Ecological study of the predictors of successful management of dyslipidemia in HIV-infected patients on ART: the Swiss HIV Cohort Study

PURPOSE: Antiretroviral therapy (ART) may induce metabolic changes and increase the risk of coronary heart disease (CHD). Based on a health care system approach, we investigated predictors for normalization of dyslipidemia in HIV-infected individuals receiving ART. METHOD: Individuals included in the study were registered in the Swiss HIV Cohort Study (SHCS), had dyslipidemia but were not on lipid-lowering medication, were on potent ART for >or= 3 months, and had >or= 2 follow-up visits. Dyslipidemia was defined as two consecutive total cholesterol (TC) values above recommended levels. Predictors of achieving treatment goals for TC were assessed using Cox models. RESULTS: Analysis included 958 individuals with median followup of 2.3 years (IQR 1.2-4.0). 454 patients (47.4%) achieved TC treatment goals. In adjusted analyses, variables significantly associated with a lower hazard of reaching TC treatment goals were as follows: older age (compared to 18-37 year olds: hazard ratio [HR] 0.62 for 45-52 year olds, 95% CI 0.47-0.82; HR 0.40 for 53-85, 95% CI 0.29-0.54), diabetes (HR 0.39, 95% CI 0.26-0.59), history of coronary heart disease (HR 0.27, 95% CI 0.10-0.71), higher baseline TC (HR 0.78, 95% CI 0.71-0.85), baseline triple nucleoside regimen (HR 0.12 compared to PI-only regimen, 95% CI 0.07-0.21), longer time on PI-only regimen (HR 0.39, 95% CI 0.33-0.46), longer time on NNRTI only regimen (HR 0.35, 95% CI 0.29-0.43), and longer time on PI/NNRTI regimen (HR 0.34, 95% CI 0.26-0.43). Switching ART regimen when viral load was undetectable was associated with a higher hazard of reaching TC treatment goals (HR 1.48, 95% CI 1.14-1.91). CONCLUSION: In SHCS participants on ART, several ART-related and not ART-related epidemiological factors were associated with insufficient control of dyslipidemia. Control of dyslipidemia in ART recipients must be further improved.

Gender and the use of antiretroviral treatment in resource-constrained settings: findings from a multicenter collaboration

AIMS: To compare the gender distribution of HIV-infected adults receiving highly active antiretroviral treatment (HAART) in resource-constrained settings with estimates of the gender distribution of HIV infection; to describe the clinical characteristics of women and men receiving HAART. METHODS: The Antiretroviral Therapy in Lower-Income Countries, ART-LINC Collaboration is a network of clinics providing HAART in Africa, Latin America, and Asia. We compared UNAIDS data on the gender distribution of HIV infection with the proportions of women and men receiving HAART in the ART-LINC Collaboration. RESULTS: Twenty-nine centers in 13 countries participated. Among 33,164 individuals, 19,989 (60.3%) were women. Proportions of women receiving HAART in ART-LINC centers were similar to, or higher than, UNAIDS estimates of the proportions of HIV-infected women in all but two centers. There were fewer women receiving HAART than expected from UNAIDS data in one center in Uganda and one center in India. Taking into account heterogeneity across cohorts, women were younger than men, less likely to have advanced HIV infection, and more likely to be anemic at HAART initiation. CONCLUSIONS: Women in resource-constrained settings are not necessarily disadvantaged in their access to HAART. More attention needs to be paid to ensuring that HIV-infected men are seeking care and starting HAART.

Optimal time for initiating antiretroviral therapy (ART) in HIV-infected, treatment-naive children aged 2 to 5 years old

BACKGROUND The use of combination antiretroviral therapy (cART) comprising three antiretroviral medications from at least two classes of drugs is the current standard treatment for HIV infection in adults and children. Current World Health Organization (WHO) guidelines for antiretroviral therapy recommend early treatment regardless of immunologic thresholds or the clinical condition for all infants (less than one years of age) and children under the age of two years. For children aged two to five years current WHO guidelines recommend (based on low quality evidence) that clinical and immunological thresholds be used to identify those who need to start cART (advanced clinical stage or CD4 counts ≤ 750 cells/mm(3) or per cent CD4 ≤ 25%). This Cochrane review will inform the current available evidence regarding the optimal time for treatment initiation in children aged two to five years with the goal of informing the revision of WHO 2013 recommendations on when to initiate cART in children. OBJECTIVES To assess the evidence for the optimal time to initiate cART in treatment-naive, HIV-infected children aged 2 to 5 years. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the AEGIS conference database, specific relevant conferences, www.clinicaltrials.gov, the World Health Organization International Clinical Trials Registry platform and reference lists of articles. The date of the most recent search was 30 September 2012. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared immediate with deferred initiation of cART, and prospective cohort studies which followed children from enrolment to start of cART and on cART. DATA COLLECTION AND ANALYSIS Two review authors considered studies for inclusion in the review, assessed the risk of bias, and extracted data on the primary outcome of death from all causes and several secondary outcomes, including incidence of CDC category C and B clinical events and per cent CD4 cells (CD4%) at study end. For RCTs we calculated relative risks (RR) or mean differences with 95% confidence intervals (95% CI). For cohort data, we extracted relative risks with 95% CI from adjusted analyses. We combined results from RCTs using a random effects model and examined statistical heterogeneity. MAIN RESULTS Two RCTs in HIV-positive children aged 1 to 12 years were identified. One trial was the pilot study for the larger second trial and both compared initiation of cART regardless of clinical-immunological conditions with deferred initiation until per cent CD4 dropped to <15%. The two trials were conducted in Thailand, and Thailand and Cambodia, respectively. Unpublished analyses of the 122 children enrolled at ages 2 to 5 years were included in this review. There was one death in the immediate cART group and no deaths in the deferred group (RR 2.9; 95% CI 0.12 to 68.9). In the subgroup analysis of children aged 24 to 59 months, there was one CDC C event in each group (RR 0.96; 95% CI 0.06 to 14.87) and 8 and 11 CDC B events in the immediate and deferred groups respectively (RR 0.95; 95% CI 0.24 to 3.73). In this subgroup, the mean difference in CD4 per cent at study end was 5.9% (95% CI 2.7 to 9.1). One cohort study from South Africa, which compared the effect of delaying cART for up to 60 days in 573 HIV-positive children starting tuberculosis treatment (median age 3.5 years), was also included. The adjusted hazard ratios for the effect on mortality of delaying ART for more than 60 days was 1.32 (95% CI 0.55 to 3.16). AUTHORS' CONCLUSIONS This systematic review shows that there is insufficient evidence from clinical trials in support of either early or CD4-guided initiation of ART in HIV-infected children aged 2 to 5 years. Programmatic issues such as the retention in care of children in ART programmes in resource-limited settings will need to be considered when formulating WHO 2013 recommendations.

When to start antiretroviral therapy in children aged 2-5 years: a collaborative causal modelling analysis of cohort studies from southern Africa

BACKGROUND There is limited evidence on the optimal timing of antiretroviral therapy (ART) initiation in children 2-5 y of age. We conducted a causal modelling analysis using the International Epidemiologic Databases to Evaluate AIDS-Southern Africa (IeDEA-SA) collaborative dataset to determine the difference in mortality when starting ART in children aged 2-5 y immediately (irrespective of CD4 criteria), as recommended in the World Health Organization (WHO) 2013 guidelines, compared to deferring to lower CD4 thresholds, for example, the WHO 2010 recommended threshold of CD4 count <750 cells/mm(3) or CD4 percentage (CD4%) <25%. METHODS AND FINDINGS ART-naïve children enrolling in HIV care at IeDEA-SA sites who were between 24 and 59 mo of age at first visit and with ≥1 visit prior to ART initiation and ≥1 follow-up visit were included. We estimated mortality for ART initiation at different CD4 thresholds for up to 3 y using g-computation, adjusting for measured time-dependent confounding of CD4 percent, CD4 count, and weight-for-age z-score. Confidence intervals were constructed using bootstrapping. The median (first; third quartile) age at first visit of 2,934 children (51% male) included in the analysis was 3.3 y (2.6; 4.1), with a median (first; third quartile) CD4 count of 592 cells/mm(3) (356; 895) and median (first; third quartile) CD4% of 16% (10%; 23%). The estimated cumulative mortality after 3 y for ART initiation at different CD4 thresholds ranged from 3.4% (95% CI: 2.1-6.5) (no ART) to 2.1% (95% CI: 1.3%-3.5%) (ART irrespective of CD4 value). Estimated mortality was overall higher when initiating ART at lower CD4 values or not at all. There was no mortality difference between starting ART immediately, irrespective of CD4 value, and ART initiation at the WHO 2010 recommended threshold of CD4 count <750 cells/mm(3) or CD4% <25%, with mortality estimates of 2.1% (95% CI: 1.3%-3.5%) and 2.2% (95% CI: 1.4%-3.5%) after 3 y, respectively. The analysis was limited by loss to follow-up and the unavailability of WHO staging data. CONCLUSIONS The results indicate no mortality difference for up to 3 y between ART initiation irrespective of CD4 value and ART initiation at a threshold of CD4 count <750 cells/mm(3) or CD4% <25%, but there are overall higher point estimates for mortality when ART is initiated at lower CD4 values. Please see later in the article for the Editors' Summary.

Chevkinite-Group Minerals from Granulite-Facies Metamorphic Rocks and Associated Pegmatites of East Antarctica and South India

Electron microprobe data are presented for chevkinite-group minerals from granulite-facies rocks and associated pegmatities of the Napier Complex and Mawson Station charnockite in East Antarctica and from the Eastern Ghats, South India. Their compositions conform to the general formula for this group, viz. A(4)BC(2)D(2)Si(4)O(22) where, in the analysed specimens A = (rare-earth elements (REE), Ca, Y, Th), B = Fe(2+) Mg, C = (Al, Mg, Ti, Fe(2+), Fe(3+), Zr) and D = Ti and plot within the perrierite field oftlic total Fe (as FeO) (wt.%) vs. CaO (wt.%) discriminator diagram of Macdonald and Belkin (2002). In contrast to most chevkinite-group minerals, the A site shows unusual enrichment in the MREE and HREE relative to the LREE and Ca. In one sample from the Napier Complex, Y is the dominant cation among the total REE + Y in the A site, the first reported case of Y-dominance in the chevkinite group. The minerals include the most Al-rich yet reported in the chevkinite group (<= 9.15 wt.% Al(2)O(3)), sufficient to fill the C site in two samples. Conversely, the amount of Ti in these samples does not fill the D site. and, thus, some of the Al could be making up the deficiency at D, a situation not previously reported in the chevkinite group. Fe abudances are low, requiring Mg to occupy up to 45% of the B site. The chevkinite-group minerals analysed originated from three distinct parageneses: (1) pegmatites containing hornblende and orthopyroxene or garnet; (2) orthopyroxene-bearing gneiss and granulite; (3) highly aluminous paragneisses in which the associated minerals are relatively magnesian or aluminous. Chevkinite-group minerals from the first two parageneses have relatively high FeO content and low MgO and Al(2)O(3) contents; their compositions plot in the field for mafic and intermediate igneous rocks. In contrast, chevkinite-group minerals from the third paragenesis are notably more aluminous and have greater Mg/Fe ratios.

Measurement of the differential cross-section of B⁺ meson production in pp collisions at sqrts = 7 TeV at ATLAS

The production cross-section of B+ mesons is measured as a function of transverse momentum p T and rapidity y in proton-proton collisions at centre-of-mass energy root s = 7 TeV, using 2.4 fb(-1) of data recorded with the ATLAS detector at the Large Hadron Collider. The differential production cross-sections, determined in the range 9 GeV < p(T) < 120 GeV and vertical bar y vertical bar < 2.25, are compared to next-to-leading-order theoretical predictions.

Sensory innervation of the dorsal longitudinal ligament and the meninges in the lumbar spine of the dog

Although intervertebral disc herniation is a well-known disease in dogs, pain management for this condition has remained a challenge. The goal of the present study is to address the lack of information regarding the innervation of anatomical structures within the canine vertebral canal. Immunolabeling was performed with antibodies against protein gene product 9.5, Tuj-1 (neuron-specific class III β-tubulin), calcitonin gene-related peptide, and neuropeptide Y in combination with the lectin from Lycopersicon esculentum as a marker for blood vessels. Staining was indicative of both sensory and sympathetic fibers. Innervation density was the highest in lateral areas, intermediate in dorsal areas, and the lowest in ventral areas. In the dorsal longitudinal ligament (DLL), the highest innervation density was observed in the lateral regions. Innervation was lower at mid-vertebral levels than at intervertebral levels. The presence of sensory and sympathetic fibers in the canine dura and DLL suggests that pain may originate from both these structures. Due to these regional differences in sensory innervation patterns, trauma to intervertebral DLL and lateral dura is expected to be particularly painful. The results ought to provide a better basis for the assessment of medicinal and surgical procedures.

The New Cockney: New Ethnicities and Adolescent Speech in the Traditional East End of London

The New Cockney provides a sociolinguistic account of speech variation among adolescents in the 'traditional' East End of London. The study takes account of the social and economic upheaval in the area since the 1950s, primarily concentrating on factors such as the immigration of the Bangladeshi community and its effect on the Cockney dialect. By paying attention to the particular, this book contributes to a better understanding of the more general concerns of linguistic variation. With a focus on the interaction and social practices of a group of adolescents attending a youth centre, the study highlights some of the possible mechanisms for language change.

Investigación en el campo del arte : Presentación de un caso y niveles de anclaje

Muchas veces en la investigación en el campo del arte los términos son ambiguos si no se los precisa. Retomamos la distinción entre cuestiones ontológicas (tipos de objetos de investigación), epistemológicas (conocimientos producidos) y metodológicas propiamente dichas (discusiones en torno de los vínculos con las Ciencias Sociales). A su vez distinguimos la investigación en el campo del arte de la investigación artística (IENA) propiamente dicha, reservando para esta última los sentidos de un tipo de indagación estética creativa en la incorporación de nuevos lenguajes y modalidades de obras. El trabajo busca ser una excusa para que, presentando una exploración en curso dentro de la casa/museo El fogón de los arrieros, podamos actualizar brevemente un debate sobre dos concepciones vinculadas: la IENA y la investigación sobre objetos artísticos. Además de arriesgar una propuesta de abordaje con matriz de datos para estratificar los niveles de análisis, dejando interrogantes para sucesivos planteos que contengan los rasgos propios de la pesquisa teórica y práctica sobre artes.

Belleza y Felicidad en la vorágine del 2001 : Algunas percepciones contemporáneas sobre las condiciones de un arte político

Muy discutida en su momento, la producción de Belleza y Felicidad, y especialmente los debates que generó en torno suyo, permite iluminar retrospectivamente los conceptos y valoraciones subyacentes en las discusiones sobre arte y poesía de fines de los noventa y principios de la década del dos mil. Este artículo recorre, desde esta premisa, tres textos críticos publicados en el período por Martín Prieto y Daniel García Helder, César Aira y Mario Ortiz, en los que a propósito de la lectura crítica de Belleza y Felicidad, se ordenan ciertos modos posibles de la vinculación entre poesía y política.

Investigación en el campo del arte : Presentación de un caso y niveles de anclaje

Muchas veces en la investigación en el campo del arte los términos son ambiguos si no se los precisa. Retomamos la distinción entre cuestiones ontológicas (tipos de objetos de investigación), epistemológicas (conocimientos producidos) y metodológicas propiamente dichas (discusiones en torno de los vínculos con las Ciencias Sociales). A su vez distinguimos la investigación en el campo del arte de la investigación artística (IENA) propiamente dicha, reservando para esta última los sentidos de un tipo de indagación estética creativa en la incorporación de nuevos lenguajes y modalidades de obras. El trabajo busca ser una excusa para que, presentando una exploración en curso dentro de la casa/museo El fogón de los arrieros, podamos actualizar brevemente un debate sobre dos concepciones vinculadas: la IENA y la investigación sobre objetos artísticos. Además de arriesgar una propuesta de abordaje con matriz de datos para estratificar los niveles de análisis, dejando interrogantes para sucesivos planteos que contengan los rasgos propios de la pesquisa teórica y práctica sobre artes.

Investigación en el campo del arte : Presentación de un caso y niveles de anclaje

Muchas veces en la investigación en el campo del arte los términos son ambiguos si no se los precisa. Retomamos la distinción entre cuestiones ontológicas (tipos de objetos de investigación), epistemológicas (conocimientos producidos) y metodológicas propiamente dichas (discusiones en torno de los vínculos con las Ciencias Sociales). A su vez distinguimos la investigación en el campo del arte de la investigación artística (IENA) propiamente dicha, reservando para esta última los sentidos de un tipo de indagación estética creativa en la incorporación de nuevos lenguajes y modalidades de obras. El trabajo busca ser una excusa para que, presentando una exploración en curso dentro de la casa/museo El fogón de los arrieros, podamos actualizar brevemente un debate sobre dos concepciones vinculadas: la IENA y la investigación sobre objetos artísticos. Además de arriesgar una propuesta de abordaje con matriz de datos para estratificar los niveles de análisis, dejando interrogantes para sucesivos planteos que contengan los rasgos propios de la pesquisa teórica y práctica sobre artes.