1,056 research outputs found
A comparison of estimated glomerular filtration rates using cockcroft-gault and the chronic kidney disease epidemiology collaboration estimating equations in HIV infection
No full textObjectives: The aim of this study was to determine whether the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)- or Cockcroft-Gault (CG)-based estimated glomerular filtration rates (eGFRs) performs better in the cohort setting for predicting moderate/advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD). Methods: A total of 9521 persons in the EuroSIDA study contributed 133873 eGFRs. Poisson regression was used to model the incidence of moderate and advanced CKD (confirmed eGFR <60 and <30mL/min/1.73m, respectively) or ESRD (fatal/nonfatal) using CG and CKD-EPI eGFRs. Results: Of 133873 eGFR values, the ratio of CG to CKD-EPI was ≥1.1 in 22092 (16.5%) and the difference between them (CG minus CKD-EPI) was ≥10mL/min/1.73m in 20867 (15.6%). Differences between CKD-EPI and CG were much greater when CG was not standardized for body surface area (BSA). A total of 403 persons developed moderate CKD using CG [incidence 8.9/1000 person-years of follow-up (PYFU); 95% confidence interval (CI) 8.0-9.8] and 364 using CKD-EPI (incidence 7.3/1000 PYFU; 95% CI 6.5-8.0). CG-derived eGFRs were equal to CKD-EPI-derived eGFRs at predicting ESRD (n=36) and death (n=565), as measured by the Akaike information criterion. CG-based moderate and advanced CKDs were associated with ESRD [adjusted incidence rate ratio (aIRR) 7.17; 95% CI 2.65-19.36 and aIRR 23.46; 95% CI 8.54-64.48, respectively], as were CKD-EPI-based moderate and advanced CKDs (aIRR 12.41; 95% CI 4.74-32.51 and aIRR 12.44; 95% CI 4.83-32.03, respectively). Conclusions: Differences between eGFRs using CG adjusted for BSA or CKD-EPI were modest. In the absence of a gold standard, the two formulae predicted clinical outcomes with equal precision and can be used to estimate GFR in HIV-positive persons. © 2013 British HIV Association
Heavy arv exposure and exhausted/limited arv options: predictors and clinical outcomes
No full textObjectives: People with HIV and extensive antiretroviral exposure may have limited/exhausted treatment options (LExTO) due to resistance, comorbidities, or antiretroviral-related toxicity. Predictors of LExTO were investigated in the RESPOND cohort. Methods: Participants on ART for at least 5 years were defined as having LExTO when switched to at least two anchor agents and one-third antiretroviral (any class), a two-drug regimen of two anchor agents (excluding rilpivirine with dolutegravir/cabotegravir), or at least three nucleoside reverse transcriptase inhibitors. Baseline was the latest of January 1, 2012, cohort enrolment or 5 years after starting antiretrovirals. Poisson regression modeled LExTO rates and clinical events (all-cause mortality, non-AIDS malignancy, cardiovascular disease [CVD], and chronic kidney disease [CKD]). Results: Of 23 827 participants, 2164 progressed to LExTO (9.1%) during 130 061 person-years follow-up (PYFU); incidence 1.66/100 PYFU (95% CI 1.59-1.73). Predictors of LExTO were HIV duration more than 15 years (vs. 7.5-15; adjusted incidence rate ratio [aIRR] 1.32; 95% CI 1.19-1.46), development of CKD (1.84; 1.59-2.13), CVD (1.64; 1.38-1.94), AIDS (1.18; 1.07-1.30), and current CD4+ cell count of 350 cells/μl or less (vs. 351-500 cells/μl, 1.51; 1.32-1.74). Those followed between 2018 and 2021 had lower rates of LExTO (vs. 2015-2017; 0.52; 0.47-0.59), as did those with baseline viral load of 200 cp/ml or less (0.46; 0.40-0.53) and individuals under 40. Development of LExTO was not significantly associated with clinical events after adjustment for age and current CD4, except CKD (1.74; 1.48-2.05). Conclusion: Despite an aging and increasingly comorbid population, we found declining LExTO rates by 2018-2021, reflecting recent developments in contemporary ART options and clinical management. Reassuringly, LExTO was not associated with a significantly increased incidence of serious clinical events apart from CKD
2D-LWR in large-scale network with space dependent fundamental diagram
No full textInternational audienceTraffic modeling of large-scale urban networks is a challenging task. In the literature, the network is mainly assumed to be homogeneous. However, in a large-scale scenario, it is unlikely that the traffic network characteristics–such as speed limit, number of lanes, or the network geometry–remain constant throughout the network. Therefore, we introduce a two dimensional macroscopic model for large-scale traffic networks where the fundamental diagram is space-dependent and varies with respect to the area considered. We simulate our model and compare the results with those obtained by microsimulation
A decision support and planning mobility method for large scale traffic networks
No full textInternational audienceThis paper presents a new planning and decision-making method in large scale traffic networks for predicting how traffic evolves in special events, emergencies and changes in the city mobility demands. The proposed method is based on a 2-D aggregated traffic model for large scale traffic networks [1], [2] which describes traffic evolution as a fluid in two space dimensions. We propose an extension of the model by including additional state density variables, each one associated to a particular layer describing vehicles evolving in different directions. The model is a 2D-PDE described by a system of conservation laws. For this specific case, the resulting PDE is not anymore hyperbolic as typically the LWR model but results in a hybrid hyperbolic-elliptic PDE depending on the density level. In this case, usual numerical schemes may be not valid and often lead to oscillation in the solution. Thus, we consider a high order numerical scheme to improve the numerical solution. Finally, the model is used to predict how the typical traffic evolution will be impacted in particular scenarios like special events or changes in demands. Comparative simulations are provided
Dolutegravir as a trigger for DRESS syndrome?
No full textDolutegravir is an increasingly-used second-generation human immunodeficiency virus integrase strand transfer inhibitor. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome has been described in several patients treated with raltegravir but to our knowledge, there is no previous report of DRESS syndrome associated with dolutegravir.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
Predictors of hepatitis B virus genotype and viraemia in HIV-infected patients with chronic hepatitis B in Europe
No full textBackground: Both natural history and treatment outcome of hepatitis B virus (HBV) infection are influenced by genotypes and viral load. Information about factors determining HBV genotype distribution and viraemia in HIV/HBV-co-infected patients is scarce. Methods: All HIV-positive patients living in Europe and Argentina recruited in EuroSIDA (1994-2006) were tested for serum HBV surface antigen (HBsAg). Chronic carriers were further characterized virologically at one central laboratory. Variables influencing HBV genotype distribution and viraemia were assessed using logistic regression. Results: From 16505 HIV patients enrolled in EuroSIDA, 1179 (7.1%) were HBsAg positive, of whom 474 had specimens that allowed inclusion in the virological substudy. Overall 293 (62%) were treated with anti-HBV active antiretroviral drugs at the time of testing. Hepatitis delta virus superinfection was recognized in 14% and hepatitis C virus (HCV) antibodies in 27%. Serum HBV DNA was detectable in 315 (66.5%) and HBV genotyping gave results in 170 (35.9%) patients. HBV genotype distribution was as follows: A (72.9%), D (17.1%), G (1.8%), E (1.2%), F (1.2%) and C (0.6%); another 5.9% were co-infected with multiple HBV genotypes. In the multivariate analysis, the best predictor of HBV genotype A infection was risk exposure other than intravenous drug use, whereas predictors for detectable HBV viraemia were lower CD4 counts and lack of HCV antibodies. Conclusion: A substantial proportion of HIV-positive patients with chronic hepatitis B show detectable HBV viraemia despite being treated with anti-HBV active antiretroviral drugs (mainly lamivudine). Low CD4 counts were associated with an independent higher risk of detectable HBV viraemia, which supports an earlier introduction of antiretroviral therapy, including anti-HBV drug(s) more potent than lamivudine. © The Author 2010. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy
Is it safe to discontinue primary Pneumocystis jiroveci pneumonia prophylaxis in patients with virologically suppressed HIV infection and a CD4 cell count
No full textCurrent guidelines suggest that primary prophylaxis for Pneumocystis jiroveci pneumonia (PcP) can be safely stopped in human immunodeficiency virus (HIV)-infected patients who are receiving combined antiretroviral therapy (cART) and who have a CD4 cell count <200 cells/microL. There are few data regarding the incidence of PcP or safety of stopping prophylaxis in virologically suppressed patients with CD4 cell counts of 101-200 cells/microL
Switching from boosted PIs to dolutegravir decreases soluble CD14 and adiponectin in high cardiovascular risk people living with HIV
No full textSwitching from boosted PIs to dolutegravir in people living with HIV (PLWH) with high cardiovascular risk improved plasma lipids at 48 weeks in the NEAT022 trial. Whether this strategy may have an impact on cardiovascular biomarkers is unknown
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