1,721,172 research outputs found
The pharmacokinetics of lopinavir in HIV-infected adults receiving rifampicin with adjusted doses of lopinavir
No full textIncludes bibliographical references.Globally Sub-Saharan Africa carries the biggest burden of patients infected with human immunodeficiency virus (HIV). Tuberculosis is the most common opportunistic infection in patients infected with HIV. Although antiretroviral therapy (ART) has decreased the burden of tuberculosis in HIV-infected patients, the incidence of tuberculosis remains higher than in the general population. HIV-tuberculosis co-infection requires dual treatment with ART and tuberculosis treatment, exposing patients to multiple drug-drug interactions. As ART programs mature, more patients will be changed from first-line to second-line ART. In South Africa, the adult second-line ART consists of the protease inhibitor (PI) lopinavir/ritonavir (LPV/r) and 2 nucleoside reverse transcriptase inhibitors (NRTls). This review will focus on the data of the drug-drug interactions between the PIs and rifampicin, with an emphasis on LPV/r
Antiretroviral therapy adherence and effectiveness in a private sector disease management programme in Southern Africa
No full textIncludes abstract.
Includes bibliographical references
TNF-[alpha] in host immunity to tuberculosis : in vivo and in vitro studies of protection and pathogenesis
No full textBibliography: leaves 113-130.Tuberculosis has been widespread from earliest history as demonstrated by skeletal deformities suggestive of spinal tuberculosis (Potts Disease) seen in Neolithic man (5000 BC) [Sager P, Schalimtzek M and Moller-Christensen V, 1972]. The earliest written reports similar of tuberculosis probably come from Chinese writings of about 2700 BC, which mention "lung fever" and "lung cough"
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Factors associated with loss to follow-up after occupational HIV exposure among health care workers attending the Groote Schuur Hospital Occupational Health Clinic
Full text linkBackground
There is limited data on factors associated with loss to follow-up (LTFU) of health care workers (HCWs) following occupational exposure to HIV, and most studies were conducted in an era when poorly tolerated antiretrovirals (ART) like zidovudine were used.
Methods
A retrospective cohort study was conducted of HCWs attending a referral hospital’s Occupational Health Clinic (OHC) in Cape Town, South Africa, for post-exposure prophylaxis (PEP) during a period when tenofovir (TDF) was available. Data was obtained from an existing database maintained by the OHC. Our primary outcome was to identify factors associated with LTFU at the 3-month visit, with secondary outcomes evaluating factors associated with LTFU at the 6-week and 6-months visits. We selected 7 variables a priori for our logistic regression model and ensured there were at least 10 outcome events per variable to minimize bias.
Results
Two hundred and ninety-three folders were evaluated for descriptive analysis. LTFU worsened with successive visits: 36% at 6 weeks, 60% at 3 months, and 72% at 6 months. In multivariate analysis at the 3-month visit LTFU was associated with age (adjusted odds ratio (aOR), 0.6 per 10-year increase [95% CI, 0.5 to 0.9]), HCW category of doctor (aOR 2.7 [95% CI, 1.3 to 5.5]), and time from exposure to receiving PEP of more than 24 hours (aOR 5.9 [95% CI, 1.3 to 26.9]). Discussion Our finding that LTFU increases with successive visits is consistent with other studies. It is believed higher LTFU in younger HCWs may be related to the greater change and instability they experience in their younger years.
Doctors are more likely to be LTFU than other HCWs which could be related to concerns of confidentiality in performing HIV testing at their facility. Additionally, doctors may be making their own assessments of the risk of exposure. Lastly, doctors may be submitting their own blood samples for HIV testing instead of attending the OHC. One study showed longer time from exposure to receiving PEP was not associated with attendance of visits, but we showed this did influence LTFU at the 3-month visit. This could be explained by HCWs who present after 24 hours having a perceived lower benefit from PEP. Newer studies have shown that completion of PEP is based on the tolerability of ART and not on whether dual or triple therapy are used. This could explain why in our cohort there was no correlation between type of ART and LTFU. There is literature to support increased attendance of follow-up visits by contacting HCWs by telephone or mail. Furthermore, the WHO has recently advised the final follow-up visit to be at 3 months rather than 6 months. We suspect with fewer visits, there may be less LTFU.
Conclusion
We identified factors associated with LTFU of HCWs after occupational HIV exposure, which could be used to target interventions to improve follow-up
The Risk of Virologic Failure Decreases with Duration of HIV Suppression, at Greater than 50% Adherence to Antiretroviral Therapy
Full text linkBackground: We hypothesized that the percent adherence to antiretroviral therapy necessary to maintain HIV suppression would decrease with longer duration of viral suppression. Methodology: Eligible participants were identified from the REACH cohort of marginally housed HIV infected adults in San Francisco. Adherence to antiretroviral therapy was measured through pill counts obtained at unannounced visits by research staff to each participant's usual place of residence. Marginal structural models and targeted maximum likelihood estimation methodologies were used to determine the effect of adherence to antiretroviral therapy on the probability of virologic failure during early and late viral suppression. Principal Findings: A total of 221 subjects were studied (median age 44.1 years; median CD4+ T cell nadir 206 cells/mm3). Most subjects were taking the following types of antiretroviral regimens: non-nucleoside reverse transcriptase inhibitor based (37%), ritonavir boosted protease inhibitor based (28%), or unboosted protease inhibitor based (25%). Comparing the probability of failure just after achieving suppression vs. after 12 consecutive months of suppression, there was a statistically significant decrease in the probability of virologic failure for each range of adherence proportions we considered, as long as adherence was greater than 50%. The estimated risk difference, comparing the probability of virologic failure after 1 month vs. after 12 months of continuous viral suppression was 0.47 (95% CI 0.23–0.63) at 50–74% adherence, 0.29 (CI 0.03–0.50) at 75–89% adherence, and 0.36 (CI 0.23–0.48) at 90–100% adherence. Conclusions: The risk of virologic failure for adherence greater than 50% declines with longer duration of continuous suppression. While high adherence is required to maximize the probability of durable viral suppression, the range of adherence capable of sustaining viral suppression is wider after prolonged periods of viral suppression.Version of Recor
Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy
No full textThe management of patients failing second line antiretroviral therapy (ART) is a critical area of study considering the increasing numbers of patients on second line regimens, and the expense and poor availability of third line ART. Most patients who experience virologic failure (VF) on second line ART in low-middle income countries fail due to poor adherence rather than antiretroviral resistance. Pharmacy refill is an easily implementable adherence measure which has shown to correlate with viral load monitoring and survival, and has potential over the short term to be used as a simple adherence tool to detect probable VF on second line ART. The benefit would be conservation of resources by rationally limiting need for viral load (VL) testing and, in those countries with access to third line ART, the need for resistance testing. We conducted an observational cohort study of patients who initiated second line ART at the McCord hospital ART clinic, “Sinikithemba†in Kwazulu-Natal, South Africa. Using clinical and pharmacy refill data extracted from the clinic’s electronic database, we determined risk factors for VF. Three different methods of calculating short term pharmacy refill adherence were evaluated and compared with long term adherence after second line initiation. Different interval durations of short term pharmacy refill were also assessed to determine the optimum time period of pharmacy refill that correlates best with a virologic response on second line ART
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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