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Sample records for active anti-retroviral therapy

  1. The emergence of drug resistant HIV variants and novel anti-retroviral therapy

    Institute of Scientific and Technical Information of China (English)

    Koosha Paydary; Parisa Khaghani; Sahra Emamzadeh-Fard; SeyedAhmad SeyedAlinaghi; Kazem Baesi

    2013-01-01

    After its identification in 1980s, HIV has infected more than 30 million people worldwide. In the era of highly active anti-retroviral therapy, anti-retroviral drug resistance results from insufficient anti-retroviral pressure, which may lead to treatment failure. Preliminary studies support the idea that anti-retroviral drug resistance has evolved largely as a result of low-adherence of patients to therapy and extensive use of anti-retroviral drugs in the developed world;however, a highly heterogeneous horde of viral quasi-species are currently circulating in developing nations. Thus, the prioritizing of strategies adopted in such two worlds should be quite different considering the varying anti-retroviral drug resistance prevalence. In this article, we explore differences in anti-retroviral drug resistance patterns between developed and developing countries, as they represent two distinct ecological niches of HIV from an evolutionary standpoint.

  2. [Successful treatment with hyper-CVAD and highly active anti-retroviral therapy (HAART) for AIDS-related Burkitt lymphoma].

    Science.gov (United States)

    Suzuki, Kazuhito; Nakazato, Tomonori; Sanada, Yukinari; Mihara, Ai; Tachikawa, Natsuo; Kurai, Hanako; Yoshimura, Yukihiro; Hayashi, Hiroyuki; Yoshida, Sachiko; Kakimoto, Tsunayuki

    2010-03-01

    A 38-year-old man was admitted to our hospital because of continuous fever and right facial palsy. He was diagnosed as HIV positive. Abdominal CT scan showed a large mass in the ascending colon. Gallium scintigraphy demonstrated increased uptake in the ascending colon. Colonoscopy was performed and histological examination of the colon tumor revealed Burkitt's lymphoma (BL). He received highly active anti-retroviral therapy (HAART) and his facial palsy improved. Because CD4 count was significantly low at 31/microl, he was treated with dose-adjusted EPOCH (DA-EPOCH) combined with HAART. Although the tumor was decreased in size by DA-EPOCH, we changed to the combination of hyper-CVAD/MTX-Ara-C alternating therapy with HAART in order to increase dose intensity. Six cycles of hyper-CVAD/MTX-Ara-C were performed and complete remission was obtained. In the HAART era, the survival of patients with AIDS-related diffuse large cell lymphoma (DLCL) improved dramatically, whereas the survival of similarly treated patients with AIDS-related BL remained poor. Our case suggests that intensive chemotherapy with hyper-CVAD/MTX-Ara-C combined with HAART may be well tolerated and effective in AIDS-related BL.

  3. [Successful treatment of HIV-associated chronic inflammatory demyelinating polyneuropathy by early initiation of highly active anti-retroviral therapy].

    Science.gov (United States)

    Kume, Kodai; Ikeda, Kazuyo; Kamada, Masaki; Touge, Tetsuo; Deguchi, Kazushi; Masaki, Tsutomu

    2013-01-01

    A 47-year-old man with HIV infection presented with lower leg dominant dysesthesia, muscle weakness and sensory ataxia of 3 month's duration. Nerve conduction studies (NCS) showed demyelination change in the median and tibial nerves and sensory nerve action potential (SNAP) in the sural nerve was not evoked. Somatosensory evoked potential (SEP) showed the delayed N9 latency. Diagnose of HIV-associated chronic inflammatory demyelinating polyneuropathy (CIDP) was made. Although the CD4 lymphocyte counts were relatively preserved (466/μl), highly active anti-retroviral therapy (HAART) was started according to a new guideline for the use of antiretroviral agents in HIV-1-infected adults and adolescents recommending early initiation of treatment. After six months, HIV1-RNA was not detected and the CD4 lymphocyte counts showed a recovering trend (585/μl). His symptoms had disappeared, except for dysesthesia in the tip of a toe. Repeated NCS demonstrated full recovery from the demyelination and appearance of SNAP in the sural nerve. The improvement of his symptoms and NCS findings has been maintained for two years. Although effectiveness of immunotherapies such as oral prednisone, high-dose immunoglobulins and plasmapheresis have been reported in HIV-associated CIDP, early initiation of HAART may be also important for favorable prognosis in HIV-associated CIDP.

  4. Immune reconstitution inflammatory syndrome in HIV-infected patients with mycobacterial infections starting highly active anti-retroviral therapy

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    Buckingham, S.J.; Haddow, L.J.; Shaw, P.J.; Miller, R.F. E-mail: rmiller@gum.ucl.ac.uk

    2004-06-01

    AIM: To describe the radiological appearances of immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-infected patients with mycobacterial infections starting highly active anti-retroviral therapy (HAART). MATERIALS AND METHODS: Five consecutive HIV infected patients with IRIS due to mycobacterial infection were studied. Intercurrent infection and poor drug compliance were excluded as causes of presentation. The chest radiological appearances at the time of starting HAART and at the time of diagnosis of IRIS were compared. RESULTS: In these five patients there was clinical and radiological deterioration, occurring between 10 days and 7 months after starting HAART, leading to unmasking of previously undiagnosed mycobacterial infection or to worsening of mycobacterial disease. All five patients had HAART-induced increases in CD4+ T lymphocyte counts and reductions in peripheral blood HIV 'viral load'. Chest radiographic abnormalities due to IRIS included marked mediastinal lymphadenopathy in three patients--severe enough to produce tracheal compression in two patients (one of whom had stridor)--and was associated with new pulmonary infiltrates in two patients. The other two patients had new infiltrates, which in one patient was associated with a pleural effusion. CONCLUSION: These cases illustrate the diverse chest radiographic appearances of IRIS occurring after HAART in patients with mycobacterial and HIV co-infection. Marked mediastinal lymphadenopathy occurred in three of these five patients (with associated tracheal narrowing in two patients); four patients developed pulmonary infiltrates and one had an effusion. The cases further highlight that the onset of IRIS may be delayed for several months after HAART is started.

  5. Mitochondrial DNA Haplogroups influence lipoatrophy after Highly Active Anti-retroviral Therapy

    Science.gov (United States)

    Hendrickson, Sher L.; Kingsley, Lawrence A.; Ruiz-Pesini, Eduardo; Poole, Jason C.; Jacobson, Lisa P.; Palella, Frank J.; Bream, Jay H.; Wallace, Douglas C.; O’Brien, Stephen J.

    2009-01-01

    Although highly active retroviral therapy (HAART) has been extremely effective in lowering AIDS incidence among patients infected with HIV, certain drugs included in HAART can cause serious mitochondrial toxicities. One of the most frequent adverse events is lipoatrophy, which is the loss of subcutaneous fat in the face, arms, buttocks and/or legs as an adverse reaction to nucleoside reverse transcriptase inhibitors (NRTIs). The clinical symptoms of lipoatrophy resemble those of inherited mitochondrial diseases, which suggests that host mitochondrial genotype may play a role in susceptibility. We analyzed the association between mitochondrial haplogroup and severity of lipoatrophy in HIV-infected European American patients on HAART in the Multicenter AIDS cohort Study (MACS) and found that mitochondrial haplogroup H was strongly associated with increased atrophy (arms: p = 0.007, OR = 1.77, 95% CI = 1.17–2.69 legs: p = 0.037, OR = 1.54 95% CI = 1.03–2.31, and buttocks: p = 0.10, OR = 1.41 95% CI = 0.94–2.12). We also saw borderline significance for haplogroup T as protective against lipoatrophy (p = 0.05, OR = 0.52, 95% CI = 0.20–1.00). These data suggest that mitochondrial DNA haplogroup may influence the propensity for lipoatrophy in patients receiving NRTIs. PMID:19339895

  6. Increased levels of regulatory T cells (Tregs) in human immunodeficiency virus-infected patients after 5 years of highly active anti-retroviral therapy may be due to increased thymic production of naive Tregs

    DEFF Research Database (Denmark)

    Kolte, L.; Gaardbo, J.C.; Skogstrand, K.;

    2009-01-01

    This study determines levels of regulatory T cells (T(regs)), naive T(regs), immune activation and cytokine patterns in 15 adult human immunodeficiency virus (HIV)-infected patients receiving prolonged highly active anti-retroviral therapy (HAART) who have known thymic output, and explores if naive...

  7. T cell anergy and activation are associated with suboptimal humoral responses to measles revaccination in HIV-infected children on anti-retroviral therapy in Nairobi, Kenya.

    Science.gov (United States)

    Buechler, M B; Newman, L P; Chohan, B H; Njoroge, A; Wamalwa, D; Farquhar, C

    2015-09-01

    HIV-infected children are less capable of mounting and maintaining protective humoral responses to vaccination against measles compared to HIV-uninfected children. This poses a public health challenge in countries with high HIV burdens. Administration of anti-retroviral therapy (ART) and revaccinating children against measles is one approach to increase measles immunity in HIV-infected children, yet it is not effective in all cases. Immune anergy and activation during HIV infection are factors that could influence responses to measles revaccination. We utilized a flow cytometry-based approach to examine whether T cell anergy and activation were associated with the maintenance of measles-specific immunoglobulin (Ig)G antibodies generated in response to measles revaccination in a cohort of HIV-infected children on ART in Nairobi, Kenya. Children who sustained measles-specific IgG for at least 1 year after revaccination displayed significantly lower programmed cell death 1 (PD-1) surface expression on CD8(+) T cells on a per-cell basis and exhibited less activated CD4(+) T cells compared to those unable to maintain detectable measles-specific antibodies. Children in both groups were similar in age and sex, CD4(+) T cell frequency, duration of ART treatment and HIV viral load at enrolment. These data suggest that aberrant T cell anergy and activation are associated with the impaired ability to sustain an antibody response to measles revaccination in HIV-infected children on ART.

  8. Associations between HIV, highly active anti-retroviral therapy, and hypertensive disorders of pregnancy among maternal deaths in South Africa 2011-2013.

    Science.gov (United States)

    Sebitloane, Hannah M; Moodley, Jagidesa; Sartorius, Benn

    2017-02-01

    To explore potential relationships between HIV and highly active anti-retroviral therapy (HAART), and hypertensive disorders of pregnancy (HDP). A retrospective secondary analysis of maternal-deaths data from the 2011-2013 Saving Mothers Report from South Africa. The incidence of HIV infection amongst individuals who died owing to HDP was determined and comparisons were made based on HIV status and the use of HAART. Among 4452 maternal deaths recorded in the Saving Mothers report, a lower risk of a maternal deaths being due to HDP was observed among women who had HIV infections compared with women who did not have HIV (relative risk [RR] 0.57, 95% confidence interval [CI] 0.51-0.64). Further, reduced odds of death being due to HDP were recorded among women with AIDS not undergoing HAART compared with women with HIV who did not require treatment (RR 0.42, 95% CI 0.3-0.58). Notably, among all women with AIDS, a greater risk of death due to HDP was demonstrated among those who received HAART compared with those who did not (RR 1.15, 95% CI 1.02-1.29). HIV and AIDS were associated with a decreased risk of HDP being the primary cause of death; the use of HAART increased this risk. © 2016 International Federation of Gynecology and Obstetrics.

  9. Crystalluria in HIV/AIDS patients on highly active anti-retroviral therapy in the Kumasi metropolis; a cross sectional study

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    Richard K. D. Ephraim

    2014-01-01

    Full Text Available Background: Crystalluria is associated with some highly active anti-retroviral therapies (HAART′s used in the management of HIV/AIDS. Aims: This study used light microscopy to establish the prevalence of crystalluria among HIV/AIDS patients on HAART and identified the routine crystals present in their urine. Materials and Methods: In this simple randomised cross-sectional study, 200 HIV/AIDS participants, comprising 150 on HAART and 50 HAART-naοve were recruited from the HIV clinic at the Komfo Anokye Teaching Hospital (KATH. Urine and blood samples were collected, for urinalysis and the determination of the CD4 count, respectively. A well-structured pre-tested questionnaire was used to obtain socio-demographic data and clinical history of the participants. Results: The prevalence of crystalluria was higher among HIV-infected persons on HAART than those not on HAART (6.7% vs 4%; P = 0.733. Calcium oxalate and triple phosphate crystals were the crystal types present in their urine (3.5% and 2.5%, respectively and was present only in HIV subjects on first line of treatment (without protease inhibitors. Participants aged between 40-50 years and those with hypersthenuria and acidic urine had the highest amount of crystalluria (41.6%, 83.3%, and 58.3%, respectively. Conclusion: HAART is associated with crystalluria in HIV patients. Light microscopy will be of disgnostic value in resource limited settings.

  10. Prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus and on highly active anti-retroviral therapy.

    Science.gov (United States)

    Iduoriyekemwen, Nosakhare J; Sadoh, Wilson E; Sadoh, Ayebo E

    2013-01-01

    Access to highly active anti-retroviral therapy (HAART) has improved the prognosis of Nigerian children infected with the human immunodeficiency virus (HIV); thus, more children are surviving. Long-term exposure to HAART is potentially nephrotoxic. We therefore aimed at assessing the prevalence of renal disease in Nigerian children infected with HIV, who are on HAART. In this cross-sectional study, we studied children, aged ten months to 17 years, infected with HIV, attending the pediatric HIV clinics of the University of Benin Teaching Hospital. Demographic and clinical data were obtained by parental interview as well as from the medical records. Each child's urine was tested for albumin and microalbuminuria using multi test strips and mitral test strips, respectively. The serum creatinine level of each child was also estimated and used in calculating the glomerular filtration rate (GFR). Renal disease was defined as the presence of significant proteinuria of 1+ and above on dipstick or the presence of microalbuminuria of ≥20 mg and/or GFR renal disease was 16.2%. Microalbuminuria was seen in 11 children with renal disease (11.1%); 3 of them had significant proteinuria. GFR of less than 60 mL/min/1.73 m 2 was seen in five children (5.1%) with renal disease, but none had end-stage renal disease (GFR less than 15 mL/min/1.73 m 2 ). Renal disease was found to be significantly associated with advanced stage of HIV infection (P renal disease in HAART-treated Nigerian children is high and majority of them are asymptomatic of renal disease, but in the advanced stages of HIV infection.

  11. Implementing tools to promote adherence to anti-retroviral therapy at ...

    African Journals Online (AJOL)

    Implementing tools to promote adherence to anti-retroviral therapy at facilities in Kenya. ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search · USING ... Background: Lack of effective systems and tools to identify and track ...

  12. Cognitive and psychosocial development of HIV pediatric patients receiving highly active anti-retroviral therapy: a case-control study

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    Theodoridou Maria

    2010-12-01

    Full Text Available Abstract Background The psychosocial development of pediatric HIV patients has not been extensively evaluated. The study objectives were to evaluate whether emotional and social functions are differentially associated with HIV-related complications. Methods A matched case-control study design was conducted. The case group (n = 20 consisted of vertically infected children with HIV (aged 3-18 years receiving HAART in Greece. Each case was matched with two randomly selected healthy controls from a school-based population. CNS imaging and clinical findings were used to identify patients with HIV-related neuroimaging abnormalities. The Wechsler Intelligence Scale III and Griffiths Mental Abilities Scales were applied to assess cognitive abilities. The age specific Strengths and Difficulties Questionnaire was used to evaluate emotional adjustment and social skills. The Fisher's exact test, student's t-test, and Wilcoxon rank sum test were used to compare categorical, continuous, and ordinal scores, respectively, of the above scales between groups. Results HIV patients without neuroimaging abnormalities did not differ from patients with neuroimaging abnormalities with respect to either age at HAART initiation (p = 0.306 or months of HAART treatment (p = 0.964. While HIV patients without neuroimaging abnormalities had similar cognitive development with their healthy peers, patients with neuroimaging abnormalities had lower mean General (p = 0.027 and Practical (p = 0.042 Intelligence Quotient scores. HIV patients without neuroimaging abnormalities had an increased likelihood of both Abnormal Emotional Symptoms (p = 0.047 and Hyperactivity scores (p = 0.0009. In contrast, HIV patients with neuroimaging abnormalities had an increased likelihood of presenting with Abnormal Peer Problems (p = 0.033. Conclusions HIV patients without neuroimaging abnormalities are more likely to experience maladjustment with respect to their emotional and activity spheres

  13. Increased levels of regulatory T cells (T(regs)) in human immunodeficiency virus-infected patients after 5 years of highly active anti-retroviral therapy may be due to increased thymic production of naive T(regs)

    DEFF Research Database (Denmark)

    Kolte, L; Gaardbo, J C; Skogstrand, K

    2008-01-01

    (+)human leucocyte antigen D-related) were determined by flow cytometry. Forkhead box P3 mRNA expression and T cell receptor excision circles (T(REC)) content in CD4(+) cells were determined by polymerase chain reaction and cytokines analysed with Luminex technology. Levels of T(regs) were significantly......Summary This study determines levels of regulatory T cells (T(regs)), naive T(regs), immune activation and cytokine patterns in 15 adult human immunodeficiency virus (HIV)-infected patients receiving prolonged highly active anti-retroviral therapy (HAART) who have known thymic output, and explores...

  14. Increased levels of regulatory T cells (Tregs) in human immunodeficiency virus-infected patients after 5 years of highly active anti-retroviral therapy may be due to increased thymic production of naive Tregs

    DEFF Research Database (Denmark)

    Kolte, L.; Gaardbo, J.C.; Skogstrand, Kristin

    2008-01-01

    (+)human leucocyte antigen D-related) were determined by flow cytometry. Forkhead box P3 mRNA expression and T cell receptor excision circles (T(REC)) content in CD4(+) cells were determined by polymerase chain reaction and cytokines analysed with Luminex technology. Levels of T(regs) were significantly......Summary This study determines levels of regulatory T cells (T(regs)), naive T(regs), immune activation and cytokine patterns in 15 adult human immunodeficiency virus (HIV)-infected patients receiving prolonged highly active anti-retroviral therapy (HAART) who have known thymic output, and explores...

  15. Prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus and on highly active anti-retroviral therapy

    Directory of Open Access Journals (Sweden)

    Nosakhare J Iduoriyekemwen

    2013-01-01

    Full Text Available Access to highly active anti-retroviral therapy (HAART has improved the prognosis of Nigerian children infected with the human immunodeficiency virus (HIV; thus, more children are surviving. Long-term exposure to HAART is potentially nephrotoxic. We therefore aimed at assessing the prevalence of renal disease in Nigerian children infected with HIV, who are on HAART. In this cross-sectional study, we studied children, aged ten months to 17 years, infected with HIV, attending the pediatric HIV clinics of the University of Benin Teaching Hospital. Demographic and clinical data were obtained by parental interview as well as from the medical records. Each child′s urine was tested for albumin and microalbuminuria using multi test strips and mitral test strips, respectively. The serum creatinine level of each child was also estimated and used in calculating the glomerular filtration rate (GFR. Renal disease was defined as the presence of significant proteinuria of 1+ and above on dipstick or the presence of microalbuminuria of ≥20 mg and/or GFR <60 mL/min/1.73 m 2 . Of the 99 children recruited, 60 were males and 39 were females. The mean age of the children was 6.6 ± 3.5 years. All the children were on HAART and 85% had acquired the HIV infection by vertical transmission. The overall prevalence of renal disease was 16.2%. Microalbuminuria was seen in 11 children with renal disease (11.1%; 3 of them had significant proteinuria. GFR of less than 60 mL/min/1.73 m 2 was seen in five children (5.1% with renal disease, but none had end-stage renal disease (GFR less than 15 mL/min/1.73 m 2 . Renal disease was found to be significantly associated with advanced stage of HIV infection (P < 0.049. Our study showed that t he prevalence of renal disease in HAART-treated Nigerian children is high and majority of them are asymptomatic of renal disease, but in the advanced stages of HIV infection.

  16. [Effect of highly active anti-retroviral therapy on prevention of mother to child transmission of HIV and on infant growth and development].

    Science.gov (United States)

    He, Yan; Luo, Yan; Ding, Yi-ling; Zheng, Yu-huang; Li, Jing; Huang, Jian; Li, Jie-min

    2011-10-01

    To identify the effect of highly active anti-retroviral therapy (HAART) on prevention of mother to child transmission (PMTCT) of HIV and on infant growth and development. A total of 16 HIV-infected women or pregnant women selected in this study received HAART before or 18 - 24 weeks after pregnancy. The treatment included taking Zidovudine (AZT) 0.3 g each time, twice a day, Lamivudine (3TC) 0.3 g each time, once a day and Nevirapine (NVP) 0.2 g each time, twice a day or Efavirenz (EFV) 0.6 g each time, once a day, as well as labor intervention and artificial feeding. The growth index for 17 infants from HIV-infected mothers (experimental group) and 16 normal infants (control group) were observed for 18 months. Neonatal hemoglobin (Hb), liver and kidney function, serum iron and calcium were detected at neonatal period and at 12(th) month, respectively. All the pregnant women were in good conditions and had tolerance with HAART. The birth weight, length and Apgar score of the newborns in the experimental group were (3.5 ± 0.9) kg, (54.2 ± 3.8) cm and 7 - 10 scores respectively, however those in the control group were (3.6 ± 0.8) kg, (55.6 ± 3.6) cm and 8 - 10 scores (t(weight) = 1.01, t(length) = 6.98, P > 0.05). Weight and length of infants in experimental group were (9.36 ± 1.8) kg and (76.3 ± 2.7) cm at 12(th) month, while those in control group were (9.86 ± 2.5) kg and (76.8 ± 2.9) cm (t(weight) = 0.83, t(length) = 1.00, P > 0.05). The level of Hb in experimental group was (126.2 ± 16.7) g/L, and was (148.6 ± 20.5) g/L in control group (t = -5.89, P = 0.11). At 12(th) month, the levels of Hb and the total bilirubin (TB) were (125.9 ± 19.8) g/L and (11.7 ± 3.5) µmol/L in experimental group; and those in the control group were (130.1 ± 18.7) g/L and (13.2 ± 3.7) µmol/L (t(Hb) = -3.82, t(TB) = -2.14, P > 0.05). Serum iron and calcium were (25.4 ± 5.7) µmol/L and (26.4 ± 7.2) µmol/L at neonatal period and were (2.3 ± 0.6) mol/L and (2.8 ± 0

  17. Regulatory T cells in human immunodeficiency virus-infected patients are elevated and independent of immunological and virological status, as well as initiation of highly active anti-retroviral therapy

    DEFF Research Database (Denmark)

    Gaardbo, J.C.; Nielsen, S.D.; Vedel, S.J.

    2008-01-01

    mechanisms. During recent years it has become evident that a subpopulation of T cells [T regulatory (T(regs))] play a major role in sustaining tolerance to self-antigens. To investigate the influence of initiation of highly active anti-retroviral therapy (HAART) on the T(reg) level in HIV-infected patients......Infection with human immunodeficiency virus (HIV) causes a dysregulation of the immune system. This is caused by HIV-specific as well as non-specific mechanisms and has not been explained fully. In particular, knowledge is lacking about the potential role of host-mediated immunosuppressive...... we have conducted a prospective study enrolling treatment-naive HIV-infected patients just prior to starting treatment with HAART, measuring levels of T(regs) by flow cytometry and mRNA expression of forkhead box P3 (FoxP3) at weeks 0, 4, 12 and 24 of treatment. In this prospective study neither...

  18. Outcome of surgery in post-cytomegalovirus retinal detachment: Experience before and in the era of highly active anti-retroviral therapy in Indian eyes

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    Ramandeep Singh

    2013-01-01

    Full Text Available Purpose: To evaluate the outcome of surgery for cytomegalovirus associated retinal detachment (CMVRD in human immunodeficiency virus (HIV-infected patients in pre-highly active antiretroviral therapy (HAART and HAART era in Indian eyes. Materials and Methods: Retrospective, we reviewed medical records of all consecutive HIV patients, who underwent surgical repair for CMVRD from July 1998 to June 2011. We divided patients into two groups, i.e. group 1, pre HAART era and group 2, HAART era. We compared two groups for various parameters like visual outcome, surgical success, additional procedures, follow-up, etc., Results: Twenty-eight eyes of 26 patients were included; 12 eyes of the 11 patients in group 1 and 16 eyes of the 15 patients in group 2. Significant visual acuity improvement was seen in both groups. Complete anatomic success was seen in 11 eyes in group 1 and 15 eyes in group 2. One additional procedure in group 1 and 29 additional procedures were done in group 2. A mean follow-up was 16 months in group 1 and 41 months in group 2. Conclusion: There was no difference in outcome in pre-HAART and HAART group, except for longer follow-up and additional surgical procedures in HAART group.

  19. Interferons and interferon (IFN)-inducible protein 10 during highly active anti-retroviral therapy (HAART)-possible immunosuppressive role of IFN-alpha in HIV infection

    DEFF Research Database (Denmark)

    Stylianou, E; Aukrust, P; Bendtzen, K;

    2000-01-01

    Interferons play an important, but incompletely understood role in HIV-related disease. We investigated the effect of HAART on plasma levels of IFN-alpha, IFN-gamma, neopterin and interferon-inducible protein 10 (IP-10) in 41 HIV-infected patients during 78 weeks of therapy. At baseline HIV...... seemed not to involve enhanced lymphocyte apoptosis. Our findings suggest a pathogenic role of IFN-alpha in HIV infection, which may be a potential target for immunomodulating therapy in combination with HAART....

  20. Interferons and interferon (IFN)-inducible protein 10 during highly active anti-retroviral therapy (HAART)-possible immunosuppressive role of IFN-alpha in HIV infection

    DEFF Research Database (Denmark)

    Stylianou, E; Aukrust, P; Bendtzen, K;

    2000-01-01

    Interferons play an important, but incompletely understood role in HIV-related disease. We investigated the effect of HAART on plasma levels of IFN-alpha, IFN-gamma, neopterin and interferon-inducible protein 10 (IP-10) in 41 HIV-infected patients during 78 weeks of therapy. At baseline HIV-infec...

  1. An audit on virological efficacy of anti-retroviral therapy in a specialist infectious disease clinic.

    LENUS (Irish Health Repository)

    Reyad, A

    2009-06-01

    We have assessed the efficacy of anti retroviral therapy (ART) using undetectable viral load (VL) (<50 RNA copies\\/ml) as a marker of virological success, in patients who have Human Immunodeficiency Virus (HIV) attending the Department of Infectious Disease. A cross-sectional review of patients\\' case notes was used to obtain their demographics and treatment details. 79% (253) of the hospital case notes of clinic population was available for analysis, which represents 90% of those receiving ART in the clinic. 166\\/253 of the cohort were receiving treatment at the time of this study and 95% (157\\/166) of these were on treatment for greater than 6 months. The total virological success rate is 93%, which is comparable to other centres and are as good as those from published clinical trials. 56% of those on therapy who have virological failure were Intravenous Drug Users (IVDUs). Case by case investigation for those with treatment failure is warranted.

  2. Lesões anorretais em pacientes HIV positivos usuários de terapia anti-retroviral de alta efetividade Anorrectal lesions in HIV-positive patients using highly active antiretroviral therapy

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    Manuel Retamozo-Palacios

    2007-06-01

    Full Text Available As lesões anorretais são comuns nos pacientes positivos para o vírus da imunodeficiência humana. A terapia antirretroviral de alta efetividade tem pouca influência na progressão das neoplasias anais. Estudou-se a prevalência das lesões anorretais em 88 pacientes HIV positivos atendidos no serviço de doenças infecto-parasitárias do Hospital Universitário de Brasília, em uso de terapia antirretroviral de alta efetividade. Dados sócio-demográficos foram coletados usando um questionário pré-elaborado e os pacientes foram submetidos a exame proctológico. Cerca de 71% relataram coito anal e 30,7% estavam em uso de inibidor de protease. A prevalência das lesões anorretais foi 36,4%, sendo as mais freqüentes: condiloma acuminado e fissura anal. O condiloma acuminado foi a lesão anorretal mais prevalente e teve associação com o uso de lopinavir/ritonavir. Sugere-se o rastreamento das lesões anorretais causadas pelo papilomavírus humano nos pacientes HIV positivos/AIDS em uso de inibidor de protease.Anorectal lesions are common in patients with human immunodeficiency virus (HIV. Highly active anti-retroviral therapy (HAART has little influence on the progression of anal neoplasms. The prevalence of anorectal lesions in 88 HIV-positive patients attended at the infectious diseases service of the University Hospital of Brasília who were using HAART was studied. Sociodemographic data were collected using a pre-prepared questionnaire and then the patients underwent proctological examination. Around 71% of the patients said they practiced anal intercourse. 30.7% were using a protease inhibitor. The prevalence of anorectal lesions was 36.4%, and condyloma acuminata and anal fissure were the most frequent of these. Condyloma acuminata was the most prevalent anorectal lesion and was strongly associated with the use of lopinavir/ritonavir. Screening for anorectal lesions caused by human papillomavirus in HIV/AIDS patients who use protease

  3. Exacerbation of microcytic anemia associated with cessation of anti-retroviral therapy in an HIV-1-infected patient with beta thalassemia.

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    Furukawa, Yoshitaka; Hashiguchi, Teruto; Minami, Rumi; Yamamoto, Masahiro; Takashima, Hiroshi

    2014-06-01

    We report a patient with Japanese minor β thalassemia and HIV-1 infection. The patient showed prolonged anemia, which was originally attributed to chronic parvovirus B19 infection. Twelve years later, the patient presented with exacerbation of microcytic anemia following cessation of anti-retroviral therapy; the exacerbation resolved when anti-retroviral therapy was resumed. Sequencing of the β globin gene revealed heterozygosity for a four-nucleotides deletion at codon 41/42 and minor β thalassemia was confirmed. Because HIV-1-infected patients frequently show anemia due to nutritional deficiencies, opportunistic infections, AIDS-related malignancies, drug treatment and a direct effect of HIV-1 on the bone marrow, it is likely to overlook other causes of anemia. Thalassemia should be considered in the differential diagnosis of anemia even in HIV-1 infected patients, when microcytic anemia without iron deficiency is observed. Our case suggested that active HIV infection may have worsened β thalassemia, and early introduction of anti-retroviral therapy is beneficial for the recovery of anemia. Copyright © 2014 China Ordnance Society. Published by Elsevier Ltd. All rights reserved.

  4. Manifestações otoneurológicas associadas à terapia anti-retroviral Otoneurological manifestations associated with antiretroviral therapy

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    Andrêza Batista Cheloni Vieira

    2008-02-01

    Full Text Available Ototoxicidade e terapia anti-retroviral parecem estar associadas. O objetivo desse estudo foi avaliar essa possível correlação. Foram avaliados 779 prontuários médicos de pacientes infectados pelo HIV e regularmente acompanhados, sendo 162 tratados com terapia anti-retroviral e 122 não tratados (controle. Pacientes em tratamento eram mais velhos (média 42 anos, com maior tempo de confirmação sorológica (80 meses e com menor carga viral (p=0,00. CD4+ foi semelhante entre os grupos (P=0,60. No grupo tratado, três (1,8% casos de perda auditiva idiopática e dois (1,3% de perda auditiva relacionada a otosclerose foram observadas e ambas iniciadas após terapia anti-retroviral. Nenhuma diferença estatística relacionada à perda auditiva idiopática foi encontrada entre os grupos. Enquanto estudos descritivos consideram possível ototoxidade associada à terapia anti-retroviral, esse possível efeito adverso não foi relacionado à terapia anti-retroviral neste estudo. Contrariamente, otosclerose poderia estar correlacionada à terapia anti-retroviral. Este assunto merece ser estudado.Ototoxicity and antiretroviral therapy seem to be associated. The aim of this study was to evaluate this possible correlation. Evaluations were carried out on 779 medical records from HIV-infected patients who were being regularly followed up, of whom 162 were being treated with antiretroviral therapy and 122 were untreated (controls. The patients undergoing treatment were older (mean: 42 years, had had serological confirmation for longer times (80 months and had smaller viral loads (P = 0.00. CD4+ was similar between the groups (P = 0.60. In the treated group, three cases (1.8% of idiopathic hearing loss and two (1.3% of otosclerosis-related hearing loss were observed, which both started after antiretroviral therapy. No statistical difference relating to idiopathic hearing loss was found between the groups. While descriptive studies consider possible

  5. Clients’ Satisfaction with Anti Retroviral Therapy Services at Hamidia Hospital Bhopal

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    Bhagat Vimal Kishor, Pal D K, Lodha Rama S, Bankwar Vishal

    2011-01-01

    Full Text Available Background: The HIV/AIDS pandemic is a major public health problem with an estimated 33.33 million people living with the virus globally. Free antiretroviral treatment was initiated in India 2004. Patients’ satisfaction is one of the commonly used outcome measures of patient care. Objective: To assess the satisfaction of people living with HIV/AIDS with services provided at anti retroviral therapy Centre Hamidia Hospital Bhopal. Material and Methods: A hospital based cross-sectional study was undertaken from August 2008 to July 2009 on all the registered people living with HIV/AIDS (PLWHA following antiretroviral treatment at Hamidia Hospital Bhopal. Data was collected and by using pre-designed & pre-tested questionnaire and analyzed using Epi-info version 3.5.3. Results: For most of the questions regarding satisfaction on the care services of the center, participants responded positively (excellent & good.The overall mean satisfaction score was “Excellent”. Conclusion: The services of the Center were rated positively (Excellent and above.The hospital management should work to strengthen the clinic services by helping the ART clinic staff to involve patients in the treatment process and recognize their opinions on follow up.

  6. Cost-effectiveness of anti-retroviral therapy at a district hospital in southern Ethiopia

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    Robberstad Bjarne

    2009-07-01

    Full Text Available Abstract Background As the resource implications of expanding anti-retroviral therapy (ART are likely to be large, there is a need to explore its cost-effectiveness. So far, there is no such information available from Ethiopia. Objective To assess the cost-effectiveness of ART for routine clinical practice in a district hospital setting in Ethiopia. Methods We estimated the unit cost of HIV-related care from the 2004/5 fiscal year expenditure of Arba Minch Hospital in southern Ethiopia. We estimated outpatient and inpatient service use from HIV-infected patients who received care and treatment at the hospital between January 2003 and March 2006. We measured the health effect as life years gained (LYG for patients receiving ART compared with those not receiving such treatment. The study adopted a health care provider perspective and included both direct and overhead costs. We used Markov model to estimate the lifetime costs, health benefits and cost-effectiveness of ART. Findings ART yielded an undiscounted 9.4 years expected survival, and resulted in 7.1 extra LYG compared to patients not receiving ART. The lifetime incremental cost is US$2,215 and the undiscounted incremental cost per LYG is US$314. When discounted at 3%, the additional LYG decreases to 5.5 years and the incremental cost per LYG increases to US$325. Conclusion The undiscounted and discounted incremental costs per LYG from introducing ART were less than the per capita GDP threshold at the base year. Thus, ART could be regarded as cost-effective in a district hospital setting in Ethiopia.

  7. Circulating heat shock protein 60 levels are elevated in HIV patients and are reduced by anti-retroviral therapy.

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    Itaru Anraku

    Full Text Available Circulating heat shock protein 60 (Hsp60 and heat shock protein 10 (Hsp10 have been associated with pro- and anti-inflammatory activity, respectively. To determine whether these heat shock proteins might be associated with the immune activation seen in HIV-infected patients, the plasma levels of Hsp60 and Hsp10 were determined in a cohort of 20 HIV-infected patients before and after effective combination anti-retroviral therapy (cART. We show for the first time that circulating Hsp60 levels are elevated in HIV-infected patients, with levels significantly reduced after cART, but still higher than those in HIV-negative individuals. Hsp60 levels correlated significantly with viral load, CD4 counts, and circulating soluble CD14 and lipopolysaccharide levels. No differences or correlations were seen for Hsp10 levels. Elevated circulating Hsp60 may contribute to the immune dysfunction and non-AIDS clinical events seen in HIV-infected patients.

  8. CD4 lymphocyte response following anti-retroviral therapy in HIV/AIDS patients - A study in Osmania General Hospital

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    Srinivasa Rao Nanyam; Ravala Siddeswari; Budithi Sudarsi; Barla Suryanarayana; Challagali Prabhu Kumar; Thatikala Abhilash

    2016-01-01

    The present study aims serial four year assessment of CD4 cell response after initiation of anti-retroviral therapy (ART) in patients with HIV/AIDS attending Osmania General Hospital, Hyderabad. It was a retrospective hospital based observational study. We included 110 HIV/AIDS who were on ART. Data was collected over a period of 04 years from 2005 to 2008 in the ART Centre, Upgraded Department of General Medicine, Osmania General Hospital. Data regarding CD4 cell count over 4 years was asse...

  9. Cognitive and Behavioural Correlates of Non-Adherence to HIV Anti-Retroviral Therapy: Theoretical and Practical Insight for Clinical Psychology and Health Psychology

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    Begley, Kim; McLaws, Mary-Louise; Ross, Michael W.; Gold, Julian

    2008-01-01

    This cross-sectional study identified variables associated with protease inhibitor (PI) non-adherence in 179 patients taking anti-retroviral therapy. Univariate analyses identified 11 variables associated with PI non-adherence. Multiple logistic regression modelling identified three predictors of PI non-adherence: low adherence self-efficacy and…

  10. Economic evaluation of task-shifting approaches to the dispensing of anti-retroviral therapy

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    Foster Nicola

    2012-09-01

    Full Text Available Abstract Background A scarcity of human resources for health has been identified as one of the primary constraints to the scale-up of the provision of Anti-Retroviral Treatment (ART. In South Africa there is a particularly severe lack of pharmacists. The study aims to compare two task-shifting approaches to the dispensing of ART: Indirectly Supervised Pharmacist’s Assistants (ISPA and Nurse-based pharmaceutical care models against the standard of care which involves a pharmacist dispensing ART. Methods A cross-sectional mixed methods study design was used. Patient exit interviews, time and motion studies, expert interviews and staff costs were used to conduct a costing from the societal perspective. Six facilities were sampled in the Western Cape province of South Africa, and 230 patient interviews conducted. Results The ISPA model was found to be the least costly task-shifting pharmaceutical model. However, patients preferred receiving medication from the nurse. This related to a fear of stigma and being identified by virtue of receiving ART at the pharmacy. Conclusions While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.

  11. In vivo mitochondrial function in HIV-infected persons treated with contemporary anti-retroviral therapy: a magnetic resonance spectroscopy study.

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    Brendan A I Payne

    Full Text Available Modern anti-retroviral therapy is highly effective at suppressing viral replication and restoring immune function in HIV-infected persons. However, such individuals show reduced physiological performance and increased frailty compared with age-matched uninfected persons. Contemporary anti-retroviral therapy is thought to be largely free from neuromuscular complications, whereas several anti-retroviral drugs previously in common usage have been associated with mitochondrial toxicity. It has recently been established that patients with prior exposure to such drugs exhibit irreversible cellular and molecular mitochondrial defects. However the functional significance of such damage remains unknown. Here we use phosphorus magnetic resonance spectroscopy ((31P-MRS to measure in vivo muscle mitochondrial oxidative function, in patients treated with contemporary anti-retroviral therapy, and compare with biopsy findings (cytochrome c oxidase (COX histochemistry. We show that dynamic oxidative function (post-exertional ATP (adenosine triphosphate resynthesis was largely maintained in the face of mild to moderate COX defects (affecting up to ∼10% of fibers: τ½ ADP (half-life of adenosine diphosphate clearance, HIV-infected 22.1±9.9 s, HIV-uninfected 18.8±4.4 s, p = 0.09. In contrast, HIV-infected patients had a significant derangement of resting state ATP metabolism compared with controls: ADP/ATP ratio, HIV-infected 1.24±0.08×10(-3, HIV-uninfected 1.16±0.05×10(-3, p = 0.001. These observations are broadly reassuring in that they suggest that in vivo mitochondrial function in patients on contemporary anti-retroviral therapy is largely maintained at the whole organ level, despite histochemical (COX defects within individual cells. Basal energy requirements may nevertheless be increased.

  12. Helminthic Infections Rates and Malaria in HIV-Infected Pregnant Women on Anti-Retroviral Therapy in Rwanda

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    Ivan, Emil; Crowther, Nigel J.; Mutimura, Eugene; Osuwat, Lawrence Obado; Janssen, Saskia; Grobusch, Martin P.

    2013-01-01

    Background Within sub-Saharan Africa, helminth and malaria infections cause considerable morbidity in HIV-positive pregnant women and their offspring. Helminth infections are also associated with a higher risk of mother-to-child HIV transmission. The aim of this study was to determine the prevalence of, and the protective and risk factors for helminth and malaria infections in pregnant HIV-positive Rwandan women receiving anti-retroviral therapy (ART). Methodology and principle findings Pregnant females (n = 980) were recruited from health centres in rural and peri-urban locations in the central and eastern provinces of Rwanda. Helminth infection was diagnosed using the Kato Katz method whilst the presence of Plasmodium falciparum was identified from blood smears. The prevalence of helminth infections was 34.3%; of malaria 13.3%, and of co-infections 6.6%. Helminth infections were more common in rural (43.1%) than peri-urban (18.0%; p<0.0005) sites. A CD4 count ≤350 cells/mm3 was associated with a higher risk of helminth infections (odds ratio, 3.39; 95% CIs, 2.16–5.33; p<0.0005) and malaria (3.37 [2.11–5.38]; p<0.0005) whilst helminth infection was a risk factor for malaria infection and vice versa. Education and employment reduced the risk of all types of infection whilst hand washing protected against helminth infection (0.29 [0.19–0.46]; p<0.0005);). The TDF-3TC-NVP (3.47 [2.21–5.45]; p<0.0005), D4T-3TC-NVP (2.47 [1.27–4.80]; p<0.05) and AZT-NVP (2.60 [1.33–5.08]; p<0.05) regimens each yielded higher helminth infection rates than the AZT-3TC-NVP regimen. Anti-retroviral therapy had no effect on the risk of malaria. Conclusion/significance HIV-positive pregnant women would benefit from the scaling up of de-worming programs alongside health education and hygiene interventions. The differential effect of certain ART combinations (as observed here most strongly with AZT-3TC-NVP) possibly protecting against helminth infection warrants further

  13. Quality of life among people living with acquired immune deficiency syndrome receiving anti-retroviral therapy: a study from Nepal

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    Giri S

    2013-09-01

    Full Text Available Smith Giri, Maniraj Neupane, Sushil Pant, Utsav Timalsina, Sagar Koirala, Santosh Timalsina, Sashi Sharma Department of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal Purpose: The present study was undertaken to determine the impact of acquired immune deficiency syndrome (AIDS on the quality of life of affected individuals in Nepal. Patients and methods: A cross sectional study was done among 70 individuals attending the Anti-Retroviral Therapy clinic of the University Hospital in Nepal. Quality of life (QOL was evaluated using World Health Organization Quality of life questionnaire (WHO QOL-BREF instrument. Statistical analysis was done using SPSS Version 17.0. Results: The median scores with interquartile range (IQR in four domains of QOL in descending order were physical (61; IQR 22, social (58; IQR 33, environmental (56; IQR 13, and psychological (54; IQR 8. Older age was associated with lower perceived overall QOL. Females were more likely to have lower QOL scores in the social and psychological domains. Higher CD4 counts and a married status were significant predictors of higher QOL scores in the environmental domain. Conclusion: Being older, female, single, and having advanced clinical stage is associated with lower QOL scores in people living with AIDS. Lowest QOL scores were seen in the psychological domain suggesting the need of psychological interventions. Keywords: quality of life, AIDS, Nepal, WHO QOL-BREF

  14. Pentecostalism and AIDS treatment in Mozambique: creating new approaches to HIV prevention through anti-retroviral therapy.

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    Pfeiffer, James

    2011-01-01

    Pentecostal fervor has rapidly spread throughout central and southern Mozambique since the end of its protracted civil war in the early 1990s. In the peri-urban bairros and septic fringes of Mozambican cities African Independent Churches (AICs) with Pentecostal roots and mainstream Pentecostals can now claim over half the population as adherents. Over this same period another important phenomenon has coincided with this church expansion: the AIDS epidemic. Pentecostalism and HIV have travelled along similar vectors and been propelled by deepening inequality. Recognising this relationship has important implications for HIV/AIDS prevention and treatment strategies. The striking overlap between high HIV prevalence in peri-urban populations and high Pentecostal participation suggests that creative strategies, to include these movements in HIV/AIDS programming, may influence the long-term success of HIV care and the scale-up of anti-retroviral treatment (ART) across the region. The provision of ART has opened up new possibilities for engaging with local communities, especially Pentecostals and AICS, who are witnessing the immediate benefits of ARV therapy. Expanded treatment may be the key to successful prevention as advocates of a comprehensive approach to the epidemic have long argued.

  15. Fluticasone furoate induced iatrogenic Cushing syndrome in a pediatric patient receiving anti-retroviral therapy

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    S A A van den Berg

    2017-04-01

    Full Text Available We present a case of iatrogenic Cushing’s syndrome, induced by treatment with fluticasone furoate (1–2 dd, 27.5 μg in each nostril in a pediatric patient treated for congenital HIV. The pediatric patient described in this case report is a young girl of African descent, treated for congenital HIV with a combination therapy of Lopinavir/Ritonavir (1 dd 320/80 mg, Lamivudine (1 dd 160 mg and Abacavir (1 dd 320 mg. Our pediatric patient presented with typical Cushingoid features (i.e. striae of the upper legs, full moon face, increased body and facial hair within weeks after starting fluticasone furoate therapy, which was exacerbated after increasing the dose to 2 dd because of complaints of unresolved rhinitis. Biochemical analysis fitted iatrogenic Cushing’s syndrome, with a repeatedly low cortisol (<0.03 μM, ref 0.14–0.60 μM and low ACTH (9 pg/mL, ref 9–52 pg/mL without signs of adrenal insufficiency. No other biochemical abnormalities that could point to adrenal or pituitary dysfunction were detected; electrolytes, thyroid and gonadal function, and IGF-1 were within the normal range. Pharmacogenetic analysis revealed that the pediatric patient carried the CYP3A4 *1B/*1G and CYP3A5 *3/*3 genotype (associated with a partial and complete loss of enzyme activity, respectively which is associated with the development of iatrogenic Cushing’s syndrome in patients treated for HIV due to the strong inhibition of CYP3 enzymes by Ritonavir. Upon discontinuation of fluticasone treatment, the pediatric patient improved both clinically and biochemically with normalisation of cortisol and ACTH within a couple of weeks.

  16. Effects of a High Protein Food Supplement on Physical Activity, Motor Performance and Health Related Quality of Life of HIV Infected Botswana Children on Anti-Retroviral Therapy (ART

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    Leapetswe Malete

    2017-05-01

    Full Text Available Objective: Despite existing evidence about the benefits of nutrition, physical activity (PA and sport to the overall health and wellbeing of children, knowledge gaps remain on this relationship in children living with chronic conditions like HIV/AIDS. Such knowledge should inform context specific programs that could enhance the quality of life of children. The purpose of this study was to examine the effects of integrating a nutrition intervention (culturally tailored food supplement into antiretroviral therapy (ART on psychosocial outcomes and physical activity among HIV-positive children in Botswana. Method: 201 HIV-positive children (6–15 years; M = 9.44, SD = 2.40 were recruited and randomly assigned (stratified by age and gender to two groups. The intervention group (n = 97 received a high protein (bean-sorghum plus micronutrients food supplement, while the control group (n = 104 received a sorghum plus micronutrients supplement. Participants were followed over 12 months. Anthropometric measures, PA, motor performance, and health related quality of life (HRQL were collected at baseline, 6 and 12 months. Results: Mixed repeated-measures ANOVA revealed a significant time effect of the food supplement on target variables except body fat percentage, speed, and school functioning. Time×treatment interaction was found for physical functioning, psyioning achosocial functnd total quality of life score. Scores on physical functioning and total of quality life in the intervention group significantly increased from baseline to 6 months compared with the control group (p = 0.015. Conclusion: A combination of ART and nutritional intervention had a positive effect on physical functioning and total quality of life of HIV-positive children in this study. There were also improvements to physical activity and motor performance tests over time. More research is needed on long term effects of nutrition and PA interventions on HRQL in children living with

  17. Assessment of factors influencing adherence to anti-retroviral therapy for human immunodeficiency virus positive mothers and their infected children

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    Arun Kumar De

    2012-01-01

    Full Text Available Background and Objectives: Mothers and children are biologically related and dependent. They should be considered as a single unit which is very important regarding adherence to anti-retroviral therapy (ART. Very high levels of adherence are required for effective ART. We therefore carried out this study to examine the adherence levels and different factors associated with adherence among human immunodeficiency virus (HIV-positive mothers and their HIV-positive children receiving ART. Design and Setting: A hospital-based cross-sectional study. Materials and Methods: Ninety-four HIV-positive mothers and their 94 HIV-positive children under ART attending the ART center of a tertiary care hospital were recruited in this study. Consenting mothers were asked to complete the "Case Study Form" containing socio-demographic and care-giving details. Mothers were also asked to complete the Beck′s depression inventory, State trait anxiety inventory, and Ways of coping inventory. Adherence was assessed using pill count. Criteria for good and poor adherence were defined. Current CD4 counts were retrieved from the hospital record. Results: Fifty-six percent of respondent mothers and 65.8% of respondent children showed good adherence to ART. Different factors were associated with poor adherence in both mothers and their children. Conclusion: Adherence of HIV-positive mothers and their HIV-positive children to ART is influenced by multiple factors and identification of these factors is necessary to get complete adherence to ART. There is statistically significant relationship between maternal and pediatric adherence to ART.

  18. Predictors of mortality among HIV-infected patients initiating anti retroviral therapy at a tertiary care hospital in Eastern India

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    Ananya Bhowmik; Subhasis Bhandari; Rajyasree De; Subhasish Kamal Guha

    2012-01-01

    Objective: To assess early mortality and identify its predictors among the ART naive HIV-infected patients initiating anti retroviral therapy (ART) available free of cost at the ART Centres.Methods: A retrospective cohort analysis of routinely collected programme data was done for assessing mortality of all ART naive adult patients who received first-line ART at a government tertiary care hospital in eastern India during 1st March 2009 and 28th February 2010. Bivariate and multiple regression analyses of the baseline demographic, clinical and laboratory records using SPSS 15.0 were done to identify independent predictors of mortality. Results: The mortality rate at one year was estimated to be 7.66 (95% CI 5.84-9.83) deaths/100 patient-years and more than 50% of the deaths occurred during first three months of ART initiation with a median time interval of 73 days. Tuberculosis was the major cause of death. ART naive patients with baseline serum albumin <3.5 mg/dL were eight (OR 7.9; 95% CI: 3.8-16.5) at risk of death than those with higher serum albumin levels and patients with CD4 count <100 cells/μL were two times (OR 2.2;95% CI: 1.1-4.4) at risk of death compared to higher CD4 counts. Conclusions: Risk of mortality is increased when ART is initiated at advanced stages of immunosuppression denoted by low serum albumin levels and CD4 cell counts. This highlights the importance of early detection of HIV infection, early management of opportunistic infections including tuberculosis and timely initiation of the antiretroviral drugs in the resource-limited countries, now available free in the Indian national ART programme.

  19. Inhibition of CYP2B6 by Medicinal Plant Extracts: Implication for Use of Efavirenz and Nevirapine-Based Highly Active Anti-Retroviral Therapy (HAART in Resource-Limited Settings

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    Nicholas E. Thomford

    2016-02-01

    Full Text Available Highly active antiretroviral therapy (HAART has greatly improved health parameters of HIV infected individuals. However, there are several challenges associated with the chronic nature of HAART administration. For populations in health transition, dual use of medicinal plant extracts and conventional medicine poses a significant challenge. There is need to evaluate interactions between commonly used medicinal plant extracts and antiretroviral drugs used against HIV/AIDS. Efavirenz (EFV and nevirapine (NVP are the major components of HAART both metabolized by CYP2B6, an enzyme that can potentially be inhibited or induced by compounds found in medicinal plant extracts. The purpose of this study was to evaluate the effects of extracts of selected commonly used medicinal plants on CYP2B6 enzyme activity. Recombinant human CYP2B6 was used to evaluate inhibition, allowing the assessment of herb-drug interactions (HDI of medicinal plants Hyptis suaveolens, Myrothamnus flabellifolius, Launaea taraxacifolia, Boerhavia diffusa and Newbouldia laevis. The potential of these medicinal extracts to cause HDI was ranked accordingly for reversible inhibition and also classified as potential time-dependent inhibitor (TDI candidates. The most potent inhibitor for CYP2B6 was Hyptis suaveolens extract (IC50 = 19.09 ± 1.16 µg/mL, followed by Myrothamnus flabellifolius extract (IC50 = 23.66 ± 4.86 µg/mL, Launaea taraxacifolia extract (IC50 = 33.87 ± 1.54 µg/mL, and Boerhavia diffusa extract (IC50 = 34.93 ± 1.06 µg/mL. Newbouldia laevis extract, however, exhibited weak inhibitory effects (IC50 = 100 ± 8.71 µg/mL on CYP2B6. Launaea taraxacifolia exhibited a TDI (3.17 effect on CYP2B6 and showed a high concentration of known CYP450 inhibitory phenolic compounds, chlorogenic acid and caffeic acid. The implication for these observations is that drugs that are metabolized by CYP2B6 when co-administered with these herbal medicines and when adequate amounts of the

  20. Microfinance and HIV mitigation among people living with HIV in the era of anti-retroviral therapy: emerging lessons from Cote d'Ivoire.

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    Holmes, Kathleen; Winskell, Kate; Hennink, Monique; Chidiac, Sybil

    2011-01-01

    The effects of HIV/AIDS have been far-reaching in Africa. Beyond adverse health outcomes and the tremendous toll on life, AIDS has serious economic impacts on households, increasing livelihood insecurity while simultaneously depleting socio-economic resources. Although microfinance is believed to have the potential to mitigate the economic impacts of HIV by helping affected households and communities better prepare for and cope with HIV-related economic shocks, little empirical research exists on this subject. This qualitative study examines the socio-economic impacts of economic strengthening activities on people living with HIV (PLHIV) in the era of increased access to anti-retroviral therapy to determine if savings-led, community-managed microfinance is a justified activity for HIV programmes. Findings from a village savings and loan programme, implemented by CARE International in Cote d'Ivoire, revealed that when appropriate medical treatment is available PLHIV are capable of participating in and benefit from microfinance activities, which increased HIV-positive clients' access to money and economic self-sufficiency. By bringing individuals with similar experiences together, savings and loan groups also acted as self-support groups providing psychosocial support while reducing stigmatisation and increasing members' sense of dignity and self-worth.

  1. Who is utilizing anti-retroviral therapy in Ghana: An analysis of ART service utilization

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    Dako-Gyeke Phyllis

    2012-10-01

    Full Text Available Abstract Introduction The global scale-up of antiretroviral therapy (ART for HIV patients has led to concerns regarding inequities in utilization of ART services in resource-limited contexts. In this paper, we describe regional and sex differentials in the distribution of ART among adult HIV patients in Ghana. We highlight the need for interventions to address the gender-based and geographic inequities related to the utilization of ART services in Ghana. Methods We reviewed National AIDS/STIs Control Program’s ART service provision records from January 2003 through December 2010, extracting data on adults aged 15+ who initiated ART in Ghana over a period of eight years. Data on the number of patients on treatment, year of enrollment, sex, and region were obtained and compared. Results The number of HIV patients receiving ART in Ghana increased more than 200-fold from 197 in 2003, to over 45,000 in 2010. However, for each of six continuous years (2005-2010 males comprised approximately one-third of adults newly enrolled on ART. As ART coverage has expanded in Ghana, the proportion of males receiving ART declined from 41.7% in 2004 to 30.1% in 2008 and to 27.6% in 2010. Also, there is disproportionate regional ART utilization across the country. Some regions report ART enrollment lower than their percent share of number of HIV infected persons in the country. Conclusions Attention to the comparatively fewer males initiating ART, as well as disproportionate regional ART utilization is urgently needed. All forms of gender-based inequities in relation to HIV care must be addressed in order for Ghana to realize successful outcomes at the population level. Policy makers in Ghana and elsewhere need to understand how gender-based health inequities in relation to HIV care affect both men and women and begin to design appropriate interventions.

  2. Incidence of WHO stage 3 and 4 conditions following initiation of anti-retroviral therapy in resource limited settings.

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    Andrea J Curtis

    Full Text Available OBJECTIVES: To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART in resource limited settings (RLS. DESIGN/SETTING: A descriptive analysis of routine program data collected prospectively from 25 Médecins Sans Frontières supported HIV treatment programs in eight countries between 2002 and 2010. SUBJECTS/PARTICIPANTS: 35,349 study participants with median follow-up on ART of 1.33 years (IQR 0.51-2.41. OUTCOME MEASURES: Incidence in 100 person-years of WHO stage 3 or 4 conditions during 5 periods after ART initiation. Diagnoses of conditions were made according to WHO criteria and relied upon clinical assessments supported by basic laboratory investigations. RESULTS: The incidence of any WHO clinical stage 3 or 4 condition over 3 years was 40.02 per 100 person-years (31.77 for stage 3 and 8.25 for stage 4. The incidence of stage 3 and 4 conditions fell by over 97% between months 0-3 and months 25-36 (77.81 to 2.40 for stage 3 and 28.70 to 0.64 for stage 4. During months 0-3 pulmonary tuberculosis was the most common condition diagnosed in adults (incidence 22.24 per 100 person-years and children aged 5-14 years (25.76 and oral candidiasis was the most common in children <5 years (25.79. Overall incidences were higher in Africa compared with Asia (43.98 versus 12.97 for stage 3 and 8.98 versus 7.05 for stage 4 conditions, p<0.001. Pulmonary tuberculosis, weight loss, oral and oesophageal candidiasis, chronic diarrhoea, HIV wasting syndrome and severe bacterial infections were more common in Africa. Extra-pulmonary tuberculosis, non-tuberculous mycobacterial infection, cryptococcosis, penicilliosis and toxoplasmosis were more common in Asia. CONCLUSIONS: The incidence of WHO stage 3 and 4 conditions during the early period after ART initiation in RLS is high, but greatly reduces over time. This is likely due to both the benefits of ART and deaths of the sickest patients occurring shortly

  3. Adesão à terapêutica anti-retroviral por indivíduos com HIV/AIDS assistidos em uma instituição do interior paulista Adhesión a la terapéutica anti-retroviral por los individuos con VIH/SIDA de uno servicio del interior paulista Adhesion to anti-retroviral therapy by individuals with HIV/AIDS attended at an institution in the interior of São Paulo

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    Elucir Gir

    2005-10-01

    -retrovirales desde hace en promedio 5 años. La cantidad diaria de comprimidos anti-retrovirales varió de 3 a 24. Como principales dificultades de la adhesión mencionaron: sabor, tamaño, cantidad, olor de los comprimidos (40,0%; efectos colaterales (14,4%; factores psicológicos (13,7%; diferentes horarios de medicación (10,8%. Cuanto a las facilidades, el 26,2% relató horarios coincidentes de los comprimidos; el 16,4% ninguna facilidad y el 16,0% ingestión condicionada a algún hábito. Esos datos requieren de la enfermería mayor vigilancia supervisada, acciones educativas e intervenciones.Inadequate adherence to highly active anti-retroviral therapy (HAART provokes important secondary effects in people living with aids. The objective was to identify the factors that make HAART adherence easy or difficult, according to aids patients attended at a university hospital in the state of São Paulo, Brazil. We interviewed 200 diagnosed aids patients using HAART for at least 6 months. Patients were interviewed individually, using a semi-structured design. Qualitative and quantitative analysis was used. 59% of the participants were men; average age was 38.2 years; 51% did not finish basic education; 50.5% did not perform any remunerated work. Patients had been using anti-retroviral agents for an average time of 5 years. The number of anti-retroviral pills ranged from 3 to 24. The main difficulties mentioned for adherence were: taste, size, number, smell of pills (40.0%; intense collateral effects (14.4%; psychological factors (13.7%; different times to take the pills (10.8%. Patients mentioned the following facilitators: coincidence of times to take the drugs (26.2%, no facility (16.4%, and administration associated to some habit (16.0%. The nursing group needs to reinforce supervised surveillance, educational and intervention actions.

  4. Abordagem metabólica e nutricional da lipodistrofia em uso da terapia anti-retroviral Metabolic and nutritional approach of lipodystrophy in the use of antiretroviral therapy

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    Claudia Daniele Tavares Dutra

    2008-08-01

    Full Text Available A terapia anti-retroviral altamente ativa, usada contra o Vírus da Imunodeficiência Humana, vem possibilitando a melhora do quadro clínico-laboratorial de portadores da Síndrome da Imunodeficiência Adquirida. Contudo, alterações metabólicas e complicações morfológicas, associadas ao uso da terapia, vêm sendo investigadas. A utilização prolongada desta terapia tem um impacto importante sobre o estado nutricional dos pacientes. Antes da sua utilização, a perda de peso e a desnutrição, conseqüências das infecções oportunistas, eram os maiores problemas nutricionais. Atualmente, o foco principal das discussões têm sido as complicações metabólicas e morfológicas, dentre elas a lipodistrofia, com a dislipidemia, a resistência à insulina, a osteopenia, e a distribuição alterada da gordura corporal, aumentando assim os riscos de doenças cardiovasculares. A nutrição desempenha um papel fundamental no suporte da saúde desses pacientes, integrando as equipes multiprofissionais, promovendo a melhora da adesão à terapia anti-retroviral e do prognóstico da doença. No entanto, para que se tenha mais conhecimento sobre a terapia, as proporções de seus efeitos adversos, e o perfil nutricional desses pacientes, a curto e a longo prazos, é de suma importância que se estude mais sobre este assunto, a fim de permitir perspectivas de um regime terapêutico mais seguro dentro de seus alcances metodológicos, proporcionando uma melhor qualidade de vida aos pacientes.The highly active antiretroviral therapy used against Human Immunodeficiency Virus provides an improvement in laboratory and clinical findings of patients with Acquired Immunodeficiency Syndrome. However, metabolic and morphologic disturbances associated with the therapy are being investigated. The drawn out use of these therapy has an important impact on the nutritional status of the patients. Before the use of this therapy, weight loss and malnutrition caused by

  5. Metabolic changes associated with antiretroviral therapy in HIV-positive patients Alteraciones metabólicas asociadas a la terapia anti-retroviral en pacientes HIV-positivos Alterações metabólicas associadas à terapia anti-retroviral em pacientes HIV-positivos

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    Sabrina Esteves de Matos Almeida

    2009-04-01

    Full Text Available OBJECTIVE: To evaluate metabolic changes associated with highly active antiretroviral therapy (HAART in HIV-positive patients, and to identify risk factors associated. METHODS: Retrospective study that included 110 HIV-positive patients who where on HAART in the city of Porto Alegre (Southern Brazil between January 2003 and March 2004. Data on demographic variables, cigarette smoking, diabetes mellitus, cholesterol and triglyceride levels, stage of HIV infection, antiretroviral therapy and HCV coinfection were collected. General linear models procedure for repeated measures was used to test the interaction between HAART and HCV coinfection or protease inhibitor treatment. RESULTS: Total cholesterol, triglycerides, and glucose levels significantly increased after receiving HAART (pOBJETIVO: Evaluar las alteraciones metabólicas asociadas a la terapia anti-retroviral potente en pacientes HIV-positivos e identificar factores de riesgo asociados. MÉTODOS: Estudio retrospectivo con 110 pacientes HIV-positivos que estaban en terapia anti-retroviral potente (HAART en la ciudad de Porto Alegre (Sur de Brasil, entre enero de 2003 y marzo de 2004. Los datos colectados incluyen variables demográficas, tabaquismo, diabetes mellitas, niveles de colesterol y triglicéridos, fase de la infección viral, terapia anti-retroviral y co-infección con hepatitis C. El análisis multivariado para medidas repetidas (General Linear Model procedure for Repeated Measures fue utilizada para analizar la interacción entre el efecto de uso de HAART y el uso de inhibidores de proteasa o co-infección por hepatitis C. RESULTADOS: Fueron observados aumentos significativos en los niveles de colesterol total, triglicéridos y glucosa posterior al tratamiento con HAART (pOBJETIVO: Avaliar as alterações metabólicas associadas à terapia anti-retroviral potente em pacientes HIV-positivos e identificar fatores de risco associados. MÉTODOS: Estudo retrospectivo com 110

  6. Improved outcomes from HIV/TB co-infection in Singapore following a switch to earlier anti-retroviral therapy

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    Barnaby Young

    2014-11-01

    Full Text Available Introduction: Recent clinical trials have provided clear evidence to support early anti-retroviral therapy (ART in patients with HIV/TB co-infection and low CD4 counts. We investigated how this has changed treatment and outcomes in Singapore. Materials and Methods: A retrospective review was performed with inpatient and outpatient records for all subjects diagnosed with HIV/TB co-infection from 2006 to 2011 attending the Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore. Data for subjects with a presenting CD4<200 cell/mm3 were extracted and split into two groups, “Delayed”: ART more than 8/52 after starting TB treatment, and “Early”: ART within 8/52 of starting TB treatment. Results: One hundred thirty-four out of 180 subjects in the database met the inclusion criteria for this study, 89 in the delayed group and 45 in the early. No statistically significant differences in baseline demographics between the two groups were identified. Both groups presented with markedly low CD4 counts, with overall 60% <50cells/mm3. Median CD4 counts were lower in the delayed ART group (37 vs 50, p=0.015. Prevalence of other opportunistic infections at TB diagnosis was not significantly different (20%, but TB in the early ART group was more likely to include extra-pulmonary disease (46% vs 57%, p=0.038. Four cases were culture negative, 2 multi-drug resistant and 10 (7.8% were isoniazid mono-resistant. There was a significant trend to earlier ART with more recent TB diagnosis (p<0.001. In the first 365 days after TB diagnosis, 11 deaths occurred in the delayed ART group, and 0 in the early (p=0.033. A Kaplan-Meier time-to-event analysis demonstrated a clear separation in the frequency of death or opportunistic infections at eight weeks (Figure 1, p<0.001. Immune reconstitution disease was significantly more likely in the early ART group, but did not result in death (9% vs 38%, p<0.001. Treatment interruptions due to adverse drug events (ADE

  7. Analysis of HIV- type 1 protease and reverse transcriptase in Brazilian children failing highly active antiretroviral therapy (HAART Análise da protease e transcriptase reversa do HIV-1 em crianças com falha terapêutica em uso de terapia anti-retroviral altamente eficaz (HAART

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    Daisy Maria Machado

    2005-02-01

    Full Text Available The aim of this study was to evaluate the genotypic resistance profiles of HIV-1 in children failing highly active antiretroviral therapy (HAART. Forty-one children (median age = 67 months receiving HAART were submitted to genotypic testing when virological failure was detected. cDNA was extracted from PBMCs and amplified by nested PCR for the reverse transcriptase and protease regions of the pol gene. Drug resistance genotypes were determined from DNA sequencing. According to the genotypic analysis, 12/36 (33.3% and 6/36 (16.6% children showed resistance and possible resistance, respectively, to ZDV; 5/36 (14% and 4/36 (11.1%, respectively, showed resistance and possible resistance to ddI; 4/36 (11.1% showed resistance to 3TC and D4T; and 3/36 (8.3% showed resistance to Abacavir. A high percentage (54% of children exhibited mutations conferring resistance to NNRTI class drugs. Respective rates of resistance and possible resistance to PIs were: RTV (12.2%, 7.3%; APV (2.4%, 12.1%; SQV(0%, 12.1%; IDV (14.6%, 4.9%, NFV (22%, 4.9%, LPV/RTV (2.4%, 12.1%. Overall, 37/41 (90% children exhibited virus with mutations related to drug resistance, while 9% exhibited resistance to all three antiretroviral drug classes.O objetivo deste estudo foi avaliar o perfil de resistência genotípica do HIV-1 em crianças com falha terapêutica ao tratamento anti-retroviral (HAART. Quarenta e uma crianças (idade mediana = 67 meses em uso de HAART foram submetidas ao teste de genotipagem no momento da detecção de falha ao tratamento. Foi realizada extração de cDNA de células periféricas mononucleares e amplificação do mesmo (regiões da transcriptase reversa e protease do gene pol através de PCR-nested. O perfil genotípico foi determinado através do seqüenciamnto de nucleotídeos. De acordo com a análise genotípica, 12/36 (33,3% e 6/36 (16,6% crianças apresentaram, respectivamente, resistência e possível resistência ao AZT; 5/36 (14% e 4/36 (11

  8. Access to highly active antiretroviral therapy for injection drug users: adherence, resistance, and death Acesso de usuários de drogas injetáveis ao tratamento anti-retroviral altamente potente: aderência, resistência e mortalidade

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    David Vlahov

    2006-04-01

    Full Text Available Injection drug users (IDUs continue to comprise a major risk group for HIV infection throughout the world and represent the focal population for HIV epidemics in Asia and Eastern Europe/Russia. HIV prevention programs have ranged from HIV testing and counseling, education, behavioral and network interventions, drug abuse treatment, bleach disinfection of needles, needle exchange and expanded syringe access, as well as reducing transition to injection and primary substance abuse prevention. With the advent of highly active antiretroviral therapy (HAART in 1996, dramatic clinical improvements have been seen. In addition, the treatment's impact on reducing HIV viral load (and therefore transmission by all routes provides a stronger rationale for an expansion of the focus on prevention to emphasize early identification and treatment of HIV infected individuals. However, treatment of IDUs has many challenges including adherence, resistance and relapse to high risk behaviors, all of which impact issues of access and ultimately effectiveness of potent antiretroviral treatment. A major current challenge in addressing the HIV epidemic revolves around an appropriate approach to HIV treatment for IDUs.Os usuários de drogas injetáveis (UDI ainda representam um importante grupo de risco para a infecção pelo HIV no mundo em geral, além de constituir o grupo central das epidemias de HIV na Ásia e no Leste Europeu e Rússia. Os programas de prevenção do HIV variam, desde a testagem sorológica e aconselhamento, educação, intervenções comportamentais e em redes, tratamento da dependência química, desinfecção de agulhas com água sanitária, troca de agulhas e ampliação do acesso a seringas, além da redução da transição ao uso injetável e a prevenção primária da dependência química. Com o advento da terapia anti-retroviral altamente potente (HAART, em 1996, houve uma melhora clínica dramática. Além disso, o impacto do tratamento

  9. The First Synthesis and Anti-retroviral Activity of 5',5'-Difluoro-3'-Hydroxy-Apiosyl Nucleoside Cyclomonophosphonic Acid Analogs

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seyeon; Hong, Joon Hee [Chosun University, Gwangju (Korea, Republic of)

    2016-04-15

    The first synthesis of novel 5',5'-difluoro-30-hydroxy apiose nucleoside cyclomonophosphonic acid analogs was performed as potent anti-retroviral agents. Phosphonation was performed by direct displacement of a triflate intermediate with diethyl(lithiodifluoromethyl) phosphonate to give the corresponding(α, α-difluoroalkyl) phosphonate. Condensation successfully proceeded from a glycosyl donor with persilylated bases to yield the nucleoside phosphonate analogs. Deprotection of diethyl phosphonates provided the target nucleoside cyclomonophosphonic acid analogs. The synthesized nucleoside analogs were subjected to anti-viral screening against the human immunodeficiency virus-1 (HIV-1). Cytosine analogs show significant anti-HIV activity.

  10. In vitro and in vivo anti-retroviral activity of the substance purified from the aqueous extract of Chelidonium majus L.

    Science.gov (United States)

    Gerencer, Marijan; Turecek, Peter L; Kistner, Otfried; Mitterer, Artur; Savidis-Dacho, Helga; Barrett, Noel P

    2006-11-01

    We have isolated a substance with anti-retroviral activity from the freshly prepared crude extract of Chelidonium majus L. (greater celandine) by 9-aminoacridine precipitation method and ion exchange chromatography using Dowex-50W/H+ resin followed by the gel filtration on Sephadex-75 column. Elemental and phenol/sulfuric acid method analyses as well as the mass spectrometry of the purified substance indicated that it may represent a low-sulfated poly-glycosaminoglycan moiety with molecular weight of approximately 3800 Da. The substance prevented infection of human CD4+ T-cell lines AA2 and H9 with HIV-1 at concentration of 25 microg/mL as well as the cell-to-cell virus spread in H9 cells continuously infected with HIV-1, as determined by the measurement of reverse transcriptase activity and p24 content in cell cultures. Furthermore, we have shown in a murine AIDS model that the treatment with purified substance significantly prevented splenomegaly and the enlargement of cervical lymph nodes in C57Bl/6 mice chronically infected with the pool of murine leukemia retroviruses. The mechanism(s) of anti-retroviral activity of this substance have to be elucidated.

  11. Family planning practice and predictors of risk of inconsistent condom use among HIV-positive women on anti-retroviral therapy in Cambodia.

    Science.gov (United States)

    Nakaie, Naomi; Tuon, Sovanna; Nozaki, Ikuma; Yamaguchi, Fuzuki; Sasaki, Yuri; Kakimoto, Kazuhiro

    2014-02-17

    In Cambodia, while anti-retroviral therapy (ART) services are increasingly available, the unmet needs of family planning among general population are high. These facts raise concern on possible exposure of many HIV-positive women on ART to the potential risk of unintended pregnancy. This study aimed to clarify family planning practices in Cambodia and determine predictors of risk of inconsistent condom use among women on ART. A cross-sectional survey with a structured questionnaire was conducted at five government-run health centers in Phnom Penh, Cambodia, from June to September, 2012. Multiple logistic regression analysis was used to identify predictors of risk of inconsistent condom use among regular users of contraceptive methods. Of 408 respondents, 40, 17 and 10 used the pill, IUD, and injection, respectively, while 193 used condoms. 374 were not planning to have a child. Among 238 sexually active women who were not planning to have a baby, 59 were exposed to the risk of unintended pregnancy. Multivariate logistic regression analysis that did not include variables related to partners identified "seeking family planning information" (adjusted odds ratio (AOR): 2.6, 95% confidence intervals (95% CI): 1.1-6.2), awareness of mother-to-child transmission (MTCT) (AOR: 4.7, 95% CI: 1.9-11.6) and "having a son" (AOR: 2.0, 95% CI: 1.1-3.9) were significant predictors of inconsistent condom use. Another model that included all variables identified "able to ask a partner to use condom at every sexual intercourse" was the only predictor (AOR: 23.7, 95% CI: 5.8-97.6). About one-quarter of women on ART are at risk to unintended pregnancy although most do not plan to get pregnant. Furthermore, women on ART could be more empowered through improvement of communication and negotiation skills with partners to demand the use of condom during sexual intercourse. The use of other contraceptive methods that do not need partner involvement should be promoted.

  12. Effect of Micronutrient and Probiotic Fortified Yogurt on Immune-Function of Anti-Retroviral Therapy Naive HIV Patients  

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    J. Dik F. Habbema

    2011-10-01

    Full Text Available Background: Micronutrient supplementation has been shown to reduce the progression of HIV but does not have an effect on the intestinal barrier or the intestinal microbiota of HIV patients. Studies have suggested that probiotics could potentially complement micronutrients in preserving the immune-function of HIV patients. Objective: Assess the impact of micronutrient supplemented probiotic yogurt on the immune function of HIV patients. Design: We performed a randomized, double blind, controlled trial with CD4 count as primary outcome among HIV patients naïve to anti-retroviral treatment. Secondary outcomes included hematological parameters, incidence of diarrhea and clinical symptoms. A total of 112 HIV patients were randomized to receive a micronutrient fortified yogurt with (n = 55 or without additional probiotic Lactobacillus rhamnosus GR-1 (n = 57 for four weeks. Results: An average decline in CD4 count of −70 cells/μL (95% CI: −154 to −15 was observed in the micronutrient, probiotic group versus a decrease of −63 cells/μL (95% CI: −157 to −30 in the micronutrient control group (p = 0.9. Additional probiotic supplementation was well tolerated and not associated with adverse events. No difference between groups was detected in incidence of diarrhea or clinical symptoms. An improvement of hemoglobin levels was observed for all subjects, based upon a mean difference from baseline of 1.4 g/L (SD = 6 (p = 0.02. Conclusion: The addition of probiotics to a micronutrient fortified yogurt was well tolerated by HIV patients but was not associated with a further increase in CD4 count after one month.

  13. Risk factors of non-alcoholic fatty liver disease in patients with HIV-infection after receiving highly active anti-retroviral therapy%HIV感染者进行高效抗反转录病毒治疗过程中发生非酒精性脂肪性肝病的相关因素分析

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    梁洪远; 王芳; 肖江; 赵红心; 杨涤; 韩宁; 吴亮; 倪量; 郜桂菊

    2016-01-01

    目的:分析HIV感染者进行高效抗反转录病毒治疗(HAART)后非酒精性脂肪性肝病(NAFLD)的发生情况及影响因素。方法选择2013年至2015年于本院门诊领取国家免费抗病毒药物2年并规律随访的HIV感染者,所有患者HAART治疗前均无NAFLD。回顾性分析不同年龄、性别和HAART方案患者NAFLD的发生情况及HAART 2年时的相关指标。统计患者肝功能、肾功能、血糖、血脂、乳酸、CD4+T淋巴细胞计数及BMI等数据,并对其与NAFLD的关系进行横断面分析。结果共收集99例患者,其中发生NAFLD 29例,占29.3%。发生NAFLD和未发生NAFLD患者的CD4+T淋巴细胞计数、ALT、甘油三酯、总胆固醇及乳酸水平差异有统计学意义(P均<0.05)。单因素分析显示,不同HAART方案中含TDF组合可减少NAFLD的发生率,不同年龄及性别发生NAFLD的风险无统计学差异(P均<0.05)。结论 HAART治疗过程中NAFLD发生率较高,可能与抗病毒药物所致的脂代谢紊乱及线粒体损伤等有关,使用TDF组合可能减少NAFLD的发生率,HAART过程中CD4+T淋巴细胞计数、ALT、甘油三酯、总胆固醇及乳酸水平可能对NAFLD的发生有提示作用,需要在临床中予以监测。%Objective To investigate the prevalence and risk factors of non-alcoholic fatty liver disease in patients with HIV-infection after receiving highly active antiretroviral therapy (HAART).Methods HIV-infected patients who received a government free anti-retroviral drugs and were followed-up regularly for 2 years in our hospital from 2013 to 2015 were selected. All the patients had no non-alcoholic fatty liver disease (NAFLD) before HAART. The occurrence of NAFLD between different age, gender and HAART were analyzed retrospectively. Liver functions, renal functions, serum glucose levels, serum fat levels, lactic acid levels, CD4+ T cell and BMI were recorded and the relationship with NAFLD was evaluated

  14. Effects of PPARγ and RBP4 gene variants on metabolic syndrome in HIV-infected patients with anti-retroviral therapy.

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    Yuan-Pin Hung

    Full Text Available BACKGROUND: PPARγ and RBP4 are known to regulate lipid and glucose metabolism and insulin resistance. The influences of PPARγ (C1431T and Pro12Ala and RBP4 (-803GA polymorphisms on metabolic syndrome in HIV-infected patients receiving anti-retroviral therapy were examined in this study. MATERIALS AND METHODS: A cross-sectional study of HIV-1 infected adults with antiretroviral therapy for more than one year in the National Cheng Kung University Hospital was conducted. The gene polymorphisms were determined by quantitative PCR. RESULTS: Ninety-one patients were included in the study. Eighty-two (90.1% patients were males with a mean age of 44.4 years. For the C1431T polymorphism in PPARγ, while patients with the T allele (48.4% had trends toward lower rate of hypertriglyceridemia, the borderline significance together with insignificant power did not support the protective effect of the T allele against development of hypertriglyceridemia. For the Pro12Ala polymorphism in PPARγ, although patients with the Pro/Ala genotype (8.8% had a higher level of serum LDL (138.0 vs. 111.5 mg/dl, P = 0.04 and trends toward higher rates of hypercholesterolemia and serum LDL>110 mg/dl, these variables were found to be independent of the Pro/Ala genotype in the multivariate analysis. For the -803GA polymorphism in RBP4, patients with the A allele (23.1% more often had insulin resistance (HOMA>3.8; 33.3 vs. 8.7%, P = 0.01 and more often received anti-hypoglycemic drugs (14.3 vs. 1.4%, P = 0.04. The detrimental effect of the A allele in RBP4 -803GA polymorphism on development of insulin resistance was supported by the multivariate analysis adjusting for covariates. CONCLUSION: The impacts of PPARγ C1431T and Pro12Ala polymorphisms on metabolism in HIV-infected patients are not significant. RBP4 -803GA polymorphism has increased risk of insulin resistance in HIV-infected patients with anti-retroviral therapy.

  15. A humanized mouse model for HIV-2 infection and efficacy testing of a single-pill triple-drug combination anti-retroviral therapy.

    Science.gov (United States)

    Hu, Shuang; Neff, Charles Preston; Kumar, Dipu Mohan; Habu, Yuichiro; Akkina, Sarah R; Seki, Takahiro; Akkina, Ramesh

    2017-01-15

    While HIV-2 is a causative agent for AIDS in addition to the better studied HIV-1, there is currently no suitable animal model for experimental studies for HIV-2 infection and evaluating promising drugs in vivo. Here we evaluated humanized mice for their susceptibility to HIV-2 infection and tested a single-pill three drug formulation of anti-retrovirals (NRTIs abacavir and lamivudine, integrase inhibitor dolutegravir) (trade name, Triumeq(R)). Our results showed that hu-mice are susceptible to HIV-2 infection showing persistent viremia and CD4 T cell loss, key hallmarks of AIDS pathogenesis. Oral drug treatment led to full viral suppression and protection from CD4 T cell depletion. Cessation of therapy resulted in viral rebound and CD4 T cell loss. These proof-of-concept studies establish the utility of hu-mice for evaluating HIV-2 pathogenesis in more detail in the future, testing novel therapies and providing pre-clinical efficacy data of a three drug combination to treat HIV-2 infections. Copyright © 2016. Published by Elsevier Inc.

  16. Predictors of treatment failure and time to detection and switching in HIV-infected Ethiopian children receiving first line anti-retroviral therapy.

    Science.gov (United States)

    Bacha, Tigist; Tilahun, Birkneh; Worku, Alemayehu

    2012-08-24

    authors based on their records. Hence, they were not detected and these patients were not offered second line ARTs. Having chronic malnutrition, low CD4 at base line, chronic diarrhea after initiation of first line ART, substitution of ART drugs and age less than 3 years old were found to be independent predictors of first line ART failure in children. Most of the first line ART failure cases were not detected early and those that were detected were not switched to second line drugs in a timely fashion. Children with the above risk factors should be closely monitored for a timely switch to second line highly active anti-retroviral therapy.

  17. Predictors of treatment failure and time to detection and switching in HIV-infected Ethiopian children receiving first line anti-retroviral therapy

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    Bacha Tigist

    2012-08-01

    to have treatment failure retrospectively by the authors based on their records. Hence, they were not detected and these patients were not offered second line ARTs. Conclusions Having chronic malnutrition, low CD4 at base line, chronic diarrhea after initiation of first line ART, substitution of ART drugs and age less than 3 years old were found to be independent predictors of first line ART failure in children. Most of the first line ART failure cases were not detected early and those that were detected were not switched to second line drugs in a timely fashion. Children with the above risk factors should be closely monitored for a timely switch to second line highly active anti-retroviral therapy.

  18. Retention of HIV-Infected Children in the First 12 Months of Anti-Retroviral Therapy and Predictors of Attrition in Resource Limited Settings: A Systematic Review.

    Science.gov (United States)

    Abuogi, Lisa L; Smith, Christiana; McFarland, Elizabeth J

    2016-01-01

    Current UNAIDS goals aimed to end the AIDS epidemic set out to ensure that 90% of all people living with HIV know their status, 90% initiate and continue life-long anti-retroviral therapy (ART), and 90% achieve viral load suppression. In 2014 there were an estimated 2.6 million children under 15 years of age living with HIV, of which only one-third were receiving ART. Little literature exists describing retention of HIV-infected children in the first year on ART. We conducted a systematic search for English language publications reporting on retention of children with median age at ART initiation less than ten years in resource limited settings. The proportion of children retained in care on ART and predictors of attrition were identified. Twelve studies documented retention at one year ranging from 71-95% amongst 31877 African children. Among the 5558 children not retained, 4082 (73%) were reported as lost to follow up (LFU) and 1476 (27%) were confirmed to have died. No studies confirmed the outcomes of children LFU. Predictors of attrition included younger age, shorter duration of time on ART, and severe immunosuppression. In conclusion, significant attrition occurs in children in the first 12 months after ART initiation, the majority attributed to LFU, although true outcomes of children labeled as LFU are unknown. Focused efforts to ensure retention and minimize early mortality are needed as universal ART for children is scaled up.

  19. Evaluation of the Impact of Anti-Retroviral Therapy on the Prevalence of Oral Lesions in Human Immunodeficiency Virus Infected Patients

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    P. Davoodi

    2013-10-01

    Full Text Available Introduction & Objective: Oral lesions have important diagnostic and prognostic roles in HIV infected patients. It seems that HAART reduces the prevalence of oral lesions. The aim of the present study was to evaluate the prevalence of oral lesions in HIV infected patients on/not on HAART. Materials & Methods: In this retrospective study, 40 HIV infected patients receiving HAART and 40 who were not on HAART were evaluated in Behavioral Consultation Center in Kermanshah. The diagnosis of the oral lesions was recorded by using established presump-tive clinical criteria. Data were gathered and analyzed using SPSS version 16 by chi-square test. Results: In the current study 80 HIV infected patients with mean age of 38.86 were chosen. 72.5% and 27.5% of participants were male and female respectively. The most common le-sions in those receiving HAART were hairy leukoplakia, hairy tongue and oral pigmentation. However the prevalence of these lesions had declined in comparison to those who were not on HAART but the difference was not significant (P>0.05. Although comparing lesions in the two groups showed no significant difference, the total number of lesions significantly reduced in patients receiving HAART (P=0.046 Conclusion: According to the results of the present study using anti retroviral therapy leaded to reduction in the oral lesions in HIV infected patients. However, more research in this field seems necessary. (Sci J Hamadan Univ Med Sci 2013; 20 (3:215-222

  20. Cost estimates of HIV care and treatment with and without anti-retroviral therapy at Arba Minch Hospital in southern Ethiopia

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    Robberstad Bjarne

    2009-04-01

    Full Text Available Abstract Background Little is known about the costs of HIV care in Ethiopia. Objective To estimate the average per person year (PPY cost of care for HIV patients with and without anti-retroviral therapy (ART in a district hospital. Methods Data on costs and utilization of HIV-related services were taken from Arba Minch Hospital (AMH in southern Ethiopia. Mean annual outpatient and inpatient costs and corresponding 95% confidence intervals (CI were calculated. We adopted a district hospital perspective and focused on hospital costs. Findings PPY average (95% CI costs under ART were US$235.44 (US$218.11–252.78 and US$29.44 (US$24.30–34.58 for outpatient and inpatient care, respectively. Estimates for the non-ART condition were US$38.12 (US$34.36–41.88 and US$80.88 (US$63.66–98.11 for outpatient and inpatient care, respectively. The major cost driver under the ART scheme was cost of ART drugs, whereas it was inpatient care and treatment in the non-ART scheme. Conclusion The cost profile of ART at a district hospital level may be useful in the planning and budgeting of implementing ART programs in Ethiopia. Further studies that focus on patient costs are warranted to capture all patterns of service use and relevant costs. Economic evaluations combining cost estimates with clinical outcomes would be useful for ranking of ART services.

  1. Comparison of anti-retroviral therapy treatment strategies in prevention of mother-to-child transmission in a teaching hospital in Ethiopia.

    Science.gov (United States)

    Kumela, Kabaye; Amenu, Demisew; Chelkeba, Legese

    2015-01-01

    More than 90% of Human immunodeficiency virus (HIV) infection in children is acquired due to mother-to-child transmission, which is spreading during pregnancy, delivery or breastfeeding. To determine the effectiveness of highly active antiretroviral and short course antiretroviral regimens in prevention of mother-to-child transmission of HIV and associated factors Jimma University Specialized Hospital (JUSH). A hospital based retrospective cohort study was conducted on HIV infected pregnant mothers who gave birth and had follow up at anti-retroviral therapy (ART) clinic for at least 6 months during a time period paired with their infants. The primary and secondary outcomes were rate of infant infection by HIV at 6 weeks and 6 months respectively. The Chi-square was used for the comparison of categorical data multivariate logistic regression model was used to identify the determinants of early mother-to-child transmission of HIV at 6 weeks. Cox proportional hazard model was used to analyze factors that affect the 6 month HIV free survival of infants born to HIV infected mothers. A total of 180 mother infant pairs were considered for the final analysis, 90(50%) mothers received single dose nevirapine (sdNVP) designated as regimen-3, 67 (37.2%) mothers were on different types of ARV regimens commonly AZT + 3TC + NVP (regimen-1), while the rest 23 (12.8%) mothers were on short course dual regimen AZT + 3TC + sdNVP (regimen-2). Early mother-to-child transmission rate at 6 weeks for regimens 1, 2 and 3 were 5.9% (4/67), 8.6% (2/23), and 15.5% (14/90) respectively. The late cumulative mother-to-child transmission rate of HIV at 6 months regardless of regimen type was 15.5% (28/180). Postnatal transmission at 6 months was 28.5% (8/28) of infected children. Factors that were found to be associated with high risk of early mother-to-child transmission of HIV include duration of ARV regimen shorter than 2 months during pregnancy (OR=4.3, 95%CI =1.38-13.46), base line CD4 less

  2. Tendências da epidemia de Aids no Brasil após a terapia anti-retroviral AIDS epidemic trends after the introduction of antiretroviral therapy in Brazil

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    Inês Dourado

    2006-04-01

    from 1990 to 2003 using the Ministry of Health's databases. Exponential regression models adjusted to the 1990-1996 trends were used to estimate expected values for the entire period. RESULTS: The proportion of AIDS hospitalizations has not changed over the study period but there was a decrease in hospitalizations among those using ARV therapy. There was a 2.7 growth in those receiving Highly Active Anti-Retroviral Therapy (HAART from 1997 to 2003. HIV/AIDS incidence and mortality rates rose up to 1995 in all regions. From 1996, there has been a gradual reduction in mortality rates while incidence rates have increased. In all regions, except in the Northern region, expected incidence rates have been greater than the observed ones in the last years but these differences were statistically significant only in the Southeastern and Midwestern regions. CONCLUSIONS: The observed trend can be explained by universal access to ARV therapy in Brazil, which had a significant impact on HIV/AIDS mortality. But other factors, such as years of epidemic, prevention actions, knowledge on HIV/AIDS, years of schooling, need to be considered as well.

  3. Incubation periods under various anti-retroviral therapies in homogeneous mixing and age-structured dynamical models: A theoretical approach

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    Rao, Arni S R Srinivasa

    2008-01-01

    Abstract. We consider previously well-known models in epidemiology where the parameter for incubation period is used as one of the important components to explain the dynamics of the variables. Such models are extended here to explain the dynamics with respect to a given therapy that prolongs the incubation period. A deconvolution method is demonstrated for estimation of parameters in the situations when no-therapy and multiple therapies are given to the infected population. The models and deconvolution method are extended in order to study the impact of therapy in age-structured populations. A generalisation for a situation when n-types of therapies are available is given.

  4. Rinossinusites em crianças infectadas pelo HIV sob terapia anti-retroviral Rhinosinusitis in HIV-infected children undergoing antiretroviral therapy

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    Carlos Diógenes Pinheiro Neto

    2009-02-01

    Full Text Available A associação dos inibidores de protease (IP à terapia anti-retroviral provocou mudanças importantes na morbidade e mortalidade de pacientes infectados pelo HIV. OBJETIVOS: Avaliar o impacto desta associação na prevalência de rinossinusite (RS e na contagem sérica de linfócitos CD4 em crianças infectadas pelo HIV. CASUÍSTICA E MÉTODOS: A forma de estudo foi cross-sectional com 471 crianças infectadas pelo HIV. Em 1996, inibidores de protease foram liberados para terapia anti-retroviral. Desta forma, dois grupos de crianças foram formados: as que não fizeram uso de IP e as que fizeram uso desta droga após 1996. A prevalência de RS e a contagem sérica de linfócitos CD4 foram comparadas entre estes grupos. RESULTADOS: 14,4% das crianças infectadas pelo HIV apresentaram RS. A RS crônica foi mais prevalente que a RS aguda em ambos os grupos. Crianças menores de 6 anos tratadas com a associação de IP apresentaram maior prevalência de RS aguda. A associação de IP esteve associada à maior contagem de linfócitos CD4 séricos com menor prevalência de RS crônica. CONCLUSÕES: A terapia com IP esteve associada ao aumento na contagem de linfócitos CD4. Crianças abaixo dos 6 anos em uso de IP apresentaram menor tendência à cronificação da doença.The association of protease inhibitors (PI to antiretroviral therapy has generated sensible changes in morbidity and mortality of HIV-infected patients. AIM: Aims at evaluating the impact of this association on the prevalence of rhinosinusitis (RS and CD4+ lymphocyte count in HIV-infected children. METHODS: Retrospective cross-sectional study of the medical charts of 471 HIV-infected children. In 1996, protease inhibitors were approved for use as an association drug in antiretroviral therapy. Children were divided into two groups: one which did not receive PI and another which received PI after 1996. The prevalence of RS and CD4+ lymphocyte counts were compared between these groups

  5. Effect of concurrent use of anti-retroviral therapy and levonorgestrel sub-dermal implant for contraception on CD4 counts: a prospective cohort study in Kenya

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    David Hubacher

    2013-03-01

    Full Text Available Introduction: Simultaneous use of contraceptive hormones and anti-retroviral therapy (ART may theoretically lessen the effectiveness of both. Women on ART need assurance that hormonal contraception is safe and effective. The sub-dermal implant is an ideal product to study: low and steady progestin release and no adherence uncertainties. We sought to determine if the medications’ effectiveness is compromised. Methods: We conducted a prospective cohort study among women on first line ART (stavudine or zidovudine and lamivudine+nevirapine. We recruited new implant users and matched them to women not using hormonal contraception, based on age and baseline CD4. Participants were followed prospectively for up to two years, recording serial CD4 measures and medical histories. We used generalized growth curve models and Wald chi-square tests to compare changes in CD4 counts across study groups. Prospective CD4 measures were censored (excluded if any of the following events occurred: change in ART, implant removal or use of any hormonal contraception among controls. We examined incidence of opportunistic infection and pregnancy. Results: We matched 48 implant users to 33 non-hormonal controls. Over time, CD4 counts for both groups rose slightly but did not deviate significantly from each other (p=0.44. Opportunistic infection rates did not differ between the groups. None of the implant users and one of the non-hormonal controls became pregnant during follow-up. Conclusions: This small study found concurrent use of contraceptive implants and ART to be safe and effective. Although other hormonal contraceptive products and ART regimens may interact in unknown ways, the results of this study are reassuring.

  6. Evaluation of oral manifestations and oral health status among pediatric human immunodeficiency virus patients-under anti-retroviral therapy: A cross-sectional study

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    Monika Aroquiadasse

    2016-01-01

    Full Text Available Introduction: The human immunodeficiency virus (HIV acquired immunodeficiency syndrome disease has evolved to become a social and economic catastrophe, with far-reaching implications affecting every phase of life of the diseased individual. Data on adults and children diagnosed with HIV infection are useful for determining populations needing prevention and treatment services. Oral lesions may be the presenting symptoms of HIV infection and may differ entirely from those manifested in the adult population. Aim and Objective: We aimed to evaluate the prevalence of HIV related oral lesions among pediatric HIV patients and to assess the oral health status of HIV infected children residing in a selected childcare facility in Puducherry. Materials and Methods: A cross-sectional study was conducted during September 2015 in child care facility for HIV infected children located in Puducherry U.T, India. All children <18 years, who are diagnosed with HIV infection and are put on anti-retroviral therapy (ART or pre-ART care, were included in the study. After obtaining informed consent from the care-givers and assent of the children, they were interviewed and examined by a team comprising a qualified dental surgeon and a trained physician. Results: Majority of the children were under first-line ART (73% and were on ART for more than 4 years. The CD4 count of 23 (52.3 was between 500–1000 cells/μL. The recent viral load assay in 32 (72.7 patients was <150/not detected. Tooth decay was the most common oral manifestation with 28 (63.6 being affected. Nonspecific lymphadenopathy 26 (59.1 was the most common coexisting systemic illness. Conclusion: This study proves that constant surveillance by monitoring the general health status, CD4 counts, viral load coupled with stringent ART care has improved the overall quality of life of these children and consequently resulted in lesser oral manifestations.

  7. Adherence to anti-retroviral therapy & factors associated with it: A community based cross-sectional study from West Bengal, India

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    Sobha Pahari

    2015-01-01

    Full Text Available Background & objectives: Failure to adhere to anti-retroviral therapy (ART can lead to a range of unfavourable consequences impacting upon people living with HIV (PLH and society. It is, therefore, paramount that ART adherence is measured in a reliable manner and factors associated with adherence are identified. Lack of such data from West Bengal necessitated undertaking the current study. Methods: Participants were included during August-October, 2011 from three Drop-In-Centres (DICs from the three districts of West Bengal, India. ART-adherence was calculated by using formula based on pill-count and records collected from ART-card in possession of each of the 128 consenting adult PLH. Information on self-reported adherence, socio-demography, and adherence influencing issues was also collected through interviewer-administered questionnaire. Results: Of the 128 PLH, 99 (77% and 93 (73% PLH had ≥90 per cent and ≥95 per cent adherence, respectively to ART. Conversely, subjective reporting captured much higher proportion of PLH as ′well adherent′; a finding having implications for ongoing ART programme. Factors, independently associated with poor adherence (<90%, were ′7 th to 12 th month period of ART intake′ (adjusted OR=9.5; 90% CI 1.9 - 47.3; p0 =0.02 and ′non-disclosure of HIV status to family members′ (adjusted OR=4; 90% CI 1.3 - 13; P=0.05. Results at 95 per cent adherence cut-off were similar. Interpretation & conclusions: Enabling environment, which would encourage people to disclose their HIV status and in turn seek adherence partners from families and beyond and ongoing adherence-counselling appear to be important issues in the programme. Relevance of these study findings in wider context is conceivable.

  8. Why do Patients in Pre-Anti Retroviral Therapy (ART) Care Default: A Cross-Sectional Study.

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    Chakravarty, Jaya; Kansal, Sangeeta; Tiwary, Narendra; Sundar, Shyam

    2016-01-01

    Approximately, 40% of the patients registered in the National AIDS Control Program in India are not on antiretroviral therapy (ART), i.e., are in pre-ART care. However, there are scarce data regarding the retention of pre-ART patients under routine program conditions. The main objective of this study was to find out the reasons for default among patients in pre-ART care. Patients enrolled in the ART Centre, Banaras Hindu University (BHU) between January and December 2009 and in pre-ART care were included in the study. Defaulters were those pre-ART patients who missed their last appointment of CD4 count by more than 1 month. Defaulters were traced telephonically in 2011 and those who returned and gave their consent for the study were interviewed using a semi-structured questionnaire. Out of 620 patients in pre-ART care, 384 (68.2%) were defaulters. One hundred forty-four of the defaulters were traced and only 83 reached the ART center for interview. Among defaulters who did not reach the ART center, illiterate and unmarried were significantly more and mean duration from registration to default was also significantly less as compared to those who came back for the interview. Most defaulters gave more than one reason for defaulting that were as follows: Inconvenient clinic timings (98%), need for multiple mode of transport (92%), perceived improved health (65%), distance of center from home (61%), lack of social support (62%), and financial difficulty (59%). Active tracing of pre-ART patients through outreach and strengthening of the Link ART centers will improve the retention of patients in the program.

  9. Mechanisms of leukemogenesis induced by bovine leukemia virus: prospects for novel anti-retroviral therapies in human

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    Burny Arsène

    2007-03-01

    Full Text Available Abstract In 1871, the observation of yellowish nodules in the enlarged spleen of a cow was considered to be the first reported case of bovine leukemia. The etiological agent of this lymphoproliferative disease, bovine leukemia virus (BLV, belongs to the deltaretrovirus genus which also includes the related human T-lymphotropic virus type 1 (HTLV-1. This review summarizes current knowledge of this viral system, which is important as a model for leukemogenesis. Recently, the BLV model has also cast light onto novel prospects for therapies of HTLV induced diseases, for which no satisfactory treatment exists so far.

  10. Use of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic review.

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    Matthew Arentz

    Full Text Available INTRODUCTION: Use of antiretroviral therapy (ART during treatment of drug susceptible tuberculosis (TB improves survival. However, data from HIV infected individuals with drug resistant TB are lacking. Second line TB drugs when combined with ART may increase drug interactions and lead to higher rates of toxicity and greater noncompliance. This systematic review sought to determine the benefit of ART in the setting of second line drug therapy for drug resistant TB. METHODS: We included individual patient data from studies that evaluated treatment of drug-resistant tuberculosis in HIV-1 infected individuals published between January 1980 and December of 2009. We evaluated the effect of ART on treatment outcomes, time to smear and culture conversion, and adverse events. RESULTS: Ten observational studies, including data from 217 subjects, were analyzed. Patients using ART during TB treatment had increased likelihood of cure (hazard ratio (HR 3.4, 95% CI 1.6-7.4 and decreased likelihood of death (HR 0.4, 95% CI 0.3-0.6 during treatment for drug resistant TB. These associations remained significant in patients with a CD4 less than 200 cells/mm(3 and less than 50 cells/mm(3, and when correcting for drug resistance pattern. LIMITATIONS: We identified only observational studies from which individual patient data could be drawn. Limitations in study design, and heterogeneity in a number of the outcomes of interest had the potential to introduce bias. DISCUSSION: While there are insufficient data to determine if ART use increases adverse drug interactions when used with second line TB drugs, ART use during treatment of drug resistant TB appears to improve cure rates and decrease risk of death. All individuals with HIV appear to benefit from ART use during treatment for TB.

  11. Intestinal Parasitosis in Relation to Anti-Retroviral Therapy, CD4(+) T-cell Count and Diarrhea in HIV Patients.

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    Khalil, Shehla; Mirdha, Bijay Ranjan; Sinha, Sanjeev; Panda, Ashutosh; Singh, Yogita; Joseph, Anju; Deb, Manorama

    2015-12-01

    Intestinal parasitic infections are one of the major causes of diarrhea in human immunodeficiency virus (HIV) seropositive individuals. Antiretroviral therapy has markedly reduced the incidence of many opportunistic infections, but parasite-related diarrhea still remains frequent and often underestimated especially in developing countries. The present hospital-based study was conducted to determine the spectrum of intestinal parasitosis in adult HIV/AIDS (acquired immunodeficiency syndrome) patients with or without diarrhea with the levels of CD4(+) T-cell counts. A total of 400 individuals were enrolled and were screened for intestinal parasitosis. Of these study population, 200 were HIV seropositives, and the remaining 200 were HIV uninfected individuals with or without diarrhea. Intestinal parasites were identified by using microscopy as well as PCR assay. A total of 130 (32.5%) out of 400 patients were positive for any kinds of intestinal parasites. The cumulative number of parasite positive patients was 152 due to multiple infections. A significant association of Cryptosporidium (P<0.001) was detected among individuals with CD4(+) T-cell counts less than 200 cells/μl.

  12. Accelerated Failure Time Shared Frailty Models: Application to HIV/AIDS Patients on Anti-Retroviral Therapy in Delhi, India

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    Prafulla Kumar SWAIN

    2016-04-01

    Full Text Available Objective: The present paper demonstrates the applications of Accelerated Failure Time (AFT model with gamma and inverse Gaussian frailty distributions to estimate the effect of prognostic factors on the survival of HIV/AIDS patients undergoing Antiretroviral Therapy (ART in Delhi, India. Material and Methods: The results of both these models have been compared to without frailty model. Akaike Information Criterion (AIC and Bayesian Information criterion (BIC have been used to select best model for HIV/AIDS data. Results: The prognostic factors sex, mode of transmission, baseline hemoglobin and weight are found to be statistically significant (P-value <0.05 for HIV/AIDS patients on ART. Gamma shared frailty model with lognormal as baseline distribution is found to be the best model for HIV/AIDS patients. The model also reflected there is strong evidence of high degree of heterogeneity in the HIV/AIDS patients. Conclusion: Therefore shared frailty model is an appropriate approach for analyzing the HIV/AIDS data than without frailty model.

  13. 艾滋病高效抗反转录病毒治疗后并发血脂代谢异常的干预研究%Intervention Study on the Abnormal Metabolism of Lipid Metabolism in the Treatment of HIV/AIDS with High Effective Anti Retroviral Therapy

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    李雪琴

    2015-01-01

    Highly effective anti retroviral therapy can effectively inhibit viral replication and reduce the mortality of AIDS. But antiviral treatment can affect fatty acid binding protein, lipid metabolism and lipid in the liver cells and abnormal deposition of destruction and lead to abnor-mal lipid metabolism and lipid metabolism in different often increases the risk of cardiovascular and cerebrovascular disease. Therefore, the use of highly effective anti retroviral therapy for pa-tients with abnormal lipid metabolism in patients with abnormal blood lipids should be active in-tervention.In this article, the corresponding intervention measures of the abnormal lipid metabolism in the treatment of HIV/AIDS with high efficiency and anti retroviral virus were reviewed.%高效抗反转录病毒治疗可以有效抑制病毒复制,降低艾滋病的病死率. 但是抗病毒治疗可以影响脂肪酸结合蛋白、破坏脂质代谢、脂质在肝细胞内异常沉积,导致脂质代谢异常,而血脂代谢异常常增加心脑血管疾病风险. 因此,对采用高效抗反转录病毒方法治疗后并发血脂代谢异常的艾滋病患者应进行积极干预. 本文综述了艾滋病高效抗反转录病毒治疗后出现血脂代谢异常的相应干预措施,阐述了有效改善此类患者血脂代谢异常的临床方法.

  14. Who has access to counseling and testing and anti-retroviral therapy in Malawi – an equity analysis

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    Banda Talumba

    2009-05-01

    Full Text Available Abstract Background The HIV and AIDS epidemic in Malawi poses multiple challenges from an equity perspective. It is estimated that 12% of Malawians are living with HIV or AIDS among the 15-49 age group. This paper synthesises available information to bring an equity lens on Counselling and Testing (CT and Antiretroviral Therapy (ART policy, practice and provision in Malawi. Methods A synthesis of a wide range of published and unpublished reports and studies using a variety of methodological approaches was undertaken. The analysis and recommendations were developed, through consultation with key stakeholders in Malawi. Findings At the policy level Malawi is unique in having an equity in access to ART policy, and equity considerations are also included in key CT documents. The number of people accessing CT has increased considerably from 149,540 in 2002 to 482,364 in 2005. There is urban bias in provision of CT and more women than men access CT. ART has been provided free since June 2004 and scale up of ART provision is gathering pace. By end December 2006, there were 85,168 patients who had ever started on ART in both the public and private health sector, 39% of the patients were male while 61% were female. The majority of patients were adults, and 7% were children, aged 14 years or below. Despite free ART services, patients, especially poor rural patients face significant barriers in access and adherence to services. There are missed opportunities in strengthening integration between CT and ART and TB, Sexually Transmitted Infections (STI and maternal health services. Conclusion To promote equitable access for CT and ART in Malawi there is need to further invest in human resources for health, and seize opportunities to integrate CT and ART services with tuberculosis, sexually transmitted infections and maternal health services. This should not only promote access to services but also ensure that resources available for CT and ART strengthen

  15. Impact of highly active antiretroviral therapy (HAART on the incidence of opportunistic infections, hospitalizations and mortality among children and adolescents living with HIV/AIDS in Belo Horizonte, Minas Gerais State, Brazil Impacto da terapia anti-retroviral de alta potência (HAART na incidência de infecções oportunistas, hospitalização e mortalidade associadas em crianças e adolescentes vivendo com HIV/AIDS em Belo Horizonte, Minas Gerais, Brasil

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    Talitah M. S. Candiani

    2007-01-01

    Full Text Available The impact of highly active antiretroviral therapy (HAART can be evaluated using indicators, such as rates of opportunistic infections, hospitalizations by cause of infection, and associated death. This study aimed to estimate the impact of HAART on the incidence of these indicators, in children and adolescents with HIV/AIDS. It was a hybrid cohort study; 371 patients were followed from 1989 to 2003. In December 2003, 76% of the patients were still being followed, while 12.1% had died, 9.5% had dropped out, and 2.4% had been transferred. The overall rate of opportunistic infections was 18.32 infections/100 persons-year and 2.63 in the pre- and post-HAART periods, respectively. In the multivariate analysis, the risk of developing an opportunistic infection was 5.4 times greater and 3.3 times greater for hospitalization risk before HAART. Respiratory causes represented 65% of the hospitalizations and they were reduced by 44.6% with therapeutic intervention. The average hospital stay of 15 days was reduced to 9.There was a post-HAART decline in deaths of 38%. This study demonstrates the effectiveness of HAART in significantly reducing opportunistic infections, hospitalizations, and deaths in this Brazilian cohort.O impacto da terapia anti-retroviral de alta potência ativa (HAART pode ser avaliado utilizando-se indicadores, como taxas de incidências de infecções oportunistas, hospitalizações por causas infecciosas e mortalidade associada. O objetivo deste trabalho foi estimar o impacto da HAART na incidência desses indicadores em crianças e adolescentes com HIV/AIDS. Trata-se de uma coorte híbrida, na qual foram acompanhados 371 pacientes no período de 1989-2003. Em dezembro de 2003, 76% dos pacientes permaneciam em acompanhamento, 12,1% faleceram, 9,5% foram perda de seguimento e 2,4% transferidos. A taxa de incidência global de infecções oportunistas foi de 18,32 infecções/100 pessoas-ano e 2,63 nos períodos pré e p

  16. 人类免疫缺陷病毒感染者混合感染丙型和乙型肝炎病毒后对高效抗逆转录病毒治疗疗效的影响%The influence of human immunodeficiency virus co-infection with hepatitis C virus and hepatitis B virus on the efficacy of high active anti-retroviral therapy

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    李晓菲; 阚全程; 何云; 余祖江; 李志勤; 梁红霞

    2010-01-01

    Objective To evaluate the impact of HIV co-infection with HCV or HBV on the efficacy of highly active anti-retroviral therapy (HARRT). Methods The patients were divided into three groups: HIV + HBV + HCV co-infection group ( 23 patients), HIV + HCV co-infection group ( 166 patients), and HIV-only group (178 patients). HIV RNA, HCV RNA or HBV DNA were detected by real time PCR before treatment and 1,3,6,9 and 12 monthes after treatment, meanwhile the counts of CD4+ T lymphocyte and liver function including ALT, AST and TBil were tested. Results During one-year HAART, HIV RNA of HIV-only group, HIV + HBV + HCV co-infection group and HIV + HCV co-infection group decreased significantly from (6.78 ± 1.08), (6.23 ± 1.34), (6.54 ± 1.23) lg copies/ml to (0.53 ±0.15), (0.67 ±0.16),(0.43 ±0.11 ) lg copies/ml respectively (P<.001 ). And CD4+ T lymphocyte counts of the three groups elevated significantly from ( 197 ± 127), (184 ± 113), (213 ± 143) cells/μl to (382 ±74), (383 ±70),(378 ±76) cells/μl respectively (P <0.001 ). However there were no differences among the three groups in HIV RNA and CD4+ T lymphocyte counts. There were no differences in liver functions including ALT,AST and TBil among the three groups. Conclusiom HIV co-infected with HBV and/or HCV does not impact on the efficacy of HAART. What more, HAART does not impact HCV replication.%目的 观察HIV感染者合并HCV和HBV感染后对高效抗逆转录病毒治疗(HAART)疗效的影响.方法 对某地区HIV、HCV共感染患者166例(HIV+HCV组),HIV、HCV和HBV混合感染患者23例(H1V+HCV+HBV组)及单纯HIV感染者178例,给予1年的HAART治疗,观察3组患者病毒学反应、免疫学反应和肝功能动态变化.以流式细胞仪检测外周血CD4+T淋巴细胞;实时PCR定量检测HCV、HIV和HBV病毒载量.结果 单纯HIV感染组、HIV+HCV+HBV组和HIV+HCV组经HAART 1年后,HIV病毒载量分别由治疗前(6.78±1.08)、(6.23±1.34)、(6.54±1.23)lg拷贝/ml下降至(0

  17. Acceptance of anti-retroviral therapy among patients infected with HIV and tuberculosis in rural Malawi is low and associated with cost of transport.

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    Rony Zachariah

    Full Text Available BACKGROUND: A study was conducted among newly registered HIV-positive tuberculosis (TB patients systematically offered anti-retroviral treatment (ART in a district hospital in rural Malawi in order to a determine the acceptance of ART b conduct a geographic mapping of those placed on ART and c examine the association between "cost of transport" and ART acceptance. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cross-sectional analysis was performed on routine program data for the period of February 2003 to July 2004. Standardized registers and patient cards were used to gather data. The place of residence was used to determine road distances to the Thyolo district hospital. Cost of transport from different parts of the district was based on the known cost for public transport to the road-stop closest to the patient's residence. Of 1,290 newly registered TB patients, 1,003(78% underwent HIV-testing of whom 770 (77% were HIV-positive. 742 of these individuals (pulmonary TB = 607; extra-pulmonary TB = 135 were considered eligible for ART of whom only 101(13.6% accepted ART. Cost of transport to the hospital ART site was significantly associated with ART acceptance and there was a linear trend in association between cost and ART acceptance (chi(2 for trend = 25.4, P<0.001. Individuals who had to pay 50 Malawi Kwacha (1 United States Dollar = 100 Malawi Kwacha, MW or less for a one-way trip to the Thyolo hospital were four times more likely to accept ART than those who had to pay over 100 MW (Adjusted Odds ratio = 4.0, 95% confidence interval: 2.0-8.1, P<0.001. CONCLUSIONS/SIGNIFICANCE: ART acceptance among TB patients in a rural district in Malawi is low and associated with cost of transport to the centralized hospital based ART site. Decentralizing the ART offer from the hospital to health centers that are closer to home communities would be an essential step towards reducing the overall cost and burden of travel.

  18. Adesão e não-adesão à terapia anti-retroviral: as duas faces de uma mesma vivência Adhesión y no adhesión a la terapia antiretroviral: las dos caras de una misma vivencia Adhesion and non adhesion to anti-retroviral therapy: the two faces of a same experience

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    Ana Lúcia Cardoso Nogueira da Silva

    2009-04-01

    Full Text Available O objetivo do estudo foi compreender, a partir da perspectiva de portadores e familiares, os aspectos que influenciam na adesão à terapêutica anti-retroviral. Trata-se de um estudo descritivo, de natureza qualitativa, desenvolvido no período de junho de 2006 a julho de 2007, junto a 10 indivíduos portadores do HIV/Aids, acompanhados pelo Serviço de Atendimento Especializado em Aids de Campo Mourão - PR e seus familiares. Constituem fatores facilitadores da adesão: adoção de estratégias para lembrar horários e mascarar o gosto do medicamento, ausência de efeitos colaterais, número reduzido de medicamentos a serem ingeridos e capacidade para reconhecê-los, lembrança dos sintomas da doença e o apoio da rede social. A ausência destes fatores pode culminar na não-adesão.El objetivo del estudio fue comprender, a partir de la perspectiva de portadores y familiares, los aspectos que influyen en la adhesión a la terapéutica antiretroviral. Se trata de un estudio descriptivo, de naturaleza cualitativa, desarrollado en el período de junio de 2006 a julio de 2007, junto a 10 individuos portadores del VIH/SIDA, acompañados por el Servicio de Atención Especializado en SIDA de Campo Mourão - PR y sus familiares. Constituyen factores que facilitan la adhesión: adopción de estrategias para recordar horarios y enmascarar el sabor del medicamento, ausencia de efectos colaterales, número reducido de medicamentos a ser ingeridos y capacidad para reconocerlos, recuerdo de los síntomas de la enfermedad y el apoyo de la red social. La ausencia de estos factores puede culminar en la no-adhesión.The objective of the study was to understand, from the perspective of HIV bearers and family, the aspects that influence in the adhesion to the antiretroviral therapy. It is a descriptive study, of qualitative nature, carried out from June 2006 to July 2007, with 10 HIV/Aids positive individuals, attended at the Service of Specialized Care on Aids

  19. Adesão à terapia antiretroviral para HIV/AIDS Adhesión a la terapia anti-retroviral para el vih/sida Adherence to the antiretroviral therapy for HIV/AIDS

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    Maria Rosa Ceccato Colombrini

    2006-12-01

    Full Text Available A não-adesão à terapêutica antiretroviral altamente eficaz (HAART é considerada, no plano individual, como um dos mais ameaçadores perigos para a efetividade do tratamento da pessoa com HIV/aids e para a disseminação de vírus-resistência, no plano coletivo. Assim, o objetivo deste estudo foi analisar, mediante revisão de literatura, os fatores de risco para não-adesão à HAART, além de agrupá-los e relacioná-los à pessoa em tratamento, à doença, ao tratamento e ao serviço de saúde e suporte social. A literatura aponta para a necessidade da realização de estudos que avaliem aspectos socioculturais, crenças, qualidade do serviço prestado, relações do cliente com a equipe multiprofissional e outros referentes à raça e aos efeitos colaterais dos anti-retrovirais. Estes estudos visam a favorecer o estabelecimento de estratégias que melhorem a adesão dos clientes à HAART, ao mesmo tempo em e que contribuem para a construção e exercício da cidadania.La no adhesión a la terapéutica anti-retroviral altamente eficaz (HAART es considerada, en el plano individual, como uno de los más amenazadores peligros para la efectividad del tratamiento de la persona con VIH/SIDA y para la diseminación del virus-resistencia, en el plano colectivo. Así, el objetivo de este estudio fue analizar, mediante revisión de la literatura, los factores de riesgo para la no adhesión a la HAART, además de agruparlos y relacionarlos a la persona en tratamiento, a la enfermedad, al tratamiento y al servicio de salud y soporte social. La literatura apunta hacia la necesidad de realizar estudios que evalúen aspectos socioculturales, creencias, calidad del servicio prestado, relaciones del cliente con el equipo multi-profesional y otros referentes a la raza y a los efectos colaterales de los anti-retrovirales. Estos estudios visan a favorecer el establecimiento de estrategias que mejoren la adhesión de los clientes a la HAART, al mismo tiempo

  20. Impact of HIV Infection and Anti-Retroviral Therapy on the Immune Profile of and Microbial Translocation in HIV-Infected Children in Vietnam

    Science.gov (United States)

    Bi, Xiuqiong; Ishizaki, Azumi; Nguyen, Lam Van; Matsuda, Kazunori; Pham, Hung Viet; Phan, Chung Thi Thu; Ogata, Kiyohito; Giang, Thuy Thi Thanh; Phung, Thuy Thi Bich; Nguyen, Tuyen Thi; Tokoro, Masaharu; Pham, An Nhat; Khu, Dung Thi Khanh; Ichimura, Hiroshi

    2016-01-01

    CD4+ T-lymphocyte destruction, microbial translocation, and systemic immune activation are the main mechanisms of the pathogenesis of human immunodeficiency virus type 1 (HIV) infection. To investigate the impact of HIV infection and antiretroviral therapy (ART) on the immune profile of and microbial translocation in HIV-infected children, 60 HIV vertically infected children (31 without ART: HIV(+) and 29 with ART: ART(+)) and 20 HIV-uninfected children (HIV(−)) aged 2–12 years were recruited in Vietnam, and their blood samples were immunologically and bacteriologically analyzed. Among the HIV(+) children, the total CD4+-cell and their subset (type 1 helper T-cell (Th1)/Th2/Th17) counts were inversely correlated with age (all p < 0.05), whereas regulatory T-cell (Treg) counts and CD4/CD8 ratios had become lower, and the CD38+HLA (human leukocyte antigen)-DR+CD8+- (activated CD8+) cell percentage and plasma soluble CD14 (sCD14, a monocyte activation marker) levels had become higher than those of HIV(−) children by the age of 2 years; the CD4/CD8 ratio was inversely correlated with the plasma HIV RNA load and CD8+-cell activation status. Among the ART(+) children, the total CD4+-cell and Th2/Th17/Treg-subset counts and the CD4/CD8 ratio gradually increased, with estimated ART periods of normalization being 4.8–8.3 years, whereas Th1 counts and the CD8+-cell activation status normalized within 1 year of ART initiation. sCD14 levels remained high even after ART initiation. The detection frequency of bacterial 16S/23S ribosomal DNA/RNA in blood did not differ between HIV-infected and -uninfected children. Thus, in children, HIV infection caused a rapid decrease in Treg counts and the early activation of CD8+ cells and monocytes, and ART induced rapid Th1 recovery and early CD8+-cell activation normalization but had little effect on monocyte activation. The CD4/CD8 ratio could therefore be an additional marker for ART monitoring. PMID:27490536

  1. Tendência da transmissão vertical de Aids após terapia anti-retroviral no Brasil Trends in maternal-infant transmission of AIDS after antiretroviral therapy in Brazil

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    Ana Maria de Brito

    2006-04-01

    Full Text Available OBJETIVO: O crescimento de casos de Aids entre mulheres teve como conseqüência o aumento da transmissão vertical da infecção pelo vírus da imunodeficiência adquirida. Medidas de controle dessa modalidade de transmissão foram implementadas a partir de 1996. O objetivo do estudo foi analisar a tendência temporal da transmissão vertical de Aids em crianças brasileiras. MÉTODOS: Foram incluídas no estudo crianças nascidas entre 1990 e 2001 no Brasil. Utilizou-se o banco de casos notificados como Aids em menores de 13 anos, no período de 1990 a 2004. Modelos de regressão exponencial, ajustados à série temporal, forneceram as taxas de variação anual e os valores observados e esperados para todo o período. RESULTADOS: Observou-se tendência significativamente crescente para os casos com ano de nascimento no período anterior à introdução da terapia anti-retroviral, com taxa de crescimento em torno de 12% (tOBJECTIVE: the increase in the number of AIDS cases among women has lead to an increase in the maternal-infant transmission of human acquired immunodeficiency virus. Measures for the control of this type of transmission were implemented in Brazil in 1996. The aim of the present study was to analyze time trends in maternal-infant transmission of AIDS among Brazilian children. METHODS: The present study included children born in Brazil between 1990 and 2001. We used the database of notified AIDS cases in children 13 years of age or younger between 1990 and 2004. Exponential regression models adjusted to the time series provided the annual variation rates and observed and expected values for the period. RESULTS: We found a significant increasing trend for cases born prior to the year in which anti retroviral therapy was introduced, with an increase rate of about 12% (t<0.003 per year. Rates from different states ranged from 5.9% to 31%. The analysis of expected and observed cases for each of the country's five Regions showed a

  2. Retinal arterioles narrow with increasing duration of anti-retroviral therapy in HIV infection: a novel estimator of vascular risk in HIV?

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    Sophia Pathai

    Full Text Available OBJECTIVES: HIV infection is associated with an increased risk of age-related morbidity mediated by immune dysfunction, atherosclerosis and inflammation. Changes in retinal vessel calibre may reflect cumulative structural damage arising from these mechanisms. The relationship of retinal vessel calibre with clinical and demographic characteristics was investigated in a population of HIV-infected individuals in South Africa. METHODS: Case-control study of 491 adults ≥30 years, composed of 242 HIV-infected adults and 249 age- and gender-matched HIV-negative controls. Retinal vessel calibre was measured using computer-assisted techniques to determine mean arteriolar and venular diameters of each eye. RESULTS: The median age was 40 years (IQR: 35-48 years. Among HIV-infected adults, 87.1% were receiving highly active antiretroviral therapy (HAART (median duration, 58 months, their median CD4 count was 468 cells/µL, and 84.3% had undetectable plasma viral load. Unadjusted mean retinal arteriolar diameters were 163.67±17.69 µm in cases and 161.34±17.38 µm in controls (p = 0.15. Unadjusted mean venular diameters were 267.77±18.21 µm in cases and 270.81±18.98 µm in controls (p = 0.07. Age modified the effect of retinal arteriolar and venular diameters in relation to HIV status, with a tendency towards narrower retinal diameters in HIV cases but not in controls. Among cases, retinal arteriolar diameters narrowed with increasing duration of HAART, independently of age (167.83 µm 6 years, p-trend = 0.02, and with a HIV viral load >10,000 copies/mL while on HAART (p = 0.05. HIV-related venular changes were not detected. CONCLUSIONS: Narrowing of retinal arteriolar diameters is associated with HAART duration and viral load, and may reflect heightened inflammatory and pro-atherogenic states of the systemic vasculature. Measurement of retinal vascular calibre could be an innovative non-invasive method of estimating vascular risk in HIV

  3. Effect of anti retroviral therapy (ART) on CD4 T lymphocyte count and the spectrum of opportunistic infections in HIV/AIDS in Manipur.

    Science.gov (United States)

    Chitra, Yengkokpam; Urgen, Sherpa; Dayananda, Ingudam; Brajachand, Singh Ng

    2009-03-01

    Reports of variable response to antiretroviral therapy as indicated by CD4 count has been of concern as facilities for viral load estimation/drug resistance testing is not available everywhere. Hence the present study. was done to assess the magnitude of problem in high prevalence state of Manipur as evidenced by the CD4 T lymphocyte count. It was also prudent to study various OIs as extensive awareness campaigns about HIV and related morbidity with support system has been undertaken since the last decade. The study revealed that HAART must be used judiciously as 17.3% showed no improvement in CD4 T lymphocyte count. Among opportunistic infections, fungal infections predominatd in HIV/AIDS.

  4. Reasons Why High Religiosity Can Co-exist with and Precipitate Discontinuation of Anti-retroviral Therapy among Different HIV Clients in Uganda: An Exploratory Study.

    Science.gov (United States)

    Tumwine, Christopher; Neema, Stella; Wagner, Glenn

    2012-01-01

    In-depth interviews were conducted with 39 very religious people living with HIV (16 had ever and 23 had never discontinued antiretroviral therapy-ART) to assess the role of religion in these treatment decisions and in coping with HIV. Participants who had ever discontinued ART gave reasons such as: teachings and prophecies from religious leaders, and supporting Biblical scriptures all of which led them to feel that God and their faith, not ART, would help them; and testimonies by their "already healed" peers who had stopped ART. Participants who had never discontinued ART gave reasons such as continuous adherence counseling from multiple sources, improvement in physical health as a result of ART, and beliefs that God heals in different ways and that non-adherence is equal to putting God to a test. High religiosity was reported to help participants cope with HIV through engagement in personal and or community protective behaviours, "taking care of other illness", and reducing worries. When high religiosity among people living with HIV (PHAs) becomes a barrier to ART adherence, the adherence counseling provided can draw on experiences of PHAs with high religiosity who have sustained good adherence to ART and achieved good health outcomes.

  5. Associated oral lesions in human immunodefeciency virus infected children of age 1 to 14 years in anti retroviral therapy centers in Tamil Nadu

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    R Krishna Kumar

    2013-01-01

    Full Text Available Aim: To evaluate the prevalence of oral lesions status in human immunodeficiency virus (HIV infected children of age 1 to 14 years in Anti Retro viral therapy (ART centres in Tamil Nadu. Materials and Methods: A of total 326 HIV infected children, age 1 to 14 years of which 174 male children and 152 female children were examined for Oral lesions in the Department of Pedodontics and Preventive Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University in association with the ART centers in Villupuram, Vellore and HIV Homes in Thiruvannamalai, Trichy and Salem in Tamil Nadu towns. Statistical Analysis: Statistical Package for Social Science for Windows (version 11 code: 3000135939012345. Result: Of the total 326 children, 201 (61.65% had oral lesions. (68 [20.86%] with Oral Candidiasis [OC], 54 [16.56%] with Angular Cheilitis, 27 [8.28%] with Necrotizing Ulcerative Gingivitis [NUG], 25 [7.66%] with Necrotizing Ulcerative Periodontitis [NUP], 18 [5.53%] with Linear Gingival Erythema [LGE] and 9 [2.76%] with Apthous Ulcer. Conclusion Among the oral lesions in HIV infected children, OC 20.86% was the predominant oral lesion followed by Angular Chelitis 16.56%, NUG 8.28%, NUP 7.66%, LGE5.53% and Apthous Ulcer 2.76%.

  6. HIV associated neurocognitive disorders (HAND in Malawian adults and effect on adherence to combination anti-retroviral therapy: a cross sectional study.

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    Christine M Kelly

    Full Text Available Little is known about the prevalence and burden of HIV associated neurocognitive disorder (HAND among patients on combination antiretroviral therapy (cART in sub-Saharan Africa. We estimated the prevalence of HAND in adult Malawians on cART and investigated the relationship between HAND and adherence to cART.HIV positive adults in Blantyre, Malawi underwent a full medical history, neurocognitive test battery, depression score, Karnofsky Performance Score and adherence assessment. The Frascati criteria were used to diagnose HAND and the Global Deficit Score (GDS was also assessed. Blood was drawn for CD4 count and plasma nevirapine and efavirenz concentrations. HIV negative adults were recruited from the HIV testing clinic to provide normative scores for the neurocognitive battery.One hundred and six HIV positive patients, with median (range age 39 (18-71 years, 73% female and median (range CD4 count 323.5 (68-1039 cells/µl were studied. Symptomatic neurocognitive impairment was present in 15% (12% mild neurocognitive disorder [MND], 3% HIV associated dementia [HAD]. A further 55% fulfilled Frascati criteria for asymptomatic neurocognitive impairment (ANI; however factors other than neurocognitive impairment could have confounded this estimate. Neither the symptomatic (MND and HAD nor asymptomatic (ANI forms of HAND were associated with subtherapeutic nevirapine/efavirenz concentrations, adjusted odds ratio 1.44 (CI. 0.234, 8.798; p = 0.696 and aOR 0.577 (CI. 0.09, 3.605; p = 0.556 respectively. All patients with subtherapeutic nevirapine/efavirenz levels had a GDS of less than 0.6, consistent with normal neurocognition.Fifteen percent of adult Malawians on cART had a diagnosis of MND or HAD. Subtherapeutic drug concentrations were found exclusively in patients with normal neurocognitive function suggesting HAND did not affect cART adherence. Further study of HAND requires more robust locally derived normative neurocognitive values and

  7. Therapeutic drug monitoring of indinavir and nelfinavir to assess adherence to therapy in human immunodeficiency virus-infected children

    NARCIS (Netherlands)

    Van Rossum, AMC; Bergshoeff, AS; Fraaij, PLA; Hugen, PWH; Hartwig, NG; Geelen, SPM; Wolfs, TFW; Weemaes, CMR; De Groot, R; Burger, DM

    2002-01-01

    Introduction. Adherence to highly active anti-retroviral therapy is required to obtain an optimal long term virologic response rate of HIV-1-infected children. Plasma concentrations of protease inhibitors (PIs) outside the limits of the reference values indicate nonadherence to anti-retroviral thera

  8. AIDS na infância: acometimento cardíaco com e sem a terapia anti-retroviral tríplice combinada AIDS in childhood: cardiac involvement with and without triple combination antiretroviral therapy

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    Maria do Carmo Soares Alves Cunha

    2008-01-01

    Full Text Available OBJETIVO: Descrever a prevalência de alterações cardíacas ao ecocardiograma em crianças com AIDS acompanhadas em serviço de referência aos 18±6 meses do diagnóstico confirmado de AIDS. MÉTODOS: Estudo transversal, com corte aos 18±6 meses do diagnóstico de AIDS. Incluídas 93 crianças com diagnóstico confirmado de AIDS por transmissão vertical, sem doença maligna, que, na avaliação cardiológica, realizaram ecocardiograma (eco. De forma exploratória avaliaram-se as alterações cardíacas nos pacientes sem uso (G1 e com uso (G2 de terapia combinada anti-retroviral. RESULTADOS: Quando do diagnóstico de AIDS, as crianças tinham em média 3,07 anos e 50,50% eram do sexo feminino. Esquema de terapia combinado com anti-retrovirais foi utilizado por 47 pacientes (G2. O acometimento cardíaco esteve presente em 40 crianças (43,00%. A presença de disfunção ventricular esquerda (G1:39,10%;G2:10,60% e o aumento isolado de ventrículo esquerdo (G1:6,60%;G2:14,90% foram os achados mais freqüentes. Observou-se associação significativa entre os grupos sem e com terapia anti-retroviral combinada quanto à presença de disfunção ventricular esquerda (RP=3,42; [1,41-8,26]; p =0,02 e de desnutrição (RP=1,79; [1,00-3,20]; p=0,04. CONCLUSÃO: O acometimento cardíaco foi freqüente nas crianças com AIDS, sendo a disfunção ventricular esquerda a alteração mais observada ao ecocardiograma. Houve diferença estatisticamente significativa entre os grupos com e sem tratamento tríplice combinado quanto à presença de disfunção ventricular esquerda e de desnutrição.OBJECTIVE: To describe the prevalence of cardiac abnormalities in the echocardiogram of children with AIDS followed up in a reference service at 18±6 months of AIDS confirmed diagnosis. METHODS: A cross-section study with a cohort after 18±6 months of AIDS diagnosis. The study included a total of 93 children with a confirmed diagnosis of AIDS with vertical

  9. Enteropatógenos relacionados à diarréia em pacientes HIV que fazem uso de terapia anti-retroviral Enteropathogens relating to diarrhea in HIV patients on antiretroviral therapy

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    Áurea Regina Telles Pupulin

    2009-10-01

    Full Text Available A etiologia do processo diarréico na AIDS pode ser causada por vírus, bactérias, fungos, protozoários e helmintos, assim como pelo próprio HIV. Este trabalho avaliou enteropatogenos relacionados à diarréia em pacientes HIV que fazem uso de terapia anti-retroviral. Os métodos parasitológicos utilizados foram Faust, Hoffmann e Kinyoun. O isolamento e cultura dos fungos foram realizados conforme metodologia recomendada por NCCLS M27-A standard. A identificação das espécies de leveduras foi realizada através da reação em cadeia da polimerase. O isolamento de bactérias, foi feito em agar Mac Conkey e agar SS, a identificação das espécies através do Enterokit B (Probac do Brasil e métodos bioquímicos. Foram avaliados 49 pacientes, 44,9% apresentaram enteroparasitas, 48,1% Candida sp com 61,5% Candida albicans, 7,6% Candida sp e 30,7% Candida não- albicans. Foram isoladas bactérias de 72% dos pacientes, 49% Escherichia coli, 13% Salmonella parathyphi, Klebsiella sp ou Proteus e 6% Citrobacter freundii ou Yersinia sp. Houve alta prevalência de Candida sp nos pacientes HIV com diarréia e foram isoladas espécies não albicans cuja presença pode ser entendida como cúmplice ou causa da infecção.The etiology of the diarrheic process in AIDS may be caused by viruses, bacteria, fungi, protozoa or helminths, as well as HIV itself. This study evaluated enteropathogens relating to diarrhea in HIV patients who were on antiretroviral therapy. The parasitological methods used were Faust, Hoffmann and Kinyoun. Isolation and culturing of fungi were carried out in accordance with the methodology recommended by the NCCLS M27-A standard. The yeast species were identified using the polymerase chain reaction (PCR. Bacteria were isolated on MacConkey and SS agar and the species were identified using Enterokit B (Probac do Brasil and biochemical methods. Forty-nine patients were evaluated: 44.89% presented enteroparasites and 48.1% presented

  10. Adherence to antiretroviral therapy: a qualitative study with physicians from Rio de Janeiro, Brazil Aderência à terapia anti-retroviral: um estudo qualitativo com médicos no Rio de Janeiro, Brasil

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    Monica Malta

    2005-10-01

    Full Text Available Brazil provides free antiretroviral (ARV therapy to some 150,000 individuals living with HIV/ AIDS. ARV regimens require optimal adherence to achieve undetectable viral loads and to avoid viral resistance. Physicians play a key role to foster ARV adherence, but until now little is known about the communication between physicians/ people living with HIV/AIDS in this setting. In-depth interviews were conducted with 40 physicians treating people living with HIV/AIDS at six public reference centers in Rio de Janeiro, Brazil. Interview topics included: experiences in the treatment of people living with HIV/AIDS, relationship and dialogue with patients, barriers/facilitators to adherence, and effectiveness of available services. Barriers to ARV adherence were mainly related to the low quality of patient-provider relationship. Other barriers were related to "chaotic" patients' lifestyles, and inadequate knowledge and/or negative beliefs about HIV/AIDS and ARV effectiveness. It is necessary to improve networking between services, establish agile referral systems, and improve health professionals' integration. These structural changes could contribute to improved adherence, resulting in improved quality of life for people living with HIV/AIDS.O Brasil fornece gratuitamente terapia anti-retroviral (ARV para cerca de 150 mil pessoas vivendo com HIV/ AIDS. A terapia ARV requer aderência ótima, visando alcançar carga viral indetectável e evitar resistência viral. Os médicos desempenham papel central quanto à aderência à ARV, mas há escassa informação sobre a comunicação entre médicos/pessoas vivendo com HIV/ AIDS. Entrevistas em profundidade foram realizadas com 40 médicos assistentes de seis hospitais de referência do Rio de Janeiro, Brasil. Tópicos da entrevista incluíram: experiências relativas ao tratamento de pessoas vivendo com HIV/AIDS, relacionamento/diálogo com pacientes, barreiras/facilitadores para aderência aos servi

  11. Fatores de risco para a não adesão ao tratamento com terapia antiretroviral altamente eficaz Factores de riesgo para la no-adherencia al tratamiento con terapia anti-retroviral altamente eficiente Risk factors for non-compliance to treatment with highly effective antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Maria Rosa Ceccato Colombrini

    2008-09-01

    Full Text Available O estudo objetivou: mensurar a prevalência de não-adesão à terapia anti-retroviral altamente eficaz (HAART em pacientes com AIDS; identificar se alguns fatores relacionados na literatura estavam associados com a não-adesão; estabelecer o valor preditivo dos fatores associados à não-adesão à HAART. Foi realizado um estudo analítico de prevalência (N=60. Foram considerados os três dias anteriores à entrevista e os pacientes classificados como aderentes quando ingeriam 95% ou mais do total de comprimidos prescritos por dia. A adesão foi de 73,3%. A análise de regressão logística multivariada indicou que indivíduos da raça negra apresentaram 6,48 vezes mais risco de não-adesão; aqueles que apresentaram ausência de efeito colateral tiveram um risco 7,6 vezes maior, e a cada comprimido ingerido o risco foi de 1,12. A adesão observada foi maior que a encontrada na literatura. Os fatores sociodemográficos e culturais podem interferir na adesão à HAART.Objetivo del estudio: medir la prevalencia por falta de seguimiento al tratamiento anti-retroviral altamente eficaz (HAART en pacientes con SIDA; identificar si algunos factores relacionados en la bibliografía se encuentran asociados con la falta de seguimiento; establecer el valor preditivo de los factores asociados con la falta de seguimiento al HAART. Para lo cual fue realizado un estudio analitico de prevalencia (N=60, considerándose los tres días anteriores a la entrevista, donde aquellos pacientes con ingesta del 95% o más del total de comprimidos prescritos por día eran clasificados como seguidores del tratamiento. El seguimiento fue de 73,3%. El análisis de regresion logística multi-variable mostró que sujetos de raza negra presentaron 6,48 veces mayor riesgo de no continuar con el tratamiento; aquellos individuos sin efectos colaterales tuvieron un riesgo 7,6 veces mayor, asimismo, cada comprimido ingerido produjo un riesgo de 1,12. El seguimiento observado fue

  12. 复方新诺明预防治疗对艾滋病患者生存状况的影响%Effect of co-trimoxazole prophylaxis used for AIDS patients under anti-retroviral therapy

    Institute of Scientific and Technical Information of China (English)

    杨文杰; 梁妍; 李洁; 马彦民; 李宁; 孙定勇; 王哲

    2014-01-01

    Objective To analyze the situation of survival among AIDS patients under co-trimoxazole prophylaxis as initial anti-retroviral therapy(ART),in Henan province during 2007-2011. Methods Information on AIDS patients receiving initial ART during 2007-2011 was collected from the Chinese HIV/AIDS Integrated Control System. Kaplan-Meier estimation was used to generate survival curves,and Cox proportional hazard regression model was used to determine associated factors of survival status. According to the previous CTX use before ART,the subjects were divided into 3 groups including who had never taken CTX,who had taken CTX and still taking now,who had taken CTX and not current taking. Results A total of 13 103 eligible AIDS patients were identified. 1 702 patients died within 6 years after the initiation of ART,with the mortality as 4.46/100 person year. Among the 455 patients who died within 3 months and 970 died within 12 months,the mortality rates were 14.15/100 person year and 7.78/100 person year,respectively. The Kaplan-Meier survival curves showed that the survival time and mortality of the patients who had taken CTX was longer AND lower than those patients who had never taken CTX when starting the ART program. Results from the log-rank test showed that the difference of two groups was statistically significant during 12 months after the ART(log-rank=5.15,P=0.02). After controlling for other variables,results from multivariable analysis of COX model showed that factors as age,gender,marital status,perion between confirmed diagnosis and receiving the ART,baseline CD4+T cells count,clinical stage,initial therapy schedule,date when starting the ART,number of symptoms at baseline,use of CTX before starting the ART and ART being skipped in the last seven days etc,were associated with the time of survival in patients after the initiation of ART. Patients who had been taking CTX at ART initiation were at lower risk of death (adjusted HR=0.71,95%CI:0.63-0.80;P=0

  13. Anti-retroviral Therapy Based HIV Prevention Among a Sample of Men Who Have Sex with Men in Cape Town, South Africa: Use of Post-exposure Prophylaxis and Knowledge on Pre-exposure Prophylaxis.

    Science.gov (United States)

    Hugo, J M; Stall, R D; Rebe, K; Egan, J E; De Swardt, G; Struthers, H; McIntyre, J A

    2016-12-01

    Men who have Sex with Men (MSM) have been affected disproportionately by the global HIV pandemic. Rates of consistent condom-use are low and there is a need for further biomedical prevention interventions to prevent new HIV infections. Post exposure prophylaxis (PEP) can reduce the risk of HIV, but uptake among MSM is low. Pre-exposure prophylaxis (PrEP), an innovative anti-retroviral-based HIV prevention tool might be an appropriate intervention for MSM who have recently accessed PEP that involves HIV negative individuals taking daily tenofovir+emtricitabine for HIV prevention. 44 MSM, attending a primary health-care level MSM-focused sexual health clinic in Cape Town, South Africa, who had initiated PEP were enrolled in this study. Participants were followed up after 2, 4 and 12 weeks. Self-administered electronic surveys were completed at the initial, 4 and 12 week visit. Barriers and facilitators to accessing PEP and remaining adherent were examined, as was knowledge about PrEP. Thirty-two participants (80 %) were South Africa. Adherence was high and demonstrates that adherence support is feasible from a state health clinic. Reported risk behaviors in some high-risk participants did not change over time, demonstrating the need for additional longer-term HIV preventions such as PrEP. PEP users could conceivably be transitioned from PEP to PrEP.

  14. Genetic variation of the HIV-1 integrase region in newly diagnosed anti-retroviral drug-naïve patients with HIV/AIDS in Korea.

    Science.gov (United States)

    Kim, J-Y; Kim, E-J; Choi, J-Y; Kwon, O-K; Kim, G J; Choi, S Y; Kim, S S

    2011-08-01

    The survival time of HIV/AIDS patients in Korea has increased since HAART (highly active anti-retroviral therapy) was introduced. However, the occurrence of drug-resistant strains requires new anti-retroviral drugs, one of which, an integrase inhibitor (INI), was approved by the US Food and Drug Administration (FDA) in 2007. INIs have been used for therapy in many countries and are about to be employed in Korea. Therefore, it is important to identify basic mutant variants prior to the introduction of INIs in order to estimate their efficacy. To monitor potential drug-resistant INI mutations in Korean HIV/AIDS patients, the polymorphism of the int gene was investigated together with the pol gene using a genotypic assay for 75 randomly selected Korean HIV-1 patients newly diagnosed in 2007. The drug-resistant mutation sequences were analysed using the Stanford HIV DB and the International AIDS Society resistance testing-USA panel (IAS-USA). Seventy strains of Korean subtype B were compared with foreign subtype-B strains, and there were no significantly different variants of the int gene region in the study population. Major mutation sites in the integrase (E92Q, F121Y, G140A/S, Y143C/R, Q148H/R/K and N155H) were not detected, and only a few minor mutation sites (L74M, V151I, E157Q, V165I, I203M, S230N and D232N) were identified in 21 strains (28%). Resistance due to mutations in the pol gene was observed in a single strain (1.3%) resistant to protease inhibitors (PIs) and in four strains (5.3%) resistant to reverse transcriptase inhibitors (RTIs). In summary, this demonstrates that INIs will be susceptible to drug naïve HIV/AIDS patients in Korea.

  15. Lipodystrophy syndrome associated with antiretroviral therapy in HIV patients: considerations for psychosocial aspects Síndrome de la lipodistrofia asociado con la terapia antiretroviral en pacientes con VIH: consideraciones para los aspectos psicosociales Sindrome da lipodistrofia associada com a terapia anti-retroviral em portadores do HIV: considerações para os aspectos psicossociais

    Directory of Open Access Journals (Sweden)

    Ana Paula Morais Fernandes

    2007-10-01

    son necesarios para entender mejor este complejo síndrome, proveyendo nueva información para ser utilizada en el cuidado de enfermería para pacientes con VIH que están afectados por este problema.Diversos efeitos colaterais têm sido associados à terapia anti-retroviral em portadores da infecção pelo HIV, dentre esses, a síndrome da lipodistrofia apresentando hiperlipidemia e alterações na forma do corpo, com hipertrofia adiposa central e lipoatrofia periférica, relatada pelos pacientes como um visível marcador para a identificação de portadores da infecção pelo HIV. Este estudo consiste em análise da produção científica sobre aspectos psicossociais em portadores da infecção pelo HIV que apresentam lipodistrofia associada à utilização da terapia anti-retroviral. Os resultados mostram que alterações corporais podem ser suficientemente perturbadoras para o bem-estar psicossocial, afetando a qualidade de vida e aumentando o estigma da doença, ocasionando perturbações nas relações sociais. Esta revisão possibilita uma análise preliminar dos aspectos psicossocias da lipodistrofia; entretanto, outros estudos são necessários para o melhor entendimento desta complexa síndrome, trazendo novas informações a serem utilizadas no cuidado de enfermagem a portadores da infecção pelo HIV afetados por este problema.

  16. Disclosure of HIV status and its impact on the loss in the follow-up of HIV-infected patients on potent anti-retroviral therapy programs in a (post-) conflict setting: A retrospective cohort study from Goma, Democratic Republic of Congo

    Science.gov (United States)

    Akilimali, Pierre Zalagile; Musumari, Patou Masika; Kashala-Abotnes, Espérance; Kayembe, Patrick Kalambayi; Lepira, François B.; Mutombo, Paulin Beya; Tylleskar, Thorkild; Ali, Mapatano Mala

    2017-01-01

    Background The study aimed to identify the impact of non-disclosure of HIV status on the loss to follow-up (LTFU) of patients receiving anti-retroviral therapy. Methodology A historic cohort of HIV patients from 2 major hospitals in Goma, Democratic Republic of Congo was followed from 2004 to 2012. LTFU was defined as not taking an ART refill for a period of 3 months or longer since the last attendance, and had not yet been classified as ‘dead’ or ‘transferred-out’. Kaplan-Meier plots were used to determine the probability of LTFU as a function of time as inclusive of the cohort. The log-rank test was used to compare survival curves based on determinants. Cox proportional hazard modeling was used to measure predictors of LTFU from the time of treatment induction until December 15th, 2012 (the end-point). Results The median follow-up time was 3.99 years (IQR = 2.33 to 5.59). Seventy percent of patients had shared their HIV status with others (95% CI: 66.3–73.1). The proportion of LTFU was 12% (95%CI: 9.6–14.4). Patients who did not share their HIV status (Adjusted HR 2.28, 95% CI 1.46–2.29), patients who did not live in the city of Goma (Adjusted HR 1.97, 95% CI 1.02–3.77), and those who attained secondary or higher education level (Adjusted HR 1.60, 95% CI 1.02–2.53) had a higher hazard of being LTFU. Conclusion This study shows the relationship between the non–disclosure HIV status and LTFU. Healthcare workers in similar settings should pay more attention to clients who have not disclosed their HIV status, and to those living far from health settings where they receive medication. PMID:28170410

  17. The role of integrated home-based care in patient adherence to antiretroviral therapy O papel da assistência domiciliar integrada na adesão do paciente à terapia anti-retroviral

    Directory of Open Access Journals (Sweden)

    Neil Gupta

    2005-05-01

    Full Text Available Non-adherence is one of the primary obstacles to successful antiretroviral therapy in HIV+ patients worldwide. In Brazil, the Domiciliary Therapeutic Assistance is a multidisciplinary and integrated home-based assistance program provided for HIV+ patients confined in their homes due to physical deficiency. This study investigated ADT's ability to monitor and promote appropriate adherence to ARV therapy. Fifty-six individuals were recruited from three study groups: Group 1 - patients currently in the ADT program, Group 2 - 21 patients previously treated by the ADT program, and Group 3 - 20 patients who have always been treated using conventional ambulatory care. Using multivariable self-reporting to evaluate adherence, patients in the ADT program had significantly better adherence than patients in ambulatory care (F = 6.66, p = 0.003. This effect was independent of demographic and socioeconomic characteristics as well as medical history. Patients in the ADT program also showed a trend towards greater therapeutic success than ambulatory patients. These results suggest the incorporation of characteristics of ADT in conventional ambulatory care as a strategy to increase adherence to ARV therapy.O sucesso da terapia antiretroviral depende da adesão ao tratamento. A Assistência Domiciliar Terapêutica é um programa de atendimento multidisciplinar a pacientes com HIV/AIDS e com dificuldades de se deslocar para atendimento ambulatorial. Este estudo compara a adesão de pacientes ao esquema ARV em um programa ADT com aqueles em tratamento ambulatorial convencional. Foram estudados: Grupo 1 - 15 pacientes no programa de ADT, Grupo 2 - 21 pacientes em tratamento ambulatorial convencional, Grupo 3 - 20 pacientes em tratamento ambulatorial convencional que nunca freqüentaram o programa ADT. Os pacientes inscritos no programa ADT apresentaram significativamente maior adesão ao tratamento do que pacientes ambulatoriais (F = 6.66, p= 0,003. Os resultados

  18. Validação e reprodutibilidade de uma escala de auto-eficácia para adesão ao tratamento anti-retroviral em pais ou cuidadores de crianças e adolescentes vivendo com HIV/AIDS Validity and reliability of a self-efficacy expectancy scale for adherence to antiretroviral therapy for parents and carers of children and adolescents with HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Luciana Scarlazzari Costa

    2008-02-01

    Full Text Available OBJETIVO: Validar uma escala de auto-eficácia para adesão ao tratamento anti-retroviral em crianças e adolescentes com HIV/AIDS, levando em consideração a perspectiva dos pais/responsáveis, e avaliar a sua reprodutibilidade. MÉTODOS: O estudo foi realizado no Hospital-Dia do Centro de Referência e Treinamento em DST/AIDS de São Paulo. Foram entrevistados os pais/responsáveis de 54 crianças e adolescentes de 6 meses a 20 anos que passaram em consulta de rotina pelo serviço. Os dados de auto-eficácia foram levantados pela escala de auto-eficácia para seguir prescrição anti-retroviral (AE, que foi calculada de duas maneiras: análise fatorial e fórmula já definida. A consistência interna da escala foi verificada pelo coeficiente ade Cronbach. A validade foi avaliada pela comparação das médias dos escores entre grupos de pacientes aderentes e não aderentes ao tratamento anti-retroviral (teste de Mann-Whitney e cálculo do coeficiente de correlação de Spearman entre os escores e parâmetros clínicos. A reprodutibilidade foi verificada por meio do teste de Wilcoxon, pelo coeficiente de correlação intraclasse (CCI e pelo gráfico de Bland-Altman. RESULTADOS: A escala de AE apresentou boa consistência interna (a= 0,87 e boa reprodutibilidade (CCI = 0,69 e CCI = 0,75. Quanto à validade, a escala de AE conseguiu discriminar pacientes aderentes e não aderentes ao tratamento anti-retroviral (p = 0,002 e apresentou correlação significativa com a contagem de CD4 (r = 0,28; p = 0,04. CONCLUSÕES: A escala de AE pode ser utilizada para avaliar a adesão à terapia anti-retroviral em crianças e adolescentes com HIV/AIDS, levando em consideração a perspectiva dos pais/cuidadores.OBJECTIVE: To validate and evaluate the reproducibility of a self-efficacy (SE scale for adherence to antiretroviral therapy in children and adolescents with HIV/AIDS, taking into account the perspective of parents/guardians. METHODS: The study was

  19. Impacto da terapia anti-retroviral na magnitude da epidemia do HIV/AIDS no Brasil: diversos cenários Impact of antiretroviral therapy on the magnitude of the HIV/AIDS epidemic in Brazil: various scenarios

    Directory of Open Access Journals (Sweden)

    Maria Tereza S. Barbosa

    2003-04-01

    Full Text Available Neste trabalho, utilizaram-se os algoritmos EM e EMS aplicados ao método do Cálculo Retroativo para estimar a magnitude da epidemia do HIV no Brasil. Fazendo-se suposições a respeito do comportamento dos infectados, em relação à utilização da terapia combinada das drogas anti-retrovirais, construíram-se cinco cenários para a epidemia brasileira. O objetivo foi o de ilustrar os impactos que a utilização da terapia combinada das drogas anti-retrovirais possam estar tendo ou possam vir a ter na incubação do vírus e, por conseguinte, nas avaliações da epidemia realizadas a partir dos casos de Aids notificados.We applied the back-calculation method to estimate the magnitude of the HIV epidemic in Brazil, using the EM and EMS algorithms. Under certain assumptions regarding the behavior of infected patients towards combined antiretroviral therapy, we discuss five different scenarios applied to the Brazilian epidemic. Our objective was to illustrate the impact of combined antiretroviral treatment on the incubation period and thus on estimates of the size of the HIV-infected population, based on reported AIDS cases.

  20. Sub-optimal adherence to combination anti-retroviral therapy and its associated factors according to self-report, clinician-recorded and pharmacy-refill assessment methods among HIV-infected adults in Addis Ababa.

    Science.gov (United States)

    Mekuria, Legese A; Prins, Jan M; Yalew, Alemayehu W; Sprangers, Mirjam A G; Nieuwkerk, Pythia T

    2017-04-01

    Adherence to combination antiretroviral therapy (cART) is generally high in most resource-limited settings. However, sub-optimal adherence occurs in a sizable proportion of patients, and is independently predictive of detectable viremia. We investigated sub-optimal adherence according to self-report, clinician-recorded, and pharmacy-refill assessment methods, and their associated factors among HIV-infected adults receiving cART in Addis Ababa, Ethiopia. Eight-hundred seventy patients who initiated cART between May 2009 and April 2012 were randomly selected, and 664 patients who were alive, had remained in clinical care and were receiving cART for at least six-months were included. Sub-optimal adherence was defined as patients' response of less than "all-of the time" to the self-report adherence question, or any clinician-recorded poor adherence during the six most recent clinic visits, or a pharmacy-refill of sub-optimal adherence. The average adherence level to cART, expressed as MPR, was nearly 97%. However, sub-optimal adherence occurred in 12%, 4%, and 27% of patients according to self-report, clinician-recorded, and pharmacy-refill measures, respectively. More satisfaction with social support was significantly associated with less sub-optimal adherence according to self-report and clinician-record. Younger age, lower educational level, and lower CD4 cell count at cART initiation were significantly associated with sub-optimal refill-based adherence. Findings from our large multi-center study suggest that sub-optimal adherence was present in up to a quarter of the patients, despite a high degree of average adherence to cART. Interventions aimed at preventing sub-optimal adherence should focus on improving social support, on younger patients, on patients with lower educational level, and on those who started cART at a lower CD4 cell count.

  1. THE EVOLUTION OF ANTI-RETROVIRAL THERAPY IN NIGERIA ...

    African Journals Online (AJOL)

    approved for use in HIV-1 infection. ... condition into a chronic manageable disease, however, ... First description of the mechanism of HIV resistance to AZT ... of HIV pathogenesis: rapid viral turnover and mechanisms of HIV resistance to anti-.

  2. Patients' perceptions of a rural decentralised anti-retroviral therapy ...

    African Journals Online (AJOL)

    2017-09-03

    Sep 3, 2017 ... Postgraduate Student, Discipline of Pharmaceutical Sciences, School of Health Sciences, University of ... centralisation of care have reduced the impact of human resource shortages and improved accessibility to Antiret-.

  3. CD4 + CELL RESPONSE TO ANTI-RETROVIRAL THERAPY (ARTs ...

    African Journals Online (AJOL)

    CLINICAL CARE OVER ONE YEAR PERIOD IN A COHORT OF HAART NAIVE, ... had non- Hodgkin's lymphoma, oral candidiasis, hepatitis B virus, pneumocytis ..... the natural course of HIV infection by reducing morbidity ... Effects of antiretroviral drugs on human immunodeficiency virus type 1 induced CD4+ cell death.

  4. Tratamiento antirretroviral en pacientes con sida y micobacteriosis Anti-retroviral treatment in patients with AIDS and mycobacterial diseases

    Directory of Open Access Journals (Sweden)

    Marcelo E. Corti

    2005-08-01

    Full Text Available La tuberculosis y otras micobacteriosis constituyen asociaciones o coinfecciones frecuentes en pacientes con sida y se asocian con una elevada mortalidad. En esta revisión se actualizan los tratamientos de las principales enfermedades micobacterianas asociadas al sida (tuberculosis y micobacteriosis por Mycobacterium avium, con especial énfasis en las interacciones farmacológicas entre antimicobacterianos, principalmente rifampicina y claritromicina, y fármacos antirretrovirales. Se analizan los esquemas de tratamiento, su duración, la quimioprofilaxis primaria y secundaria y el momento óptimo de iniciación del tratamiento antirretroviral. Finalmente se describe el síndrome inflamatorio de reconstitución inmune y su tratamiento.Tuberculosis and other mycobacterial diseases are frequent coinfections in AIDS patients with an increased related mortality. In this review we have updated the treatment of the main mycobacterial diseases (tuberculosis and Mycobacterium avium disease, under the scope of pharmacological interactions between antimycobacterial drugs, specially rifampicin and clarithromycin, and anti-retroviral drugs. Antimycobacterial treatment schemes, their duration, primary and secondary chemoprophylaxis and the optimal time to start the anti-retroviral therapy are analized. Finally, the immnune reconstitution inflammatory syndrome and its treatment are discussed.

  5. Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania.

    NARCIS (Netherlands)

    Hamza, O.; Matee, M.I.N.; Simon, E.N.; Kikwilu, E.; Moshi, M.J.; Mugusi, F.; Mikx, F.H.M.; Verweij, P.E.; Ven, A.J.A.M. van der

    2006-01-01

    ABSTRACT: BACKGROUND: The aim of the study was to compare the prevalence and types of HIV-related oral lesions between children and adult Tanzanian patients on HAART with those not on HAART and to relate the occurrence of the lesions with anti-HIV drug regimen, clinical stage of HIV disease and CD4+

  6. Isoniazid Prophylactic Therapy for the Prevention of Tuberculosis in HIV Infected Adults : A Systematic Review and Meta-Analysis of Randomized Trials

    NARCIS (Netherlands)

    Ayele, Henok Tadesse; Mourik, Maaike S M van; Debray, Thomas P A; Bonten, Marc J M

    2015-01-01

    BACKGROUND: Infection with Human Immunodeficiency virus (HIV) is an important risk factor for Tuberculosis (TB). Anti-Retroviral Therapy (ART) has improved the prognosis of HIV and reduced the risk of TB infected patients. Isoniazid Preventive Therapy (IPT) aims to reduce the development of active T

  7. Isoniazid Prophylactic Therapy for the Prevention of Tuberculosis in HIV Infected Adults : A Systematic Review and Meta-Analysis of Randomized Trials

    NARCIS (Netherlands)

    Ayele, Henok Tadesse; Mourik, Maaike S M van; Debray, Thomas P A; Bonten, Marc J M

    2015-01-01

    BACKGROUND: Infection with Human Immunodeficiency virus (HIV) is an important risk factor for Tuberculosis (TB). Anti-Retroviral Therapy (ART) has improved the prognosis of HIV and reduced the risk of TB infected patients. Isoniazid Preventive Therapy (IPT) aims to reduce the development of active

  8. Comparison of immunologic restoration and virologic response in plasma, tonsillar tissue, and cerebrospinal fluid in HIV-1-infected patients treated with double versus triple antiretroviral therapy in very early stages: The Spanish EARTH-2 Study. Early Anti-Retroviral Therapy Study.

    Science.gov (United States)

    García, F; Alonso, M M; Romeu, J; Knobel, H; Arrizabalaga, J; Ferrer, E; Dalmau, D; Ruiz, I; Vidal, F; Frances, A; Segura, F; Gomez-Sirvent, J L; Cruceta, A; Clotet, B; Pumarola, T; Gallart, T; O'Brien, W A; Miró, J M; Gatell, J M

    2000-09-01

    ) was greater than in patients treated with double therapy. Markers of activation decreased further in patients treated with the regimen that included protease inhibitors. Proliferative responses to HIV-1 p24 antigen were never recovered after double or triple therapy. Our study suggests that even in very early stages of HIV-1 disease only therapy with two NRTIs and one protease inhibitor reduces plasma, lymphoid tissue, and CSF VL to undetectable levels. HIV-1-related immune system abnormalities improved but were still defective after 1 year of antiretroviral therapy.

  9. Anti-Retroviral Strategies for AIDS and Related Diseases

    Directory of Open Access Journals (Sweden)

    Mark A Wainberg

    1991-01-01

    Full Text Available The replication cycle of human immunodeficiency virus type 1 (HIV-1 and other retroviruses consists of four stages: attachment of the virus to specific receptors on the cell surface; uncoating of the viral nucleic acid and conversion to DNA; production of viral RNA and proteins; and assembly and liberation of progeny virus from the cell. Each of these steps represents a potential target for antiviral chemotherapy. Combinations of drugs which act against different steps in the viral replication cycle might be expected to have synergistic potential. Zidovudine (AZT is the most widely used drug to date for impeding the replication of HIV-1. Although AZT therapy has been reasonably successful, it has not been free from toxicity. In addition, there have been several reports of isolation of AZT-resistant variants of HIV-1.

  10. challenges experienced by unemployed adults on anti-retroviral ...

    African Journals Online (AJOL)

    J MUGUMBATE

    economic challenges mainly evidenced by hyperinflation and collapse of the local ... economic constraints, such as rising poverty levels, unstable exchange rates and .... The high utilization of medical services by the economically active age ...

  11. Molecular Mechanisms in Activation of Latent HIV-1

    NARCIS (Netherlands)

    H. Rafati (Haleh)

    2014-01-01

    markdownabstract__Abstract__ Finding a cure for the human immunodeficiency virus type 1 (HIV-1) is extremely challenging. Development of highly active anti-retroviral therapy (HAART), transformed HIV-1 infection from an acute syndrome into chronic disease. Although using HAART results in suppressio

  12. HIV reverse transcriptase gene mutations in anti-retroviral treatment naïve rural people living with HIV/AIDS.

    Science.gov (United States)

    Mohanakrishnan, K; Kasthuri, A; Amsavathani, S K; Sumathi, G

    2015-01-01

    This study is designed to find out the mutational variations of reverse transcriptase (RT) gene of HIV, after the traditional drug usage among anti-retroviral therapy naïve rural people living with HIV/AIDS. HIV Reactive patients, who were exposed for indigenous medicines such as Siddha, Ayurveda etc., for a minimum period of 6 months were taken for this study. Among 40 patients, two samples (5.55%) demonstrated high-level mutational resistance variations for nucleoside RT inhibitor (NRTI) and non-NRTI. The predominant polymorphisms detected were K122E (91.7%), V60I (91.7%), V35T (89%), Q207E (89%), D177E (89%), T200A (86.1%), S48T (83.33%), K173A (80.6%).

  13. Global HIV-1 transmitted drug resistance in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

    DEFF Research Database (Denmark)

    Baxter, J D; Dunn, D; White, E;

    2015-01-01

    of resistance testing in START trial participants. METHODS: In the Strategic Timing of AntiRetroviral Treatment (START) trial, baseline genotypic resistance testing results were collected at study entry and analysed centrally to determine the prevalence of TDR in the study population. Resistance was based...

  14. Anti-Retroviral Lectins Have Modest Effects on Adherence of Trichomonas vaginalis to Epithelial Cells In Vitro and on Recovery of Tritrichomonas foetus in a Mouse Vaginal Model.

    Science.gov (United States)

    Chatterjee, Aparajita; Ratner, Daniel M; Ryan, Christopher M; Johnson, Patricia J; O'Keefe, Barry R; Secor, W Evan; Anderson, Deborah J; Robbins, Phillips W; Samuelson, John

    2015-01-01

    Trichomonas vaginalis causes vaginitis and increases the risk of HIV transmission by heterosexual sex, while Tritrichomonas foetus causes premature abortion in cattle. Our goals were to determine the effects, if any, of anti-retroviral lectins, which are designed to prevent heterosexual transmission of HIV, on adherence of Trichomonas to ectocervical cells and on Tritrichomonas infections in a mouse model. We show that Trichomonas Asn-linked glycans (N-glycans), like those of HIV, bind the mannose-binding lectin (MBL) that is part of the innate immune system. N-glycans of Trichomonas and Tritrichomonas bind anti-retroviral lectins (cyanovirin-N and griffithsin) and the 2G12 monoclonal antibody, each of which binds HIV N-glycans. Binding of cyanovirin-N appears to be independent of susceptibility to metronidazole, the major drug used to treat Trichomonas. Anti-retroviral lectins, MBL, and galectin-1 cause Trichomonas to self-aggregate and precipitate. The anti-retroviral lectins also increase adherence of ricin-resistant mutants, which are less adherent than parent cells, to ectocervical cell monolayers and to organotypic EpiVaginal tissue cells. Topical application of either anti-retroviral lectins or yeast N-glycans decreases by 40 to 70% the recovery of Tritrichomonas from the mouse vagina. These results, which are explained by a few simple models, suggest that the anti-retroviral lectins have a modest potential for preventing or treating human infections with Trichomonas.

  15. Anti-Retroviral Lectins Have Modest Effects on Adherence of Trichomonas vaginalis to Epithelial Cells In Vitro and on Recovery of Tritrichomonas foetus in a Mouse Vaginal Model.

    Directory of Open Access Journals (Sweden)

    Aparajita Chatterjee

    Full Text Available Trichomonas vaginalis causes vaginitis and increases the risk of HIV transmission by heterosexual sex, while Tritrichomonas foetus causes premature abortion in cattle. Our goals were to determine the effects, if any, of anti-retroviral lectins, which are designed to prevent heterosexual transmission of HIV, on adherence of Trichomonas to ectocervical cells and on Tritrichomonas infections in a mouse model. We show that Trichomonas Asn-linked glycans (N-glycans, like those of HIV, bind the mannose-binding lectin (MBL that is part of the innate immune system. N-glycans of Trichomonas and Tritrichomonas bind anti-retroviral lectins (cyanovirin-N and griffithsin and the 2G12 monoclonal antibody, each of which binds HIV N-glycans. Binding of cyanovirin-N appears to be independent of susceptibility to metronidazole, the major drug used to treat Trichomonas. Anti-retroviral lectins, MBL, and galectin-1 cause Trichomonas to self-aggregate and precipitate. The anti-retroviral lectins also increase adherence of ricin-resistant mutants, which are less adherent than parent cells, to ectocervical cell monolayers and to organotypic EpiVaginal tissue cells. Topical application of either anti-retroviral lectins or yeast N-glycans decreases by 40 to 70% the recovery of Tritrichomonas from the mouse vagina. These results, which are explained by a few simple models, suggest that the anti-retroviral lectins have a modest potential for preventing or treating human infections with Trichomonas.

  16. 人类免疫缺陷病毒感染儿童抗病毒治疗后外周血单个核细胞线粒体DNA含量检测%Mitochondrial DNA of peripheral blood mononuclear cells detection in HIV-infected children treated with anti-retroviral therapy

    Institute of Scientific and Technical Information of China (English)

    张洪海; 张蕾; 孙玉; 石英; 郑加生; 陈德喜

    2014-01-01

    目的 研究我国人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染儿童抗逆转录病毒治疗(active anti-retrovirus therapy,ART)后外周血单个核细胞(peripheral blood mononuclear cells,PBMC)线粒体DNA含量及其相关影响因素.方法 选择96例ART的HIV感染患儿、30例未治疗的HIV感染患儿及55例正常对照儿童,检测PBMC线粒体DNA含量,结合儿童的临床信息及实验室检测结果进行综合分析.结果 ART组患儿PBMC内线粒体DNA含量为(17.39±9.31),明显低于未治疗组患儿(26.35±11.74)及对照组儿童(28.37±12.14)PBMC内线粒体DNA含量,差异有统计学意义(P<0.01);患儿ART后PBMC内线粒体DNA含量与基线CD4+T淋巴细胞计数、基线病毒载量、性别、年龄及HIV感染途径均无相关性.结论 PBMC线粒体DNA含量可反映儿童抗病毒治疗后的线粒体损伤毒性,可能成为线粒体毒性检测指标.

  17. Screening for Cryptococcal Antigenemia in Anti-Retroviral Naïve AIDS Patients in Benin City, Nigeria

    Directory of Open Access Journals (Sweden)

    Favour Osazuwa

    2012-05-01

    Full Text Available Objectives: Cryptococcus neoformans is the most incriminated fungal pathogen causing meningitis in acquired immune deficiency syndrome (AIDS patients, and is known to constitute a major cause of deaths in AIDS patients. This study thus aimed to determine the baseline sero-prevalence of Cryptococcus neoformans infection in anti-retroviral naïve (ART-naïve AIDS patients using the serum Cryptococcal antigen (crag detection method. Baseline effect of variation in CD4 counts, as well as sex and age with sero-positivity for crag were also determined.Methods: This descriptive cross-sectional study included 150 (61 males and 89 females ART-naïve AIDS patients attending the Human Immunodeficiency Virus clinic (HIV at the University of Benin Teaching hospital, Benin City, Nigeria, within the period from February 2011- July 2011. Forty (18 males and 22 females HIV positive outpatients with CD4 counts >200 cells/µl who were ART-naive were recruited and used as controls. The sero-prevalence of crag in the patients and the control group was measured using the cryptococcal antigen latex agglutination system (CALAS (Meridian Bioscience, Europe and CD4 counts were measured using flow cytometry (Partec flow cytometer, Germany.Results: Of the 150 ART-naïve AIDS patients with CD4 counts £200 cells/µL; 19 (12.7% were positive for serum Cryptococcal antigen. ART-naïve AIDS patients with CD4 count ≤50 cells/µl had the highest prevalence of serum crag. Lower CD4 counts were significantly associated with positivity for serum crag (p<0.001. Age and sex had no significant effect on the sero-positivity for serum crag. One (2.5% of the controls was sero-positive for crag. Thus, serum crag was significantly associated with AIDS but not with HIV (p<0.001.Conclusion: This study uncovers a high prevalence of crag in ART- naïve AIDS patients in Benin City. The prevalence of crag was higher in ART-naïve AIDS patients with lower CD4 counts. There is an urgent need to

  18. A randomized, controlled trial of initial anti-retroviral therapy with abacavir/lamivudine/zidovudine twice-daily compared to atazanavir once-daily with lamivudine/zidovudine twice-daily in HIV-infected patients over 48 weeks (ESS100327, the ACTION Study

    Directory of Open Access Journals (Sweden)

    McClernon Daniel

    2009-04-01

    Full Text Available Abstract Background Traditional first line regimens containing a non-nucleoside reverse transcriptase inhibitor or protease inhibitor may not be suitable for a subset of antiretroviral-naïve patients such as those with certain co-morbidities, women of child-bearing potential, and intolerability to components of standard first line therapy. This study was conducted to determine if alternate treatment options may meet the needs of both general and special patient populations. The ACTION study was a randomized, open-label, multicenter, 48-week trial that compared the safety and efficacy of a triple nucleoside regimen versus a protease inhibitor plus a dual nucleoside regimen in HIV-1 treatment-naïve subjects. Results 279 HIV-infected subjects with HIV-1 RNA (VL >5000 but 3 were randomized (1:1 to receive abacavir sulfate/lamivudine/zidovudine (ABC/3TC/ZDV twice-daily or atazanavir (ATV once-daily plus lamivudine/zidovudine (3TC/ZDV twice-daily. Protocol-defined virologic failure was based on multiple failure criteria. Non-inferiority of ABC/3TC/ZDV to ATV+3TC/ZDV was established with 62% vs. 59% of subjects achieving a VL Conclusion ABC/3TC/ZDV demonstrated comparable virologic efficacy to ATV+3TC/ZDV in this population over 48 weeks. In those with a baseline VL ≥ 100,000 c/mL, subjects in the ATV+3TC/ZDV showed better virologic efficacy. Both regimens offer benefits in select therapy-naïve subjects. Trial Registration [Clinical Trials Identifier, NCT00082394].

  19. Avaliação ultra-sonográfica, ecocardiográfica fetal e resultados perinatais em gestantes portadoras do HIV em uso de terapia anti-retroviral Ultrasound examination, fetal echocardiography and prenatal outcome in HIV-positive pregnant women under antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Marco Antonio Borges Lopes

    2007-10-01

    Full Text Available OBJETIVO: descrever as alterações estruturais e/ou funcionais fetais à ultra-sonografia e à ecocardiografia fetais e os resultados perinatais em gestantes soropositivas para o vírus da imunodeficiência humana (HIV em relação a um grupo controle de pacientes atendidas pelo pré-natal de baixo risco. MÉTODOS: foram avaliadas, prospectivamente, 109 gestantes soropositivas para o HIV em uso de anti-retrovirais (Grupo de Estudo, GE e 200 gestantes controles (GC, sendo realizado acompanhamento ultra-sonográfico obstétrico mensal e ecocardiografia fetal e pós-natal com a avaliação do volume de líquido amniótico, da adequação do peso fetal, da presença de alterações estruturais fetais e dos resultados perinatais. RESULTADOS: foram observados oito casos de alterações estruturais fetais (7,3% contra dois (1% no GC (p=0,61. Observamos quatro casos de cardiopatia congênita e quatro de hidronefrose no GE, com diferença estatística para as cardiopatias (p=0,015. Foram diagnosticados, no GE, oito (7,3% casos de oligoidrâmnio e 11 (10% casos de polidrâmnio contra dois casos (1% de oligoidrâminio e nenhum de polidrâmnio (p de 0,004 e pPURPOSE: to evaluate fetal structural and/or functional abnormalities by ultrasound examination and fetal echocardiography, in pregnant women positive for human immunodeficiency virus (HIV. METHODS: we analyzed prospectively 109 HIV positive pregnant women under antiretroviral therapy (Study Group and 200 low risk pregnant patients (Control Group. All of them were submitted to ultrasound scan and fetal and neonatal echocardiography once a month. The amniotic fluid volume, fetal growth, fetal structural and functional alteration and the perinatal outcome were evaluated. RESULTS: there were eight (7.3% cases of fetal structural abnormality in the Study Group and two (1% in the Control Group (p=0.616. There were four cases of congenital heart disease and four cases of hydronephrosis in the Study Group

  20. Late Reporting Among Newly Registered Patients for Anti Retroviral Therapy in a Central District Ujjain, India

    Directory of Open Access Journals (Sweden)

    Vidit Khandelwal, Yogesh D Sabde, Riddhi Pradhan, Mehta Chandra Sathsh

    2013-01-01

    Conclusion: Late reporting at the initiation of ART was reported in about one third of the patients which could adversely affect effectiveness of ART. Efforts to investigate lesser representation of women and rural people are indicated. The study raised concerns about the possible routes of transmission need more investigation.

  1. anti-retroviral therapy related liver injury (arli): a series of 11 cases

    African Journals Online (AJOL)

    2013-12-02

    Dec 2, 2013 ... Risk factors for liver injury should be evaluated ... Weight (Kg) using a Salter weighing scale and height (Cms) ... ascertain other risk factors which affect ART related ..... associated with an increased propensity to develop.

  2. A decade of Anti-Retroviral Therapy in Nigeria: Efficacy of First Line ...

    African Journals Online (AJOL)

    Alasia Datonye

    phenomenon is infection with resistant virus strains, as. [8]. [9]. [10] ... Clinical response was measured as ... Those positive for hepatitis B surface antigen or hepatitis C .... characteristics and natural history of the virus. Clin ... Positive effects of.

  3. Desenvolvimento de uma escala de auto-eficácia para adesão ao tratamento anti-retroviral

    Directory of Open Access Journals (Sweden)

    Leite José Carlos de Carvalho

    2002-01-01

    Full Text Available Uma escala de expectativa de auto-eficácia para seguir prescrição anti-retroviral em situações difíceis (21 itens foi desenvolvida pela análise do conteúdo de entrevistas com pacientes que estavam em tratamento ou que o abandonaram. A consistência interna e a validade de construto foram examinadas em 60 sujeitos que freqüentaram ambulatório para pacientes em estágios avançados da doença (hospital-dia. Um escore de expectativa de auto-eficácia para adesão ao tratamento foi derivado do primeiro componente da análise de componentes principais. A média do escore foi 0,25 para os sujeitos aderentes e -0,33 para os não-aderentes ao tratamento (teste t, p = 0,046. A chance de adesão duplicou quando o escore de expectativa de auto-eficácia era maior em uma unidade (OR = 2,07; IC95% = 1,002 a 4,26. A consistência interna foi alta (alfa de Cronbach = 0.96. A escala demonstrou validade de construto e confiabilidade para medir auto-eficácia para tratamento anti-retroviral nesses pacientes.

  4. Do HIV-specific CTL continue to have an antiviral function during antiretroviral therapy? If not, why not, and what can be done about it?

    OpenAIRE

    Dorian eMcIlroy

    2013-01-01

    Pharmacological re-activation of HIV expression from latent proviruses coupled with fully suppressive anti-retroviral therapy (ART) has been suggested as a strategy to eradicate HIV infection. In order for this strategy to be effective, latently infected cells must be killed either by the cytopathic effect of reactivated HIV gene expression, or by HIV-specific CTL. However, a review of current data reveals little evidence that CTL retain an anti-viral effector capacity in patients on fully su...

  5. [Rapid development of anemia in a HIV-positive patient with alpha-thalassemia after zidovudine therapy].

    Science.gov (United States)

    Altinbaş, Akif; Ozkaya, Gülşen; Büyükaşik, Yahya; Unal, Serhat

    2007-07-01

    Anemia, which may develop due to direct effect of the virus or indirect effect of zidovudine a widely used antiviral agent for the treatment, is not an uncommon complication in human immundeficiency virus (HIV) infections. In this report, a 26 years old male HIV positive patient who developed rapid anemia in the HAART (Highly active anti-retroviral therapy) protocol including zidovudine, was presented. The patient has been followed since May 2003 without anti-retroviral therapy. He was diagnosed as alpha-thalassemia trait, because of the low mean red blood cell volume (MCV), high red blood cell count and living in an Mediterranian country. However, no treatment for thalassemia had been given in this period, since the other laboratory findings [hemoglobin, hematocrit, red cell distribution width index (RDWI), iron and iron binding capacity, transferrin saturation and ferritin levels] were normal. During the follow-up of patient, HAART protocol with zidovudine, lamivudine and indinavir, was started depending on the findings of low CD4+ T-cell count (443/mm3) and high HIV serum load (1,330,000 copies/ml). In the second month of the therapy the hemoglobin level decreased to 12.9 gr/dL, and then to 9.9 gr/dL in the fourth month, while it was 14.5 gr/dL before anti-retroviral therapy. Although the patient had no hemolysis findings, and his serum folic acid level was normal, folbiol treatment was initiated with the possibility of the presence of folic acid deficiency at cellular level. Anemia resolved with folic acid replacement without discontinuation of zidovudine or a reduction in dosage. It was thought that the presence of alpha-thalassemia co-morbidity has facilitated the development of anti-retroviral-induced anemia in this patient. As a result, it is concluded that thalassemia should be considered in the differential diagnosis of anemia in HIV positive patients, especially for the ones from Mediterranian countries.

  6. Neurological disease in HIV-infected patients in the era of highly active antiretroviral treatment: a Brazilian experience Doença neurológica em pacientes infectados pelo HIV na era da terapia anti-retroviral altamente ativa: uma experiência brasileira

    OpenAIRE

    Jacqueline Ferreira de Oliveira; Dirceu Bartolomeu Greco; Guilherme Correa Oliveira; Paulo Pereira Christo; Mark Drew Crosland Guimarães; Rodrigo Corrêa Oliveira

    2006-01-01

    To study characteristics of neurological disorders in HIV/AIDS patients and their relationship to highly active antiretroviral treatment, a cross-sectional study was conducted in an infectious disease public hospital in Belo Horizonte, Brazil, between February 1999 and March 2000. Of the 417 patients enrolled, neurological disease was observed in 194 (46.5%) and a new AIDS-defining neurological event developed in 23.7% of individuals. Toxoplasmosis (42.3%), cryptococcosis meningitis (12.9%) a...

  7. Demographic and HIV-specific characteristics of participants enrolled in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

    DEFF Research Database (Denmark)

    Sharma, S; Babiker, A G; Emery, S;

    2015-01-01

    OBJECTIVES: The risks and benefits of initiating antiretroviral treatment (ART) at high CD4 cell counts have not been reliably quantified. The Strategic Timing of AntiRetroviral Treatment (START) study is a randomized international clinical trial that compares immediate with deferred initiation...

  8. Evaluation of Potential Anti-Pathogenic and Anti-Retroviral Effects of a Proprietary Bioactive Silicate Alka-Vita™/Alka-V6™/Alkahydroxy™ (AVAH

    Directory of Open Access Journals (Sweden)

    D Townsend

    2010-12-01

    Full Text Available Summary: Alka-Vita™/Alka-V6™/Alkahydroxy™ (AVAH, a modified sodium silicate dietary supplement manufactured by Cisne Enterprises Inc. (Odessa, TX was evaluated for its in vitro anti-retroviral and anti-pathogenic effects. Effects on nitric oxide (NO dependent antiviral activities were measured in neutrophils using standard assays. Assays for inhibition of HIV-II reverse transcriptase (RT, HIV-II protease (PR and glucohydrolase [glucuronidase (GH-1 and glucosidase (GH-2] important for viral replication, coat assembly and virulence respectively, were performed using standard kits. Higher NO (~ 2 fold was detected in neutrophil medium indicating an increase NO mediated antipathogeic activity. Results suggest that the product significantly decreased HIV-RT activity in a dose dependent manner (ED50= 20.4 mM. HIV-PR activity decreased (IC50=14.6 mM with increasing product concentration. The product also decreased the HIV-II virulence by inhibiting the GH-1 (IC50= 34.29 mM and GH-2 (IC50=14.6 mM activity which decreased protein glucosylation and glucuronylation. Changes in surface EPS carbohydrates assed in Pseudomonas aeruginosa suggested a modulatory effect on various carbohydrates and therefore the composition of EPS. Industrial relevance: Pathologies caused by retroviral agents and microorganisms are prevalent both in developed and developing countries.  Indiscriminate use of single target medical drugs has resulted in the development of resistance in these pathogens. Development of novel therapeutic  agents that can effect multiple intrinsic and extrinsic targets in host and the pathogen may prove to be more effective and are less likely to promote drug induced selection. The effectiveness of Alka-Vita™/Alka-V6™/Alkahydroxy™ (AVAH in mitigating various virulence and survival pathways in pathogens is promising. Additionally, it was also effective in inducing a NO mediated immune response.

  9. Anti-retroviral drugs do not facilitate hepatitis C virus (HCV) infection in vitro.

    Science.gov (United States)

    Sandmann, Lisa; Wilson, Matthew; Back, David; Wedemeyer, Heiner; Manns, Michael P; Steinmann, Eike; Pietschmann, Thomas; von Hahn, Thomas; Ciesek, Sandra

    2012-10-01

    An estimated 4 to 5 million people are co-infected with HIV/HCV worldwide. Recently observed outbreaks of acute HCV infection among HIV-positive men who have sex with men (MSM) have been linked to behavioral factors such as high risk sexual practices and recreational drug use. However, at the molecular level, many drugs such as glucocorticoids or cyclosporine A have been found to modulate viral replication. Thus, it is conceivable that drugs used in highly active antiretroviral therapy (HAART) may heighten susceptibility to HCV infection and contribute to the recent outbreaks. We therefore performed a comprehensive screen of antiretroviral drugs covering all available drug classes both individually and in typical combinations used during HAART to probe for direct effects on HCV cell entry, replication, new particle assembly and release. Importantly, no significant enhancement or inhibition of HCV cell entry, replication or new particle production was detected. While raltegravir and ritonavir boosted atazanavir reduce HCV replication, a tenfold reduction of HCVcc entry by the CCR5 antagonist maraviroc was observed. In conclusion, commonly used HAART agents do not specifically enhance HCV replication. Thus recent epidemic outbreaks of acute HCV in HIV-infected MSM are unlikely to be related to enhancing effects of HAART drugs.

  10. Challenges, successes and patterns of enrolment in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial.

    Science.gov (United States)

    Grarup, J; Rappoport, C; Engen, N W; Carey, C; Hudson, F; Denning, E; Sharma, S; Florence, E; Vjecha, M J

    2015-04-01

    The aim of this report is to describe the challenges, successes and patterns of enrolment in the Strategic Timing of AntiRetroviral Treatment (START) study. START is a collaboration of many partners with central coordination provided by the protocol team, the statistical and data management centre (SDMC), the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) network leadership, international coordinating centres and site coordinating centres. The SDMC prepared reports on study accrual, baseline characteristics and site performance that allowed monitoring of enrolment and data quality and helped to ensure the successful enrolment of this large international trial. We describe the pattern of enrolment and challenges faced during the enrolment period of the trial. An initial pilot phase began in April 2009 and established feasibility of accrual at 101 sites. In August 2010, funding approval for an expanded definitive phase led to the successful accrual of 4688 participants from 215 sites in 35 countries by December 2013. Challenges to accrual included regulatory delays (e.g. national/local ethics approval and drug importation approval) and logistical obstacles (e.g. execution of contracts with pharmaceutical companies, setting up of a central drug repository and translation of participant materials). The personal engagement of investigators, strong central study coordination, and frequent and transparent communication with site investigators, community members and participants were key contributing factors to this success. Accrual into START was completed in a timely fashion despite multiple challenges. This success was attributable to the efforts of site investigators committed to maintaining study equipoise, transparent and responsive study coordination, and community involvement in problem-solving. © 2015 British HIV Association.

  11. Combination of anti-retroviral drugs and radioimmunotherapy specifically kills infected cells from HIV infected individuals

    Directory of Open Access Journals (Sweden)

    Dina Tsukrov

    2016-09-01

    Full Text Available Eliminating virally infected cells is an essential component of any HIV eradication strategy. Radioimmunotherapy (RIT, a clinically established method for killing cells using radiolabeled antibodies, was recently applied to target HIV-1 gp41 antigen expressed on the surface of infect-ed cells. Since gp41 expression by infected cells is likely down-regulated in patients on an-tiretroviral therapy (ART, we evaluated the ability of RIT to kill ART-treated infected cells us-ing both in vitro models and lymphocytes isolated from HIV-infected subjects. Human peripheral blood mononuclear cells (PBMCs were infected with HIV and cultured in the presence of two clinically relevant ART combinations. Scatchard analysis of the 2556 human monoclonal anti-body to HIV gp41 binding to the infected and ART-treated cells demonstrated sufficient residual expression of gp41 on the cell surface to warrant subsequent RIT. This is the first time the quantification of gp41 post-ART is being reported. Cells were then treated with Bismuth-213-labeled 2556 antibody. conjugated to the human monoclonal antibody 2556, which binds to HIV gp41. Cell survival was quantified by Trypan blue and residual viremia by p24 ELISA. Cell surface gp41 expression was assessed by Scatchard analysis. The experiments were repeated using PBMCs isolated from blood specimens obtained from 15 HIV-infected individuals: ten on ART and five ART-naive. We found that 213Bi-2556 killed ART-treated infected PBMCs and reduced viral production to undetectable levels. ART and RIT co-treatment was more effective at reducing viral load in vitro than either therapy alone, indicating that gp41 expression under ART was sufficient to allow 213Bi-2556 to deliver cytocidal doses of radiation to infected cells. This study provides proof of concept that 213Bi-2556 may represent an innovative and effective targeting method for killing HIV-infected cells treated with ART, and supports continued development of 213Bi

  12. Suplementação de N-acetilcisteína em pacientes infectados pelo HIV submetidos ao primeiro tratamento anti-retroviral: Avaliação do efeito sobre a carga viral, TNF-α, IL-6, IL-8, β2-microglobulina, IgA, IgG e IgM, haptoglobina e α1-glicoproteína ácida N-acetylcysteine supplementation of HIV-infected patients under the first anti-retroviral treatment: Evaluation of the effect on viral load, TNF-α, IL-6, IL-8, β2-microglobulin, IgA, IgG, IgM, haptoglobin and α1-acid glycoprotein

    Directory of Open Access Journals (Sweden)

    Aricio Treitinger

    2002-03-01

    alterations are characterized by elevated levels of tumor necrosis factor alpha (TNF-α, interleukin 8 (IL-8, β2-microglobulin, IgA, IgG, IgM, haptoglobin and a1-acid glycoprotein. The goal of this double blind placebo-controlled study was to evaluate the effect of N-acetylcysteine supplementation on virological, immunological and inflammatory markers in 24 HIVinfected individuals who were taking their first anti-retroviral therapy. Eleven individuals were treated with anti-retroviral therapy plus placebo supplementation and thirteen were treated with anti-retroviral therapy plus 600 mg/day of Nacetylcysteine. The levels of the studied markers were evaluated at the day before and after 60, 120 and 180 days of treatment. In both groups a significant decrease in serum levels of TNF-α (p=0.0001, IL-6 (p>0.05, IL-8 (p=0.0001, b2 microglobulin (p=0.0005, IgA (p=0.007, IgG (p=0.001, IgM (p=0.0001, haptoglobin (p=0.0001 e α1-acid glycoprotein (p=0.012 was found due to anti-retroviral therapy. N-acetylcysteine supplementation had no additive or synergistic effects on the studied parameters. In conclusion, N-acetylcysteine had no additional beneficial effects, at least at the dose used in this study, on the treatment of HIV-infected patients under anti-retroviral therapy.

  13. Effect of micronutrient and probiotic fortified yogurt on immune-function of anti-retroviral therapy naive HIV patients

    NARCIS (Netherlands)

    R.B.S. Hummelen (Ruben); J. Hemsworth (Jaimie); J. Changalucha (John); N.L. Butamanya (Nicodemus); S. Hekmat (Sharareh); J.D.F. Habbema (Dik); G. Reid (Gregor)

    2011-01-01

    textabstractBackground: Micronutrient supplementation has been shown to reduce the progression of HIV but does not have an effect on the intestinal barrier or the intestinal microbiota of HIV patients. Studies have suggested that probiotics could potentially complement micronutrients in preserving t

  14. Multi-scale modeling of HIV infection in vitro and APOBEC3G-based anti-retroviral therapy.

    Directory of Open Access Journals (Sweden)

    Iraj Hosseini

    2012-02-01

    Full Text Available The human APOBEC3G is an innate restriction factor that, in the absence of Vif, restricts HIV-1 replication by inducing excessive deamination of cytidine residues in nascent reverse transcripts and inhibiting reverse transcription and integration. To shed light on impact of A3G-Vif interactions on HIV replication, we developed a multi-scale computational system consisting of intracellular (single-cell, cellular and extracellular (multicellular events by using ordinary differential equations. The single-cell model describes molecular-level events within individual cells (such as production and degradation of host and viral proteins, and assembly and release of new virions, whereas the multicellular model describes the viral dynamics and multiple cycles of infection within a population of cells. We estimated the model parameters either directly from previously published experimental data or by running simulations to find the optimum values. We validated our integrated model by reproducing the results of in vitro T cell culture experiments. Crucially, both downstream effects of A3G (hypermutation and reduction of viral burst size were necessary to replicate the experimental results in silico. We also used the model to study anti-HIV capability of several possible therapeutic strategies including: an antibody to Vif; upregulation of A3G; and mutated forms of A3G. According to our simulations, A3G with a mutated Vif binding site is predicted to be significantly more effective than other molecules at the same dose. Ultimately, we performed sensitivity analysis to identify important model parameters. The results showed that the timing of particle formation and virus release had the highest impacts on HIV replication. The model also predicted that the degradation of A3G by Vif is not a crucial step in HIV pathogenesis.

  15. Effect of micronutrient and probiotic fortified yogurt on immune-function of anti-retroviral therapy naive HIV patients

    NARCIS (Netherlands)

    R.B.S. Hummelen (Ruben); J. Hemsworth (Jaimie); J. Changalucha (John); N.L. Butamanya (Nicodemus); S. Hekmat (Sharareh); J.D.F. Habbema (Dik); G. Reid (Gregor)

    2011-01-01

    textabstractBackground: Micronutrient supplementation has been shown to reduce the progression of HIV but does not have an effect on the intestinal barrier or the intestinal microbiota of HIV patients. Studies have suggested that probiotics could potentially complement micronutrients in preserving t

  16. Terapia anti-retroviral em indivíduos vivendo com HIV/Aids, Belo Horizonte, 2001 - 2003: o desafio da adesão

    OpenAIRE

    Palmira de Fatima Bonolo

    2005-01-01

    É consenso, entre pesquisadores e profissionais de saúde, que a adesão à terapia anti-retroviral (TARV) é um grande desafio. Os medicamentos anti-retrovirais (ARV) trouxeram excelentes resultados clínicos, mas esses benefícios são diretamente dependentes da adesão ao tratamento. Estudos têm mostrado que dentre os fatores associados com a não-adesão estão àqueles ligados ao serviço de saúde, ao regime terapêutico e ao paciente, e ao contexto sóciocultural, muitos deles passíveis de interven...

  17. Pessoas vivendo com HIV/AIDS: variáveis associadas à adesão ao tratamento anti-retroviral Persons living with HIV/AIDS: factors associated with adherence to antiretroviral treatment

    Directory of Open Access Journals (Sweden)

    Eliane Maria Fleury Seidl

    2007-10-01

    Full Text Available O estudo objetivou descrever o comportamento de adesão ao tratamento anti-retroviral em pessoas vivendo com HIV/AIDS e investigar preditores da adesão entre as variáveis escolaridade, presença de efeitos colaterais, interrupção anterior da terapia anti-retroviral (TARV por conta própria, auto-estima, expectativa de auto-eficácia, estratégias de enfrentamento, suporte social e satisfação com a relação profissional de saúde-usuário. Adesão foi medida pelo auto-relato da perda do número de comprimidos/cápsulas dos medicamentos anti-retrovirais na última semana e mês, sendo considerada satisfatória na ocorrência de omissão inferior a 5% do total prescrito. Participaram 101 pessoas, 60,4% homens, idades entre 20 a 71 anos (M = 37,9 anos, 73,3% sintomáticos. A coleta de dados incluiu entrevista e instrumentos auto-aplicáveis. A maioria (n = 73; 72,3% relatou adesão igual ou superior a 95%. Nos resultados da regressão logística, interrupção anterior da TARV e expectativa de auto-eficácia foram preditores significativos da adesão. Faz-se necessária a qualificação da assistência pela constituição de equipes interdisciplinares, para o desenvolvimento de abordagens adequadas às dificuldades médicas e psicossociais de adesão das pessoas vivendo com HIV/AIDS.This study aimed to describe the adherence of persons living with HIV/AIDS to antiretroviral therapy (ART and to investigate adherence predictors among the following: level of schooling, presence of side effects, current or previous interruption of ART by the persons themselves, self-esteem, self-efficacy expectation, coping strategies, social support, and satisfaction with the health professional-patient relationship. Adherence was measured by self-reported number of ART pills/capsules missed during the previous week and previous month, evaluated as satisfactory when less than 5%. 101 HIV+ adults took part in this study, 60.4% males, ranging from 20 to 71 years

  18. Patentes farmacêuticas e saúde pública: desafios à política brasileira de acesso ao tratamento anti-retroviral Pharmaceutical patents and public health: challenges for the Brazilian antiretroviral treatment policy

    Directory of Open Access Journals (Sweden)

    Constance Marie Milward de Azevedo Meiners

    2008-07-01

    Full Text Available O preço elevado de medicamentos patenteados tem intensificado o debate em torno do impacto do regime da propriedade intelectual sobre o acesso a tratamentos de saúde, merecendo destaque o caso do HIV/AIDS. A política brasileira de tratamento anti-retroviral, parte de um programa nacional que integra medidas de prevenção e promoção da saúde, permitiu o alcance de uma ampla cobertura com qualidade, tendo sido apontada como modelo para outros países. Não obstante, conforme amadurece o Programa Nacional de DST e AIDS, os gastos com a incorporação de anti-retrovirais patenteados ao esquema terapêutico para pacientes em tratamento atinge um peso, cada vez maior, em seu orçamento. O presente artigo toma em conta os desafios apresentados pelas patentes farmacêuticas à saúde pública e discute possíveis caminhos para a sustentação da política de acesso universal e gratuito ao tratamento contra HIV/AIDS no Brasil.The high prices of patented drugs have fueled the debate regarding the impact of the intellectual property system on access to treatment, with a special focus on HIV/AIDS. The Brazilian policy for antiretroviral treatment, part of a comprehensive program that includes both disease prevention and health promotion activities, has allowed the country to meet goals for coverage and quality and has been considered a model for other countries. However, as the Brazilian STD/AIDS Program reaches maturity, the increasing incorporation of patented drugs into the AIDS treatment regimen imposes an increasing burden on the country's health budget. This article discusses the public health challenges raised by pharmaceutical patents and discusses possible ways to sustain the national policy for free, universal access to HIV/AIDS treatment.

  19. Longitudinal comparison between plasma and seminal HIV-1 viral loads during antiretroviral treatment Comparação longitudinal entre cargas virais seminais e plasmáticas do HIV-1 durante terapia anti-retroviral

    Directory of Open Access Journals (Sweden)

    Lauro Ferreira da Silva Pinto Neto

    2003-12-01

    Full Text Available This study was designed to investigate the impact of anti-retroviral therapy on both plasma and seminal HIV-1 viral loads and the correlation between viral loads in these compartments after treatment. Viral load, CD4+ and CD8+ T-cell counts were evaluated in paired plasma and semen samples from 36 antiretroviral therapy-naïve patients at baseline and on days 45, 90, and 180 of treatment. Slopes for blood and seminal viral loads in all treated patients were similar (p = 0.21. Median HIV-1 RNA titers in plasma and semen at baseline were 4.95 log10 and 4.48 log10 copies/ml, respectively. After 180 days of therapy, the median viral load declined to 3.15 log10 copies/ml (plasma and 3.2 log10 copies/ml (semen. At this timepoint 22 patients presented HIV-1 viral load below 400 copies/ml in either plasma or semen, but only 9 had viral loads below 400 copies/ml in both compartments.Este estudo foi desenhado para investigar o impacto do tratamento com anti-retrovirais na evolução das cargas virais plasmáticas e seminais do HIV-1. A carga viral do HIV-1 e a contagem de linfócitos T CD4+ e CD8+ foi determinada em amostras pareadas de sangue e sêmen de 36 pacientes virgem de tratamento nos dias 0, 45, 90 e 180 após o início da terapia. As curvas de declínio das cargas virais plasmática e seminal foram semelhantes (p= 0.21. As medianas da carga viral plasmática e seminal no pré-tratamento (dia 0 foram 4.95 e 4.48 log10 cópias/ml, respectivamente. Seis meses após o início da terapia, a mediana da carga viral plasmática era 3.15 log10 cópias/ml e a seminal 3.2 log10 cópias/ml. Neste mesmo periodo, 22 pacientes apresentavam carga viral abaixo de 400 cópias/ml no plasma e/ou sêmen, enquanto apenas 9 pacientes apresentavam carga viral abaixo do limite de detecção nos dois compartimentos.

  20. Combination therapy: the next opportunity and challenge of medicine

    Directory of Open Access Journals (Sweden)

    Marincola Francesco M

    2011-07-01

    Full Text Available Abstract From an historical point of view, combination therapy was the basis for the care of important diseases like infection diseases or cancer. Today the "cocktail drug" of the Highly Active Anti Retroviral Therapy (HAART has reduced the death for HIV infection changing the outcome of such disease. Moreover, the combination of different strategies changed the course of transplants (both in haematology and surgical transplant. Different diseases with high social impact including cardiovascular, metabolic (obesity, hypercholesterolaemia and diabetes and autoimmune diseases, have better results with combinations of different drug classes of drugs. After recent successes in the immunotherapy field (Sepuleucel-T, ipilimumab and the new promising small molecule therapies, cancer should be the next challenge for combination strategies.

  1. Anxiety-like behaviour is attenuated by gabapentin, morphine and diazepam in a rodent model of HIV anti-retroviral-associated neuropathic pain.

    Science.gov (United States)

    Wallace, Victoria C J; Segerdahl, Andrew R; Blackbeard, Julie; Pheby, Timothy; Rice, Andrew S C

    2008-12-19

    Neuropathic pain is commonly associated with affective disorders such as anxiety and depression. We have previously characterised a rodent model of HIV, anti-retroviral-associated neuropathy in which rats develop hypersensitivity to a punctate mechanical stimulus and display anxiety-like behaviour in the open field paradigm. To assess the potential of this behavioural paradigm for the assessment of pain related co-morbidities in rodent models of pain, here we test the sensitivity of this anxiety-like behaviour to the analgesic agents gabapentin and morphine in comparison to the known anxiolytic drug diazepam. We found that gabapentin (30 mg/kg, i.p.) and morphine (2.5 mg/kg, i.p.), which reduce mechanical hypersensitivity in these rats, significantly reduces measures of thigmotaxis in the open field. The effect of gabapentin and morphine did not differ significantly from diazepam (1 mg/kg, i.p.). This study highlights the potential use of this rodent model and behavioural paradigm in the validation of the affective component of novel analgesic pharmacological targets and elucidation of underlying pathophysiological mechanisms.

  2. Estudo da Adesão à Quimioprofilaxia Anti-retroviral para a Infecção por HIV em Mulheres Sexualmente Vitimadas Study of Adherence to Antiretroviral Chemoprophylaxis for HIV Infection in Sexually Abused Women

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    Jefferson Drezett

    1999-10-01

    Full Text Available Objetivos: embora não existam dados apropriados para estabelecer sua eficácia, alguns serviços tem utilizado, profilaticamente, a terapia anti-retroviral para o HIV nos casos de violência sexual. O objetivo deste estudo foi avaliar a aceitabilidade, tolerância e adesão a um esquema quimioprofilático para o HIV. Pacientes e método: foram avaliadas 62 mulheres vítimas de estupro e/ou atentado violento ao pudor com coito ectópico anal. Os agressores foram referidos como desconhecidos. A profilaxia foi iniciada dentro das primeiras 48 h da violência e mantida por 4 semanas, sendo administrados diariamente: zidovudina, 600 mg; indinavir, 2.400 mg e lamivudina, 300 mg. Resultados: a taxa de descontinuidade foi de 24,2%, sendo em 12 casos (80% decorrente de intolerância gástrica. Os efeitos colaterais estiveram presentes em 43 casos (69,4%, sendo as náuseas e vômitos os mais freqüentes. A complexidade posológica e o tempo de uso foram fatores possivelmente associados ao uso inadequado das drogas, ocorrendo em 10,6% dos casos. Conclusão: a taxa de descontinuidade da quimioprofilaxia foi semelhante à observada em outras indicações.Purpose: some medical institutions have been prophylactically ministrating anti-HIV therapy in cases of sexual violence, although there are no appropriate basic facts to establish its efficacy. The aim of the present study was to evaluate the acceptance, tolerance and adhesion of these women under a chemoprophylaxis plan for HIV. Methods: sixty-two women victims of rape and/or anal intercourse with unknown aggressors have been evaluated. Prophylaxis has been started within the first 48 h after violence and maintained for 4 weeks, with daily administration of zidovudine, 600 mg; indinavir, 2,400 mg and lamivudine, 300 mg. Results: the discontinuance rate was 24.2%, withe 12 cases (80% due to gastric intolerance. The side effects were present in 43 cases (69.4%, including nausea and vomitting as the most

  3. Determinantes da aderência à terapia anti-retroviral combinada em Brasília, Distrito Federal, Brasil, 1999-2000

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    Cláudio Viveiros de Carvalho

    Full Text Available A aderência ao tratamento é um dos principais problemas relacionados à terapia anti-retroviral, já que a tomada incompleta dos medicamentos pode levar à resistência viral. Efeitos colaterais podem interferir com a qualidade de vida dos pacientes. Buscou-se estimar níveis de aderência à terapia e investigar seus determinantes, através de um estudo transversal. Definiram-se dois pontos de corte como boa aderência: a tomada de pelo menos 80% ou de 95% da medicação conforme a prescrição. Realizaram-se entrevistas semi-estruturadas em uma amostra seqüencial de 150 pacientes atendidos no Hospital-Dia de Brasília. Observou-se que a média de aderência foi 85,8%. As variáveis que se mostraram significativamente associadas à baixa aderência foram: idade, escolaridade, situação de emprego, rendas pessoal e familiar, uso de substâncias ilícitas, estrutura familiar e/ou comunitária, presença de infecção oportunista no momento do diagnóstico e ocorrência de efeitos colaterais relacionados à terapia. As razões de prevalência variaram de 1,6 a 4,5. Concluiu-se que variáveis sócio-econômicas e de hábitos tiveram maior força de associação com o nível de aderência do que as relacionadas com a doença ou com o tratamento.

  4. Prevalence and clinical and laboratory characteristics of kidney disease in anti-retroviral-naive human immunodeficiency virus-infected patients in South-South Nigeria

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    U H Okafor

    2016-01-01

    Full Text Available Since the emergence of acquired immune deficiency syndrome (AIDS about three decades ago, several renal disorders have been reported as common complications of human immunodeficiency virus (HIV infection. These renal disorders result from diverse etiologies. The aim of this cross-sectional study was to determine the prevalence and clinical and laboratory characteristics of anti-retroviral-naοve HIV-infected patients with impaired kidney disorder in South-South Nigeria. This study was conducted on patients presenting at the University of Benin Teaching Hospital, Benin City in South-South Nigeria for six months. The patients′ demographic data and clinical, hematological and biochemical parameters were assessed. Their glomerular filtration rate (GFR was calculated and the protein excretion was assessed from the protein- creatinine ratio. Data were analyzed using statistical software program SPSS version 15.0. Threehundred and eighty-three patients with a mean age of 35.39 ± 8.78 years and a male: female ratio of 1:1 were studied; 53.3% had evidence of kidney disorder. The main clinical features in patients with kidney disorder were evidence of fluid retention, urinary symptoms, pallor and encephalopathy. The mean systolic and diastolic blood pressures were 115.33 ± 17.17 and 72.33 ± 14.31 mm Hg, respectively. The mean estimated GFR was 52.5 mL/min/1.73 m 2 . Patients with kidney disorder had higher proteinuria (P = 0.001, lower mean CD4 cell count and packed cell volume (P = 0.019 and 0.001, respectively. Kidney disorder is a common complication in HIV-infected patients, and they have clinical and laboratory anomalies. Screening of HIV/AIDS patients at the time of diagnosis will facilitate early diagnosis of kidney disorders in them.

  5. Metabolic Disturbances in Liver {sup 1}H MR Spectroscopy in HIV and HCV Co-infected Patients as a Potential Marker of Hepatocyte Activation

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    Tarasow, E.; Wierciska-Drapao, A.; Jaroszewicz, J.; Siergiejczyk, L.; Orzechowska-Bobkiewicz, A.; Prokopowicz, D.; Walecki, J. [Medical Academy Hospital, Bialystok (Poland). Dept. of Radiology

    2004-12-01

    Purpose : To evaluate proton magnetic resonance spectroscopy ({sup 1}H MRS) features in order to assess hepatocellular activation in chronic hepatitis C and human immunodeficiency virus/hepatitis C (HIV/HCV) co-infected patients. Material and Methods : Liver in vivo {sup 1}H MR spectra were obtained in 14 patients with hepatitis C virus infection (HCV), 20 HIV/HCV co-infected individuals, and 24 healthy volunteers. Resonances of lipids, glutamine/glutamate (Glx), phosphomonoesters (PME), glycogen/glucose (Glc) were assessed and metabolite ratios to total lipids (TL) were calculated. Results : A significant increase in Glx/TL and PME/TL was observed in the HCV group as compared to healthy individuals. Patients with HIV and HCV co-infection had a further increase of all metabolite ratios. Changes in metabolite ratios were due to both the increase in particular metabolite contents and to the decrease in lipid levels. HIV/HCV-infected patients treated with highly active anti-retroviral therapy (HAART) showed elevated PME and Glx levels and significantly decreased TL compared to patients not undergoing anti-retroviral treatment. Conclusions : Our findings suggest clinical usefulness of liver {sup 1}H MR spectroscopy in detecting even slight disturbances in liver metabolism.

  6. Occurrence of intestinal parasites amongst persons on highly active antiretroviral drug therapy in Calabar, Cross River State, Nigeria

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    Paul C. Inyang-Etoh

    2015-02-01

    Full Text Available Opportunistic and intestinal parasite infections are common health problem among HIV/AIDS patients. Early detection and treatment of these parasites are important to improve the quality of life of this category of patients. The occurrence of intestinal parasites among 400 patients on highly active anti-retroviral drug therapy (HAART aged 11-60 years was investigated. Standard parasitological techniques like direct microscopy, formol ether concentration and modified Ziehl- Neelsen staining techniques were used to analyze the stool samples. Intestinal parasite infections were positive in 116 (29% of the subjects on HAART while control subjects had 12 (12% and the difference was statistically significant (P<0.05. Subjects in the age group 21-30 years had the highest infection rate 54 (35.1%. There was no statistically significant difference in infection according to age (P>0.05. Females 76 (32.5% had a higher prevalence rate than males 40 (24.1%. But there was no statistically significant difference in infection according to gender (P<0.05. Patients with CD4 count of less than 200 cells/mm3 were observed to be more infected than those with CD4 count of more than 200 cells/mm3. There was a strong positive correlation (r=0.94 between CD4 count and the occurrence of intestinal parasite infection. Protozoan parasites 84 (21.0% accounted for a higher prevalence rate than helminthic parasites 32 (8.0%. These findings has revealed a high prevalence of intestinal parasite infection among patients on HAART thus the routine screening of stool samples from these category of patients for intestinal parasites is advocated for effective management of the disease.

  7. Reasons Why High Religiosity Can Co-exist with and Precipitate Discontinuation of Anti-retroviral Therapy among Different HIV Clients in Uganda: An Exploratory Study

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    Glenn Wagner

    2012-09-01

    Full Text Available In-depth interviews were conducted with 39 very religious people living with HIV (16 had ever and 23 had never discontinued antiretroviral therapy—ART to assess the role of religion in these treatment decisions and in coping with HIV. Participants who had ever discontinued ART gave reasons such as: teachings and prophecies from religious leaders, and supporting Biblical scriptures all of which led them to feel that God and their faith, not ART, would help them; and testimonies by their “already healed” peers who had stopped ART. Participants who had never discontinued ART gave reasons such as continuous adherence counseling from multiple sources, improvement in physical health as a result of ART, and beliefs that God heals in different ways and that non-adherence is equal to putting God to a test. High religiosity was reported to help participants cope with HIV through engagement in personal and or community protective behaviours, “taking care of other illness”, and reducing worries. When high religiosity among people living with HIV (PHAs becomes a barrier to ART adherence, the adherence counseling provided can draw on experiences of PHAs with high religiosity who have sustained good adherence to ART and achieved good health outcomes.

  8. Reasons Why High Religiosity Can Co-exist with and Precipitate Discontinuation of Anti-retroviral Therapy among Different HIV Clients in Uganda: An Exploratory Study

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    Tumwine, Christopher; Neema, Stella; Wagner, Glenn

    2014-01-01

    In-depth interviews were conducted with 39 very religious people living with HIV (16 had ever and 23 had never discontinued antiretroviral therapy—ART) to assess the role of religion in these treatment decisions and in coping with HIV. Participants who had ever discontinued ART gave reasons such as: teachings and prophecies from religious leaders, and supporting Biblical scriptures all of which led them to feel that God and their faith, not ART, would help them; and testimonies by their “already healed” peers who had stopped ART. Participants who had never discontinued ART gave reasons such as continuous adherence counseling from multiple sources, improvement in physical health as a result of ART, and beliefs that God heals in different ways and that non-adherence is equal to putting God to a test. High religiosity was reported to help participants cope with HIV through engagement in personal and or community protective behaviours, “taking care of other illness”, and reducing worries. When high religiosity among people living with HIV (PHAs) becomes a barrier to ART adherence, the adherence counseling provided can draw on experiences of PHAs with high religiosity who have sustained good adherence to ART and achieved good health outcomes. PMID:24432189

  9. The Effect of HIV and the Modifying Effect of Anti-Retroviral Therapy (ART) on Body Mass Index (BMI) and Blood Pressure Levels in Rural South Africa.

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    Feigl, Andrea B; Bloom, David E; Danaei, Goodarz; Pillay, Deenan; Salomon, Joshua A; Tanser, Frank; Bärnighausen, Till W

    2016-01-01

    High BMI and blood pressure are leading chronic disease risk factors in South Africa. Longterm effects of HIV and ART on adiposity and blood pressure are poorly understood, and direct comparisons of risk factor trajectories in HIV- versus HIV+ populations are rare. In 2003 and 2010, height, weight, and blood pressure were recorded in a study population (n = 505) in KwaZulu-Natal, South Africa (30% adult HIV prevalence). We modeled change in BMI and BP longitudinally in HIV- individuals (n = 315), seroconverters (n = 32), HIV+ patients not on ART (HIV+ART-; n = 52), HIV+ patients on ART for 0-ART0-ART for 2-5 years (HIV+ART2-5yrs; n = 44), and a subgroup with unknown HIV status (n = 44). Difference-in-differences were assessed in reference to the HIV- population. Between 2003 and 2010, BMI increased significantly in the HIV- group, by 0.874 (95% CI 0.339, 1.41; p = 0.001), to 30.4. BMI drop was significantly greater in HIV+ART0-ART2-5yrs (p = 0.005). DID in BMI in HIV+ART0-ART2-5yrs versus reference was -1.35 (95% CI -2.89, 0.189; p = 0.086). DID in SBP in HIV+ART-vs HIV- DID was -7.55 mmHg (95% CI -13.2 to -1.90; p = 0.009). Short-term ART (0-ART or long-term ART. Once on ART for 2+ years, individuals 'caught up' on weight gain with the HIV- population. Our results showcase the importance of health system readiness to address the burgeoning double burden of disease in South Africa.

  10. Hepatitis B co-infection in HIV-infected patients receiving antiretroviral therapy at the TC Newman Anti Retroviral Treatment Clinic in Paarl, Western Cape

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    Jeanmari King

    2016-02-01

    Full Text Available Background: Hepatitis B virus (HBV and human immunodeficiency virus (HIV co-infection in South Africa is estimated to be between 5% and 23%; however, only limited evidence is available. Co-infection increases the risk of chronification of HBV, liver cirrhosis and death.Objective: To assess the HBV and/or HIV co-infection rate amongst the adult antiretroviral treatment cohort at the TC Newman ART Clinic in Paarl, Western Cape.Methods: In a retrospective, cross-sectional study, the routine hepatitis B surface antigen screening results for all adult HIV patients who were started on antiretroviral treatment over a period of 19 months were collected and analysed for gender, CD4 count and age.Results: Amongst the 498 participants (60% female participants, the Hepatitis B surface Antigen positivity rate was 7.6%. Male gender, age between 50 and 59 years and a low CD4 count were correlated with higher rates.Conclusion: Useful insight could be obtained by analysing routine data. The prevalence of almost 8% confirms the need for testing of HIV-positive patients for hepatitis B.Keywords: hepatitis B; prevalence; HIV-infected; adults; co-infection

  11. German-Austrian recommendations for HIV-therapy in pregnancy--common declaration of The German AIDS-society (DAIG), The Austrian AIDS-society (OEAG) as well as The Robert-Koch Institute Berlin (RKI), The German Association of Physicians specialized in HIV Care (DAGNAE), The German Society of Pediatric and Youth Medicine (DGKJ), The German AIDS Pediatric Association (PAAD), The German Society of Obstetrics and Gynecology (DGGG), The National Reference Center for Retroviruses (NRZ), German AIDS Assistance (DAH).

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    Buchholz, Bernd; Marcus, Ulrich; Beichert, Matthias; Grubert, Thomas; Gingelmaier, Andrea; Kaestner, Ralph; Grosch-Woerner, Ilse; Brockmeyer, Norbert H

    2002-10-29

    Anti-retroviral therapy during pregnancy--The German/Austrian recommendations to optimise prevention of vertical transmission of HIV and to minimise adverse drug effects. In Germany during the last years about 200 HIV infected pregnant women delivered a baby each year, a number that is currently increasing. To determine the HIV-status early in pregnancy voluntary HIV-testing of all pregnant women is recommended in Germany and Austria as part of prenatal care. In those cases, where HIV infection was known during pregnancy, since 1995 the rate of vertical transmission of HIV was reduced to 1-2%. This low transmission rate has been achieved by the combination of anti-retroviral therapy of pregnant women, cesarean section scheduled before onset of labor, anti-retroviral prophylaxis in the newborn and refraining from breast-feeding by the HIV infected mother. In 1998 an interdisciplinary consensus meeting consisting of gynaecologists, infectious disease specialists, paediatricians, pharmacologists, virologists and members of the German AIDS Hilfe (NGO) updated this combined strategy for the first time. A second update became necessary because of new results in research, approval of new anti-retroviral drugs and changes in the general treatment recommendations for HIV infected adults, which are referred to in the pregnancy guidelines. The updating process was started in July 2000 and was finalized in May 2001. In the updated guidelines recommendations for monitoring of HIV infected pregnant women in prenatal care and for preventive procedures for the newborn in delivery room have been included. The guidelines provide new recommendations on the indication and the starting point for anti-retroviral therapy in pregnancies without complications, drugs and drug combinations to be used preferably in these pregnancies and updated information on adverse effects of anti-retroviral drugs. Also the procedures for different scenarios and risk constellations in pregnancy have been

  12. Survival and predictors of mortality among human immunodeficiency virus patients on anti-retroviral treatment at Jinka Hospital, South Omo, Ethiopia: a six years retrospective cohort study.

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    Tachbele, Erdaw; Ameni, Gobena

    2016-01-01

    The survival rate of human immunodeficiency virus (HIV)-infected patients receiving treatment in Ethiopia is poorly understood. This study aimed to determine the survival rate and predictors of mortality among HIV-infected adults on antiretroviral therapy (ART) at Jinka Hospital, South Omo, Ethiopia. A 6-year retrospective cohort study was conducted using 350 patient records drawn from 1,899 patients on ART at Jinka Hospital from September 2010 to August 2015. The data were analyzed using Kaplan-Meier statistics and Cox regression models. Of the 350 study participants, 315 (90.0%) were censored and 35 (10.0%) died. Twenty-two (62.9%) of the deaths occurred during the first year of treatment. The total follow-up encompassed 1,995 person-years, with an incidence rate of 1.75 deaths per 100 person-years. The mean survival time of patients on highly active antiretroviral therapy (HAART) was 30.84±19.57 months. The overall survival of patients on HAART was 64.00% (95% confidence interval [CI], 61.85 to 66.21%) at 72 months of follow-up. The significant predictors of mortality included non-disclosure of HIV status (adjusted hazard ratio [aHR], 5.82; 95% CI, 1.91 to 17.72), a history of tuberculosis (aHR, 1.82; 95% CI, 1.41 to 3.51), and ambulatory (aHR, 2.97; 95% CI, 1.20 to 8.86) or bedridden (aHR, 4.67; 95% CI, 1.30 to 17.27) functional status, World Health Organization (WHO) clinical stage IV illness (aHR, 24.97; 95% CI, 2.75 to 26.45), and substance abusers (aHR, 3.72; 95% CI, 1.39 to 9.97). Patients with a history of tuberculosis treatment, ambulatory or bedridden functional status, or advanced WHO clinical stage disease, as well substance abusers, should be carefully monitored, particularly in the first few months after initiating antiretroviral therapy. Patients should also be encouraged to disclose their status to their relatives.

  13. Terapia anti-retroviral: fatores que interferem na adesão de crianças com HIV/AIDS Terapia anti-retroviral: factores que interfieren en la adherencia de niños con VIH/SIDA Antiretroviral therapy: factors interfering in the adherence of children with HIV/AIDS

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    Ana Claúdia Feitosa

    2008-09-01

    Full Text Available O objetivo deste estudo foi conhecer os fatores que interferem na adesão à terapêutica medicamentosa em crianças infectadas pelo HIV/AIDS, relatados por 12 cuidadores em um serviço de referência em AIDS, em Fortaleza-CE. Os dados foram obtidos mediante entrevista, e, com eles, foram apurados fatores que dificultaram a adesão terapêutica, evidenciando relatos referentes à apresentação da droga, horário da tomada do medicamento, efeitos colaterais, falta na distribuição de medicamento gratuito, dificuldade de acesso regular ao serviço de saúde e problemas financeiros. Constatou-se a importância de conhecer o contexto social no qual a criança está inserida e as dificuldades no uso dos anti-retrovirais para intervir de forma eficiente e possibilitar uma melhor qualidade de vida às crianças.La finalidad de este estudio fue conocer los factores que interfieren en la adherencia a la terapéutica medicamentosa en niños infectados por el VIH/sida relatados por 12 cuidadores en un servicio de referencia en sida, en Fortaleza-CE, Brasil. Los datos fueron obtenidos mediante entrevista, y, con ellos fueran apurados factores que dificultaron la adherencia terapéutica, evidenciando relatos referentes a la presentación de la droga, horario de la toma del medicamento, efectos colaterales, falta en la distribución de medicamento gratuito, dificultad de acceso regular al servicio de salud y problemas financieros. Se constató la importancia de conocer el contexto social en que el niño está insertado y las dificultades en el uso de los anti-retrovirales para intervenir de forma eficiente y posibilitar una mejor calidad de vida a los niños.This study aimed to get to know the factors that interfere in medication treatment adherence among children infected by HIV/aids, as reported by 12 caregivers in a service reference to aids in Fortaleza/CE, Brazil. Data were collected through interviews, verifying factors that made treatment adherence difficult, evidencing reports about drug forms, time of medication intake, collateral effects, shortage in the free drugs distribution, difficulty to get regular access to the health service and financial problems. The importance was revealed of getting to know the social context the child is inserted in and the difficulties in the use of antiretroviral drugs, so as to intervene efficiently and permit a better quality of life for the children.

  14. Facility-level intervention to improve attendance and adherence among patients on anti-retroviral treatment in Kenya--a quasi-experimental study using time series analysis.

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    Boruett, Patrick; Kagai, Dorine; Njogo, Susan; Nguhiu, Peter; Awuor, Christine; Gitau, Lillian; Chalker, John; Ross-Degnan, Dennis; Wahlström, Rolf; Tomson, Göran

    2013-07-01

    Achieving high rates of adherence to antiretroviral therapy (ART) in resource-poor settings comprises serious, but different, challenges in both the first months of treatment and during the life-long maintenance phase. We measured the impact of a health system-oriented, facility-based intervention to improve clinic attendance and patient adherence. This was a quasi-experimental, longitudinal, controlled intervention study using interrupted time series analysis. The intervention consisted of (1) using a clinic appointment diary to track patient attendance and monitor monthly performance; (2) changing the mode of asking for self-reported adherence; (3) training staff on adherence concepts, intervention methods, and use of monitoring data; (4) conducting visits to support facility teams with the implementation.We conducted the study in 12 rural district hospitals (6 intervention, 6 control) in Kenya and randomly selected 1894 adult patients over 18 years of age in two cohorts: experienced patients on treatment for at least one year, and newly treated patients initiating ART during the study. Outcome measures were: attending the clinic on or before the date of a scheduled appointment, attending within 3 days of a scheduled appointment, reporting perfect adherence, and experiencing a gap in medication supply of more than 14 days. Among experienced patients, the percentage attending the clinic on or before a scheduled appointment increased in both level (average total increase immediately after intervention) (+5.7%; 95% CI=2.1, 9.3) and trend (increase per month) (+1.0% per month; 95% CI=0.6, 1.5) following the intervention, as did the level and trend of those keeping appointments within three days (+4.2%; 95% CI=1.6, 6.7; and +0.8% per month; 95% CI=0.6, 1.1, respectively). The relative difference between the intervention and control groups based on the monthly difference in visit rates increased significantly in both level (+6.5; 95% CI=1.4, 11.6) and trend (1.0% per

  15. Humanized mice recapitulate key features of HIV-1 infection: a novel concept using long-acting anti-retroviral drugs for treating HIV-1.

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    Marc Nischang

    Full Text Available BACKGROUND: Humanized mice generate a lymphoid system of human origin subsequent to transplantation of human CD34+ cells and thus are highly susceptible to HIV infection. Here we examined the efficacy of antiretroviral treatment (ART when added to food pellets, and of long-acting (LA antiretroviral compounds, either as monotherapy or in combination. These studies shall be inspiring for establishing a gold standard of ART, which is easy to administer and well supported by the mice, and for subsequent studies such as latency. Furthermore, they should disclose whether viral breakthrough and emergence of resistance occurs similar as in HIV-infected patients when ART is insufficient. METHODS/PRINCIPAL FINDINGS: NOD/shi-scid/γ(cnull (NOG mice were used in all experimentations. We first performed pharmacokinetic studies of the drugs used, either added to food pellets (AZT, TDF, 3TC, RTV or in a LA formulation that permitted once weekly subcutaneous administration (TMC278: non-nucleoside reverse transcriptase inhibitor, TMC181: protease inhibitor. A combination of 3TC, TDF and TMC278-LA or 3TC, TDF, TMC278-LA and TMC181-LA suppressed the viral load to undetectable levels in 15/19 (79% and 14/14 (100% mice, respectively. In successfully treated mice, subsequent monotherapy with TMC278-LA resulted in viral breakthrough; in contrast, the two LA compounds together prevented viral breakthrough. Resistance mutations matched the mutations most commonly observed in HIV patients failing therapy. Importantly, viral rebound after interruption of ART, presence of HIV DNA in successfully treated mice and in vitro reactivation of early HIV transcripts point to an existing latent HIV reservoir. CONCLUSIONS/SIGNIFICANCE: This report is a unique description of multiple aspects of HIV infection in humanized mice that comprised efficacy testing of various treatment regimens, including LA compounds, resistance mutation analysis as well as viral rebound after treatment

  16. Facility-level intervention to improve attendance and adherence among patients on anti-retroviral treatment in Kenya—a quasi-experimental study using time series analysis

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    2013-01-01

    Background Achieving high rates of adherence to antiretroviral therapy (ART) in resource-poor settings comprises serious, but different, challenges in both the first months of treatment and during the life-long maintenance phase. We measured the impact of a health system-oriented, facility-based intervention to improve clinic attendance and patient adherence. Methods This was a quasi-experimental, longitudinal, controlled intervention study using interrupted time series analysis. The intervention consisted of (1) using a clinic appointment diary to track patient attendance and monitor monthly performance; (2) changing the mode of asking for self-reported adherence; (3) training staff on adherence concepts, intervention methods, and use of monitoring data; (4) conducting visits to support facility teams with the implementation. We conducted the study in 12 rural district hospitals (6 intervention, 6 control) in Kenya and randomly selected 1894 adult patients over 18 years of age in two cohorts: experienced patients on treatment for at least one year, and newly treated patients initiating ART during the study. Outcome measures were: attending the clinic on or before the date of a scheduled appointment, attending within 3 days of a scheduled appointment, reporting perfect adherence, and experiencing a gap in medication supply of more than 14 days. Results Among experienced patients, the percentage attending the clinic on or before a scheduled appointment increased in both level (average total increase immediately after intervention) (+5.7%; 95% CI = 2.1, 9.3) and trend (increase per month) (+1.0% per month; 95% CI = 0.6, 1.5) following the intervention, as did the level and trend of those keeping appointments within three days (+4.2%; 95% CI = 1.6, 6.7; and +0.8% per month; 95% CI = 0.6, 1.1, respectively). The relative difference between the intervention and control groups based on the monthly difference in visit rates increased significantly in both

  17. Determinantes da adesão ao tratamento anti-retroviral em Brasília, DF: um estudo de caso-controle Determinants of antiretroviral treatment adherence in Brasília, Federal District: a case-control study

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    Cláudio Viveiros de Carvalho

    2007-10-01

    Full Text Available Buscou-se avaliar os fatores relacionados à adesão ao tratamento anti-retroviral no Distrito Federal. De 150 pacientes entrevistados em sete centros de referência, 35 não aderentes foram definidos como casos, sendo selecionados 70 controles aderentes, pareados por idade. Avaliaram-se variáveis sócio-demográficas, hábitos, suporte social, qualidade de vida, questões relacionadas a doença, estado clínico, tratamento e serviço. Na análise bivariada, houve associação da adesão com raça/cor, escolaridade, centros de referência em que faz acompanhamento e renda familiar. Após ajuste, cor parda, centros de referência localizado no Plano Piloto, escolaridade alta e receber apoio dos amigos quanto às necessidades permaneceram associados com adesão. Retirando raça/cor do modelo, mantiveram-se centros de referência, escolaridade, profissão, renda, apoio (contar com alguém que demonstre gostar de você e satisfação com o atendimento na farmácia de dispensação. Além dos fatores já consolidados na literatura, questões relacionadas ao apoio no âmbito micro-social e aos serviços de assistência mostraram-se associados à observância terapêutica.We sought to evaluate factors relating to adherence to antiretroviral treatment in the Federal District. Out of 150 patients interviewed at seven reference centers; 35 non-adherent subjects were considered to be cases; we selected 70 age-matched adherent individuals as controls. Variables relating to sociodemographics, habits, social support, quality of life, disease-related issues, clinical conditions, treatment and healthcare services were evaluated. Bivariate analysis showed that adherence was associated with race/color, educational level, the reference center where the patient was followed up and familial income. After adjustments, mixed race (parda, reference center location in central Brasília, high educational level and friends’ support for needs remained associated with

  18. Tuberculosis treatment in HIV infected Ugandans with CD4 counts>350 cells/mm reduces immune activation with no effect on HIV load or CD4 count.

    Directory of Open Access Journals (Sweden)

    C Scott Mahan

    Full Text Available BACKGROUND: Both HIV and TB cause a state of heightened immune activation. Immune activation in HIV is associated with progression to AIDS. Prior studies, focusing on persons with advanced HIV, have shown no decline in markers of cellular activation in response to TB therapy alone. METHODOLOGY: This prospective cohort study, composed of participants within a larger phase 3 open-label randomized controlled clinical trial, measured the impact of TB treatment on immune activation in persons with non-advanced HIV infection (CD4>350 cells/mm3 and pulmonary TB. HIV load, CD4 count, and markers of immune activation (CD38 and HLA-DR on CD4 and CD8 T cells were measured prior to starting, during, and for 6 months after completion of standard 6 month anti-tuberculosis (TB therapy in 38 HIV infected Ugandans with smear and culture confirmed pulmonary TB. RESULTS: Expression of CD38, and co-expression of CD38 and HLA-DR, on CD8 cells declined significantly within 3 months of starting standard TB therapy in the absence of anti-retroviral therapy, and remained suppressed for 6 months after completion of therapy. In contrast, HIV load and CD4 count remained unchanged throughout the study period. CONCLUSION: TB therapy leads to measurable decreases in immune activation in persons with HIV/TB co-infection and CD4 counts>350 cells/mm3.

  19. Nutritional therapy for active Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Nutritional therapy for active Crohn's disease (CD) is an underutilised form of treatment in adult patients, though its use is common in the paediatric population. There is evidence that nutritional therapy can effectively induce remission of CD in adult patients. Enteral nutrition therapy is safe and generally well tolerated, leta-analysis data suggest that corticosteroids are superior to nutritional treatment for induction of remission in active CD. However, the potential side effects of such pharmacotherapy must be taken into consideration. This review examines the evidence for the efficacy of elemental and polymeric diets, and the use of total parenteral nutrition in active CD.

  20. Activity Therapy Services and Chemical Dependency Rehabilitation.

    Science.gov (United States)

    James, Mark R.; Townsley, Robin K.

    1989-01-01

    Discusses how music, occupational, and recreation therapies can contribute to comprehensive treatment programs for chemical dependency. Sees prime contribution of activity therapy as lying in nature of experiential education, applying insight gained in counseling sessions and discussion groups to practical real-life situations. (Author/NB)

  1. Increased Intrathecal Immune Activation in Virally Suppressed HIV-1 Infected Patients with Neurocognitive Impairment.

    Directory of Open Access Journals (Sweden)

    Arvid Edén

    Full Text Available Although milder forms of HIV-associated neurocognitive disorder (HAND remain prevalent, a correlation to neuronal injury has not been established in patients on antiretroviral therapy (ART. We examined the relationship between mild HAND and CSF neurofilament light protein (NFL, a biomarker of neuronal injury; and CSF neopterin, a biomarker of CNS immunoactivation, in virally suppressed patients on antiretroviral therapy (ART.We selected 99 subjects on suppressive ART followed longitudinally from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER study. Based on standardized comprehensive neurocognitive performance (NP testing, subjects were classified as neurocognitively normal (NCN; n = 29 or impaired (NCI; n = 70. The NCI group included subjects with asymptomatic (ANI; n = 37 or mild (MND; n = 33 HAND. CSF biomarkers were analyzed on two occasions.Geometric mean CSF neopterin was 25% higher in the NCI group (p = 0.04 and NFL and neopterin were significantly correlated within the NCI group (r = 0.30; p<0.001 but not in the NCN group (r = -0.13; p = 0.3. Additionally, a trend towards higher NFL was seen in the NCI group (p = 0.06.Mild HAND was associated with increased intrathecal immune activation, and the correlation between neopterin and NFL found in NCI subjects indicates an association between neurocognitive impairment, CNS inflammation and neuronal damage. Together these findings suggest that NCI despite ART may represent an active pathological process within the CNS that needs further characterization in prospective studies.

  2. Increased Intrathecal Immune Activation in Virally Suppressed HIV-1 Infected Patients with Neurocognitive Impairment

    Science.gov (United States)

    Edén, Arvid; Marcotte, Thomas D.; Heaton, Robert K.; Nilsson, Staffan; Zetterberg, Henrik; Fuchs, Dietmar; Franklin, Donald; Price, Richard W.; Grant, Igor; Letendre, Scott L.; Gisslén, Magnus

    2016-01-01

    Objective Although milder forms of HIV-associated neurocognitive disorder (HAND) remain prevalent, a correlation to neuronal injury has not been established in patients on antiretroviral therapy (ART). We examined the relationship between mild HAND and CSF neurofilament light protein (NFL), a biomarker of neuronal injury; and CSF neopterin, a biomarker of CNS immunoactivation, in virally suppressed patients on antiretroviral therapy (ART). Design and Methods We selected 99 subjects on suppressive ART followed longitudinally from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study. Based on standardized comprehensive neurocognitive performance (NP) testing, subjects were classified as neurocognitively normal (NCN; n = 29) or impaired (NCI; n = 70). The NCI group included subjects with asymptomatic (ANI; n = 37) or mild (MND; n = 33) HAND. CSF biomarkers were analyzed on two occasions. Results Geometric mean CSF neopterin was 25% higher in the NCI group (p = 0.04) and NFL and neopterin were significantly correlated within the NCI group (r = 0.30; pNFL was seen in the NCI group (p = 0.06). Conclusions Mild HAND was associated with increased intrathecal immune activation, and the correlation between neopterin and NFL found in NCI subjects indicates an association between neurocognitive impairment, CNS inflammation and neuronal damage. Together these findings suggest that NCI despite ART may represent an active pathological process within the CNS that needs further characterization in prospective studies. PMID:27295036

  3. The Burden of Image Based Emphysema and Bronchiolitis in HIV-Infected Individuals on Antiretroviral Therapy

    Science.gov (United States)

    Guaraldi, Giovanni; Besutti, Giulia; Scaglioni, Riccardo; Santoro, Antonella; Zona, Stefano; Guido, Ligabue; Marchioni, Alessandro; Orlando, Gabriella; Carli, Federica; Beghe, Bianca; Fabbri, Leonardo; Leipsic, Jonathon; Sin, Don D.; Man, S. F. Paul

    2014-01-01

    Background With the widespread use of anti-retroviral therapy (ART), individuals infected with human immune deficiency virus (HIV) are increasingly experiencing morbidity and mortality from respiratory disorders. However, the prevalence or the risk factors associated with emphysema and bronchiolitis are largely unknown. Methods Thoracic computed tomography (CT) scans were performed in 1,446 patients infected with HIV who were on ART and who attended a tertiary care metabolic clinic (average age 48 years and 29% females). Detailed history and physical examination including anthropometric measurements were performed. Complete pulmonary function tests were performed in a subset of these patients (n = 364). No subjects were acutely ill with a respiratory condition at the time of CT scanning. Findings Nearly 50% of the subjects had CT evidence for emphysema, bronchiolitis or both with 13% (n = 195) showing bronchiolitis, 19% (n = 274) showing emphysema and 16% (n = 238) revealing both. These phenotypes were synergistically associated with reduced regular physical activity (p for interaction bronchiolitis are extremely common in HIV-infected patients who are treated with ART and can be identified by use of thoracic CT scanning. PMID:25354261

  4. Progress on anti-retroviral therapy for acquired immunodeficiency syndrome and inflammation%获得性免疫缺陷综合征与炎症的抗逆转录病毒治疗进展

    Institute of Scientific and Technical Information of China (English)

    董耘婷; 卢洪洲

    2014-01-01

    抗逆转录病毒治疗(ART)可抑制人免疫缺陷病毒(HIV)的复制,减少机会性感染的发生,但不能完全抑制HIV引起的炎症和免疫激活,残留的炎症导致一系列疾病(HIV并存病).本文简要综述近几年来国内外HIV与炎症的ART进展.

  5. Horticulture Therapy Activities for Exceptional Students.

    Science.gov (United States)

    Airhart, Douglas L.; And Others

    1988-01-01

    The Tennessee Technological University's Program of Special Education sponsors a "Super Saturday" of enrichment activities for gifted and talented students as well as students with learning disabilities. A session on horticulture was planned and arranged by students in a class on horticultural therapy who designed learning activities of…

  6. Human papillomavirus prevalence, viral load and pre-cancerous lesions of the cervix in women initiating highly active antiretroviral therapy in South Africa: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Rybicki Ed

    2009-08-01

    Full Text Available Abstract Background Cervical cancer and infection with human immunodeficiency virus (HIV are both important public health problems in South Africa (SA. The aim of this study was to determine the prevalence of cervical squamous intraepithelial lesions (SILs, high-risk human papillomavirus (HR-HPV, HPV viral load and HPV genotypes in HIV positive women initiating anti-retroviral (ARV therapy. Methods A cross-sectional survey was conducted at an anti-retroviral (ARV treatment clinic in Cape Town, SA in 2007. Cervical specimens were taken for cytological analysis and HPV testing. The Digene Hybrid Capture 2 (HC2 test was used to detect HR-HPV. Relative light units (RLU were used as a measure of HPV viral load. HPV types were determined using the Roche Linear Array HPV Genotyping test. Crude associations with abnormal cytology were tested and multiple logistic regression was used to determine independent risk factors for abnormal cytology. Results The median age of the 109 participants was 31 years, the median CD4 count was 125/mm3, 66.3% had an abnormal Pap smear, the HR-HPV prevalence was 78.9% (Digene, the median HPV viral load was 181.1 RLU (HC2 positive samples only and 78.4% had multiple genotypes. Among women with abnormal smears the most prevalent HR-HPV types were HPV types 16, 58 and 51, all with a prevalence of 28.5%. On univariate analysis HR-HPV, multiple HPV types and HPV viral load were significantly associated with the presence of low and high-grade SILs (LSIL/HSIL. The multivariate logistic regression showed that HPV viral load was associated with an increased odds of LSIL/HSIL, odds ratio of 10.7 (95% CI 2.0 – 57.7 for those that were HC2 positive and had a viral load of ≤ 181.1 RLU (the median HPV viral load, and 33.8 (95% CI 6.4 – 178.9 for those that were HC2 positive with a HPV viral load > 181.1 RLU. Conclusion Women initiating ARVs have a high prevalence of abnormal Pap smears and HR-HPV. Our results underscore the need

  7. Terapia hipolipemiante em situações especiais: síndrome de imunodeficiência adquirida Hypolipidemic therapy under special conditions: acquired immune deficiency syndrome

    Directory of Open Access Journals (Sweden)

    Pai Ching Yu

    2005-10-01

    Full Text Available Dislipidemias podem ser observadas precocemente entre pacientes com AIDS. Frequentemente, estas anormalidades lipídicas incluem HDL baixo e moderado aumento dos triglicérides sanguíneos. A terapia anti-retroviral combinada (HAART pode agravar a dislipidemia nestes pacientes, com importante aumento nos triglicérides e no LDL. Vários mecanismos são propostos para explicar a dislipidemia mista observada nestes indivíduos, incluindo diferentes etapas do metabolismo lipídico. A importância do tratamento desses distúrbios lipídicos tem se tornado evidente com o aumento da expectativa de vida e os relatos de complicações cardiovasculares nestes pacientes. Existe um estado de resistência à insulina nos pacientes com AIDS em tratamento com HAART,que apresentam lipodistrofia, hipertrigliceridemia e baixos níveis de HDL. Drogas retro-antivirais são metabolizadas pelo CYP P450 3A4 e interações com algumas estatinas, especialmente com sinvastatina podem ocorrer. O tratamento com agentes hipolipemiantes deve ser baseado no perfil lipídico e no risco de coronariopatia. Para hipertrigliceridemias, fibratos (principalmente fenofibrato ou bezafibrato devem ser as drogas de escolha, bem como as estatinas (principalmente pravastatina. Terapia combinada usando estatinas mais fibratos é recomendada para dislipidemias mistas graves e sempre sob rigoroso monitoramento de efeitos adversos.Lipid alterations can be observed early among patients with AIDS disease. Commonly, these lipid abnormalities include low HDL-C and modest increase in triglyceride plasma levels. Highly Active Anti-Retroviral Therapy (HAART in these patients may aggravate the dyslipidemia, with notable increases in triglycerides as well as in LDL-C. There are several mechanisms proposed to explain the mixed hyperlipidemia observed in these subjects, including different steps in lipid metabolism. The importance of the treatment of dyslipidemia became evident with the increased life

  8. Do HIV-specific CTL continue to have an antiviral function during antiretroviral therapy? If not, why not, and what can be done about it?

    Directory of Open Access Journals (Sweden)

    Dorian eMcIlroy

    2013-03-01

    Full Text Available Pharmacological re-activation of HIV expression from latent proviruses coupled with fully suppressive anti-retroviral therapy (ART has been suggested as a strategy to eradicate HIV infection. In order for this strategy to be effective, latently infected cells must be killed either by the cytopathic effect of reactivated HIV gene expression, or by HIV-specific CTL. However, a review of current data reveals little evidence that CTL retain an anti-viral effector capacity in patients on fully suppressive ART, implying that the HIV-specific CTL present in these patients will not be able to eliminate HIV-infected CD4+ T-cells effectively. If this is due to functional impairment or a quantitative deficit of HIV-specific CTL during ART, then therapeutic vaccination may improve the prospects for eradicating latent reservoirs. However, data from the macaque SIV model indicate that in vivo, SIV-specific CTL are only effective during the early stages of the viral replication cycle, and this constitutes an alternative explanation why HIV-specific CTL do not appear to have an impact on HIV reservoirs during ART. In that case, immunotoxins that target HIV-expressing cells may be a more promising approach for HIV eradication.

  9. Effects of highly active antiretroviral therapy on the survival of HIV-infected adult patients in urban slums of Kenya.

    Science.gov (United States)

    Muhula, Samuel Opondo; Peter, Memiah; Sibhatu, Biadgilign; Meshack, Ndirangu; Lennie, Kyomuhangi

    2015-01-01

    Recent improvements in access to Anti-Retroviral Therapy (ART) have radically reduced hospitalizations and deaths associated with HIV infection in both developed countries and sub-Saharan Africa. Not much is known about survival of patients on ART in slums. The objective of this study was to identify factors associated with mortality among adult patients on ART in resource poor, urban, sub-Saharan African setting. A prospective open cohort study was conducted with adult patients on ART at a clinic in Kibera slums, Nairobi, Kenya. The patients' enrollment to care was between March 2005 and November 2011. Descriptive statistics were computed and Kaplan-Meier (KM) methods used to estimate survival time while Cox's proportional hazards (CPH) model fitted to determine mortality predictors. A total of 2,011 adult patients were studied, 69% being female. Female gender (p=0.0016), zidovudine-based regimen patients (p351 patients (p<0.0001), WHO stage I patients (p<0.0001) and "Working" functional status patients recorded better survival probability on ART. In CPH analysis, the hazard of dying was higher in patients on Stavudine-based regimen(hazard ratio (HR)=.8; 95% CI, 1.5-2.2; p<0.0001),CD4 count<50 cells/µl (HR=1.6; 95% CI, 1.5-1.7;p<0.0001), WHO Stage IV at ART initiation (HR=1.3; 95% CI, 1.1-1.6; p=0.016) and bedridden patients (HR=2.7; 95% CI, 1.7-4.4;p<0.0001). There was increased mortality among the males, those with advanced Immunosuppression, late WHO stage and bedridden patients. The findings further justify the need to switch patients on Stavudine-based regimen as per the WHO recommendations.

  10. Workshop on photon activation therapy: proceedings

    Energy Technology Data Exchange (ETDEWEB)

    Fairchild, R.G. (ed.)

    1985-04-18

    This Workshop was held concurrently with an IAEA Research Coordination Meeting on Exploration of the Possibility of High-LET Radiation for Non-conventional Radiotherapy in Cancer. The Workshop on Photon Activation Therapy (PAT) was given as a special session on April 18, as it was thoght PAT might eventually be found to be attractive to developing countries, which is a major concern of the IAEA. An effort was made to bring together representatives of the various groups known to be actively working on PAT; these included investigators from Sweden and Japan as well as the US. It is hoped that this compendium of papers will be of use to those currently active in this developing field, as well as to those who might join this area of endeavor in the future.

  11. German-austrian recommendations for HIV1-therapy in pregnancy and in HIV1-exposed newborn - update 2008

    Directory of Open Access Journals (Sweden)

    Buchholz Bernd

    2009-11-01

    Full Text Available Abstract German-Austrian recommendations for HIV1-therapy in pregnancy - Update 2008 Bernd Buchholz (University Medical Centre Mannheim, Pediatric Clinic, Matthias Beichert (Mannheim, Gynecology and Obstetrics Practice, Ulrich Marcus (Robert Koch Institute, Berlin, Thomas Grubert, Andrea Gingelmaier (Gynecology Clinic of the Ludwig Maximilians University of Munich, Dr. med. Annette Haberl (HIV-Department, J. W. Goethe-University Hospital, Frankfurt, Dr. med. Brigitte Schmied (Otto-Wagner Spital, Wien. In Germany during the last years about 200-250 HIV1-infected pregnant women delivered a baby each year, a number that is currently increasing. To determine the HIV-status early in pregnancy voluntary HIV-testing of all pregnant women is recommended in Germany and Austria as part of prenatal care. In those cases, where HIV1-infection was known during pregnancy, since 1995 the rate of vertical transmission of HIV1 was reduced to 1-2%. This low transmission rate has been achieved by the combination of anti-retroviral therapy of pregnant women, caesarean section scheduled before onset of labour, anti-retroviral post exposition prophylaxis in the newborn and refraining from breast-feeding by the HIV1-infected mother. To keep pace with new results in research, approval of new anti-retroviral drugs and changes in the general treatment recommendations for HIV1-infected adults, in 1998, 2001, 2003 and 2005 an interdisciplinary consensus meeting was held. Gynaecologists, infectious disease specialists, paediatricians, pharmacologists, virologists and members of the German AIDS Hilfe (NGO were participating in this conference to update the prevention strategies. A fifth update became necessary in 2008. The updating process was started in January 2008 and was terminated in September 2008. The guidelines provide new recommendations on the indication and the starting point for HIV-therapy in pregnancies without complications, drugs and drug combinations to be

  12. Síndrome de lipodistrofia en pacientes con VIH/sida que reciben terapia antirretroviral de gran actividad en Tepic, México Lipodystrophy syndrome in HIV/AIDS patients receiving highly active antiretroviral therapy in Tepic, Mexico

    Directory of Open Access Journals (Sweden)

    Rogelio Alberto Fernández Argüelles

    2012-06-01

    Full Text Available Objetivo: determinar la relación entre la manifestación del síndrome de lipodistrofia y la terapia antirretroviral de gran actividad en pacientes con VIH/sida. Métodos: se realizó un estudio descriptivo, transversal y correlacional en pacientes con VIH/sida que reciben terapia antirretroviral de gran actividad, atendidos entre marzo y diciembre de 2007 en el Centro Ambulatorio de Prevención y Atención del Sida e Infecciones de Transmisión Sexual (CAPASITS de Tepic, Nayarit, México. La definición y diagnóstico del síndrome se realizó mediante el método de The National Centre in HIV Epidemiology and Clinical Research (NCHECR de Australia. Se utilizó la prueba de chi cuadrado para evaluar la dependencia entre el síndrome y la terapia. Se evaluaron 175 pacientes (128 hombres y 47 mujeres, de 19 a 72 años de edad. Resultados: se diagnosticaron 141 pacientes (80,6 con síndrome de lipodistrofia (IC95% 74,7-86.4 %; el 82,6 % correspondió a hombres y el 74,5 % a mujeres. Según la severidad, el porcentaje fue de 17 % de grado 1, 3 % de grado 2, 10 % de grado 3 y 51 % de grado IV. Las pruebas de chi cuadrado para evaluar dependencia entre el síndrome y la terapia resultaron no significativas. Conclusiones: el síndrome de lipodistrofia severo resulta un serio problema para la apariencia de pacientes de VIH/sida que reciben o no la terapia antirretroviral y que agrega un riesgo cardiovascular importante que debe ser considerado para intentar su prevención o tratamiento. Aunque los resultados pueden presentar sesgos y limitaciones, aportan una aproximación importante para sustentar y planificar intervenciones sanitarias que disminuirían el impacto del síndrome en la salud de los pacientes con VIH/sida.Objective: to establish the relationship between lipodystrophy syndrome and highly active anti-retroviral therapy in HIV/AIDS patients. Methods: a cross-sectional, descriptive and co-relational study was conducted in HIV/AIDS patients

  13. Antistress activation therapy for cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    Miroshnik E.V.

    2016-12-01

    Full Text Available The cohort pilot study had been done. Aim: to study the effectiveness of an antistress activation therapy on the functional state of human with the purpose of formation of adaptive reactions of activation and training high levels of reactivity among the two groups of patients with cardiovascular problems, ranks first among causes of death population: arterial hypertension (AH and coronary heart disease (CHD. Material and methods. From the sub-sample of the Moscow population (396 were allocated to 2 groups of patients of 30 people in each (a control group and a group for anti-stress therapy for persons with hypertension and coronary artery disease that within 1 month took adaptogens (tincture of ginseng, Eleutherococcus, etc. is minimized by a specially developed algorithm. For stress diagnosis international integrated questionnaire Perceived Stress (PSS; as well as Hospital Anxiety and Depression Scale (HADS were used. Blood pressure, heart rate, body mass index, waist circumference were measured. In addition we used new methods "Antistress activation health improvement". Results. The average age in the intervention group was 59.4 years, and in the control group was 58.3 years, p>0.05. In compliance with results of the study has been marked that persons who were treated by methods "Antistress activation health improvement" sensed general and "internal" dumping, improving of duration and quality of sleeping. Irritability, level of stress, depression, and fatigability became rather less. Dynamics of emotions locked in psychometric scales showed distinct improvement of mood, decrease of fear, sorrow, anxiety, anger, emotional instability, increase of self-reliance, activity. Conclusion. The treatment of stress, anxiety, and depression must be complexes based on biological and psychological approaches.

  14. Comparison of bone and renal effects in HIV-infected adults switching to abacavir or tenofovir based therapy in a randomized trial

    DEFF Research Database (Denmark)

    Rasmussen, Thomas A; Jensen, Danny; Tolstrup, Martin;

    2012-01-01

    Introduction Our objective was to compare the bone and renal effects among HIV-infected patients randomized to abacavir or tenofovir-based combination anti-retroviral therapy. Methods In an open-label randomized trial, HIV-infected patients were randomized to switch from zidovudine/lamivudine (AZT....../3TC) to abacavir/lamivudine (ABC/3TC) or tenofovir/emtricitabine (TDF/FTC). We measured bone mass density (BMD) and bone turnover biomarkers (osteocalcin, osteocalcin, procollagen type 1 N-terminal propeptide (P1NP), alkaline phosphatase, type I collagen cross-linked C-telopeptide (CTx...

  15. [Recommendations of GESIDA (Grupo de Estudio de SIDA)/National Plan on AIDS with respect to the anti-retroviral treatment in adult patients infected with the human immunodeficiency virus in the year 2000 (II)].

    Science.gov (United States)

    Miró, J M; Antela, A; Arrizabalaga, J; Clotet, B; Gatell, J M; Guerra, L; Antonio Iribarren, J; Laguna, F; Moreno, S; Parras, F; Rubio, R; Santamaría, J M; Viciana, P

    2000-10-01

    To update the recommendations for antiretroviral therapy (ART) in adult HIV-infected persons according to the new scientific advances and the existence of new antiretroviral drugs in the last two years. The ART recommendations have been condensed by a panel of experts from the Spanish AIDS Study Group (Grupo de Estudio de Sida-GESIDA) of the Spanish Infectious Diseases and Clinical Microbiology Society (SEIMC) and from the Clinical Advisory Panel (CAP) of the Secretariat of the Spanish National Plan on AIDS (SPNS) of the Ministry of Health. Three levels of evidence have been established depending if the data came from randomized and controlled studies, from cohort or case-control studies or from descriptive studies and expert opinions, for that purpose we have reviewed the advanced in HIV pathophysiology and results of efficacy (clinical, virologic and immunologic) and security (toxicity) from clinical trials involving ART lasting at least 12 months, from cohort studies and pharmacokinetic and security data of antoiretrovírico drugs, presented in international conferences or published in biomedical journals in the last two years. In each situation we have established either to recommend or to consider or not recommend ART. Nowadays, ART consistent of at least three drugs constitutes the election therapy for chronic HIV infection, since it delays clinical progression, increases significantly the survival and diminishes hospital admissions and associated costs. The decision to start ART must be based upon three elements: presence or absence of symptoms, plasma vírica load and CD4+ cells counts. Thus, in asymptomatic cases with a high CD4+ cells count (> 500/microliter) and low vírica load (virus eradication was considered. On the other hand, the high number of disposable drugs, the more sensitive monitorization methods (plasma vírica load) and the possibility of performing resistance studies make therapeutic strategies more dynamic and individualized for each

  16. Estudo da síndrome da ceratoconjuntivite seca de pacientes soropositivos para o vírus da imunodeficiência adquirida humana tipo 1 e com síndrome da imunodeficiência adquirida, em uso ou não de terapia anti-retroviral combinada (HAART

    Directory of Open Access Journals (Sweden)

    Rodrigues Márcia Lopes

    2004-01-01

    Full Text Available OBJETIVOS: Verificar a presença de olho seco e de alterações no epitélio conjuntival em pacientes com sorologia positiva para o HIV-1 e com AIDS; relacionar as eventuais alterações com as características e com outras condições oculares e sistêmicas dos pacientes; estudar a influência da terapia anti-retroviral combinada na ceratoconjuntivite seca (KCS, nos pacientes com AIDS. MÉTODOS: Foram estudados pacientes com confirmação laboratorial da infecção pelo HIV, divididos em 2 grupos: I. HIV+ (sem diagnóstico clínico e com contagem de CD4+ acima de 200 células/mm³ e II. pacientes com AIDS (contagem de CD4+ abaixo de 200 células e/ou manifestação clínica. Foram estudadas alterações oculares, dados laboratoriais, análise do filme lacrimal e estudo da citologia de impressão conjuntival. Método estatístico: qui-quadrado. RESULTADOS: Incluídos 43 pacientes do grupo I e 77 do grupo II. Após a introdução do HAART houve queda significativa das manifestações oculares internas; entretanto, o mesmo não ocorreu com as externas. Dos pacientes que apresentaram quadro clínico de olho seco, 65,1% eram do sexo masculino. As alterações do teste de Schirmer e tempo de ruptura do filme lacrimal não estiveram relacionados com a gravidade da doença pelo HIV e nem com a contagem de CD4+.Todos os pacientes com alterações na citologia de impressão apresentavam KCS e 88,8% pertenciam ao grupo II. Observou-se aumento da freqüência dessas alterações nos pacientes com tempo de doença superior a 4 anos. CONCLUSÃO: O decréscimo da produção lacrimal não esteve relacionado com a gravidade da infecção pelo HIV e a introdução do HAART não interferiu na freqüência da síndrome de olho seco nos pacientes HIV positivos.

  17. The burden of image based emphysema and bronchiolitis in HIV-infected individuals on antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Giovanni Guaraldi

    Full Text Available BACKGROUND: With the widespread use of anti-retroviral therapy (ART, individuals infected with human immune deficiency virus (HIV are increasingly experiencing morbidity and mortality from respiratory disorders. However, the prevalence or the risk factors associated with emphysema and bronchiolitis are largely unknown. METHODS: Thoracic computed tomography (CT scans were performed in 1,446 patients infected with HIV who were on ART and who attended a tertiary care metabolic clinic (average age 48 years and 29% females. Detailed history and physical examination including anthropometric measurements were performed. Complete pulmonary function tests were performed in a subset of these patients (n = 364. No subjects were acutely ill with a respiratory condition at the time of CT scanning. FINDINGS: Nearly 50% of the subjects had CT evidence for emphysema, bronchiolitis or both with 13% (n = 195 showing bronchiolitis, 19% (n = 274 showing emphysema and 16% (n = 238 revealing both. These phenotypes were synergistically associated with reduced regular physical activity (p for interaction <.0001. The most significant risk factors for both phenotypes were cigarette smoking, intravenous drug use and peripheral leucocytosis. Together, the area-under-the curve statistics was 0.713 (p = 0.0037 for discriminating those with and without these phenotypes. There were no significant changes in lung volumes or flow rates related to these phenotypes, though the carbon monoxide diffusion capacity was reduced for the emphysema phenotype. INTERPRETATION: Emphysema and bronchiolitis are extremely common in HIV-infected patients who are treated with ART and can be identified by use of thoracic CT scanning.

  18. An autoimmune disease prevented by anti-retroviral drugs

    OpenAIRE

    Beck-Engeser Gabriele B; Eilat Dan; Wabl Matthias

    2011-01-01

    Abstract Background Both Aicardi-Goutières syndrome, a Mendelian mimic of congenital infection, and the autoimmune disease systemic lupus erythematosus can result from mutations in the gene encoding the enzyme Trex1. In mice, the absence of Trex1 causes severe myocarditis. The enzyme is thought to degrade endogenous retroelements, thus linking them to autoimmune disease. However, inhibition of reverse transcription by the inhibitor zidovudine (AZT) did not ameliorate the disease, weakening th...

  19. Expansion of HIV-1 Screening and Anti-retroviral Treatment ...

    African Journals Online (AJOL)

    FOMCS2

    2007-06-02

    Jun 2, 2007 ... University of Wisconsin School of Medicine and Public Health, Madison, WI1; Faith Alive Foundation Hospital and Department .... based on the first available measurement following ini- ... sees many patients who are at higher risk and impoverished. ..... support through private donors, such as the Mennonite.

  20. Centrally active nonhormonal hot flash therapies.

    Science.gov (United States)

    Loprinzi, Charles L; Stearns, Vered; Barton, Debra

    2005-12-19

    Given the problems associated with hormonal therapy, and the prominent problem of hot flashes in menopausal women, there is a need for nonhormonal agents to alleviate hot flashes. Several compounds that appear to act on the central nervous system have been investigated. Potential mechanisms for their effects on hot flashes have been described. Bellergal (no longer available on the US market, where it was known as Bellergal-S), a combination preparation sedative that consists of low-dose phenobarbital, ergotamine tartrate, and levorotatory alkaloids of belladonna, is an old agent that was popular approximately 20 years ago; however, there is limited suggestion of efficacy for this agent. Clonidine, an older antihypertensive drug, is another centrally active agent that has been studied. Randomized trials have demonstrated that it clearly works for reducing hot flashes, but the magnitude of efficacy is somewhat limited. Toxicity from this agent limits its utility in the clinic. Methyldopa is another centrally active agent that has been studied but to a more limited degree. It appears to have minimal efficacy and too much toxicity to make it clinically useful. Anecdotal observations from a number of sources suggested that newer antidepressants can alleviate hot flashes. This led to pilot trials of venlafaxine and paroxetine, with results suggesting benefit from both drugs. Subsequently, randomized, placebo-controlled, double-blind clinical trials of venlafaxine, paroxetine, and fluoxetine were conducted. All 3 of these clinical trials demonstrated statistically significant reductions in hot flashes with these newer antidepressants compared with placebo. Pilot trials of citalopram and mirtazapine, 2 other newer antidepressants, have also suggested efficacy. Toxicity evaluations have suggested that these agents are, again, well tolerated by the majority of patients. A recent trial, however, was unable to demonstrate any benefit for fluoxetine or citalopram over a placebo

  1. Brain and cognitive functions in two groups of naïve HIV patients selected for a different plan of antiretroviral therapy: A qEEG study.

    Science.gov (United States)

    Babiloni, Claudio; Pennica, Alfredo; Capotosto, Paolo; Onorati, Paolo; Muratori, Chiara; Ferracuti, Stefano; Roma, Paolo; Correr, Valentina; Piccinni, Elisa; Noce, Giuseppe; Del Percio, Claudio; Cordone, Susanna; Limatola, Cristina; Soricelli, Andrea; Di Campli, Francesco; Gianserra, Laura; Ciullini, Lorenzo; Aceti, Antonio; Viscione, Magdalena; Teti, Elisabetta; Sarmati, Loredana; Andreoni, Massimo

    2016-11-01

    Cortical sources of electroencephalographic (EEG) rhythms were investigated in two sub-populations of naïve HIV subjects, grouped based on clinical criteria to receive different combination anti-retroviral therapies (cARTs). These EEG sources were hypothesized to reflect beneficial effects of both regimes. Eyes-closed resting state EEG data were collected in 19 (Group A) and 39 (Group B) naïve HIV subjects at baseline (i.e. pre-treatment; T0) and after 5months of cART (T5). Compared with the Group A, the Group B was characterized by slightly worse serological parameters and higher cardiovascular risk. At T0, mean viral load (VL) and CD4 count were 87,694copies/ml and 435cells/μl in the Group A and 187,370copies/ml and 331cells/μl in the Group B. The EEG data were also collected in 50 matched control HIV-negative subjects. Cortical EEG sources were assessed by LORETA software. Compared to the Control Group, the HIV Groups showed lower alpha (8-12Hz) source activity at T0 while the Group B also exhibited higher delta source activity. The treatment partially normalized alpha and delta source activity in the Group A and B, respectively, in association with improved VL, CD4, and cognitive functions. Different cART regimens induced diverse beneficial effects in delta or alpha source activity in the two naïve HIV Groups. These sources might unveil different neurophysiological effects of diverse cART on brain function in naïve HIV Groups as a function of clinical status and/or therapeutic compounds. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  2. Extreme Nonresponse in Cognitive Therapy: Can Behavioral Activation Succeed where Cognitive Therapy Fails?

    Science.gov (United States)

    Coffman, Sandra J.; Martell, Christopher R.; Dimidjian, Sona; Gallop, Robert; Hollon, Steven D.

    2007-01-01

    In a recent placebo-controlled comparison, behavioral activation was superior to cognitive therapy in the treatment of moderate to severely depressed adults. Moreover, a subset of patients exhibited a pattern of extreme nonresponse to cognitive therapy on self-reports of depression not evident on the clinician ratings. These patients were severely…

  3. HIV quasispecies dynamics during pro-active treatment switching: impact on multi-drug resistance and resistance archiving in latent reservoirs.

    Directory of Open Access Journals (Sweden)

    Max von Kleist

    Full Text Available The human immunodeficiency virus (HIV can be suppressed by highly active anti-retroviral therapy (HAART in the majority of infected patients. Nevertheless, treatment interruptions inevitably result in viral rebounds from persistent, latently infected cells, necessitating lifelong treatment. Virological failure due to resistance development is a frequent event and the major threat to treatment success. Currently, it is recommended to change treatment after the confirmation of virological failure. However, at the moment virological failure is detected, drug resistant mutants already replicate in great numbers. They infect numerous cells, many of which will turn into latently infected cells. This pool of cells represents an archive of resistance, which has the potential of limiting future treatment options. The objective of this study was to design a treatment strategy for treatment-naive patients that decreases the likelihood of early treatment failure and preserves future treatment options. We propose to apply a single, pro-active treatment switch, following a period of treatment with an induction regimen. The main goal of the induction regimen is to decrease the abundance of randomly generated mutants that confer resistance to the maintenance regimen, thereby increasing subsequent treatment success. Treatment is switched before the overgrowth and archiving of mutant strains that carry resistance against the induction regimen and would limit its future re-use. In silico modelling shows that an optimal trade-off is achieved by switching treatment at days after the initiation of antiviral therapy. Evaluation of the proposed treatment strategy demonstrated significant improvements in terms of resistance archiving and virological response, as compared to conventional HAART. While continuous pro-active treatment alternation improved the clinical outcome in a randomized trial, our results indicate that a similar improvement might also be reached after

  4. X-Ray Psoralen Activated Cancer Therapy (X-PACT)

    OpenAIRE

    Oldham, Mark; Yoon, Paul; Fathi, Zak; Wayne F Beyer; Adamson, Justus; Liu, Leihua; Alcorta, David; Xia, Wenle; Osada, Takuya; Liu, Congxiao; Yang, Xiao Y.; Dodd, Rebecca D.; Herndon, James E.; Meng, Boyu; Kirsch, David G.

    2016-01-01

    This work investigates X-PACT (X-ray Psoralen Activated Cancer Therapy): a new approach for the treatment of solid cancer. X-PACT utilizes psoralen, a potent anti-cancer therapeutic with current application to proliferative disease and extracorporeal photopheresis (ECP) of cutaneous T Cell Lymphoma. An immunogenic role for light-activated psoralen has been reported, contributing to long-term clinical responses. Psoralen therapies have to-date been limited to superficial or extracorporeal scen...

  5. Monitoring Oral Anticoagulant Therapy: Measuring Coagulant Activity

    DEFF Research Database (Denmark)

    Attermann, Jorn

    and the time for the next visit based on laboratory analyses of the INR. This conventional treatment regimen is relatively inconvenient for the patient, since it requires frequent outpatient visits and venipunctures. Moreover, errors may occur due to insufficient communication between patient and physician...... of anticoagulant therapy. The specific hypotheses were: • The precision of patient’s own measurements of INR performed at home on a portable coagulometer is sufficient to allow for self management of OAT (substudy 1). • For selected pairs of thromboplastins, the relation between logarithmic prothrombin times...... substudy it was shown that for selected patients the precision of the patients’ own measurements of INR is sufficient to allow for reliable routine patient self testing of INR. In the same substudy we found large discrepancies between the INR measurements on portable coagulometers and in the Department...

  6. PRO 140--a novel CCR5 co-receptor inhibitor.

    Science.gov (United States)

    Khatib, Nadia; Das, Satyajit

    2010-01-01

    Despite an increase in the variety of anti-retroviral agents in the market, there remains a need for novel agents to treat HIV 1 infected individuals, in order to overcome existing problems with adherence, toxicities, drug interactions and viral resistance. In this article, we will describe Pro 140, one of the recently developed class of anti-retroviral agent, the CCR5 co-receptor inhibitor. We will also describe several preclinical and clinical studies that have evaluated the efficacy, tolerability and toxicity profiles of Pro-140. We will also look at how its mechanism of action and mode of delivery may change the way patients take highly active anti-retroviral therapy. There are some promising patents discussed in this short review for the use of PRO 140 as CCR5 co-receptor Inhibitor.

  7. P52 Activation and Enzalutamide Therapy in Prostate Cancer

    Science.gov (United States)

    2016-10-01

    AWARD NUMBER: W81XWH-14-1-0437 TITLE: p52 Activation and Enzalutamide Therapy in Prostate Cancer PRINCIPAL INVESTIGATOR: Allen C Gao, MD, PhD...Enzalutamide Therapy in Prostate Cancer 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-14-1-0437 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Allen C...that provide temporary respite, almost all patients will go on to die from progressive and resistant prostate cancer . Therefore, there is an urgent

  8. HIV INFECTION STAGE, ANTIRETROVIRAL THERAPY SCHEME AND PATIENT IMMUNE STATUS INFLUENCE ON HIV/TB CO-INFECTION OUTCOME

    Directory of Open Access Journals (Sweden)

    A. V. Mordyk

    2016-01-01

    Full Text Available Retrospective research of 381 clinical records is conducted to study HIV infection influence on stationary stage of tuberculosis treatment outcome in HIV-TB co-infected patients. All cases were divided depending on a hospitalization outcome on favorable and adverse. At most of patients tuberculosis of respiratory organs met. Immunological researches were conducted, the stage of HIV infection was registered and the issue of purpose of anti-retroviral therapy was resolved. Besides, as indirect signs of an immunodeficiency at the patients with a combination of tuberculosis and HIV infection who were on hospitalization the indicators received when carrying out clinical laboratory trials were analyzed: absolute and relative quantity of lymphocytes according to the general blood test, the contents the globulin fractions and circulating immune complexes concentration according to the clinical chemistry blood test. At an assessment of results in both groups of research more than at a half of patients existence of HIV infection at late stages that speaks about late identification and neglect of an immunodeficiency was revealed. At patients with tuberculosis of lungs in combination with HIV infection at a failure statistically significant decrease in an immunoregulatory index is revealed. It is interesting that the level of CD4 lymphocytes and a stage of HIV infection had no impact on the co-infection’s outcome. However, existence of virus loa ding more than 100 000 copies/ml reduced probability favorable an outcome of treatment of tuberculosis at the patient with HIV infection. Timely purpose of anti-retroviral therapy at patients with co-infection increased chances of treatment of tuberculosis at patients with an immunodeficiency. Frequency of adverse side effect of antiviral therapy met equally often at patients in both groups. Thus, patients at any stages of HIV infection with any forms of tuberculosis, including generalized, had a

  9. Bioluminescence-activated deep-tissue photodynamic therapy of cancer.

    Science.gov (United States)

    Kim, Yi Rang; Kim, Seonghoon; Choi, Jin Woo; Choi, Sung Yong; Lee, Sang-Hee; Kim, Homin; Hahn, Sei Kwang; Koh, Gou Young; Yun, Seok Hyun

    2015-01-01

    Optical energy can trigger a variety of photochemical processes useful for therapies. Owing to the shallow penetration of light in tissues, however, the clinical applications of light-activated therapies have been limited. Bioluminescence resonant energy transfer (BRET) may provide a new way of inducing photochemical activation. Here, we show that efficient bioluminescence energy-induced photodynamic therapy (PDT) of macroscopic tumors and metastases in deep tissue. For monolayer cell culture in vitro incubated with Chlorin e6, BRET energy of about 1 nJ per cell generated as strong cytotoxicity as red laser light irradiation at 2.2 mW/cm(2) for 180 s. Regional delivery of bioluminescence agents via draining lymphatic vessels killed tumor cells spread to the sentinel and secondary lymph nodes, reduced distant metastases in the lung and improved animal survival. Our results show the promising potential of novel bioluminescence-activated PDT.

  10. Frequent hepatitis B virus rebound among HIV-hepatitis B virus-coinfected patients following antiretroviral therapy interruption

    DEFF Research Database (Denmark)

    Dore, Gregory J; Soriano, Vicente; Rockstroh, Jürgen

    2010-01-01

    BACKGROUND: The impact of antiretroviral therapy (ART) interruption in HIV-hepatitis B virus (HBV)-coinfected patients was examined in the Strategic Management of AntiRetroviral Therapy (SMART) study. METHODS: Plasma HBV DNA was measured in all hepatitis B surface antigen-positive (HBV.......0002), nondetectable HBV DNA at baseline (P = 0.007), and black race (P = 0.03). Time to ART reinitiation was shorter (7.5, 15.6, and 17.8 months; P hepatitis C virus-positive and non-HBV/hepatitis...... C virus participants in the drug conservation arm. No hepatic decompensation events occurred among HBV-positive participants in either arm. CONCLUSION: HBV DNA rebound following ART interruption is common and may be associated with accelerated immune deficiency in HIV-HBV-coinfected patients....

  11. African Health Sciences Vol 9 Special Issue.pmd

    African Journals Online (AJOL)

    Administrator

    ... active anti-retroviral therapy (HAART) in Uganda: A pilot study. ... Organization (WHO); the Global Fund to FightAIDS, ... study of HIV positive adult individuals aged 18 years and above ... value was 53% and the Positive predictive value was. 87%.16 In ... exact test for qualitative variables, independent- sample t tests for ...

  12. Estimation and prediction of the HIV-AIDS-epidemic under conditions of HAART using mixtures of incubation time distributions

    NARCIS (Netherlands)

    Heisterkamp, S. H.; de Vries, R.; Sprenger, H. G.; Hubben, G. A. A.; Postma, M. J.

    2008-01-01

    The estimation of the HIV-AIDS epidemic by means of back-calculation (BC) has been difficult since the introduction of highly active anti-retroviral therapy (HAART) because the incubation time distributions needed for BC were poorly known. Moreover, it has been assumed that if the general public is

  13. Adrenaline-induced mobilization of T cells in HIV-infected patients

    DEFF Research Database (Denmark)

    Søndergaard, S R; Cozzi-Lepri, A; Ullum, H

    2000-01-01

    The present study aimed to investigate lymphocyte mobilization from peripheral cell reservoirs in HIV-infected patients. Nine HIV-infected patients on stable highly active anti-retroviral therapy (HAART), eight treatment-naive HIV-infected patients and eight HIV- controls received a 1-h adrenalin...

  14. Active Interventions in Clinical Practice: Contributions of Gestalt Therapy.

    Science.gov (United States)

    Lammert, Marilyn; Dolan, Mary M.

    1983-01-01

    Describes two dimensions of Gestalt therapy that can enhance clinical practice--orientation to the present and active-experimental style--and examines them in relation to some traditional principles of practice. Gestalt theory offers a method of discovery that is a combination of phenomenology and behaviorism. (JAC)

  15. Behavioural activation therapy for adolescents 'at risk' for psychosis?

    Science.gov (United States)

    Welsh, Patrick; Kitchen, Charlotte E W; Ekers, David; Webster, Lisa; Tiffin, Paul A

    2016-04-01

    The following hypothesis explores the possibility of using behavioural activation therapy for adolescents with an at-risk mental state for psychosis. Support is drawn from psychosis-related survey and pilot data as well as a robust evidence base for adult depression. However, we acknowledge that extensive feasibility work is required before exploring this hypothesis further.

  16. Thrombolytic Therapy by Tissue Plasminogen Activator for Pulmonary Embolism.

    Science.gov (United States)

    Islam, Md Shahidul

    2017-01-01

    Clinicians need to make decisions about the use of thrombolytic (fibrinolytic) therapy for pulmonary embolism (PE) after carefully considering the risks of major complications from bleeding, and the benefits of treatment, for each individual patient. They should probably not use systemic thrombolysis for PE patients with normal blood pressure. Treatment by human recombinant tissue plasminogen activator (rt-PA), alteplase, saves the lives of high-risk PE patients, that is, those with hypotension or in shock. Even in the absence of strong evidence, clinicians need to choose the most appropriate regimen for administering alteplase for individual patients, based on assessment of the urgency of the situation, risks for major complications from bleeding, and patient's body weight. In addition, invasive strategies should be considered when absolute contraindications for thrombolytic therapy exist, serious complications arise, or thrombolytic therapy fails.

  17. Legubicin, a Tumor-Activated Prodrug for Breast Cancer Therapy

    Science.gov (United States)

    2007-04-01

    Activated Prodrug for Breast Cancer Therapy 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-05-1-0318 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Cheng...cyclophosphamide, non-lyophilized cyclophosphamide, cytarabine, daca dactinomycin, daunorubicin, diethyistilbestrol, epoetin alfa, esperamycin, etidronat...0562 (to R. Xiang) from the US Department of Defense; California Tobacco- Related Disease Research Program grant 12 RT-0002 (to R.A. Reisfeld

  18. Gold Nanorod Bioconjugates for Active Tumor Targeting and Photothermal Therapy

    OpenAIRE

    Green, Hadiyah N; Martyshkin, Dmitry V; Rodenburg, Cynthia M.; Rosenthal, Eben L.; Mirov, Sergey B.

    2011-01-01

    The mastery of active tumor targeting is a great challenge in near infrared photothermal therapy (NIRPTT). To improve efficiency for targeted treatment of malignant tumors, we modify the technique of conjugating gold nanoparticles to tumor-specific antibodies. Polyethylene glycol-coated (PEGylated) gold nanorods (GNRs) were fabricated and conjugated to an anti-EGFR antibody. We characterized the conjugation efficiency of the GNRs by comparing the efficiency of antibody binding and the phototh...

  19. Beyond Photodynamic Therapy: Light-Activated Cancer Chemotherapy.

    Science.gov (United States)

    Szymanski, Wiktor; Reeßing, Friederike

    2016-09-06

    Light-activatable cytotoxic agents present a novel approach in targeted cancer therapy. The selectivity in addressing cancer cells is a crucial aspect in minimizing unwanted side effects that stem from unspecific cytotoxic activity of cancer chemotherapeutics. Photoactivated chemotherapy is based on the use of inactive prodrugs whose biological activity is significantly increased upon exposure to light. As light can be delivered with a very high spatiotemporal resolution, this technique is a promising approach to selectively activate cytotoxic drugs at their site of action and thus to improve the tolerability and safety of chemotherapy. This innovative strategy can be applied to both cytotoxic metal complexes and organic compounds. In the first case, the photoresponsive element can either be part of the ligand backbone or be the metal center itself. In the second case, the activity of a known organic, cytotoxic compound is caged with a photocleavable protecting group, providing the release of the active compound upon irradiation. Besides these approaches, also the use of photoswitchable (photopharmacological) chemotherapeutics, which allow an "on" and "off" switching of biological activity, is being developed. The aim of this review is to present the current state of photoactivated cancer therapy and to identify its challenges and opportunities.

  20. The syndrome of continuous muscle fibre activity following gold therapy.

    Science.gov (United States)

    Grisold, W; Mamoli, B

    1984-01-01

    A 72-year-old man suffering from arthritis received a total dose of 500 mg sodium aurothiomalate during a period of 5 months. His clinical state then deteriorated and he had to be hospitalized. Upon admission he was bedridden, his level of consciousness was slightly impaired, he was confused and respiration was laboured. Continuous muscle activity was noted on all extremities and at first, erroneously, fasciculations were diagnosed. The EMG exhibited continuous muscle fibre activity consisting of duplets, triplets and multiplets. The discharges occurred in an irregular pattern; when various muscles were examined at the same time no synchronicity could be observed between muscle discharges. In the left m. deltoideus an increased percentage of polyphasic potentials was found, whereas mean duration of motor unit potentials was normal. Spontaneous activity remained unchanged during sleep and administration of intravenous diazepam or phenytoin. Blocking of ulnar nerve at either elbow or wrist level did not stop spontaneous activity in m. abductor digiti quinti. Ischaemia increased the amount of discharges after 7 min. Within 4 months after termination of gold therapy the patient's condition improved and he was discharged from hospital. Regular EMG follow-up after 8 months showed complete cessation of abnormal spontaneous activities. Nerve conduction velocities were normal except for markedly reduced compound action potential in peroneal nerves. Continuous muscle fibre activity as a side-effect of gold therapy is described.

  1. Activation of endogenous neural stem cells for multiple sclerosis therapy

    Directory of Open Access Journals (Sweden)

    Iliana eMichailidou

    2015-01-01

    Full Text Available Multiple sclerosis (MS is a chronic inflammatory disorder of the central nervous system, leading to severe neurological deficits. Current MS treatment regimens, consist of immunomodulatory agents aiming to reduce the rate of relapses. However, these agents are usually insufficient to treat chronic neurological disability.A promising perspective for future therapy of MS is the regeneration of lesions with replacement of the damaged oligodendrocytes or neurons. Therapies targeting to the enhancement of endogenous remyelination, aim to promote the activation of either the parenchymal oligodendrocyte progenitor cells or the subventricular zone-derived neural stem cells (NSCs. Less studied but highly potent, is the strategy of neuronal regeneration with endogenous NSCs that although being linked to numerous limitations, is anticipated to ameliorate cognitive disability in MS. Focusing on the forebrain, this review highlights the role of NSCs in the regeneration of MS lesions.

  2. Factor XI and contact activation as targets for antithrombotic therapy.

    Science.gov (United States)

    Gailani, D; Bane, C E; Gruber, A

    2015-08-01

    The most commonly used anticoagulants produce therapeutic antithrombotic effects either by inhibiting thrombin or factor Xa (FXa) or by lowering the plasma levels of the precursors of these key enzymes, prothrombin and FX. These drugs do not distinguish between thrombin generation contributing to thrombosis from thrombin generation required for hemostasis. Thus, anticoagulants increase bleeding risk, and many patients who would benefit from therapy go untreated because of comorbidities that place them at unacceptable risk for hemorrhage. Studies in animals demonstrate that components of the plasma contact activation system contribute to experimentally induced thrombosis, despite playing little or no role in hemostasis. Attention has focused on FXII, the zymogen of a protease (FXIIa) that initiates contact activation when blood is exposed to foreign surfaces, and FXI, the zymogen of the protease FXIa, which links contact activation to the thrombin generation mechanism. In the case of FXI, epidemiologic data indicate this protein contributes to stroke and venous thromboembolism, and perhaps myocardial infarction, in humans. A phase 2 trial showing that reduction of FXI may be more effective than low molecular weight heparin at preventing venous thrombosis during knee replacement surgery provides proof of concept for the premise that an antithrombotic effect can be uncoupled from an anticoagulant effect in humans by targeting components of contact activation. Here, we review data on the role of FXI and FXII in thrombosis and results of preclinical and human trials for therapies targeting these proteins.

  3. Fibrinolytic changes in pregnant women on highly active antiretroviral therapy.

    Science.gov (United States)

    Osime, Odaburhine E; Ese-Onakewhor, Joseph U; Kolade, Samson O

    2015-02-01

    To report on the changes in fibrinolytic activity in human immunodeficiency virus (HIV) infected pregnant women who are undergoing highly active antiretroviral therapy (HAART). Blood was collected from 50 HIV positive women on HAART (test subjects), and 50 HIV positive women not on HAART (controls). These women were attending the prevention of mother to child clinic (PMTCT) of the University of Benin Teaching Hospital, Benin City, Nigeria from January to June 2014. Standard manual techniques were used to estimate plasma fibrinogen concentration (PFC), euglobulin lysis time (ELT), packed cell volume (PCV), and plasma viscosity (PV). The mean ± standard error of mean (SEM) of PFC was 4.02±0.13 g/l and ELT from the test subjects was 378±15 mins was significantly higher (p0.05). There were differences in the various parameters investigated when the various trimesters were compared. These differences did not, however, follow a particular pattern. Highly active antiretroviral therapy can cause changes in fibrinolytic activity that may predispose pregnant women to hyperfibrinogenemia and anemia.

  4. 含替诺福韦的治疗方案对中国初治 HIV/AIDS 病人肾功能的影响%The impact on renal function of tenofovir-containing first-line anti-retroviral regimen among Chinese HIV-infected antiretroviral therapy-naive patients during 48 weeks

    Institute of Scientific and Technical Information of China (English)

    李宁; 张程达; 李冠群; 韩杨; 祝婷; 李太生

    2015-01-01

    目的 比较含和不含替诺福韦(TDF)的一线抗病毒治疗方案,在48周随访过程中,对中国初治艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人肾功能的影响.方法 将722例病人按照抗病毒治疗方案的不同分为TDF组(364例)和对照组(358例),所有病人的临床资料和实验室数据均在病历中记录.定期随访两组人群在基线和治疗4、8、12、24、36、48周的肾功能,各个随访点的肌酐清除率通过CKD-EPI公式估算获得,肾小球滤过率(eGFR)下降超过基线的25%为肾脏损伤,计算两组人群的肾脏损伤的发病率,分析两组病人48周内血清肌酐值和肌酐清除率的动态变化.结果 TDF组HIV-1初治病人,接受含“拉米夫定(3TC)+TDF+依非韦伦(EFV)”的抗病毒治疗方案;对照组HIV-1初治病人,接受含“3TC+齐多夫定(AZT)/司坦夫定(D4T)+奈韦拉平(NVP)/EFV”的抗病毒治疗方案.治疗48周后,TDF组和对照组的肌酐清除率分别为68.2[四分位数间距(IQR):60.0~79.0]mL/min和68.7(IQR:60.1~78.4)mL/min(P<0.001);eGFR<基线的25%的发生率在TDF和对照组分别4.5/100人年和6.6/100人年(P—0.12).肌酐值和肌酐清除率在48周的高效抗反转录病毒治疗(HAART)过程中的动态变化没有明显的统计学差异(P>0.05).结论 含TDF的一线抗病毒治疗方案对肾功能正常的中国初治HIV-1病人的肾功能影响小,但由于随访时间有限,仍需要长时间随访以迸一步评估TDF的肾毒性.

  5. Direct Activation of Bax Protein for Cancer Therapy

    Science.gov (United States)

    Liu, Zhiqing; Ding, Ye; Ye, Na; Wild, Christopher; Chen, Haiying; Zhou, Jia

    2015-01-01

    Bax, a central cell death regulator, is an indispensable gateway to mitochondrial dysfunction and a major pro-apoptotic member of the Bcl-2 family proteins that control apoptosis in normal and cancer cells. Dysfunction of apoptosis renders the cancer cell resistant to treatment as well as promotes tumorigenesis. Bax activation induces mitochondrial membrane permeabilization, thereby leading to the release of apoptotic factor cytochrome c and consequently cancer cell death. A number of drugs in clinical use are known to indirectly activate Bax. Intriguingly, recent efforts demonstrate that Bax can serve as a promising direct target for small-molecule drug discovery. Several direct Bax activators have been identified to hold promise for cancer therapy with the advantages of specificity and the potential of overcoming chemo- and radioresistance. Further investigation of this new class of drug candidates will be needed to advance them into the clinic as a novel means to treat cancer. PMID:26395559

  6. X-Ray Psoralen Activated Cancer Therapy (X-PACT).

    Science.gov (United States)

    Oldham, Mark; Yoon, Paul; Fathi, Zak; Beyer, Wayne F; Adamson, Justus; Liu, Leihua; Alcorta, David; Xia, Wenle; Osada, Takuya; Liu, Congxiao; Yang, Xiao Y; Dodd, Rebecca D; Herndon, James E; Meng, Boyu; Kirsch, David G; Lyerly, H Kim; Dewhirst, Mark W; Fecci, Peter; Walder, Harold; Spector, Neil L

    2016-01-01

    This work investigates X-PACT (X-ray Psoralen Activated Cancer Therapy): a new approach for the treatment of solid cancer. X-PACT utilizes psoralen, a potent anti-cancer therapeutic with current application to proliferative disease and extracorporeal photopheresis (ECP) of cutaneous T Cell Lymphoma. An immunogenic role for light-activated psoralen has been reported, contributing to long-term clinical responses. Psoralen therapies have to-date been limited to superficial or extracorporeal scenarios due to the requirement for psoralen activation by UVA light, which has limited penetration in tissue. X-PACT solves this challenge by activating psoralen with UV light emitted from novel non-tethered phosphors (co-incubated with psoralen) that absorb x-rays and re-radiate (phosphoresce) at UV wavelengths. The efficacy of X-PACT was evaluated in both in-vitro and in-vivo settings. In-vitro studies utilized breast (4T1), glioma (CT2A) and sarcoma (KP-B) cell lines. Cells were exposed to X-PACT treatments where the concentrations of drug (psoralen and phosphor) and radiation parameters (energy, dose, and dose rate) were varied. Efficacy was evaluated primarily using flow cell cytometry in combination with complimentary assays, and the in-vivo mouse study. In an in-vitro study, we show that X-PACT induces significant tumor cell apoptosis and cytotoxicity, unlike psoralen or phosphor alone (pPACT than with saline or AMT + X-ray (pPACT, and provide a foundation and rationale for future studies. In summary, X-PACT represents a novel treatment approach in which well-tolerated low doses of x-ray radiation are delivered to a specific tumor site to generate UVA light which in-turn unleashes both short- and potentially long-term antitumor activity of photo-active therapeutics like psoralen.

  7. Inflammatory bowel diseases activity in patients undergoing pelvic radiation therapy

    Science.gov (United States)

    Seisen, Thomas; Klotz, Caroline; Mazeron, Renaud; Maroun, Pierre; Petit, Claire; Deutsch, Eric; Bossi, Alberto; Haie-Meder, Christine; Chargari, Cyrus; Blanchard, Pierre

    2017-01-01

    Background Few studies with contradictory results have been published on the safety of pelvic radiation therapy (RT) in patients with inflammatory bowel disease (IBD). Methods From 1989 to 2015, a single center retrospective analysis was performed including all IBD patients who received pelvic external beam radiation therapy (EBRT) or brachytherapy (BT) for a pelvic malignancy. Treatment characteristics, IBD activity and gastrointestinal (GI) toxicity were examined. Results Overall, 28 patients with Crohn’s disease (CD) (n=13) or ulcerative colitis (n=15) were included in the present study. Median follow-up time after irradiation was 5.9 years. Regarding IBD activity, only one and two patients experienced a severe episode within and after 6 months of follow-up, respectively. Grade 3/4 acute GI toxicity occurred in 3 (11%) patients, whereas one (3.6%) patient experienced late grade 3/4 GI toxicity. Only patients with rectal IBD location (P=0.016) or low body mass index (BMI) (P=0.012) experienced more severe IBD activity within or after 6 months following RT, respectively. Conclusions We report an acceptable tolerance of RT in IBD patients with pelvic malignancies. Specifically, a low risk of uncontrolled flare-up was observed. PMID:28280621

  8. Low level laser therapy reduces inflammation in activated Achilles tendinitis

    Science.gov (United States)

    Bjordal, Jan M.; Iversen, Vegard; Lopes-Martins, Rodrigo Alvaro B.

    2006-02-01

    Objective: Low level laser therapy (LLLT) has been forwarded as therapy for osteoarthritis and tendinopathy. Results in animal and cell studies suggest that LLLT may act through a biological mechanism of inflammatory modulation. The current study was designed to investigate if LLLT has an anti-inflammatory effect on activated tendinitis of the Achilles tendon. Methods: Seven patients with bilateral Achilles tendonitis (14 tendons) who had aggravated symptoms by pain-inducing activity immediately prior to the study. LLLT (1.8 Joules for each of three points along the Achilles tendon with 904nm infrared laser) and placebo LLLT were administered to either Achilles tendons in a random order to which patients and therapist were blinded. Inflammation was examined by 1) mini-invasive microdialysis for measuring the concentration of inflammatory marker PGE II in the peritendinous tissue, 2) ultrasound with Doppler measurement of peri- and intratendinous blood flow, 3) pressure pain algometry and 4) single hop test. Results: PGE 2- levels were significantly reduced at 75, 90 and 105 minutes after active LLLT compared both to pre-treatment levels (p=0.026) and to placebo LLLT (p=0.009). Changes in pressure pain threshold (PPT) were significantly different (P=0.012) between groups. PPT increased by a mean value of 0.19 kg/cm2 [95%CI:0.04 to 0.34] after treatment in the active LLLT group, while pressure pain threshold was reduced by -0.20 kg/cm2 [95%CI:-0.45 to 0.05] after placebo LLLT. Conclusion: LLLT can be used to reduce inflammatory musculskeletal pain as it reduces inflammation and increases pressure pain threshold levels in activity-induced pain episodes of Achilles tendinopathy.

  9. Continued High Prevalence and Adverse Clinical Impact of Human Immunodeficiency Virus–Associated Sensory Neuropathy in the Era of Combination Antiretroviral Therapy

    Science.gov (United States)

    Ellis, Ronald J.; Rosario, Debralee; Clifford, David B.; McArthur, Justin C.; Simpson, David; Alexander, Terry; Gelman, Benjamin B.; Vaida, Florin; Collier, Ann; Marra, Christina M.; Ances, Beau; Atkinson, J. Hampton; Dworkin, Robert H.; Morgello, Susan; Grant, Igor

    2014-01-01

    Objective To provide updated estimates of the prevalence and clinical impact of human immunodeficiency virus−associated sensory neuropathy (HIV-SN) and neuropathic pain due to HIV-SN in the combination antiretroviral therapy (CART) era. Design Prospective, cross-sectional analysis. Clinical correlates for HIV-SN and neuropathic pain, including age, exposure to CART, CD4 levels, plasma viral load, hepatitis C virus infection, and alcohol use disorders, were evaluated in univariate and multivariate models. Setting Six US academic medical centers. Patients One thousand five hundred thirty-nine HIV-infected individuals enrolled in the CNS (Central Nervous System) HIV Anti-Retroviral Therapy Effects Research study. Main Outcome Measures The presence of HIV-SN, defined by 1 or more clinical signs (diminished vibration or sharp sensation in the legs and feet; reduced ankle reflexes) in a distal, symmetrical pattern. Neuropathic pain was defined as aching, stabbing, or burning in a similar distribution. The effect on quality of life was assessed with the Medical Outcomes Study HIV Health Survey. Results We found HIV-SN in 881 participants. Of these, 38.0% reported neuropathic pain. Neuropathic pain was significantly associated with disability in daily activities, unemployment, and reduced quality of life. Risk factors for HIV-SN after adjustment were advancing age (odds ratio, 2.1 [95%confidence interval, 1.8–2.5] per 10 years), lower CD4 nadir (1.2 [1.1–1.2] per 100-cell decrease), current CART use (1.6 [1.3–2.8]), and past “D-drug” use (specific dideoxynucleoside analogue antiretrovirals) (2.0 [1.3–2.6]). Risk factors for neuropathic pain were past D-drug use and higher CD4 nadir. Conclusions Neuropathic pain and HIV-SN remain prevalent, causing substantial disability and reduced quality of life even with successful CART. The clinical correlates of HIV-SN have changed with the evolution of treatment. These findings argue for redoubled efforts to determine

  10. Virtual reality exposure therapy for active duty soldiers.

    Science.gov (United States)

    Reger, Greg M; Gahm, Gregory A

    2008-08-01

    Virtual reality exposure (VRE) therapy is a promising treatment for a variety of anxiety disorders and has recently been extended to the treatment of posttraumatic stress disorder (PTSD). In this article, the authors briefly review the rationale for VRE and its key processes. They illustrate the treatment with an active-duty Army soldier diagnosed with combat-related PTSD. Six sessions of VRE were provided using an immersive simulation of a military convoy in Iraq. Self-reported PTSD symptoms and psychological distress were reduced at posttreatment relative to pretreatment reports, as assessed by the PTSD Checklist-Military Version and the Behavior and Symptom Identification Scale-24. The case outcomes parallel those reported in the research with other disorders and suggest the applicability of VRE in treating active duty soldiers with combat-related PTSD.

  11. [Practice of Behavioral Activation in Cognitive-behavioral Therapy].

    Science.gov (United States)

    Kitagawa, Nobuki

    2015-01-01

    An approach focusing on behavioral activation (BA) was adopted in the cognitive therapy of A. T. Beck, and it came to be considered that BA can play an important role in cognitive-behavioral therapy (CBT) for depression. Therefore, in recent years, BA based on clinical behavior analysis has been developed as a new treatment (Martell, et al.). The core characteristics are as follows: 1) focusing attention on context in daily life to promote the behavior control of patients and avoidance of a hatred experience ; 2) breaking the vicious circle; 3) promoting the behavior according to the purpose that the patients originally expect; 4) recognizing a relationship between behavior and the situation (contingency), thereby recovering self-efficacy tied to the long-term results that one originally expects. This does not increase pleasant activity at random when the patient is inactive, or give a sense of accomplishment. We know that depression is maintained by conducting functional analysis of detailed life behavior, and encourage the patients to have healthy behavior according to individual values. We help them to complete schedules regardless of mood and reflect on the results patiently. It is considered that those processes are important. BA may be easy to apply in clinical practice and effective for the chronic cases, or the patients in a convalescent stage. Also, in principle in the CBT for major depression, it may be effective that behavioral activation is provided in an early stage, and cognitive reconstruction in a latter stage. However, an approach to carry out functional analysis by small steps with careful activity monitoring is essential when the symptoms are severe. Furthermore, it should be considered that the way of psychoeducation requires caution because we encourage rest in the treatment of depression in our country. In particular, we must be careful not to take an attitude that an inactive behavior pattern is unproductive only based model cases.

  12. Could low level laser therapy and highly active antiretroviral therapy lead to complete eradication of HIV-1 in vitro?

    CSIR Research Space (South Africa)

    Lugongolo, Masixole Y

    2017-01-01

    Full Text Available Human immunodeficiency virus (HIV-1) infection remains a major health problem despite the use of highly active antiretroviral therapy (HAART), which has greatly reduced mortality rates. Due to the unavailability of an effective vaccine or a...

  13. Sclerosing cholangitis by cytomegalovirus in highly active antiretroviral therapy era

    Directory of Open Access Journals (Sweden)

    Carmen Hidalgo-Tenorio

    2013-10-01

    Full Text Available Sclerosing colangitis (SC due to cytomegalovirus (CMV is very rare. It has been described mainly in immunocompromised patients. Currently, in HIV infected patients it is exceptional. The most of cases belong to pre-highly active antiretroviral therapy (pre-HAART and those cases were in stage AIDS with less than 100 CD4/μl. The most frequently involved pathogen in pre-HAART period was Cryptosporidium parvum (30-57% and CMV (10-30%; in late HAART period this information are unaware. CMV has been implicated as a possible etiological agent in primary SC partly because of the ability to cause liver damage and its relationship with smooth muscle antibodies. The most effective treatment for SC was the combination of antiretroviral therapy and endoscopic retrograde cholangiopancreatography with sphincterotomy and stent placement. Following, we present the first case of late HAART period which describes a SC extrahepatic without papillary stenosis with CMV as the only cause and clinical presentation of HIV infection in a woman with 177 CD4/μl.

  14. Qualidade de vida e adesão ao tratamento anti-retroviral de pacientes portadores de HIV Calidad de vida y adhesión al tratamiento antiretroviral de pacientes portadores de VIH Quality of life and adherence to HAART in HIV-infected patients

    Directory of Open Access Journals (Sweden)

    Luciana Geocze

    2010-08-01

    Full Text Available Foi realizada uma revisão da literatura científica sobre adesão terapêutica à highly active antiretroviral therapy e sobre a qualidade de vida dos pacientes portadores do HIV, indexada no MEDLINE no período entre 1998 e 2008. Foram incluídos estudos em pacientes maiores de 18 anos, publicados em português, espanhol ou inglês. Foram excluídos estudos de revisão, relatos de caso e cartas. Dos 21 estudos encontrados, 12 foram incluídos (três ensaios clínicos, três coortes prospectivos, seis transversais. A relação entre qualidade de vida e adesão terapêutica permanece controversa, embora estudos descritivos apontem a possibilidade de uma relação positiva. Os resultados podem ter sido influenciados por características específicas dos ensaios clínicos descritos e mostram não haver consenso sobre o impacto da adesão terapêutica sobre a qualidade de vida dos pacientes.Se realizó una revisión de la literatura científica sobre adhesión terapéutica a la terapia antirretroviral altamente activa y sobre la calidad de vida de los pacientes portadores de VIH, indexados en el MEDLINE en el período entre 1998 y 2008. Se incluyeron estudios en pacientes mayores de 18 años, publicados en portugués, español o inglés. Se excluyeron estudios de revisión, relatos de caso y cartas. De los 21 estudios encontrados, 12 fueron incluidos (tres ensayos clínicos, tres cohortes prospectivas, seis transversales. La relación entre calidad de vida y adhesión terapéutica permanece controversial a pesar de que estudios descriptivos señalen la posibilidad de una relación positiva. Los resultados pueden haber sido influenciados por características específicas de los ensayos clínicos descritos y muestran no haber consenso con relación al impacto de la adhesión terapéutica sobre la calidad de vida de los pacientes.A review on adherence to highly active antiretroviral therapy and the quality of life of patients living with HIV in the

  15. Isoniazid Prophylactic Therapy for the Prevention of Tuberculosis in HIV Infected Adults: A Systematic Review and Meta-Analysis of Randomized Trials.

    Directory of Open Access Journals (Sweden)

    Henok Tadesse Ayele

    Full Text Available Infection with Human Immunodeficiency virus (HIV is an important risk factor for Tuberculosis (TB. Anti-Retroviral Therapy (ART has improved the prognosis of HIV and reduced the risk of TB infected patients. Isoniazid Preventive Therapy (IPT aims to reduce the development of active TB in patients with latent TB.Systematically review and synthesize effect estimates of IPT for TB prevention in adult HIV patients. Secondary objectives were to assess the effect of IPT on HIV disease progression, all-cause mortality and adverse drug reaction (ADR.Electronic databases were searched to identify relevant articles in English available by September 11th 2015.Research articles comparing IPT to placebo or no treatment in HIV infected adults using randomized clinical trials.A qualitative review included study-level information on randomization and treatment allocation. Effect estimates were pooled using random-effects models to account for between-study heterogeneity.This review assessed ten randomized clinical trials that assigned 7619 HIV patients to IPT or placebo. An overall 35% of TB risk reduction (RR = 0.65, 95% CI (0.51, 0.84 was found in all participants, however, larger benefit of IPT was observed in Tuberculin Skin Test (TST positive participants, with pooled relative risk reduction of 52% [RR = 0.48; 95% CI (0.29, 0.82] and with a prediction interval ranging from 0.13 to 1.81. There was no statistically significant effect of IPT on TB occurrence in TST negative or unknown participants. IPT also reduced the risk of HIV disease progression in all participants (RR = 0.69; 95% CI (0.48, 0.99 despite no benefits observed in TST strata. All-cause mortality was not affected by IPT although participants who had 12 months of IPT tend to have a reduced risk (RR = 0.65; 95% CI(0.47, 0.90. IPT had an elevated, yet statistically non-significant, risk of adverse drug reaction [RR = 1.20; 95% CI (1.20, 1.71]. Only a single study assessed the effect of IPT in

  16. Effect of action observation therapy on daily activities and motor recovery in stroke patients

    Directory of Open Access Journals (Sweden)

    Mei-Hong Zhu

    2015-09-01

    Conclusion: Action observation therapy significantly improves upper extremity motor function and performance of activities of daily living, and alleviates upper limb spasticity in patients with stroke.

  17. Recurrence or rebound of clinical relapses after discontinuation of natalizumab therapy in highly active MS patients

    DEFF Research Database (Denmark)

    Sorensen, Per Soelberg; Koch-Henriksen, Nils; Petersen, Thor;

    2014-01-01

    A number of studies have reported flare-up of multiple sclerosis (MS) disease activity after cessation of natalizumab, increasing to a level beyond the pre-natalizumab treatment level. Our aim was to describe the development in clinical disease activity following cessation of natalizumab therapy...... in a large unselected cohort of highly active patients. We studied 375 highly active patients who had suffered at least two significant relapses within 1 year or three relapses within 2 years, or had been treated with mitoxantrone for highly active disease. All patients had discontinued therapy...... with natalizumab after at least 24 weeks on therapy, and had been followed 3-12 months (mean 8.9 months) after cessation of natalizumab therapy. The annualised relapse rate before start of natalizumab therapy was 0.94 (95 % confidence interval [CI] 0.88-1.00), 0.47 (95 % CI 0.43-0.52) during natalizumab therapy, 0...

  18. Gold Nanorod Bioconjugates for Active Tumor Targeting and Photothermal Therapy

    Directory of Open Access Journals (Sweden)

    Hadiyah N. Green

    2011-01-01

    Full Text Available The mastery of active tumor targeting is a great challenge in near infrared photothermal therapy (NIRPTT. To improve efficiency for targeted treatment of malignant tumors, we modify the technique of conjugating gold nanoparticles to tumor-specific antibodies. Polyethylene glycol-coated (PEGylated gold nanorods (GNRs were fabricated and conjugated to an anti-EGFR antibody. We characterized the conjugation efficiency of the GNRs by comparing the efficiency of antibody binding and the photothermal effect of the GNRs before and after conjugation. We demonstrate that the binding efficiency of the antibodies conjugated to the PEGylated GNRs is comparable to the binding efficiency of the unmodified antibodies and 33.9% greater than PEGylated antibody-GNR conjugates as reported by Liao and Hafner (2005. In addition, cell death by NIRPTT was sufficient to kill nearly 90% of tumor cells, which is comparable to NIRPTT with GNRs alone confirming that NIRPTT using GNRs is not compromised by conjugation of GNRs to antibodies.

  19. Use of Alternative Therapies by Active Duty Air Force Personnel

    Science.gov (United States)

    1996-05-13

    are led by lay people. Table I Healing Matrix Orthodox Marginal Alternative Physical Surgery Chiropractic Rolfing Cranial-sacral Manipulation...and. finally chiropractic therapy (9) . Commercial weight loss programs and self-help groups were also used by the respondents. Symptoms for which...mainstream of conventional medicine. These unconventional or alternative therapies include treatments by chiropractors, acupuncturists, herbal therapists , and

  20. Integrating Therapy Dog Teams in a Physical Activity Program for Children with Autism Spectrum Disorders

    Science.gov (United States)

    Obrusnikova, Iva; Bibik, Janice M.; Cavalier, Albert R.; Manley, Kyle

    2012-01-01

    The use of therapy-dog teams in programs for children with disabilities is becoming increasingly popular in school and therapeutic settings and has been shown to provide physical, social, and emotional benefits for the children. This article describes the basic steps for implementing therapy dog-assisted activities in physical activity programs…

  1. Melanoma brain metastases: an unmet challenge in the era of active therapy.

    Science.gov (United States)

    Gorantla, Vikram; Kirkwood, John M; Tawbi, Hussein A

    2013-10-01

    Metastatic disease to the brain is a frequent manifestation of melanoma and is associated with significant morbidity and mortality and poor prognosis. Surgery and stereotactic radiosurgery provide local control but less frequently affect the overall outcome of melanoma brain metastases (MBM). The role of systemic therapies for active brain lesions has been largely underinvestigated, and patients with active brain lesions are excluded from the vast majority of clinical trials. The advent of active systemic therapy has revolutionized the care of melanoma patients, but this benefit has not been systematically translated into intracranial activity. In this article, we review the biology and clinical outcomes of patients with MBM, and the evidence supporting the use of radiation, surgery, and systemic therapy in MBM. Prospective studies that included patients with active MBM have shown clinical intracranial activity that parallels systemic activity and support the inclusion of patients with active MBM in clinical trials involving novel agents and combination therapies.

  2. Highly active antiretroviral therapy: Does it Sound toxic?

    Directory of Open Access Journals (Sweden)

    Katijah Khoza-Shangase

    2011-01-01

    Full Text Available Objective : The main objective of the current study is to monitor the auditory status in a group of adults with AIDS, receiving Highly Active Antiretroviral Therapy (HAART (3TC -lamivudine, D4T - stavudine, and efavirenz in a hospital outpatient clinic in Gauteng. A total sample of 54 adults (between the ages of 18 and 50 years in the experimental group and 16 in the control group were assessed prospectively following a repeated measures design. All participants were assessed at baseline at three months, and at six months into the treatment. Materials and Methods : The participants underwent case history interviews and medical record reviews, otoscopy, and tympanometry, as well as conventional pure tone audiometry and distortion product otoacoustic emission testing. Both descriptive and inferential statistics were used to analyze the data. Results : On audiological monitoring, statistically significant changes (P<0.05 were established, only in the experimental group, for pure tone audiometry - with clinically significant changes found at high frequencies. Statistically significant changes with clinically significant changes were obtained for distortion product otoacoustic emissions (DPOAEs in the experimental group, particularly at high frequencies - implying subclinical hearing function changes; while lack of statistically significant changes with no clinically significant changes were found in the control group. The subclinical hearing changes in the experimental group were also evident in the findings of the subclinical hearing loss group, who, although they had normal pure tone function after six months of follow up, presented with clinical changes on DPOAEs at 6 and 8 kHz. Conclusions : Findings highlight the need for closer monitoring of the effects of antiretroviral drugs (ARVs on hearing, through the use of more sensitive tools of assessment when conducting drug trials.

  3. Active Theater as a Complementary Therapy for Parkinson's Disease Rehabilitation: A Pilot Study

    OpenAIRE

    Nicola Modugno; Sara Iaconelli; Mariagrazia Fiorlli; Francesco Lena; Imogen Kusch; Giovanni Mirabella

    2010-01-01

    Most medical treatments of Parkinson's disease (PD) are aimed at the reduction of motor symptoms. However, even when motor improvements are evident, patients often report a deterioration of their daily lives. Thus, to achieve a global improvement in personal well-being, not only drugs, but also complementary therapies, such as physical exercise, occupational and speech therapy, and active music therapy, have been used. We hypothesized that theater could reduce clinical disability and improve ...

  4. Pivotal role of tissue plasminogen activator in the mechanism of action of electroconvulsive therapy.

    Science.gov (United States)

    Hoirisch-Clapauch, Silvia; Mezzasalma, Marco A U; Nardi, Antonio E

    2014-02-01

    Electroconvulsive therapy is an important treatment option for major depressive disorders, acute mania, mood disorders with psychotic features, and catatonia. Several hypotheses have been proposed as electroconvulsive therapy's mechanism of action. Our hypothesis involves many converging pathways facilitated by increased synthesis and release of tissue-plasminogen activator. Human and animal experiments have shown that tissue-plasminogen activator participates in many mechanisms of action of electroconvulsive therapy or its animal variant, electroconvulsive stimulus, including improved N-methyl-D-aspartate receptor-mediated signaling, activation of both brain-derived neurotrophic factor and vascular endothelial growth factor, increased bioavailability of zinc, purinergic release, and increased mobility of dendritic spines. As a result, tissue-plasminogen activator helps promote neurogenesis in limbic structures, modulates synaptic transmission and plasticity, improves cognitive function, and mediates antidepressant effects. Notably, electroconvulsive therapy seems to influence tissue-plasminogen activator metabolism. For example, electroconvulsive stimulus increases the expression of glutamate decarboxylase 65 isoform in γ-aminobutyric acid-releasing neurons, which enhances the release of tissue-plasminogen activator, and the expression of p11, a protein involved in plasminogen and tissue-plasminogen activator assembling. This paper reviews how electroconvulsive therapy correlates with tissue-plasminogen activator. We suggest that interventions aiming at increasing tissue-plasminogen activator levels or its bioavailability - such as daily aerobic exercises together with a carbohydrate-restricted diet, or normalization of homocysteine levels - be evaluated in controlled studies assessing response and remission duration in patients who undergo electroconvulsive therapy.

  5. Behavioral activation therapy for remediating persistent social deficits in medication-responsive chronic depression.

    Science.gov (United States)

    Erickson, Gregory; Hellerstein, David J

    2011-05-01

    The purpose of this article is to explore the use of behavioral activation therapy in patients with medication-responsive chronic depression who continue to experience social and occupational deficits. The classification of chronic depression includes a variety of disorders that are both common and debilitating and that frequently leave patients socially impaired even after remission of mood symptoms. Medication is often only partially effective in remedying these social impairments. As a result, other interventions, including forms of psychotherapy, may be justified as an adjunct to medication to improve residual social impairment. Behavioral activation therapy is one such treatment that may be especially appropriate for such individuals. The authors offer a brief description of behavioral activation therapy and examine how to adapt this therapy for use in patients with medication-responsive chronic depression. Preliminary evidence suggests that the therapy can be easily implemented with few modifications to improve social and occupational difficulties.

  6. Thrombolytic therapy preserves vagal activity early after acute myocardial infarction

    DEFF Research Database (Denmark)

    Lind, P; Hintze, U; Møller, M

    2001-01-01

    OBJECTIVE: The purpose of this study was to evaluate the effects of thrombolytic therapy on vagal tone after acute myocardial infarction (AMI). DESIGN: Holter monitoring for 24 h was performed at hospital discharge and 6 weeks after AMI in 74 consecutive male survivors of a first AMI, who fulfill...

  7. [Cost of therapy for neurodegenerative diseases. Applying an activity-based costing system].

    Science.gov (United States)

    Sánchez-Rebull, María-Victoria; Terceño Gómez, Antonio; Travé Bautista, Angeles

    2013-01-01

    To apply the activity based costing (ABC) model to calculate the cost of therapy for neurodegenerative disorders in order to improve hospital management and allocate resources more efficiently. We used the case study method in the Francolí long-term care day center. We applied all phases of an ABC system to quantify the cost of the activities developed in the center. We identified 60 activities; the information was collected in June 2009. The ABC system allowed us to calculate the average cost per patient with respect to the therapies received. The most costly and commonly applied technique was psycho-stimulation therapy. Focusing on this therapy and on others related to the admissions process could lead to significant cost savings. ABC costing is a viable method for costing activities and therapies in long-term day care centers because it can be adapted to their structure and standard practice. This type of costing allows the costs of each activity and therapy, or combination of therapies, to be determined and aids measures to improve management. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

  8. Factor XI and Contact Activation as Targets for Antithrombotic Therapy

    OpenAIRE

    Gailani, David; Bane, Charles E.; Gruber, Andras

    2015-01-01

    The most commonly used anticoagulants produce therapeutic antithrombotic effects either by inhibiting thrombin or factor Xa, or by lowering the plasma levels of the precursors of these key enzymes, prothrombin and factor X. These drugs do not distinguish between thrombin generation contributing to thrombosis from thrombin generation required for hemostasis. Thus, anticoagulants increase bleeding risk, and many patients who would benefit from therapy go untreated because of comorbidities that ...

  9. The impact of integrating food supplementation, nutritional education and HAART (Highly Active Antiretroviral Therapy) on the nutritional status of patients living with HIV/AIDS in Mozambique: results from the DREAM Programme.

    Science.gov (United States)

    Scarcella, P; Buonomo, E; Zimba, I; Doro Altan, A M; Germano, P; Palombi, L; Marazzi, M C

    2011-01-01

    DREAM (Drug Resources Enhancement against AIDS and Malnutrition) is a multiregional health program active in Mozambique since 2002 and provides free of charge an integrating package of care consisting of peer to peer nutritional and health education, food supplementation, voluntary counseling and testing, immunological, virological, clinical assessment and HAART (Highly Active AntiRetroviral Treatment). The main goals of this paper are to describe the state of health and nutrition and the adequacy of the diet of a sample of HIV/AIDS patients in Mozambique on HAART and not. A single-arm retrospective cohort study was conducted. 106 HIV/AIDS adult patients (84 in HAART), all receiving food supplementation and peer-to-peer nutritional education, were randomly recruited in Mozambique in two public health centres where DREAM is running. The programme is characterized by: provision of HAART, clinical and laboratory monitoring, peer to peer health and nutritional education and food supplementation. We measured BMI, haemoglobin, viral load, CD4 count at baseline (T0) and after at least 1 year (T1). Dietary intake was estimated using 24h food recall and dietary diversity was assessed by using the Dietary Diversity Score (DDS) at T1. Overall, the patients'diet appeared to be quite balanced in nutrients. In the cohort not in HAART the mean BMI values showed an increases but not significant (initial value: 21.9 ± 2.9; final value: 22.5 ± 3.3 ) and the mean haemoglobin values (g/dl) showed a significant increases (initial value: 10.5+ 2.1; final value: 11.5 ± 1.7 pnutritional status improvement was observed in both cohorts. The improvement in BMI was significant and substantially higher in HAART patients because of the impact of HAART on nutritional status of AIDS patients. Subjects on HAART and with a DDS > 5, showed a substantial BMI gain. This association showed an additional expression of the synergic effect of integrating food supplementation, nutritional education and

  10. Multicentric Castleman's disease & HIV infection.

    LENUS (Irish Health Repository)

    Cotter, A

    2009-10-01

    We report the case of a 35 year patient from Nigeria who presented with fever and splenomegaly. The initial diagnosis was Salmonellosis. However, relapsing symptoms lead to a re-evaluation and ultimately a diagnosis of Multicentric Castleman\\'s Disease (MCD). There is no gold standard treatment but our patient responded to Rituximab and Highly active anti-retroviral therapy. MCD is a rare, aggressive disease that should be considered in a HIV positive patient presenting with fever and significant lymphadenopathy.

  11. Current oral manifestations of HIV infection.

    Science.gov (United States)

    Navazesh, M

    2001-02-01

    The oral manifestations of human immunodeficiency virus infection have changed drastically since the introduction of the highly active anti-retroviral therapy (HAART) in developed countries. Recent studies have documented significant reductions in morbidity and mortality rates among HIV-infected patients on HAART. This article focuses on the latest information about the oral manifestations of HIV infection and will discuss the impact of HAART.

  12. Therapeutic genes for anti-HIV/AIDS gene therapy.

    Science.gov (United States)

    Bovolenta, Chiara; Porcellini, Simona; Alberici, Luca

    2013-01-01

    The multiple therapeutic approaches developed so far to cope HIV-1 infection, such as anti-retroviral drugs, germicides and several attempts of therapeutic vaccination have provided significant amelioration in terms of life-quality and survival rate of AIDS patients. Nevertheless, no approach has demonstrated efficacy in eradicating this lethal, if untreated, infection. The curative power of gene therapy has been proven for the treatment of monogenic immunodeficiensies, where permanent gene modification of host cells is sufficient to correct the defect for life-time. No doubt, a similar concept is not applicable for gene therapy of infectious immunodeficiensies as AIDS, where there is not a single gene to be corrected; rather engineered cells must gain immunotherapeutic or antiviral features to grant either short- or long-term efficacy mostly by acquisition of antiviral genes or payloads. Anti-HIV/AIDS gene therapy is one of the most promising strategy, although challenging, to eradicate HIV-1 infection. In fact, genetic modification of hematopoietic stem cells with one or multiple therapeutic genes is expected to originate blood cell progenies resistant to viral infection and thereby able to prevail on infected unprotected cells. Ultimately, protected cells will re-establish a functional immune system able to control HIV-1 replication. More than hundred gene therapy clinical trials against AIDS employing different viral vectors and transgenes have been approved or are currently ongoing worldwide. This review will overview anti-HIV-1 infection gene therapy field evaluating strength and weakness of the transgenes and payloads used in the past and of those potentially exploitable in the future.

  13. Biologic therapy improves psoriasis by decreasing the activity of monocytes and neutrophils.

    Science.gov (United States)

    Yamanaka, Keiichi; Umezawa, Yoshinori; Yamagiwa, Akisa; Saeki, Hidehisa; Kondo, Makoto; Gabazza, Esteban C; Nakagawa, Hidemi; Mizutani, Hitoshi

    2014-08-01

    Therapy with monoclonal antibodies to tumor necrosis factor (TNF)-α and the interleukin (IL)-12/23 p40 subunit has significantly improved the clinical outcome of patients with psoriasis. These antibodies inhibit the effects of the target cytokines and thus the major concern during their use is the induction of excessive immunosuppression. Recent studies evaluating the long-term efficacy and safety of biologic therapy in psoriasis have shown no significant appearance of serious adverse effects including infections and malignancies. However, the immunological consequence and the mechanism by which the blockade of a single cytokine by biologics can successfully control the activity of psoriasis remain unclear. In the current study, we investigated the effect of biologic therapy on cytokine production of various lymphocytes and on the activity of monocytes and neutrophils in psoriatic patients. Neutrophils, monocytes and T cells were purified from heparinized peripheral venous blood by Ficoll density gradient centrifugation, and γ-interferon, TNF-α and IL-17 production from lymphocytes was measured by flow cytometer. The activation maker of neutrophils and the activated subsets of monocytes were also analyzed. Biologic therapy induced no significant changes in the cytokine production by lymphocytes from the skin and gut-homing T cells. However, neutrophil activity and the ratio of activated monocyte population increased in severely psoriatic patients were normalized in psoriatic patients receiving biologic therapy. The present study showed that biologic therapy ameliorates clinical symptoms and controls the immune response in patients with psoriasis.

  14. Changes in physical activity measured by accelerometry following initiation of DMARD therapy in rheumatoid arthritis.

    Science.gov (United States)

    Prioreschi, Alessandra; Hodkinson, Bridget; Tikly, Mohammed; McVeigh, Joanne A

    2014-05-01

    The aim of this study was to assess changes in habitual physical activity levels in response to DMARD therapy in RA patients. Eighteen drug-naive RA patients were prospectively assessed at baseline and following 3 months of DMARD therapy for habitual physical activity by accelerometry, disease activity using the clinical disease activity index (CDAI) and functional disability using the modified HAQ (mHAQ). Baseline physical activity was also compared with an equal number of healthy control participants matched for age, sex and BMI. Following 3 months of DMARD therapy, in parallel with significant improvements in CDAI scores (P physically active than control participants in the morning (P = 0.048) and in the late afternoon (P = 0.016), but these diurnal differences were no longer significant after the DMARD intervention. These findings suggest that accelerometry may potentially be a viable objective method of assessing changes in physical disability in response to various disease-modifying drugs.

  15. Activity determination of radionuclides for diagnostic and therapy; Aktivitaetsbestimmung von Radionukliden fuer Diagnostik und Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Kossert, Karsten [Physikalisch-Technische Bundesanstalt (PTB), Braunschweig (Germany). Arbeitsgruppe ' Aktivitaetseinheit'

    2013-06-15

    The application of radionuclides plays in medicine an important role and requires reliable activity determination. The PTB provides for this activity normals and determines the activity of the presented sources. The article describes, how activity determinations in the PTB occur, and by which ways this can be used for nuclear medicine. Research and development works in the PTB are just so illuminated as the determination of nuclide data of some isotopes relevant for medicine.

  16. The Effects of Constraint-Induced Movement Therapy on Activities Important to Independent School Participation of Children with Hemiparesis

    Science.gov (United States)

    Carney, Joan

    2012-01-01

    This study investigated the efficacy of constraint-induced movement therapy (CI therapy) on activities important to school participation in children with hemiparesis. Four children, ages 4-0 to 7-10 participated in an intensive CI therapy program in a clinical setting. Constraining casts were worn 24 hours daily. Therapy was delivered 6 hours…

  17. The Effects of Constraint-Induced Movement Therapy on Activities Important to Independent School Participation of Children with Hemiparesis

    Science.gov (United States)

    Carney, Joan

    2012-01-01

    This study investigated the efficacy of constraint-induced movement therapy (CI therapy) on activities important to school participation in children with hemiparesis. Four children, ages 4-0 to 7-10 participated in an intensive CI therapy program in a clinical setting. Constraining casts were worn 24 hours daily. Therapy was delivered 6 hours…

  18. Could low level laser therapy and highly active antiretroviral therapy lead to complete eradication of HIV-1 in vitro?

    Science.gov (United States)

    Lugongolo, Masixole Yvonne; Manoto, Sello Lebohang; Ombinda-Lemboumba, Saturnin; Maaza, Malik; Mthunzi-Kufa, Patience

    2017-02-01

    Human immunodeficiency virus (HIV-1) infection remains a major health problem despite the use of highly active antiretroviral therapy (HAART), which has greatly reduced mortality rates. Due to the unavailability of an effective vaccine or a treatment that would completely eradicate the virus, the quest for new and combination therapies continues. In this study we explored the influence of Low Level Laser Therapy (LLLT) in HIV-1 infected and uninfected cells. Literature reports LLLT as widely used to treat different medical conditions such as diabetic wounds, sports injuries and others. The technique involves exposure of cells or tissue to low levels of red and near infrared laser light. Both HIV infected and uninfected cells were laser irradiated at a wavelength of 640 nm with fluencies ranging from 2 to 10 J/cm2 and cellular responses were assessed 24 hours post laser treatment. In our studies, laser therapy had no inhibitory effects in HIV-1 uninfected cells as was indicated by the cell morphology and proliferation results. However, laser irradiation enhanced cell apoptosis in HIV-1 infected cells as the laser fluencies increased. This led to further studies in which laser irradiation would be conducted in the presence of HAART to determine whether HAART would minimise the detrimental effects of laser irradiation in infected cells.

  19. A pilot study to evaluate the magnitude of association of the use of electronic personal health records with patient activation and empowerment in HIV-infected veterans

    Directory of Open Access Journals (Sweden)

    Pierre-Cédric B. Crouch

    2015-03-01

    Full Text Available The HITECH Act signed into law in 2009 requires hospitals to provide patients with electronic access to their health information through an electronic personal health record (ePHR in order to receive Medicare/Medicaid incentive payments. Little is known about who uses these systems or the impact these systems will have on patient outcomes in HIV care. The health care empowerment model provides rationale for the hypothesis that knowledge from an electronic personal health record can lead to greater patient empowerment resulting in improved outcomes. The objective was to determine the patient characteristics and patient activation, empowerment, satisfaction, knowledge of their CD4, Viral Loads, and antiretroviral medication, and medication adherence outcomes associated with electronic personal health record use in Veterans living with HIV at the San Francisco VA Medical Center. The participants included HIV-Infected Veterans receiving care in a low volume HIV-clinic at the San Francisco VA Medical Center, divided into two groups of users and non-users of electronic personal health records. The research was conducted using in-person surveys either online or on paper and data abstraction from medical records for current anti-retroviral therapy (ART, CD4 count, and plasma HIV-1 viral load. The measures included the Patient Activation Measure, Health Care Empowerment Inventory, ART adherence, provider satisfaction, current CD4 count, current plasma viral load, knowledge of current ART, knowledge of CD4 counts, and knowledge of viral load. In all, 40 participants were recruited. The use of electronic personal health records was associated with significantly higher levels of patient activation and levels of patient satisfaction for getting timely appointments, care, and information. ePHR was also associated with greater proportions of undetectable plasma HIV-1 viral loads, of knowledge of current CD4 count, and of knowledge of current viral load. The

  20. Soluble urokinase plasminogen activator receptor is a marker of dysmetabolism in HIV-infected patients receiving highly active antiretroviral therapy

    DEFF Research Database (Denmark)

    Andersen, Ove; Eugen-Olsen, Jesper; Kofoed, Kristian;

    2008-01-01

    Circulating soluble urokinase plasminogen activator receptor (suPAR) reflects the immune and pro-inflammatory status of the HIV-infected patient. Highly active antiretroviral therapy (HAART) suppresses suPAR. Independent of the immune response to HAART, suPAR remains elevated in some HIV-infected...

  1. Aptamers: active targeting ligands for cancer diagnosis and therapy.

    Science.gov (United States)

    Wu, Xu; Chen, Jiao; Wu, Min; Zhao, Julia Xiaojun

    2015-01-01

    Aptamers, including DNA, RNA and peptide aptamers, are a group of promising recognition units that can specifically bind to target molecules and cells. Due to their excellent specificity and high affinity to targets, aptamers have attracted great attention in various fields in which selective recognition units are required. They have been used in biosensing, drug delivery, disease diagnosis and therapy (especially for cancer treatment). In this review, we summarized recent applications of DNA and RNA aptamers in cancer theranostics. The specific binding ability of aptamers to cancer-related markers and cancer cells ensured their high performance for early diagnosis of cancer. Meanwhile, the efficient targeting ability of aptamers to cancer cells and tissues provided a promising way to deliver imaging agents and drugs for cancer imaging and therapy. Furthermore, with the development of nanoscience and nanotechnology, the conjugation of aptamers with functional nanomaterials paved an exciting way for the fabrication of theranostic agents for different types of cancers, which might be a powerful tool for cancer treatment.

  2. How does directly observed therapy work? The mechanisms and impact of a comprehensive directly observed therapy intervention of highly active antiretroviral therapy in Peru.

    Science.gov (United States)

    Shin, Sonya; Muñoz, Maribel; Zeladita, Jhon; Slavin, Sam; Caldas, Adolfo; Sanchez, Eduardo; Callacna, Miriam; Rojas, Christian; Arevalo, Jorge; Sebastian, Jose Luis; Bayona, Jaime

    2011-05-01

    From December 2005 through August 2008, we provided community-based accompaniment with supervised antiretroviral therapy (CASA) to impoverished individuals starting highly active antiretroviral therapy. Adherence support was provided for 18 months by a community-based team comprised of several nurses and two types of community health workers: field supervisors and directly observed therapy (DOT) volunteers. To complement our quantitative data collection in 2008 using purposive sampling, we conducted two gender-mixed focus group discussions with 13 CASA patient participants and 13 DOT volunteers from Lima, Peru to identify the mediating mechanisms by which CASA improved well-being, and to understand the benefits of the intervention, as perceived by these individuals. Using standard qualitative methods for the review and analysis of transcripts and interview notes, we identified central themes and developed a coding scheme for categorising participants' statements. Two individuals blinded to each other's coding, coded interview transcripts for theme and content from which a third reviewer compared their coding to arbitrate discrepancies. Additional domains were added if necessary and all domains were integrated into a theoretical scheme. Among the forms of support delivered by the CASA team, DOT volunteers reported emotional support, instrumental support, directly observed therapy, building trust, education, advocacy, exercise of moral authority and preparation for transition off CASA support. CASA participants described outcomes of improved adherence, ability to resume social roles, increased self-efficacy, hopefulness, changes in non-HIV-related behaviour, reduced internalised and externalised stigma, as well as ability to disclose. Both sets of focus group participants highlighted remaining challenges after completion of CASA support: stigma in the community, difficulties achieving economic recovery and persistent barriers to health services. Based on our prior

  3. A Longitudinal Electromyography Study of Complex Movements in Poststroke Therapy. 2: Changes in Coordinated Muscle Activation

    Directory of Open Access Journals (Sweden)

    Negin Hesam-Shariati

    2017-07-01

    Full Text Available Fine motor control is achieved through the coordinated activation of groups of muscles, or “muscle synergies.” Muscle synergies change after stroke as a consequence of the motor deficit. We investigated the pattern and longitudinal changes in upper limb muscle synergies during therapy in a largely unconstrained movement in patients with a broad spectrum of poststroke residual voluntary motor capacity. Electromyography (EMG was recorded using wireless telemetry from 6 muscles acting on the more-affected upper body in 24 stroke patients at early and late therapy during formal Wii-based Movement Therapy (WMT sessions, and in a subset of 13 patients at 6-month follow-up. Patients were classified with low, moderate, or high motor-function. The Wii-baseball swing was analyzed using a non-negative matrix factorization (NMF algorithm to extract muscle synergies from EMG recordings based on the temporal activation of each synergy and the contribution of each muscle to a synergy. Motor-function was clinically assessed immediately pre- and post-therapy and at 6-month follow-up using the Wolf Motor Function Test, upper limb motor Fugl-Meyer Assessment, and Motor Activity Log Quality of Movement scale. Clinical assessments and game performance demonstrated improved motor-function for all patients at post-therapy (p < 0.01, and these improvements were sustained at 6-month follow-up (p > 0.05. NMF analysis revealed fewer muscle synergies (mean ± SE for patients with low motor-function (3.38 ± 0.2 than those with high motor-function (4.00 ± 0.3 at early therapy (p = 0.036 with an association trend between the number of synergies and the level of motor-function. By late therapy, there was no significant change between groups, although there was a pattern of increase for those with low motor-function over time. The variability accounted for demonstrated differences with motor-function level (p < 0.05 but not time. Cluster

  4. WHO 2009 GUIDELINES FOR ANTI-RETROVIRAL THERAPHY: ITS IMPLICATION FOR PRIMARY CARE PHYSICIAN

    Directory of Open Access Journals (Sweden)

    KOH KC

    2010-01-01

    Full Text Available -The HIV epidemic in Malaysia is slowing down but has now spread to spouses and sexual partners of traditional at risk populations, via heterosexual transmission. -The WHO 2009 guideline advocates starting HAART at CD4 level of 350 cells/mm3, marking a significant departure from starting at CD4 level of 200 cells/mm3 previously. -The WHO 2009 guideline recommended replacing stavudine with either zidovudine or tenofovir as part of the first line HAART regimen due to the former’s adverse effects. -Early detection of HIV infection and earlier initiation of HAART translates into better quality of life and lower risk of Tuberculosis co-infection. -Earlier detection of HIV infection requires picking up on subtle signs of the infection as well as employing a host of available diagnostic tests in cases where HIV infection is strongly suspected. -HIV test should be offered as a part of a routine health check screening. This facilitates early detection of HIV infection and early referral to the hospital for further management. -Collaboration and communications with non-governmental organizations involved in care of HIV infected people can be a good mean of providing support and counselling to newly diagnosed HIV infected individuals. -Asymptomatic undiagnosed HIV infected patients may pose a risk for disease transmission to health care workers in the primary care setting. Steps must be taken to minimize the risk of transmission and easy access to post-exposure prophylaxis. -The primary care physician should be well versed with the many possible drug interactions between HAART and other commonly used medications for other illnesses in order to avoid potentially fatal adverse reactions or treatment failure in patients taking HAART.

  5. Impact of maternal anti retroviral drugs during pregnancy on risk of ...

    African Journals Online (AJOL)

    Preterm birth and low birth weight contribute significantly to perinatal morbidity and mortality. ... Others demonstrated no effect on risk of prematurity while others ... Other associated factors were immunosuppression, multiple pregnancies and ...

  6. Formulation and characterization of solid lipid nanoparticles for an anti-retroviral drug darunavir

    Science.gov (United States)

    Bhalekar, Mangesh; Upadhaya, Prashant; Madgulkar, Ashwini

    2017-02-01

    Darunavir, an anti-HIV drug having poor solubility in aqueous and lipid medium, illustrates degradation above its melting point, i.e. 74 °C, thus, posing a challenge to dosage formulation. Despite, the drug suffers from poor oral bioavailability (37%) owing to less permeability and being poly-glycoprotein and cyp3A metabolism substrate. The study aimed formulating a SLN system to overcome the formulation and bioavailability associated problems of the drug. Based on the drug solubility and stable dispersion findings, lipid and surfactant were chosen and nanoparticles were prepared using hot-homogenization technique. Optimization of variables such as lipid concentration, oil-surfactant and homogenization cycle was carried and their effect on particle size and entrapment efficiency was studied. Freeze-dried SLN further characterized using SEM, DSC and PXRD analysis revealed complete entrapment of the drug and amorphous nature of the SLN. In vitro pH release studies in 0.1 N HCl and 6.8 pH buffer demonstrated 84 and 80% release at the end of 12th h. The apparent permeability of the SLN across rat intestine was found to be 24 × 10-6 at 37 °C at the end of 30 min while at 4 °C the same was found to be 5.6 × 10-6 prompting involvement of endocytic processes in the uptake of SLN. Accelerated stability studies revealed no prominent changes upon storage.

  7. Pregnancy Outcome of HIV-Infected Women on Anti-Retroviral ...

    African Journals Online (AJOL)

    User

    (PWLHIV) in Nigeria received ARVs in 2011.9 The problem has been repeatedly attributed to long standing health .... 35-39. 36 (12.4). 40-49. 6 (2.1). Marital Status. Single. 27(9.3). Married. 263(90.7) ..... 10.7448/IAS.16.1.18588. [Cited 2014 ...

  8. Toll-like receptor 7 controls the anti-retroviral germinal center response.

    Directory of Open Access Journals (Sweden)

    Edward P Browne

    2011-10-01

    Full Text Available The development of vaccines that can enhance immunity to viral pathogens is an important goal. However, the innate molecular pathways that regulate the strength and quality of the immune response remain largely uncharacterized. To define the role of Toll-like receptor (TLR signaling in control of a model retroviral pathogen, Friend virus (FV, I generated mice in which the TLR signaling adapter Myd88 was selectively deleted in dendritic cell (DC or in B cell lineages. Deletion of Myd88 in DCs had little effect on immune control of FV, while B cell specific deletion of Myd88 caused a dramatic increase in viral infectious centers and a significantly reduced antibody response, indicating that B cell-intrinsic TLR signaling plays a crucial role, while TLR signaling in DCs is less important. I then identified the single-stranded RNA sensing protein TLR7 as being required for antibody-mediated control of FV by analyzing mice deficient in TLR7. Remarkably, B cells in infected TLR7-deficient mice upregulated CD69 and CD86 early in infection, but failed to develop into germinal center B cells. CD4 T cell responses were also attenuated in the absence of TLR7, but CD8 responses were TLR7 independent, suggesting the existence of additional pathways for detection of retroviral particles. Together these results demonstrate that the vertebrate immune system detects retroviruses in vivo via TLR7 and that this pathway regulates a key checkpoint controlling development of germinal center B cells.

  9. Angiogenic activity in patients with psoriasis is significantly decreased by Goeckerman's therapy

    Energy Technology Data Exchange (ETDEWEB)

    Andrys, C.; Borska, L.; Pohl, D.; Fiala, Z.; Hamakova, K.; Krejsek, J. [Faculty Hospital, Hradec Kralove (Czech Republic). Dept. of Clinical Immunology & Allergy

    2007-03-15

    Goeckerman's therapy (GT) of psoriasis is based on daily application of pharmacy grade coal tar on affected skin with subsequent exposure to UV light. Goeckerman's therapy is still the first line therapy of psoriasis in the Czech Republic because of its low cost and long-term efficacy. Disturbances in angiogenic activity are characteristic for the immunopathogenesis of psoriasis. An abnormal spectrum of cytokines, growth factors and proangiogenic mediators is produced by keratinocytes and inflammatory cells in patients suffering from the disease. The aim of this study was to evaluate the influence of GT of psoriasis on angiogenic activities by comparing serum levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in 44 patients with psoriasis in peripheral blood samples collected before and after therapy. It was found that the angiogenic potential which is abnormally increased in patients with psoriasis is significantly alleviated by GT.

  10. Adventure Therapy with Girls At-Risk: Responses to Outdoor Experiential Activities.

    Science.gov (United States)

    Autry, Cari E.

    2001-01-01

    Explored the feelings, attitudes, and perceptions of at- risk adolescent girls from a psychiatric rehabilitation facility following their participation in adventure therapy that involved outdoor experiential activities. Interview data indicated that participants found positive meaning within various activities. The resulting themes were…

  11. Occupational, Physical, and Speech Therapy Treatment Activities During Inpatient Rehabilitation for Traumatic Brain Injury.

    Science.gov (United States)

    Beaulieu, Cynthia L; Dijkers, Marcel P; Barrett, Ryan S; Horn, Susan D; Giuffrida, Clare G; Timpson, Misti L; Carroll, Deborah M; Smout, Randy J; Hammond, Flora M

    2015-08-01

    To describe the use of occupational therapy (OT), physical therapy (PT), and speech therapy (ST) treatment activities throughout the acute rehabilitation stay of patients with traumatic brain injury. Multisite prospective observational cohort study. Inpatient rehabilitation settings. Patients (N=2130) admitted for initial acute rehabilitation after traumatic brain injury. Patients were categorized on the basis of admission FIM cognitive scores, resulting in 5 fairly homogeneous cognitive groups. Not applicable. Percentage of patients engaged in specific activities and mean time patients engaged in these activities for each 10-hour block of time for OT, PT, and ST combined. Therapy activities in OT, PT, and ST across all 5 cognitive groups had a primary focus on basic activities. Although advanced activities occurred in each discipline and within each cognitive group, these advanced activities occurred with fewer patients and usually only toward the end of the rehabilitation stay. The pattern of activities engaged in was both similar to and different from patterns seen in previous practice-based evidence studies with different rehabilitation diagnostic groups. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. Estrogen receptor activation by tobacco smoke condensate in hormonal therapy-resistant breast cancer cells.

    Science.gov (United States)

    Niwa, Toshifumi; Shinagawa, Yuri; Asari, Yosuke; Suzuki, Kanae; Takanobu, Junko; Gohno, Tatsuyuki; Yamaguchi, Yuri; Hayashi, Shin-Ichi

    2017-01-01

    The relationship between tobacco smoke and breast cancer incidence has been studied for many years, but the effect of smoking on hormonal therapy has not been previously reported. We investigated the effect of smoking on hormonal therapy by performing in vitro experiments. We first prepared tobacco smoke condensate (TSC) and examined its effect on estrogen receptor (ER) activity. The ER activity was analyzed using MCF-7-E10 cells into which the estrogen-responsive element (ERE)-green fluorescent protein (GFP) reporter gene had been stably introduced (GFP assay) and performing an ERE-luciferase assay. TSC significantly activated ERs, and upregulated its endogenous target genes. This activation was inhibited by fulvestrant but more weakly by tamoxifen. These results suggest that the activation mechanism may be different from that for estrogen. Furthermore, using E10 estrogen depletion-resistant cells (EDR cells) established as a hormonal therapy-resistant model showing estrogen-independent ER activity, ER activation and induction of ER target genes were significantly higher following TSC treatment than by estradiol (E2). These responses were much higher than those of the parental E10 cells. In addition, the phosphorylation status of signaling factors (ERK1/2, Akt) and ER in the E10-EDR cells treated with TSC increased. The gene expression profile induced by estrogenic effects of TSC was characterized by microarray analysis. The findings suggested that TSC activates ER by both ligand-dependent and -independent mechanisms. Although TSC constituents will be metabolized in vivo, breast cancer tissues might be exposed for a long period along with hormonal therapy. Tobacco smoke may have a possibility to interfere with hormonal therapy for breast cancer, which may have important implications for the management of therapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Adapted physical activity in the prevention and therapy of osteoporosis

    Directory of Open Access Journals (Sweden)

    Bošković Ksenija

    2013-01-01

    Full Text Available Introduction. Osteoporosis, a disease characterized by the progressive loss of bone tissue, is one of the most common complications of aging. Epidemiology. According to some calculations, there were 25% of women and 4% of men older than 50 years with osteoporosis in the world in 2010. It is assumed that the number of patients with osteoporosis will increase by 30% in every 10 years in the 21st century. There are many reasons for that: the world’s population is growing older, diet is getting poorer in vitamins and minerals and physical activity is decreasing. The Quality and Quantity of Bone Tissue. Developing bones are much more responsive to mechanical loading and physical activity than mature bones. This suggests that training in early childhood may be an important factor in the prevention of osteoporosis in later life. It is important to note that the quality of bone achieved by training at younger age cannot be maintained permanently if it is not supported by physical activity later in life. Adapted physical activity represents physical activity individually tailored according to the psychosomatic capabilities of a person and the goal to be achieved. It can be applied at any age in order to maintain strong bones and reduce the risk of fracture. Adapted physical activity is different for men and women, for different age, as well as for the individuals. Aerobic exercises, which lead to an acceleration of breathing, increased heart rate and mild perspiration, as well as resistance exercises and exercises against resistance done by stretching elastic bands, for hands, legs and torso have been proven to increase bone density and improve bone strength. Coordination and balance exercises are important in an individual workout program. An explanation of the action of adapted physical activity is the basis for the theory of control and modulation of bone loss, muscle strength, coordination and balance. Physical activity is very effective in

  14. Clinical regressions and broad immune activation following combination therapy targeting human NKT cells in myeloma.

    Science.gov (United States)

    Richter, Joshua; Neparidze, Natalia; Zhang, Lin; Nair, Shiny; Monesmith, Tamara; Sundaram, Ranjini; Miesowicz, Fred; Dhodapkar, Kavita M; Dhodapkar, Madhav V

    2013-01-17

    Natural killer T (iNKT) cells can help mediate immune surveillance against tumors in mice. Prior studies targeting human iNKT cells were limited to therapy of advanced cancer and led to only modest activation of innate immunity. Clinical myeloma is preceded by an asymptomatic precursor phase. Lenalidomide was shown to mediate antigen-specific costimulation of human iNKT cells. We treated 6 patients with asymptomatic myeloma with 3 cycles of combination of α-galactosylceramide-loaded monocyte-derived dendritic cells and low-dose lenalidomide. Therapy was well tolerated and led to reduction in tumor-associated monoclonal immunoglobulin in 3 of 4 patients with measurable disease. Combination therapy led to activation-induced decline in measurable iNKT cells and activation of NK cells with an increase in NKG2D and CD56 expression. Treatment also led to activation of monocytes with an increase in CD16 expression. Each cycle of therapy was associated with induction of eosinophilia as well as an increase in serum soluble IL2 receptor. Clinical responses correlated with pre-existing or treatment-induced antitumor T-cell immunity. These data demonstrate synergistic activation of several innate immune cells by this combination and the capacity to mediate tumor regression. Combination therapies targeting iNKT cells may be of benefit toward prevention of cancer in humans.

  15. Active Music Therapy and Physical Improvements From Rehabilitation for Neurological Conditions.

    Science.gov (United States)

    Kogutek, Demian Leandro; Holmes, Jeffrey David; Grahn, Jessica Adrienne; Lutz, Sara G; Ready, Emily

    2016-01-01

    Context • A variety of rehabilitation-based interventions are currently available for individuals with physical impairments resulting from neurological conditions, including physiotherapy, occupational therapy, and speech language pathology. Many individuals find participation in those therapies to be challenging. Alternative therapies have emerged as beneficial adjunctive treatments for individuals undergoing neurological rehabilitation, including music therapy (MT). Objective • The study intended to identify and collate systematically the evidence on MT interventions that address physical improvements in a rehabilitative setting. Design • The research team performed a literature review, searching electronic databases from their inception to April 2014, including Embase, CINAHL, PubMed, Scopus, and ProQuest. The review included original studies that examined the use of active MT as an intervention that promotes physical improvements for adults >18 y of age. Articles were excluded if the studies focused primarily on psychosocial, emotional, or spiritual therapeutic goals. The review identified the studies' outcome measures for different populations and the MT approaches and interventions and obtained a general description of the clinical sessions, such as the frequency and duration of the therapy, interventions performed, sessions designs, populations, equipment used, and credentials of the therapists. Results • Eleven studies identified 2 major categories for the delivery of MT sessions: individual and group. One study included group sessions, and 10 studies included individual sessions. The studies included a total of 290 participants, 32 in the group MT, and 258 in the individual MT. The one study that used group therapy was based on active MT improvisation. For the individual therapy, 2 studies had investigated therapeutic instrument music performance and 8 used music-supported therapy. Conclusions • The findings of the review suggested that active MT

  16. [Evaluating influence of Captopril therapy on occupational activity of engine operators with hypertension].

    Science.gov (United States)

    Serikov, V V; Kolyagin, V Ya; Bogdanova, V E

    2016-01-01

    The article covers results of study concerning influence of Captopril (25 mg) therapy on occupational activity of locomotive crew workers in real night travels model on training complex "EP1M locomotive operator cabin". Findings are that single use of Captopril (25 mg) in modelled railway activity enabled to increase reliability of occupational activity, that manifested in lower number of errors in locomotive operators' actions at night, and in psychophysiologic regulation of various psychic acts.

  17. Periodontal therapy reduces arginase activity in saliva of patients with chronic periodontitis.

    Science.gov (United States)

    Gheren, L W; Cortelli, J R; Rodrigues, E; Holzhausen, M; Saad, W A

    2008-03-01

    This present study evaluated the salivary arginase activity (SAA) in patients with chronic periodontitis and the effect of periodontal therapy on the activity of such enzyme. Thirty-six patients (mean age, 45.97 +/- 14.52), 18 chronic periodontitis subjects (test group), and 18 periodontally healthy individuals (control group) participated in the study. Clinical periodontal examinations included measurements of probing pocket depth (PD), clinical attachment level (CAL), plaque (PI), and gingival (GI) indexes. The test group received periodontal therapy according to individual needs. The saliva sample was collected from all study population at baseline (both groups) and 30 days after periodontal therapy (test group). SAA was determined by measuring the L: -ornithine formation from L-arginine and was expressed as mU/ml. The results showed that the mean values of SAA were statistically different between control and test groups. SAA was about 2.5 times higher in test than control groups. Thirty days after periodontal therapy, enzyme levels were 1.56 times lower than before periodontal therapy. We concluded that SAA is increased in chronic periodontitis subjects when compared to periodontally healthy individuals and that periodontal therapy significantly reduced SAA levels. It was suggested that in the near future, SAA may be used as a salivary marker of periodontal status.

  18. What, Why, How - Creative Activities in Occupational Therapy Practice in Sweden.

    Science.gov (United States)

    Müllersdorf, Maria; Ivarsson, Ann-Britt

    2016-12-01

    Creative activities have historically been used in occupational therapy, and although their usage has declined in recent decades, they are still used in Swedish practice. The aim of this study was to better understand how occupational therapists use creative activities in practice. A web-based survey was sent to 520 occupational therapists, of which 304 (58.5%) responded. The main reason identified for using creative activities was to strengthen the client's occupational performance, well-being and self-esteem. The expected outcomes of applying creative activities were to support the client in self-expression and experiencing joy and desire. More than half of the occupational therapist respondents did not use creative activities to the extent they desired. Creative activities in occupational therapy are still used as a vital treatment to strengthen the clients' occupational performance abilities. The survey has looked at only a professional perspective on effectiveness of applying creative activities in occupational therapy. More research is needed to evaluate how occupational therapists internationally apply creative activities. There is also a need to gain information from the client's perspective on the therapeutic value of creative activities. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  19. Access to highly active antiretroviral therapy (HAART) in the WHO European Region 2003-2005

    DEFF Research Database (Denmark)

    Bollerup, Annemarie R; Donoghoe, Martin C; Lazarus, Jeff

    2008-01-01

    To assess changes in access to highly active antiretroviral therapy (HAART) between the end of 2002 and the end of 2005, and to review the capacity for further HAART scale-up in the then 52 Member States of the WHO European Region.......To assess changes in access to highly active antiretroviral therapy (HAART) between the end of 2002 and the end of 2005, and to review the capacity for further HAART scale-up in the then 52 Member States of the WHO European Region....

  20. Identifying factors hampering physical activity in longstanding rheumatoid arthritis: what is the role of glucocorticoid therapy?

    Science.gov (United States)

    van der Goes, M C; Hoes, J N; Cramer, M J; van der Veen, M J; van der Werf, J H; Bijlsma, J W J; Jacobs, J W G

    2014-01-01

    To identify factors hampering the level of physical activity in longstanding rheumatoid arthritis (RA) patients, and to evaluate the effects of glucocorticoid therapy on physical activity. Patient characteristics, disease characteristics and cardiovascular parameters were recorded in 170 patients, who participated in a study about glucose metabolism in longstanding RA treated with or without glucocorticoids. Disease activity scores (DAS28) were calculated and x-rays of hands and feet were taken and scored according to the Sharp van der Heijde score (SHS). Participants completed the health assessment questionnaire and short questionnaire to assess health-enhancing physical activity (SQUASH), which reflect physical disability and physical activity, respectively. Adherence rates to recommendations on physical activity were calculated, and patients were categorised as fully adhering, insufficiently adhering (adherence on less than the recommended number of days per week) or inactive (adherence on none of the days). Forty-four percent of the patients showed adherence to the recommended minimum level of physical activity, and 22% were classified as inactive. Higher DAS28 and SHS, glucocorticoid therapy, and presence of cardiovascular risk factors were associated with lower total SQUASH physical activity scores univariately. In a multivariate model, higher age, higher body mass index (BMI), higher DAS28, and higher SHS negatively influenced the score significantly; cardiovascular risk factors and glucocorticoid therapy were no longer significantly influencing physical activity. Physical activity in longstanding RA is hampered by higher age, higher BMI, higher disease activity, and more radiographic joint damage. Glucocorticoid therapy was not identified as independent risk factor in multivariate analyses.

  1. Activation and inflammation markers in HIV-1-infected patients in dependency of treatment strategies

    Directory of Open Access Journals (Sweden)

    R Ehret

    2012-11-01

    Full Text Available Purpose of the study: HIV-1-infected patients have elevated levels of immune activation and systemic inflammatory markers which are partially strong predictors of disease progression or are associated with increased cardiovascular risk. The dependency of anti-retroviral treatment (ART, the usage of NNRTI or PI-based and the application of non-nuc regimens is analysed here on the basis of a dataset (Chronic Inflammation Dependency on TREatment: CIDRE cohort from 1500 patients in Berlin. Methods: In a retrospective analysis we compared relative CD4+ cell counts, viral load, relative CD8+CD38+DR-and CD3+DR+cells, concentration of high-sensitivity C-reactive protein (hsCRP and interleukin-6 (IL-6 in therapy-naïve or treated patients dependent on usage or non-usage of NUCs, PI or NNRTI. Statistics were performed with R (R Core Team; 2012; R: A language and environment for statistical computing using Wilcoxon rank sum test in two-sided analysis. Summary of results: As to expect, ART-naïve patients (n=190 had significantly higher viral loads and lower CD4+cell counts (p: both<0.05 and showed higher activation levels than treated patient (CD8+CD38+DR- and CD3+DR+both<0.05. But no significant difference was calculated for hsCRP or IL-6. Nuc-sparing regimen (n=46 did not show any distinction compared to nuc-containing therapies (n=1249 for the analysed parameters. Significant differences were detected for PI-regimen (n=711 with lower CD4+ cell counts and higher activation (CD8+38+DR-, CD3+DR+ and IL-6 (p: all<0.05 but not for hsCRP (p=0.39. The opposite was true for NNRTI-based therapies (n=445 with higher CD4+ cell percentages and lower activation and inflammation markers (p: all<0.05 and as well no difference in hsCRP (p=0.97 compared with all other treated patients. Conclusions: The lack of differences between therapy-naïve patients and patients on ART for inflammation markers may be due to the relative good immunological state of the first group

  2. Active Change in Psychodynamic Therapy: Moments of High Receptiveness.

    Science.gov (United States)

    De Gauna, Mariano De Iceta Ibáñez; Roibal, M Angela Soler; Ruiz, José Antonio Méndez; Fernández, Joaquin Ingelmo; Bleichmar, Hugo B

    2015-01-01

    This article presents the concept of "moments of high receptiveness" (MoHR or "Momentos de Alta Receptividad"), which is derived from the concept of "experiential coupling" ("Acoplamiento de Experiencias") proposed by Bleichmar (2001). Experiential coupling recently received empirical support by the work of Schiller and colleagues (2010). We will also show the conceptual placing of moments of high receptiveness with respect to the developments of Stern and colleagues (Stern and et al., 1998; Stern, 2004). In order to achieve both objectives, we focus on various clinical vignettes stressing the differences in repercussions of the technique. We describe use of stimuli for active evocation, explain how to identify moments of high receptiveness, and review ways to take advantage of these moments. Lastly, to minimize the risk of iatrogenic symptoms, we examine the role of therapists and some features of the therapeutic process when using this technique.

  3. STUDY REGARDING THE OCCUPATIONAL THERAPY INTERVENTION IN FREEDOM-DEPRIVED PERSONS' LEISURE TIME ATHLETIC ACTIVITIES

    Directory of Open Access Journals (Sweden)

    Ciocan Dana

    2013-12-01

    Full Text Available The choice of the theme for this research was determined by the combination of two of my professional interests: occupational therapy, and physical education and sports. The aim and tasks of this paper are to identify and contribute to the introduction of occupational therapy in the freedom-deprived persons in penitentiaries, following their involvement in leisure time athletic activities. The study was conducted at the Bacau Penitentiary for minors and youths, over the course of three months, March-May, 2013, the group of subjects being composed of 18 minors. The initial hypothesis presumes that the use of the occupational therapy intervention in the minor freedom-deprived persons contributes to a more effective use of their leisure time performing activities that would give them satisfactions, improving their health and quality of life. The research consisted in applying an intervention with the help of several students, who over the course of three months assessed the freedom-deprived penitentiary minors, conceived an intervention plan for the leisure time athletic activities, and applied it. The results obtained after the initial assessment indicated the existence of certain occupational problems in the area of leisure time athletic activities, in the studied subjects. After the occupational therapy intervention, a questionnaire was applied to assess the effectiveness of the intervention. The development of the study and the interpretation of the results have lead to the following conclusions: One can say that the use of occupational therapy for the freedom-deprived minors lead to the improvement of their quality of life, thus confirming the initial hypothesis. The regular practice of athletic activities leads to a healthy life pattern and to structuring your leisure time through activities that have a positive effect, forming self-efficacy beliefs and competences, and have a direct relation with self-esteem, overshadowing the passive

  4. Effects of mirror therapy combined with motor tasks on upper extremity function and activities daily living of stroke patients.

    Science.gov (United States)

    Kim, Kyunghoon; Lee, Sukmin; Kim, Donghoon; Lee, Kyoungbo; Kim, Youlim

    2016-01-01

    [Purpose] The objective of this study was to investigate the effects of mirror therapy combined with exercise tasks on the function of the upper limbs and activities of daily living. [Subjects and Methods] Twenty-five stroke patients who were receiving physical therapy at K Hospital in Gyeonggi-do, South Korea, were classified into a mirror therapy group (n=12) and a conventional therapy group (n=13). The therapies were applied for 30 minutes per day, five times per week, for a total of four weeks. Upper limb function was measured with the Action Research Arm test, the Fugl-Meyer Assessment, and the Box and Block test, and activities of daily living were measured with the Functional Independence Measure. A paired test was performed to compare the intragroup differences between before training and after four weeks of therapy, and an independent t-test was performed to compare the differences between the two groups before and after four weeks of therapy. [Results] In the intragroup comparison, both groups showed significant differences between measurements taken before and after four weeks of therapy. In the intergroup comparison, the mirror therapy group showed significant improvements compared with the conventional therapy group, both in upper limb function and activities of daily living. [Conclusion] The findings of this study demonstrated that mirror therapy is more effective than conventional therapy for the training of stroke patients to improve their upper limb function and activities of daily living.

  5. Antiretroviral therapy effects on sources of cortical rhythms in HIV subjects: responders vs. mild responders.

    Science.gov (United States)

    Babiloni, Claudio; Pennica, Alfredo; Vecchio, Fabrizio; Onorati, Paolo; Muratori, Chiara; Ferracuti, Stefano; Roma, Paolo; Donato, Nicole; Noce, Giuseppe; Del Percio, Claudio; Bonacci, Cristiano; Di Campli, Francesco; Gianserra, Laura; Teti, Elisabetta; Aceti, Antonio; Soricelli, Andrea; Viscione, Magdalena; Rossini, Paolo M; Andreoni, Massimo

    2015-01-01

    We tested the hypothesis that 5months of combined anti-retroviral therapy (cART) affect cortical sources of resting state cortical electroencephalographic (EEG) rhythms in naïve HIV subjects. Eyes-closed resting state EEG data were recorded at baseline (i.e. pre-treatment; T0), T1 (after 4weeks of cART), T2 (after 8weeks of cART), and T5 (after 5months of cART) in 38 naïve HIV subjects. EEG data were also recorded in 40 age-matched cognitively normal subjects for control purposes. EEG rhythms of interest were delta (2-4Hz), theta (4-8Hz), alpha 1 (8-10.5Hz), alpha 2 (10.5-13Hz), beta 1 (13-20Hz), and beta 2 (20-30Hz). Cortical EEG sources were estimated by LORETA software. Compared to the control group, the HIV group at T0 showed greater delta sources and lower widespread alpha sources. cART induced a global improvement of biological (viral load, CD4 count) and EEG (delta, alpha) markers, remarkable even after 4weeks. Compared to HIV Responders (>100cells/μl at 5-month follow up), the HIV Mild Responders (rhythms. The present EEG markers may be useful secondary neurophysiological end points for pharmacological clinical trials in naïve HIV subjects. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  6. Neurocognitive Change in the Era of HIV Combination Antiretroviral Therapy: The Longitudinal CHARTER Study

    Science.gov (United States)

    Heaton, Robert K.; Franklin, Donald R.; Deutsch, Reena; Letendre, Scott; Ellis, Ronald J.; Casaletto, Kaitlin; Marquine, Maria J.; Woods, Steven P.; Vaida, Florin; Atkinson, J. Hampton; Marcotte, Thomas D.; McCutchan, J. Allen; Collier, Ann C.; Marra, Christina M.; Clifford, David B.; Gelman, Benjamin B.; Sacktor, Ned; Morgello, Susan; Simpson, David M.; Abramson, Ian; Gamst, Anthony C.; Fennema-Notestine, Christine; Smith, David M.; Grant, Igor; Grant, Igor; McCutchan, J. Allen; Ellis, Ronald J.; Marcotte, Thomas D.; Franklin, Donald; Ellis, Ronald J.; McCutchan, J. Allen; Alexander, Terry; Letendre, Scott; Capparelli, Edmund; Heaton, Robert K.; Atkinson, J. Hampton; Woods, Steven Paul; Dawson, Matthew; Smith, David M.; Fennema-Notestine, Christine; Taylor, Michael J.; Theilmann, Rebecca; Gamst, Anthony C.; Cushman, Clint; Abramson, Ian; Vaida, Florin; Marcotte, Thomas D.; Marquie-Beck, Jennifer; McArthur, Justin; Rogalski, Vincent; Morgello, Susan; Simpson, David; Mintz, Letty; McCutchan, J. Allen; Toperoff, Will; Collier, Ann; Marra, Christina; Jones, Trudy; Gelman, Benjamin; Head, Eleanor; Clifford, David; Al-Lozi, Muhammad; Teshome, Mengesha

    2015-01-01

    Background. Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) can show variable clinical trajectories. Previous longitudinal studies of HAND typically have been brief, did not use adequate normative standards, or were conducted in the context of a clinical trial, thereby limiting our understanding of incident neurocognitive (NC) decline and recovery. Methods. We investigated the incidence and predictors of NC change over 16–72 (mean, 35) months in 436 HIV-infected participants in the CNS HIV Anti-Retroviral Therapy Effects Research cohort. Comprehensive laboratory, neuromedical, and NC assessments were obtained every 6 months. Published, regression-based norms for NC change were used to generate overall change status (decline vs stable vs improved) at each study visit. Survival analysis was used to examine the predictors of time to NC change. Results. Ninety-nine participants (22.7%) declined, 265 (60.8%) remained stable, and 72 (16.5%) improved. In multivariable analyses, predictors of NC improvements or declines included time-dependent treatment status and indicators of disease severity (current hematocrit, albumin, total protein, aspartate aminotransferase), and baseline demographics and estimated premorbid intelligence quotient, non-HIV-related comorbidities, current depressive symptoms, and lifetime psychiatric diagnoses (overall model P < .0001). Conclusions. NC change is common in HIV infection and appears to be driven by a complex set of risk factors involving HIV disease, its treatment, and comorbid conditions. PMID:25362201

  7. Prevalence of oral candidiasis in HIV/AIDS children in highly active antiretroviral therapy era. A literature analysis.

    Science.gov (United States)

    Gaitán-Cepeda, Luis Alberto; Sánchez-Vargas, Octavio; Castillo, Nydia

    2015-08-01

    SummaryHighly active antiretroviral therapy has decreased the morbidity and mortality related to HIV infection, including oral opportunistic infections. This paper offers an analysis of the scientific literature on the epidemiological aspects of oral candidiasis in HIV-positive children in the combination antiretroviral therapy era. An electronic databases search was made covering the highly active antiretroviral therapy era (1998 onwards). The terms used were oral lesions, oral candidiasis and their combination with highly active antiretroviral therapy and HIV/AIDS children. The following data were collected from each paper: year and country in which the investigation was conducted, antiretroviral treatment, oral candidiasis prevalence and diagnostic parameters (clinical or microbiological). Prevalence of oral candidiasis varied from 2.9% in American HIV-positive children undergoing highly active antiretroviral therapy to 88% in Chilean HIV-positive children without antiretroviral therapy. With respect to geographical location and antiretroviral treatment, higher oral candidiasis prevalence in HIV-positive children on combination antiretroviral therapy/antiretroviral therapy was reported in African children (79.1%) followed by 45.9% reported in Hindu children. In HIV-positive Chilean children on no antiretroviral therapy, high oral candidiasis prevalence was reported (88%) followed by Nigerian children (80%). Oral candidiasis is still frequent in HIV-positive children in the highly active antiretroviral therapy era irrespective of geographical location, race and use of antiretroviral therapy.

  8. Hormone therapy affects plasma measures of factor VII-activating protease in younger postmenopausal women

    DEFF Research Database (Denmark)

    Mathiasen, Jørn Sidelmann; Skouby, S.O.; Vitzthum, F.;

    2010-01-01

    Objectives Current reviews indicate that hormone therapy (HT) has a protective role in coronary heart disease (CHD) in younger postmenopausal women, whereas HT contributes to CHD in older women Factor VII-activating protease (FSAP) is a serine protease that accumulates in unstable atherosclerotic...

  9. Detection of lipoatrophy in human immunodeficiency virus-1-infected children treated with highly active antiretroviral therapy.

    NARCIS (Netherlands)

    Hartman, K.; Verweel, G.; Groot, R. de; Hartwig, N.G.

    2006-01-01

    BACKGROUND: Highly active antiretroviral therapy has been associated with lipodystrophy in adults. Much is unknown about its characteristics, especially in children. OBJECTIVE: To obtain an objective case definition of the lipodystrophy syndrome. METHODS: This was a cross-sectional study. One invest

  10. Prevalence of Lipodystrophy in HIV-infected Children in Tanzania on Highly Active Antiretroviral Therapy

    NARCIS (Netherlands)

    Kinabo, G.; Sprengers, M.; Msuya, L.J.; Shayo, A.M.; Asten, H.A.G.H. van; Dolmans, W.M.V.; Ven, A.J.A.M. van der; Warris, A.

    2013-01-01

    OBJECTIVE: : Highly active antiretroviral therapy (HAART) has been associated with lipodystrophy (LD) in adults but data are more limited for children. The purpose of this study was to determine the prevalence of and risk factors for LD in Tanzanian children receiving HAART by clinical assessment an

  11. [Analysis of antibacterial activity of a new antiseptic for therapy of maxillofacial inflammations].

    Science.gov (United States)

    Leont'ev, V K; Kuznetsova, L I; Leshchankina, E L; Kuznetsov, V L

    2002-01-01

    Clinical and experimental studies of polydimethyldiallylammonium chloride (PDMDAAC) experimentally validated the choice of optimal concentration and composition of this agent. The results indicate a high antiseptic activity of 1% PDMDAAC and the possibility of using it in local therapy of periodontitis and posttraumatic infection.

  12. Training Extract. AFSC 4D0X1 Diet Therapy (Active Duty)

    Science.gov (United States)

    2002-07-01

    212* 23* 52* 49* 109* 51* V0165 Diet (s) exp- Vegan Diet ...2* 2* V0165 Diet (s) exp- Vegan Diet TOT ALL AETC ACC AMC PAC AFE...UNITED STATES AIR FORCE TRAINING EXTRACT AFSC 4D0X1 DIET THERAPY (ACTIVE DUTY) OSSN: 2472 JULY 2002 OCCUPATIONAL ANALYSIS PROGRAM AIR FORCE

  13. Whole Body Activity Retentions in the Peptide Receptor Radionuclide Therapy with Lu-177

    NARCIS (Netherlands)

    Liu, B.

    2013-01-01

    The patients with the neuroendocrine tumours (liver, spleen, etc.) often need treatment by the Peptide Receptor Radionuclide Therapy with 177Lu. The amount of 177Lu activity in the body of patients has to be known accurately for assessment of the dosimetry and for evaluation of the effectiveness of

  14. Active music therapy approach for stroke patients in the post-acute rehabilitation.

    Science.gov (United States)

    Raglio, Alfredo; Zaliani, Alberto; Baiardi, Paola; Bossi, Daniela; Sguazzin, Cinzia; Capodaglio, Edda; Imbriani, Chiara; Gontero, Giulia; Imbriani, Marcello

    2017-01-30

    Guidelines in stroke rehabilitation recommend the use of a multidisciplinary approach. Different approaches and techniques with music are used in the stroke rehabilitation to improve motor and cognitive functions but also psychological outcomes. In this randomized controlled pilot trial, relational active music therapy approaches were tested in the post-acute phase of disease. Thirty-eight hospitalized patients with ischemic and hemorrhagic stroke were recruited and allocated in two groups. The experimental group underwent the standard of care (physiotherapy and occupational therapy daily sessions) and relational active music therapy treatments. The control group underwent the standard of care only. Motor functions and psychological aspects were assessed before and after treatments. Music therapy process was also evaluated using a specific rating scale. All groups showed a positive trend in quality of life, functional and disability levels, and gross mobility. The experimental group showed a decrease of anxiety and, in particular, of depression (p = 0.016). In addition, the strength of non-dominant hand (grip) significantly increased in the experimental group (p = 0.041). Music therapy assessment showed a significant improvement over time of non-verbal and sonorous-music relationships. Future studies, including a greater number of patients and follow-up evaluations, are needed to confirm promising results of this study.

  15. Activation of the contact system and inflammation after thrombolytic therapy in patients with acute myocardial infarction.

    Science.gov (United States)

    Merlini, Piera Angelica; Cugno, Massimo; Rossi, Marco L; Agricola, Pietro; Repetto, Alessandra; Fetiveau, Raffaella; Diotallevi, Paolo; Canosi, Umberto; Mannucci, Pier Mannuccio; Ardissino, Diego

    2004-04-01

    Thrombolytic therapy activates the contact system, and factor XII activation may activate the coagulation cascade and inflammation. It is not known whether an early inflammatory response is induced by thrombolytic therapy in patients with acute myocardial infarction (AMI). We prospectively measured the plasma levels of activated factor XII, cleaved kininogen, prothrombin fragment 1 + 2 (as indexes of the contact phase and coagulation activation), and interleukin-6 and C-reactive protein (CRP) (as indexes of inflammation) in 39 patients hospitalized for AMI within 12 hours of symptom onset: 26 receiving thrombolytic therapy and 13 heparin alone. Blood samples were collected at baseline and after 90 minutes and 24 hours. Patients undergoing thrombolysis had a significant early increase in activated factor XII (from 2.2 ng/ml at baseline to 4.7 ng/ml after 90 minutes; p = 0.0001), cleaved kininogen (from 26% to 37%; p = 0.001), and fragment 1 + 2 (from 1.4 to 2.1 nmol/L; p = 0.0001), whereas the 24-hour levels were similar to baseline levels. The levels of interleukin-6 significantly increased during the first 90 minutes (from 3.9 to 6.3 microg/ml; p = 0.001), and were even higher after 24 hours (11.9 ng/ml, p = 0.0001). CRP levels increased only after 24 hours (p = 0.0001). There were no changes in these parameters in patients receiving heparin alone, except for a 24-hour increase in interleukin-6 and CRP levels. Thus, in patients with AMI receiving thrombolytic therapy, early activation of inflammation parallels the activation of the contact system and the coagulation cascade, which might contribute to microvascular obstruction and reperfusion injury.

  16. A novel approach to the antimicrobial activity of maggot debridement therapy

    DEFF Research Database (Denmark)

    Andersen, Anders S; Sandvang, Dorthe; Schnorr, Kirk M

    2010-01-01

    Commercially produced sterile green bottle fly Lucilia sericata maggots are successfully employed by practitioners worldwide to clean a multitude of chronic necrotic wounds and reduce wound bacterial burdens during maggot debridement therapy (MDT). Secretions from the maggots exhibit antimicrobial...... activity along with other activities beneficial for wound healing. With the rise of multidrug-resistant bacteria, new approaches to identifying the active compounds responsible for the antimicrobial activity within this treatment are imperative. Therefore, the aim of this study was to use a novel approach...

  17. A novel anticancer therapy that simultaneously targets aberrant p53 and Notch activities in tumors.

    Directory of Open Access Journals (Sweden)

    Yuting Yao

    Full Text Available Notch signaling pathway plays an important role in tumorigenesis by maintaining the activity of self-renewal of cancer stem cells, and therefore, it is hypothesized that interference of Notch signaling may inhibit tumor formation and progression. H101 is a recombinant oncolytic adenovirus that is cytolytic in cells lacking intact p53, but it is unable to eradicate caner stem cells. In this study, we tested a new strategy of tumor gene therapy by combining a Notch1-siRNA with H101 oncolytic adenovirus. In HeLa-S3 tumor cells, the combined therapy blocked the Notch pathway and induced apoptosis in tumors that are p53-inactive. In nude mice bearing xenograft tumors derived from HeLa-S3 cells, the combination of H101/Notch1-siRNA therapies inhibited tumor growth. Moreover, Notch1-siRNA increased Hexon gene expression at both the transcriptional and the translational levels, and promoted H101 replication in tumors, thereby enhancing the oncolytic activity of H101. These data demonstrate the feasibility to combine H101 p53-targted oncolysis and anti-Notch siRNA activities as a novel anti-cancer therapy.

  18. Laser therapy reduces gelatinolytic activity in the rat trigeminal ganglion during temporomandibular joint inflammation.

    Science.gov (United States)

    Desiderá, A C; Nascimento, G C; Gerlach, R F; Leite-Panissi, C R A

    2015-07-01

    To investigate whether low-level laser therapy (LLLT) alters the expression and activity of MMP-2 and MMP-9 in the trigeminal ganglion (TG) during different stages of temporomandibular joint (TMJ) inflammation in rats. It also evaluated whether LLLT modifies mechanical allodynia and orofacial hyperalgesia. Wistar rats (±250 g) were divided into groups that received saline (SAL) or complete Freund's adjuvant (CFA, 50 μl) in the TMJ, and that later underwent LLLT (20 J cm(-2) ) at their TMJ or not (groups SAL, SAL + LLLT, CFA, and CFA + LLLT). LLLT was applied on days 3, 5, 7, and 9 after SAL or CFA. Mechanical allodynia was evaluated on days 1, 3, 5, 7, and 10; orofacial hyperalgesia was assessed on day 10. Gelatin zymography and in situ zymography aided quantification of MMPs in the TG. Low-level laser therapy abolished the reduction in the mechanical orofacial threshold and the increase in orofacial rubbing during the orofacial formalin test induced by CFA. LLLT also decreased the CFA-induced rise in the levels of MMP-9 and MMP-2 as well as the gelatinolytic activity in the TG. Low-level laser therapy could constitute an adjuvant therapy to treat temporomandibular disorders and prevent inflammation-induced alterations in the levels of MMP-2 and MMP-9 and in the gelatinolytic activity in TGs. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Research on AIDS patients’ survival time after highly active antiretroviral therapy, treatment effect and treatment modes

    Directory of Open Access Journals (Sweden)

    Riying Lv

    2016-05-01

    Full Text Available To fully define clinical efficacy of highly active antiretroviral therapy for AIDS, analyze patients’ survival time and treatment mode after receiving treatment, and provide scientific theory to guide improvement of antiviral therapy, this paper selected 3100 cases of patients diagnosed with AIDS during April 2006 and April 2014 as object of this study. All patients were treated with highly active antiretroviral therapy. The main analysis contents of this study include CD4 + T lymphocyte count, viral load changes, incidence of opportunistic infections, specific cause of death and the like. The results show that patients’ CD4 + T lymphocyte levels are significantly increased 3, 18, and 24 months after treatment, difference between the situation after and before receiving treatment, P < 0.05, with statistically significant difference. Analyzed from effective inhibition of virus, effective inhibition rate is 72.58.0% (2250/3100. Main causes of death in patients is usually respiratory failure. It thus can be concluded that highly active antiretroviral therapy for AIDS is with good clinical effect, which can effectively improve survival time of patients. So it enjoys application value of being widely used in clinical treatment of AIDS.

  20. Effects of lithium therapy on Na+-K+-ATPase activity and lipid peroxidation in bipolar disorder.

    Science.gov (United States)

    Banerjee, Ushasi; Dasgupta, Anindya; Rout, Jayanta Kumar; Singh, Om Prakash

    2012-04-27

    Oxidative stress induced lipid peroxidation along with a reduced Na(+)-K(+)-ATPase activity has been implicated in the pathophysiology of bipolar disorders (BPD). Although, lithium therapy results in significant improvement in the symptoms of the disease, studies regarding its effect on the altered sodium pump activity and lipid peroxidation status have come out with conflicting results. The present study was undertaken to evaluate the status of lipid peroxidation and analyze the role of lithium and Na(+)-K(+)-ATPase activity in its regulation in BPD patients in our region. We measured RBC membrane Na(+)-K(+)-ATPase activity and serum thiobarbituric acid reacting substances (TBARS) level in 73 BPD patients and serum lithium, in addition, in 48 patients receiving lithium therapy among them. Na(+)-K(+)-ATPase activity and serum TBARS level were significantly decreased and increased respectively in all BPD patients compared to age and sex matched healthy controls. Same trend was observed in the BPD patients stabilized on lithium therapy compared to the lithium naive ones. Although, the enzyme activity showed a reciprocal relationship with TBARS in all patients of BPD, a significant positive correlation and dependence of the enzyme activity was evident with serum lithium level only in the lithium stabilized BPD group. BPD patients showed significantly compromised Na(+)-K(+)-ATPase activity and increased lipid peroxidation. Lithium induced improvement in the enzyme activity was associated with significant reduction in lipid peroxidation. Enhancement of the Na(+)-K(+)-ATPase activity by optimum dosage of lithium may be a potential contributing factor for reducing oxidative stress in BPD patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Consecutive monitoring of faecal calprotectin during mesalazine suppository therapy for active rectal inflammation in ulcerative colitis.

    Science.gov (United States)

    Yamamoto, T; Shimoyama, T; Matsumoto, K

    2015-09-01

    No studies have monitored the levels of faecal calprotectin (FC) during mesalazine suppository therapy for proctitis in ulcerative colitis (UC). To evaluate the value of consecutive monitoring of FC in patients with UC during mesalazine suppository therapy. One hundred and sixty patients with active inflammation limited to the rectum were treated with mesalazine 1 g suppository once daily for 8 weeks. Patients who achieved clinical remission were advised to maintain the treatment, and were followed up for further 40 weeks. FC levels were measured every 8 weeks during the study. At week 8, 118 patients (74%) went into clinical remission, of whom 88 achieved endoscopic healing. The median FC level significantly decreased in patients with clinical and endoscopic remission (both P suppositories. Serial monitoring of faecal calprotectin appears to be valuable for the prediction and early diagnosis of relapse during maintenance therapy. © 2015 John Wiley & Sons Ltd.

  2. The influence of statin therapy on platelet activity markers in hyperlipidemic patients after ischemic stroke

    Science.gov (United States)

    Chmielewski, Henryk; Kaczorowska, Beata; Przybyła, Monika; Baj, Zbigniew

    2015-01-01

    Introduction Low-density lipoprotein cholesterol (LDL-C) has been reported to increase platelet activation. Reducing the level of LDL-C with statins induces important pleiotropic effects such as platelet inhibition. This association between platelet activity and statin therapy may be clinically important in reducing the risk of ischemic stroke. We investigated the effect of simvastatin therapy on platelet activation markers (platelet CD62P, sP-selectin, and platelet-derived microparticles (PDMPs)) in hyperlipidemic patients after ischemic stroke. Material and methods The study group consisted of 21 hyperlipidemic patients after ischemic stroke confirmed by CT, and 20 healthy subjects served as controls. We assessed the CD62P expression on resting and thrombin-activated blood platelets. CD62P and PDMPs were analyzed by the use of monoclonal antibodies anti-CD61 and anti-CD62 on a flow cytometer. The level of sP-selectin in serum was measured by the ELISA (enzyme-linked immunosorbent assay) method. All markers were re-analyzed after 6 months of treatment with simvastatin (20 mg/day). Results Hyperlipidemic patients presented a significantly higher percentage of CD62+ platelets and higher reactivity to thrombin compared to control subjects. After simvastatin therapy hyperlipidemic patients showed a reduction of the percentage of resting CD62P(+) platelets (p = 0.005) and a reduction of expression and percentage of CD62P(+) platelets after activation by thrombin (median p < 0.05; percentage: p = 0.001). A decrease of sP-selectin levels (p = 0.001) and percentage of PDMPs (p < 0.05) in this group was also observed. Conclusions HMG-CoA reductase inhibitor therapy in stroke patients with hyperlipidemia may be useful not only due to the lipid-lowering effect but also because of a significant role in reduction of platelet activation and reactivity. PMID:25861297

  3. Interdisciplinary therapy changes superoxide dismutase activity and adiponectin in obese adolescents: a randomised controlled trial.

    Science.gov (United States)

    Nunes, João Elias Dias; Cunha, Heitor Santos; Freitas, Zulmária Rezende; Nogueira, Ana Maria Caixeta; Dâmaso, Ana Raimunda; Espindola, Foued Salmen; Cheik, Nadia Carla

    2016-01-01

    The objective of this study is to evaluate the effect of interdisciplinary therapy in the parameters of the oxidative stress and the anti-inflammatory responses of obese adolescents. We selected 57 participants, who were randomly divided into 2 groups: interdisciplinary therapy group and a control group. After 6 months of intervention, 17 participants of the interdisciplinary therapy group and 8 of the control group returned for re-evaluation. The interdisciplinary therapy group participated in a treatment with 4 weekly sessions of exercise, a weekly group therapy session and a weekly nutritional education session. Blood parameters of oxidative stress and anti-inflammatory response were evaluated. The results demonstrated that there were significant increases in the interdisciplinary therapy group for superoxide dismutase activity (6.56 ± 3.22 to 11.40 ± 7.49) and ferric-reducing antioxidant potential concentration (532.91 ± 106.48 to 573.25 ± 112.57), although adiponectin levels did not reduce (40.9 ± 29.34 to 49.05 ± 41.22). A significant decrease in nitrite levels was also found (14.23 ± 8.48 to 11.45 ± 6.05). In the control group, significant reduction was found in adiponectin (31.56 ± 18.88 to 18.01 ± 11.66). This study suggests that interdisciplinary therapy for 6 months was effective in improving the anti-inflammatory responses and the antioxidant defences in obese adolescents.

  4. Physical Therapy Activities in Stroke, Knee Arthroplasty, and Traumatic Brain Injury Rehabilitation: Their Variation, Similarities, and Association With Functional Outcomes

    Science.gov (United States)

    Hsieh, Ching-Hui; Putman, Koen; Smout, Randall J.; Horn, Susan D.; Tian, Wenqiang

    2011-01-01

    Background The mix of physical therapy services is thought to be different with different impairment groups. However, it is not clear how much variation there is across impairment groups. Furthermore, the extent to which the same physical therapy activities are associated with functional outcomes across different types of patients is unknown. Objective The purposes of this study were: (1) to examine similarities and differences in the mix of physical therapy activities used in rehabilitation among patients from different impairment groups and (2) to examine whether the same physical therapy activities are associated with functional improvement across impairment groups. Design This was a prospective observational cohort study. Methods The study was conducted in inpatient rehabilitation facilities. The participants were 433 patients with stroke, 429 patients with total knee arthroplasty (TKA), and 207 patients with traumatic brain injury (TBI). Measures used in this study included: (1) the Comprehensive Severity Index to measure the severity of each patient's medical condition, (2) the Functional Independence Measure (FIM) to measure function, and (3) point-of-care instruments to measure time spent in specific physical therapy activities. Results All 3 groups had similar admission motor FIM scores but varying cognitive FIM scores. Patients with TKA spent more time on exercise than the other 2 groups (average=31.7 versus 6.2 minutes per day). Patients with TKA received the most physical therapy (average=65.3 minutes per day), whereas the TBI group received the least physical therapy (average=38.3 minutes per day). Multivariate analysis showed that only 2 physical therapy activities (gait training and community mobility) were both positively associated with discharge motor FIM outcomes across all 3 groups. Three physical therapy activities (assessment time, bed mobility, and transfers) were negatively associated with discharge motor FIM outcome. Limitations The study

  5. Activity-specific aquatic therapy targeting gait for a patient with incomplete spinal cord injury.

    Science.gov (United States)

    Wall, Tracy; Falvo, Lisa; Kesten, Adam

    2017-04-01

    Aquatic therapy can lead to improved mobility and health in individuals with various conditions. This case report looks at an activity-specific aquatic therapy targeting gait for a patient with incomplete spinal cord injury (iSCI). The patient participated in an individualized aquatic therapy program two times a week for 6 weeks. Assessment occurred prior to the intervention. There were two follow-up assessments after the intervention. Follow-up assessment 1 was completed within the same week as the final intervention. Follow-up assessment 2 was completed 4 weeks after the first follow-up to assess for carryover. Improvements that met minimal detectable change and minimal clinically important difference were noted in The Walking for Spinal Cord Injury Index-II, Spinal Cord Injury Functional Ambulation Index gait parameters, and gait speed. An activity-specific aquatic therapy program improved gait in a patient with iSCI. The properties of water create a practical environment for safe practice of skills. Further studies are warranted in large samples.

  6. Exercise Therapy for Management of Type 2 Diabetes Mellitus: Superior Efficacy of Activity Monitors over Pedometers

    Science.gov (United States)

    Umezono, Tomoya; Fukagawa, Masafumi

    2016-01-01

    We compared the efficacy of activity monitor (which displays exercise intensity and number of steps) versus that of pedometer in exercise therapy for patients with type 2 diabetes. The study subjects were divided into the activity monitor group (n = 92) and pedometer group (n = 95). The primary goal was improvement in hemoglobin A1c (HbA1c). The exercise target was set at 8,000 steps/day and 20 minutes of moderate-intensity exercise (≥3.5 metabolic equivalents). The activity monitor is equipped with a triple-axis accelerometer sensor capable of measuring medium-intensity walking duration, number of steps, walking distance, calorie consumption, and total calorie consumption. The pedometer counts the number of steps. Blood samples for laboratory tests were obtained during the visits. The first examination was conducted at the start of the study and repeated at 2 and 6 months. A significant difference in the decrease in HbA1c level was observed between the two groups at 2 months. The results suggest that the use of activity level monitor that displays information on exercise intensity, in addition to the number of steps, is useful in exercise therapy as it enhances the concept of exercise therapy and promotes lowering of HbA1c in diabetic patients. PMID:27761471

  7. Exercise Therapy for Management of Type 2 Diabetes Mellitus: Superior Efficacy of Activity Monitors over Pedometers

    Directory of Open Access Journals (Sweden)

    Masaaki Miyauchi

    2016-01-01

    Full Text Available We compared the efficacy of activity monitor (which displays exercise intensity and number of steps versus that of pedometer in exercise therapy for patients with type 2 diabetes. The study subjects were divided into the activity monitor group (n=92 and pedometer group (n=95. The primary goal was improvement in hemoglobin A1c (HbA1c. The exercise target was set at 8,000 steps/day and 20 minutes of moderate-intensity exercise (≥3.5 metabolic equivalents. The activity monitor is equipped with a triple-axis accelerometer sensor capable of measuring medium-intensity walking duration, number of steps, walking distance, calorie consumption, and total calorie consumption. The pedometer counts the number of steps. Blood samples for laboratory tests were obtained during the visits. The first examination was conducted at the start of the study and repeated at 2 and 6 months. A significant difference in the decrease in HbA1c level was observed between the two groups at 2 months. The results suggest that the use of activity level monitor that displays information on exercise intensity, in addition to the number of steps, is useful in exercise therapy as it enhances the concept of exercise therapy and promotes lowering of HbA1c in diabetic patients.

  8. Monocyte Activation in Immunopathology: Cellular Test for Development of Diagnostics and Therapy

    Directory of Open Access Journals (Sweden)

    Ekaterina A. Ivanova

    2016-01-01

    Full Text Available Several highly prevalent human diseases are associated with immunopathology. Alterations in the immune system are found in such life-threatening disorders as cancer and atherosclerosis. Monocyte activation followed by macrophage polarization is an important step in normal immune response to pathogens and other relevant stimuli. Depending on the nature of the activation signal, macrophages can acquire pro- or anti-inflammatory phenotypes that are characterized by the expression of distinct patterns of secreted cytokines and surface antigens. This process is disturbed in immunopathologies resulting in abnormal monocyte activation and/or bias of macrophage polarization towards one or the other phenotype. Such alterations could be used as important diagnostic markers and also as possible targets for the development of immunomodulating therapy. Recently developed cellular tests are designed to analyze the phenotype and activity of living cells circulating in patient’s bloodstream. Monocyte/macrophage activation test is a successful example of cellular test relevant for atherosclerosis and oncopathology. This test demonstrated changes in macrophage activation in subclinical atherosclerosis and breast cancer and could also be used for screening a panel of natural agents with immunomodulatory activity. Further development of cellular tests will allow broadening the scope of their clinical implication. Such tests may become useful tools for drug research and therapy optimization.

  9. The relative merits of therapies being developed to tackle inappropriate ('self'-directed) complement activation.

    Science.gov (United States)

    Antwi-Baffour, Samuel; Kyeremeh, Ransford; Adjei, Jonathan Kofi; Aryeh, Claudia; Kpentey, George

    2016-12-01

    The complement system is an enzyme cascade that helps defend against infection. Many complement proteins occur in serum as inactive enzyme precursors or reside on cell surfaces. Complement components have many biologic functions and their activation can eventually damage the plasma membranes of cells and some bacteria. Although a direct link between complement activation and autoimmune diseases has not been found, there is increasing evidence that complement activation significantly contributes to the pathogenesis of a large number of inflammatory diseases that may have autoimmune linkage. The inhibition of complement may therefore be very important in a variety of autoimmune diseases since their activation may be detrimental to the individual involved. However, a complete and long-term inhibition of complement may have some contra side effects such as increased susceptibility to infection. The site of complement activation will, however, determine the type of inhibitor to be used, its route of application and dosage level. Compared with conventional drugs, complement inhibitors may be the best option for treatment of autoimmune diseases. The review takes a critical look at the relative merits of therapies being developed to tackle inappropriate complement activation that are likely to result in sporadic autoimmune diseases or worsen already existing one. It covers the complement system, general aspects of complement inhibition therapy, therapeutic strategies and examples of complement inhibitors. It concludes by highlighting on the possibility that a better inhibitor of complement activation when found will help provide a formidable treatment for autoimmune diseases as well as preventing one.

  10. Peripheral neuropathy in HIV patients in sub-Saharan Africa failing first-line therapy and the response to second-line ART in the EARNEST trial.

    Science.gov (United States)

    Arenas-Pinto, Alejandro; Thompson, Jennifer; Musoro, Godfrey; Musana, Hellen; Lugemwa, Abbas; Kambugu, Andrew; Mweemba, Aggrey; Atwongyeire, Dickens; Thomason, Margaret J; Walker, A Sarah; Paton, Nicholas I

    2016-02-01

    Sensory peripheral neuropathy (PN) remains a common complication in HIV-positive patients despite effective combination anti-retroviral therapy (ART). Data on PN on second-line ART is scarce. We assessed PN using a standard tool in patients failing first-line ART and for 96 weeks following a switch to PI-based second-line ART in a large Randomised Clinical Trial in Sub-Saharan Africa. Factors associated with PN were investigated using logistic regression. Symptomatic PN (SPN) prevalence was 22% at entry (N = 1,251) and was associated (p therapy across all treatment groups, but we did not find any advantage to the NRTI-free regimens. The increase of APN and stability of PN-signs regardless of symptoms suggest an underlying trend of neuropathy progression that may be masked by reduction of symptoms accompanying general health improvement induced by second-line ART. SPN was strongly associated with isoniazid given for TB treatment.

  11. Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review

    Directory of Open Access Journals (Sweden)

    Hsiu-Ching Chiu

    2016-07-01

    Full Text Available Questions: Does constraint-induced movement therapy improve activity and participation in children with hemiplegic cerebral palsy? Does it improve activity and participation more than the same dose of upper limb therapy without restraint? Is the effect of constraint-induced movement therapy related to the duration of intervention or the age of the children? Design: Systematic review of randomised trials with meta-analysis. Participants: Children with hemiplegic cerebral palsy with any level of motor disability. Intervention: The experimental group received constraint-induced movement therapy (defined as restraint of the less affected upper limb during supervised activity practice of the more affected upper limb. The control group received no intervention, sham intervention, or the same dose of upper limb therapy. Outcome measures: Measures of upper limb activity and participation were used in the analysis. Results: Constraint-induced movement therapy was more effective than no/sham intervention in terms of upper limb activity (SMD 0.63, 95% CI 0.20 to 1.06 and participation (SMD 1.21, 95% CI 0.41 to 2.02. However, constraint-induced movement therapy was no better than the same dose of upper limb therapy without restraint either in terms of upper limb activity (SMD 0.05, 95% CI –0.21 to 0.32 or participation (SMD –0.02, 95% CI –0.34 to 0.31. The effect of constraint-induced movement therapy was not related to the duration of intervention or the age of the children. Conclusions: This review suggests that constraint-induced movement therapy is more effective than no intervention, but no more effective than the same dose of upper limb practice without restraint. Registration: PROSPERO CRD42015024665. [Chiu H-C, Ada L (2016 Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review. Journal of Physiotherapy 62: 130–137

  12. Mesenchymal stem cell therapy in osteoarthritis: advanced tissue repair or intervention with smouldering synovial activation?

    Science.gov (United States)

    van Lent, Peter L E M; van den Berg, Wim B

    2013-03-20

    Although it is generally accepted that osteoarthritis is a degenerative condition of the cartilage, other tissues such as synovium in which immunological and inflammatory reactions occur contribute to the development of joint pathology. This sheds new light on the potential mechanism of action of mesenchymal stem cell therapy in osteoarthritis. Rather than tissue repair due to local transformation of injected mesenchymal stem cells to chondrocytes and filling defects in cartilage, such treatment might suppress synovial activation and indirectly ameliorate cartilage damage. Desando and co-workers report in Arthritis Research & Therapy that intra-articular delivery of adipose-derived stem cells attenuates progression of synovial activation and joint destruction in osteoarthritis in an experimental rabbit model. Clinical studies are warranted to see whether this approach might be a novel way to combat development of joint destruction in inflammatory subtypes of osteoarthritis.

  13. Immune function and phenotype before and after highly active antiretroviral therapy

    DEFF Research Database (Denmark)

    Søndergaard, S R; Aladdin, H; Ullum, H

    1999-01-01

    Immune functions represented by equal CD4 counts before and after highly active antiretroviral therapy (i.e., pre- and post-HAART) in the same HIV-infected patients, were examined. Twelve HIV-infected patients were included. Patients had equal CD4 counts pre- and post-HAART and were studied...... with pokeweed mitogens or Candida, and was correlated to expression of CD28 on T cells (p memory T...

  14. Multiphoton microscopy and image guided light activated therapy using nanomaterials (Conference Presentation)

    Science.gov (United States)

    Prasad, Paras N.

    2017-02-01

    This talk will focus on design and applications of nanomaterials exhibiting strong multiphoton upconversion for multiphoton microscopy as well as for image-guided and light activated therapy .1-3 Such processes can occur by truly nonlinear optical interactions proceeding through virtual intermediate states or by stepwise coupled linear excitations through real intermediate states. Multiphoton processes in biocompatible multifunctional nanoparticles allow for 3D deep tissue imaging. In addition, they can produce in-situ photon conversion of deep tissue penetrating near IR light into a needed shorter wavelength light for photo-activated therapy at a targeted site, thus overcoming the limited penetration of UV or visible light into biological media. We are using near IR emitters such as silicon quantum dots which also exhibit strong multiphoton excitation for multiphoton microscopy. Another approach involves nonlinear nanocrystals such as ZnO which can produce four wave mixing, sum frequency generation as well as second harmonic generation to convert a deep tissue penetrating Near IR light at the targeted biological site to a desired shorter wavelength light suitable for bio imaging or activation of a therapy. We have utilized this approach to activate a photosensitizer for photodynamic therapy. Yet another type of upconversion materials is rare-earth ion doped optical nanotransformers which transform a Near IR (NIR) light from an external source by sequential single photon absorption, in situ and on demand, to a needed wavelength. Applications of these nanotransformers in multiphoton photoacoustic imaging will also be presented. An exciting direction pursued by us using these multiphoton nanoparticles, is functional imaging of brain. Simultaneously, they can effect optogenetics for regioselective stimulation of neurons for providing an effective intervention/augmentation strategy to enhance the cognitive state and lead to a foundation for futuristic vision of super

  15. Erectile Dysfunction Among HIV Patients Undergoing Highly Active Antiretroviral Therapy: Dyslipidemia as a Main Risk Factor

    Directory of Open Access Journals (Sweden)

    Gustavo Romero‐Velez, MD

    2014-04-01

    Conclusions: ED is highly prevalent in HIV patients. Dyslipidemia should be considered as a risk factor for ED in HIV patients. Romero‐Velez G, Lisker‐Cervantes A, Villeda‐Sandoval CI, Sotomayor de Zavaleta M, Olvera‐Posada D, Sierra‐Madero JG, Arreguin‐Camacho LO, and Castillejos‐Molina RA. Erectile dysfunction among HIV patients undergoing highly active antiretroviral therapy: Dyslipidemia as a main risk factor. Sex Med 2014;2:24–30.

  16. Highly active antiretroviral therapy and changing spectrum of liver diseases in HIV infected patients

    OpenAIRE

    Kavita S. Joshi; Rohit R. Shriwastav

    2016-01-01

    Background: HIV is now considered as chronic disease than a fatal disease. HIV infected individual is having normal life expectancy post highly active antiretroviral therapy (HAART) era. Liver disease is the major cause of morbidity and mortality in HIV infected patients. The objective was to study the prevalence, clinical profile of various liver diseases in HIV infected individuals on HAART and also to study aetiologies of liver involvement in HIV patients. Methods: It was a cross secti...

  17. Stem cell-based gene therapy activated using magnetic hyperthermia to enhance the treatment of cancer.

    Science.gov (United States)

    Yin, Perry T; Shah, Shreyas; Pasquale, Nicholas J; Garbuzenko, Olga B; Minko, Tamara; Lee, Ki-Bum

    2016-03-01

    Stem cell-based gene therapies, wherein stem cells are genetically engineered to express therapeutic molecules, have shown tremendous potential for cancer applications owing to their innate ability to home to tumors. However, traditional stem cell-based gene therapies are hampered by our current inability to control when the therapeutic genes are actually turned on, thereby resulting in detrimental side effects. Here, we report the novel application of magnetic core-shell nanoparticles for the dual purpose of delivering and activating a heat-inducible gene vector that encodes TNF-related apoptosis-inducing ligand (TRAIL) in adipose-derived mesenchymal stem cells (AD-MSCs). By combining the tumor tropism of the AD-MSCs with the spatiotemporal MCNP-based delivery and activation of TRAIL expression, this platform provides an attractive means with which to enhance our control over the activation of stem cell-based gene therapies. In particular, we found that these engineered AD-MSCs retained their innate ability to proliferate, differentiate, and, most importantly, home to tumors, making them ideal cellular carriers. Moreover, exposure of the engineered AD-MSCS to mild magnetic hyperthermia resulted in the selective expression of TRAIL from the engineered AD-MSCs and, as a result, induced significant ovarian cancer cell death in vitro and in vivo.

  18. DMXL2 drives epithelial to mesenchymal transition in hormonal therapy resistant breast cancer through notch hyper-activation

    OpenAIRE

    Faronato, M.; Nguyen, VTM; Patten, DK; Lombardo, Y; Steel, JH; Patel, N; Woodley, L; Shousha, S; Coombes, RC; Magnani, LM

    2015-01-01

    The acquisition of endocrine therapy resistance in estrogen receptor α (ERα) breast cancer patients represents a major clinical problem. Notch signalling has been extensively linked to breast cancer especially in patients who fail to respond to endocrine therapy. Following activation, Notch intracellular domain is released and enters the nucleus where activates transcription of target genes. The numerous steps that cascade after activation of the receptor complicate using Notch as biomarker. ...

  19. Activity of matrix metalloproteinases during antimycobacterial therapy in mice with simulated tuberculous inflammation.

    Science.gov (United States)

    Sumenkova, D V; Russkikh, G S; Poteryaeva, O N; Polyakov, L M; Panin, L E

    2013-05-01

    Matrix metalloproteinases are shown to be involved in the pathogenesis of tuberculosis inflammation. In the early stages of BCG-granuloma formation in mouse liver and lungs, the serum levels of matrix metalloproteinases 2 and 7 increased by 4.5 times and remained unchanged while the pathology developed. Antimycobacterial therapy with isoniazid reduced enzyme activity almost to the level of intact control. The decrease in activity of matrix metalloproteinases 2 and 7 that play the most prominent role in the development of destructive forms of tuberculosis is of great therapeutic importance.

  20. Active music therapy approach in amyotrophic lateral sclerosis: a randomized-controlled trial.

    Science.gov (United States)

    Raglio, Alfredo; Giovanazzi, Elena; Pain, Debora; Baiardi, Paola; Imbriani, Chiara; Imbriani, Marcello; Mora, Gabriele

    2016-12-01

    This randomized controlled study assessed the efficacy of active music therapy (AMT) on anxiety, depression, and quality of life in amyotrophic lateral sclerosis (ALS). Communication and relationship during AMT treatment were also evaluated. Thirty patients were assigned randomly to experimental [AMT plus standard of care (SC)] or control (SC) groups. AMT consisted of 12 sessions (three times a week), whereas the SC treatment was based on physical and speech rehabilitation sessions, occupational therapy, and psychological support. ALS Functional Rating Scale-Revised, Hospital Anxiety and Depression Scale, McGill Quality of Life Questionnaire, and Music Therapy Rating Scale were administered to assess functional, psychological, and music therapy outcomes. The AMT group improved significantly in McGill Quality of Life Questionnaire global scores (P=0.035) and showed a positive trend in nonverbal and sonorous-music relationship during the treatment. Further studies involving larger samples in a longer AMT intervention are needed to confirm the effectiveness of this approach in ALS.

  1. Human Exportin-1 is a Target for Combined Therapy of HIV and AIDS Related Lymphoma.

    Science.gov (United States)

    Boons, Eline; Vanstreels, Els; Jacquemyn, Maarten; Nogueira, Tatiane C; Neggers, Jasper E; Vercruysse, Thomas; van den Oord, Joost; Tamir, Sharon; Shacham, Sharon; Landesman, Yosef; Snoeck, Robert; Pannecouque, Christophe; Andrei, Graciela; Daelemans, Dirk

    2015-09-01

    Infection with HIV ultimately leads to advanced immunodeficiency resulting in an increased incidence of cancer. For example primary effusion lymphoma (PEL) is an aggressive non-Hodgkin lymphoma with very poor prognosis that typically affects HIV infected individuals in advanced stages of immunodeficiency. Here we report on the dual anti-HIV and anti-PEL effect of targeting a single process common in both diseases. Inhibition of the exportin-1 (XPO1) mediated nuclear transport by clinical stage orally bioavailable small molecule inhibitors (SINE) prevented the nuclear export of the late intron-containing HIV RNA species and consequently potently suppressed viral replication. In contrast, in CRISPR-Cas9 genome edited cells expressing mutant C528S XPO1, viral replication was unaffected upon treatment, clearly demonstrating the anti-XPO1 mechanism of action. At the same time, SINE caused the nuclear accumulation of p53 tumor suppressor protein as well as inhibition of NF-κB activity in PEL cells resulting in cell cycle arrest and effective apoptosis induction. In vivo, oral administration arrested PEL tumor growth in engrafted mice. Our findings provide strong rationale for inhibiting XPO1 as an innovative strategy for the combined anti-retroviral and anti-neoplastic treatment of HIV and PEL and offer perspectives for the treatment of other AIDS-associated cancers and potentially other virus-related malignancies.

  2. Human Exportin-1 is a Target for Combined Therapy of HIV and AIDS Related Lymphoma

    Directory of Open Access Journals (Sweden)

    Eline Boons

    2015-09-01

    Full Text Available Infection with HIV ultimately leads to advanced immunodeficiency resulting in an increased incidence of cancer. For example primary effusion lymphoma (PEL is an aggressive non-Hodgkin lymphoma with very poor prognosis that typically affects HIV infected individuals in advanced stages of immunodeficiency. Here we report on the dual anti-HIV and anti-PEL effect of targeting a single process common in both diseases. Inhibition of the exportin-1 (XPO1 mediated nuclear transport by clinical stage orally bioavailable small molecule inhibitors (SINE prevented the nuclear export of the late intron-containing HIV RNA species and consequently potently suppressed viral replication. In contrast, in CRISPR-Cas9 genome edited cells expressing mutant C528S XPO1, viral replication was unaffected upon treatment, clearly demonstrating the anti-XPO1 mechanism of action. At the same time, SINE caused the nuclear accumulation of p53 tumor suppressor protein as well as inhibition of NF-κB activity in PEL cells resulting in cell cycle arrest and effective apoptosis induction. In vivo, oral administration arrested PEL tumor growth in engrafted mice. Our findings provide strong rationale for inhibiting XPO1 as an innovative strategy for the combined anti-retroviral and anti-neoplastic treatment of HIV and PEL and offer perspectives for the treatment of other AIDS-associated cancers and potentially other virus-related malignancies.

  3. Active Theater as a Complementary Therapy for Parkinson's Disease Rehabilitation: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Nicola Modugno

    2010-01-01

    Full Text Available Most medical treatments of Parkinson's disease (PD are aimed at the reduction of motor symptoms. However, even when motor improvements are evident, patients often report a deterioration of their daily lives. Thus, to achieve a global improvement in personal well-being, not only drugs, but also complementary therapies, such as physical exercise, occupational and speech therapy, and active music therapy, have been used. We hypothesized that theater could reduce clinical disability and improve the quality of life of PD patients (primary end points more efficiently than other complementary therapies because (1 in order to impersonate a character, patients are forced to regain the control of their bodies; and (2 while being part of a group, patients have a high degree of social interaction. The need to regain the control of their bodies and their social functioning is very likely to deeply motivate patients. To assess this hypothesis, we ran a randomized, controlled, and single-blinded study that lasted 3 years, on 20 subjects affected by a moderate form of idiopathic PD, in stable treatment with L-dopa and L-dopa agonists, and without severe sensory deficits. Ten patients were randomly assigned to an active theater program (in which patients were required to participate, while the others underwent physiotherapy (control group, the most common nonpharmacological treatment for PD rehabilitation. Patients of both groups were evaluated at the beginning of each year, using five clinical rating scales (Unified ParkinsonParkinson'ss Disease Rating Scale [UPDRS], Schwab and England Scale, ParkinsonParkinson'ss Disease Quality of Life [PDQ39] Scale, Epworth Sleepiness Scale, and Hamilton Depression Rating Scale. The theater patients showed progressive improvements and, at the end of the third year, they showed significant improvements in all clinical scales. Conversely, the control patients did not exhibit significant ameliorations with time. Thus, the

  4. Active theater as a complementary therapy for Parkinson's disease rehabilitation: a pilot study.

    Science.gov (United States)

    Modugno, Nicola; Iaconelli, Sara; Fiorlli, Mariagrazia; Lena, Francesco; Kusch, Imogen; Mirabella, Giovanni

    2010-11-16

    Most medical treatments of Parkinson's disease (PD) are aimed at the reduction of motor symptoms. However, even when motor improvements are evident, patients often report a deterioration of their daily lives. Thus, to achieve a global improvement in personal well-being, not only drugs, but also complementary therapies, such as physical exercise, occupational and speech therapy, and active music therapy, have been used. We hypothesized that theater could reduce clinical disability and improve the quality of life of PD patients (primary end points) more efficiently than other complementary therapies because (1) in order to impersonate a character, patients are forced to regain the control of their bodies; and (2) while being part of a group, patients have a high degree of social interaction. The need to regain the control of their bodies and their social functioning is very likely to deeply motivate patients. To assess this hypothesis, we ran a randomized, controlled, and single-blinded study that lasted 3 years, on 20 subjects affected by a moderate form of idiopathic PD, in stable treatment with L-dopa and L-dopa agonists, and without severe sensory deficits. Ten patients were randomly assigned to an active theater program (in which patients were required to participate), while the others underwent physiotherapy (control group), the most common nonpharmacological treatment for PD rehabilitation. Patients of both groups were evaluated at the beginning of each year, using five clinical rating scales (Unified Parkinson's Disease Rating Scale [UPDRS], Schwab and England Scale, Parkinson's Disease Quality of Life [PDQ39] Scale, Epworth Sleepiness Scale, and Hamilton Depression Rating Scale). The theater patients showed progressive improvements and, at the end of the third year, they showed significant improvements in all clinical scales. Conversely, the control patients did not exhibit significant ameliorations with time. Thus, the present study provides the first

  5. [Morita Therapy to Treat Depression: When and How to Encourage Patients to Join Activities].

    Science.gov (United States)

    Nakamura, Kei

    2015-01-01

    The author discusses how Morita therapy is used to treat depression, illustrated with a clinical case, and makes comparisons between Morita therapy and behavioral activation (BA). The author further examines the issue of when and how to encourage patients to join activities in clinical practice in Japan. Both Morita therapy and BA share at least a common view that it is effective to activate patients' constructive behavior at a certain point in depression treatment. However, BA therapists, compared to Morita therapists, seem to pay less attention to the necessity of resting and the appropriate timing for introducing behavioral activation. There may be some contextual differences between depressive patients in Japan and those in North America. In the case of Japanese patients, exhaustion from overwork is often considered a factor triggering the development of depression. At the same time, the Morita-based pathogenic model of depression seems different from BA's model of the same disorder. BA's approach to understanding depression may be considered a psychological (behavioristic) model. In this model, the cause of depression lies in: (a) a lack of positive reinforcement, and (b) negative reinforcement resulting from avoidance of the experience of discomfort. Therefore, the basic strategy of BA is to release depressive patients from an avoidant lifestyle, which serves as a basis for negative reinforcement, and to redirect the patients toward activities which offer the experience of positive reinforcement BA is primarily practiced by clinical psychologists in the U. S. while psychiatrists prescribe medication as a medical service. On the other hand, the clinical practice of treating depression in Japan is based primarily on medical models of depression. This is also true of Morita therapy, but in a broad sense. While those who follow medical models in a narrow sense try to identify the cause of illness and then remove it, Morita therapists pay more attention to the

  6. Disease-modifying therapeutic concepts for HIV in the era of highly active antiretroviral therapy.

    Science.gov (United States)

    Butler, Scott L; Valdez, Hernan; Westby, Michael; Perros, Manos; June, Carl H; Jacobson, Jeffrey M; Levy, Yves; Cooper, David A; Douek, Daniel; Lederman, Michael M; Tebas, Pablo

    2011-11-01

    Chronic HIV infection is associated with persistent immune activation and inflammation even among patients virologically suppressed on antiretroviral therapy for years. Chronic immune activation has been associated with poor outcomes--both AIDS-defining and non-AIDS-defining clinical events--and persistent CD4 T-cell depletion. The cause of chronic immune activation in well-controlled HIV infection is unknown. Proposed drivers include residual viral replication, microbial translocation, and coinfecting pathogens. Therapeutic interventions targeting immune activation are emerging, from approaches that interfere directly with activation and inflammatory pathways to those that prevent microbial translocation or decrease the availability of host target cells for the virus. In the context of the disappointing results of the interleukin-2 trials, the main challenges to developing these disease-modifying therapies include identifying an adequate target population and choosing surrogate endpoints that will provide positive proof-of-concept that the interventions will translate into long-term clinical benefit before embarking on large clinical endpoint trials.

  7. Tumor therapy with a urokinase plasminogen activator-activated anthrax lethal toxin alone and in combination with paclitaxel

    Science.gov (United States)

    Wein, Alexander N.; Liu, Shihui; Zhang, Yi; McKenzie, Andrew T.; Leppla, Stephen H.

    2013-01-01

    PA-U2, an engineered anthrax protective antigen that is activated by urokinase was combined with wild-type lethal factor in the treatment of Colo205 colon adenocarcinoma in vitro and B16-BL6 mouse melanoma in vitro and in vivo. This therapy was also tested in combination with the small molecule paclitaxel, based on prior reports suggesting synergy between ERK1/2 inhibition and chemotherapeutics. Colo205 was sensitive to PA-U2/LF while B16-BL6 was not. For the combination treatment of B16-BL6, paclitaxel showed a dose response in vitro, but cells remained resistant to PA-U2/LF even in the presence of paclitaxel. In vivo, each therapy slowed tumor progression, and an additive effect between the two was observed. Since LF targets tumor vasculature while paclitaxel is an anti-mitotic, it is possible the agents were acting against different cells in the stroma, precluding a synergistic effect. The engineered anthrax toxin PA-U2/LF warrants further development and testing, possibly in combination with an anti-angiogenesis therapy such as sunitinib or sorafinib. PMID:22843210

  8. The terms occupation and activity over the history of official occupational therapy publications.

    Science.gov (United States)

    Bauerschmidt, Bree; Nelson, David L

    2011-01-01

    The history of articles in the American Journal of Occupational Therapy and its predecessors reflects trends and changes in professional terminology and the thoughts underlying that terminology. In this study, we investigate use of occupation, activity, and related terms across 9 decades of occupational therapy literature from the 1920s to the 2000s. The literature for 3 years of each of the 9 decades was scanned electronically. A random numbers table was used to equalize the number of words across decades, and a computer search function was used to determine each term's frequency of use for each decade. Results indicated that the term occupation was widely used in the 1920s but then declined until the 1980s. With a rapid increase in use in the 2000s, the term occupation actually appeared more often than it did in the 1920s. The term activity appeared infrequently in the 1920s but gained popularity from the 1930s to the 1960s. From the 1970s to the 1990s, the use of both terms was quite low. This study shows that basic occupational therapy terminology has fluctuated dramatically over time. Given the essential link between terminology and theory, these changes arguably reflect authors' and editors' changing viewpoints on the profession's fundamental nature.

  9. Impact of gender on response to highly active antiretroviral therapy in HIV-1 infected patients

    DEFF Research Database (Denmark)

    Thorsteinsson, Kristina; Ladelund, Steen; Jensen-Fangel, Søren;

    2012-01-01

    ABSTRACT: BACKGROUND: Impact of gender on time to initiation, response to and risk of modification of highly active antiretroviral therapy (HAART) in HIV-1 infected individuals is still controversial. METHODS: From a nationwide cohort of Danish HIV infected individuals we identified all heterosex......ABSTRACT: BACKGROUND: Impact of gender on time to initiation, response to and risk of modification of highly active antiretroviral therapy (HAART) in HIV-1 infected individuals is still controversial. METHODS: From a nationwide cohort of Danish HIV infected individuals we identified all...... counts (adjusted p=0.21). We observed no delay in time to initiation of HAART in women compared to men (HR 0.91, 95% CI 0.79-1.06). There were no gender differences in risk of treatment modification of the original HAART regimen during the first year of therapy for either toxicity (IRR 0.97 95% CI 0.......66-1.44) or other/unknown reasons (IRR 1.18 95% CI 0.76-1.82). Finally, CD4 counts and the risk of having a detectable viral load at 1, 3 and 6 years did not differ between genders. CONCLUSIONS: In a setting with free access to healthcare and HAART, gender does neither affect time from eligibility to HAART...

  10. The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients.

    Science.gov (United States)

    Park, Jin-Young; Chang, Moonyoung; Kim, Kyeong-Mi; Kim, Hee-Jung

    2015-06-01

    The purpose of this study was to examine the effects of mirror therapy on upper-extremity function and activities of daily living in chronic stroke patients. [Subjects and Methods] Fifteen subjects were each assigned to a mirror therapy group and a sham therapy group. The Fugl-Meyer Motor Function Assessment and the Box and Block Test were performed to compare paretic upper-extremity function and hand coordination abilities. The functional independence measurement was conducted to compare abilities to perform activities of daily living. [Results] Paretic upper-extremity function and hand coordination abilities were significantly different between the mirror therapy and sham therapy groups. Intervention in the mirror therapy group was more effective than in the sham therapy group for improving the ability to perform activities of daily living. Self-care showed statistically significant differences between the two groups. [Conclusion] Mirror therapy is effective in improving paretic upper-extremity function and activities of daily living in chronic stroke patients.

  11. Antimicrobial Activity of Photodynamic Therapy Against Enterococcus faecalis Before and After Reciprocating Instrumentation in Permanent Molars.

    Science.gov (United States)

    Pinheiro, Sérgio Luiz; Azenha, Giuliana Rodrigues; Democh, Yasmin Marialva; Nunes, Daniela Camila; Provasi, Silvia; Fontanetti, Giovana Masiero; Duarte, Danilo Antônio; Fontana, Carlos Eduardo; da Silveira Bueno, Carlos Eduardo

    2016-12-01

    The present study sought to evaluate the antimicrobial activity against Enterococcus faecalis of photodynamic therapy applied before and after reciprocating instrumentation of permanent molars. Apical extrusion of debris can cause flare-ups due to introduction of bacteria into the periapical tissues. Eighteen mesial roots from permanent mandibular molars were selected. The crowns were removed to obtain a standard root length of 15 mm. The included mesial roots had an angulation of 10°-40° and canals with independent foramina. The orifice of each mesiolingual canal was sealed with light-curing resin, and the working length was established visually, 1 mm short of the apical foramen. The roots were rendered impermeable and sterilized, and the mesiobuccal canals were contaminated with a standard strain of E. faecalis for 21 days. Specimens were randomly divided into three groups (n = 6): G1, photodynamic therapy performed before instrumentation and irrigation with 0.9% NaCl (saline) solution; G2, photodynamic therapy performed after instrumentation and irrigation with 0.9% NaCl; and G3 (control), instrumentation and irrigation with 2.5% NaOCl (sodium hypochlorite) solution. Canals were shaped with a WaveOne primary file (25.08) and irrigated with 0.9% NaCl. E. faecalis samples were collected before and after each procedure, and the results were analyzed using descriptive statistics and the Kruskal-Wallis and Wilcoxon tests. Significant reductions in E. faecalis were observed when photodynamic therapy was performed before and after instrumentation of the root canal system (p Photodynamic therapy was effective in removing E. faecalis from the root canal system, whether performed before or after reciprocating instrumentation.

  12. Some strategies of activation therapy using radiations of microwave ranges in experiments on tumorbearing animals

    Directory of Open Access Journals (Sweden)

    Galina V. Zhukova

    2015-11-01

    Full Text Available The paper offers an analysis of activation therapy approaches to an increase in efficacy of antitumor treatment with the use of electromagnetic-nature factors as developed by L.Kh. Garkavi and E.B.Kvakina. Basic principles of optimization of the effects of exposures to electromagnetic radiation in various frequency bands, considering the patterns of development of general unspecific adaptation reactions of the organism as well as conceptual presentation of the organism as a complex nonlinear dissipative system, are described herein. Analyzed are effects of exposure to low-intensity radiationin the millimeter and decimeter wave bands, undertaken according to the above principles, detected in oculated tumor bearing rats. A weak infra-low magnetic field was applied in the study as an additional factor. The experimental study shows a possibility to obtain marked antitumor effects without use of conventional antitumor therapy means.

  13. Mycobacterium avium-Intracellulare Complex (MAC) Producing a Periportal Pseudotumor in a Patient With HIV and a Normal CD4 Count

    Science.gov (United States)

    Johnson, Jessica; Driscoll, Meghan; Cohen, Michael

    2016-01-01

    Mycobacterium avium-intracellulare complex (MAC) is an opportunistic infection typically associated with profound immunosuppression, such as AIDS. The presentation of disseminated MAC can be subtle and mimic systemic symptoms associated with lymphoma; abdominal pseudotumor is an exceptionally rare presentation. In the era of highly active anti-retroviral therapy (HAART), opportunistic infections are increasingly rare, and secondary prophylaxis for MAC may be discontinued after adequate therapy and immune reconstitution. Recurrence of disseminated MAC after adequate therapy may be due to macrolide resistance, but with an adequate CD4 T-cell count and undetectable HIV viral load, recurrence raises questions of more subtle immune dysregulation.

  14. association between finger clubbing and chronic lung disease in hiv ...

    African Journals Online (AJOL)

    2013-11-11

    Nov 11, 2013 ... Background: Finger clubbing in HIV infected children is associated with pulmonary ... CD4 counts/ percentage, anti-retroviral therapy duration and pulmonary ... Duration of ART use was shorter in finger clubbed patients.

  15. Browse Title Index

    African Journals Online (AJOL)

    Vol 90, No 12 (2013): Supplement, Reasons for Change of Anti-Retroviral Therapy ... Vol 84, No 8 (2007):, Reconstruction of urethral injuries, Abstract PDF .... Vol 92, No 6 (2015), Rising pattern of breast cancer in young women, Abstract.

  16. Role of toll like receptors in bacterial and viral diseases – A ...

    African Journals Online (AJOL)

    Avishek Das

    2017-05-20

    May 20, 2017 ... Conclusion: This study reports the frequency distribution and association of human TLR genes with the .... patients who did not receive anti retroviral therapy (ART) had ..... phages and also in intestinal epithelium cells.

  17. Effect of low-level laser therapy on the modulation of the mitochondrial activity of macrophages

    Directory of Open Access Journals (Sweden)

    Nadhia H. C. Souza

    2014-08-01

    Full Text Available BACKGROUND: Macrophages play a major role among the inflammatory cells that invade muscle tissue following an injury. Low-level laser therapy (LLLT has long been used in clinical practice to accelerate the muscle repair process. However, little is known regarding its effect on macrophages. OBJECTIVE: This study evaluated the effect of LLLT on the mitochondrial activity (MA of macrophages. METHOD: J774 macrophages were treated with lipopolysaccharide (LPS and interferon - gamma (IFN-γ (activation for 24 h to simulate an inflammatory process, then irradiated with LLLT using two sets of parameters (780 nm; 70 mW; 3 J/cm2 and 660 nm; 15 mW; 7.5 J/cm2. Non-activated/non-irradiated cells composed the control group. MA was evaluated by the cell mitochondrial activity (MTT assay (after 1, 3 and 5 days in three independent experiments. The data were analyzed statistically. RESULTS: After 1 day of culture, activated and 780 nm irradiated macrophages showed lower MA than activated macrophages, but activated and 660 nm irradiated macrophages showed MA similar to activated cells. After 3 days, activated and irradiated (660 nm and 780 nm macrophages showed greater MA than activated macrophages, and after 5 days, the activated and irradiated (660 nm and 780 nm macrophages showed similar MA to the activated macrophages. CONCLUSIONS: These results show that 660 nm and 780 nm LLLT can modulate the cellular activation status of macrophages in inflammation, highlighting the importance of this resource and of the correct determination of its parameters in the repair process of skeletal muscle.

  18. Effect of low-level laser therapy on the modulation of the mitochondrial activity of macrophages

    Science.gov (United States)

    Souza, Nadhia H. C.; Ferrari, Raquel A. M.; Silva, Daniela F. T.; Nunes, Fabio D.; Bussadori, Sandra K.; Fernandes, Kristianne P. S.

    2014-01-01

    BACKGROUND: Macrophages play a major role among the inflammatory cells that invade muscle tissue following an injury. Low-level laser therapy (LLLT) has long been used in clinical practice to accelerate the muscle repair process. However, little is known regarding its effect on macrophages. OBJECTIVE: This study evaluated the effect of LLLT on the mitochondrial activity (MA) of macrophages. METHOD: J774 macrophages were treated with lipopolysaccharide (LPS) and interferon - gamma (IFN-γ) (activation) for 24 h to simulate an inflammatory process, then irradiated with LLLT using two sets of parameters (780 nm; 70 mW; 3 J/cm2 and 660 nm; 15 mW; 7.5 J/cm2). Non-activated/non-irradiated cells composed the control group. MA was evaluated by the cell mitochondrial activity (MTT) assay (after 1, 3 and 5 days) in three independent experiments. The data were analyzed statistically. RESULTS: After 1 day of culture, activated and 780 nm irradiated macrophages showed lower MA than activated macrophages, but activated and 660 nm irradiated macrophages showed MA similar to activated cells. After 3 days, activated and irradiated (660 nm and 780 nm) macrophages showed greater MA than activated macrophages, and after 5 days, the activated and irradiated (660 nm and 780 nm) macrophages showed similar MA to the activated macrophages. CONCLUSIONS: These results show that 660 nm and 780 nm LLLT can modulate the cellular activation status of macrophages in inflammation, highlighting the importance of this resource and of the correct determination of its parameters in the repair process of skeletal muscle. PMID:25076002

  19. Body position effects on sternocleidomastoid and masseter EMG pattern activity in patients undergoing occlusal splint therapy.

    Science.gov (United States)

    Ormeño, G; Miralles, R; Santander, H; Casassus, R; Ferrer, P; Palazzi, C; Moya, H

    1997-10-01

    This study was conducted in order to determine the effects of body position on electromyographic (EMG) activity of sternocleidomastoid and masseter muscles, in 15 patients with myogenic cranio-cervical-mandibular dysfunction undergoing occlusal splint therapy. EMG activity was recorded by placing surface electrodes on the sternocleidomastoid and masseter muscles (contralateral to the habitual sleeping side of each patient). EMG activity at rest and during swallowing of saliva and maximal voluntary clenching was recorded in the following body positions: standing, supine and lateral decubitus. In the sternocleidomastoid muscle significant higher EMG activities at rest and during swallowing were recorded in the lateral decubitus position, whereas during maximal voluntary clenching EMG activity did not change. In the masseter muscle significant higher EMG activity during maximal voluntary clenching in a standing position was observed, whereas EMG activity at rest and during swallowing did not change. The opposite pattern of EMG activity supports the idea that there may exist a differential modulation of the motor neuron pools of the sternocleidomastoid and masseter muscles, of peripheral and/or central origin. This suggests that the presence of parafunctional habits and body position could be closely correlated with the clinical symptomatology in these muscles in patients with myogenic craniomandibular dysfunction.

  20. Constitutive STAT5 Activation Correlates With Better Survival in Cervical Cancer Patients Treated With Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Helen H.W. [Department of Radiation Oncology, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan (China); Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (China); Chou, Cheng-Yang [Department of Obstetrics and Gynecology, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan (China); Wu, Yuan-Hua; Hsueh, Wei-Ting; Hsu, Chiung-Hui [Department of Radiation Oncology, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan (China); Guo, How-Ran [Department of Environmental and Occupational Health, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan (China); Lee, Wen-Ying, E-mail: 7707@so-net.net.tw [Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan (China) and Department of Pathology, College of Medicine, Taipei Medical University, Taipei, Taiwan (China); Su, Wu-Chou, E-mail: sunnysu@mail.ncku.edu.tw [Department of Internal Medicine, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan (China)

    2012-02-01

    Purpose: Constitutively activated signal transducers and activators of transcription (STAT) factors, in particular STAT1, STAT3, and STAT5, have been detected in a wide variety of human primary tumors and have been demonstrated to directly contribute to oncogenesis. However, the expression pattern of these STATs in cervical carcinoma is still unknown, as is whether or not they have prognostic significance. This study investigated the expression patterns of STAT1, STAT3, and STAT5 in cervical cancer and their associations with clinical outcomes in patients treated with radical radiation therapy. Methods and Materials: A total of 165 consecutive patients with International Federation of Gynecology and Obstetrics (FIGO) Stages IB to IVA cervical cancer underwent radical radiation therapy, including external beam and/or high-dose-rate brachytherapy between 1989 and 2002. Immunohistochemical studies of their formalin-fixed, paraffin-embedded tissues were performed. Univariate and multivariate analyses were performed to identify and to evaluate the effects of these factors affecting patient survival. Results: Constitutive activations of STAT1, STAT3, and STAT5 were observed in 11%, 22%, and 61% of the participants, respectively. While STAT5 activation was associated with significantly better metastasis-free survival (p < 0.01) and overall survival (p = 0.04), STAT1 and STAT3 activation were not. Multivariate analyses showed that STAT5 activation, bulky tumor ({>=}4 cm), advanced stage (FIGO Stages III and IV), and brachytherapy (yes vs. no) were independent prognostic factors for cause-specific overall survival. None of the STATs was associated with local relapse. STAT5 activation (odds ratio = 0.29, 95% confidence interval = 0.13-0.63) and advanced stage (odds ratio = 2.54; 95% confidence interval = 1.03-6.26) were independent predictors of distant metastasis. Conclusions: This is the first report to provide the overall expression patterns and prognostic significance of

  1. Occupational therapy for adults with problems in activities of daily living after stroke.

    Science.gov (United States)

    Legg, Lynn A; Lewis, Sharon R; Schofield-Robinson, Oliver J; Drummond, Avril; Langhorne, Peter

    2017-07-19

    A stroke occurs when the blood supply to part of the brain is cut off. Activities of daily living (ADL) are daily home-based activities that people carry out to maintain health and well-being. ADLs include the ability to: eat and drink unassisted, move, go to the toilet, carry out personal hygiene tasks, dress unassisted, and groom. Stroke causes impairment-related functional limitations that may result in difficulties participating in ADLs independent of supervision, direction, or physical assistance.For adults with stroke, the goal of occupational therapy is to improve their ability to carry out activities of daily living. Strategies used by occupational therapists include assessment, treatment, adaptive techniques, assistive technology, and environmental adaptations. This is an update of the Cochrane review first published in 2006. To assess the effects of occupational therapy interventions on the functional ability of adults with stroke in the domain of activities of daily living, compared with no intervention or standard care/practice. For this update, we searched the Cochrane Stroke Group Trials Register (last searched 30 January 2017), the Cochrane Controlled Trials Register (The Cochrane Library, January 2017), MEDLINE (1946 to 5 January 2017), Embase (1974 to 5 January 2017), CINAHL (1937 to January 2017), PsycINFO (1806 to 2 November 2016), AMED (1985 to 1 November 2016), and Web of Science (1900 to 6 January 2017). We also searched grey literature and clinical trials registers. We identified randomised controlled trials of an occupational therapy intervention (compared with no intervention or standard care/practice) where people with stroke practiced activities of daily living, or where performance in activities of daily living was the focus of the occupational therapy intervention. Two review authors independently selected trials, assessed risk of bias, and extracted data for prespecified outcomes. The primary outcomes were the proportion of

  2. EFFECTS OF INTERFERON THERAPY UPON IMMUNE MARKER PROFILE AND ENZYMATIC ACTIVITY IN PERIPHERAL BLOOD LYMPHOCYTES OF PATIENTS WITH RENAL CANCER

    Directory of Open Access Journals (Sweden)

    L. M. Kurtasova

    2014-01-01

    Full Text Available We have observed forty-four patients with metastatic renal cancer before and after interferon therapy. Immune markers of of peripheral blood lymphocytes were determined by flow cytometry. Activity of NAD (P-dependent dehydrogenase in blood lymphocytes was studied by means of bioluminescence technique. Changes of immune marker profiles and enzymatic activities of peripheral blood lymphocytes were found in patients with renal cancer after a course of interferon therapy.

  3. Baroreflex Activation Therapy in Congestive Heart Failure: Novel Findings and Future Insights.

    Science.gov (United States)

    Grassi, Guido; Brambilla, GianMaria; Pizzalla, Daniela Prata; Seravalle, Gino

    2016-08-01

    Congestive heart failure is characterized by hemodynamic and non-hemodynamic abnormalities, the latter including an activation of the sympathetic influences to the heart and peripheral circulation coupled with an impairment of baroreceptor control of autonomic function. Evidence has been provided that both these alterations are hallmark features of the disease with a specific relevance for the disease progression as well as for the development of life-threatening cardiac arrhythmias. In addition, a number of studies have documented in heart failure the adverse prognostic role of the sympathetic and baroreflex alterations, which both are regarded as major independent determinants of cardiovascular morbidity and mortality. This represents the pathophysiological and clinical background for the use of carotid baroreceptor activation therapy in the treatment of congestive heart failure. Promising data collected in experimental animal models of heart failure have supported the recent performance of pilot small-scale clinical studies, aimed at providing initial information in this area. The results of these studies demonstrated the clinical safety and efficacy of the intervention which has been tested in large-scale clinical studies. The present paper will critically review the background and main results of the published studies designed at defining the clinical impact of baroreflex activation therapy in congestive heart failure patients. Emphasis will be given to the strengths and limitations of such studies, which represent the background for the ongoing clinical trials testing the long-term effects of the device in heart failure patients.

  4. Successful Interferon Therapy Reverses Enhanced Hepatic Progenitor Cell Activation in Patients with Chronic Hepatitis C.

    Science.gov (United States)

    Noritake, Hidenao; Kobayashi, Yoshimasa; Ooba, Yukimasa; Matsunaga, Erika; Ohta, Kazuyoshi; Shimoyama, Shin; Yamazaki, Satoru; Chida, Takeshi; Kawata, Kazuhito; Sakaguchi, Takanori; Suda, Takafumi

    2015-12-01

    The enhanced accumulation of hepatic progenitor cells (HPCs) is related to the risk of progression to hepatocellular carcinoma (HCC). Interferon (IFN) treatment reduces HCC risk in patients with chronic hepatitis C virus (HCV) infection. However, the underlying mechanisms remain unclear. The aim of this study was to examine the effects of IFN treatment on HPC activation in HCV patients. Immunohistochemical detection and computer-assisted quantitative image analyses of cytokeratin 7 (CK7) were performed to evaluate HPC activation in paired pre- and post-treatment liver biopsies from 18 HCV patients with sustained virological response (SVR) to IFN-based therapy and from 23 patients without SVR, as well as normal liver tissues obtained from surgical resection specimens of 10 patients. Pretreatment HCV livers showed increased CK7 immunoreactivity, compared with normal livers (HCV: median, 1.38%; normal: median, 0.69%, P=0.006). IFN treatment reduced hepatic CK7 immunoreactivity (median, 1.57% pre-IFN vs. 0.69% post-IFN, P=0.006) in SVR patients, but not in non-SVR patients. The development of HCC following IFN treatment was encountered in 3 non-SVR patients who showed high post-IFN treatment CK7 immunoreactivity (>4%). Successful IFN therapy can reverse enhanced HPC activation in HCV patients, which may contribute to the reduced risk of HCC development in these patients.

  5. Effect of simultaneous use of highly active antiretroviral therapy on survival of HIV patients with tuberculosis.

    Science.gov (United States)

    Velasco, Maria; Castilla, Virgilio; Sanz, José; Gaspar, Gabriel; Condes, Emilia; Barros, Carlos; Cervero, Miguel; Torres, Rafael; Guijarro, Carlos

    2009-02-01

    The optimal timing for initiation of highly active antiretroviral therapy (HAART) in patients with AIDS and tuberculosis (TB) is an unresolved question. To assess the effect of HAART on the survival of patients with TB, we designed this study. We selected all HIV patients included in the COMESEM cohort with TB diagnosis after 1996. Clinical and epidemiological data were registered. We compared patients who started HAART at the diagnosis of TB [simultaneous therapy (ST)] or not. Survival was assessed by Cox analysis. Among the 6934 HIV patients included in the cohort, 1217 patients had TB, 322 of them (26.5%) after 1996. At the time of TB diagnosis, 45% of them started HAART (ST). There were no differences between groups regarding basal characteristics, except for a lower viral load in ST patients. ST therapy was associated with improved survival (hazard ratio 0.38; 95% confidence interval 0.20 to 0.72, P = 0.003). By univariate analysis, survival was also associated with no endovenous drug use and a later year of TB diagnosis. After adjusting for other prognostic variables, by Cox multivariate analysis, ST remained robustly associated with improved survival (hazard ratio 0.37; 95% confidence interval 0.17 to 0.66, P = 0.001). Simultaneous HAART and TB treatment in HIV patients with TB is associated with improved survival.

  6. Antibacterial and Antibiofilm Activities of the Photothermal Therapy Using Gold Nanorods against Seven Different Bacterial Strains

    OpenAIRE

    Juan Carlos Castillo-Martínez; Gabriel Alejandro Martínez-Castañón; Fidel Martínez-Gutierrez; Norma Veronica Zavala-Alonso; Nuria Patiño-Marín; Nereyda Niño-Martinez; Zaragoza-Magaña, V.; Cabral-Romero, C.

    2015-01-01

    The objective of this work was to determine the bactericidal and antibiofilm activities of gold nanorods (AuNRs) using plasmonic photothermal therapy (PPTT) against oral microorganisms. AuNRs were synthesized by the seed and growth solution method and the gold nanoclusters were characterized with a size of 33.2 nm ± 2.23 length and 7.33 nm ± 1.60 width. The efficacy of PPTT related to its temperature was done reaching 67°C. Minimum inhibitory concentration (MIC) and minimum bactericide concen...

  7. Influence of balneophysical therapy on activity, functional capacity, and quality of life in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Stojanović Sonja

    2009-01-01

    Full Text Available Introduction It has been well known that balneophysical therapy has a therapeutic effect on clinical and biological parameters of disease activity in the patients with rheumatoid arthritis (RA. Objective. To determine the influence of balneophysical therapy on functional capacity, activity and quality of life of the patients with RA primarily treated with some of disease modifying antirheumatic drugs. Methods. The study enrolled 73 patients with RA treated with some of disease modifying antirheumatic drugs (Methotrexate in 85% of patients. During hospitalization at the Clinical Rheumatologic Department of the Institute 'Niska Banja', the patients were treated, beside the medicamentous therapy, by hydrotherapy (oligomineral, homeothermic, low radioactive water, mineral peloid therapy, electrotherapy and kinesiotherapy. Before and after balneotherapy, the patients filled in the Health Assessment Questionnaire (HAQ and the Quality of Life Rheumatoid Arthritis (QOL-RA scale. The Disease Activity Score (DAS 28 was used to measure the disease activity before and after balneotherapy. A possible value of HAQ was from 0 to 3, and QOL-RA from 0 to 10. Results. The mean value of the duration of balneophysical therapy was 14.7±4.8 days. We found significant improvement of functional capacity in the patients with RA. The average HAQ score before balneotherapy was 1.07±0.61, and 0.86±0.55 after balneotherapy, which was statistically significantly lower (p<0.05. DAS 28 after balneotherapy was also statistically significantly lower than DAS 28 before balneotherapy: the mean value of DAS 28 before therapy was 6.30±0.81 and after therapy 5.48±0.75 (p<0.001. The quality of life significantly improved after balneophysical therapy: the mean value of QOL-RA scale before therapy was 5.38±1.62 and after therapy 7.35±1.81 (p<0.05. Conclusion. Balneophysical therapy, when properly dosed, is an effective, adjuvant therapy in the patients with RA of mild disease

  8. Effects of periodontal therapy on disease activity and systemic inflammation in rheumatoid arthritis patients.

    Science.gov (United States)

    Erciyas, K; Sezer, U; Ustün, K; Pehlivan, Y; Kisacik, B; Senyurt, S Z; Tarakçioğlu, M; Onat, A M

    2013-05-01

    This observational prospective cohort study aimed to evaluate the effects of non-surgical periodontal treatment on clinical periodontal measurements and systemic inflammatory mediator levels in low or moderate to highly active rheumatoid arthritis (RA) patients with chronic periodontitis. Rheumatoid arthritis activity was assessed with disease activity score test (DAS28). Thirty patients with RA with moderate to high disease activity (DAS28 ≥ 3.2) and chronic periodontitis (MHDA group) and thirty patients with RA with low disease activity (DAS28 periodontitis (LDA group) were enrolled in the study. The patients were monitored at the beginning and 3 months after undergoing periodontal therapy. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-α) levels in serum, DAS28 and periodontal parameters were evaluated. Erythrocyte sedimentation rate, CRP, TNF-α levels in serum, DAS28 and periodontal parameters exhibited similar and significant reduction 3 months after the non-surgical periodontal treatment. Non-surgical periodontal treatment may prove beneficial in reducing RA severity as measured by ESR, CRP, TNF-α levels in serum and DAS28 in low or moderate to highly active RA patients with chronic periodontitis. © 2012 John Wiley & Sons A/S.

  9. Influence of ultrasonic activation on photodynamic therapy over root canal system infected with Enterococcus faecalis--an in vitro study.

    Science.gov (United States)

    Ghinzelli, Guilherme Cavagnoli; Souza, Matheus Albino; Cecchin, Doglas; Farina, Ana Paula; de Figueiredo, José Antônio Poli

    2014-12-01

    The purpose of this study was to evaluate, in vitro, the influence of ultrasonic activation on photodynamic therapy over root canal system infected with Enterococcus faecalis. The root canals of 50 single-rooted human extracted teeth were enlarged up to a file 60, autoclaved, inoculated with Enterococcus faecalis and incubated for 30 days. The samples were divided into five groups (n=10) according to the protocol of decontamination: G1 (control group) - no procedure was performed; G2 - photosensitizer (0.01% methylene blue); G3 - ultrasonic activation of photosensitizer (0.01% methylene blue); G4 - photodynamic therapy with no ultrasonic activation; and G5 - photodynamic therapy with ultrasonic activation. Microbiological tests (CFU counting) and scanning electron microscopy (SEM) were performed to evaluate and illustrate, respectively, the effectiveness of proposed treatments. Data were subjected to one-way ANOVA followed by post hoc Tukey test (α=0.05). The microbiological test demonstrated that G5 (photodynamic therapy with ultrasonic activation) showed the lowest mean contamination (3.17 log CFU/mL), which was statistically different from all other groups (pphotodynamic therapy) showed a mean of contamination of 3.60 log CFU/mL, which was statistically different from groups 1, 2 and 3 (pphotodynamic therapy improved its potential for decontamination, resulting in the higher elimination Enterococcus faecalis from the root canal space. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Heidelberg Neuro-Music Therapy Enhances Task-Negative Activity in Tinnitus Patients.

    Science.gov (United States)

    Krick, Christoph M; Argstatter, Heike; Grapp, Miriam; Plinkert, Peter K; Reith, Wolfgang

    2017-01-01

    Background: Suffering from tinnitus causes mental distress in most patients. Recent findings point toward a diminished activity of the brain's default-mode network (DMN) in subjects with mental disorders including depression or anxiety and also recently in subjects with tinnitus-related distress. We recently developed a therapeutic intervention, namely the Heidelberg Neuro-Music Therapy (HNMT), which shows an effective reduction of tinnitus-related distress following a 1-week short-term treatment. This approach offers the possibility to evaluate the neural changes associated with the improvements in tinnitus distress. We previously reported gray matter (GM) reorganization in DMN regions and in primary auditory areas following HNMT in cases of recent-onset tinnitus. Here we evaluate on the same patient group, using functional MRI (fMRI), the activity of the DMN following the improvements tinnitus-related distress related to the HNMT intervention. Methods: The DMN activity was estimated by the task-negative activation (TNA) during long inter-trial intervals in a word recognition task. The level of TNA was evaluated twice, before and after the 1-week study period, in 18 treated tinnitus patients ("treatment group," TG), 21 passive tinnitus controls (PTC), and 22 active healthy controls (AC). During the study, the participants in TG and AC groups were treated with HNMT, whereas PTC patients did not receive any tinnitus-specific treatment. Therapy-related effects on DMN activity were assessed by comparing the pairs of fMRI records from the TG and PTC groups. Results: Treatment of the TG group with HNMT resulted in an augmented DMN activity in the PCC by 2.5% whereas no change was found in AC and PTC groups. This enhancement of PCC activity correlated with a reduction in tinnitus distress (Spearman Rho: -0.5; p < 0.005). Conclusion: Our findings show that an increased DMN activity, especially in the PCC, underlies the improvements in tinnitus-related distress triggered

  11. Spatiotemporally synchronized cancer combination therapy using photo-activated nanoparticle drug delivery systems (Conference Presentation)

    Science.gov (United States)

    Hasan, Tayyaba

    2016-03-01

    This talk will introduce a new nanotechnology platform for cancer combination therapy that utilizes near infrared light activation not only for photodynamic damage but also as an extrinsic mechanism to initiate release of complimentary drugs to suppress dynamic bursts in molecular signaling networks that promote tumor cell survival and treatment escape. The goal is to achieve co-delivery with concomitant activity of photodynamic, molecular inhibitor and chemotherapeutic agents, selectively within the tumor. This approach overcomes challenges in achieving synergistic interactions using sequential drug delivery. Conventional drug delivery is compromised by the differential pharmacokinetics of individual agents and potentially antagonistic effects—such as vascular shutdown by one agent that limits delivery of the second. Here, photodynamic damage—which efficiently kills drug-resistant cells via damage of common proteins involved in drug-resistance (such as anti-apoptosis factors and drug-efflux transporters)—is synchronized spatially and temporally with the photo-initiated release of complimentary agents—to enable full interaction amongst the individual therapies. This spatiotemporal synchronization offers new prospects for exploiting time-sensitive synergistic interactions. Specific implementations of these concepts will be presented in preclinical models of cancer. Strategies to enable molecular-targeting of cancer cells via site-specific attachment of targeting moieties to the outer lipid shell of these nanovehicles will also be discussed. If successful in humans, this new paradigm for synchronized, tumor-focused combination therapy will ultimately supersede the present use of chronic drug injection by increasing efficacy per cycle whilst reducing systemic exposure to toxic drugs.

  12. Metabolic abnormalities and overweight in HIV/AIDS persons-treated with antiretroviral therapy Anormalidades metabólicas e sobrepeso em portadores de HIV/AIDS em terapia com anti-retrovirais

    Directory of Open Access Journals (Sweden)

    Luísa Helena Maia Leite

    2008-06-01

    Full Text Available OBJECTIVE: To describe the proportion of overweight among patients with human immunodeficiency virus/Acquired Immune Deficiency Syndrome and correlate overweight and highly active antiretroviral therapy with metabolic complications. METHODS: A cross-sectional study was conducted among human immunodeficiency virus/Acquired Immune Deficiency Syndrome outpatients undergoing nutritional therapy from 2000 to 2006 in a University Health Center. The sample consisted of 393 human immunodeficiency virus/Acquired Immune Deficiency Syndrome patients. Nutritional and medical records were used as a source of data on personal, clinical and biochemical information. Data analysis included descriptive statistics and the Chi-square test. RESULTS: Sixty-nine percent of the patients were males aging from 26 to 49 years. Overweight and obesity were identified in 49% of this population. The most important metabolic complications were low levels of high-density lipoprotein (70% and high levels of triglycerides (48% and cholesterol (40%. Higher body mass index was associated with higher lipid levels and more evidence of insulin resistance. CONCLUSION: This study demonstrated an important proportion of overweight and obesity among human immunodeficiency virus/Acquired Immune Deficiency Syndrome patients. These results suggest that nutritional interventions and lifestyle modifications may be useful strategies to decrease the cardiovascular risk in this population.OBJETIVO: Estimar a proporção de sobrepeso em pessoas com Vírus da Imunodeficiência Humana /Síndrome da Imunodeficiência Adquirida e avaliar a associação do sobrepeso e do uso da terapia anti-retroviral de alta potência (Highly Active Antiretroviral Therap com a presença de anormalidades metabólicas. MÉTODOS: Foi conduzido um estudo transversal entre pacientes ambulatoriais sob acompanhamento nutricional em um hospital universitário entre 2000-2006. A amostra incluiu 393 pacientes com Vírus da

  13. Treatment of actinic cheilitis by photodynamic therapy with 5-aminolevulinic acid and blue light activation.

    Science.gov (United States)

    Zaiac, Martin; Clement, Annabelle

    2011-11-01

    Actinic cheilitis (AC), a common disorder of the lower lip, should be treated early to prevent progression to invasive squamous cell carcinoma. This study evaluated the safety and efficacy of photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) activated by blue light for the treatment of AC. Fifteen patients with clinically evident or biopsy-proven AC received two treatments with ALA PDT with blue light activation. Treatments were spaced three to five weeks apart. Most patients achieved 65% to 75% clearance three to five weeks after the first treatment and all achieved more than 75% clearance one month after the second treatment. Three patients achieved complete clearance. Pain and burning during irradiation were absent or mild. All patients said they would repeat the procedure. ALA PDT with 417 nm blue light is a promising option for the treatment of AC of the lower lip.

  14. Enzyme-activatable imaging probe reveals enhanced neutrophil elastase activity in tumors following photodynamic therapy.

    Science.gov (United States)

    Mitra, Soumya; Modi, Kshitij D; Foster, Thomas H

    2013-10-01

    We demonstrate the use of an enzyme-activatable fluorogenic probe, Neutrophil Elastase 680 FAST (NE680), for in vivo imaging of neutrophil elastase (NE) activity in tumors subjected to photodynamic therapy (PDT). NE protease activity was assayed in SCC VII and EMT6 tumors established in C3H and BALB/c mice, respectively. Four nanomoles of NE680 was injected intravenously immediately following PDT irradiation. 5 h following administration of NE680, whole-mouse fluorescence imaging was performed. At this time point, levels of NE680 fluorescence were at least threefold greater in irradiated versus unirradiated SCC VII and EMT6 tumors sensitized with Photofrin. To compare possible photosensitizer-specific differences in therapy-induced elastase activity, EMT6 tumors were also subjected to 2-(1-hexyloxyethyl)-2-devinyl pyropheophorbide-a (HPPH)-PDT. NE levels measured in HPPH-PDT-treated tumors were twofold higher than in unirradiated controls. Ex vivo labeling of host cells using fluorophore-conjugated antibodies and confocal imaging were used to visualize Gr1+ cells in Photofrin-PDT-treated EMT6 tumors. These data were compared with recently reported analysis of Gr1+ cell accumulation in EMT6 tumors subjected to HPPH-PDT. The population density of infiltrating Gr1+ cells in treated versus unirradiated drug-only control tumors suggests that the differential in NE680 fold enhancement observed in Photofrin versus HPPH treatment may be attributed to the significantly increased inflammatory response induced by Photofrin-PDT. The in vivo imaging of NE680, which is a fluorescent reporter of NE extracellular release caused by neutrophil activation, demonstrates that PDT results in increased NE levels in treated tumors, and the accumulation of the cleaved probe tracks qualitatively with the intratumor Gr1+ cell population.

  15. 5-ALA mediated photodynamic therapy induces autophagic cell death via AMP-activated protein kinase

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    Lin Yu-Hsin

    2010-04-01

    Full Text Available Abstract Photodynamic therapy (PDT has been developed as an anticancer treatment, which is based on the tumor-specific accumulation of a photosensitizer that induces cell death after irradiation of light with a specific wavelength. Depending on the subcellular localization of the photosensitizer, PDT could trigger various signal transduction cascades and induce cell death such as apoptosis, autophagy, and necrosis. In this study, we report that both AMP-activated protein kinase (AMPK and mitogen-activated protein kinase (MAPK signaling cascades are activated following 5-aminolevulinic acid (ALA-mediated PDT in both PC12 and CL1-0 cells. Although the activities of caspase-9 and -3 are elevated, the caspase inhibitor zVAD-fmk did not protect cells against ALA-PDT-induced cell death. Instead, autophagic cell death was found in PC12 and CL1-0 cells treated with ALA-PDT. Most importantly, we report here for the first time that it is the activation of AMPK, but not MAPKs that plays a crucial role in mediating autophagic cell death induced by ALA-PDT. This novel observation indicates that the AMPK pathway play an important role in ALA-PDT-induced autophagy.

  16. Energy Optimization And Calculation Of Dose Absorption Enhancement Factor In Photon Activation Therapy

    Directory of Open Access Journals (Sweden)

    Hassan Ranjbar

    2010-06-01

    Full Text Available Introduction: Secondary radiation such as photoelectrons, Auger electrons and characteristic radiations cause a local boost in dose for a tumor when irradiated with an external X-ray beam after being loaded with elements capable of activating the tumor, e.g.; I and Gd. Materials and Methods:  In this investigation, the MCNPX code was used for simulation and calculation of dose enhancement factor for a tumor loaded with activating elements. The designed model comprised the X-ray source, phantom (target tissue and loaded tumor with activating agent, detector, interactions modeling and results. The source was defined as monochromatic and plane surface situated at 50 cm (z = 50. Phantom geometry was a 10 × 10 × 10 cm3 cube centered at (0, 0, 0 with a 2.2 × 2.2 × 2.2 cm3 cubic tumor with a center located at 3 cm depth inside the phantom Results: Dose enhancement factor and optimum energy in radiotherapy are evaluated using the photon activation therapy method. Result show that the dose enhancement factor increases with activating concentration in the tumor. The maximum dose enhancement factor for iodine in the tumor occurs for photons in the energy range of 50-60 keV. Dose uniformity is less for lower energy photons within the activated region inside the tumor. Results indicate that the dose enhancement factor varies linearly with the activating concentration agent. Discussion and Conclusion: In this study, the obtained results point out a considerable enhancement in dose in the presence of activating agents in the tumor regions.

  17. Physical activity in anorexia nervosa: How relevant is it to therapy response?

    Science.gov (United States)

    Sauchelli, S; Arcelus, J; Sánchez, I; Riesco, N; Jiménez-Murcia, S; Granero, R; Gunnard, K; Baños, R; Botella, C; de la Torre, R; Fernández-García, J C; Fernández-Real, J M; Frühbeck, G; Gómez-Ambrosi, J; Tinahones, F J; Casanueva, F F; Menchón, J M; Fernandez-Aranda, F

    2015-11-01

    Elevated physical activity has been observed in some patients with anorexia nervosa (AN) despite their emaciated condition. However, its effects on treatment outcome remain unclear. This study aimed to examine objectively measured physical activity in this clinical population and how it might be related to a partial hospitalization therapy response, after considering potential confounders. The sample comprised 88 AN patients consecutively enrolled in a day hospital treatment program, and 116 healthy-weight controls. All participants were female and a baseline assessment took place using an accelerometer (Actiwatch AW7) to measure physical activity, the Eating Disorders Inventory-2 and the Depression subscale of the Symptom Checklist-Revised. Outcome was evaluated upon the termination of the treatment program by expert clinicians. Although AN patients and controls did not differ in the average time spent in moderate-to-vigorous physical activity (MVPA) (P=.21), nor daytime physical activity (P=.34), fewer AN patients presented a high physical activity profile compared to the controls (37% vs. 61%, respectively; P=.014). Both lower levels of MVPA and greater eating disorder severity had a direct effect on a poor treatment outcome. Depression symptoms in the patients were associated with lower MVPA, as well as with an older age, a shorter duration of the disorder and greater eating disorder psychopathology. There is a notable variation in the physical activity profile of AN patients, characterized by either low or very high patterns. Physical activity is a highly relevant issue in AN that must be taken into account during the treatment process. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. Effects of antiplatelet therapy on platelet extracellular vesicle release and procoagulant activity in health and in cardiovascular disease.

    Science.gov (United States)

    Connor, David E; Ly, Ken; Aslam, Anoosha; Boland, John; Low, Joyce; Jarvis, Susan; Muller, David W; Joseph, Joanne E

    2016-12-01

    Dual antiplatelet therapy with aspirin and clopidogrel is commonly used to prevent recurrent ischemic events in patients with cardiovascular disease. Whilst their effects on platelet reactivity are well documented, it is unclear, however, whether antiplatelet therapy inhibits platelet extracellular vesicle (EV) release. The aim of this study was to investigate the effects of antiplatelet therapy on platelet EV formation and procoagulant activity. Blood samples from 10 healthy controls not receiving antiplatelet therapy were incubated in vitro with aspirin or a P2Y12 inhibitor (MeSAMP). Blood samples from 50 patients receiving long-term dual antiplatelet therapy and undergoing coronary angiography were also studied. Platelet reactivity was assessed by Multiplate™ impedance aggregometry. Platelet EV formation and procoagulant activity of pretreated and untreated blood samples in response to arachidonic acid (AA), adenosine diphosphate (ADP), ADP+PGE1, and thrombin receptor-activating peptide (TRAP) stimulation were assessed by flow cytometry and Procoag-PL assays, respectively. Incubation of normal platelets with aspirin significantly inhibited AA-induced platelet reactivity, EV formation, and procoagulant activity, whilst MeSAMP significantly inhibited platelet reactivity and EV formation in response to AA, ADP, and TRAP, but had minimal effect on procoagulant activity. Most patients receiving dual antiplatelet therapy showed an appropriate reduction in platelet reactivity in response to their treatment; however there was not complete inhibition of increased platelet and EV procoagulant activity in response to ADP, AA, or TRAP. In addition, we could not find any correlation between platelet reactivity and procoagulant activity in patients receiving dual antiplatelet therapy.

  19. Magnitude and correlates of moderate to severe anemia among adult HIV patients receiving first line HAART in Northwestern Tanzania: a cross sectional clinic based study

    Science.gov (United States)

    Gunda, Daniel Wilfred; Kilonzo, Semvua Bukheti; Mpondo, Bonaventura Cornel

    2016-01-01

    Introduction Moderate to severe anemia is an important clinical problem in HIV patients on Highly Active Antiretroviral Therapy. The rate of progression and mortality in this sub group of patients is high compared to non anemic patients. In sub Saharan Africa with scale up of Anti retroviral therapy, the magnitude of this problem is not known especially in Tanzania. This study aimed at determining the magnitude and correlates of moderate to severe anemia in HIV patients receiving first line ART in northwestern Tanzania. Methods This was a cross sectional clinic based study, involving adult HIV patients on first line Highly Active Antiretroviral Therapy at Bugando Medical Centre Care and Treatment Center. The patients’ data were analyzed using STATA version 11 to determine the prevalence of moderate to severe anemia and risk factors that could predict occurrence of anemia. Results In this study 346 patients on Highly Active Anti-Retroviral Therapy were enrolled, of whom 100(40.46%) had moderate to severe anemia. The odds of being anemic were strongly predicted by Zidovudine based regime, low baseline CD4 count (100fl. Conclusion The prevalence of moderate to severe anemia is significantly high in this cohort of HIV-infected patients on first line Anti Retroviral Therapy and it is strongly predicted by Zidovudine based regime, low baseline CD4 and HIV stage 3 and 4. On clinical grounds this suggests that patients who are initiated on Zidovudine based regimen and those in advanced HIV at enrollment should have regular haemoglobin follow up to identify anemia at its earliest stage to improve the clinical outcome of these patients. PMID:27200131

  20. Changes of activated circulating endothelial cells and survivin in patients with non-small cell lung cancer after antiangiogenesis therapy

    Institute of Scientific and Technical Information of China (English)

    WANG Jing; HUANG Chun; WEI Xi-yin; QI Da-liang; GONG Li-qun; MU Hai-yu; YAO Qiang; LI Kai

    2008-01-01

    Background Although antiangiogenesis therapy plays an important role in anti-neoplastic treatment with its recognized efficacy and slight adverse effect,there is no prospective clinical trial to define ideal markers for predicting efficacy of antiangiogenic therapy.This study was undertaken to investigate the changes of activated circulating endothelial cells (aCECs) and survMn after anti-angiogenesis therapy and their significance in predicting the efficacy of the therapy.Methods Patients of non-small cell lung cancer (NSCLC) treated with chemotherapy with or without Endostar were observed.The amount of activated CECs was detected by flow cytometry,and the expression of survivin mRNA was determined by real-time polymerase chain reaction (PCR).Results After treatment,the amount of activated CECs decreased significantly in clinical benefit cases (P=-0.021 in chemotherapy alone,P=0.001 in chemotherapy plus Endostar),increased in disease progressive cases (P=-0.015 in chemotherapy alone,but P=0.293 in chemotherapy with Endotatar).After therapy,the expression of survivin mRNA decreased in clinical benefit cases (P=0.001) and increased in disease progressive cases (P=0.018).A positive correlation was found between activated CECs and survivin in the chemotherapy group pre- and post-therapy (P=0.001 and 0.021,respectively),but only in the chemotherapy with Endostar group pre-therapy (P=0.030) rather than post-therapy.A positive correlation was found between the decreased activated CECs after therapy and time to progression (TTP) (r=0.322,P=0.012);a negative correlation was found between the amount of survivin mRNA in serum post-therapy and TTP(r= -0.291,P=0.048).Conclusions Activated CECs and survMn may be ideal markers forecasting efficacy and prognosis of NSCLC.The former can reflect more sensitively antiangiogenic efficacy and the latter is more sensitive to shrinkage or swelling of tumors.Their combination can evaluate more accurately the efficacy of antiangiogenic

  1. Utilization of contraception among sexually active HIV positive women attending art clinic in University of Gondar Hospital: a hospital based cross-sectional study.

    Science.gov (United States)

    Worke, Mulugeta Dile; Bezabih, Lealem Meseret; Woldetasdik, Mulat Adefris

    2016-10-21

    Contraception helps to prevent unplanned pregnancies among human immune virus positive women. The contraceptive utilization status and associated factors were not well addressed in the study area. Therefore, this study aimed to assess utilization of contraceptives and associated factors among human immune virus positive reproductive age group women appearing at anti-retroviral therapy clinic at the University of Gondar Hospital, North West Ethiopia. An institution based cross-sectional study was conducted among 397 systematically selected HIV positive reproductive age women who visited ART unit of the University of Gondar teaching referral hospital from January 8-20, 2014. The data were collected using pre tested and structured questionnaires through face-to-face interviews. The data were entered into Epi-Info version 3.5, and cleaned and analyzed using SPSS version 20. Descriptive summary of the data and logistic regression were used to identify possible predictors using odds ratio with 95 % confidence interval and P-value of 0.05. The study revealed that the overall utilization of any type of contraception was 50 %. Of them, 4.1 % got contraception from anti-retroviral therapy unit. Fear of side effects was the most common (42 %) reason for not using contraception. Women who attended secondary education, married and who had 4-6 children were more likely to use contraception than their counterparts were; (AOR: 5.63; 95 % CI: 1.74-18.21), (AOR: 8.07; 95 % CI: 3.10-20.99) and (AOR: 3.61; 95 % CI: 1.16-11.26) respectively. However, Women between 35-49 years, had no intention to have another child and discordant couples were 83 %, 76 % and 65 % less likely to use contraception respectively than their counterparts. The results of this study revealed that the utilization of contraception was low. Women between 35-49 years, those who had no intention to have another child and whose partner was HIV sero-negative and fear of side effect of the contraception

  2. Active music therapy improves cognition and behaviour in chronic vascular encephalopathy: a case report.

    Science.gov (United States)

    Giovagnoli, Anna Rita; Oliveri, Serena; Schifano, Letizia; Raglio, Alfredo

    2014-02-01

    This study describes the effects of active music therapy (AMT) on cognition and behaviour in chronic vascular encephalopathy. A single case study investigated different cognitive and psycho-behavioural changes after AMT. An adult patient with memory, attention, and verbal fluency deficits associated with Vascular Cognitive Impairment-No Dementia (VCI-ND) was treated. A four-months AMT course was based on creative and interactive music playing. Sixteen sessions were conducted simultaneously to the pharmacological therapy. Cognitive performances, mood, interpersonal interactions, and perceived abilities were assessed using standardized neuropsychological and psycho-behavioural measurements. At baseline, the patient reported a tendency to feel tense, nervous, and angry and difficulties in memory and visuospatial performances, frequently accompanied by attention drops. The social network was a habitual component of the patient's life, but not a source of sharing of personal experiences, safety or comfort. Neuropsychological tests showed deficits in object and figure naming, verbal fluency, short and long-term verbal memory, short-term spatial memory, selective attention, and visuomotor coordination. After AMT, the cognitive profile significantly improved in attention, visuomotor coordination, and verbal and spatial memory. Such positive changes were confirmed at the three-months follow-up. An increase of the interpersonal interactions and consistent reduction of anxiety were also observed. In selected patients with VCI-ND, a well-structured AMT intervention added to standard therapy may contribute in determining a stable improvement of cognitive and psycho-behavioural aspects. Controlled studies are needed to confirm these promising results. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Gene therapy with IL-12 induced enhanced anti-tumor activity in fibrosarcoma mouse model.

    Science.gov (United States)

    Razi Soofiyani, Saiedeh; Kazemi, Tohid; Lotfipour, Farzaneh; Mohammad Hosseini, Akbar; Shanehbandi, Dariush; Hallaj-Nezhadi, Somayeh; Baradaran, Behzad

    2016-12-01

    Context Immunotherapy is among the most promising modalities for treatment of cancer. Recently, interleukin 12 (IL-12) has been used as an immunotherapeutic agent in cancer gene therapy. IL-12 can activate dendritic cells (DCs) and boost anti-tumor immune responses. Objective In the current study, we have investigated if IL-12 gene therapy can lead to the regression of tumor mass in a mouse model of fibrosarcoma. Material and methods To investigate the therapeutic efficacy of IL-12, WEHI-164 tumor cells were transfected with murine-IL12 plasmids using Lipofectamine. Enzyme linked immunosorbent assay (ELISA) was used to confirm IL-12 expression in transfected cells. The fibrosarcoma mouse model was established by subcutaneous injection of transfected cells to Balb/C mice. Mice were sacrificed and the tumors were extracted. Tumor sizes were measured by caliper. The expression of IL-12 and IFN-γ was studied with real-time PCR and western blotting. The expression of Ki-67(a tumor proliferation marker) in tumor mass was studied by immunohistochemistry staining. Results and discussion The group treated with IL-12 showed a significant decrease in tumor mass volume (P: 0.000). The results of real-time PCR and western blotting showed that IL-12 and IFN-γ expression increased in the group treated with IL-12 (relative expression of IL-12: 1.9 and relative expression of IFN-γ: 1.766). Immunohistochemistry staining showed that Ki-67 expression was reduced in the group treated with IL-12. Conclusion IL-12 gene therapy successfully led to regress of tumor mass in the fibrosarcoma mouse model. This may serve as a candidate therapeutic approach for treatment of cancer.

  4. ANALGESIC AND ANTI-INFLAMMATORY ACTIVITY OF LEECH THERAPY IN THE MANAGEMENT OF ARTHRITIS

    Directory of Open Access Journals (Sweden)

    Singh Akhilesh Kumar

    2011-12-01

    Full Text Available The day-to-day advancement in each and every aspect has made human’s life very fast, hectic and full of stress. In such an outfit every person is compelled to make the life fast and mechanical even shifted their food habits to fast food, altered their social structure and life style, having various negative impacts on the body. Occurrence of arthritis on large scale is one of the outcomes of this modification. It is commonest among acute as well as chronic inflammatory joint disease in which joint become painful, swollen and stiff. This study was designed to access the analgesic and anti-inflammatory activity of Leech Therapy in the treatment Arthritis. The study was randomized open phase clinical trial. Jalauka used for the therapy were obtained from fresh water pond of Madhyam Akara (4-6gms weight. Jalaukas were applied once in every week for six weeks duration.The patients of age group 18 to 60 were selected on the basis of Ayurvedic signs and symptoms of Sandhigata Vata. Observations were recorded for Pain, Swelling, Stiffness, Score of ACR, RA index, ARA joint count, Tenderness. The laboratory values of ESR, CRP and S.uric Acid were also recorded before and after the treatment. Since the assessment criteria was Quantitative, paired 't' test was applied. In the current Study the treatment was found significantly effective in treating arthritis. The effect of treatment was 44% patients were of Uttam Upashya in relieving Pain, 40% in swelling, 28% in stiffness, 32% in restricted movement, 16% in deformity. So, we can conclude that leech therapy is effective in the treatment of arthritis.

  5. Photo-activated elimination of Aggregatibacter actinomycetemcomitans in planktonic culture: Comparison of photodynamic therapy versus photothermal therapy method.

    Science.gov (United States)

    Fekrazad, Reza; Khoei, Farzaneh; Bahador, Abbas; Hakimiha, Neda

    2017-09-01

    Periodontal pathogens are the main factors responsible for periodontal diseases and considering the limitations of conventional mechanical debridement, new treatment approaches are under investigation. This study was designed to evaluate and compare the antibacterial effects of two different systems of photodynamic and photothermal therapy on Aggregatibacter actinomycetemcomitans as the main pathogen involved in aggressive Periodontitis. Cultures of Aggregatibacter actinomycetemcomitans were exposed to 662nm laser in presence of Radachlorin(®) photosensitizer (photodynamic group) or 810nm laser in presence of EmunDo(®) photosensitizer (photothermal group), then bacterial suspension of each well in the study groups were diluted and subcultured on the surface of Muller-Hinton agar plates. subsequently the number of colony forming units per milliliter of the wells were determined and checked by analysis of variance and Tukey test (pphotodynamic and photothermal therapy with no priority. Based on the results of this study, photodynamic and photothermal therapy can be proposed as a new promising approaches for bacterial elimination in periodontal diseases. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Treatment of severe active systemic lupus erythematosus by PMC therapy combined Langchuang Fuzheng Jiedu capsule: a clinical observation

    Institute of Scientific and Technical Information of China (English)

    宋欣伟

    2013-01-01

    Objective To evaluate the efficacy and safety of PMC therapy (Prednisone,Methotrexate,Chloroquine) combined Langchuang Fuzheng Jiedu Capsule (LFJC) ,thus choosing a better therapy of integrative medicine for SLE in the period of glucocorticoid use.Methods Sixty active SLE patients were randomly assigned to two groups,the control group and the treatment group.Those in the control group received PMC therapy (As for Prednisone,it was given at the daily dose of 1 mg/kg till 2weeks after the condition being stable or after 8 weeks of

  7. Therapy students' recommendations of physical activity for managing persistent low back pain in older adults.

    Science.gov (United States)

    Ryan, Cormac G; Schofield, Patricia; Martin, Denis J

    2013-07-01

    Negative views of older adults can lead to suboptimal care. For older adults with persistent low back pain (LBP), promotion of physical activity by health care professionals is important. Health care professionals' views of older adults are influenced by their training. This study aimed to compare recommendations for physical activity for managing persistent LBP offered by students in physiotherapy and occupational therapy to an older person vs. a younger person. In a cross-sectional online survey, participants (N = 77) randomly received a vignette of either a 40-yr-old or 70-yr-old patient with persistent LBP. Other than age, the vignettes were identical. There was no difference between the younger and older vignettes in the likelihood of participants making overall appropriate physical activity recommendations--63% vs. 59%, OR (95% CI) = 1.19 (0.48-2.99), p = .71--although there was a trend toward age bias on recommendations specific to daily activity. Postqualification education may be where ageist views need to be addressed.

  8. Uncoupling RARA transcriptional activation and degradation clarifies the bases for APL response to therapies.

    Science.gov (United States)

    Ablain, Julien; Leiva, Magdalena; Peres, Laurent; Fonsart, Julien; Anthony, Elodie; de Thé, Hugues

    2013-04-01

    In PML/RARA-driven acute promyelocytic leukemia (APL), retinoic acid (RA) induces leukemia cell differentiation and transiently clears the disease. Molecularly, RA activates PML/RARA-dependent transcription and also initiates its proteasome-mediated degradation. In contrast, arsenic, the other potent anti-APL therapy, only induces PML/RARA degradation by specifically targeting its PML moiety. The respective contributions of RA-triggered transcriptional activation and proteolysis to clinical response remain disputed. Here, we identify synthetic retinoids that potently activate RARA- or PML/RARA-dependent transcription, but fail to down-regulate RARA or PML/RARA protein levels. Similar to RA, these uncoupled retinoids elicit terminal differentiation, but unexpectedly fail to impair leukemia-initiating activity of PML/RARA-transformed cells ex vivo or in vivo. Accordingly, the survival benefit conferred by uncoupled retinoids in APL mice is dramatically lower than the one provided by RA. Differentiated APL blasts sorted from uncoupled retinoid-treated mice retain PML/RARA expression and reinitiate APL in secondary transplants. Thus, differentiation is insufficient for APL eradication, whereas PML/RARA loss is essential. These observations unify the modes of action of RA and arsenic and shed light on the potency of their combination in mice or patients.

  9. Treatment of primary HIV-1 infection with cyclosporin A coupled with highly active antiretroviral therapy

    Science.gov (United States)

    Rizzardi, G. Paolo; Harari, Alexandre; Capiluppi, Brunella; Tambussi, Giuseppe; Ellefsen, Kim; Ciuffreda, Donatella; Champagne, Patrick; Bart, Pierre-Alexandre; Chave, Jean-Philippe; Lazzarin, Adriano; Pantaleo, Giuseppe

    2002-01-01

    Primary HIV-1 infection causes extensive immune activation, during which CD4+ T cell activation supports massive HIV-1 production. We tested the safety and the immune-modulating effects of combining cyclosporin A (CsA) treatment with highly active antiretroviral therapy (HAART) during primary HIV-1 infection. Nine adults with primary HIV-1 infection were treated with CsA along with HAART. At week 8, all patients discontinued CsA but maintained HAART. Viral replication was suppressed to a comparable extent in the CsA + HAART cohort and in 29 control patients whose primary infection was treated with HAART alone. CsA restored normal CD4+ T cell levels, both in terms of percentage and absolute numbers. The increase in CD4+ T cells was apparent within a week and persisted throughout the study period. CsA was not detrimental to virus-specific CD8+ or CD4+ T cell responses. At week 48, the proportion of IFN-γ–secreting CD4+ and CD4+CCR7– T cells was significantly higher in the CsA + HAART cohort than in the HAART-alone cohort. In conclusion, rapid shutdown of T cell activation in the early phases of primary HIV-1 infection can have long-term beneficial effects and establish a more favorable immunologic set-point. Appropriate, immune-based therapeutic interventions may represent a valuable complement to HAART for treating HIV infection. PMID:11877476

  10. Antibacterial and Antibiofilm Activities of the Photothermal Therapy Using Gold Nanorods against Seven Different Bacterial Strains

    Directory of Open Access Journals (Sweden)

    Juan Carlos Castillo-Martínez

    2015-01-01

    Full Text Available The objective of this work was to determine the bactericidal and antibiofilm activities of gold nanorods (AuNRs using plasmonic photothermal therapy (PPTT against oral microorganisms. AuNRs were synthesized by the seed and growth solution method and the gold nanoclusters were characterized with a size of 33.2 nm ± 2.23 length and 7.33 nm ± 1.60 width. The efficacy of PPTT related to its temperature was done reaching 67°C. Minimum inhibitory concentration (MIC and minimum bactericide concentration (MBC of AuNRs and AuNRs PPTT were determined against Enterococcus faecalis, Staphylococcus aureus, Streptococcus mutans, Streptococcus sobrinus, Streptococcus oralis, Streptococcus salivarius, and Escherichia coli growth. The antibiofilm activity of AuNRs was explored by fluorescence microscopy. After experimental analyses, AuNRs PPTT shows better results in MICs and MBCs, when it was compared with AuNRs alone. The laser employed to activate the AuNRs had no antibacterial effect against oral microbes. The MICs and MBCs values were higher for S. aureus and E. coli and lower against S. oralis. Surprisingly, the AuNRs alone presented a high antibiofilm activity, inhibiting the biofilm formation of S. mutans. Altogether, these results strongly suggest that AuNRs could be an interesting option to control oral biofilms.

  11. Long-term effectiveness of highly active antiretroviral therapy (HAART) in perinatally HIV-infected children in Denmark

    DEFF Research Database (Denmark)

    Bracher, Linda; Valerius, Niels Henrik; Rosenfeldt, Vibeke

    2007-01-01

    The long-term impact of highly active antiretroviral therapy (HAART) on HIV-1 infected children is not well known. The Danish Paediatric HIV Cohort Study includes all patients HIV-1 infection in Denmark. We report the complete follow-up from 1996 to 2005 of 49 perinatally infected...... characteristics were median CD4 percentage 14% and HIV-RNA viral load 4.9 log(10). Within the first 12 weeks of therapy approximately 60% achieved HIV-RNA viral load

  12. Effects of active rehabilitation therapy on muscular back strength and subjective pain degree in chronic lower back pain patients

    OpenAIRE

    Choi, Hea-Kyung; Gwon, Hak-ju; Kim, Seon-Rye; Park, Chan-Seok; Cho, Byung-Jun

    2016-01-01

    [Purpose] This study applied active rehabilitation therapy to muscular back strength and assessed the subjective pain degree in chronic low back pain patients. [Subjects and Methods] Subjects were randomly assigned to two groups: experimental (n=8) and control (n=8). The experimental group performed two types of rehabilitation therapy programs four times per week for eight weeks. The rehabilitation program was based on the Korea Occupational Safety and Health Agency’s program. There were seve...

  13. Epicardial Fat is Associated with Duration of Antiretroviral Therapy and Coronary Atherosclerosis: The Multicenter AIDS Cohort Study

    Science.gov (United States)

    Brener, Michael; Ketlogetswe, Kerunne; Budoff, Matthew; Jacobson, Lisa P.; Li, Xiuhong; Rezaeian, Panteha; Razipour, Aryabod; Palella, Frank J; Kingsley, Lawrence; Witt, Mallory D; George, Richard T; Post, Wendy S

    2014-01-01

    Objective Cytokines released by epicardial fat are implicated in the pathogenesis of atherosclerosis. HIV infection and anti-retroviral therapy have been associated with changes in body fat distribution and coronary artery disease. We sought to determine if HIV infection is associated with greater epicardial fat and if epicardial fat is associated with subclinical coronary atherosclerosis. Design We studied 579 HIV-infected and 353 HIV-uninfected men age 40 to 70 years with non-contrast computed tomography (CT) to measure epicardial adipose tissue volume (EAT) and coronary artery calcium (CAC). Total plaque score (TPS), and plaque subtypes (non-calcified, calcified and mixed) were measured by coronary CT angiography in 706 men. Methods We evaluated the association between EAT and HIV serostatus, and the association of EAT with subclinical atherosclerosis, adjusting for age, race and serostatus and with additional cardiovascular (CV) risk factors and tested for modifying effects of HIV serostatus. Results HIV-infected men had greater EAT than HIV-uninfected men (p=0.001). EAT was positively associated with duration of antiretroviral therapy (p=0.02), specifically AZT (p<0.05). EAT was associated with presence of any coronary artery plaque (p=0.006) and non-calcified plaque (p=0.001), adjusting for age, race, serostatus and CV risk factors. Among men with CAC, EAT was associated with CAC extent (p=0.006). HIV serostatus did not modify associations between EAT and either CAC extent or presence of plaque. Conclusions Greater epicardial fat volume in HIV-infected men and its association with coronary plaque and antiretroviral therapy duration suggest potential mechanisms that might lead to increased risk for cardiovascular disease in HIV. PMID:24809732

  14. SU-E-J-49: Distal Edge Activity Fall Off Of Proton Therapy Beams

    Energy Technology Data Exchange (ETDEWEB)

    Elmekawy, A; Ewell, L [Hampton University, Hampton, VA (United States); Butuceanu, C; Zhu, L [HUPTI, Hampton, VA (United States)

    2014-06-01

    Purpose: To characterize and quantify the distal edge activity fall off, created in a phantom by a proton therapy beam Method and Materials: A 30x30x10cm polymethylmethacrylate phantom was irradiated with a proton therapy beam using different ranges and beams. The irradiation volume is approximated by a right circular cylinder of diameter 7.6cm and varying lengths. After irradiation, the phantom was scanned via a Philips Gemini Big Bore™ PET-CT for isotope activation. Varian Eclipse™ treatment planning system as well as ImageJ™ were used to analyze the resulting PET and CT scans. The region of activity within the phantom was longitudinally measured as a function of PET slice number. Dose estimations were made via Monte Carlo (GATE) simulation. Results: For both the spread out Bragg peak (SOBP) and the mono-energetic pristine Bragg peak proton beams, the proximal activation rise was steep: average slope −0.735 (average intensity/slice number) ± 0.091 (standard deviation) for the pristine beams and −1.149 ± 0.117 for the SOBP beams. In contrast, the distal fall offs were dissimilar. The distal fall off in activity for the pristine beams was fit well by a linear curve: R{sup 2} (Pierson Product) was 0.9968, 0.9955 and 0.9909 for the 13.5, 17.0 and 21.0cm range beams respectively. The good fit allows for a slope comparison between the different ranges. The slope varied as a function of range from 1.021 for the 13.5cm beam to 0.8407 (average intensity/slice number) for the 21.0cm beam. This dependence can be characterized: −0.0234(average intensity/slice number/cm range). For the SOBP beams, the slopes were significantly less and were also less linear: average slope 0.2628 ± 0.0474, average R{sup 2}=0.9236. Conclusion: The distal activation fall off edge for pristine proton beams was linear and steep. The corresponding quantities for SOBP beams were shallower and less linear. Philips has provided support for this work.

  15. Magnetic field activated drug release system based on magnetic PLGA microspheres for chemo-thermal therapy.

    Science.gov (United States)

    Fang, Kun; Song, Lina; Gu, Zhuxiao; Yang, Fang; Zhang, Yu; Gu, Ning

    2015-12-01

    Controlled drug delivery systems have been extensively investigated for cancer therapy in order to obtain better specific targeting and therapeutic efficiency. Herein, we developed doxorubicin-loaded magnetic PLGA microspheres (DOX-MMS), in which DOX was encapsulated in the core and high contents (28.3 wt%) of γ-Fe2O3 nanoparticles (IOs) were electrostatically assembled on the surface of microsphere to ensure the high sensitivity to response of an external alternating current magnetic field (ACMF). The IOs in PLGA shell can both induce the heat effect and trigger shell permeability enhancement to release drugs when DOX-MMs was activated by ACMF. Results show that the cumulative drug release from DOX-MMs exposed to ACMF for 30 min (21.6%) was significantly higher (approximately 7 times higher) than that not exposed to ACMF (2.8%). The combination of hyperthermia and enhanced DOX release from DOX-MMS is beneficial for in vitro 4T1 breast cancer cell apoptosis as well as effective inhibition of tumor growth in 4T1 tumor xenografts. Therefore, the DOX-MMS can be optimized as powerful delivery system for efficient magnetic responsive drug release and chemo-thermal therapy.

  16. Disseminated rhodococcus equi infection in HIV infection despite highly active antiretroviral therapy

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    Ferretti Francesca

    2011-12-01

    Full Text Available Abstract Background Rhodococcus equi (R.equi is an acid fast, GRAM + coccobacillus, which is widespread in the soil and causes pulmonary and extrapulmonary infections in immunocompromised people. In the context of HIV infection, R.equi infection (rhodococcosis is regarded as an opportunistic disease, and its outcome is influenced by highly active antiretroviral therapy (HAART. Case presentation We report two cases of HIV-related rhodococcosis that disseminated despite suppressive HAART and anti-rhodococcal treatment; in both cases there was no immunological recovery, with CD4+ cells count below 200/μL. In the first case, pulmonary rhodococcosis presented 6 months after initiation of HAART, and was followed by an extracerebral intracranial and a cerebral rhodococcal abscess 1 and 8 months, respectively, after onset of pulmonary infection. The second case was characterized by a protracted course with spread of infection to various organs, including subcutaneous tissue, skin, colon and other intra-abdominal tissues, and central nervous system; the spread started 4 years after clinical resolution of a first pulmonary manifestation and progressed over a period of 2 years. Conclusions Our report highlights the importance of an effective immune recovery, despite fully suppressive HAART, along with anti-rhodococcal therapy, in order to clear rhodococcal infection.

  17. Natural healers: a review of animal assisted therapy and activities as complementary treatment for chronic conditions.

    Science.gov (United States)

    Reed, Reiley; Ferrer, Lilian; Villegas, Natalia

    2012-01-01

    The primary objective of this review is to synthesize the existing literature on the use of animal-assisted therapy and activity (AAT/A) as complementary treatment among people living with chronic disease and to discuss the possible application of this practice among children living with HIV. Relevant databases were searched between March 10 and April 11, 2011, using the words: animal assisted therapy or treatment and chronic conditions or diseases. Thirty-one articles were found and 18 followed the inclusion and exclusion criteria. Research suggests that AAT/A is effective for different patient profiles, particularly children. Interaction with dogs has been found to increase positive behaviors, such as sensitivity and focus, in children with social disabilities. Decreased levels of pain have also been reported among child patients as a result of AAT/A. More research should be done in the area of children living with chronic diseases that require strict adherence to treatment, such as HIV, and on AAT/A's prospective use as an educational tool to teach children about the importance of self-care for their medical conditions.

  18. Decline in HIV infectivity following the introduction of highly active antiretroviral therapy

    Science.gov (United States)

    Porco, Travis C.; Martin, Jeffrey N.; Page-Shafer, Kimberly A.; Cheng, Amber; Charlebois, Edwin; Grant, Robert M.; Osmond, Dennis H.

    2008-01-01

    Objective Little is known about the degree to which widespread use of antiretroviral therapy in a community reduces uninfected individuals’ risk of acquiring HIV. We estimated the degree to which the probability of HIV infection from an infected partner (the infectivity) declined following the introduction of highly active antiretroviral therapy (HAART) in San Francisco. Design Homosexual men from the San Francisco Young Men’s Health Study, who were initially uninfected with HIV, were asked about sexual practices, and tested for HIV antibodies at each of four follow-up visits during a 6-year period spanning the advent of widespread use of HAART (1994 to 1999). Methods We estimated the infectivity of HIV (per-partnership probability of transmission from an infected partner) using a probabilistic risk model based on observed incident infections and self-reported sexual risk behavior, and tested the hypothesis that infectivity was the same before and after HAART was introduced. Results A total of 534 homosexual men were evaluated. Decreasing trends in HIV seroincidence were observed despite increases in reported number of unprotected receptive anal intercourse partners. Conservatively assuming a constant prevalence of HIV infection between 1994 and 1999, HIV infectivity decreased from 0.120 prior to widespread use of HAART, to 0.048 after the widespread use of HAART – a decline of 60% (P = 0.028). Conclusions Use of HAART by infected persons in a community appears to reduce their infectiousness and therefore may provide an important HIV prevention tool. PMID:15090833

  19. Simultaneous two-photon activation of type-I photodynamic therapy agents.

    Science.gov (United States)

    Fisher, W G; Partridge, W P; Dees, C; Wachter, E A

    1997-08-01

    The excitation and emission properties of several psoralen derivatives are compared using conventional single-photon excitation and simultaneous two-photon excitation (TPE). Two-photon excitation is effected using the output of a mode-locked titanium: sapphire laser, the near infrared output of which is used to promote nonresonant TPE directly. Specifically, the excitation spectra and excited-state properties of 8-methoxypsoralen and 4'-aminomethyl-4,5,8-trimethylpsoralen are shown to be equivalent using both modes of excitation. Further, in vitro feasibility of two-photon photodynamic therapy (PDT) is demonstrated using Salmonella typhimurium. Two-photon excitation may be beneficial in the practice of PDT because it would allow replacement of visible or UV excitation light with highly penetrating, nondamaging near infrared light and could provide a means for improving localization of therapy. Comparison of possible laser excitation sources for PDT reveals the titanium: sapphire laser to be exceptionally well suited for nonlinear excitation of PDT agents in biological systems due to its extremely short pulse width and high repetition rate that together provide efficient PDT activation and greatly reduced potential for biological damage.

  20. Effect of Atorvastatin intensive therapy on the serum inflammatory factors, platelet activity and fibrinolytic activity in patients with acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    Xiao-Li Zhu; Yun Zhou; Fang Liu

    2016-01-01

    Objective:To observe the effect of Atorvastatin intensive therapy on the serum inflammatory factors, platelet activity and fibrinolytic activity in patients with acute coronary syndrome (ACS).Methods:A total of 92 patients with ACS were randomly divided into observation group (47 cases) and control group (45 cases). The control group was given Atorvastatin (10 mg/d) based on the conventional therapy, while the observation group was given Atorvastatin at an intensive dose (40 mg/d) based on the conventional therapy. Half a month later, the changes of IL-6, IL-8, hs-CRP, TNF-α, TXB2, GMP-140, PAI-1 and t-PA were observed and compared between the two groups.Results:After treatment, the inflammatory factors (IL-6, IL-8, hs-CRP and TNF-α) and the indicators of platelet activity (TXB2, GMP-140 and PAI-1) were obviously decreased, while the indicator of fibrinolytic activity (t-PA) was apparently increased in the two groups. Besides, the amplitudes of change referring to these indicators in the observation group were bigger than those in the control group after treatment, and the differences were statistically significant.Conclusion: The intensive therapy with the administration of Atorvastatin at a dose of 40 mg/d was better than the conventional therapy (Atorvastatin: 10 mg/d) in aspects of reducing inflammatory factors, inhibiting platelet activity and correcting the high coagulation state of fibrinolytic system.

  1. QTF-Gold assay for monitoring of anti-tuberculosis therapy in subjects with active TB

    Directory of Open Access Journals (Sweden)

    Ilaria Sauzullo

    2008-09-01

    Full Text Available Introduction: The identification and characterization of two M. tuberculosis-specific antigens (ESAT-6 and CFP- 10 has led to the development of a whole blood new generation of M. tuberculosis specific diagnostic tests, that have several advantages over tuberculin skin test (TST, in terms of higher specificity, better correlation with surrogate measures of exposure to M. tuberculosis in low-incidence setting, and less cross-reactivity with M. bovis (BCG vaccine and environmental mycobacteria.The role of these new tests in evaluating post-therapy tuberculosis eradication has not been investigated yet. Aim of this longitudinal study was to determinate changes of response to M. tuberculosis-specific antigens in patients during the standard tuberculosis treatment and to investigate the in vitro effects of tuberculosis drugs on the IFN-γ release. Methods: 23 individuals with active tuberculosis were enrolled and followed over time.They were tested with QuantiFERON TB-Gold (QFT-Gold at four time points: at diagnosis (t0, after 3 and 6 months of treatment (t1- t2 and at the end of the specific treatment (t3. Results: At baseline all patients were positive by QFT-Gold.At second time-point 17 out of 23 (74% were positive, at third time-point 11 of 23 (47% were positive, at treatment completion 3/23 (13% were positive.The conversion to negative response to M. tuberculosis-specific antigens was found in 87% patients analyzed after successful therapy. Longitudinal QFT-Gold testing shown a significant decrease (p<0.001 of IFN-γ response during the therapy. No inhibitory effect on IFN-γ release was noted in vitro for chemotherapy using at concentrations compatible with those achieved in serum of treated patients.We have revealed an inhibitory effect only at concentrations 2-3 times greater than those previously tested. Conclusion: A successful therapy for tuberculosis causes a significant decrease of the ESAT-6 and CFP-10 response and this data suggest

  2. Impediments to Enhancement of CPT-11 Anticancer Activity by E. coli Directed Beta-Glucuronidase Therapy

    Science.gov (United States)

    Hsieh, Yuan-Ting; Chen, Kai-Chuan; Cheng, Chiu-Min; Cheng, Tian-Lu; Tao, Mi-Hua; Roffler, Steve R.

    2015-01-01

    CPT-11 is a camptothecin analog used for the clinical treatment of colorectal adenocarcinoma. CPT-11 is converted into the therapeutic anti-cancer agent SN-38 by liver enzymes and can be further metabolized to a non-toxic glucuronide SN-38G, resulting in low SN-38 but high SN-38G concentrations in the circulation. We previously demonstrated that adenoviral expression of membrane-anchored beta-glucuronidase could promote conversion of SN-38G to SN-38 in tumors and increase the anticancer activity of CPT-11. Here, we identified impediments to effective tumor therapy with E. coli that were engineered to constitutively express highly active E. coli beta-glucuronidase intracellularly to enhance the anticancer activity of CPT-11. The engineered bacteria, E. coli (lux/βG), could hydrolyze SN-38G to SN-38, increased the sensitivity of cultured tumor cells to SN-38G by about 100 fold and selectively accumulated in tumors. However, E. coli (lux/βG) did not more effectively increase CPT-11 anticancer activity in human tumor xenografts as compared to non-engineered E. coli. SN-38G conversion to SN-38 by E. coli (lux/βG) appeared to be limited by slow uptake into bacteria as well as by segregation of E. coli in necrotic regions of tumors that may be relatively inaccessible to systemically-administered drug molecules. Studies using a fluorescent glucuronide probe showed that significantly greater glucuronide hydrolysis could be achieved in mice pretreated with E. coli (lux/βG) by direct intratumoral injection of the glucuronide probe or by intratumoral lysis of bacteria to release intracellular beta-glucuronidase. Our study suggests that the distribution of beta-glucuronidase, and possibly other therapeutic proteins, in the tumor microenvironment might be an important barrier for effective bacterial-based tumor therapy. Expression of secreted therapeutic proteins or induction of therapeutic protein release from bacteria might therefore be a promising strategy to enhance anti

  3. Impediments to enhancement of CPT-11 anticancer activity by E. coli directed beta-glucuronidase therapy.

    Science.gov (United States)

    Hsieh, Yuan-Ting; Chen, Kai-Chuan; Cheng, Chiu-Min; Cheng, Tian-Lu; Tao, Mi-Hua; Roffler, Steve R

    2015-01-01

    CPT-11 is a camptothecin analog used for the clinical treatment of colorectal adenocarcinoma. CPT-11 is converted into the therapeutic anti-cancer agent SN-38 by liver enzymes and can be further metabolized to a non-toxic glucuronide SN-38G, resulting in low SN-38 but high SN-38G concentrations in the circulation. We previously demonstrated that adenoviral expression of membrane-anchored beta-glucuronidase could promote conversion of SN-38G to SN-38 in tumors and increase the anticancer activity of CPT-11. Here, we identified impediments to effective tumor therapy with E. coli that were engineered to constitutively express highly active E. coli beta-glucuronidase intracellularly to enhance the anticancer activity of CPT-11. The engineered bacteria, E. coli (lux/βG), could hydrolyze SN-38G to SN-38, increased the sensitivity of cultured tumor cells to SN-38G by about 100 fold and selectively accumulated in tumors. However, E. coli (lux/βG) did not more effectively increase CPT-11 anticancer activity in human tumor xenografts as compared to non-engineered E. coli. SN-38G conversion to SN-38 by E. coli (lux/βG) appeared to be limited by slow uptake into bacteria as well as by segregation of E. coli in necrotic regions of tumors that may be relatively inaccessible to systemically-administered drug molecules. Studies using a fluorescent glucuronide probe showed that significantly greater glucuronide hydrolysis could be achieved in mice pretreated with E. coli (lux/βG) by direct intratumoral injection of the glucuronide probe or by intratumoral lysis of bacteria to release intracellular beta-glucuronidase. Our study suggests that the distribution of beta-glucuronidase, and possibly other therapeutic proteins, in the tumor microenvironment might be an important barrier for effective bacterial-based tumor therapy. Expression of secreted therapeutic proteins or induction of therapeutic protein release from bacteria might therefore be a promising strategy to enhance anti

  4. Evaluation of adherence to highly active antiretroviral therapy in adults in Jamaica.

    Science.gov (United States)

    Harvey, K M; Carrington, D; Duncan, J; Figueroa, J P; Hirschorn, L; Manning, D; Jackson, S

    2008-06-01

    Highly active antiretroviral therapy (HAART) has improved morbidity and mortality and quality of life, revitalized communities and transformed the perception of HIV/AIDS from being a "death sentence" to a chronic illness. Strict and sustained adherence to medication is essential long-term viral suppression. In April 2005, an Adherence Support Programme was introduced to Jamaica's HIV Programme, whereby Persons Living with HIV/AIDS (PLWHA) who had achieved high levels of adherence were trained to provide support to other PLWHA in order to increase their adherence to HAART regimens. A cross-sectional survey of 116 individuals with advanced HIV and on HAART was performed in June and July 2006. Many participants were unemployed, poor persons with limited education. Based on self-report of seven-day adherence, 54.8% of persons were 95-100% adherent, 37.5% were 80-94% adherent and 7.7% were alarm clocks and cell phones must be reinforced.

  5. A case of atypical progressive outer retinal necrosis after highly active antiretroviral therapy.

    Science.gov (United States)

    Woo, Se Joon; Yu, Hyeong Gon; Chung, Hum

    2004-06-01

    This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients.

  6. Assessing disease activity in psoriasis and psoriatic arthritis: impact on management and therapy.

    Science.gov (United States)

    Chandran, Vinod; Maharaj, Ajesh B

    2016-01-01

    The management of psoriatic arthritis (PsA) and psoriasis has undergone major advancements over the last decade. This has been made possible, in part, due to the introduction of new therapies for their management, as well as global collaboration in the development of outcome measures and "treat- to- target" paradigms. In this review article, we discuss how disease activity is measured and the outcome measures that have been recently developed for the management of PsA. The importance of assessing the individual domains as well as global assessments both from the physician and patient perspective, and the development of composite measures are discussed. The newer PsA specific measures are expected to be more commonly used in clinical trials as well as clinical practice.

  7. Exploring sudden gains in behavioral activation therapy for Major Depressive Disorder.

    Science.gov (United States)

    Hunnicutt-Ferguson, Kallio; Hoxha, Denada; Gollan, Jackie

    2012-03-01

    Understanding the onset and course of sudden gains in treatment provides clinical information to the patient and clinician, and encourages clinicians to strive for these sudden clinical gains with their patients. This study characterizes the occurrence of sudden gains with Behavioral Activation (BA; Martell, Addis, & Jacobson, 2001), and the extent to which pre-treatment dysfunctional depressive thinking predicts sudden gains during treatment. We enrolled a sample of adults (n = 42) between ages 18-65 diagnosed with primary Major Depressive Disorder. All participants completed a 16-week course of BA, with clinical and self-report assessments at pre-, mid- and post-treatment. Results indicated that sudden gain and non-sudden gain participants showed differential improvement across treatment. No significant effects emerged for the dysfunctional cognitive style as a predictor of sudden gain status. Sudden gains may result from interaction of non-specific factors with the BA techniques implemented during early phases of therapy.

  8. Impact of highly active antiretroviral therapy in the development and remission of oral plasmablastic lymphoma

    Directory of Open Access Journals (Sweden)

    Vivian Petersen Wagner

    2016-01-01

    Full Text Available Plasmablastic lymphoma (PBL represents a rare type of non-Hodgkin lymphoma associated with human immunodeficiency virus (HIV infection. The impact of highly active antiretroviral therapy (HAART in this tumor is poorly known due to its small incidence. This study reports a case of a 33-year-old HIV-positive woman who was referred to the Stomatology Department complaining about a painful gingival growth and cervical nodule both with 20 days of evolution. The lesions appeared 7 months after the patient stopped HAART. The final diagnosis was PBL. After resuming HAART for 45 days, the gingival lesion presented complete remission. The patient continued with HAART alongside chemotherapy. At 24 months follow-up, the patient was stable. The dental surgeon plays an essential role in orientation and retention in care of HIV patients once the adherence of HAART seems to play an important role in PBL development and response to treatment.

  9. Enhancing team-based active learning through hands-on experience with nicotine replacement therapy.

    Science.gov (United States)

    Franks, Andrea S

    2013-08-12

    To enhance tobacco cessation active-learning in an ambulatory care elective course by adding hands-on experience with nicotine replacement therapy to a team-based learning (TBL) session. A hands-on experience that included students chewing a piece of nicotine gum was added to a TBL class session. Student pairs used a skills checklist to evaluate and give peer feedback on appropriate counseling and gum use. Students' scores on a tobacco cessation examination were higher than those of students enrolled in the previous course in which TBL alone had been used. Based on pre- and post-experience survey responses, students' perceptions regarding their abilities to provide tobacco cessation counseling improved. Subjective student comments regarding the experience were positive. Participating in a TBL session that incorporated hands-on experience with nicotine gum in an ambulatory care elective course increased students' confidence in their ability to provide tobacco cessation counseling and provided a unique perspective on the product's characteristics.

  10. Complement activation and choriocapillaris loss in early AMD: implications for pathophysiology and therapy.

    Science.gov (United States)

    Whitmore, S Scott; Sohn, Elliott H; Chirco, Kathleen R; Drack, Arlene V; Stone, Edwin M; Tucker, Budd A; Mullins, Robert F

    2015-03-01

    Age-related macular degeneration (AMD) is a common and devastating disease that can result in severe visual dysfunction. Over the last decade, great progress has been made in identifying genetic variants that contribute to AMD, many of which lie in genes involved in the complement cascade. In this review we discuss the significance of complement activation in AMD, particularly with respect to the formation of the membrane attack complex in the aging choriocapillaris. We review the clinical, histological and biochemical data that indicate that vascular loss in the choroid occurs very early in the pathogenesis of AMD, and discuss the potential impact of vascular dropout on the retinal pigment epithelium, Bruch's membrane and the photoreceptor cells. Finally, we present a hypothesis for the pathogenesis of early AMD and consider the implications of this model on the development of new therapies.

  11. Effects of Baroreflex Activation Therapy on Ambulatory Blood Pressure in Patients With Resistant Hypertension.

    Science.gov (United States)

    Wallbach, Manuel; Lehnig, Luca-Yves; Schroer, Charlotte; Lüders, Stephan; Böhning, Enrico; Müller, Gerhard A; Wachter, Rolf; Koziolek, Michael J

    2016-04-01

    Baroreflex activation therapy (BAT) has been demonstrated to decrease office blood pressure (BP) in the randomized, double-blind Rheos trial. There are limited data on 24-hour BP changes measured by ambulatory BP measurements (ABPMs) using the first generation rheos BAT system suggesting a significant reduction but there are no information about the effect of the currently used, unilateral BAT neo device on ABPM. Patients treated with the BAT neo device for uncontrolled resistant hypertension were prospectively included into this study. ABPM was performed before BAT implantation and 6 months after initiation of BAT. A total of 51 patients were included into this study, 7 dropped out from analysis because of missing or insufficient follow-up. After 6 months, 24-hour ambulatory systolic (from 148 ± 17 mm Hg to 140 ± 23 mm Hg, Phypertension. Randomized controlled trials are needed to evaluate BAT effects on ABPM in patients with resistant hypertension accurately.

  12. Maggot debridement therapy promotes diabetic foot wound healing by up-regulating endothelial cell activity.

    Science.gov (United States)

    Sun, Xinjuan; Chen, Jin'an; Zhang, Jie; Wang, Wei; Sun, Jinshan; Wang, Aiping

    2016-03-01

    To determine the role of maggot debridement therapy (MDT) on diabetic foot wound healing, we compared growth related factors in wounds before and after treatment. Furthermore, we utilized human umbilical vein endothelial cells (HUVECs) to explore responses to maggot excretions/secretions on markers of angiogenesis and proliferation. The results showed that there was neo-granulation and angiogenesis in diabetic foot wounds after MDT. Moreover, significant elevation in CD34 and CD68 levels was also observed in treated wounds. In vitro, ES increased HUVEC proliferation, improved tube formation, and increased expression of vascular endothelial growth factor receptor 2 in a dose dependent manner. These results demonstrate that MDT and maggot ES can promote diabetic foot wound healing by up-regulating endothelial cell activity.

  13. Different physical therapy interventions on daily physical activities in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Marrara, Kamilla Tays; Marino, Diego Marmorato; de Held, Priscila Antonichelli; de Oliveira Junior, Antônio Delfino; Jamami, Maurício; Di Lorenzo, Valéria Amorim Pires

    2008-04-01

    To verify the outcome of different physical therapy interventions in activities of daily living of individuals with chronic obstructive pulmonary disease (COPD). Twenty-two COPD individuals were randomly divided into three groups: the Lower Limb Training Group (LLTG, n=8) performed treadmill exercise, Upper Limb Training Group (ULTG, n=8) performed upper limb (UL) training, and Control Group (CG, n=6) underwent bronchial hygiene therapy for 6 weeks, three times per week. The following were simulated in the activities of the daily living test: blackboard erasing, weight lifting exercise, stair climbing and treadmill walking. The duration of these tasks was 5 min of blackboard erasing and weight lifting, and 6 min of stair climbing and treadmill walking. Intragroup analysis presented a significant post-treatment ventilatory demand (V(E)/MVV) decrease for the LLTG during basal conditions and walking, and significant decrease during blackboard erasing and walking for the ULTG, with similar metabolic demand (VO(2)/VO(2)max) for both groups. Dyspnoea decreased significantly in the LLTG during post-treatment walking and increased for CG. The number of stairs climbed decreased significantly for the CG and increased for LLTG and ULTG post treatment, along with the walked distance for LLTG. The intergroup analysis presented significant differences in post-treatment dyspnoea with greater values observed for the CG during walking. The different protocols utilized promoted benefits towards physical exercise tolerance, particularly in the ULTG that presented better performance in sustained UL tasks, which may suggest better conditioning and coordination of the muscles involved in UL elevation.

  14. Active exercises utilizing a facilitating device in the treatment of lymphedema resulting from breast cancer therapy

    Directory of Open Access Journals (Sweden)

    de Fátima Guerreiro Godoy, Maria

    2010-01-01

    Full Text Available The aim of this study was to evaluate the reduction in volume of arm lymphedema secondary to breast cancer therapy utilizing an exercise facilitating device. Twenty-one women with arm lymphedema resulting from the surgical and radiotherapeutic treatment of breast cancer were randomly selected. Evaluation was made by water-displacement volumetry before and after each session. The patients were submitted to a series of active exercises using a facilitating device for four 12-minute sessions with intervals of 3 minutes between sessions in the sitting position with alignment of the spinal column. The lymphedematous arm was maintained under compression using a cotton-polyester sleeve. The active exercising device used was a mobile flexion bar fixed on a metal base at a height of 30 cm from the tabletop and at a distance of 10 cm from the patient’s body. The paired t-test was utilized for statistical analysis with an alpha error of 5% (p-value ≤0.05 being considered significant. The initial mean volume of the arms was 2,089.9 and the final volume was 2,023.0 mL with a mean loss of 66.9 mL (p-value <0.001. In conclusion, active exercises utilizing facilitating devices can contribute to a reduction in size of lymphedematous limbs.

  15. Hormone therapy at early post-menopause increases cognitive control-related prefrontal activity

    Science.gov (United States)

    Girard, Romuald; Météreau, Elise; Thomas, Julie; Pugeat, Michel; Qu, Chen; Dreher, Jean-Claude

    2017-01-01

    Clinical data have been equivocal and controversial as to the benefits to the brain and cognition of hormone therapy (HT) in postmenopausal women. Recent reevaluation of the role of estrogens proposed that HT may effectively prevent the deleterious effects of aging on cognition, and reduces the risks of dementia, including Alzheimer’s disease, if initiated early at the beginning of menopause. Yet, little is known about the effects of HT on brain activation related to cognitive control, the ability to make flexible decisions in relation to internal goals. Here, we used fMRI to directly test for a modulation of sequential 17β estradiol (2 mg/day) plus oral progesterone (100 mg/day) on task switching-related brain activity in women at early postmenopause. The results showed that HT enhanced dorsolateral prefrontal cortex recruitment during task switching. Between-subjects correlation analyses revealed that women who engaged more the dorsolateral prefrontal cortex showed higher task switching performance after HT administration. These results suggest that HT, when taken early at the beginning of postmenopause, may have beneficial effect on cognitive control prefrontal mechanisms. Together, these findings demonstrate that HT can prevent the appearance of reduced prefrontal cortex activity, a neurophysiological measure observed both in healthy aging and early dementia.

  16. [Cognitive-behavioral therapy in obesity and activities of the STOB (Stop to Obesity) society].

    Science.gov (United States)

    Málková, I

    2002-01-01

    STOB Society (STop to OBesity) was founded in the Czech Republic in 1991. It joins together psychologists, medical doctors, instructors of appropriate physical exercises and other professionals whose aim is to help obese people in the struggle with their excess weight. Activities of STOB Society are based on the method of cognitive behavioural psychotherapy, it proceeds from the assumption that inappropriate habits are learnt and so with a help of various techniques they can be also unlearnt. The aim is to induce desirable changes in behaviour, that is in eating and physical activity habits, and at the same time to get rid of the emotions and thoughts that lead to an inappropriate behaviour. The basis of cognitive-behavioural therapy is described. STOB Society popularizes appropriate and healthy way of weight reduction through articles in newspapers and journals, through programmes in radio and television and through brochure, audio and wide tapes, calendar etc. STOB Society organizes national campaigns in which it prompts thousands of obese people in the Czech Republic to appropriate eating and physical activity habits. It organizes "Weight reduction courses" in 70 towns in the Czech Republic.

  17. Effects of hormone replacement therapy on platelet activation in postmenopausal women

    Institute of Scientific and Technical Information of China (English)

    古健; 杨冬梓; 王良岸; 尹松梅; 邝健全

    2003-01-01

    Objective To assess the effects of hormone replacement therapy (HRT) on platelet activation in postmenopausal women compared with premenopausal women. Methods The expressions of CD41 and CD62P in fifteen postmenopausal women before and after HRT were detected using flow cytometry (FCM), with fifteen premenopausal women with a mean age of 47 years as controls.Results The expressions of CD41 and CD62P in postmenopausal women were higher than those in the control group. CD62P(%), CD62P(I) and CD41 were reduced from 36.40±5.9, 37.75±5.8, and 470.11±74.0 to 27.97±5.6, 26.64±4.9, and 303.23±72.8 after six months of HRT (P<0.05). Conclusions Platelet activation in postmenopausal women was higher than in premenopausal women and was reduced significantly after six months of HRT. HRT may have a favorable effect on reduction of platelet activity.

  18. Academic research as human activity: Occupational Therapy contributions for consumer participation

    Directory of Open Access Journals (Sweden)

    Tatiana Dimov

    2016-07-01

    Full Text Available The involvement of consumers in research is a recent trend in the world. Involving consumers in researches on health services, therapeutic approaches, effectiveness of support groups, mutual help groups, and even on medication is crucial for obtaining academic results that are representative of the group of consumers, and influence public policies that are effective and functional for consumers. This paper presents an analysis of how consumers can get involved in a research and what can be the role of an occupational therapist in such activity. When governed by the principles of autonomy, empowerment, and recovery, researches with consumer participation promote the principles of equality and recognition, allowing inclusion in the research process, and promoting the recognition of consumer knowledge. As an activity, research can be a motivator, mobilizing wills and desires. It can also be a possibility of leaving stagnation and making decisions. The occupational therapist can help this process. Occupational therapy focus on activities that are significant to the life of individuals. Participation in research becomes a focus for the therapeutic process to the extent that it presents itself as a demand for the client.

  19. Changes in neuronal activation patterns in response to androgen deprivation therapy: a pilot study

    Directory of Open Access Journals (Sweden)

    Shelton Amy L

    2010-01-01

    Full Text Available Abstract Background A common treatment option for men with prostate cancer is androgen deprivation therapy (ADT. However, men undergoing ADT may experience physical side effects, changes in quality of life and sometimes psychiatric and cognitive side effects. Methods In this study, hormone naïve patients without evidence of metastases with a rising PSA were treated with nine months of ADT. Functional magnetic resonance imaging (fMRI of the brain during three visuospatial tasks was performed at baseline prior to treatment and after nine months of ADT in five subjects. Seven healthy control patients, underwent neuroimaging at the same time intervals. Results ADT patients showed reduced, task-related BOLD-fMRI activation during treatment that was not observed in control subjects. Reduction in activation in right parietal-occipital regions from baseline was observed during recall of the spatial location of objects and mental rotation. Conclusions Findings, while preliminary, suggest that ADT reduces task-related neural activation in brain regions that are involved in mental rotation and accurate recall of spatial information.

  20. Effects of active music therapy on the normal brain: fMRI based evidence.

    Science.gov (United States)

    Raglio, Alfredo; Galandra, Caterina; Sibilla, Luisella; Esposito, Fabrizio; Gaeta, Francesca; Di Salle, Francesco; Moro, Luca; Carne, Irene; Bastianello, Stefano; Baldi, Maurizia; Imbriani, Marcello

    2016-03-01

    The aim of this study was to investigate the neurophysiological bases of Active Music Therapy (AMT) and its effects on the normal brain. Twelve right-handed, healthy, non-musician volunteers were recruited. The subjects underwent 2 AMT sessions based on the free sonorous-music improvisation using rhythmic and melodic instruments. After these sessions, each subject underwent 2 fMRI scan acquisitions while listening to a Syntonic (SP) and an A-Syntonic (AP) Production from the AMT sessions. A 3 T Discovery MR750 scanner with a 16-channel phased array head coil was used, and the image analysis was performed with Brain Voyager QX 2.8. The listening to SP vs AP excerpts mainly activated: (1) the right middle temporal gyrus and right superior temporal sulcus, (2) the right middle frontal gyrus and in particular the right precentral gyrus, (3) the bilateral precuneus, (4) the left superior temporal sulcus and (5) the left middle temporal gyrus. These results are consistent with the psychological bases of the AMT approach and with the activation of brain areas involved in memory and autobiographical processes, and also in personal or interpersonal significant experiences. Further studies are required to confirm these findings and to explain possible effects of AMT in clinical settings.

  1. The meaning of the Occupational Therapy activities in the hospitalization context of high risk pregnancy

    Directory of Open Access Journals (Sweden)

    Laís Abdala Martins

    2014-09-01

    Full Text Available Objective: The present study aimed to describe and interpret the meaning and realization of activities directed to motherhood during occupational therapy treatment with hospitalized high-risk pregnant women. Methods: An interpretative qualitative study carried out with forty-five high-risk pregnant women under treatment at the University Hospital of the Federal University of Parana - UFPR. Data from a total of 90 interviews, conducted with all hospitalized pregnant women who agreed to participate in the study, were collected and submitted to content analysis. Results: In the study of the two sets of categories obtained, many analysis units emerged. In the category related to hospitalization, 14 units were found: anxiety, loneliness, boredom, and worry for the baby were among the main ones. In the category related to therapeutic process, 9 units were highlighted: satisfaction, relaxation, and family proximity were among the most often mentioned. Conclusions: Hospitalization is a stressful life event and influences the emotional state of pregnant women. The process of realization of therapeutic occupational activities directed to motherhood allowed the rescue of being active, being able to live and revive positive and natural experiences of the gestational process, allowing the reframing of hospitalization.

  2. Working life and physical activity in ankylosing spondylitis pre and post anti-tumor necrosis factor-alpha therapy.

    Science.gov (United States)

    Prince, David S; McGuigan, Louis E; McGirr, Ellen E

    2014-02-01

    To assess effects of ankylosing spondylitis (AS) on working life and physical activity in Australia; to quantify changes in working life and physical activity that occur after anti-tumor necrosis factor-alpha (TNF-α) treatment; and to assess efficacy of anti-TNF-α therapy for AS in an Australian context. This is a multi-centre observational study of people with AS on anti-TNF-α therapy. All participants satisfied the New York Modified Criteria and had active and refractory disease at anti-TNF-α therapy commencement. Participation involved a standardized interview, a metrology assessment, assessment of disease remission and medical record review. Interviews and patients' records were used to compare working life (employment, sick leave and productivity) and physical activity (participation rate, hours/week, and physical intensity) between the pre-AS, post-AS and post-anti-TNF-α therapy periods. Fifty-two patients took part. Participants were on average 44.8 years old, predominately male (86.5%) and had been on anti-TNF-α therapy for 29 months; 39% were in partial remission and 75% had 50% reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Responders to anti-TNF-α therapy were 10.5 years younger than non-responders (P = 0.004). Post-anti-TNF-α therapy participants gained 6.6 h/week of work (P = 0.02), and productivity improved 31% (P Physical activity participation increased from 71% to 85% (P = 0.039) and activity intensity increased by 33% (P = 0.002) post-treatment. Participants gained 1.8 h/week of sport (P = 0.001) and 2.2 h/week of recreational physical activity (P physical activity severely affected by this disease. Treatment with anti-TNF-α therapy results in significant improvement in these parameters. © 2012 The Authors International Journal of Rheumatic Diseases © 2012 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  3. Antidepressant Effects of Electroconvulsive Therapy Correlate With Subgenual Anterior Cingulate Activity and Connectivity in Depression

    Science.gov (United States)

    Liu, Yi; Du, Lian; Li, Yongmei; Liu, Haixia; Zhao, Wenjing; Liu, Dan; Zeng, Jinkun; Li, Xingbao; Fu, Yixiao; Qiu, Haitang; Li, Xirong; Qiu, Tian; Hu, Hua; Meng, Huaqing; Luo, Qinghua

    2015-01-01

    Abstract The mechanisms underlying the effects of electroconvulsive therapy (ECT) in major depressive disorder (MDD) are not fully understood. Resting-state functional magnetic resonance imaging (rs-fMRI) is a new tool to study the effects of brain stimulation interventions, particularly ECT. The authors aim to investigate the mechanisms of ECT in MDD by rs-fMRI. They used rs-fMRI to measure functional changes in the brain of first-episode, treatment-naive MDD patients (n = 23) immediately before and then following 8 ECT sessions (brief-pulse square-wave apparatus, bitemporal). They also computed voxel-wise amplitude of low-frequency fluctuation (ALFF) as a measure of regional brain activity and selected the left subgenual anterior cingulate cortex (sgACC) to evaluate functional connectivity between the sgACC and other brain regions. Increased regional brain activity measured by ALFF mainly in the left sgACC following ECT. Functional connectivity of the left sgACC increased in the ipsilateral parahippocampal gyrus, pregenual ACC, contralateral middle temporal pole, and orbitofrontal cortex. Importantly, reduction in depressive symptoms were negatively correlated with increased ALFF in the left sgACC and left hippocampus, and with distant functional connectivity between the left sgACC and contralateral middle temporal pole. That is, across subjects, as depression improved, regional brain activity in sgACC and its functional connectivity increased in the brain. Eight ECT sessions in MDD patients modulated activity in the sgACC and its networks. The antidepressant effects of ECT were negatively correlated with sgACC brain activity and connectivity. These findings suggest that sgACC-associated prefrontal-limbic structures are associated with the therapeutic effects of ECT in MDD. PMID:26559309

  4. The efficacy of progressive muscle relaxation in combination with spinal manipulative therapy on active trigger points of the trapezius muscle

    OpenAIRE

    2013-01-01

    M.Tech. (Chiropractic) Purpose: The trapezius muscle is thought to be the muscle most commonly associated with the presence of active myofascial trigger points (MFTP’s). Studies of the trapezius muscle clearly show that muscular activity significantly increases in response to psychological stress. Cervical spine manipulation has been proven to be highly effective in the treatment of active MFTP’s and muscular tension. Progressive muscle relaxation (PMR) therapy is frequently utilized as a ...

  5. Renal responses to long-term carotid baroreflex activation therapy in patients with drug-resistant hypertension.

    Science.gov (United States)

    Alnima, Teba; de Leeuw, Peter W; Tan, Frans E S; Kroon, Abraham A

    2013-06-01

    Carotid baroreflex activation has been demonstrated to provide enduring reductions in arterial blood pressure. The aim of this study was to investigate the effect of long-term therapy on renal function. A total of 322 patients were enrolled in the Rheos Pivotal Trial. Group 1 consisted of 236 patients who started baroreflex activation therapy 1 month after device implantation, whereas in the 86 patients from group 2 the device was activated 6 months later. Serum creatinine and urine albumin/creatinine ratio were collected at screening (before device activation), and at months 6 and 12. Multilevel statistical analyses were adjusted for various covariables. Serum creatinine increased from 78 to 84 μmol/L, and glomerular filtration rate decreased from 92 to 87 mL/min per 1.73 m(2) in group 1 at month 6 (Pblood pressure reduction seemed to be significantly related to the change in glomerular filtration rate in both groups. Albumin/creatinine ratio did not change in both groups during follow-up. In conclusion, baroreflex activation therapy in hypertensive patients is associated with an initial mild decrease in glomerular filtration rate, which may be considered as a normal hemodynamic response to the drop in blood pressure. Long-term treatment does not result in further decrease in renal function, indicating baroreflex activation as a safe and effective therapy.

  6. Effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy.

    Science.gov (United States)

    Ryu, Kwangmin; Ali, Asif; Kwon, Minji; Lee, Changyoung; Kim, Yujin; Lee, Gyusung; Kim, Jingu

    2016-12-01

    [Purpose] The purpose of this study was to determine the effects of assisted aquatic movement and horseback riding therapies on emotion and brain activation in patients with cerebral palsy. [Subjects and Methods] Thirty-two right-handed patients with cerebral palsy (18 male, 14 female) whose ages ranged from 8 to 48 years participated in this experiment. Their cerebral palsy levels ranged from 1 to 3. The participants were assigned to one of three groups according to the experimental conditions: an assisted aquatic movement therapy group, a horseback riding therapy group, or a control group. Electroencephalograms, the Feeling Scale and the Felt Arousal Scale were examined as dependent variables. [Results] Analysis of self-reported data demonstrated a significant positive improvement in the emotions of participants in the assisted aquatic movement therapy group in comparison with the control group. With regard to the electroencephalogram analysis, the results of this study showed increased alpha power in the assisted aquatic movement therapy group compared with the horseback riding and control groups. [Conclusion] The results of this study suggest that professionals can consider assisted aquatic movement therapy as an effective therapeutic intervention for the improvement of mental health and brain activation.

  7. Treatment of traumatised refugees with basic body awareness therapy versus mixed physical activity as add-on treatment

    DEFF Research Database (Denmark)

    Nordbrandt, Maja Sticker; Carlsson, Jessica; Lindberg, Laura Glahder

    2015-01-01

    on this topic. METHODS/DESIGN: This study will include approximately 310 patients, randomised into three groups. All three groups receive psychiatric treatment as usual for the duration of 6-7 months, consisting of consultations with a medical doctor including pharmacological treatment and manual......-based Cognitive Behavioural Therapy. The first group only receives treatment as usual while the second and the third groups receive either Basic-Body Awareness Therapy or mixed physical activity as add-on treatments. Each physical activity is provided for an individual 1-hour consultation per week...

  8. Evaluation of activity and effectiveness of occupational therapy in stroke patients at the early stage of rehabilitation.

    Science.gov (United States)

    Petruseviciene, Daiva; Krisciūnas, Aleksandras

    2008-01-01

    In Lithuania, the stroke is not only medical, but social issue as well, since only 20% of patients suffering from stroke remain active at work. Yearly stroke incidence in Lithuania is 7000-8000 cases. The most common outcome of stroke is unilateral paralysis (hemiplegia) followed by disorders of coordination, balance, and movements. Due to dysfunctions of movements, self-care, cognition, behavior, and communication, some part of stroke patients remains disabled. They need assistance and care provided by other people. Occupational therapy, which is part of rehabilitation of patients after stroke, is directed to independence training. There are scarce data related to effectiveness of occupational therapy depending on motor, cognitive, and psychosocial dysfunctions. Goals of study were to estimate effectiveness of occupational therapy at the early stage of rehabilitation depending on type of stroke, localization of brain injury, grade of lesion, age, and gender, to identify factors influencing effectiveness of occupational therapy, and to estimate their positive predictive value. The study included 106 patients at the early stage of rehabilitation, who were admitted to Department of Neurorehabilitation after stabilization of clinical condition from Departments of Neurology and Neurosurgery (mean duration of 14+/-2 days after stroke). The program of occupational therapy was not fulfilled by 6 patients: 2 patients were transferred to Nursing Hospital due to severe condition, and 4 patients were discharged prematurely and continued rehabilitation in outpatient setting. Hence, study population consisted of 100 subjects (47 men and 53 women) who were diagnosed with stroke (ischemic or hemorrhagic). Patient's functional status and disorders of activities were evaluated using Barthel Index and Functional Independence Measure. Complexes of occupational therapy were adjusted according to examination of patient's disorders of activities, age, grade of lesion, other diseases

  9. Factor structure of the Beck Depression Inventory-II among South Africans receiving antiretroviral therapy.

    Science.gov (United States)

    Kagee, Ashraf; Nel, Adriaan; Saal, Wylene

    2014-02-01

    Considerable evidence suggests that mood disturbance is common among patients living with HIV and may be an important barrier to anti-retroviral therapy (ART) adherence. Thus the assessment of depressed mood is an important and necessary aspect of the experience of persons living with HIV as it may impact the health status of individuals directly and indirectly. We sought to determine the factor structure of the Beck Depression Inventory (BDI) among a sample of 185 South Africans living with HIV and receiving ART. The mean BDI score was 16.5 (SD 12.15) with a range from 0-50 (out of a possible 63), indicating on average moderate levels of depression. Cronbach's alpha for the total scale was 0.90. Although the four factors had eigenvalues that were technically above 1.0, only three factors could logically be extracted, the combination of which accounted for 47.29% of the variance. These three factors were Cognitive, Affective and Somatic. The results indicate that the BDI-II is a reliable measure of symptoms of depression among persons living with HIV. The factor structure among South Africans receiving ART is similar to that of other samples, although surprisingly, the item assessing appetite disturbance did not load on any factor. The results of the study suggest that the BDI-II is a useful measure among South Africans living with HIV. In the context of the need to rapidly identify depressed mood among persons receiving ART in public health clinics, the BDI may be a useful instrument. We end the paper with certain cautions associated with routine screening.

  10. Bath-PUVA therapy improves impaired resting regulatory T cells and increases activated regulatory T cells in psoriasis.

    Science.gov (United States)

    Kubo, Ryoji; Muramatsu, Shinnosuke; Sagawa, Yoko; Saito, Chiyo; Kasuya, Saori; Nishioka, Akiko; Nishida, Emi; Yamazaki, Sayuri; Morita, Akimichi

    2017-04-01

    Bath-psoralen plus ultraviolet light A (PUVA) therapy is an effective, safe, and inexpensive treatment for psoriasis. Psoriasis might be due to an unbalanced ratio of Th17 cells and regulatory T cells (Treg). The Treg functional ratio is significantly lower in patients with psoriasis compared with controls and is inversely correlated with the Psoriasis Area and Severity Index score. We previously reported that bath-PUVA therapy significantly increases the number of Treg and restores Treg function to almost normal in most patients with psoriasis. We examined the effects of bath-PUVA therapy on three distinct Foxp3(+) subsets: activated Treg (aTreg), resting Treg (rTreg), and cytokine-secreting non-suppressive T cells. We enrolled 15 patients with psoriasis and 11 healthy controls. We examined aTreg, rTreg, and cytokine-secreting non-suppressive T cells in peripheral blood obtained from the psoriasis patients before and after every fifth bath-PUVA therapy session. Levels of aTreg, which are considered to have the strongest suppressive activity in patients with psoriasis, were significantly increased in the early bath-PUVA therapy sessions, and then diminished. Levels of rTreg were lower in psoriasis patients than in healthy controls, and increased during bath-PUVA therapy. Bath-PUVA therapy induced aTreg and rTreg concomitantly with an improvement in the psoriatic lesions, suggesting a mechanism for the effectiveness of bath-PUVA therapy for psoriasis patients. Copyright © 2017 Japanese Society for Investigative Dermatology. Published by Elsevier B.V. All rights reserved.

  11. Dog-Assisted Therapies and Activities in Rehabilitation of Children with Cerebral Palsy and Physical and Mental Disabilities

    Directory of Open Access Journals (Sweden)

    Dilek Tunçay Elmacı

    2015-05-01

    Full Text Available The aim of the present study was to evaluate dog-assisted therapies and activities in the rehabilitation of children with cerebral palsy and physical and mental disabilities who have difficulties in benefiting from well-being and health-improving services. This descriptive-explanatory study was conducted in disabled children of various ages between 2008 and 2011 by an experienced team in a private training and rehabilitation center in Antalya (Turkey. In this study, five study groups were formed among the children with physical and mental disabilities. During the therapy studies, three dogs were used. For each therapy group, the goals for the children and therapist were defined, and the activities were determined according to these goals. The entire study process was followed using audio-records and photographs of patients. The expected targets were reached in all study groups. The children who experienced fear, anxiety and difficulties due to their disabilities in daily life learned to cope with their anxieties and fears, set goals and make plans to achieve their aims. During this study, the children improved their abilities to use their bodies according to their capabilities. Accordingly, they improved their ability to develop empathy between themselves and a therapy dog, to receive and present help, and to communicate. The results of the present study revealed that dog-assisted therapies and activities can be a supportive method for routine treatment procedures in the rehabilitation of children with cerebral palsy and physical and mental disabilities.

  12. Dog-assisted therapies and activities in rehabilitation of children with cerebral palsy and physical and mental disabilities.

    Science.gov (United States)

    Elmacı, Dilek Tunçay; Cevizci, Sibel

    2015-05-12

    The aim of the present study was to evaluate dog-assisted therapies and activities in the rehabilitation of children with cerebral palsy and physical and mental disabilities who have difficulties in benefiting from well-being and health-improving services. This descriptive-explanatory study was conducted in disabled children of various ages between 2008 and 2011 by an experienced team in a private training and rehabilitation center in Antalya (Turkey). In this study, five study groups were formed among the children with physical and mental disabilities. During the therapy studies, three dogs were used. For each therapy group, the goals for the children and therapist were defined, and the activities were determined according to these goals. The entire study process was followed using audio-records and photographs of patients. The expected targets were reached in all study groups. The children who experienced fear, anxiety and difficulties due to their disabilities in daily life learned to cope with their anxieties and fears, set goals and make plans to achieve their aims. During this study, the children improved their abilities to use their bodies according to their capabilities. Accordingly, they improved their ability to develop empathy between themselves and a therapy dog, to receive and present help, and to communicate. The results of the present study revealed that dog-assisted therapies and activities can be a supportive method for routine treatment procedures in the rehabilitation of children with cerebral palsy and physical and mental disabilities.

  13. Anti-TNF-α therapy reduces endothelial cell activation in non-diabetic ankylosing spondylitis patients.

    Science.gov (United States)

    Genre, Fernanda; López-Mejías, Raquel; Miranda-Filloy, José A; Ubilla, Begoña; Mijares, Verónica; Carnero-López, Beatriz; Gómez-Acebo, Inés; Dierssen-Sotos, Trinidad; Remuzgo-Martínez, Sara; Blanco, Ricardo; Pina, Trinitario; González-Juanatey, Carlos; Llorca, Javier; González-Gay, Miguel A

    2015-12-01

    Endothelial dysfunction can be detected by the presence of elevated levels of biomarkers of endothelial cell activation. In this study, we aimed to establish whether correlations of these biomarkers with characteristics of patients with ankylosing spondylitis (AS) exist. We also studied the effect of anti-TNF-α therapy on these biomarkers. Serum sE-selectin, MCP-1 and sVCAM-1 levels were measured by ELISA in 30 non-diabetic AS patients undergoing anti-TNF-α therapy, immediately before and after an infusion of infliximab. Correlations of these biomarkers with clinical features, systemic inflammation, metabolic syndrome and other serum and plasma biomarkers of cardiovascular risk were studied. Potential changes in the concentration of these biomarkers following an infliximab infusion were also assessed. sE-selectin showed a positive correlation with CRP (p = 0.02) and with other endothelial cell activation biomarkers such as sVCAM-1 (p = 0.019) and apelin (p = 0.008). sVCAM-1 negatively correlated with BMI (p = 0.018), diastolic blood pressure (p = 0.008) and serum glucose (p = 0.04). sVCAM-1 also showed a positive correlation with VAS spinal pain (p = 0.014) and apelin (p < 0.001). MCP-1 had a negative correlation with LDL cholesterol (p = 0.026) and ESR (p = 0.017). Patients with hip involvement and synovitis and/or enthesitis in other peripheral joints showed higher levels of MCP-1 (p = 0.004 and 0.02, respectively). A single infliximab infusion led to a significant reduction in sE-selectin (p = 0.0015) and sVCAM-1 (p = 0.04). Endothelial dysfunction correlates with inflammation and metabolic syndrome features in patients with AS. A beneficial effect of the anti-TNF-α blockade on endothelial dysfunction, manifested by a reduction in levels of biomarkers of endothelial cell activation, was observed.

  14. DMXL2 drives epithelial to mesenchymal transition in hormonal therapy resistant breast cancer through Notch hyper-activation.

    Science.gov (United States)

    Faronato, Monica; Nguyen, Van T M; Patten, Darren K; Lombardo, Ylenia; Steel, Jennifer H; Patel, Naina; Woodley, Laura; Shousha, Sami; Pruneri, Giancarlo; Coombes, R Charles; Magnani, Luca

    2015-09-08

    The acquisition of endocrine therapy resistance in estrogen receptor α (ERα) breast cancer patients represents a major clinical problem. Notch signalling has been extensively linked to breast cancer especially in patients who fail to respond to endocrine therapy. Following activation, Notch intracellular domain is released and enters the nucleus where activates transcription of target genes. The numerous steps that cascade after activation of the receptor complicate using Notch as biomarker. Hence, this warrants the development of reliable indicators of Notch activity. DMXL2 is a novel regulator of Notch signalling not yet investigated in breast cancer. Here, we demonstrate that DMXL2 is overexpressed in a subset of endocrine therapy resistant breast cancer cell lines where it promotes epithelial to mesenchymal transition through hyper-activation of Notch signalling via V-ATPase dependent acidification. Following DMXL2 depletion or treatment with Bafilomycin A1, both EMT targets and Notch signalling pathway significantly decrease. We show for the first time that DMXL2 protein levels are significantly increased in ERα positive breast cancer patients that progress after endocrine therapy. Finally, we demonstrate that DMXL2 is a transmembrane protein with a potential extra-cellular domain. These findings identify DMXL2 as a novel, functional biomarker for ERα positive breast cancer.

  15. Mindfulness-based therapy and behavioral activation: A randomized controlled trial with depressed college students.

    Science.gov (United States)

    McIndoo, C C; File, A A; Preddy, T; Clark, C G; Hopko, D R

    2016-02-01

    Major Depressive Disorder (MDD) manifests in 20-30% of college students, with increased incidence in recent decades. Very limited research has assessed the efficacy of evidence-based interventions for MDD in college students. Mindfulness-Based Therapy (MBT) and Behavioral Activation (BA) are two interventions with significant potential to meet demands of college counseling clinics and effectively treat college students with MDD. This study utilized a randomized controlled research design (n = 50) to examine the efficacy of four-sessions of abbreviated MBT and BA relative to a wait-list control condition with depressed college students. Intent-to-treat data analyses on depression outcome measures suggested both treatments were superior to the control group. There were significant pre-post treatment improvements across measures of depression, rumination, stress, and mindfulness, gains largely maintained at 1-month follow-up. Neither active treatment effectively reduced somatic anxiety. Both treatments generally had moderate-strong effect sizes relative to the control group, and based on depression response and remission criteria, 56-79% of patients exhibited clinically significant improvement. Based on reliable change indices, 75-85% experienced clinically significant reductions in depression. There was strong therapist competence and adherence to treatment protocols and high patient satisfaction with both interventions. Study limitations and implications for the assessment and treatment of depressed college students are discussed.

  16. Modulation of intrinsic brain activity by electroconvulsive therapy in major depression

    Science.gov (United States)

    Leaver, Amber M.; Espinoza, Randall; Pirnia, Tara; Joshi, Shantanu H.; Woods, Roger P.; Narr, Katherine L.

    2015-01-01

    Introduction One of the most effective interventions for intractable major depressive episodes is electroconvulsive therapy (ECT). Because ECT is also relatively fast-acting, longitudinal study of its neurobiological effects offers critical insight into the mechanisms underlying depression and antidepressant response. Here we assessed modulation of intrinsic brain activity in corticolimbic networks associated with ECT and clinical response. Methods We measured resting-state functional connectivity (RSFC) in patients with treatment-resistant depression (n=30), using functional magnetic resonance imaging (fMRI) acquired before and after completing a treatment series with right-unilateral ECT. Using independent component analysis, we assessed changes in RSFC with 1) symptom improvement and 2) ECT regardless of treatment outcome in patients, with reference to healthy controls (n=33, also scanned twice). Results After ECT, consistent changes in RSFC within targeted depression-relevant functional networks were observed in the dorsal anterior cingulate (ACC), mediodorsal thalamus (mdTh), hippocampus, and right anterior temporal, medial parietal, and posterior cingulate cortex in all patients. In a separate analysis, changes in depressive symptoms were associated with RSFC changes in the dorsal ACC, mdTh, putamen, medial prefrontal, and lateral parietal cortex. RSFC of these regions did not change in healthy controls. Conclusions Neuroplasticity underlying clinical change was in part separable from changes associated with the effects of ECT observed in all patients. However, both ECT and clinical change were associated with RSFC modulation in dorsal ACC, mdTh and hippocampus, which may indicate that these regions underlie the mechanisms of clinical outcome in ECT and may be effective targets for future neurostimulation therapies. PMID:26878070

  17. The physical activity levels among people living with human immunodeficiency virus/acquired immunodeficiency syndrome receiving high active antiretroviral therapy in Rwanda.

    Science.gov (United States)

    Frantz, J M; Murenzi, A

    2013-01-01

    The accessibility of high active antiretroviral therapy (HAART) for local human immunodeficiency virus (HIV) patients is improving in Rwanda. It is well known that this therapy is associated with serious adverse effects, such as metabolic and morphologic changes. One of the recommended preventive modalities for these complications is participation in physical activity. The current study aims to determine the anthropometric profile and physical activity levels among people living with HIV and receiving HAART in Kigali, Rwanda. The study was a cross-sectional, descriptive quantitative survey. The participant's levels of physical activity participation and their association with anthropometric profiles were measured, using a structured self-administered questionnaire for 407 clients passing through the clinics. Of the participants, approximately 70% were inactive and in addition, 40% were obese and 43% overweight. Obesity was found to be strongly associated with inactivity. Lack of motivation, and time as well as fear of worsening the disease were found to be barriers to participation in physical activity.

  18. Relapse Prevention in Major Depressive Disorder: Mindfulness-Based Cognitive Therapy Versus an Active Control Condition

    Science.gov (United States)

    Shallcross, Amanda J.; Gross, James J.; Visvanathan, Pallavi D.; Kumar, Niketa; Palfrey, Amy; Ford, Brett Q.; Dimidjian, Sona; Shirk, Stephen; Holm-Denoma, Jill; Goode, Kari M.; Cox, Erica; Chaplin, William; Mauss, Iris B.

    2015-01-01

    Objective We evaluated the comparative effectiveness of Mindfulness-based cognitive therapy (MBCT) versus an active control condition (ACC) for depression relapse prevention, depressive symptom reduction, and improvement in life satisfaction. Method Ninety-two participants in remission from Major Depressive Disorder with residual depressive symptoms were randomized to either an 8-week MBCT or a validated ACC that is structurally equivalent to MBCT and controls for non-specific effects (e.g., interaction with a facilitator, perceived social support, treatment outcome expectations). Both interventions were delivered according to their published manuals. Results Intention-to-treat analyses indicated no differences between MBCT and ACC in depression relapse rates or time to relapse over a 60-week follow-up. Both groups experienced significant and equal reductions in depressive symptoms and improvements in life satisfaction. A significant quadratic interaction (group x time) indicated that the pattern of depressive symptom reduction differed between groups. The ACC experienced immediate symptom reduction post-intervention and then a gradual increase over the 60-week follow-up. The MBCT group experienced a gradual linear symptom reduction. The pattern for life satisfaction was identical but only marginally significant. Conclusions MBCT did not differ from an ACC on rates of depression relapse, symptom reduction, or life satisfaction, suggesting that MBCT is no more effective for preventing depression relapse and reducing depressive symptoms than the active components of the ACC. Differences in trajectory of depressive symptom improvement suggest that the intervention-specific skills acquired may be associated with differential rates of therapeutic benefit. This study demonstrates the importance of comparing psychotherapeutic interventions to active control conditions. PMID:26371618

  19. Photodynamic therapy activated signaling from epidermal growth factor receptor and STAT3

    Science.gov (United States)

    Edmonds, Christine; Hagan, Sarah; Gallagher-Colombo, Shannon M.; Busch, Theresa M.; Cengel, Keith A.

    2012-01-01

    Patients with serosal (pleural or peritoneal) spread of malignancy have few definitive treatment options and consequently have a very poor prognosis. We have previously shown that photodynamic therapy (PDT) can be an effective treatment for these patients, but that the therapeutic index is relatively narrow. Here, we test the hypothesis that EGFR and STAT3 activation increase survival following PDT, and that inhibiting these pathways leads to increased PDT-mediated direct cellular cytotoxicity by examining BPD-PDT in OvCa and NSCLC cells. We found that BPD-mediated PDT stimulated EGFR tyrosine phosphorylation and nuclear translocation, and that EGFR inhibition by erlotinib resulted in reduction of PDT-mediated EGFR activation and nuclear translocation. Nuclear translocation and PDT-mediated activation of EGFR were also observed in response to BPD-mediated PDT in multiple cell lines, including OvCa, NSCLC and head and neck cancer cells, and was observed to occur in response to porfimer sodium-mediated PDT. In addition, we found that PDT stimulates nuclear translocation of STAT3 and STAT3/EGFR association and that inhibiting STAT3 signaling prior to PDT leads to increased PDT cytotoxicity. Finally, we found that inhibition of EGFR signaling leads to increased PDT cytotoxicity through a mechanism that involves increased apoptotic cell death. Taken together, these results demonstrate that PDT stimulates the nuclear accumulation of both EGFR and STAT3 and that targeting these survival pathways is a potentially promising strategy that could be adapted for clinical trials of PDT for patients with serosal spread of malignancy. PMID:22986230

  20. Predictive Factors of Clinical Response of Infliximab Therapy in Active Nonradiographic Axial Spondyloarthritis Patients

    Science.gov (United States)

    Lin, Zhiming; Liao, Zetao; Huang, Jianlin; Ai, Maixing; Pan, Yunfeng; Wu, Henglian; Lu, Jun; Cao, Shuangyan; Li, Li; Wei, Qiujing; Tang, Deshen; Wei, Yanlin; Li, Tianwang; Wu, Yuqiong; Xu, Manlong; Li, Qiuxia; Jin, Ou; Yu, Buyun; Gu, Jieruo

    2015-01-01

    Objectives. To evaluate the efficiency and the predictive factors of clinical response of infliximab in active nonradiographic axial spondyloarthritis patients. Methods. Active nonradiographic patients fulfilling ESSG criteria for SpA but not fulfilling modified New York criteria were included. All patients received infliximab treatment for 24 weeks. The primary endpoint was ASAS20 response at weeks 12 and 24. The abilities of baseline parameters and response at week 2 to predict ASAS20 response at weeks 12 and 24 were assessed using ROC curve and logistic regression analysis, respectively. Results. Of 70 axial SpA patients included, the proportions of patients achieving an ASAS20 response at weeks 2, 6, 12, and 24 were 85.7%, 88.6%, 87.1%, and 84.3%, respectively. Baseline MRI sacroiliitis score (AUC = 0.791; P = 0.005), CRP (AUC = 0.75; P = 0.017), and ASDAS (AUC = 0.778, P = 0.007) significantly predicted ASAS20 response at week 12. However, only ASDAS (AUC = 0.696, P = 0.040) significantly predicted ASAS20 response at week 24. Achievement of ASAS20 response after the first infliximab infusion was a significant predictor of subsequent ASAS20 response at weeks 12 and 24 (wald χ2 = 6.87, P = 0.009, and wald χ2 = 5.171, P = 0.023). Conclusions. Infliximab shows efficiency in active nonradiographic axial spondyloarthritis patients. ASDAS score and first-dose response could help predicting clinical efficacy of infliximab therapy in these patients. PMID:26273654

  1. p53 activated by AND gate genetic circuit under radiation and hypoxia for targeted cancer gene therapy.

    Science.gov (United States)

    Ding, Miao; Li, Rong; He, Rong; Wang, Xingyong; Yi, Qijian; Wang, Weidong

    2015-09-01

    Radio-activated gene therapy has been developed as a novel therapeutic strategy against cancer; however, expression of therapeutic gene in peritumoral tissues will result in unacceptable toxicity to normal cells. To restrict gene expression in targeted tumor mass, we used hypoxia and radiation tolerance features of tumor cells to develop a synthetic AND gate genetic circuit through connecting radiation sensitivity promoter cArG6 , heat shock response elements SNF1, HSF1 and HSE4 with retroviral vector plxsn. Their construction and dynamic activity process were identified through downstream enhanced green fluorescent protein and wtp53 expression in non-small cell lung cancer A549 cells and in a nude mice model. The result showed that AND gate genetic circuit could be activated by lower required radiation dose (6 Gy) and after activated, AND gate could induce significant apoptosis effects and growth inhibition of cancer cells in vitro and in vivo. The radiation- and hypoxia-activated AND gate genetic circuit, which could lead to more powerful target tumoricidal activity represented a promising strategy for both targeted and effective gene therapy of human lung adenocarcinoma and low dose activation character of the AND gate genetic circuit implied that this model could be further exploited to decrease side-effects of clinical radiation therapy.

  2. Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Prevention of Relapse and Recurrence in Major Depression

    Science.gov (United States)

    Dobson, Keith S.; Hollon, Steven D.; Dimidjian, Sona; Schmaling, Karen B.; Kohlenberg, Robert J.; Gallop, Robert J.; Rizvi, Shireen L.; Gollan, Jackie K.; Dunner, David L.; Jacobson, Neil S.

    2008-01-01

    This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior…

  3. Physical activity and exercise adherence in physical therapy exercise treatment in patients with osteoarthritis of hip or knee.

    NARCIS (Netherlands)

    Pisters, M.F.; Veenhof, C.; Bakker, D. de; Schellevis, F.G.; Dekker, J.

    2008-01-01

    Purpose: a lack of regular physical activity in patients with osteoarthritis (OA) of the hip and/or knee is an important risk factor for functional decline. The ultimate goal of exercise therapy is to improve the overall physical function and to help individuals meet the demands of daily living. Ear

  4. Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Prevention of Relapse and Recurrence in Major Depression

    Science.gov (United States)

    Dobson, Keith S.; Hollon, Steven D.; Dimidjian, Sona; Schmaling, Karen B.; Kohlenberg, Robert J.; Gallop, Robert J.; Rizvi, Shireen L.; Gollan, Jackie K.; Dunner, David L.; Jacobson, Neil S.

    2008-01-01

    This study followed treatment responders from a randomized controlled trial of adults with major depression. Patients treated with medication but withdrawn onto pill-placebo had more relapse through 1 year of follow-up compared to patients who received prior behavioral activation, prior cognitive therapy, or continued medication. Prior…

  5. A clinically prognostic scoring system for patients receiving highly active antiretroviral therapy: results from the EuroSIDA study

    DEFF Research Database (Denmark)

    Lundgren, Jens Dilling; Mocroft, Amanda; Gatell, Jose M

    2002-01-01

    The risk of clinical progression for human immunodeficiency virus (HIV)-infected persons receiving treatment with highly active antiretroviral therapy (HAART) is poorly defined. From an inception cohort of 8457 HIV-infected persons, 2027 patients who started HAART during prospective follow-up wer...

  6. Non-Hodgkin lymphoma in HIV-infected patients in the era of highly active antiretroviral therapy

    DEFF Research Database (Denmark)

    Kirk, O; Pedersen, C; Cozzi-Lepri, A;

    2001-01-01

    This study was designed to assess the influence of highly active antiretroviral therapy (HAART) on non-Hodgkin lymphoma (NHL) among patients infected with human immunodeficiency virus (HIV). Within EuroSIDA, a multicenter observational cohort of more than 8500 patients from across Europe, the inc...

  7. Depleted skeletal muscle mitochondrial DNA, hyperlactatemia, and decreased oxidative capacity in HIV-infected patients on highly active antiretroviral therapy

    DEFF Research Database (Denmark)

    Haugaard, Steen B; Andersen, Ove; Pedersen, Steen B;

    2005-01-01

    hyperlactatemia is associated with depletion of skeletal muscle (sm)-mtDNA and decreased oxidative capacity in HIV-infected patients on NRTI based highly active antiretroviral therapy (HAART) and whether HIV infection itself is associated with sm-mtDNA depletion. Sm-mtDNA was determined in 42 HIV...... in part could be mediated through an enhanced pro-inflammatory response....

  8. Task Lists for Health Occupations. Radiologic Aide. Activity Aide. Optometric Assistant. Physical Therapy Aide. Education for Employment Task Lists.

    Science.gov (United States)

    Lathrop, Janice

    These task lists contain employability skills and tasks for the following health occupations: radiologic aide, activity aide, physical therapy aide, and optometric assistant. The duties and tasks found in these lists form the basis of instructional content for secondary, postsecondary, and adult occupational training programs. Employability skills…

  9. Physical activity monitoring in adolescents with juvenile fibromyalgia: findings from a clinical trial of cognitive behavioral therapy

    OpenAIRE

    Kashikar-Zuck, Susmita; Flowers, Stacy R.; Strotman, Daniel; Sil, Soumitri; Ting, Tracy V; Schikler, Kenneth N.

    2013-01-01

    Juvenile fibromyalgia (JFM) is a chronic musculoskeletal pain condition that is associated with reduced physical function. Recent research has demonstrated that cognitive-behavioral therapy (CBT) is effective in improving daily functioning among adolescents with JFM. However, it is not known whether these improvements were accompanied by increased physical activity levels.

  10. Physical activity and exercise adherence in physical therapy exercise treatment in patients with osteoarthritis of hip or knee.

    NARCIS (Netherlands)

    Pisters, M.F.; Veenhof, C.; Bakker, D. de; Schellevis, F.G.; Dekker, J.

    2008-01-01

    Purpose: a lack of regular physical activity in patients with osteoarthritis (OA) of the hip and/or knee is an important risk factor for functional decline. The ultimate goal of exercise therapy is to improve the overall physical function and to help individuals meet the demands of daily living. Ear

  11. A clinically prognostic scoring system for patients receiving highly active antiretroviral therapy: results from the EuroSIDA study

    DEFF Research Database (Denmark)

    Lundgren, Jens Dilling; Mocroft, Amanda; Gatell, Jose M;

    2002-01-01

    The risk of clinical progression for human immunodeficiency virus (HIV)-infected persons receiving treatment with highly active antiretroviral therapy (HAART) is poorly defined. From an inception cohort of 8457 HIV-infected persons, 2027 patients who started HAART during prospective follow-up wer...

  12. Association between diarrhea and quality of life in HIV-infected patients receiving highly active antiretroviral therapy

    NARCIS (Netherlands)

    Tramarin, A; Parise, N; Campostrini, S; Yin, DD; Postma, MJ; Lyu, R; Grisetti, R; Capetti, A; Cattelan, AM; Di Toro, MT; Mastroianni, A; Pignattari, E; Mondardini, [No Value; Calleri, G; Raise, E; Starace, F

    2004-01-01

    Diarrhea is a common symptom that many HIV patients experience either as a consequence of HIV infection or of highly active antiretroviral therapy (HAART). A multicenter, prospective observational study was conducted in 11 AIDS clinics in Italy to determine the effect of diarrhea on health-related q

  13. Systemic Cyclosporine Therapy for Scleritis: A Proposal of a Novel System to Assess the Activity of Scleritis

    Directory of Open Access Journals (Sweden)

    Haruka Aoki

    2015-05-01

    Full Text Available In the present study, two female patients with unilateral scleritis without systemic complications were examined. Both patients were suffering from ocular pain and received corticosteroid therapy. The first patient, a 45-year-old woman, was diagnosed with scleritis and iritis in her right eye. Topical corticosteroid treatment could eradicate the iritis but not the scleritis. Oral corticosteroid administration and corticosteroid pulse therapy were applied with little effect. The application of systemic cyclosporine had a satisfactory effect in controlling the scleritis. The other patient, a 60-year-old woman, was suffering from scleritis and lid swelling in her right eye. Not only did topical and systemic corticosteroid therapy prove insufficient, they also resulted in the elevation of her intraocular pressure. After termination of corticosteroid therapy, the systemic cyclosporine was applied orally. Subsequently, the patient's scleritis improved without any severe side effects. Scleritis is a painful and destructive inflammatory disease of the sclera that causes congestion of the scleral venous plexus. In this study, we have established a new grading system for assessing activity in scleritis that can score the extent of ocular pain and the area of congestion. This system provides a practical method for following the clinical course and monitoring the outcome of therapy. We report two cases of unilateral scleritis that were resistant to corticosteroid therapy but responsive to systemic administration of cyclosporine. Findings from these cases indicate that cyclosporine is an effective drug for controlling severe scleritis.

  14. Systemic Cyclosporine Therapy for Scleritis: A Proposal of a Novel System to Assess the Activity of Scleritis.

    Science.gov (United States)

    Aoki, Haruka; Hiraoka, Miki; Hashimoto, Masato; Ohguro, Hiroshi

    2015-01-01

    In the present study, two female patients with unilateral scleritis without systemic complications were examined. Both patients were suffering from ocular pain and received corticosteroid therapy. The first patient, a 45-year-old woman, was diagnosed with scleritis and iritis in her right eye. Topical corticosteroid treatment could eradicate the iritis but not the scleritis. Oral corticosteroid administration and corticosteroid pulse therapy were applied with little effect. The application of systemic cyclosporine had a satisfactory effect in controlling the scleritis. The other patient, a 60-year-old woman, was suffering from scleritis and lid swelling in her right eye. Not only did topical and systemic corticosteroid therapy prove insufficient, they also resulted in the elevation of her intraocular pressure. After termination of corticosteroid therapy, the systemic cyclosporine was applied orally. Subsequently, the patient's scleritis improved without any severe side effects. Scleritis is a painful and destructive inflammatory disease of the sclera that causes congestion of the scleral venous plexus. In this study, we have established a new grading system for assessing activity in scleritis that can score the extent of ocular pain and the area of congestion. This system provides a practical method for following the clinical course and monitoring the outcome of therapy. We report two cases of unilateral scleritis that were resistant to corticosteroid therapy but responsive to systemic administration of cyclosporine. Findings from these cases indicate that cyclosporine is an effective drug for controlling severe scleritis.

  15. Considerations in the rationale, design and methods of the Strategic Timing of AntiRetroviral Treatment (START) study

    DEFF Research Database (Denmark)

    Babiker, Abdel G; Emery, Sean; Fätkenheuer, Gerd

    2013-01-01

    Untreated human immunodeficiency virus (HIV) infection is characterized by progressive depletion of CD4+ T lymphocyte (CD4) count leading to the development of opportunistic diseases (acquired immunodeficiency syndrome (AIDS)), and more recent data suggest that HIV is also associated with an incr...... is not feasible with currently available drugs. The optimal time to start ART for asymptomatic HIV infection is controversial and remains one of the key unanswered questions in the clinical management of HIV-infected individuals....... with an increased risk of serious non-AIDS (SNA) diseases including cardiovascular, renal, and liver diseases and non-AIDS-defining cancers. Although combination antiretroviral treatment (ART) has resulted in a substantial decrease in morbidity and mortality in persons with HIV infection, viral eradication...

  16. HIV Clinical Pathway: A New Approach to Combine Guidelines and Sustainability of Anti-Retroviral Treatment in Italy

    Science.gov (United States)

    Croce, Davide; Lazzarin, Adriano; Rizzardini, Giuliano; Gianotti, Nicola; Scolari, Francesca; Foglia, Emanuela; Garagiola, Elisabetta; Ricci, Elena; Bini, Teresa; Quirino, Tiziana; Viganò, Paolo; Re, Tiziana; D’Arminio Monforte, Antonella; Bonfanti, Paolo

    2016-01-01

    The present article describes the case study of a “real world” HIV practice within the debate concerning the strategic role of Clinical Governance (CG) tools in the management of a National Healthcare System’s sustainability. The study aimed at assessing the impact of a Clinical Pathway (CP) implementation, required by the Regional Healthcare Service, in terms of effectiveness (virological and immunological conditions) and efficiency (economic resources absorption), from the budget holder perspective. Data derived from a multi-centre cohort of patients treated in 6 Hospitals that provided care to approximately 42% of the total HIV+ patients, in Lombardy Region, Italy. Two phases were compared: Pre-CP (2009–2010) vs. Post-CP implementation (2011–2012). All HIV infected adults, observed in the participating hospitals during the study periods, were enrolled and stratified into the 3 categories defined by the Regional CP: first-line, switch for toxicity/other, and switch for failure. The study population was composed of 1,284 patients (Pre-CP phase) and 1,135 patients (Post-CP phase). The results showed that the same level of virological and immunological effectiveness was guaranteed to HIV+ patients: 81.2% of Pre-CP phase population and 83.2% of Post-CP phase population had undetectable HIV-RNA (defined as management of the HIV disease (ART, hospital admission and laboratory tests) decreased (-8.60%) in the Post-CP phase (p-value < 0.0001). Results confirmed that the CP provided appropriateness and quality of care, with a cost reduction for the budget holder. PMID:28030621

  17. Lesões anorretais em pacientes HIV positivos usuários de terapia anti-retroviral de alta efetividade

    OpenAIRE

    Retamozo-Palacios,Manuel; SOUSA, João Batista de; Santos,João Barberino

    2007-01-01

    As lesões anorretais são comuns nos pacientes positivos para o vírus da imunodeficiência humana. A terapia antirretroviral de alta efetividade tem pouca influência na progressão das neoplasias anais. Estudou-se a prevalência das lesões anorretais em 88 pacientes HIV positivos atendidos no serviço de doenças infecto-parasitárias do Hospital Universitário de Brasília, em uso de terapia antirretroviral de alta efetividade. Dados sócio-demográficos foram coletados usando um questionário pré-elabo...

  18. Using sculpturing during speech therapy sessions in order to involve a child with ASD in joint activities

    Directory of Open Access Journals (Sweden)

    Vlasova L.I.

    2016-06-01

    Full Text Available Children with autism spectrum disorders often have particular hardships in participating in joint activities with an adult. This makes interventions more problematic and draws back the achievement of planned educational goals. At the early stages of speech therapy, the important goal of individual sessions with the majority of children with autism spectrum disorders is not speech development in itself but developing motivation for joint activities. To ensure successful interaction between an educator and a child, different techniques can be used, including those that are not typical for speech therapy sessions, for example, sculpturing as a preferred activity with enjoyable sensory input. The article describes tips for developing rapport with children with autistic disorders, and a strategy for involving them in joint activities and further development of their speech.

  19. Prevalence of Herbal Therapy Use in Active Duty Air Force Women

    Science.gov (United States)

    2001-04-24

    back problems, insomnia , headache, anxiety, and depression. No reported conditions included herbal therapy as a primary therapy for treatment. Eighty...vitamin, or both. The most common physical complaints for which herbal therapy was used in 1997 were allergies, insomnia , lung problems, and digestive...menstrual problems and infertility, discomforts and dysfunctions of pregnancy, labor, and menopause (Beal, 1998). There have been studies reported in the

  20. Activation and coreceptor expression of T lymphocytes induced by highly active antiretroviral therapy in Chinese HIV/AIDS patients

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zi-ning; SHANG Hong; JIANG Yong-jun; LIU Jing; DAI Di; DIAO Ying-ying; GENG Wen-qing; JIN Xin; WANG Ya-nan

    2006-01-01

    Background At the end of 2005, 650 000 people lived with human immunodeficiency virus type-1 (HIV-1) in (HAART) supported by the "China CARES" program but the immune responses of HAART were seldom reported. This study investigated the effect of HAART on the activation and coreceptor expression of T lymphocytes in Chinese HIV/AIDS patients and evaluated its effect on immune reconstitution.Methods Seventeen HIV/AIDS patients were enrolled and three-color-flow cytometry was used to detect the activation of HLA-DR CD38 and the coreceptor CCR5, CXCR4 expression on T lymphocytes in whole blood samples taken from the patients before and after 3- or 6-month HAART.Results The activation percents of CD4+, CD8+ T lymphocytes were significantly higher before therapy than the normal controls (HLA-DR/CD4: 40.47± 18.85 vs 11.54±4.10; CD38/CD4: 81.34± 10.86 vs 53.34± 11.44;HLA-DR/CD8:63.94±12.71 vs 25.67±9.18; CD38/CD8:86.56±11.41 vs 58.84±6.16, all P<0.01). After 6-month combined antiretroviral treatment, the activation of T lymphocytes in HIV/AIDS patients was significantly decreased (HLA-DR/CD4:28.31 ± 13.48; CD38/CD4:69.88 ± 12.64; HLA-DR/CD8: 46.56±18.64;CD38/CD8: 70.17± 14.54, all P<0.01 compared with the pre-treatment values). Before the treatment, CCR5 expression on CD8+ T lymphocytes was up-regulated while CXCR4 expression on CD8+ T lymphocytes downregulated in HIV/AIDS patients compared with the normal controls (CD8/CCR5:70.9 1± 10.03 vs 52.70 ±7.68; CD8/CXCR4: 24.14± 11.08 vs 50.05± 11.68, all P<0.01). After 6-month HAART, CCR5 expression on CD8+ T lymphocytes significantly decreased (56.35±12.96, P<0.01), while CXCR4 expression on CD8+ T lymphocytes increased (36.95±9.96, P<0.05) compared with the pre-treatment and the normal controls. A significant statistical relationship was observed between the expression of activation markers, CCR5 and the CD4+ T lymphocyte counts after HAART (P<0.05).Conclusions Reduced activation of T lymphocytes

  1. A plasma biomarker signature of immune activation in HIV patients on antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Anupa Kamat

    Full Text Available BACKGROUND: Immune activation is a strong predictor of disease progression in HIV infection. Combinatorial plasma biomarker signatures that represent surrogate markers of immune activation in both viremic and aviremic HIV patients on combination antiretroviral therapy (cART have not been defined. Here, we identify a plasma inflammatory biomarker signature that distinguishes between both viremic and aviremic HIV patients on cART and healthy controls and examine relationships of this signature to markers of disease progression. METHODS: Multiplex profiling and ELISA were used to detect 15 cytokines/chemokines, soluble IL-2R (sIL-2R, and soluble CD14 (sCD14 in plasma from 57 HIV patients with CD4 nadir <300 cells/µl and 29 healthy controls. Supervised and unsupervised analyses were used to identify biomarkers explaining variance between groups defined by HIV status or drug abuse. Relationships between biomarkers and disease markers were examined by Spearman correlation. RESULTS: The majority (91% of HIV subjects were on cART, with 38% having undetectable viral loads (VL. Hierarchical clustering identified a biomarker cluster in plasma consisting of two interferon-stimulated gene products (CXCL9 and CXCL10, T cell activation marker (sIL-2R, and monocyte activation marker (sCD14 that distinguished both viremic and aviremic HIV patients on cART from controls (p<0.0001 and were top-ranked in variables important in projection plots. IL-12 and CCL4 were also elevated in viremic and aviremic patients compared to controls (p<0.05. IL-12 correlated with IFNα, IFNγ, CXCL9, and sIL-2R (p<0.05. CXCL10 correlated positively with plasma VL and percentage of CD16+ monocytes, and inversely with CD4 count (p = 0.001, <0.0001, and 0.04, respectively. CONCLUSION: A plasma inflammatory biomarker signature consisting of CXCL9, CXCL10, sIL-2R, and sCD14 may be useful as a surrogate marker to monitor immune activation in both viremic and aviremic HIV patients on c

  2. Kaposi’s Sarcoma of the Rectum in a Homosexual Male with HIV-AIDS

    Science.gov (United States)

    Nautsch, Deborah

    2016-01-01

    Visceral involvement in AIDS-related Kaposi’s sarcoma is common, but it is rarely seen in the absence of cutaneous disease. Most patients with gastrointestinal tract Kaposi’s sarcoma remain asymptomatic and are often diagnosed on endoscopy or autopsy. We report a case of a 24-year-old homosexual man who presented with rectal pain and bleeding and was found to have skin-sparing, disseminated Kaposi’s sarcoma with rectum, liver, lungs, and lymph node involvement. Despite treatment with highly active anti-retroviral therapy, he developed multiorgan failure resulting in death. PMID:28119943

  3. 南京市HIV感染者及艾滋病患者抗病毒治疗依从性及影响因素研究%Compliance of antiviral therapy and influencing factors in people living with HIV/AIDS in ;Nanjing

    Institute of Scientific and Technical Information of China (English)

    魏洪霞; 傅更锋; 还锡萍; 王璐; 李萌; 张夏燕; 步凯; 冯一冰; 刘晓燕; 史灵恩; 陈禹衡; 柏春琴

    2015-01-01

    Objective To understand the compliance of highly active anti-retroviral therapy (HAART) and influencing factors in people living with HIV/AIDS (PLWHA) in Nanjing. Methods PLWHA receiving HAART in No. 2 Hospital of Nanjing during May-June 2014 were recruited in this study. Self-administrated questionnaire was used to collect the data about HAART compliance and socio-demographic characteristics of PLWHA surveyed. Descriptive and multivariate statistical analysis were conducted to examine the effects of the factors on self-reported HAART adherence. Results A total of 276 PLWHA were surveyed,According to the evaluation criterion of Center for Adherence Support Evaluation (CASE),252 cases showed good compliance (91.3%). logistic regression analysis revealed that smoking,progress of the disease and side effects,reminding of taking drug and age were correlated with self-reported HAART adherence. Conclusion It is suggested to strengthen the education about antiviral therapy compliance in PLWHA with mild infection and those who are smokers and young,suffer from side effects,have no reminding methods for taking drug.%目的:了解南京市接受抗病毒治疗(ART)的HIV感染者及艾滋病患者(HIV/AIDS)的ART依从性及其影响因素,为提高HIV/AIDS人群的ART依从性提供参考。方法2014年5-6月在南京市第二医院接受免费高效抗反转录病毒治疗(HAART)的HIV/AIDS作为研究对象,收集一般人口学、ART情况及社会支持与歧视等信息,利用logistic回归分析HAART依从性的影响因素。结果共调查HIV/AIDS 276例,以依从性支持评价中心的依从性指数为评价标准,调查发现总体依从性良好252例,占91.3%。经单因素及多因素分析显示,提醒服药(OR=0.13,95%CI:0.04~0.37)、年龄较大者(OR=0.52,95%CI:0.31~0.89)服药依从性较好;而存在ART副作用(OR=4.11,95%CI:1.35~12.56)、WHO分期较诊断时降低(OR=3.56,95

  4. Comparison of bone and renal effects in HIV-infected adults switching to abacavir or tenofovir based therapy in a randomized trial.

    Directory of Open Access Journals (Sweden)

    Thomas A Rasmussen

    Full Text Available INTRODUCTION: Our objective was to compare the bone and renal effects among HIV-infected patients randomized to abacavir or tenofovir-based combination anti-retroviral therapy. METHODS: In an open-label randomized trial, HIV-infected patients were randomized to switch from zidovudine/lamivudine (AZT/3TC to abacavir/lamivudine (ABC/3TC or tenofovir/emtricitabine (TDF/FTC. We measured bone mass density (BMD and bone turnover biomarkers (osteocalcin, osteocalcin, procollagen type 1 N-terminal propeptide (P1NP, alkaline phosphatase, type I collagen cross-linked C-telopeptide (CTx, and osteoprotegerin. We assessed renal function by estimated creatinine clearance, plasma cystatin C, and urinary levels of creatinine, albumin, cystatin C, and neutrophil gelatinase-associated lipocalin (NGAL. The changes from baseline in BMD and renal and bone biomarkers were compared across study arms. RESULTS: Of 40 included patients, 35 completed 48 weeks of randomized therapy and follow up. BMD was measured in 33, 26, and 27 patients at baseline, week 24, and week 48, respectively. In TDF/FTC-treated patients we observed significant reductions from baseline in hip and lumbar spine BMD at week 24 (-1.8% and -2.5% and week 48 (-2.1% and -2.1%, whereas BMD was stable in patients in the ABC/3TC arm. The changes from baseline in BMD were significantly different between study arms. All bone turnover biomarkers except osteoprotegerin increased in the TDF/FTC arm compared with the ABC/3TC arm, but early changes did not predict subsequent loss of BMD. Renal function parameters were similar between study arms although a small increase in NGAL was detected among TDF-treated patients. CONCLUSION: Switching to TDF/FTC-based therapy led to decreases in BMD and increases in bone turnover markers compared with ABC/3TC-based treatment. No major difference in renal function was observed. TRIAL REGISTRATION: Clinicaltrials.gov NCT00647244.

  5. A computational analysis of the structural determinants of APOBEC3's catalytic activity and vulnerability to HIV-1 Vif.

    Science.gov (United States)

    Shandilya, Shivender M D; Bohn, Markus-Frederik; Schiffer, Celia A

    2014-12-01

    APOBEC3s (A3) are Zn(2+) dependent cytidine deaminases with diverse biological functions and implications for cancer and immunity. Four of the seven human A3s restrict HIV by 'hypermutating' the reverse-transcribed viral genomic DNA. HIV Virion Infectivity Factor (Vif) counters this restriction by targeting A3s to proteasomal degradation. However, there is no apparent correlation between catalytic activity, Vif binding, and sequence similarity between A3 domains. Our comparative structural analysis reveals features required for binding Vif and features influencing polynucleotide deaminase activity in A3 proteins. All Vif-binding A3s share a negatively charged surface region that includes residues previously implicated in binding the highly-positively charged Vif. Additionally, catalytically active A3s share a positively charged groove near the Zn(2+) coordinating active site, which may accommodate the negatively charged polynucleotide substrate. Our findings suggest surface electrostatics, as well as the spatial extent of substrate accommodating region, are critical determinants of substrate and Vif binding across A3 proteins with implications for anti-retroviral and anti-cancer therapeutic design.

  6. Alemtuzumab: a new therapy for active relapsing-remitting multiple sclerosis.

    Science.gov (United States)

    Hartung, Hans-Peter; Aktas, Orhan; Boyko, Alexey N

    2015-01-01

    Alemtuzumab is a humanized monoclonal antibody directed against CD52 to deplete circulating T and B lymphocytes; lymphocyte depletion is followed by a distinctive pattern of T- and B-cell repopulation, changing the balance of the immune system. This review reports the efficacy and safety findings of the phase 2 CAMMS223 trial and the phase 3 CARE-MS I and II trials investigating alemtuzumab for the treatment of active relapsing-remitting MS. Alemtuzumab, administered intravenously, was shown to improve relapse rate versus subcutaneous interferon beta-1a in patients who were treatment-naive (CAMMS223 and CARE-MS I) or had relapsed on prior therapy (CARE-MS II), and to reduce sustained accumulation of disability (CAMMS223 and CARE-MS II). Important adverse events were infusion-associated reactions, serious infections and autoimmune events. A safety monitoring program allowed for early detection and management of autoimmune events. Recommendations for the monitoring of adverse events are made. Alemtuzumab's mechanism of action, pharmacodynamics and opportunities for future research are discussed.

  7. A Systematic Review of Cognitive Behavioral Therapy and Behavioral Activation Apps for Depression.

    Directory of Open Access Journals (Sweden)

    Anna Huguet

    Full Text Available Depression is a common mental health condition for which many mobile apps aim to provide support. This review aims to identify self-help apps available exclusively for people with depression and evaluate those that offer cognitive behavioural therapy (CBT or behavioural activation (BA. One hundred and seventeen apps have been identified after searching both the scientific literature and the commercial market. 10.26% (n = 12 of these apps identified through our search offer support that seems to be consistent with evidence-based principles of CBT or BA. Taking into account the non existence of effectiveness/efficacy studies, and the low level of adherence to the core ingredients of the CBT/BA models, the utility of these CBT/BA apps are questionable. The usability of reviewed apps is highly variable and they rarely are accompanied by explicit privacy or safety policies. Despite the growing public demand, there is a concerning lack of appropiate CBT or BA apps, especially from a clinical and legal point of view. The application of superior scientific, technological, and legal knowledge is needed to improve the development, testing, and accessibility of apps for people with depression.

  8. Music therapy modulates fronto-temporal activity in rest-EEG in depressed clients.

    Science.gov (United States)

    Fachner, Jörg; Gold, Christian; Erkkilä, Jaakko

    2013-04-01

    Fronto-temporal areas process shared elements of speech and music. Improvisational psychodynamic music therapy (MT) utilizes verbal and musical reflection on emotions and images arising from clinical improvisation. Music listening is shifting frontal alpha asymmetries (FAA) in depression, and increases frontal midline theta (FMT). In a two-armed randomized controlled trial (RCT) with 79 depressed clients (with comorbid anxiety), we compared standard care (SC) versus MT added to SC at intake and after 3 months. We found that MT significantly reduced depression and anxiety symptoms. The purpose of this study is to test whether or not MT has an impact on anterior fronto-temporal resting state alpha and theta oscillations. Correlations between anterior EEG, Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hospital Anxiety and Depression Scale-Anxiety Subscale (HADS-A), power spectral analysis (topography, means, asymmetry) and normative EEG database comparisons were explored. After 3 month of MT, lasting changes in resting EEG were observed, i.e., significant absolute power increases at left fronto-temporal alpha, but most distinct for theta (also at left fronto-central and right temporoparietal leads). MT differed to SC at F7-F8 (z scored FAA, p effects on cortical activity in depression, suggesting an impact of MT on anxiety reduction.

  9. Dyslipidemia in a cohort of HIV-infected Latin American children receiving highly active antiretroviral therapy.

    Science.gov (United States)

    Brewinski, Margaret; Megazzini, Karen; Hance, Laura Freimanis; Cruz, Miguel Cashat; Pavia-Ruz, Noris; Della Negra, Marinella; Ferreira, Flavia Gomes Faleiro; Marques, Heloisa; Hazra, Rohan

    2011-10-01

    In order to describe the prevalence of hypercholesterolemia and hypertriglyceridemia in a cohort of HIV-infected children and adolescents in Latin America and to determine associations with highly active antiretroviral therapy (HAART), we performed this cross-sectional analysis within the NICHD International Site Development Initiative pediatric cohort study. Eligible children had to be at least 2 years of age and be on HAART. Among the 477 eligible HIV-infected youth, 98 (20.5%) had hypercholesterolemia and 140 (29.4%) had hypertriglyceridemia. In multivariable analyses, children receiving protease inhibitor (PI)-containing HAART were at increased risk for hypercholesterolemia [adjusted odds ratio (AOR) =  2.7, 95% confidence interval (CI) 1.3-5.6] and hypertriglyceridemia (AOR = 3.5, 95% CI 1.9-6.4) compared with children receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing HAART. In conclusion, HIV-infected youth receiving PI-containing HAART in this Latin American cohort were at increased risk for hypercholesterolemia and hypertriglyceridemia compared with those receiving NNRTI-containing HAART.

  10. Vitamin E Concentrations in Adults with HIV/AIDS on Highly Active Antiretroviral Therapy

    Directory of Open Access Journals (Sweden)

    Daniella J. Itinoseki Kaio

    2014-09-01

    Full Text Available HIV/AIDS patients are probably more predisposed to vitamin E deficiency, considering that they are more exposed to oxidative stress. Additionally, there are an extensive number of drugs in the highly active antiretroviral therapy (HAART regimens that may interfere with vitamin E concentrations. The objective of this study was to compare serum concentrations of alpha-tocopherol in 182 HIV/AIDS patients receiving different HAART regimens. The patients were divided into three groups according to regimen: nucleoside analog reverse-transcriptase inhibitors (NRTIs + non-nucleoside analog reverse-transcriptase inhibitors (NNRTIs; NRTIs + protease inhibitors + ritonavir; NRTIs + other classes. Alpha-tocopherol was assessed by high-performance liquid chromatography. Multiple linear regression analysis was used to evaluate the effects of HAART regimen, time of use, and compliance with the regimen on alpha-tocopherol concentrations. Alpha-tocopherol concentrations were on average 4.12 μmol/L lower for the NRTIs + other classes regimen when compared to the NRTIs + NNRTIs regimen (p = 0.037. A positive association (p < 0.001 was observed between alpha-tocopherol and cholesterol concentrations, a finding due, in part, to the relationship between liposoluble vitamins and lipid profile. This study demonstrated differences in alpha-tocopherol concentrations between patients using different HAART regimens, especially regimens involving the use of new drugs. Long-term prospective cohort studies are needed to monitor vitamin E status in HIV/AIDS patients since the beginning of treatment.

  11. Dyslipidemia in a Cohort of HIV-infected Latin American Children Receiving Highly Active Antiretroviral Therapy*

    Science.gov (United States)

    Brewinski, Margaret; Megazzini, Karen; Freimanis Hance, Laura; Cruz, Miguel Cashat; Pavia-Ruz, Noris; Della Negra, Marinella; Ferreira, Flavia Gomes Faleiro; Marques, Heloisa

    2011-01-01

    In order to describe the prevalence of hypercholesterolemia and hypertriglyceridemia in a cohort of HIV-infected children and adolescents in Latin America and to determine associations with highly active antiretroviral therapy (HAART), we performed this cross-sectional analysis within the NICHD International Site Development Initiative pediatric cohort study. Eligible children had to be at least 2 years of age and be on HAART. Among the 477 eligible HIV-infected youth, 98 (20.5%) had hypercholesterolemia and 140 (29.4%) had hypertriglyceridemia. In multivariable analyses, children receiving protease inhibitor (PI)-containing HAART were at increased risk for hypercholesterolemia [adjusted odds ratio (AOR) = 2.7, 95% confidence interval (CI) 1.3–5.6] and hypertriglyceridemia (AOR = 3.5, 95% CI 1.9–6.4) compared with children receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing HAART. In conclusion, HIV-infected youth receiving PI-containing HAART in this Latin American cohort were at increased risk for hypercholesterolemia and hypertriglyceridemia compared with those receiving NNRTI-containing HAART. PMID:20889625

  12. Magnetic resonance imaging evaluation of lipodystrophy in HIV-positive patients receiving highly active antiretroviral therapy.

    Science.gov (United States)

    Eichler, K; Bickel, T M; Klauke, S; Eisen, J; Vogl, T J; Zangos, S

    2015-07-01

    We evaluated retrospectively an automated method for the separate detection of subcutaneous and visceral fat in the abdominal region by magnetic resonance studies in HIV-positive patients on highly active antiretroviral therapy. The patients were divided into four different groups: lipoatrophy, lipohypertrophy, mixed and the control group. The use of software for the automated detection of abdominal compartment visceral adipose tissue (VAT), total adipose tissue (TAT) and subcutaneous adipose tissue (SAT) was compared to manual evaluation methods (fuzzy C-mean). The results of ROC analysis showed that the parameters, particularly the VAT, are better than the VAT/TAT and at identifying patients with the symptoms of abdominal fat accumulation. A sensitivity of 80.3% and a specificity of 79.5% resulted from a threshold VAT value of >87 cm(2). Moreover, the manual evaluation method was shown to provide greater values for VAT and the VAT/TAT ratio than those given by the automated method. In the present study, a rapid MRI protocol for the detection and assessment of the course of lipodystrophy was presented and tested on a group of patients with signs of HALS, as well as on an antiretroviral naïve control group.

  13. Potential Suitable Methods for Measuring the Effects of Animal-Assisted Activities and Therapy: a Review

    Directory of Open Access Journals (Sweden)

    Machová K.

    2016-09-01

    Full Text Available Dogs are companions of humans since time beyond memory and their use in rehabilitation processes is increasingly frequent. Dogs can be used for animal-assisted activities (AAA as well as animal-assisted therapy (AAT. The effects, however, have not been fully demonstrated, reasons for this including difficulties in providing evidence of positive action. According to previous studies, there is a decrease in heart and respiratory rate, blood pressure reduction, more positive mood as well as warming of muscles, which promotes relaxation of spastic areas. Regulation of hormone levels might also occur as a result of AAA/AAT. Indeed, increases in oxytocin levels and decreases of cortisol have been found. However, a unified methodology for clear measuring the entire impact of AAA/AAT on patients is missing. This survey evaluated different methods for measuring the effects of AAA/AAT, with results showing that the most suitable ones, selected on the basis of the effect of rehabilitation, comprise thermography, spectral analysis of heart rate, electromyography (EMG, polyelectromyography (PEMG, and blood sampling. Because AAT making use of dogs has not yet been recognized as an official method of treatment, it is very important to find out objective means to evidence its beneficial effects. Highlights:

  14. Access to highly active antiretroviral therapy for injection drug users: adherence, resistance, and death

    Directory of Open Access Journals (Sweden)

    David Vlahov

    Full Text Available Injection drug users (IDUs continue to comprise a major risk group for HIV infection throughout the world and represent the focal population for HIV epidemics in Asia and Eastern Europe/Russia. HIV prevention programs have ranged from HIV testing and counseling, education, behavioral and network interventions, drug abuse treatment, bleach disinfection of needles, needle exchange and expanded syringe access, as well as reducing transition to injection and primary substance abuse prevention. With the advent of highly active antiretroviral therapy (HAART in 1996, dramatic clinical improvements have been seen. In addition, the treatment's impact on reducing HIV viral load (and therefore transmission by all routes provides a stronger rationale for an expansion of the focus on prevention to emphasize early identification and treatment of HIV infected individuals. However, treatment of IDUs has many challenges including adherence, resistance and relapse to high risk behaviors, all of which impact issues of access and ultimately effectiveness of potent antiretroviral treatment. A major current challenge in addressing the HIV epidemic revolves around an appropriate approach to HIV treatment for IDUs.

  15. Transdiagnostic group behavioral activation and exposure therapy for youth anxiety and depression: Initial randomized controlled trial.

    Science.gov (United States)

    Chu, Brian C; Crocco, Sofia T; Esseling, Petra; Areizaga, Margaret J; Lindner, Alison M; Skriner, Laura C

    2016-01-01

    Anxiety and depression are debilitating and commonly co-occurring in young adolescents, yet few interventions are designed to treat both disorder classes together. Initial efficacy is presented of a school-based transdiagnostic group behavioral activation therapy (GBAT) that emphasizes anti-avoidance in vivo exposure. Youth (N = 35; ages 12-14; 50.9% male) were randomly assigned to either GBAT (n = 21) or WL (n = 14) after completing a double-gated screening process. Multi-reporter, multi-domain outcomes were assessed at pretreatment, posttreatment, and four-month follow-up (FU). GBAT was associated with greater posttreatment remission rates than WL in principal diagnosis (57.1% vs. 28.6%; X1(2) = 2.76, p = .09) and secondary diagnosis (70.6% vs. 10%; X1(2) = 9.26, p = .003), and greater improvement in Clinical Global Impairment - Severity ratings, B = -1.10 (0.42), p = .01. Symptom outcomes were not significantly different at posttreatment. GBAT produced greater posttreatment behavioral activation (large effect size) and fewer negative thoughts (medium effect), two transdiagnostic processes, both at the trend level. Most outcomes showed linear improvement from pretreatment to FU that did not differ depending on initial condition assignment. Sample size was small, but GBAT is a promising transdiagnostic intervention for youth anxiety and unipolar mood disorders that can feasibly and acceptably be applied in school settings.

  16. [High activity antiretroviral therapy change associated to adverse drug reactions in a specialized center in Venezuela].

    Science.gov (United States)

    Subiela, José D; Dapena, Elida

    2016-03-01

    Adverse drug reactions (ADRs) represent the first cause of change of the first-line highly active antiretroviral therapy (HAART) regimen, therefore, they constitute the main limiting factor in the long-term follow up of HIV patients in treatment. A retrospective study was carried out in a specialized center in Lara State, Venezuela, including 99 patients over 18 years of age who had change of first-line HAART regimen due to ADRs, between 2010 and 2013. The aims of this research were to describe the sociodemographic and clinical variables, frequency of ADRs related to change of HAART, duration of the first-line HAART regimen, to determine the drugs associated with ARVs and to identify the risk factors. The ADRs constituted 47.5% of all causes of change of first-line HAART regimen, the median duration was 1.08±0.28 years. The most frequent ADRs were anemia (34.3%), hypersensitivity reactions (20.2%) and gastrointestinal intolerance (13.1%). The most frequent ARV regimen type was the protease inhibitors-based regimen (59.6%), but zidovudine was the ARV most linked to ADRs (41.4%). The regression analysis showed increased risk of ADRs in singles and students in the univariate analysis and heterosexuals and homosexuals in multivariate analysis; and decreased risk in active workers. The present work shows the high prevalence of ADRs in the studied population and represents the first case-based study that describes the pharmacoepidemiology of a cohort of HIV-positive patients treated in Venezuela.

  17. Azithromycin in a triple therapy for H. pylori eradication in active duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    Vladimir T. Ivashkin; Tatiana L. Lapina; Oksana Yu. Bondarenko; Olga A. Sklanskaya; Petr Ya. Grigoriev; Yuri V. Vasiliev; Emilia P. Yakovenko; Pavel V. Gulyaev; Valeri I. Fedchenko

    2002-01-01

    AIM: To assess and compare the efficacy and safety of twotriple regimes: A) metronidazole, amoxicillin and omeprazole,which is still widely used in Russia, and B) azithromycin,amoxicillin and omeprazole in healing active duodenal ulcerand H.pylori eradication. METHODS: 100 patients with active duodenal ulcer wereincluded in the open, multicentre, randomized study withcomparative groups. Patients were randomly assigned toone of the following one-week triple regimes: A)metronidazole 500 mg bid, amoxicillin 1 g bid and omeprazole20 mg bid (OAM, n=50) and B) azithromycin 1 g od for thefirst 3 days (total dose 3 g), amoxicillin 1 g bid andomeprazole 20 mg bid (OAA, n=50). Omeprazole 20 mg odwas given after the eradication course as a monotherapyfor three weeks. The control endoscopy was performed 8weeks after the entry. H. pylori infection was determined inthe entry of the study and four weeks after the cessation oftreatment by means of histology and CLO-test.RESULTS: 97 patients completed the study according tothe protocol (1 patient of the OAM group did not come tothe control endoscopy, 2 patients of the OAA group stoppedthe treatment because of mild allergic urticaria). Duodenalulcers were healed in 48 patients of the OAM group (96 %;CI 90.5-100 %) and in 46 patients of the OAA group (92 %;CI 89.5-94.5 %) (p=ns). H. pylori infection was eradicatedin 15 out of 50 patients with OAM (30 %; CI 17-43 %) andin 36 out of 50 patients treated with OAA (72 %; CI 59-85 %)(P<0.001)-ITT analysis.CONCLUSION: The triple therapy with omeprazole,amoxicillin and metronidazole failed to eradicate H. pylori inthe majority of patients, which is an essential argument towithdraw this regimen out of the national recommendations.Macrolide with amoxicillin are preferable to achieve highereradication rates. Azithromycin (1 g od for the first 3 days)can be considered as a successful component of the triplePPI-based regimen.

  18. The Immune Pathogenesis of Immune Reconstitution Inflammatory Syndrome Associated with Highly Active Antiretroviral Therapy in AIDS

    Science.gov (United States)

    Zhou, Huaying; He, Yan; Chen, Zi; He, Bo; He, Mei

    2014-01-01

    Abstract The present study investigated the immunological pathogenesis of immune reconstitution inflammatory syndrome (IRIS) in acquired immunodeficiency syndrome (AIDS) patients undergoing highly active antiretroviral therapy (HAART). A total of 238 patients with AIDS who received initial HAART were included in this prospective cohort study. Blood samples were collected immediately, at baseline, at week 12, and at week 24 after initial HAART and at the onset of IRIS. Lymphocyte subsets, Th1 and Th2 cytokines, and interleukin (IL)-7 levels were measured by flow cytometry or ELISA. Among the 238 patients with AIDS who received HAART, 47 patients developed IRIS. The percentages of CD4+ and CD8+ naive, memory, and activated cells exhibited no significant differences between AIDS patients with and without IRIS 24 weeks after initial HAART. The percentage of CD4+CD25+Foxp3+ regulatory T cells was lower in IRIS patients than in non-IRIS patients before HAART, 12 weeks after HAART, 24 weeks after HAART, and at the onset of IRIS. IL-2 and interferon (IFN)-γ levels were significantly higher at week 4 and at the onset of IRIS in IRIS patients than in non-IRIS patients. In contrast, IL-4 and IL-10 levels were significantly lower at week 4 and at the onset of IRIS in IRIS patients than in non-IRIS patients. Plasma IL-7 decreased gradually with the progression of HAART. The level of IL-7 was higher in IRIS patients than in non-IRIS patients at all follow-up time points. An imbalance of Th1/Th2 cytokines, a consistently low CD+CD25+Fox3+ percentage, and a high IL-7 level may be crucial in the pathogenesis of IRIS in AIDS patients who had received HAART. PMID:25131160

  19. Magnetic resonance imaging of the femoral head to detect avascular necrosis in active rheumatoid arthritis treated with methylprednisolone pulse therapy

    Energy Technology Data Exchange (ETDEWEB)

    Vugt, R.M. van; Sijbrandij, E.S.; Bijlsma, J.W.J. [Univ. Hospital Utrecht (Netherlands)

    1996-03-01

    Efficacious management of patients with avascular necrosis of bone (AVN) necessitates the identification of patients with a high risk of collapse of the femoral head. In this prospective study we imaged both hips of 10 patients with active rheumatoid arthritis, who were treated with methylprednisolone pulse therapy. MRI and conventional radiography were performed before MP-pulse therapy and 6 and 12 months thereafter. Two patients showed unilateral changes compatible with AVN. One patient became symptomatic and revealed characteristic radiographic abnormalities. The other patient remained asymptomatic and the MRI appearance returned to normal after 6 months. 18 refs., 2 figs., 1 tab.

  20. Access to highly active antiretroviral therapy (HAART) for women and children in the WHO European Region 2002-2006

    DEFF Research Database (Denmark)

    Stengaard, Annemarie Rinder; Lazarus, Jeff; Donoghoe, Martin C

    2009-01-01

    Objective. To assess the level of access to highly active antiretroviral therapy (HAART) for women and children in the WHO European Region. Methods. Analysis of data from three national surveys of 53 WHO European Member States. The comparative level of access to HAART for women and children...... was assessed by comparing the percentage of reported HIV cases with the percentage of HAART recipients in women at the end of 2002 and 2006 and in children at the end of 2004 and 2006. Findings. Overall, the data suggest that there is equivalence of access to antiretroviral therapy by gender and age in Europe...

  1. Changes in coagulation and lytic activity of the blood and tissues at the pelvic trauma during anticoagulant therapy

    Directory of Open Access Journals (Sweden)

    A. P. Vlasov

    2014-01-01

    Full Text Available The purpose of our study was exploration of coagulation and lytic activity in blood and tissues during anticoagulation therapy in the early posttraumatic period in patients with pelvic bone fracture. The study was based on experiment researches using methods allowing to estimate coagulation activity in different tissues (skeletal muscles, liver, kidneys, heart, lungs and blood at pelvic trauma during anticoagulation therapy. It was established that at pelvic trauma using anticoagulation therapy (fraxiparine leads to hemostatic system modification in the early posttraumatic period. We observed fast decrease of a hypercoagulability in a blood plasma (organism level and growth fibrinolytic activity. In liver, kidneys, heart and lungs tissues (organ level we also registered correction the hemostatic disorders. However, the rate of these recovery processes in tissues is lower than in the blood. Especially low it was in skeletal muscles in the area of injury. Thus, it is proved that anticoagulant therapy at a pelvic trauma affects on the extrinsic coagulation pathway less than on the intrinsic coagulation pathway. The established regularity explains the risks of coagulation abnormalities in the early posttraumatic period during anticoagulation treatment.

  2. Enteric parasitic infections in HIV/AIDS patients before and after the highly active antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Tatiana Paschoalette Rodrigues Bachur

    2008-04-01

    Full Text Available Enteroparasites are related to gastrointestinal alterations among patients with HIV/AIDS, some causing severe manifestations in the period before the institution of the highly active antiretroviral therapy (HAART. The prevalence of enteroparasitoses in patients with HIV/AIDS seen at two hospitals in Ceará , Brazil, was compared in the pre-HAART (Group 1; n = 482 and HAART (Group 2; n = 100 eras. Fecal parasitologic examinations (FPE were performed using the direct, Lutz, Baermann-Moraes and modified Ziehl-Neelsen methods. The following parasites were detected in Groups 1 and 2, respectively: Strongyloides stercoralis - 30.1% and 11% (p<0.0001, Ascaris lumbricoides - 15.6% and 2% (p<0.0001, hookworms - 13.7% and 2% (p<0.0001, Trichuris trichiura - 13.1% and 1% (p<0.0001, Hymenolepis nana - 0 and 1% (p = 0.1718, Giardia duodenalis - 7.9% and 1% (p = 0.0076, Entamoeba histolytica/dispar - 3.3% and 1% (p = 0.3301, Isospora belli - 4.8% and 1% (p = 0.0993, Cryptosporidium sp. - 8.1% and 0 (p = 0.0007, and non-pathogenic protozoans as well. There was a significant reduction in the prevalence of enteroparasites between the eras (63.9% to 24%; p<0.0001. In the HAART era, the following observations were made: greater frequency of enteroparasites in patients without antiretroviral therapy (p = 0.0575, as in those with AIDS (p = 0.08, and diarrhea (36% of the patients; lack of association with positive FPE (p = 0.626; and non-detection of Cryptosporidium sp. Strongyloides stercoralis showed an elevated prevalence in the two eras and was more frequent in men (32.41% than women (19.04% of Group 1 (p = 0.018, a finding suggesting the transmission of the helminth through sodomy. The advent of the HAART modified the profile of opportunistic infections, including parasites, probably due to the reconstitution of cellular immunity and the direct action of HAART on the parasites.

  3. IMPACT OF PREGNANCY ON THE ACTIVITY OF RHEUMATOID ARTHRITIS AND ITS THERAPY ACCORDING TO PROSPECTIVE FOLLOW-UP DATA

    Directory of Open Access Journals (Sweden)

    E. V. Matyanova

    2015-01-01

    Full Text Available Rheumatoid arthritis (RA frequently affects women of child-bearing age, which determines long-standing interest in studying the mutual impact of pregnancy and RA. The first observation described about 80 years ago has shown decrease of disease activity in the absolute majority of pregnant women. Later prospective studies have demonstrated that only 48–66% of women have clinical improvement during pregnancy, postpartum exacerbation of RA develops in 70% of cases, and most patients need drug therapy.Objective: to assess changes of RA activity with DAS28-CRP during pregnancy and postpartum; to examine the impact of RA activity during early pregnancy on further course of the disease; and to determine drug therapy requirement in pregnant women with RA.Subjects and methods. Thirty-two pregnancies were prospectively followed up during each trimester and within 12 months postpartum in 29 women with RA who fulfilled the 1987 ACR criteria and had been examined at the V.A. Nasonova Research Institute of Rheumatology from February 2011 to August 2014.Results and discussion. 46% of the patients with RA showed reduction of disease activity during pregnancy. Exacerbation of RA was observed in 75% of the patients within 12 months at 1.5 months postpartum on average. In patients who were in remission and had low disease activity during early pregnancy, activity of RA throughout pregnancy and 1 month postpartum remained lower than that in those with moderate and high activity in the first trimester (p = 0.0008–0.04. A similar trend was also seen in patients without active arthritis at the moment of conception (according to survey data. In 23 (71.9% patients with signs of disease activity during pregnancy, anti-inflammatory therapy was enhanced and DAS28-CRP decreased (p = 0.008 while it tended to increase in the remaining 9 (28.9% patients with low disease activity who did not received medication. After delivery, patients with high and moderate

  4. Rheumatoid arthritis patients with continued low disease activity have similar outcomes over 10 years, regardless of initial therapy.

    Science.gov (United States)

    Bergstra, Sytske Anne; Landewé, Robert B M; Huizinga, Tom W J; Allaart, Cornelia F

    2017-10-01

    To compare 10-year disease outcomes of RA patients who have continuous low disease activity and are on MTX with or without initial combination therapy with infliximab or prednisone and SSZ. Recent-onset RA patients from the Behandel Strategieen (BeSt) (Dutch acronym for Treatment Strategies) study with 10 years of follow-up were analysed. Treatment was tightly controlled, targeted at DAS ⩽ 2.4. The selected patients had low disease activity from 6 months until 10 years and therefore did not intensify treatment. Patients were grouped into those receiving MTX monotherapy and those receiving initial combination therapy. Between-group differences over time were compared, using (generalized) linear mixed model analyses, for the outcomes DAS, HAQ, ESR, visual analogue scale patient global health, percentage of patients in (drug-free) remission and percentage of patients with Sharp/van der Heijde score progression ⩾5. At 10 years, 28/247 (11%) patients on MTX monotherapy (some tapered to drug free) had continued DAS ⩽ 2.4 compared with 68/261 (26%) patients on combination therapy (all tapered to monotherapy or drug free). No between-group differences in continuous responders were found over time, except for a higher percentage of patients in drug-free remission after MTX monotherapy. Significant group-time interactions were found for DAS, ESR and visual analogue scale patient global health, but the results seem clinically negligible. More patients achieved continuous low disease activity on initial prednisone or infliximab combination therapy than on initial MTX monotherapy, but there appeared to be no additional benefits. Regardless of induction therapy, patients with continuous low disease activity have similar long-term outcomes, with only a higher proportion of patients in drug-free remission after MTX monotherapy.

  5. Repeated Radionuclide therapy in metastatic paraganglioma leading to the highest reported cumulative activity of 131I-MIBG

    Directory of Open Access Journals (Sweden)

    Ezziddin Samer

    2012-01-01

    Full Text Available Abstract 131I-MIBG therapy for neuroendocrine tumours may be dose limited. The common range of applied cumulative activities is 10-40 GBq. We report the uneventful cumulative administration of 111 GBq (= 3 Ci 131I-MIBG in a patient with metastatic paraganglioma. Ten courses of 131I-MIBG therapy were given within six years, accomplishing symptomatic, hormonal and tumour responses with no serious adverse effects. Chemotherapy with cisplatin/vinblastine/dacarbazine was the final treatment modality with temporary control of disease, but eventually the patient died of progression. The observed cumulative activity of 131I-MIBG represents the highest value reported to our knowledge, and even though 12.6 GBq of 90Y-DOTATOC were added intermediately, no associated relevant bone marrow, hepatic or other toxicity were observed. In an individual attempt to palliate metastatic disease high cumulative activity alone should not preclude the patient from repeat treatment.

  6. Long-Term Effect of Exercise Therapy and Patient Education on Impairments and Activity Limitations in People With Hip Osteoarthritis

    DEFF Research Database (Denmark)

    Svege, Ida; Fernandes, L.; Nordsletten, L

    2016-01-01

    Background. The effect of exercise on specific impairments and activity limitations in people with hip osteoarthritis (OA) is limited. Objective. The study objective was to evaluate the long-term effect of exercise therapy and patient education on range of motion (ROM), muscle strength, physical...... allocated to receive both exercise therapy and patient education (exercise group) or patient education only (control group). Intervention. All participants attended a patient education program consisting of 3 group meetings led by 2 physical therapists. Two other physical therapists were responsible...... results for ROM, muscle strength, physical fitness, and walking capacity, but exercise in addition to patient education resulted in less pain during walking in the long term. © 2016 American Physical Therapy Association....

  7. Combating oncogene activation associated with retrovirus-mediated gene therapy of X-linked severe combined immunodeficiency

    Directory of Open Access Journals (Sweden)

    B.E. Strauss

    2007-05-01

    Full Text Available A successful gene therapy clinical trial that also encountered serious adverse effects has sparked extensive study and debate about the future directions for retrovirus-mediated interventions. Treatment of X-linked severe combined immunodeficiency with an oncoretrovirus harboring a normal copy of the gc gene was applied in two clinical trials, essentially curing 13 of 16 infants, restoring a normal immune system without the need for additional immune-related therapies. Approximately 3 years after their gene therapy, tragically, 3 of these children, all from the same trial, developed leukemia as a result of this experimental treatment. The current understanding of the mechanism behind this leukemogenesis involves three critical and cooperating factors, i.e., viral integration, oncogene activation, and the function of the therapeutic gene. In this review, we will explore the causes of this unwanted event and some of the possibilities for reducing the risk of its reoccurrence.

  8. [Media use and physical activity patterns of adolescent participants in obesity therapy: Analysis of the impact of selected sociodemographic factors].

    Science.gov (United States)

    Wulff, Hagen; Wagner, Petra

    2016-02-01

    To meet the challenge of obesity, effective therapeutic concepts for adolescents focusing on lifestyle changes are necessary. Particularly relevant are nutrition and physical activity patterns associated with media use, which can be influenced by sociodemographic factors. For the optimization of obesity therapy approaches, it is essential to analyze these sociodemographic factors to adjust the aims, content, and methods of interventions, and to use the potential of media in treatment concepts. Thus, the research question is: what are the media and physical activity patterns of 11- to 17-year-old participants in obesity therapy, depending on sociodemographic factors? The national multicenter study was conducted from 2012 to 2013. A questionnaire was administered to 564 participants aged 13.4 ± 1.6 (mean ± standard deviation) years. Standardized instruments were used to assess the variables physical activity, media use, and sociodemographic factors. Participants were physically active for 1 h on 3.3 ± 1.8 days per week, 8.5 % daily. Televisions, mobile phones, and computers were available in all sociodemographic groups and were used for 2 h per day. Sociodemographic differences can be seen in the extent of media usage (h/day). These differences can be found between girls and boys concerning their usage of mobile phones (2.49 vs. 1.90; p  media usage and physical activity. Compared with existing literature, the survey results reveal reduced activity and increased media use, which vary among the groups. Thus, differentiated therapy approaches appear to be reasonable. Future research needs to evaluate to what extent media, despite the risks, can contribute to the methodological support of therapy, training, and aftercare concepts.

  9. Comparative study of the efficacy of pulsed electromagnetic field and low level laser therapy on mitogen-activated protein kinases

    Directory of Open Access Journals (Sweden)

    Ayman M. El-Makakey

    2017-03-01

    Full Text Available Mitogen-Activated Protein Kinases (MAPKs consist of three major signaling members: extracellular signal-regulated kinase (ERK, p38 and C-JUN N-terminal kinase (JNK. We investigated physiological effects of Pulsed Electromagnetic Field Therapy (PEMFT and Low Level Laser Therapy (LLLT on human body, adopting the expression level of mitogen-activated protein kinases as an indicator via assessment of the activation levels of three major families of MAPKS, ERK, p38 and JNK in the peripheral lymphocytes of patients before and after the therapies. Assessment for the expression levels of MAPKs families' were done, in the peripheral lymphocytes of patients recently have appendectomy, using flow cytometric analysis of multiple signaling pathways, pre and post LLLT and PEMFT application (twice daily for 6 successive days on the appendectomy wound. There were non-significant differences in the expression levels of MAPKs families' pre- therapies application. But there were significant increase in the ERK expression levels post application of LLLT compared to its pre application (p<0.01. Also, there was significant increase in the ERK, p38 and C-Jun N terminal expression level values post application of PEMFT compared to its pre application expression levels (p<0.01 for each. The present study demonstrates that PEMFT has a powerful healing effect more than LLLT as it increase the activation of ERK, P38 and C-Jun-N Terminal while LLLT only increase the activation of ERK. LLLT has more potent pain decreasing effect than PEMFT as it does not activate P38 pathway like PEMFT.

  10. Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors.

    Science.gov (United States)

    Ortiz, P; Bissada, N F; Palomo, L; Han, Y W; Al-Zahrani, M S; Panneerselvam, A; Askari, A

    2009-04-01

    Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions. Recent studies showed a beneficial effect of periodontal treatment on the severity of active RA. This study was undertaken to further examine the effect of non-surgical periodontal treatment on the signs and symptoms of RA in patients treated with or without anti-tumor necrosis factor-alpha (anti-TNF-alpha) medications. The effect of anti-TNF-alpha therapy on periodontitis also was assessed. Forty participants diagnosed with moderate/severe RA (under treatment for RA) and severe periodontitis were randomly assigned to receive initial non-surgical periodontal therapy with scaling/root planing and oral hygiene instructions (n = 20) or no periodontal therapy (n = 20). To control RA, all participants had been using disease-modifying anti-rheumatic drugs, and 20 had also been using anti-TNF-alpha before randomization. Probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), plaque index (PI), RA disease activity score 28 (DAS28), and erythrocyte sedimentation rate (ESR) were measured at baseline and 6 weeks later. Linear mixed models were used to identify significant differences between subjects who received periodontal treatment and those who did not. Patients receiving periodontal treatment showed a significant decrease in the mean DAS28, ESR (P periodontal treatment. Anti-TNF-alpha therapy resulted in a significant improvement in CAL, PD, BOP, and GI. Non-surgical periodontal therapy had a beneficial effect on the signs and symptoms of RA, regardless of the medications used to treat this condition. Anti-TNF-alpha therapy without periodontal treatment had no significant effect on the periodontal condition.

  11. Assessing play-based activities, child talk, and single session outcome in family therapy with young children.

    Science.gov (United States)

    Willis, Amber B; Walters, Lynda H; Crane, D Russell

    2014-07-01

    This exploratory, observational study was designed to reveal descriptive information regarding therapists' actual practices with preschool- and school-aged children in a single session of family therapy and to investigate change mechanisms in family play therapy that have been proposed to make this approach effective. A purposive sample of 30 families receiving family therapy was recruited and video-taped during a family session where at least one child between the ages of 4 and 12 was present. Following the session, the therapist and parent(s) completed questionnaires while one of the children (aged 4-12) was interviewed. Session recordings were coded, minute-by-minute, for participant talk time, visual aids or props used, and therapy technique type (e.g., play-based/activity vs. talk-only techniques). Hierarchical regression and canonical correlational analyses revealed evidence supporting the theory that play-based techniques promote young children's participation, enhance the quality of the child-therapist relationship, and build positive emotional experiences in family therapy.

  12. Up-regulation of BRAF activated non-coding RNA is associated with radiation therapy for lung cancer.

    Science.gov (United States)

    Chen, Jian-xiang; Chen, Ming; Zheng, Yuan-da; Wang, Sheng-ye; Shen, Zhu-ping

    2015-04-01

    Radiation therapy has become more effective in treating primary tumors, such as lung cancer. Recent evidence suggested that BRAF activated non-coding RNAs (BANCR) play a critical role in cellular processes and are found to be dysregulated in a variety of cancers. The clinical significance of BANCR in radiation therapy, and its molecular mechanisms controlling tumor growth are unclear. In the present study, C57BL/6 mice were inoculated Lewis lung cancer cells and exposed to radiation therapy, then BANCR expression was analyzed using qPCR. Chromatin immunoprecipitation and western blot were performed to calculate the enrichment of histone acetylation and HDAC3 protein levels in Lewis lung cancer cells, respectively. MTT assay was used to evaluate the effects of BANCR on Lewis lung cancer cell viability. Finally, we found that BANCR expression was significantly increased in C57BL/6 mice receiving radiation therapy (Pcancer cells. Histone deacetylation was observed to involve in the regulation of BANCR in Lewis lung cancer cells. Moreover, over expression HDAC3 reversed the effect of rays on BANCR expression. MTT assay showed that knockdown of BANCR expression promoted cell viability surviving from radiation. In conclusion, these findings indicated that radiation therapy was an effective treatment for lung cancer, and it may exert function through up-regulation BANCR expression.

  13. [Influence of complex therapy on the activity of glutathione-dependent enzymes of saliva in patients with parodontitis].

    Science.gov (United States)

    Gavriliuk, L A; Shevchenko, N V; Vartichan, A I; Lysyĭ, L T; Kepnataru, K F; Godorozha, P D

    2008-01-01

    The activities of antioxidative enzymes (glutathione reductase, glutathione S-transferase) and content of reduced glutathione (GSH), thiocyanate (SCN) and protein were determined in saliva of patients with parodontitis treated with traditional and complex therapy, which additionally included the antihomotoxic preparations Traumeel S ointment, Coenzyme compositum or Lymphomyosot. Inflammation process led to the metabolic disturbances and imbalance of the antioxidative defense system in the patients with parodontitis. The results suggest that complex therapy with the antihomotoxic preparations restored imbalance of the antioxidative defense and was more effective than the traditional therapy alone in the patients with parodontitis. Analysis of interrelation between salivary parameters in patients with parodontitis indicated positive correlation before and after the complex therapy (as an exception there was lack of correlation between content of protein and tiocyanate in the saliva of patients before the beginning of the therapeutic course). So these results reflect activityof pathological process and antioxidant defense imbalance in saliva of patients with parodontitis and may be a basis for recommendation of employment of the complex antihomotoxic therapy as the initial stage of pathological process.

  14. Brachyury as a potential modulator of androgen receptor activity and a key player in therapy resistance in prostate cancer

    Science.gov (United States)

    Pinto, Filipe; Pértega-Gomes, Nelma; Vizcaíno, José R.; Andrade, Raquel P.; Cárcano, Flavio M.; Reis, Rui Manuel

    2016-01-01

    Prostate cancer (PCa) is the most commonly diagnosed neoplasm and the second leading cause of cancer-related deaths in men. Acquisition of resistance to conventional therapy is a major problem for PCa patient management. Several mechanisms have been described to promote therapy resistance in PCa, such as androgen receptor (AR) activation, epithelial-to-mesenchymal transition (EMT), acquisition of stem cell properties and neuroendocrine transdifferentiation (NEtD). Recently, we identified Brachyury as a new biomarker of PCa aggressiveness and poor prognosis. In the present study we aimed to assess the role of Brachyury in PCa therapy resistance. We showed that Brachyury overexpression in prostate cancer cells lines increased resistance to docetaxel and cabazitaxel drugs, whereas Brachyury abrogation induced decrease in therapy resistance. Through ChiP-qPCR assays we further demonstrated that Brachyury is a direct regulator of AR expression as well as of the biomarker AMACR and the mesenchymal markers Snail and Fibronectin. Furthermore, in vitro Brachyury was also able to increase EMT and stem properties. By in silico analysis, clinically human Brachyury-positive PCa samples were associated with biomarkers of PCa aggressiveness and therapy resistance, including PTEN loss, and expression of NEtD markers, ERG and Bcl-2. Taken together, our results indicate that Brachyury contributes to tumor chemotherapy resistance, constituting an attractive target for advanced PCa patients. PMID:27049720

  15. Varied Understanding and Application of Counter Transference in Active Music Therapy in Adult Psychiatry

    DEFF Research Database (Denmark)

    Pedersen, Inge Nygaard

    2006-01-01

    The article presents varied ways of understanding and applying the clinical concept of counter transference. The sources are drawn from the author's own clinical praxis, from psychoanalytic and music therapy literature and from a qualitative interview examination among experienced music therapist...... applying the concept in music therapy improvisational work in adult psychiatry.......The article presents varied ways of understanding and applying the clinical concept of counter transference. The sources are drawn from the author's own clinical praxis, from psychoanalytic and music therapy literature and from a qualitative interview examination among experienced music therapists...

  16. Adherence to antiretroviral therapy and its determinants among persons living with HIV/AIDS in Bayelsa state, Nigeria

    Directory of Open Access Journals (Sweden)

    Suleiman IA

    2016-03-01

    Full Text Available Background: A high level of adherence is required to achieve the desired outcomes of antiretroviral therapy. There is paucity of information about adherence to combined antiretroviral therapy in Bayelsa State of southern Nigeria. Objectives: The objectives of the study were to determine the level of adherence to combined antiretroviral therapy among the patients, evaluate the improvement in their immune status and identify reasons for sub-optimal adherence to therapy. Methods: The cross-sectional study involved administration of an adapted and pretested questionnaire to 601 consented patients attending the two tertiary health institutions in Bayesla State, Nigeria: The Federal Medical Centre, Yenagoa and the Niger-Delta University Teaching Hospital Okolobiri. The tool was divided into various sections such as socio-demographic data, HIV knowledge and adherence to combined antiretroviral therapy. Information on the patient's CD4+ T cells count was retrieved from their medical records. Adherence was assessed by asking patients to recall their intake of prescribed doses in the last fourteen days and subjects who had 95-100% of the prescribed antiretroviral drugs were considered adherent. Results: Three hundred and forty eight (57.9% of the subjects were females and 253 (42.1% were males. The majority of them, 557 (92.7% have good knowledge of HIV and combined anti-retroviral therapy with a score of 70.0% and above. A larger proportion of the respondents, 441 (73.4%, had ≥95% adherence. Some of the most important reasons giving for missing doses include, “simply forgot” 147 (24.5%, and “wanted to avoid the side-effects of drugs” 33(5.5%. There were remarkable improvements in the immune status of the subjects with an increment in the proportion of the subjects with CD4+ T cells count of greater than 350 cells/mm3 from 33 (5.5% at therapy initiation to 338 (56.3% at study period (p<0.0001. Conclusion: The adherence level of 73.4% was low

  17. Adherence to antiretroviral therapy and its determinants among persons living with HIV/AIDS in Bayelsa state, Nigeria.

    Science.gov (United States)

    Suleiman, Ismail A; Momo, Andrew

    2016-01-01

    A high level of adherence is required to achieve the desired outcomes of antiretroviral therapy. There is paucity of information about adherence to combined antiretroviral therapy in Bayelsa State of southern Nigeria. The objectives of the study were to determine the level of adherence to combined antiretroviral therapy among the patients, evaluate the improvement in their immune status and identify reasons for sub-optimal adherence to therapy. The cross-sectional study involved administration of an adapted and pretested questionnaire to 601 consented patients attending the two tertiary health institutions in Bayesla State. The Federal Medical Centre, Yenagoa and the Niger-Delta University Teaching Hospital Okolobiri. The tool was divided into various sections such as socio-demographic data, HIV knowledge and adherence to combined antiretroviral therapy. Information on the patient's CD4+ T cells count was retrieved from their medical records. Adherence was assessed by asking patients to recall their intake of prescribed doses in the last fourteen days and subjects who had 95-100% of the prescribed antiretroviral drugs were considered adherent. Three hundred and forty eight (57.9%) of the subjects were females and 253 (42.1%) were males. The majority of them, 557 (92.7%) have good knowledge of HIV and combined anti-retroviral therapy with a score of 70.0% and above. A larger proportion of the respondents, 441 (73.4%), had ≥95% adherence. Some of the most important reasons giving for missing doses include, "simply forgot" 147 (24.5%), and "wanted to avoid the side-effects of drugs" 33(5.5%). There were remarkable improvements in the immune status of the subjects with an increment in the proportion of the subjects with CD4+ T cells count of greater than 350 cells/mm3 from 33 (5.5%) at therapy initiation to 338 (56.3%) at study period (p<0.0001). The adherence level of 73.4% was low which calls for intervention and improvement. The combined antiretroviral therapy has

  18. Conformational adaptation of Asian macaque TRIMCyp directs lineage specific antiviral activity.

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    Laura M J Ylinen

    Full Text Available TRIMCyps are anti-retroviral proteins that have arisen independently in New World and Old World primates. All TRIMCyps comprise a CypA domain fused to the tripartite domains of TRIM5alpha but they have distinct lentiviral specificities, conferring HIV-1 restriction in New World owl monkeys and HIV-2 restriction in Old World rhesus macaques. Here we provide evidence that Asian macaque TRIMCyps have acquired changes that switch restriction specificity between different lentiviral lineages, resulting in species-specific alleles that target different viruses. Structural, thermodynamic and viral restriction analysis suggests that a single mutation in the Cyp domain, R69H, occurred early in macaque TRIMCyp evolution, expanding restriction specificity to the lentiviral lineages found in African green monkeys, sooty mangabeys and chimpanzees. Subsequent mutations have enhanced restriction to particular viruses but at the cost of broad specificity. We reveal how specificity is altered by a scaffold mutation, E143K, that modifies surface electrostatics and propagates conformational changes into the active site. Our results suggest that lentiviruses may have been important pathogens in Asian macaques despite the fact that there are no reported lentiviral infections in current macaque populations.

  19. Neural activity based biofeedback therapy for Autism spectrum disorder through wearable wireless textile EEG monitoring system

    Science.gov (United States)

    Sahi, Ahna; Rai, Pratyush; Oh, Sechang; Ramasamy, Mouli; Harbaugh, Robert E.; Varadan, Vijay K.

    2014-04-01

    Mu waves, also known as mu rhythms, comb or wicket rhythms are synchronized patterns of electrical activity involving large numbers of neurons, in the part of the brain that controls voluntary functions. Controlling, manipulating, or gaining greater awareness of these functions can be done through the process of Biofeedback. Biofeedback is a process that enables an individual to learn how to change voluntary movements for purposes of improving health and performance through the means of instruments such as EEG which rapidly and accurately 'feedback' information to the user. Biofeedback is used for therapeutic purpose for Autism Spectrum Disorder (ASD) by focusing on Mu waves for detecting anomalies in brain wave patterns of mirror neurons. Conventional EEG measurement systems use gel based gold cup electrodes, attached to the scalp with adhesive. It is obtrusive and wires sticking out of the electrodes to signal acquisition system make them impractical for use in sensitive subjects like infants and children with ASD. To remedy this, sensors can be incorporated with skull cap and baseball cap that are commonly used for infants and children. Feasibility of Textile based Sensor system has been investigated here. Textile based multi-electrode EEG, EOG and EMG monitoring system with embedded electronics for data acquisition and wireless transmission has been seamlessly integrated into fabric of these items for continuous detection of Mu waves. Textile electrodes were placed on positions C3, CZ, C4 according to 10-20 international system and their capability to detect Mu waves was tested. The system is ergonomic and can potentially be used for early diagnosis in infants and planning therapy for ASD patients.

  20. Prevalence of depressive symptoms amongst highly active antiretroviral therapy (HAART patients in AIDSRelief Uganda

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    Constance Shumba

    2013-11-01

    Full Text Available There is limited data on the prevalence of depression in HIV and AIDS patients in Sub- Saharan Africa and little resources have been allocated to address this issue. Depression affects patient adherence to treatment and predisposes patients to resistance which poses a public health threat. It also affects quality of life and productivity of patients. From August 2008 to March 2009, 731 patient adherence surveys were administered to assess disease, treatment knowledge and services received. The primary variable of interest was patients’ level of depressive symptoms score, constructed using factor analysis from five survey questions relating to: sadness, need to be alone, hopelessness and confusion and was categorized as no depressive symptoms (score 0, low depressive symptoms (score 1-2, moderate depressive symptoms (score 3-4 and high depressive symptoms (score 5-10. Majority of the patients on highly active antiretroviral therapy (HAART (59% were found to have depressive symptoms and this was more among women than men (66% vs 43%. There was some association of depressive symptoms with non-disclosure (70% of those who had not disclosed had depressive symptoms compared to 53% among those who had disclosed. There is a high prevalence of depressive symptoms among adult patients on HAART. There is need for in-depth evaluation to find out the root causes of depressive symptoms among HAART patients in AIDSRelief clinics. There is need to integrate mental health management in HIV care and treatment as well as training the existing health workers on mental health management.

  1. Acute stroke alert activation, emergency service use, and reperfusion therapy in Sweden.

    Science.gov (United States)

    Eriksson, Marie; Glader, Eva-Lotta; Norrving, Bo; Stegmayr, Birgitta; Asplund, Kjell

    2017-04-01

    Ambulance services and stroke alerts reduce the time from stroke onset to acute stroke diagnosis. We describe the use of stroke alerts and ambulance services in different hospitals and patient groups and their relationship with reperfusion therapy. This nationwide study included 49,907 patients admitted with acute stroke who were registered in The Swedish Stroke Register (Riksstroke) in 2011-2012. The proportions of patients admitted as stroke alerts out of all acute stroke admissions varied from 12.2% to 45.7% in university hospitals (n = 9), 0.5% to 38.7% in specialized nonuniversity hospitals (n = 22), and 4.2% to 40.3% in community hospitals (n = 41). Younger age, atrial fibrillation (AF), living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were factors associated with a higher probability of stroke alerts. Living alone, primary school education, non-European origin, previous stroke, diabetes, smoking, and dependency in activities of daily living (ADL) were associated with a lower probability of stroke alert. The proportion of patients arriving at the hospital by ambulance varied from 60.3% to 94.5%. Older age, living alone, primary school education, being born in a European country, previous stroke, AF, dependency in ADL, living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were associated with ambulance services. Hospital stroke alert frequencies correlated strongly with reperfusion rates (r = .75). Acute stroke alerts have a significant potential to improve stroke reperfusion rates. Prehospital stroke management varies conspicuously between hospitals and patient groups, and the elderly and patients living alone have a markedly reduced likelihood of stroke alerts.

  2. T-CELL RESPONSE OF ADVANCED AIDS PATIENTS AFTER HIGHLY ACTIVE ANTIRETROVIRAL THERAPY

    Institute of Scientific and Technical Information of China (English)

    Ai-xia Wang; Tai-sheng Li; Yun-zhen Cao; Yang Han; Zhi-feng Qiu; Jing Xie

    2005-01-01

    Objective To investigate the response on late stage Chinese AIDS patients after highly active antiretroviral therapy (HAART).Methods From October 2002 to March 2004, 20 cases of late stage Chinese AIDS patients were selected to participate in this opened and randomised study, we purposely chose those with CD4+ T cell counts < 100/mm3. All of them had one or two opportunistic infections and none had been treated with anti-HIV drugs. All patients were tested with CD4+(naive CD4+ T cell defined by CD45RA+ and CD62L+, memory CD4+ T cell defined by CD45RA-), CD8+ T cell,plasma HIV viral load, and clinical manifestations on before, during, and after HAART (5 different regimes) on 1, 3, 6, 9,and 12 months.Results Before HAART mean CD4+ T cell counts were 32 ± 31 (range 2-91)/mm3, and plasma HIV viral load were 5.07±0.85(range 2.04-5.70) log copies/mL. In 1 month's time patients treated with HAART had mean CD4+ and CD8T cell counts increasing rapidly. After 1 month the increasing speed turned to slow down, but HIV viral load decreased predominantly within the first 3 months. The major part of increasing CD4+ T cells were memory CD4+ T cells, as for naive CD4+ T cells increasing low and slow. Clinical symptoms and signs improved, and opportunistic infections reduced. The quality of life will be far much better than before. Each patient was followed for 12 months, and had finished 12 months' HAART.Conclusion This is the first report in China that late stage Chinese AIDS patients after HAART could have their immune reconstitution. The regular pattern is similar to what had been reported in Western countries and also in China. So it is worth to treat late stage Chinese AIDS patients with HAART.

  3. Rapid turnover of 2-LTR HIV-1 DNA during early stage of highly active antiretroviral therapy.

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    Weijun Zhu

    Full Text Available BACKGROUND: Despite prolonged treatment with highly active antiretroviral therapy (HAART, the infectious HIV-1 continues to replicate and resides latently in the resting memory CD4+ T lymphocytes, which blocks the eradication of HIV-1. The viral persistence of HIV-1 is mainly caused by its proviral DNA being either linear nonintegrated, circular nonintegrated, or integrated. Previous reports have largely focused on the dynamics of HIV-1 DNA from the samples collected with relatively long time intervals during the process of disease and HAART treatment, which may have missed the intricate changes during the intervals in early treatment. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we investigated the dynamics of HIV-1 DNA in patients during the early phase of HARRT treatment. Using optimized real time PCR, we observed significant changes in 2-LTR during the first 12-week of treatment, while total and integrated HIV-1 DNA remained stable. The doubling time and half-life of 2-LTR were not correlated with the baseline and the rate of changes in plasma viral load and various CD4+ T-cell populations. Longitudinal analyses on 2-LTR sequences and plasma lipopolysaccharide (LPS levels did not reveal any significant changes in the same treatment period. CONCLUSIONS/SIGNIFICANCE: Our study revealed the rapid changes in 2-LTR concentration in a relatively large number of patients during the early HAART treatment. The rapid changes indicate the rapid infusion and clearance of cells bearing 2-LTR in the peripheral blood. Those changes are not expected to be caused by the blocking of viral integration, as our study did not include the integrase inhibitor raltegravir. Our study helps better understand the dynamics of HIV-DNA and its potential role as a biomarker for the diseases and for the treatment efficacy of HAART.

  4. Highly active antiretroviral therapy adherence and its determinants in selected regions in Indonesia

    Directory of Open Access Journals (Sweden)

    Felix F. Widjaja

    2011-02-01

    Full Text Available Background: Highly active antiretroviral therapy (HAART can reduce morbidity and mortality of HIV-infected patients. However, it depends upon adherence to medication. The objective of this study was to examine the adherence to HAART and to evaluate individual patient characteristics i.e. self-efficacy, depression level, and social support and to finally determine HAART adherence in selected regions in Indonesia.Methods: This cross-sectional study was conducted in Jakarta, Malang, Bandung, Makasar and Banda Aceh. The subject of the study was HIV-infected patients who were older than 13 years old and had taken HAART for at least a month. They were recruited consecutively then asked how many pills they had missed during the previous month. Poor adherence can be stated if the percentage of adherence rate is below 95%. HIV treatment adherence self-efficacy scale  (HIVASES, Beck Depression Inventory (BDI-II and Interpersonal Support Evaluation List (ISEL was adapted to assess self-efficacy, depression level and social support, respectively.Results: We found that 96% (n=53 of the subjects adhered to HAART. There were no associations between adherence with self-efficacy, depression level, and social support. The main cause of non-adherence in this study was ‘simply  forget’.Conclusion: Adherence to HAART was found to be high and not associated with self-efficacy, depression level and social support in some central regions in Indonesia. (Med J Indones 2011; 20:50-5Keywords: adherence, depression, HAART, HIV, self-efficacy, social support

  5. [Clinical characteristics of highly active antiretroviral therapy-associated immune reconstruction inflammation in acquired immunodeficiency syndrome].

    Science.gov (United States)

    Liu, Meng; Zheng, Yu-Huang; Zhou, Guo-Qiang; Zhou, Hua-Ying; Chen, Zi; He, Yan; Chen, Xia; Zheng, Li-Wen; Jia, Lu; He, Mei

    2011-02-01

    To summarize the morbidity, mortality, clinical manifestations and risk factors for IRIS (immune reconstruction inflammatory syndrome) during HAART (highly active antiretroviral therapy) in China. From October 2007 to September 2009, a prospective cohort of 238 AIDS (acquired immunodeficiency syndrome) patients on HAART from Hunan and Jianxi provinces was recruited for a follow-up of 24 weeks. And 47 and 191 patients were assigned into the IRIS and non-IRIS groups respectively. The data of general information, clinical manifestations and treatment of two groups were collected and compared. Blood samples were collected in both groups at pre-and post-HAART 12 weeks, 24 weeks for HIV viral load and CD4(+) cell count examinations. A statistical analysis was performed. A total of 47 (19.7%) IRIS cases was analyzed. The median onset of IRIS was 28 (9 - 36) days. And 29 (61.7%) cases of tuberculosis IRIS were found. There was no significant difference in age, gender, route of transmission and antiretroviral regimens between the IRIS and non-IRIS groups. At baseline, Weeks 12 and 24, both groups showed a significant decline of viral load. And there was no significant difference between them. Both groups showed a significant increase of CD4(+) cell count. But there was no significant difference between two groups. However, the baseline CD4(+) cell count was markedly lower in the IRIS group than that in the non-IRIS group. In 85.1% (40/47) of cases, the CD4(+) cell count was HIV RNA viral load decreases in both IRIS and non-IRIS groups without any significant difference. The patients with a CD4(+) cell count < 100/µl are more vulnerable to develop IRIS.

  6. Speed of sound estimation with active PZT element for thermal monitoring during ablation therapy: feasibility study

    Science.gov (United States)

    Kim, Younsu; Guo, Xiaoyu; Cheng, Alexis; Boctor, Emad M.

    2016-04-01

    Controlling the thermal dose during ablation therapy is instrumental to successfully removing the tumor while preserving the surrounding healthy tissue. In the practical scenario, surgeons must be able to determine the ablation completeness in the tu