsterdam, the Netherlands. 53.3% of the population had suboptimal BP control, defined as BP ≥140/90 mmHg despite prescribed antihypertensives. Using multivariate logistic regression analysis, female sex (OR 0.50, 95%CI 0.43‐0.59), being married (0.83, 0.72‐0.96), smoking (0.78, 0.65‐0.94), alcohol intake (0.80, 0.66‐0.96), obesity (1.67, 1.35‐2.06), cardiovascular disease (CVD) history (0.56, 0.46‐0.68), non‐adherence to antihypertensives (1.26, 1.00‐1.58), and family history of hypertension (1.19, 1.02‐1.38) were identified to be independently associated with suboptimal BP control in the total population. In the ethnic‐stratified analysis, factors associated with better BP control were female sex (all ethnic groups), smoking (Turks), and CVD history (Dutch, South‐Asian Surinamese, and African Surinamese), whereas factors associated with suboptimal BP control were older age (Turks), obesity (Dutch, African Surinamese, Ghanaian, and Turks), and non‐adherence to antihypertensives (Dutch). In conclusion, our analysis identifies several key determinants that are independently associated with suboptimal BP control in a multi‐ethnic population, with some important variations between ethnic groups. Targeting these determinants may help to improve BP control.     

2015/16 I‐MOVE/I‐MOVE+ multicentre case‐control study in Europe: Moderate vaccine effectiveness estimates against influenza A(H1N1)pdm09 and low estimates against lineage‐mismatched influenza B among children

Background

During the 2015/16 influenza season in Europe, the cocirculating influenza viruses were A(H1N1)pdm09 and B/Victoria, which was antigenically distinct from the B/Yamagata component in the trivalent influenza vaccine.

Methods

We used the test‐negative design in a multicentre case‐control study in twelve European countries to measure 2015/16 influenza vaccine effectiveness (VE) against medically attended influenza‐like illness (ILI) laboratory‐confirmed as influenza. General practitioners swabbed a systematic sample of consulting ILI patients and a random sample of influenza‐positive swabs was sequenced. We calculated adjusted VE against influenza A(H1N1)pdm09, A(H1N1)pdm09 genetic group 6B.1 and influenza B overall and by age group.

Results

We included 11 430 ILI patients, of which 2272 were influenza A(H1N1)pdm09 and 2901 were influenza B cases. Overall VE against influenza A(H1N1)pdm09 was 32.9% (95% CI: 15.5‐46.7). Among those aged 0‐14, 15‐64 and ≥65 years, VE against A(H1N1)pdm09 was 31.9% (95% CI: ? 32.3 to 65.0), 41.4% (95% CI: 20.5‐56.7) and 13.2% (95% CI: ? 38.0 to 45.3), respectively. Overall VE against influenza A(H1N1)pdm09 genetic group 6B.1 was 32.8% (95% CI: ? 4.1 to 56.7). Among those aged 0‐14, 15‐64 and ≥65 years, VE against influenza B was ? 47.6% (95% CI: ? 124.9 to 3.1), 27.3% (95% CI: ? 4.6 to 49.4) and 9.3% (95% CI: ? 44.1 to 42.9), respectively.

Conclusions

Vaccine effectiveness (VE) against influenza A(H1N1)pdm09 and its genetic group 6B.1 was moderate in children and adults, and low among individuals ≥65 years. Vaccine effectiveness (VE) against influenza B was low and heterogeneous among age groups. More information on effects of previous vaccination and previous infection is needed to understand the VE results against influenza B in the context of a mismatched vaccine.

     

Combination of disease duration‐to‐age at diagnosis and hemoglobin A1c‐to‐serum C‐peptide reactivity ratios predicts patient response to glucose‐lowering medication in type 2 diabetes: A retrospective cohort study across Japan (JDDM59)

Aims/IntroductionKnowing the collective clinical factors that determine patient response to glucose‐lowering medication would be beneficial in the treatment of type 2 diabetes. We carried out a retrospective cohort study to explore the combination of clinical factors involved in its therapeutic efficacy.Materials and MethodsThe results of cohort studies retrieved using the CoDiC^® database across Japan from January 2005 to July 2018 were analyzed based on criterion that using insulin therapy indicates severe type 2 diabetes.ResultsA logistic regression analysis showed that age at diagnosis, disease duration, hemoglobin A1c (HbA1c) and serum C‐peptide reactivity (CPR) at medication commencement were associated with the probability of insulin treatment. Receiver operating characteristic curve showed that these clinical factors predicted insulin treatment positivity with an area under the curve of >0.600. The area under the curve increased to 0.674 and 0.720 for the disease duration‐to‐age at diagnosis ratio and HbA1c‐to‐CPR ratio, respectively. Furthermore, area under the curve increased to 0.727 and 0.750 in the indices (duration‐to‐age ratio at diagnosis × 43 + HbA1c) and (duration‐to‐age ration at diagnosis × 21 + HbA1c‐to‐CPR ratio), respectively. After stratification to three groups according to the indices, monthly HbA1c levels during 6 months of treatment were higher in the upper one‐third than in the lower one‐third of patients, and many patients did not achieve the target HbA1c level (53 mmol/mol) in the upper one‐third, although greater than fourfold more patients were administered insulin in the upper one‐third.ConclusionsThe combination of disease duration‐to‐age at diagnosis and HbA1c‐to‐CPR ratios is a collective risk factor that predicts response to the medications.     

Relationship between co‐morbidities at diagnosis,survival and ultimate cause of death in patients with chronic lymphocytic leukaemia (CLL): a prospective cohort study

The ultimate cause of death for most patients with newly diagnosed chronic lymphocytic leukaemia (CLL) and its relationship to co‐morbid health conditions is poorly defined. We conducted a prospective cohort study that systematically followed 1143 patients diagnosed with CLL between June 2002 and November 2014. Comorbid health conditions at the time of CLL diagnosis and their relationship to survival and cause of death were evaluated. Collectively, 1061 (93%) patients had at least one co‐morbid health condition at the time of CLL diagnosis (median number 3). Despite this, 89% of patients had a low‐intermediate Charlson Comorbidity Index score (CCI) at diagnosis. After a median follow‐up of 6 years, 225 patients have died. Death was due to CLL progression in 85 (46%) patients, infection in 14 (8%) patients, other cancer in 35 (19%) patients and comorbid health conditions in 50 (27%) patients. Higher CCI score and a greater number of major comorbid health conditions at the time of CLL diagnosis was associated with shorter non‐CLL specific survival, but not with shorter CLL‐specific survival on multivariate analysis. In conclusion, CLL and CLL‐related complications (infections and second cancers) are the overwhelming cause of death in patients with CLL, regardless of CCI score and number of comorbid health conditions at diagnosis.