Commonly Prescribed Antiretroviral Therapy Regimens and Incidence of AIDS-Defining Neurological Conditions.

BACKGROUND: The differential effects of commonly prescribed combined antiretroviral therapy (cART) regimens on AIDS-defining neurological conditions (neuroAIDS) remain unknown. SETTING: Prospective cohort studies of HIV-positive individuals from Europe and the Americas included in the HIV-CAUSAL Collaboration. METHODS: Individuals who initiated a first-line cART regimen in 2004 or later containing a nucleoside reverse transcriptase inhibitor backbone and either atazanavir, lopinavir, darunavir, or efavirenz were followed from cART initiation until death, lost to follow-up, pregnancy, the cohort-specific administrative end of follow-up, or the event of interest, whichever occurred earliest. We evaluated 4 neuroAIDS conditions: HIV dementia and the opportunistic infections toxoplasmosis, cryptococcal meningitis, and progressive multifocal leukoencephalopathy. For each outcome, we estimated hazard ratios for atazanavir, lopinavir, and darunavir compared with efavirenz via a pooled logistic model. Our models were adjusted for baseline demographic and clinical characteristics. RESULTS: Twenty six thousand one hundred seventy-two individuals initiated efavirenz, 5858 initiated atazanavir, 8479 initiated lopinavir, and 4799 initiated darunavir. Compared with efavirenz, the adjusted HIV dementia hazard ratios (95% confidence intervals) were 1.72 (1.00 to 2.96) for atazanavir, 2.21 (1.38 to 3.54) for lopinavir, and 1.41 (0.61 to 3.24) for darunavir. The respective hazard ratios (95% confidence intervals) for the combined end point were 1.18 (0.74 to 1.88) for atazanavir, 1.61 (1.14 to 2.27) for lopinavir, and 1.36 (0.74 to 2.48) for darunavir. The results varied in subsets defined by calendar year, nucleoside reverse transcriptase inhibitor backbone, and age. CONCLUSION: Our results are consistent with an increased risk of neuroAIDS after initiating lopinavir compared with efavirenz, but temporal changes in prescribing trends and confounding by indication could explain our findings.

Off-label use of maraviroc in HIV-1-infected paediatric patients in clinical practice.

Maraviroc (MVC) is not approved for HIV-1-infected paediatric patients. This is the first assessment of the use of MVC-based salvage therapy in vertically HIV-1-infected paediatric patients in clinical settings. The results suggest that MVC-based salvage therapy is useful in children and adolescents with extensive resistance profile leading to maintained virological suppression in up to 88% of the patients with CCR5-tropic virus. The likelihood of treatment success might increase when MVC is combined with other active drugs.

Factors associated to breastfeeding cessation before 6 months.

This research aimed to identify the determinants of full breastfeeding (FBF) and any breastfeeding (ABF) cessation before 6 months, through a six-month follow-up of 248 mothers going a postpartum visit. Data were collected by personal interview during the first month and telephone interviews at four and six months postpartum. Coxs proportional hazards model was used. Not having previous ABF experience, previous ABF duration

Factors associated to breastfeeding cessation before 6 months / Fatores associados ao abandono do aleitamento materno durante os primeiros seis meses de vida / Factores asociados al abandono de la lactancia materna durante los primeros 6 meses de vida

This research aimed to identify the determinants of full breastfeeding (FBF) and any breastfeeding (ABF) cessation before 6 months, through a six-month follow-up of 248 mothers going a postpartum visit. Data were collected by personal interview during the first month and telephone interviews at four and six months postpartum. Cox’s proportional hazards model was used. Not having previous ABF experience, previous ABF duration ≤4 months and worse evaluation of previous experience were associated with cessation of ABF and FBF. Lower educational level was associated with cessation of ABF and the use of pacifiers or occasional breast-milk substitutes with cessation of FBF. Attending childbirth education was a protective factor against early FBF or ABF cessation. Activities supporting breastfeeding should be intensified for mothers with poorer access to information and with negative or without ABF previous experience. The use of pacifiers and not-medically indicated breast milk substitutes should be controlled.

O objetivo da pesquisa foi identificar os fatores associados ao abandono do aleitamento materno (AM) e do aleitamento materno completo (AMC). Foram acompanhadas 248 mães que fizeram visita pós-parto. Os dados foram coletados mediante entrevista pessoal durante o primeiro mês pós-parto e, pelo telefone, aos quatro e seis meses seguintes. A análise se realizou mediante a Regressão de Cox. Os resultados mostram associação entre o abandono da AMC e do AM com o fato de não se ter amamentado anteriormente, com AM anterior ≤4 meses, e, com pior avaliação da experiência anterior. O menor nível de estudos se relaciona com maior abandono do AM e das chupetas, ou suplementos no hospital com o abandono da AMC. A educação pré-natal é fator protetor para o AMC e o AM. Conclui-se que o apoio ao AM deveria intensificar-se nas mães: sem experiência anterior, com experiência negativa, e, com pior acesso à informação; também deveria ser controlado o uso da chupeta e dos suplementos de leite artificial (LA) não indicados.

El objetivo de la investigación fue identificar los factores asociados al abandono de la lactancia materna (LM) y de la lactancia materna completa (LMC). Fueron acompañadas 248 madres que acudieron a la visita posparto. Los datos fueron recolectados mediante entrevista personal durante el primer mes posparto y por teléfono a los cuatro y seis meses siguientes. El análisis se realizó mediante la Regresión de Cox. Los resultados muestran una asociación con el abandono de la LMC y de la LM con no haber amamantado anteriormente, con LM anterior ≤4 meses, y, con una peor valoración de la experiencia anterior. El menor nivel de estudios se relaciona con un mayor abandono de la LM y los chupetes o suplementos en el hospital con el abandono de la LMC. La educación prenatal es un factor protector para la LMC y la LM. Se concluye que el apoyo a la LM debería intensificarse las madres: sin experiencia anterior, con experiencia negativa, y, con peor acceso a la información; también debería controlarse el uso de chupetes y suplementos de leche artificial (LA) no indicados.

Occupational exposure to extremely low frequency electric and magnetic fields and Alzheimer disease: a meta-analysis.

BACKGROUND: Among potential environmental risk factors for Alzheimer disease (AD), occupational exposures have received some attention, including extremely low frequency electromagnetic fields (ELF-EMF). A systematic review and meta-analysis of published epidemiological studies on this subject was carried out. METHODS: The search was concluded in April 2006. Bibliographic databases consulted included PubMed, EMBASE, Cochrane Library and NIOSHTIC2. Pooled estimates were obtained using random-effects meta-analysis. Sources of heterogeneity between studies were explored, as was publication bias. RESULTS: Fourteen different studies (nine case-control and five cohort studies) accomplished inclusion criteria. All these studies followed standardized criteria for AD diagnosis and most of them obtained quantitative estimates of exposure. Pooled estimates suggest an increased risk of AD from case-control studies (OR(pooled) 2.03; 95% CI 1.38-3.00) and from cohort studies (RR(pooled) 1.62; 95% CI 1.16-2.27), with moderate to high statistical heterogeneity in both cases (respectively, I(2) = 58% and I(2) = 54%). Cohort studies showed consistently increased risks for exposed men (RR(pooled) 2.05; 95% CI 1.51-2.80, I(2) = 0%). Evidence of dose-response relationship was not present. Test for publication bias suggests small study effects, mostly for case-control studies. CONCLUSIONS: Available epidemiological evidence suggests an association between occupational exposure to ELF-EMF and AD. However, some limitations affecting the results from this meta-analysis should be considered. More information on relevant duration and time windows of exposure, on biological mechanisms for this potential association and on interactions between electromagnetic fields exposure and established risk factors for AD is needed.

Effectiveness of MF59-adjuvanted subunit influenza vaccine in preventing hospitalisations for cardiovascular disease, cerebrovascular disease and pneumonia in the elderly.

Annual circulation of influenza virus coincides with a peak in cardiovascular and pneumonia mortality/morbidity. This study aimed to determine the effectiveness of MF59-adjuvanted subunit influenza vaccine in preventing hospitalisation due to acute coronary syndrome (ACS), cerebrovascular accident (CVA) and pneumonia in the elderly. Three case-control studies were performed during the 2004-2005 influenza season in three health districts in Valencia, Spain (total elderly [>64 years of age] population: n=105,454). Controls were patients admitted for an acute surgical process or trauma within 10 days of case admission. In total, 159 patients were hospitalised for ACS, 148 for CVA and 242 for pneumonia. The risk of hospitalisation after the start of the influenza season was significantly lower in vaccinated patients compared with non-vaccinated patients (adjusted odds ratios: 0.13 [P=0.013] for ACS; 0.07 [P=0.007] for CVA; 0.31 [P=0.005] for pneumonia). During peak virus circulation, vaccination with MF59-adjuvanted subunit influenza vaccine was associated with an 87% relative risk reduction in hospitalisation for ACS, 93% for CVA, and 69% for pneumonia.

Delay in the initiation of HAART, poorer virological response, and higher mortality among HIV-infected injecting drug users in Spain.

Differences in the uptake and time to initiation of highly active antiretroviral therapy (HAART), the virological response to HAART, and survival from AIDS by transmission category were analyzed. A multicenter hospital-based cohort of HIV-infected patients attending 10 hospitals in Spain from January 1997 to December 2003 was used. Cross-checks with the National AIDS Registry were performed. Cox proportional hazard models were used to assess the impact of transmission category on time to HAART initiation, viral suppression (defined by first HIV-1 RNA viral load measurement <500 copies/ml after HAART), and survival from AIDS. Of 4643 patients, 73% were men and 56% were injecting drug users (IDUs). A statistically significant interaction was found between transmission category and previous non-HAART antiretroviral treatment (ART) (p < 0.05). Among ART naive patients, IDUs had a 33% lower risk of initiating HAART compared to men who have sex with men (MSM) [HR 0.67 (95% CI 0.57-0.79)]. No differences by transmission categories were seen among patients with prior non-HAART ART. IDUs had poorer viral load (VL) suppression than MSM [HR 0.86 (95% CI 0.74-0.99)] adjusting by baseline VL, AIDS diagnosis, and prior ART. Mortality from AIDS was two and a half times higher in IDUs than MSM [HR 2.51 (95% CI 1.03-6.1)]. Among patients who access the hospital network, IDUs have a lower uptake of HAART, have worse virological suppression, and have higher mortality after AIDS diagnosis. There is a need to extend the programs in order to enhance access and adherence of IDUs to HAART and consider the treatment of drug addiction as an integral part of the treatment for HIV infection.

The temporal pattern of respiratory and heart disease mortality in response to air pollution.

Short-term changes in ambient particulate matter with aerodynamic diameters < 10 micro m (PM10) have been associated with short-term fluctuations in mortality or morbidity in many studies. In this study, we tested whether those deaths are just advanced by a few days or weeks using a multicity hierarchical modeling approach for all-cause, respiratory, and cardiovascular deaths, for all ages and stratifying by age groups, within the APHEA-2 (Air Pollution and Health: A European Approach) project. We fit a Poisson regression and used an unconstrained distributed lag to model the effect of PM10 exposure on deaths up to 40 days after the exposure. In baseline models using PM10 the day of and day before the death, we found that the overall PM10 effect (per 10 micro g/m3) was 0.74% [95% confidence interval (95% CI), -0.17 to 1.66] for respiratory deaths and 0.69% (95% CI, 0.31-1.08) for cardiovascular deaths. In unrestricted distributed lag models, the effect estimates increased to 4.2% (95% CI, 1.08-7.42) for respiratory deaths and to 1.97% (95% CI, 1.38-2.55) for cardiovascular deaths. Our study confirms that most of the effect of air pollution is not simply advanced by a few weeks and that effects persist for more than a month after exposure. The effect size estimate for PM10 doubles when we considered longer-term effects for all deaths and for cardiovascular deaths and becomes five times higher for respiratory deaths. We found similar effects when stratifying by age groups. These larger effects are important for risk assessment.