Virological failure after 1 year of first-line ART is not associated with HIV minority drug resistance in rural Cameroon .

OBJECTIVES: The aim of this study was to describe clinical and virological outcomes in therapy-naive HIV-1-positive patients treated in a routine ART programme in rural Cameroon. METHODS: In a prospective cohort, 300 consecutive patients starting first-line ART were enrolled and followed for 12 months. Among 238 patients with available viral load data at Month 12, logistic regression was used to analyse risk factors for virological failure (≥1000 HIV RNA copies/mL) including clinical, immunological and virological parameters, as well as data on drug adherence. Population sequencing was performed to detect the presence of drug-resistance mutations in patients with virological failure at Month 12; minority drug-resistance mutations at baseline were analysed using next-generation sequencing in these patients and matched controls. RESULTS: At Month 12, 38/238 (16%) patients experienced virological failure (≥1000 HIV RNA copies/mL). Patients with virological failure were younger, had lower CD4 cell counts and were more often WHO stage 3 or 4 at baseline. Sixty-three percent of patients with virological failure developed at least one drug-resistance mutation. The M184V (n = 18) and K103N (n = 10) mutations were most common. At baseline, 6/30 patients (20%) experiencing virological failure and 6/35 (17%) matched controls had evidence of minority drug-resistance mutations using next-generation sequencing (P = 0.77). Lower CD4 count at baseline (OR per 100 cells/mm(3) lower 1.41, 95% CI 1.02-1.96, P = 0.04) and poorer adherence (OR per 1% lower 1.05, 95% CI 1.02-1.08, P < 0.001) were associated with a higher risk of virological failure. Unavailability of ART at the treatment centre was the single most common cause for incomplete adherence. CONCLUSIONS: Virological failure after 1 year of ART was not associated with minority drug resistance at baseline but with incomplete adherence. Strategies to assure adherence and uninterrupted drug supplies are pivotal factors for therapy success.

6-Substituted 2,2-bis(fluoromethyl)-benzopyran-4-carboxamide K+ channel openers.

In the course of our study to find an ideal antihypertensive potassium channel opener (KCO), N-(2-cyanoethyl)-2,2-bis(fluoromethyl)-6-pentafluoroethyl-2H-1-ben zopyran-4-carboxamide (13f, KC-515) showed a highly potent, slow and long-lasting antihypertensive effect with reduced reflex tachycardia, together with the beneficial effects of KCO such as improvement in lipid metabolism. These profiles identify KC-515 as a potential candidate. In conscious spontaneously hypertensive rats (SHR), the onset of the hypotensive effect of KC-515 (13f) was gradual and the maximum response was attained at around 6 h after dosing. The duration of action was over 18 h for 0.1 mg/kg. When administered to Zucker rats for 2 weeks with 0.03-0.3 mg/kg po range in the antihypertensive doses in hypertensive rat models, KC-515 (13f) significantly and dose-dependently reduced serum triglycerides to less than 70% of control without affecting total cholesterol.

Synthesis and vasorelaxant activity of 2-fluoromethylbenzopyran potassium channel openers.

The synthesis and vasorelaxant activity of 2-fluoromethylbenzopyran potassium channel openers are described. These (2-fluoromethyl) derivatives displayed smooth muscle relaxant activities comparable to or more potent than the corresponding 2-methyl analogues.

[Cytotoxic effects of diclofenac sodium].

The authors studied the cytotoxic effect of diclofenac sodium, a prostaglandin synthetic inhibitor, on Chang's cultured human conjunctival cells. Diclofenac sodium inhibited cell growth dose-dependently. Although cell growth was interrupted 12 hrs later by one minute of exposure to a 0.1% solution of diclofenac sodium, the cells began to grow again 24 hrs later. Twenty-four hours later, a one-minute exposure to a 0.1% solution of diclofenac sodium revealed no cytotoxic effects electron microscopically. The effect on the cell cycle of exposure to 0.1% diclofenac sodium was studied using a flow cytometer. Twelve hours after exposure to diclofenac sodium, DNA histograms showed a broader G1 peak, and increase in mitotic phase cells and dead cells with a low DNA content on the left of the G1 peak. 24 hrs later, the number of dead cells and DNA synthetic phase cells increased and mitotic cells gradually decreased, almost disappearing within 48 hrs.