Access to HIV community services by vulnerable populations: evidence from an enhanced HIV/AIDS surveillance system.

HIV disproportionately affects vulnerable populations such as black and minority ethnic groups, men who have sex with men (MSM) and migrants, in many countries including those in the UK. Community organisations in the UK are charitable non-governmental organisations with a proportion of the workforce who volunteer, and provide invaluable additional support for people living with HIV (PLWHIV). Information on their contribution to HIV care in vulnerable groups is relatively sparse. Data generated from an enhanced HIV surveillance system in North West England, UK, was utilised for this study. We aimed to determine the characteristics of individuals who chose to access community services in addition to clinical services (1375 out of 4195 records of PLWHIV in clinical services). Demographic information, risk factors including residency status, uniquely gathered in this region, and deprivation scores were examined. Multivariate logistic regression modelling was conducted to predict the relative effect of patient characteristics on attendance at community services. Attendance at community services was highest in those living in the most, compared with least, deprived areas (p<0.001), and was most evident in MSM and heterosexuals. Compared to white UK nationals attendance was significantly higher in non-UK nationals of uncertain residency status (Adjusted odds ratio [AOR] = 21.91, 95% confidence interval [CI] 10.48-45.83; p<0.001), refugees (AOR = 5.75, 95% CI 3.3-10.03; p<0.001), migrant workers (AOR = 5.48, 95% CI 2.22-13.51; p<0.001) and temporary visitors (AOR = 3.44, 95% CI 1.68-7.05; p<0.001). Community services, initially established predominantly to support MSM, have responded to the changing demography of HIV and reach the most vulnerable members of society. Consequent to their support of migrant populations, community services are vital for the management of HIV in black and minority groups. Paradoxically, this coincides with increasing funding pressures on these services.

Validation of a simple, rapid, and economical technique for distinguishing type 1 and 2 fibres in fixed and frozen skeletal muscle.

AIMS: To produce a method of distinguishing between type 1 and 2 skeletal muscle fibres that would be more economical and reproducible than the standard ATPase method and be applicable to both fixed and frozen tissue. Because the ATPase method has been accepted as the basis for fibre identification for the past 50 years, the new method should not give significantly different results. METHODS: Isoforms of myosin correlate with isoforms of myofibrillar ATPase and an immunohistochemical (IHC) double labelling protocol was devised using monoclonal antibodies to fast and slow myosin. This required one tissue section rather than four. The results of the two methods were compared by means of morphometric analysis of skeletal muscle biopsies from 20 normal healthy volunteers. RESULTS: There were no significant differences (p = 0.57) in the percentages of type 1 (46% using the IHC method v 48% using ATPase) or type 2 fibres (54% v 52%, respectively). The 2a and 2b subtypes were distinguished easily. Analysis of variance revealed that cross sectional area (mu m(2)), diameter (mu m), form factor, and density of fibre staining (a measure of substrate-enzyme or protein) were all similar. The method worked equally well on fixed material. CONCLUSION: An IHC method based on the fast and slow isoforms of myosin shows no significant differences in fibre type analysis from the standard ATPase method although it provides important advantages because it is applicable to fixed (including archival) material, is economical and reproducible, and yields a permanent preparation.

Identification of TAXREB107 as an erythropoietin early response gene.

The protooncogenes c-myc and c-myb are erythropoietin (Epo)-regulated early response genes. They appear to play distinct roles in the growth- and differentiation-inducing signals of the hormone. Using a subtractive hybridization strategy, we have identified the murine homolog of the TAX response element-binding protein TAXREB107 as an Epo early response gene in Rauscher murine erythroleukemia cells. This was confirmed by Northern blot analyses, which showed a fourfold increase in TAXREB107 mRNA after 1 hr of erythropoietin treatment. After 3 hr the transcript had decreased to approximately twofold above control levels. Inhibition of this induction with antisense oligodeoxynucleotides increased Epo-induced hemoglobinization 2.5-fold. The results implicate TAXREB107 in erythropoiesis and support the hypothesis that the TAXREB proteins have functions outside the context of HTLV-I infection.

Stimulation of T cell immunity by arginine enhances survival in peritonitis.

T cell-mediated immunity may play a role in host responses to infection. Arginine is a known thymic and T cell stimulator which enhances host allogenic, mitogenic, and anti-tumor responses. We, therefore, examined the effect of arginine on the survival of rats with severe and lethal peritonitis induced by cecal ligation and double-needle puncture (CLP). In Experiment 1, arginine HCl (100 mg) was given bid by gavage starting immediately after CLP. In Experiment 2, the same dose of arginine was given by gavage bid for 3 days pre-CLP and continued thereafter. In Experiment 3, arginine was administered iv post-CLP (100 mg tid). Arginine had no effect on overall survival in Experiment 1. In Experiments 2 and 3, arginine therapy significantly increased survival at all times. A separate experiment was carried out to determine the reason for the differential response to arginine administered via gavage or iv post-CLP (Experiments 1 and 3). Nonseptic rats showed a 400% increase in plasma arginine 30 min after gavage with 100 mg arginine (P less than 0.001). No rise in plasma arginine was noted when arginine was administered by gavage post-CLP. The impaired intestinal absorption or markedly increased utilization of arginine in this septic model may explain why no improved survival was seen in Experiment 1. The mechanism for the improved survival with arginine therapy seen in Experiments 2 and 3 may be related to its known thymic and T cell immunostimulatory effects.