Meta-Analysis of the Safety,Tolerability, and Efficacy of Lopinavir/Ritonavir-Containing Antiretroviral Therapy in HIV-1–Infected Women

Abstract

Purpose: Women comprise ≯50% of HIV-infected patients, yet safety, tolerability, and efficacy data in women taking antiretrovirals (ARVs) are limited. Lopinavir/ ritonavir (LPV/r)–anchored regimens are globally the most widely prescribed HIV-1 protease inhibitor regimens. The objective was to investigate the safety and efficacy of LPV/r-based therapy in women. Methods: A database query yielded all available data in HIV-1–infected subjects receiving LPV/r-based triple-ARV regimens from randomized clinical trials lasting ≥48 weeks from Abbott or Abbott-supported AIDS Clinical Trials Group studies. Efficacy (HIV-1 RNA levels, CD4+ T-cell counts) and safety and tolerability (treatment discontinuation, treatment-related adverse events [AE], and clinical laboratory abnormalities) at 48 weeks were assessed for total women, women by age (≥50, <50 years) and body mass index (BMI; <25, ≥25 to <30, ≥30 kg/m²), and sex. Results: Nine hundred ninety-two women initiated LPV/r-based therapy (of whom 79.2% were ARV-naïve), with 83.6% completing 48 weeks of treatment. There were 75.5% of women who achieved a threshold of HIV RNA <400 copies/mL by intent-to-treat, non-completer equals failure (ITT, NC = F) analysis, with a mean ± SE CD4+ T-cell count increase of 191.6 ± 4.92 cells/mm³ from baseline. Women aged ≥50 versus <50 years had higher incidence of moderate-to-severe treatment-related AEs and certain laboratory abnormalities, better virologic response (HIV RNA <400 copies/mL by ITT, NC = F), similar immunologic responses, and similar overall incidence of treatment discontinuations. Higher incidences of certain moderate-to-severe treatment-related AEs and laboratory abnormalities occurred in women with BMI ≥30 kg/m²; however, no effect of BMI on efficacy or discontinuation was observed. Conclusions: LPV/r-based regimens were efficacious and well-tolerated in women without marked differences based on age and BMI categories evaluated.     

中国新疆三个少数民族的3个STR位点的遗传多态性比较

目的探讨新疆锡伯族、哈萨克族和维吾尔族群体D75820，D135317和D16S5393个STR位点的基因型及等位基因频率的分布。方法随机抽取上述民族无关个体静脉血抗凝冻存，提取DNA并用复合PCR技术，同时扩增上述3个STR位点，PAGE垂直电泳后银染。结果3个少数民族群体上述3个STR位点均符合Hardy—Weinberg平衡定律。通过种族间比较，锡伯族与哈萨克族除D7S820位点无显著差异外，其他位点新疆锡伯族与哈萨克族和维吾尔族均有明显差异。结论3个STR位点的综合检验可用于群体遗传学研究和法医学应用。     

Comparison of Common Carotid Artery Intima-Media Thickness Between Brazilian Euro-Descendants and Afro-Descendants with Atherosclerosis Risk Factors

OBJECTIVE:

To compare common carotid intima-media thickness (IMT) between the two major Brazilian ethnic groups (those of African descent and those of European descent) among individuals with one or more risk factors for atherosclerotic disease.

METHOD:

Two hundred and six patients with one or more risk factors for atherosclerotic disease were evaluated in a cross-sectional study in which their clinical, ethnic and Demographic characteristics were collected. All patients underwent duplex ultrasound examination of their carotid vessels to obtain IMT measurements.

RESULTS:

One hundred and fifty-three patients (74.3%) had a carotid IMT greater than 1.0 mm at one or more point of measurement in at least one common carotid artery. There was a significant correlation between older age and mean carotid wall thickness (R=0.479 / P<0.01). Multivariate analysis identified male sex, arterial hypertension and older age as variables associated with increased IMT (P<0.05 for all variables). When IMT was compared between the two ethnic groups in this study, no significant differences were noted. Euro-descendants and Afro-descendants had similar IMT values, even when the groups were stratified by degree of IMT (normal vs. increased) and presence of stroke and/or transient ischemic attack (yes vs. no).

CONCLUSIONS:

The risk factors associated with increased common carotid artery IMT in Brazilian individuals are similar to those in previously described populations. No differences were observed between the two main Brazilian ethnic groups. Longitudinal studies are required for a better evaluation of the incidence, etiologic factors and evolution of carotid intimomedial thickening in this population.     

Genetic affinities among Mongol ethnic groups and their relationship to Turks

The central Asian country Mongolia is home to more than 20 tribes and ethnic groups, some of which are related to neighboring Turkic populations. The main Mongolian people, Khalkha, live in central and eastern Mongolia while the Tsaatan minority lives in the north of the country. The Oold minority is from the western Altai mountain region and live in close proximity with Turkic people. We have typed the HLA-A, -B, -Cw, -DRB1 and -DQB1 loci by PCR-SSP in these three Mongolian populations as well as a sample of the German population. To examine their genetic relationships, a sample of the Turkish population already typed at the HLA-A, -B and -DRB1 loci were used. Altogether five populations were analyzed: Khalkha (n = 100), Tsaatan (n = 72), Oold (n = 52), German (n = 260) and (Anatolian) Turkish (n = 498). Nei's unbiased genetic identity (GI) and genetic distance (GD) were estimated from genotypes using PopGene v1.31, and dendrograms were constructed using phylip. The results suggested a close relationship of the Khalkha to the Tsaatan. The Turks and Germans were equally distant to all three Mongolian populations. These results confirmed the lack of strong genetic relationship between the Mongols and the Turks despite the close relationship of their languages (Altaic group) and shared historical neighborhood. This study has provided useful population data for genetic and anthropologic studies bridging eastern and western populations.     

The Hip and Knee Book: developing an active management booklet for hip and knee osteoarthritis

Background

The pain and disability of hip and knee osteoarthritis can be improved by exercise, but the best method of encouraging this is not known.

Aim

To develop an evidence-based booklet for patients with hip or knee osteoarthritis, offering information and advice on maintaining activity.

Design of study

Systematic review of reviews and guidelines, then focus groups.

Setting

Four general practices in North East Wales.

Method

Evidence-based messages were developed from a systematic review, synthesised into patient-centred messages, and then incorporated into a narrative. A draft booklet was examined by three focus groups to improve the phrasing of its messages and discuss its usefulness. The final draft was examined in a fourth focus group.

Results

Six evidence-based guidelines and 54 systematic reviews were identified. The focus groups found the draft booklet to be informative and easy to read. They reported a lack of clarity about the cause of osteoarthritis and were surprised that the pain could improve. The value of exercise and weight loss beliefs was accepted and reinforced, but there was a perceived contradiction about heavy physical work being causative, while moderate exercise was beneficial. There was a fear of dependency on analgesia and misinterpretation of the message on hyaluranon injections. The information on joint replacement empowered patients to discuss referral with their GP. The text was revised to accommodate these issues.

Conclusion

The booklet was readable, credible, and useful to end-users. A randomised controlled trial is planned, to test whether the booklet influences beliefs about osteoarthritis and exercise.     

广西罗城仫佬族青年身高的遗传与环境关系研究

目的探讨遗传因素与环境因素对仫佬族人身高的影响。方法测量17～22岁288名仫佬族青年及其父母身高,用直线回归方法以亲-子身高之间的回归系数估计子代身高的的遗传率。结果男女总体身高遗传率的点估计值为39.4%,而男性身高遗传率的点估计值为77.7%,女性身高遗传率的点估计值为53.3%。结论仫佬族青年的身高受遗传因素和环境因素共同影响,而遗传因素影响相对较大。     

新疆居民HBV基因型的分布及其与临床表现关系的初步研究

目的 了解新疆地区乙肝患者HBV基因型的分布及其与临床表现的关系.方法 从2000余份血清中筛选出HBsAg阳性血清200份.利用巢式PCR法扩增血清中HBV DNA S基因进行测序并分型;统计分析基因型分布及与临床表现的关系.结果 新疆HBV有B、C、D三个基因型,其中B基因型10例（7.8%）,C基因型58例（45.7%）,D基因型59例（46.5%）.C基因型中汉族51例（87.9%）,D型中汉族27例（45.7%）,维吾尔族24例（40.7%）.结论 新疆地区HBV基因型以C、D型为主,少量为B型.C型以汉族为主,D型中汉族和维吾尔族占多数.C型与更严重的疾病及转归有关.     

HLA配型、交叉反应组(CREGs)误配率与肾移植术后早期排斥反应的关系

目的：探讨人类白细胞抗原（HLA）配型、交叉反应组（CRECs）误配率与尸体肾移植术后早期急性排斥反应的关系。方法：应用泰萨奇单克隆抗体干板进行供受者HLA-Ⅰ类抗原分型；微量序列特异性引物法进行HLA-Ⅱ类基因分型；泰萨奇混合抗原板检测群体反应性抗体（PRA）。结果：PRA阴性131例肾移植患者HLA配型，误配率为6MM、5MM、4MM、3MM、2MM、1MM、0MM的移植例数分别为0、4、26、49、33、15、4，术后早期急性排斥反应发生率分别为0、25％、23．1％、14．3％、12．1％、6．7％、0。CREGs误配率为6MM、5MM时无移植病例。CREGs误配率为4MM、3MM、2MM、1MM、0MM时，排斥反应发生率分别为28．6％、22．9％、9．5％、6．9％、5．5％。结论：HLA配型、交叉组配型可显著提高供受者的HLA相配率，对选择最佳的供者，降低早期急性排斥反应的发生，提高肾移植效果具有重要的意义。     

Harsh humour: a therapeutic discourse

Humour research in healthcare has tended to focus on rehearsed as opposed to spontaneous humour. This paper reports an empirical example of spontaneous humour in healthcare interactions: a negative case analysis from a constructivist grounded theory study. Twenty Clinical Nurse Specialist (CNS)–patient interactions and CNS pre‐ and postinteraction audio diaries provided the baseline data corpus. Follow‐up interviews, field notes, focus groups and observations serviced theory generation with a constant comparison approach to data collection and analyses. Interpretative and illustrative frameworks incorporating humour theories, non‐laughter humour support, discursive features and prosodical features of speech were applied to all data. This paper is based upon the negative case comprising a 90‐minute follow‐up interview and 10 hours of field note observations. The negative case – a CNS working with female drug users’ sexual and reproductive health needs – contradicted emerging findings from the baseline data corpus. First, the negative case had greater awareness of humour, deliberately initiated humour and recognised parameters and exclusion zones. Second, a good patient persona was evident in the baseline data corpus but the negative case worked with ‘bad’ patients. Accordingly, a specific type of humour – harsh humour – was evident in the negative case. Harsh humour used areas of potential discord (e.g. drug use) as a focus of humour creation and maintenance. The deliberate initiation of harsh humour enabled the negative case and her colleagues to achieve their aims by engaging effectively with unpredictable, reluctant and recalcitrant patients. The negative case demonstrates how humour can be used to therapeutically enhance healthcare interactions with disenfranchised individuals. Humour is not superficial but integral to the accomplishment of key aspects of interactions. Health and social care workers should consider the potential for therapeutic humour to engage and maintain all patients – disenfranchised or otherwise – in healthcare interactions.