5 research outputs found
Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study
No full textBackground Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe
Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study
No full text10.1371/journal.pone.0139981PLoS ONE1010e013998
Interleukin-2 therapy in patients with HIV infection
No full textCollaboratore per la suddetta ricerca multicentrica in quanto membro del INSIGHT-ESPRIT Study Grou
Nimuendajú, a Senhorita Doutora e os ‘etnógrafos berlineses’: rede de conhecimento e espaços de circulaçâo na configuraçâo da etnologia alemâ na Amazônia no início do século XX
No full textThe article analyses the participation of the German zoologist Emilia Snethlage (1868-1929), researcher and later director of the Goeldi Museum, in Belém, Brazil, in the network of knowledge that was established in the early 20th century in the Amazonian region, aimed at ethnological research and to the collection of indigenous artifacts, and among its best known actors were Germans Theodor Koch-Grünberg (1872-1924) and Curt Nimuendajú (1883-1945). Both are recognized for working for the indigenous peoples of Brazil and for the scientific legacy in the fields of anthropology, archaeology and linguistics. Less well-known, Snethlage had, however, decisive participation in the insertion of Nimuendajú in the scientific environment. From an extensive research on documentary sources located in Brazil and Germany, it is shown that in the first period when Nimuendajú was linked to the Goeldi Museum between 1913 and 1921, Snethlage made possible his first expeditions and scientific publications, in addition to articulating his relations with German museums and ethnologists, including the one who would become his beloved friend and interlocutor, Koch-Grünberg, in order to allow him to work as a professional collector.[pt] O artigo analisa a participação da zoóloga alemã Emília Snethlage (1868-1929), pesquisadora e depois diretora do Museu Goeldi, em Belém, Brasil, na rede de conhecimento que se estabeleceu no início do século XX na região amazônica, destinada à investigação etnológica e à coleta de artefatos indígenas, e que teve, entre seus mais conhecidos atores, os alemães Theodor Koch-Grünberg (1872-1924) e Curt Nimuendajú (1883-1945). Ambos são reconhecidos pelo trabalho em prol dos povos indígenas do Brasil e pelo legado científico nos campos da antropologia, arqueologia e linguística. Menos conhecida, Snethlage teve, entretanto, decisiva participação na inserção de Nimuendajú no meio científico. A partir de uma extensa pesquisa em fontes documentais localizadas no Brasil e na Alemanha, demonstra-se que, no primeiro período em que Nimuendajú esteve vinculado ao Museu Goeldi, entre 1913 e 1921, Snethlage viabilizou suas primeiras expedições e publicações científicas, além de articular suas relações com museus e etnólogos alemães, incluindo aquele que viria a ser seu dileto amigo e interlocutor, Koch-Grünberg, de maneira a lhe permitir trabalhar também como coletor profissional
