1
|
Cintron C, Narasimhan PB, Locks L, Babu S, Sinha P, Rajkumari N, Kaipilyawar V, Bhargava A, Maloomian K, Chandrasekaran P, Verma S, Joseph N, Johnson WE, Wanke C, Horsburgh CR, Ellner JJ, Sarkar S, Salgame P, Lakshminarayanan S, Hochberg NS. Tuberculosis-Learning the Impact of Nutrition (TB LION): protocol for an interventional study to decrease TB risk in household contacts. BMC Infect Dis 2021; 21:1058. [PMID: 34641820 PMCID: PMC8506078 DOI: 10.1186/s12879-021-06734-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Comorbidities such as undernutrition and parasitic infections are widespread in India and other tuberculosis (TB)-endemic countries. This study examines how these conditions as well as food supplementation and parasite treatment might alter immune responses to Mycobacterium tuberculosis (Mtb) infection and risk of progression to TB disease. METHODS This is a 5-year prospective clinical trial at Jawaharlal Institute of Post Graduate Medical Education and Research in Puducherry, Tamil Nadu, India. We aim to enroll 760 household contacts (HHC) of adults with active TB in order to identify 120 who are followed prospectively for 2 years: Thirty QuantiFERON-TB Gold Plus (QFT-Plus) positive HHCs ≥ 18 years of age in four proposed groups: (1) undernourished (body mass index [BMI] < 18.5 kg/m2); (2) participants with a BMI ≥ 18.5 kg/m2 who have a parasitic infection (3) undernourished participants with a parasitic infection and (4) controls-participants with BMI ≥ 18.5 kg/m2 and without parasitic infection. We assess immune response at baseline and after food supplementation (for participants with BMI < 18.5 kg/m2) and parasite treatment (for participants with parasites). Detailed nutritional assessments, anthropometry, and parasite testing through polymerase chain reaction (PCR) and microscopy are performed. In addition, at serial time points, these samples will be further analyzed using flow cytometry and whole blood transcriptomics to elucidate the immune mechanisms involved in disease progression. CONCLUSIONS This study will help determine whether undernutrition and parasite infection are associated with gene signatures that predict risk of TB and whether providing nutritional supplementation and/or treating parasitic infections improves immune response towards this infection. This study transcends individual level care and presents the opportunity to benefit the population at large by analyzing factors that affect disease progression potentially reducing the overall burden of people who progress to TB disease. Trial registration ClinicalTrials.gov; NCT03598842; Registered on July 26, 2018; https://clinicaltrials.gov/ct2/show/NCT03598842.
Collapse
Affiliation(s)
- Chelsie Cintron
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Prakash Babu Narasimhan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Lindsey Locks
- Department of Health Sciences, Boston University College of Health and Rehabilitation Sciences Sargent College, Boston, MA, USA
| | - Senbagavalli Babu
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pranay Sinha
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Nonika Rajkumari
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vaishnavi Kaipilyawar
- Department of Medicine, Center for Emerging Pathogens, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anurag Bhargava
- Department of Internal Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | | | - Padma Chandrasekaran
- Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Sheetal Verma
- Department of Medicine, Center for Emerging Pathogens, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Noyal Joseph
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - W Evan Johnson
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA, USA
| | - Christine Wanke
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jerrold J Ellner
- Department of Medicine, Center for Emerging Pathogens, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Padmini Salgame
- Department of Medicine, Center for Emerging Pathogens, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Subitha Lakshminarayanan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Natasha S Hochberg
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
- Department of Medicine, Section of Infectious Diseases, Boston University, School of Medicine, Boston, MA, USA.
| |
Collapse
|
2
|
Sinha P, Davis J, Saag L, Wanke C, Salgame P, Mesick J, Horsburgh CR, Hochberg NS. Undernutrition and Tuberculosis: Public Health Implications. J Infect Dis 2020; 219:1356-1363. [PMID: 30476125 DOI: 10.1093/infdis/jiy675] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/20/2018] [Indexed: 12/30/2022] Open
Abstract
Almost 800 million people are chronically undernourished worldwide, of whom 98% are in low- and middle-income countries where tuberculosis is endemic. In many tuberculosis-endemic countries, undernutrition is a driver of tuberculosis incidence and associated with a high population attributable fraction of tuberculosis and poor treatment outcomes. Data suggest that undernutrition impairs innate and adaptive immune responses needed to control Mycobacterium tuberculosis infection and may affect responses to live vaccines, such as BCG. Given its impact on tuberculosis, addressing undernutrition will be a vital component of the World Health Organization End TB strategy. This narrative review describes the effect of undernutrition on the immune response, vaccine response, and tuberculosis incidence, severity, and treatment outcomes.
Collapse
Affiliation(s)
- Pranay Sinha
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Juliana Davis
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Lauren Saag
- Division of Epidemiology, Vanderbilt University, Nashville, Tennessee
| | | | - Padmini Salgame
- Centre for Emerging Pathogens, Department of Medicine, Rutgers-New Jersey Medical School, Newark
| | - Jackson Mesick
- Department of Epidemiology, Boston University School of Public Health, Massachusetts.,Department of Global Health, Boston University School of Public Health, Massachusetts
| | - C Robert Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Massachusetts.,Department of Global Health, Boston University School of Public Health, Massachusetts
| | - Natasha S Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Massachusetts
| |
Collapse
|
3
|
Beinke C, Wanke C, Eder S, Port M. Cytogenetic Analysis After Temporary Residence in the Area of the Uncontrolled Ruthenium-106 Release in Russia in September 2017. Health Phys 2019; 117:598-605. [PMID: 31124834 DOI: 10.1097/hp.0000000000001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In September and October 2017, elevated atmospheric ruthenium contamination was measured in several European countries. The most probable origin of this release of radionuclides was reconstructed to be the Southern Ural region. During that time, five workers from a German company stayed up to 2 wk about 120 km from the Chelyabinsk region in Ekaterinburg, Russia. No clinical symptoms were reported during or after the suspected radiation exposure, and no internal contamination was found in whole-body measurements. However, to investigate radiation protection issues and to clarify the workers' situation in order to reassure them, as they planned to continue working in Ekaterinburg, our laboratory was urgently requested by the company's occupational physician to perform biodosimetry using dicentric analysis to determine if the workers have been exposed to radiation by incorporation of radionuclides. The workers' dicentric yields have been compared to reference data of background frequencies in unexposed individuals, but, as it is not reasonable to quantify individual absorbed radiation doses from internalized beta emitters due to various confounding factors, individual dose estimation has not been performed. Dicentric frequencies for two workers differed significantly from the mean laboratory background level, which could have been induced by an exposure to incorporated radionuclides due to beta emissions by Ru or to gamma irradiation by the decay nuclide of Ru. However, the maximum absorbed radiation doses calculated for a resident in the Ru-contaminated area during that time does not correspond to the observed dicentric frequencies. It cannot be excluded that their dicentric frequencies were already elevated before September 2017, potentially induced by an earlier radiation exposure to diagnostic x rays or even by chance.
Collapse
Affiliation(s)
- C Beinke
- Bundeswehr Institute of Radiobiology affiliated with the University Ulm, Munich, Germany
| | - C Wanke
- Medizinische Hochschule Hannover, Stabsstelle Strahlenschutz und Abteilung Medizinische Physik
| | - S Eder
- Bundeswehr Institute of Radiobiology affiliated with the University Ulm, Munich, Germany
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Inner City Clinic, University Hospital of Munich (LMU), Munich, Germany
| | - M Port
- Bundeswehr Institute of Radiobiology affiliated with the University Ulm, Munich, Germany
| |
Collapse
|
4
|
Sackey J, Wang G, Wanke C, Tang A, Knox T. Socio-demographic Factors Associated with Diet Quality Among a Cohort of People Living with HIV (P04-075-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz051.p04-075-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To identify social, demographic and health factors associated with diet quality over time in a community-dwelling population of people living with HIV (PLHIV) in the Greater-Boston area.
Methods
Secondary analysis of data from the Cardiovascular Assessment Risk Examination (CARE) prospective cohort study carried out between 2007 and 2013. The study included 288 PLHIV recruited from the Greater-Boston area with study visits annually. Repeated measures linear regression models with diet quality [assessed using Healthy Eating Index (HEI-2010)] as the dependent variable was used to analyze the data. The HEI-2010 ranges from 0–100 with a higher score indicating higher diet quality.
Results
At baseline, study participants were mostly male (73%), 51 ± 7 years, unemployed (56%) and White (51%). They had been living with HIV for an average of 16years with an average CD4 count of 520 cells/mm3. Approximately one third reported being depressed (35%), being food insecure (37%), and binge drinking in the previous 6 months (30%). The mean HEI-2010 score at baseline was 48.7 ± 16.2 with male participants having a higher score (50.5) than females (43.7) (P = 0.004). Longer duration of highly active antiretroviral therapy (HAART), having an undetectable viral load, being food secure, fewer pack-years of smoking, and increasing age were independently associated with higher diet quality over time (P < 0.0001). There were no significant interactions between time and the significant independent variables.
Conclusions
Among this cohort of PLHIV, several sociodemographic and clinical factors were associated with higher diet quality. Interventions to improve diet quality in PLHIV should focus on younger people and those who are food insecure. In addition, clinicians should continue to push for treatment adherence and viral suppression, along with curtailing smoking. With improved long term survival due to HAART, assessment of food security and diet quality may reduce cardiometabolic risk factors and further improve mortality.
Funding Sources
National Heart, Lung, And Blood Institute.
Collapse
|
5
|
Chandrasekaran P, Shet A, Srinivasan R, Sanjeeva GN, Subramanyan S, Sunderesan S, Ramesh K, Gopalan B, Suresh E, Poornagangadevi N, Hanna LE, Chandrasekar C, Wanke C, Swaminathan S. Long-term virological outcome in children receiving first-line antiretroviral therapy. AIDS Res Ther 2018; 15:23. [PMID: 30477526 PMCID: PMC6260781 DOI: 10.1186/s12981-018-0208-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/08/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Studies relating to long-term virological outcomes among children on first-line antiretroviral therapy (ART) from low and middle-income countries are limited. METHODS Perinatally HIV infected, ART-naive children, between 2 and 12 years of age, initiating NNRTI-based ART during 2010-2015, with at least 12 months of follow-up, were included in the analysis. CD4 cell counts and plasma HIV-1 RNA were measured every 24 weeks post-ART initiation. Immunologic failure was defined as a decrease in the CD4 count to pre-therapy levels or below and virologic failure as HIV-RNA of > 1000 copies/ml at 48 weeks after ART initiation. Genotypic resistance testing was performed for children with virologic failure. Logistic regression analysis was done to identify predictors of virologic failure. RESULTS Three hundred and ninety-three ART-naïve children living with HIV [mean (SD) age: 7.6 (3) years; mean (SD) CD4%: 16% (8); median (IQR) HIV-RNA: 5.1 (3.5-5.7) log10 copies/ml] were enrolled into the study. At 48 weeks, significant improvement occurred in weight-for-age and height-for-age z-scores from baseline (all p < 0.001). The immunologic response was good; almost 90% of children showing an increase in their absolute CD4+ T cell count to more than 350 cells/mm3. Immunological failure was noted among 11% (28/261) and virologic failure in 29% (94/328) of children. Of the 94 children with virologic failure at 12 months, 36 children showed immunologic failure while the rest had good immunologic improvement. There was no demonstrable correlation between virologic and immunologic failure. 62% had reported > 90% adherence to ART. At the time of virologic failure, multiple NNRTI-associated mutations were observed: 80%-K103N and Y181C being the major NNRTI mutations-observed. Sensitivity (95% CI) of immunologic failure to detect virologic failure was 7% (2-12), specificity 97% (92.4-98.9), PPV 44% (13.7-78.8) and NPV was 72% (65-77.9). There were no statistically significant predictors to detect children who will develop virologic failure on treatment. CONCLUSIONS Considerable immunological improvement is seen in children with ART initiation, but may not be an effective tool to monitor treatment response in the long-term. There is a lack of correlation between immunologic and virologic response while on ART, which may lead to a delay in identifying treatment failures. Periodic viral load monitoring is, therefore, a priority.
Collapse
Affiliation(s)
- Padmapriyadarsini Chandrasekaran
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | - Anita Shet
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- St Johns Research Institute, Bangalore, India
| | - Ramalingam Srinivasan
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | - G. N. Sanjeeva
- Indira Gandhi Institute of Child Health, Bangalore, India
| | - Sudha Subramanyan
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | | | - Karunaianantham Ramesh
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | | | - Elumalai Suresh
- Institute of Child Health and Government Hospital for Children, Chennai, India
| | - Navaneethan Poornagangadevi
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | - Luke E. Hanna
- Department of Clinic Research, ICMR-National Institute for Research in Tuberculosis, No. 1, Mayor Sathyamoorthy Road, Chetpet, Chennai, Tamil Nadu 600031 India
| | | | | | - Soumya Swaminathan
- Indian Council of Medical Research, New Delhi, India
- Present Address: World Health Organization, Geneva, Switzerland
| |
Collapse
|
6
|
Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis 2018; 65:1963-1973. [PMID: 29194529 DOI: 10.1093/cid/cix959] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. They are not intended to replace physician judgement regarding specific patients or clinical or public health situations. This document does not provide detailed recommendations on infection prevention and control aspects related to infectious diarrhea.
Collapse
Affiliation(s)
- Andi L Shane
- Division of Infectious Diseases, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Georgia
| | - Rajal K Mody
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Washington University in St. Louis School of Medicine, Missouri
| | - Theodore S Steiner
- Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Karen Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, and the Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
| | - Joanne M Langley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine Wanke
- Division of Nutrition and Infection, Tufts University, Boston, Massachusetts
| | - Cirle Alcantara Warren
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joseph Cantey
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston
| | - Larry K Pickering
- Division of Infectious Diseases, Department of Pediatrics, Emory University, Atlanta, Georgia
| |
Collapse
|
7
|
Sackey J, Zhang FF, Rogers B, Aryeetey R, Wanke C. Food security and dietary diversity are associated with health related quality of life after 6 months of follow up among people living with HIV in Accra, Ghana. AIDS Care 2018; 30:1567-1571. [PMID: 30021465 DOI: 10.1080/09540121.2018.1500011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
With the efficacy of antiretroviral therapy, people living with HIV (PLWH) are surviving longer and improving their health related quality of life (HRQol) has become an important long-term HIV treatment and management indicator. HRQol has been associated with various factors, including food insecurity (FI). The objective of this prospective study was to examine the association between FI and dietary diversity (HDDS) and HRQol among PLWH in Accra, Ghana. We recruited 152 PLWH from the HIV clinics of six district hospitals Accra, Ghana and utilized a prospective cohort study design with data collection at baseline, three and six months after recruitment for this study. Participants completed questionnaires measuring HRQol, FI and HDDS. Repeated measures ANOVA was used to analyze the associations between FI and HRQol as well as HDDS and HRQol separately and then together. Being food secure [0.035 (95% CI = 0.005, 0.065)] and having a high dietary diversity score [0.029 (95% CI = 0.004, 0.053)] were independently associated with an improvement in quality of life scores over time after adjusting for other covariates and each other. Interventions to improve dietary diversity and food security among PLWH have the potential to improve nutritional status as well as HRQol.
Collapse
Affiliation(s)
- Joachim Sackey
- a Department of Nutritional Sciences , Rutgers Biomedical and Health Sciences , Newark , NJ , USA
| | - Fang Fang Zhang
- b Friedman School of Nutrition Science and Policy , Tufts University , Boston , MA , USA
| | - Beatrice Rogers
- b Friedman School of Nutrition Science and Policy , Tufts University , Boston , MA , USA
| | - Richmond Aryeetey
- c School of Public Health , University of Ghana , Legon , Accra , Ghana
| | | |
Collapse
|
8
|
Padmapriyadarsini C, Ramesh K, Sekar L, Ramachandran G, Reddy D, Narendran G, Sekar S, Chandrasekar C, Anbarasu D, Wanke C, Swaminathan S. Factors affecting high-density lipoprotein cholesterol in HIV-infected patients on nevirapine-based antiretroviral therapy. Indian J Med Res 2018; 145:641-650. [PMID: 28948955 PMCID: PMC5644299 DOI: 10.4103/ijmr.ijmr_1611_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background & objectives: Cardiovascular disease (CVD) risk with low high-density lipoprotein cholesterol (HDL-C) and high triglycerides is common in the general population in India. As nevirapine (NVP)-based antiretroviral therapy (ART) tends to increase HDL-C, gene polymorphisms associated with HDL-C metabolism in HIV-infected adults on stable NVP-based ART were studied. Methods: A cross-sectional study was conducted between January 2013 and July 2014 among adults receiving NVP-based ART for 12-15 months. Blood lipids were estimated and gene polymorphisms in apolipoprotein C3 (APOC3), cholesteryl ester transfer protein (CETP) and lipoprotein lipase (LPL) genes were analyzed by real-time polymerase chain reaction. Framingham's 10-yr CVD risk score was estimated. Logistic regression was done to show factors related to low HDL-C levels. Results: Of the 300 patients included (mean age: 38.6±8.7 yr; mean CD4 count 449±210 cell/μl), total cholesterol (TC) >200 mg/dl was observed in 116 (39%) patients. Thirty nine per cent males and 47 per cent females had HDL-C levels below normal while 32 per cent males and 37 per cent females had TC/HDL ratio of 4.5 and 4.0, respectively. Body mass index [adjusted odds ratio (aOR)=1.70, 95% confidence interval (CI) 1.01-2.84, P=0.04] and viral load (aOR=3.39, 95% CI: 1.52-7.52, P=0.003) were negatively associated with serum HDL-C levels. The 10-yr risk score of developing CVD was 11-20 per cent in 3 per cent patients. Allelic variants of APOC3 showed a trend towards low HDL-C. Interpretation & conclusions: High-risk lipid profiles for atherosclerosis and cardiovascular disease were common among HIV-infected individuals, even after 12 months of NVP-based ART. Targeted interventions to address these factors should be recommended in the national ART programmes.
Collapse
Affiliation(s)
- C Padmapriyadarsini
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - K Ramesh
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - L Sekar
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Geetha Ramachandran
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Devaraj Reddy
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - G Narendran
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - S Sekar
- ART Centre, Rajiv Gandhi Government General Hospital, Chennai, India
| | - C Chandrasekar
- Nodal ART Medical Officer, Government Hospital of Thoracic Medicine, Chennai, India
| | - D Anbarasu
- ART Centre, Government Vellore Medical College & Hospital, Vellore, India
| | - Christine Wanke
- Department of Medicine, Tufts University School of Medicine, Boston, USA
| | | |
Collapse
|
9
|
Sackey J, Zhang FF, Rogers B, Aryeetey R, Wanke C. Implementation of a nutrition assessment, counseling and support program and its association with body mass index among people living with HIV in Accra, Ghana. AIDS Care 2017; 30:586-590. [PMID: 29284281 DOI: 10.1080/09540121.2017.1420137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In spite of the important role nutrition plays in the management of HIV, access to nutrition services is inadequate, especially in resource limited settings. In addition, nutrition programs for people living with HIV (PLWH) have not been sufficiently evaluated for efficacy and this study was conducted to address this gap. This study aimed to evaluate the implementation of the nutrition assessment, counseling and support (NACS) program in Accra, Ghana, and to assess whether the level of implementation of NACS was associated with the body mass index (BMI) of PLWH. A cross-sectional study was conducted in six HIV clinics (3 NACS designated and 3 non-NACS). Study participants were 152 adult PLWH at least 6 months on antiretroviral therapy and not pregnant or breastfeeding. Using a NACS implementation scale developed for this study ranging from 0 to 8 (a higher score indicating better NACS implementation), median NACS implementation score was not different between NACS-designated, and non-NACS HIV clinics (5 vs 4, p = 0.14). Almost half (47%) of the respondents were overweight or obese. A higher score on the NACS implementation scale was not significantly associated with overweight or obesity (BMI >24.9 kg/m2) after adjusting for other covariates. It was concluded that, there was poor implementation of NACS in the NACS designated HIV clinics surveyed with no nutrition counseling offered nor food support available to those who might need it.
Collapse
Affiliation(s)
- Joachim Sackey
- a Department of Nutritional Sciences , Rutgers School of Health Professsions , Newark , NJ , USA
| | - Fang Fang Zhang
- b Friedman School of Nutrition Science and Policy , Tufts University , Boston , MA , USA
| | - Beatrice Rogers
- b Friedman School of Nutrition Science and Policy , Tufts University , Boston , MA , USA
| | - Richmond Aryeetey
- c School of Public Health , University of Ghana, Legon , Accra , Ghana
| | - Christine Wanke
- d Department of Public Health and Community Medicine , Tufts University School of Medicine , Boston , MA , USA
| |
Collapse
|
10
|
Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis 2017; 65:e45-e80. [PMID: 29053792 PMCID: PMC5850553 DOI: 10.1093/cid/cix669] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/26/2017] [Indexed: 12/11/2022] Open
Abstract
These guidelines are intended for use by healthcare professionals who care for children and adults with suspected or confirmed infectious diarrhea. They are not intended to replace physician judgement regarding specific patients or clinical or public health situations. This document does not provide detailed recommendations on infection prevention and control aspects related to infectious diarrhea.
Collapse
Affiliation(s)
- Andi L Shane
- Division of Infectious Diseases, Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Rajal K Mody
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina; Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Theodore S Steiner
- Nutrition, Washington University in St. Louis School of Medicine, St. Louis, MO; 5Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Karen Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, and the Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD
| | | | - Christine Wanke
- Division of Nutrition and Infection, Tufts University, Boston, Massachusetts,Cirle Alcantara Warren, MD
| | - Cirle Alcantara Warren
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joseph Cantey
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Larry K Pickering
- Division of Infectious Diseases, Department of Pediatrics, Emory University, Atlanta, Georgia
| |
Collapse
|
11
|
De Cuyper A, Hesta M, Tibosch S, Wanke C, Clauss M, Janssens GPJ. How does dietary particle size affect carnivore gastrointestinal transit: A dog model. J Anim Physiol Anim Nutr (Berl) 2017; 102:e615-e622. [DOI: 10.1111/jpn.12803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/28/2017] [Indexed: 01/12/2023]
Affiliation(s)
- A. De Cuyper
- Laboratory of Animal Nutrition; Department of Nutrition Genetics and Ethology; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - M. Hesta
- Laboratory of Animal Nutrition; Department of Nutrition Genetics and Ethology; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - S. Tibosch
- Medimetrics Personalized Drug Delivery Group; Eindhoven The Netherlands
| | - C. Wanke
- Medimetrics Personalized Drug Delivery Group; Eindhoven The Netherlands
| | - M. Clauss
- Clinic for Zoo Animals Exotic Pets and Wildlife; University of Zurich; Zurich Switzerland
| | - G. P. J. Janssens
- Laboratory of Animal Nutrition; Department of Nutrition Genetics and Ethology; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| |
Collapse
|
12
|
Wanke C, Gerrior J, Hendricks K, McNamara J, Schaefer E. Alterations in Lipid Profiles in HIV-Infected Patients Treated With Protease Inhibitor Therapy Are Not Influenced by Diet. Nutr Clin Pract 2017; 20:668-73. [PMID: 16306305 DOI: 10.1177/0115426505020006668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of protease inhibitor (PI) -based highly active antiretroviral therapy (HAART) in patients infected with human immunodeficiency virus (HIV) has been linked to alterations in lipid profiles. METHODS Longitudinal cohort study. Lipid profiles were evaluated pre- and post-PI therapy in 49 HIV-infected patients. Diet was also evaluated to determine any contribution to alterations in lipid levels. RESULTS Pre- and post-PI-based HAART samples were examined from 42 men and 7 women, mean age 40.6 years. Mean CD4 count pre-PI was 242 +/- 205 cells/mm(3); HIV RNA was 4.2 log(10) copies/mL; body mass index (BMI) was 24.7 +/- 3.6 kg/m(2); body fat was 17.1 +/- 9.1 kg by bioelectrical impedance analysis (BIA), dietary intake was 2654 +/- 732 kcal/day. Post-PI samples were collected 5.7 +/- 1.66 months after starting therapy. CD4 counts increased to 384 +/- 323 cells/mm(3) and RNA decreased 1 log post-PI. Post-PI BMI (25.2 kg/m2), percent body fat (17.4%) and caloric intake (2656 kcal/day) were unchanged. Pre-PI total cholesterol (TC) in men was 167.6 +/- 42.4 mg/dL; TC increased (190.4 +/- 47.9 mg/dL) post-PI (p < .0001). Pre-PI triglycerides (TG) were 154.5 +/- 109.4 mg/dL; TG increased post-PI (266.1 +/- 363.6 mg/dL, p < .03). Low-density lipoprotein (LDL) -C was 97.8 +/- 31 mg/dL pre-PI and rose to 107.1 +/- 34.7 mg/dL post-PI (p < .05). High density lipoproteins (HDLs) were below desired levels before initiation of PI therapy and remained low. CONCLUSIONS PI therapy significantly alters lipid profiles in HIV-infected patients. Dietary intake did not contribute to changes in lipid profile. More longitudinal studies are needed to demonstrate whether these alterations contribute to additional cardiovascular risk.
Collapse
Affiliation(s)
- Christine Wanke
- Department of Public Health and Nutrition Infection Unit, Tufts University School of Medicine, Boston, MA 02111, USA.
| | | | | | | | | |
Collapse
|
13
|
Volpe G, Skinner S, Gerrior-Schofield J, Zhang FF, Tang A, Kuvin J, Mangili A, Wanke C. A Randomized Controlled Trial of Omega-3 Fatty Acids in Human Immunodeficiency Virus (HIV): Long-Term Effects on Lipids and Vascular Function. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw194.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gretchen Volpe
- Tufts University School of Medicine, Boston, Massachusetts
- Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Sally Skinner
- Tufts University School of Medicine, Boston, Massachusetts
| | | | | | - Alice Tang
- Tufts University School of Medicine, Boston, Massachusetts
| | - Jeffrey Kuvin
- Tufts University School of Medicine, Boston, Massachusetts
- Cardiology, Tufts Medical Center, Boston, Massachusetts
| | | | - Christine Wanke
- Tufts University School of Medicine, Boston, Massachusetts
- Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
14
|
Kattula D, Jeyavelu N, Prabhakaran AD, Premkumar PS, Velusamy V, Venugopal S, Geetha JC, Lazarus RP, Das P, Nithyanandhan K, Gunasekaran C, Muliyil J, Sarkar R, Wanke C, Ajjampur SSR, Babji S, Naumova EN, Ward HD, Kang G. Natural History of Cryptosporidiosis in a Birth Cohort in Southern India. Clin Infect Dis 2016; 64:347-354. [PMID: 28013266 PMCID: PMC5241779 DOI: 10.1093/cid/ciw730] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In an Indian birth cohort, we demonstrate a high and early burden of cryptosporidiosis by polymerase chain reaction and serology. Reinfection was common and infections clustered in a subset of children. Prior infection provided some protection against subsequent infection, but not disease. Background. Cryptosporidium is a leading cause of moderate to severe childhood diarrhea in resource-poor settings. Understanding the natural history of cryptosporidiosis and the correlates of protection are essential to develop effective and sustainable approaches to disease control and prevention. Methods. Children (N = 497) were recruited at birth in semiurban slums in Vellore, India, and followed for 3 years with twice-weekly home visits. Stool samples were collected every 2 weeks and during diarrheal episodes were tested for Cryptosporidium species by polymerase chain reaction (PCR). Serum samples obtained every 6 months were evaluated for seroconversion, defined as a 4-fold increase in immunoglobulin G directed against Cryptosporidium gp15 and/or Cp23 antigens between consecutive sera. Results. Of 410 children completing follow-up, 397 (97%) acquired cryptosporidiosis by 3 years of age. PCR identified 1053 episodes of cryptosporidiosis, with an overall incidence of 0.86 infections per child-year by stool and serology. The median age for the first infection was 9 (interquartile range, 4–17) months, indicating early exposure. Although infections were mainly asymptomatic (693 [66%]), Cryptosporidium was identified in 9.4% of diarrheal episodes. The proportion of reinfected children was high (81%) and there was clustering of asymptomatic and symptomatic infections (P < .0001 for both). Protection against infection increased with the order of infection but was only 69% after 4 infections. Cryptosporidium hominis (73.3%) was the predominant Cryptosporidium species, and there was no species-specific protection. Conclusions. There is a high burden of endemic cryptosporidiosis in southern India. Clustering of infection is suggestive of host susceptibility. Multiple reinfections conferred some protection against subsequent infection.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Princey Das
- Departments of Gastrointestinal Sciences and
| | | | | | | | | | - Christine Wanke
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center.,Department of Public Health and Community Medicine, Tufts University School of Medicine, and
| | | | | | - Elena N Naumova
- Department of Public Health and Community Medicine, Tufts University School of Medicine, and.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Honorine D Ward
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center.,Department of Public Health and Community Medicine, Tufts University School of Medicine, and
| | | |
Collapse
|
15
|
Saghayam S, Wanke C. The impact of nutritional status and nutrition supplementation on outcomes along the HIV treatment cascade in the resource-limited setting. Curr Opin HIV AIDS 2016; 10:472-6. [PMID: 26444946 DOI: 10.1097/coh.0000000000000202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW This review proposes to examine the role of nutrition (defined at body mass index, food security or nutrition interventions) in each of the steps of the treatment cascade for HIV. RECENT FINDINGS Food insecurity was found to be associated with increase in risk behaviors, with decreased retention in care and with lower adherence to antiretroviral therapy; fewer studies looked at the role of baseline body weight on outcomes such as mortality. Studies of nutrition interventions had more complex outcomes but improvement in nutritional status was the outcome that was most commonly identified. SUMMARY Nutrition has an important role to play in the current care of HIV-infected individuals and can have an impact on the treatment cascade. Food in security, which may be reversed by the provision of food, is of particular interest as studies suggest associations with multiple outcomes.
Collapse
Affiliation(s)
- Suneeta Saghayam
- Women's Christian College, Chennai, Tamil Nadu, India; YRG CARE, Chennai, India
| | | |
Collapse
|
16
|
Smit E, Wanke C, Dong K, Grotheer A, Hansen S, Skinner S, Tang AM. FRAILTY, FOOD INSECURITY, AND NUTRITIONAL STATUS IN PEOPLE LIVING WITH HIV. J Frailty Aging 2016; 4:191-7. [PMID: 26689809 DOI: 10.14283/jfa.2015.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nutritional status and food insecurity are associated with frailty in the general U.S. population, yet little is known about this in the aging population of people living with HIV (PLWH). OBJECTIVES Given the potential importance of nutrition and the amenability to intervention, we examined the association between nutritional status, food insecurity, and frailty in PLWH. DESIGN Cross sectional study. SETTING Boston, Massachusetts, U.S.A. PARTICIPANTS 50 PLWH, age ≥45 years, recruited from a cohort study examining risk factors for cardiovascular disease. MEASUREMENTS Frailty, duration of HIV, use of antiretroviral therapy, disease history, food insecurity, physical function, and physical activity were assessed by questionnaire. Dietary intake was assessed using 3-day food records. Blood was drawn for CD4+ cell count, hemoglobin, hematocrit, and lipid levels. Physical measurements included height, weight, and skinfold thickness. RESULTS The prevalence of frailty was 16% (n=8), 44% were pre-frail (n=22) and 40% were not frail (n=20). The number of reported difficulties with 20 activities of daily living was highest in frail (mean 10.4±3.9 SD), followed by pre-frail (6.5±4.6), and lowest in not frail participants (2.0±2.3). Seven (88%) of the frail PLWH lost weight with an average weight loss of 22.9 pounds; 6 (75%) reported unintentional weight loss, and all 6 of these met the frailty criteria for weight loss of 10 or more pounds. Nine (45%) of the not frail PLWH reported losing weight with an average weight loss of 6.2 pounds; 5 (23%) reported unintentional weight loss of <10 pounds. Frail PLWH were more likely to report being food insecure than not frail PLWH (63% vs. 10%, p=0.02), and tended to have lower energy intake than not frail PLWH. CONCLUSION Research is needed on targeted interventions to improve food security and activities of daily living in PLWH for both the prevention and improvement of frailty.
Collapse
Affiliation(s)
- E Smit
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA
| | - C Wanke
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA
| | - K Dong
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA
| | - A Grotheer
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA
| | - S Hansen
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA
| | - S Skinner
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA
| | - A M Tang
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA
| |
Collapse
|
17
|
Isaac R, Paul B, Geethanajali FS, Kang G, Wanke C. Role of intestinal dysfunction in the nutritional compromise seen in human immunodeficiency virus-infected adults in rural India. Trop Doct 2016; 47:44-48. [PMID: 26809467 DOI: 10.1177/0049475515626338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Human immunodeficiency virus (HIV) disease progression is often marked by significant weight loss with or without chronic diarrhoea. We studied the extent of intestinal dysfunction using a D-xylose absorption test and association with nutritional compromise as measured by body mass index (BMI) and serum antioxidants levels in HIV-infected individuals through a cross-sectional survey of 45 ART naïve, HIV-positive and 45, age-socioeconomic status matched negative controls in a rural population in India. More than 40% of HIV-positive and HIV-negative participants had intestinal dysfunction (42.2% vs. 44.4%). However an increasing gradient of low D-xylose absorption was noted with decreasing CD4 counts (32%, 50% and 58.3% among those with >350, 200-350 and <200 cells/mm3, respectively). Multivariate analysis revealed a significant association between intestinal dysfunction and low BMI (P = 0.03) independent of HIV infection and calorie intake per day (P = 0.02). Weight loss in HIV-infected individuals should be investigated for intestinal dysfunction especially in low resource settings.
Collapse
Affiliation(s)
- Rita Isaac
- Associate Professor, RUHSA Department, Christian Medical College, Vellore, Tamil Nadu, India
| | - Biswajit Paul
- Associate Professor, RUHSA Department, Christian Medical College, Vellore, Tamil Nadu, India
| | - F S Geethanajali
- Professor, Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gagandeep Kang
- Professor, Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Christine Wanke
- Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Kohli R, Winston D, Sheehan H, Muzzio E, Benetucci J, Weissenbacher M, Wanke C, Knox T, Tang A. Cholesterol Levels in HIV- and/or HCV-Infected Drug Users Living in Argentina. J Int Assoc Provid AIDS Care 2015; 15:400-5. [PMID: 26518591 DOI: 10.1177/2325957415614650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Improved understanding of cholesterol levels in HIV- and hepatitis C virus (HCV)-infected persons in Argentina will guide optimal antiretroviral therapy. The authors conducted a cross-sectional study in Argentina to describe associations between HIV, HCV, and cholesterol. Of the 202 participants, 21 were HIV infected, 15 were HCV infected, 46 were HIV/HCV coinfected, and 120 were HIV/HCV uninfected. HIV/HCV-uninfected participants had the highest total cholesterol (TC) and low-density lipoprotein (LDL) levels. Multivariate modeling revealed that HIV/HCV-coinfected patients had the lowest TC levels (-28.7 mg/dL, P < .001) compared to the HIV/HCV-uninfected reference group. Hepatitis C virus and HIV/HCV coinfection were associated with lower LDL levels (-21.4 mg/dL, P = .001 and -20.3 mg/dL, P < .0001, respectively). HIV and HIV/HCV coinfection, but not HCV alone, were associated with lower high-density lipoprotein levels (-9.1 mg/dL, P = .0008 and -6.8 mg/dL, P = .0006, respectively). Further study is needed to examine whether the more favorable lipid profile observed in HIV/HCV-coinfected persons is associated with a reduction in cardiovascular risk.
Collapse
Affiliation(s)
- Rakhi Kohli
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
| | - Diana Winston
- Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Heidi Sheehan
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Estela Muzzio
- Centro Nacional de Reeducación Social, Buenos Aires, Argentina
| | - Jorge Benetucci
- Fundación de Ayuda al Inmunodeficiente, Buenos Aires, Argentina
| | | | - Christine Wanke
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Tamsin Knox
- Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Alice Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
19
|
Krsak M, Kent DM, Terrin N, Holcroft C, Skinner SC, Wanke C. Myocardial Infarction, Stroke, and Mortality in cART-Treated HIV Patients on Statins. AIDS Patient Care STDS 2015; 29:307-13. [PMID: 25855882 DOI: 10.1089/apc.2014.0309] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Despite combination antiretroviral therapy (cART), people living with HIV (PLWH) continue to have more systemic inflammation and metabolic disturbances than the general population. These risk factors for atherosclerosis and organ dysfunction may be ameliorated by statins. We retrospectively analyzed 438 cART treated PLWH from the Nutrition For Healthy Living (NFHL) cohort to determine the association between statins and myocardial infarction (MI), stroke, and all-cause mortality as a composite. We used Cox proportional hazards regression as our main analysis. The average age was 44 years, 32% were women, and 67 of the 438 subjects used statins. There was no association between statins and our composite endpoint in two separate models [1.26 (0.57-2.79) in statin history model and 0.93 (0.65-1.32) per year in statin duration model]. The composite outcome was significantly associated with CD4 count, age, and smoking status in both models. CD4 count remained significant even after exclusion of mortality from the composite (HR=0.88, p=0.02). Confounding control via propensity scoring and multiple imputations did not change the results. Statins did not have an effect on MI, stroke, and mortality. Interestingly, CD4 count appears to be an important predictor of these outcomes, even after exclusion of death from the composite.
Collapse
Affiliation(s)
- Martin Krsak
- Tufts Medical Center and Tufts University, Boston, Massachusetts
| | - David M. Kent
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Tufts Medical Center, Boston, Massachusetts
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Norma Terrin
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | | | - Sally C. Skinner
- Tufts Medical Center and Tufts University, Boston, Massachusetts
| | - Christine Wanke
- Tufts Medical Center and Tufts University, Boston, Massachusetts
| |
Collapse
|
20
|
Volpe GE, Ward H, Mwamburi M, Dinh D, Bhalchandra S, Wanke C, Kane AV. Associations of cocaine use and HIV infection with the intestinal microbiota, microbial translocation, and inflammation. J Stud Alcohol Drugs 2014; 75:347-57. [PMID: 24650829 DOI: 10.15288/jsad.2014.75.347] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE HIV and illicit drug use have been associated with altered nutrition, immune function, and metabolism. We hypothesized that altered composition and decreased diversity of the intestinal microbiota, along with microbial translocation, contribute to nutritional compromise in HIV-infected drug users. METHOD We enrolled 26 men and 6 women, 15 HIV infected and 17 HIV uninfected, in this exploratory, cross-sectional study; 7 HIV-infected and 7 HIV-uninfected participants had used cocaine within the previous month. We examined the independent effects of cocaine use and HIV infection on the composition and diversity of the intestinal microbiota, determined by 16S rRNA gene pyrosequencing. Using dietary records, anthropometrics, and dual x-ray absorptiometry, we examined the additional effects of nutritional indices on the intestinal microbiota. We compared markers of inflammation and microbial translocation between groups. RESULTS Cocaine users had a higher relative abundance of Bacteroidetes (M ± SD = 57.0% ± 21 vs. 37.1% ± 23, p = .02) than nonusers. HIV-infected individuals had a higher relative abundance of Proteobacteria (Mdn [interquartile range] = 1.56% [0.5, 2.2] vs. 0.36% [0.2, 0.7], p = .03), higher levels of soluble CD14 and tumor necrosis factor-α, and lower levels of anti-endotoxin core antibodies than uninfected subjects. HIV-infected cocaine users had higher interferon-γ levels than all other groups. Food insecurity was higher in HIV-infected cocaine users. CONCLUSIONS We identified differences in the relative abundance of major phyla of the intestinal microbiota, as well as markers of inflammation and microbial translocation, based on cocaine use and HIV infection. Nutritional factors, including alcohol use and lean body mass, may contribute to these differences.
Collapse
Affiliation(s)
- Gretchen E Volpe
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, Tufts University School of Medicine, Boston, Massachusetts
| | - Honorine Ward
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, Tufts University School of Medicine, Boston, Massachusetts
| | - Mkaya Mwamburi
- Tufts University School of Medicine, Boston, Massachusetts
| | - Duy Dinh
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Seema Bhalchandra
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Christine Wanke
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, Tufts University School of Medicine, Boston, Massachusetts
| | - Anne V Kane
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, Tufts University School of Medicine, Boston, Massachusetts
| |
Collapse
|
21
|
Aryeetey R, Esi C, Wanke C. Food and nutrition insecurity among clients of anti‐retroviral therapy clinics in Accra, Ghana (LB451). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.lb451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Richmond Aryeetey
- Population Family and Reproductive Health University of Ghana School of Public HealthAccraGhana
| | - Colecraft Esi
- Nutrition and food scienceUniversity of GhanaAccraGhana
| | | |
Collapse
|
22
|
Jordan MR, Obeng-Aduasare Y, Sheehan H, Hong SY, Terrin N, Duong DV, Trung NV, Wanke C, Kinh NV, Tang AM. Correlates of non-adherence to antiretroviral therapy in a cohort of HIV-positive drug users receiving antiretroviral therapy in Hanoi, Vietnam. Int J STD AIDS 2013; 25:662-668. [PMID: 24352130 DOI: 10.1177/0956462413516301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/18/2013] [Indexed: 11/16/2022]
Abstract
The HIV epidemic in Vietnam is concentrated, with high prevalence estimates among injection drug users and commercial sex workers. Socio-demographics, substance use and clinical correlates of antiretroviral therapy non-adherence were studied in 100 HIV-1 infected drug users receiving antiretroviral therapy for at least 6 months in Hanoi, Vietnam. All study participants were men with a mean age of 29.9 ± 4.9 years. The median duration on antiretroviral therapy was 16.2 ± 12.7 months; 83% reported 'very good' or 'perfect' adherence in the past 30 days on a subjective one-item Likert scale at time of study enrollment; 48% of participants reported drug use within the previous 6 months, with 22% reporting current drug use. Injection drug use with or without non-injection drug use in the past 6 months (95% C.I. 2.19, 1.30-3.69) and years on antiretroviral therapy (95% C.I. 1.43, 1.14-1.78) were correlated with suboptimal adherence. These findings support Vietnam's ongoing scale-up of harm reduction programmes for injection drug users and their integration with antiretroviral therapy delivery. Moreover, results highlight the need to identify and implement new ways to support high levels of antiretroviral therapy adherence as duration on antiretroviral therapy increases.
Collapse
Affiliation(s)
- M R Jordan
- Tufts Medical Center, Boston, USA.,Tufts University School of Medicine, Boston, USA
| | | | | | - S Y Hong
- Tufts Medical Center, Boston, USA.,Tufts University School of Medicine, Boston, USA
| | - N Terrin
- Tufts University School of Medicine, Boston, USA
| | - D V Duong
- National Hospital of Tropical Diseases, Hanoi, Vietnam
| | - N V Trung
- National Hospital of Tropical Diseases, Hanoi, Vietnam
| | - C Wanke
- Tufts Medical Center, Boston, USA.,Tufts University School of Medicine, Boston, USA
| | - N V Kinh
- National Hospital of Tropical Diseases, Hanoi, Vietnam
| | - A M Tang
- Tufts Medical Center, Boston, USA
| |
Collapse
|
23
|
McMahon JH, Manoharan A, Wanke C, Mammen S, Jose H, Malini T, Kadavanu T, Jordan MR, Elliott JH, Lewin SR, Mathai D. Targets for intervention to improve virological outcomes for patients receiving free antiretroviral therapy in Tamil Nadu, India. AIDS Care 2013; 26:559-66. [PMID: 24125035 DOI: 10.1080/09540121.2013.845282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Operational research to identify factors predicting poor clinical outcomes is critical to maximize patient care and prolong first-line regimens for those receiving free antiretroviral therapy (ART) in India. We sought to identify social or clinical factors amenable to intervention that predict virological outcomes after 12 months of ART. We examined a retrospective cohort of consecutive adults initiating free nonnucleoside reverse transcriptase inhibitor-based regimens. Individuals remaining in care 12 months post-ART initiation were tested for HIV viral load and surveyed to identify barriers and facilitators to adherence, and to determine clinic travel times and associated costs. Uni- and multivariate logistic regression identified factors predicting HIV viral load >200 copies/mL after 12 months of ART. Of 230 adults initiating ART, 10% of patients died, 8% transferred out, 5% were lost to follow-up, and 174/230 (76%) completed 12 months of ART, the questionnaire, and viral load testing. HIV viral load was <200 copies/mL in 140/174 (80%) patients. In multivariate models, being busy with work or caring for others (OR 2.9, p < 0.01), having clinic transport times ≥ 3 hours (OR 3.0, p = 0.02), and alcohol use (OR 4.8, p = 0.03) predicted viral load >200 copies/mL after 12 months of ART. Clinical outcomes following ART are related to programmatic factors such as prolonged travel time and individual factors such as being busy with family or using alcohol. Simple interventions that alter these factors should be evaluated to improve clinical outcomes for populations receiving free ART in similar settings.
Collapse
Affiliation(s)
- James H McMahon
- a Infectious Diseases Unit , Alfred Hospital , Melbourne , VIC , Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Schmidt M, Wanke C, Krause U. Determination of Measurement Uncertainties in Adiabatic Hot-Storage Experiments for Reactive Dusts. Chem Eng Technol 2013. [DOI: 10.1002/ceat.201300068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
25
|
Wanke C, Ritzel S, Sachse R, Michel R. Radiological evaluation of mine water discharges from hard coal mining in the Fossa Eugeniana Area, Germany. KERNTECHNIK 2013. [DOI: 10.3139/124.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Discharges of radium-carrying mine waters from hard coal mining in the area of the Fossa Eugeniana and the Rheinberger Altrhein in Germany have caused elevated radioactivity in sediments and soils. Extensive measurements of the ambient dose rate revealed some small area contaminations as well as a larger one in a nature protection area at the Rheinberger Altrhein. For the evaluation of the potential radiation exposure investigations of the activity concentrations of river sediments, soils, and biological materials were performed. The potential exposure of members of the public was modelled on the basis of the German Guidelines for the Calculation of Radiation Exposure due to Radioactivity from Mining Activities. In the assessment the present situation as well as its possible future development was considered.
Collapse
Affiliation(s)
- C. Wanke
- Zentrum für Strahlenschutz und Radioökologie, Leibniz Universität Hannover, Herrenhäuser Str. 2, D-30419 Hannover, Germany
- Carsten Wanke (E-mail: )
| | - S. Ritzel
- Zentrum für Strahlenschutz und Radioökologie, Leibniz Universität Hannover, Herrenhäuser Str. 2, D-30419 Hannover, Germany
- present address: Landesamt für Umwelt und Geologie, Zur Wetterwarte, D-01109 Dresden
| | - R. Sachse
- Zentrum für Strahlenschutz und Radioökologie, Leibniz Universität Hannover, Herrenhäuser Str. 2, D-30419 Hannover, Germany
| | - R. Michel
- Zentrum für Strahlenschutz und Radioökologie, Leibniz Universität Hannover, Herrenhäuser Str. 2, D-30419 Hannover, Germany
| |
Collapse
|
26
|
Tang A, Hendricks K, Skinner S, Dong K, Sheehan H, Wanke C. Healthy Eating Index (HEI) in drug users living in three U.S. East Coast cities. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.1054.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alice Tang
- Public Health and Community MedicineTufts University School of MedicineBostonMA
| | | | - Sally Skinner
- Public Health and Community MedicineTufts University School of MedicineBostonMA
| | - Kimberly Dong
- Public Health and Community MedicineTufts University School of MedicineBostonMA
| | - Heidi Sheehan
- Public Health and Community MedicineTufts University School of MedicineBostonMA
| | - Christine Wanke
- Public Health and Community MedicineTufts University School of MedicineBostonMA
| |
Collapse
|
27
|
Hong SY, Hendricks KM, Wanke C, Omosa G, Patta S, Mwero B, Mjomba I, Queenan J, Mwamburi M. Development of a nutrient-dense food supplement for HIV-infected women in rural Kenya using qualitative and quantitative research methods. Public Health Nutr 2013; 16:721-9. [PMID: 22974548 PMCID: PMC3984962 DOI: 10.1017/s1368980012004156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 07/16/2012] [Accepted: 08/01/2012] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Formative research to facilitate the development, packaging and delivery of a culturally acceptable nutrition intervention for HIV-infected women in rural Kenya for an intervention trial. DESIGN Focus group discussion on three areas: (i) ingredients and form of the nutrition intervention, (ii) packaging and delivery and (iii) monitoring of adherence. Two single-blind taste tests with eleven different porridge formulations of various combinations of maize flour, soyabeans, peanuts, sorghum, mung beans, dried fish, raisins and dried whole milk. Follow-up acceptability focus group discussion was also conducted. SETTING Voi, Kenya, community based. SUBJECTS Focus group discussion and two taste tests (twenty-one women aged 16-55 years). Follow-up acceptability focus group discussion (four women enrolled in intervention trial). RESULTS The preferred porridge for taste consisted of maize, soyabeans and peanuts. For animal protein, dried whole milk and dried fish were used. Although the women disliked the taste of dried fish, it was acceptable if added in small undetectable quantities. Sugar over lime was favoured for taste. Women believed they could consume at least two cups of porridge per day without displacing their usual meals. The optimal delivery interval was believed to be every two weeks in individual serving packages. Women who had been consuming porridge for several weeks felt the taste was acceptable for long-term consumption. CONCLUSIONS This formative research resulted in the development, packaging and delivery of a nutrient-dense food supplement using local ingredients to meet the dietary needs of the population and acceptable for daily consumption by women in Kenya for evaluation in an intervention trial.
Collapse
Affiliation(s)
- Steven Y Hong
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Volpe G, Sheehan H, Tang A, Duffalo C, Dinh D, Landy D, Ward H, Kane A, Wanke C. The Healthy Eating Index and the Intestinal Microbiome in HIV Infection. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.1056.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gretchen Volpe
- Public Health and Community MedicineTufts UniversityBostonMA
- Tufts Medical CenterBostonMA
| | - Heidi Sheehan
- Public Health and Community MedicineTufts UniversityBostonMA
| | - Alice Tang
- Public Health and Community MedicineTufts UniversityBostonMA
| | | | | | | | - Honorine Ward
- Public Health and Community MedicineTufts UniversityBostonMA
- Tufts Medical CenterBostonMA
| | - Anne Kane
- Public Health and Community MedicineTufts UniversityBostonMA
- Tufts Medical CenterBostonMA
| | - Christine Wanke
- Public Health and Community MedicineTufts UniversityBostonMA
- Tufts Medical CenterBostonMA
| |
Collapse
|
29
|
Hong SY, Jerger L, Jonas A, Badi A, Cohen S, Nachega JB, Parienti JJ, Tang AM, Wanke C, Terrin N, Pereko D, Blom A, Trotter AB, Jordan MR. Medication possession ratio associated with short-term virologic response in individuals initiating antiretroviral therapy in Namibia. PLoS One 2013; 8:e56307. [PMID: 23509605 PMCID: PMC3585291 DOI: 10.1371/journal.pone.0056307] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 01/09/2013] [Indexed: 11/18/2022] Open
Abstract
The visual-analogue scale (VAS), Likert item (rating scale), pills identification test (PIT), and medication possession ratio (MPR) provide estimates of antiretroviral therapy (ART) adherence which correlate with HIV viral suppression. These simple adherence measures are inexpensive and easy to administer; however, require validation and adjustment prior to implementation. The objective of this study was to define the optimal adherence assessment measure in Namibia to identify patients at risk for sub-optimal adherence and poor virologic response 6 months after ART initiation. We conducted a cross-sectional survey in HIV-infected adults receiving ART for 6-12 months prior to the adherence assessment. Adherence measures included 30-day VAS, 30-day Likert item, self-reported treatment interruptions, PIT, and MPR. Association of adherence measures with 6-month HIV-1 RNA level was assessed using two thresholds (1000 copies/mL and 5000 copies/mL). Adherence was assessed in 236 patients, mean age 37.3 years, 54% female. Mean adherence was 98.1% by 30-day VAS, 84.7% by 30-day Likert item, 97.0% by self-reported treatment interruptions, 90.6% by PIT, and 98.8% by MPR. Agreement between adherence measures was poor using kappa statistic. 76% had HIV-1 RNA <1000 copies/ml, and 88% had HIV-1 RNA <5000 copies/ml. MPR (continuous) was associated with viral suppression <5000 copies/ml (p = 0.036). MPR <75% was associated with virologic failure at ≥5000 copies/ml with OR 3.89 (1.24, 12.21), p = 0.013. Adherence was high with all measures. Only MPR, was associated with short-term virologic response, suggesting its cross-culturally utility for early identification of patients at high risk for virologic failure.
Collapse
Affiliation(s)
- Steven Y. Hong
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- * E-mail:
| | - Logan Jerger
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Anna Jonas
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Alfons Badi
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Steven Cohen
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Jean B. Nachega
- Center for Global Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Centre for Infectious Diseases, Stellenbosch University Faculty of Health Sciences, Cape Town, South Africa
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, University Hospital Center, Caen, France
| | - Alice M. Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Christine Wanke
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Norma Terrin
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Dawn Pereko
- Strengthening Health Outcomes through the Private Sector, Abt Associates Incorporated, Windhoek, Namibia
| | - Abraham Blom
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Andrew B. Trotter
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Michael R. Jordan
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| |
Collapse
|
30
|
Jordan MR, Winsett J, Tiro A, Bau V, Berbara RS, Rowley C, Bellosillo N, Wanke C, Coakley EP. HIV Drug Resistance Profiles and Clinical Outcomes in Patients with Viremia Maintained at Very Low Levels. ACTA ACUST UNITED AC 2013; 3:71-78. [PMID: 25664219 DOI: 10.4236/wja.2013.32010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We describe an observational study of clinical, virologic and drug resistance profiles in HIV-positive antiretroviral adherent subjects with stable low level viremia (LLV) 50-1,000 copies/mL for more than 12 months. Subjects were followed from time of first detectable viral load (VL). In total, 102 episodes of LLV were detected among 80 individuals. The median (mean, range) HIV copy number at genotyping was 250 (486, <50-3900) copies/mL after 14 (17.9, 0-58) months of LLV. Few patients maintained LLV for the entire 9 year period of observation, with half (52%) experiencing viremic progression following a stable period of LLV either spontaneously or after treatment interruption or failed regimen intensification. In the setting of prolonged periods of sustained LLV, mean duration 22 (range 8 - 106) months, drug resistance (DR) was almost universal. Resistance to ≥1 on-treatment drugs was defined in 97% of specimens and DR to all drugs in the treatment regimen in over half of all patients. Evolution of DR mutations during the period of LLV was observed in 20/28 (71%) subjects with specimens available for follow-up testing. This evolution was associated with viremic progression to levels >1000 copies/mL (p=0.03). Our data suggest that DR present in patients with LLV is likely to impact long term clinical outcomes, highlighting the importance of optimizing techniques to detect the presence of drug resistant HIV in the setting of LLV and the need for larger prospective studies to assess the emergence of DR in the setting of sustained LLV and the impact of this DR on treatment outcomes.
Collapse
Affiliation(s)
| | | | | | - Vuth Bau
- Tufts University School of Medicine, Boston, MA, USA
| | - Rony S Berbara
- University of Massachusetts School of Medicine, Worcester, MA, USA
| | | | | | | | | |
Collapse
|
31
|
Hong SY, Thompson D, Wanke C, Omosa G, Jordan MR, Tang AM, Patta S, Mwero B, Mjomba I, Mwamburi M. Knowledge of HIV Transmission and Associated Factors among HIV-Positive and HIV-Negative Patients in Rural Kenya. ACTA ACUST UNITED AC 2012; 3. [PMID: 23495369 DOI: 10.4172/2155-6113.1000170] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Knowledge of HIV transmission is a prerequisite to practicing safer behaviors to prevent HIV infections and may be expected to vary by region because of cultural and socioeconomic determinants. A cross-sectional study was conducted in rural Kenya using a standardized questionnaire assessing HIV transmission knowledge, socio-demographic and other characteristics. Participants were recruited from the voluntary counseling and testing clinic and the general hospital population of Moi District Hospital. "High" HIV transmission knowledge scorers (≥ 81%) (Mean score) were compared with "low" scorers (<81%). Bivariate and multivariate logistic regression analyses were performed to examine factors associated with HIV transmission knowledge. Of 214 participants, 70 (33%) were HIV-positive, 104 (49%) were HIV-negative, and 40 (19%) did not know. Factors associated with low knowledge in multivariate analyses were lower education (OR 2.36, CI 1.03-5.46), lower household money on healthcare (OR 2.03, CI 1.28-3.21), higher clinic transportation costs (OR 3.14, CI 1.20-9.82), sex without a condom (OR 2.18, CI 1.12-4.26), positive HIV status vs. negative (OR 2.50, CI 1.22-5.26) and positive HIV status vs. unknown (OR 3.57, CI 1.33-9.09). Mean HIV transmission knowledge score was relatively high; however, a large proportion of patients demonstrated low knowledge. Identifying individuals at risk for low knowledge will support targeted HIV education and prevention programs.
Collapse
Affiliation(s)
- Steven Y Hong
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, USA ; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Bé MM, Cassette P, Lépy M, Amiot MN, Kossert K, Nähle O, Ott O, Wanke C, Dryak P, Ratel G, Sahagia M, Luca A, Antohe A, Johansson L, Keightley J, Pearce A. Standardization, decay data measurements and evaluation of 64Cu. Appl Radiat Isot 2012; 70:1894-9. [DOI: 10.1016/j.apradiso.2012.02.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 02/17/2012] [Indexed: 11/24/2022]
|
33
|
Jensen JM, Scherer A, Wanke C, Bräutigam M, Bongiovanni S, Letzkus M, Staedtler F, Kehren J, Zuehlsdorf M, Schwarz T, Weichenthal M, Fölster-Holst R, Proksch E. Gene expression is differently affected by pimecrolimus and betamethasone in lesional skin of atopic dermatitis. Allergy 2012; 67:413-23. [PMID: 22142306 DOI: 10.1111/j.1398-9995.2011.02747.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Topical corticosteroids and calcineurin inhibitors are well-known treatments of atopic dermatitis (AD) but differ in their efficacy and side effects. We recently showed that betamethasone valerate (BM) although clinically more efficient impaired skin barrier repair in contrast to pimecrolimus in AD. OBJECTIVE This study elucidates the mode of action of topical BM and pimecrolimus cream in AD. METHODS Lesional AD skin samples after topical treatment with either BM or pimecrolimus were subjected to gene expression profile analysis. RESULTS Betamethasone valerate resulted in a significant reduction in mRNA levels of genes encoding markers of immune cells and inflammation, dendritic cells, T cells, cytokines, chemokines, and serine proteases, whereas pimecrolimus exerted minor effects only. This corroborates the clinical finding that BM reduces inflammation more effectively than pimecrolimus. Genes encoding molecules important for skin barrier function were differently affected. Both BM and pimecrolimus normalized the expression of filaggrin and loricrin. BM, but not pimecrolimus, significantly reduced the expression of rate-limiting enzymes for lipid synthesis and the expression of involucrin and small proline-rich proteins, which covalently bind ceramides. This may explain the lack of restoration of functional stratum corneum layers observed after BM treatment. CONCLUSION The gene expression profiles are consistent with our previous findings that corticosteroids may exert a more potent anti-inflammatory effect but may impair the restoration of the skin barrier. Corticosteroids are still the main treatment for severe and acutely exacerbated AD; pimecrolimus may be preferable for long-term treatment and stabilization.
Collapse
Affiliation(s)
- J M Jensen
- Department of Dermatology, University of Kiel, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Rogers B, Webb P, Wanke C, Sadler K, Masterson AR, Bagriansky J, Schlossman N, Narayan A, Tilahun J. Selection and use of US Title II food aid products in programming contexts. Food Nutr Bull 2011; 32:S152-65. [PMID: 22180981 DOI: 10.1177/15648265110323s303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Food aid provided by the United States has saved lives for almost two centuries. Delivering the right products is important, but of equal concern are the ways in which products are delivered and to whom. OBJECTIVE The study addresses how food products are currently used, whether interventions are appropriate to achieve nutrition objectives, and whether nutrition targets could be met more cost-effectively with a different mix of products or programs. METHODS The team conducted consultations with a broad range of stakeholders. A survey of Title II implementing partners was conducted, focusing on procurement and logistics, and uses of FBFs and other foods. Input of implementing partners, civil society, and donor organizations was obtained through individual consultations, international and small group meetings. More than 400 individuals accessed the project's website. The project convened a panel of experts in food technology and science, food policy, law, industry, medicine, development and humanitarian work, and the maritime industry, and held regular joint meetings with USDA and USAID. The draft report was widely disseminated and posted on the website. RESULTS AND CONCLUSIONS There is wide variation in the quantities of fortified blended foods provided to target populations. Most of these foods are used in health/nutrition programs, but they are also used in general family rations or as an incentive or pay. Clearer programming guidance and improved decision tools are needed to match products to nutrition goals, and programs should consider delivering nutrients across a basket of commodities, not single products. The evidence base for the effectiveness and cost-effectiveness of specific foods and programs needs to be strengthened and should be supported by FFP Research is needed to provide guidance on nutrition support for HIV/AIDS. Additional investments are needed in effective behavior change communication.
Collapse
Affiliation(s)
- Beatrice Rogers
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA 02111, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Raiten DJ, Mulligan K, Papathakis P, Wanke C. Executive summary--nutritional care of HIV-infected adolescents and adults, including pregnant and lactating women: what do we know, what can we do, and where do we go from here? Am J Clin Nutr 2011; 94:1667S-1676S. [PMID: 22089438 PMCID: PMC3226019 DOI: 10.3945/ajcn.111.019711] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The HIV pandemic continues to place an unbearable burden on the international community, with disease prevalence remaining highest in resource-limited settings in Africa, Asia, and the Americas. HIV is most often imposed on conditions of food insecurity and consequent malnutrition, poor sanitation, and chronic exposure to a myriad of infectious (eg, malaria, tuberculosis, and diarrheal) and noncommunicable (eg, obesity, diabetes, cancer, and cardiovascular) diseases. Women and children continue to bear the greatest burden. Two essential tenets underpin our approach to HIV: 1) antiretroviral drugs (ARVs) are essential to prolong lives and to halt the spread of HIV and AIDS and 2) food and sound nutrition are essential to human health. The challenge is to apply sound principles of clinical care and nutrition science to the safe and efficacious implementation of ARVs and for long-term care for people living with HIV and AIDS. The WHO has played a leading role in developing guidelines to support this goal with the generation of general recommendations regarding nutritional needs of people living with HIV and AIDS and specific guidelines for the nutritional care of HIV-infected infants and children (<14 y of age). These proceedings represent a summary of the work accomplished at a workshop sponsored by the NIH to review the existing evidence to support changes in the recommendations regarding nutrient requirements for people living with HIV and AIDS; to support development of new WHO guidelines for adolescents and adults, including for pregnant and lactating women; and to identify a research agenda to address outstanding knowledge gaps.
Collapse
Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
| | | | | | | |
Collapse
|
36
|
Abstract
RATIONALE, AIMS AND OBJECTIVES American College of Physicians (ACP) published guidelines for the diagnosis and treatment of acute pharyngitis in adults in 2001. The objective of this study is to characterize antibiotic prescribing patterns in the USA for acute pharyngitis and evaluate concordance with the 2001 ACP pharyngitis treatment guidelines. METHODS Patients aged ≥18 years identified with acute pharyngitis via diagnosis codes (ICD-9 CM) were identified from data collected annually (1996-2006) by the National Center for Health Statistics and Centers for Disease Control and Prevention from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Total US office visits for acute pharyngitis were estimated. Logistic regression was performed to determine whether antibiotic prescribing was associated with the publishing of the ACP guidelines. RESULTS A total of 3791 office visits met study criteria. We extrapolated 78.0 million visits for acute pharyngitis from 1996 to 2006. Antibiotics were prescribed in 62.6% of cases and 7.5% of cases received ACP-recommended antibiotics. There was a significant decrease in the rate of antibiotic prescriptions from 66.5% to 59.1% after publication of ACP guidelines. Univariate analysis showed that antibiotic prescribing decreased by 27% (OR = 0.73, 95% CI 0.55-0.95, P = 0.021). Multivariate analyses confirmed this finding (OR = 0.72, 95% CI 0.56-0.94, P = 0.014). The prescribing of ACP-recommended antibiotics did not significantly change (8.5% to 6.6%, P = 0.519). CONCLUSIONS Publishing of ACP guidelines for the diagnosis and treatment of pharyngitis was associated with a decrease in the overall prescribing of antibiotics but not the prescribing of ACP-recommended antibiotics.
Collapse
Affiliation(s)
- Steven Y Hong
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA 02111, USA.
| | | | | | | |
Collapse
|
37
|
Padmapriyadarsini C, Ramesh Kumar S, Terrin N, Narendran G, Menon PA, Ramachandran G, Subramanyan S, Venkatesan P, Wanke C, Swaminathan S. Dyslipidemia among HIV-infected Patients with tuberculosis taking once-daily nonnucleoside reverse-transcriptase inhibitor-based antiretroviral therapy in India. Clin Infect Dis 2011; 52:540-6. [PMID: 21252141 PMCID: PMC3060904 DOI: 10.1093/cid/ciq195] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Our aim was to study the incidence and pattern of dyslipidemia among human immunodeficiency virus (HIV)-infected patients with tuberculosis (TB) who received once-daily antiretroviral therapy (ART). METHODS Antiretroviral-naive HIV-infected patients with TB were recruited to a trial of once-daily nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based ART and treated with rifampicin-based thrice-weekly antituberculosis treatment (ATT); participants were randomized to receive didanosine (250/400 mg) and lamivudine (300 mg) with either efavirenz (600 mg) or nevirapine (400 mg) once-daily after an intensive phase of ATT. Fasting triglyceride (TG) level, total cholesterol (TC) level, low-density cholesterol (LDL-c) level and high-density cholesterol (HDL-c) level were measured at baseline and at 6 and 12 months. Lipid levels at 6 and 12 months were compared with baseline values with use of repeated measures analyses. McNemar test was used to compare the proportion of patients with lipid abnormality at baseline versus at 12 months, and χ² test was used to compare between the 2 groups. RESULTS Of 168 patients (79% men; mean age, 36 years; mean weight, 42 kg; median CD4+ cell count, 93 cells/mm³), 104 received efavirenz-based ART, and 64 received nevirapine-based ART. After 6 months, TC levels increased by 49 mg/dL, LDL-c levels by 30 mg/dL, and HDL-c levels increased by 18 mg/dL (P < .001 for all). At baseline and at 12 months, TC was >200 mg/dL for 1% and 26% of patients, respectively; LDL-c level was >130 mg/dL for 3% and 23%, respectively; HDL-c level was <40 mg/dL for 91% and 23%, respectively; and blood glucose level was >110 mg/dL for 14% and 13%, respectively. TC level >200 mg/dL was more common among patients who received efavirenz than among those who received nevirapine (32% vs 16%; P = .04). CONCLUSIONS HIV-infected patients with TB who initiate NNRTI-based ART undergo complex changes in lipid profile, highlighting the importance of screening and treating other cardiovascular disease risk factors in this population.
Collapse
|
38
|
Asztalos BF, Mujawar Z, Morrow MP, Grant A, Pushkarsky T, Wanke C, Shannon R, Geyer M, Kirchhoff F, Sviridov D, Fitzgerald ML, Bukrinsky M, Mansfield KG. Circulating Nef induces dyslipidemia in simian immunodeficiency virus-infected macaques by suppressing cholesterol efflux. J Infect Dis 2010; 202:614-23. [PMID: 20617930 DOI: 10.1086/654817] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection and subsequent antiretroviral therapy have been associated with an increased incidence of dyslipidemia and cardiovascular disease and has been shown to suppress cholesterol efflux from virus-infected macrophages by inducing Nef-dependent down-regulation of adenosine triphosphate-binding cassette transporter A1 (ABCA1). Here, the simian immunodeficiency virus (SIV)-infected macaque model was used to examine the consequences and mechanisms involved. SIV infection drove a significant remodeling of high-density lipoprotein profiles, suggesting that systemic inhibition of the ABCA1-dependent reverse cholesterol transport pathway occurred. The ABCA1 cholesterol transporter was significantly down-regulated in the livers of the SIV-infected macaques, and the viral protein Nef could be detected in the livers as well as in the plasma of infected animals. Extracellular myristoylated HIV Nef inhibited cholesterol efflux from macrophages and hepatocytes. Moreover, serum samples from SIV-infected macaques also suppressed cholesterol efflux in a Nef-dependent fashion. These results indicate that SIV infection is a significant contributor to primary dyslipidemia, likely through the ability of Nef to suppress ABCA1-dependent reverse cholesterol transport.
Collapse
Affiliation(s)
- Bela F Asztalos
- Lipid Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Firth J, Jeyaseelan L, Christina S, Vonbara V, Jeyaseelan V, Elan S, Abraham S, Joseph I, David S, Cu-Uvin S, Lurie M, Wanke C, Lionel J. HIV-1 seroprevalence and awareness of mother-to-child transmission issues among women seeking antenatal care in Tamil Nadu, India. ACTA ACUST UNITED AC 2010; 9:206-13. [PMID: 20530464 DOI: 10.1177/1545109710371132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite increasing availability of HIV-1 testing, education, and methods to prevent transmission, Indian women and their children remain at risk of acquiring HIV. We assessed the seroprevalence and awareness about HIV among pregnant women presenting to a private tertiary care hospital in South India. METHODS Seroprevalence was determined via enzyme-linked immunosorbent assay (ELISA) testing, and questionnaires were analyzed using chi-square statistics and odds ratios to look for factors associated with HIV positivity. RESULTS A total of 7956 women who presented for antenatal care were interviewed. Fifty-one women of the 7235 women who underwent HIV testing (0.7%) were found to be HIV positive. Awareness of mother-to-child transmission (MTCT) of HIV (64%), HIV transmission through breast milk (42%), and prevention of MTCT (13%) was low. CONCLUSIONS There is a need to educate South Indian women about HIV to give them information and the means to protect themselves and their unborn children from acquiring HIV.
Collapse
Affiliation(s)
- Jacqueline Firth
- Department of Medicine, Warren Alpert Medical School at Brown University, Providence, RI, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Jordan MR, Kearney M, Palmer S, Shao W, Maldarelli F, Coakley EP, Chappey C, Wanke C, Coffin JM. Comparison of standard PCR/cloning to single genome sequencing for analysis of HIV-1 populations. J Virol Methods 2010; 168:114-20. [PMID: 20451557 DOI: 10.1016/j.jviromet.2010.04.030] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 04/27/2010] [Accepted: 04/29/2010] [Indexed: 11/17/2022]
Abstract
To compare standard PCR/cloning and single genome sequencing (SGS) in their ability to reflect actual intra-patient polymorphism of HIV-1 populations, a total of 530 HIV-1 pro-pol sequences obtained by both sequencing techniques from a set of 17 ART naïve patient specimens was analyzed. For each specimen, 12 and 15 sequences, on average, were characterized by the two techniques. Using phylogenetic analysis, tests for panmixia and entropy, and Bland-Altman plots, no difference in population structure or genetic diversity was shown in 14 of the 17 subjects. Evidence of sampling bias by the presence of subsets of identical sequences was found by either method. Overall, the study shows that neither method was more biased than the other, and providing that an adequate number of PCR templates is analyzed, and that the bulk sequencing captures the diversity of the viral population, either method is likely to provide a similar measure of population diversity.
Collapse
Affiliation(s)
- Michael R Jordan
- Tufts University School of Medicine, Tufts Medical Center, Boston, MA 02111, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Tang AM, Forrester JE, Spiegelman D, Flanigan T, Dobs A, Skinner S, Wanke C. Heavy injection drug use is associated with lower percent body fat in a multi-ethnic cohort of HIV-positive and HIV-negative drug users from three U.S. cities. Am J Drug Alcohol Abuse 2010; 36:78-86. [PMID: 20141402 DOI: 10.3109/00952990903544851] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The clinical implications of lower body weight in drug using populations are uncertain given that lower mean weights may still fall within the healthy range. OBJECTIVES To determine the effect of type, mode and frequency of drug use on underlying body composition after accounting for differences in body shape and size. METHODS We conducted a cross-sectional analysis of 511 participants from the Tufts Nutrition Collaborative (TNC) Study. Data included measures of body composition, a 24-hour dietary recall, and a detailed health history and lifestyle questionnaire. Multivariate regression analysis was used to determine the independent effect of drug use on percent body fat (BF) after adjusting for BMI and waist circumference. RESULTS Heavy injection drug users (IDUs) had a 2.6% lower percent BF than non-users after adjusting for BMI, waist circumference, and other confounders. (p = 0.0006). Differences in percent BF were predominantly due to higher lean mass, rather than lower fat mass. Cocaine and heroin had similar effects on body composition. CONCLUSIONS In the U.S., where the general population is prone to over-nutrition, the average percent BF for heavy injectors does not fall into a range low enough to suggest harmful effects. However, in populations with substantial levels of under-nutrition, small differences in percent BF among drug users will have a greater impact on health status. SCIENTIFIC SIGNIFICANCE Differences in BMI, weight and body composition are not always straightforward. Accounting for underlying nutritional status and relative differences in fat and FFM is critical when interpreting results. diagnosed patients and prevent them from returning to prison.
Collapse
Affiliation(s)
- Alice M Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
| | | | | | | | | | | | | |
Collapse
|
42
|
Jordan MR, La H, Nguyen HD, Sheehan H, Lien TTM, Duong DV, Hellinger J, Wanke C, Tang AM. Correlates of HIV-1 viral suppression in a cohort of HIV-positive drug users receiving antiretroviral therapy in Hanoi, Vietnam. Int J STD AIDS 2009; 20:418-22. [PMID: 19451329 DOI: 10.1258/ijsa.2008.008389] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Injection drug users bear the burden of HIV in Vietnam and are a focus of national treatment programmes. To date, determinants of successful therapy in this population are unknown. Substance use and clinical correlates of viral suppression were studied in 100 HIV-1-infected drug users receiving antiretroviral therapy (ART) for at least six months in Hanoi, Vietnam. The mean age of the cohort was 29.9 + 4.9 years; all were men. A majority of patients (73%) achieved viral suppression (HIV-RNA <1000 copies/mL). Correlates of viral suppression include self-reported > or = 95% adherence (P < 0.01) and current use of trimethoprim/sulphamethoxazole (P < 0.01); current or ever diagnosed with tuberculosis was associated with viral non-suppression (P = 0.006). Tobacco use was prevalent (84%), and surprisingly 48% of patients reported active drug use; neither was associated with viral non-suppression. This is the first study to document successful ART treatment in a population of Vietnamese drug users; rates of viral suppression are comparable to other international populations. The 28% of patients without HIV-1 suppression highlight the need for adherence promotion, risk reduction programmes, and population-based surveillance strategies for assessing the emergence of HIV drug resistance in settings where access to viral load and drug resistance testing is limited.
Collapse
Affiliation(s)
- M R Jordan
- Tufts Medical Center, Division of Geographic Medicine and Infectious Disease, Boston, MA 02111, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Castaneda-Sceppa C, Bermudez OI, Wanke C, Forrester JE. Predictors of insulin resistance among Hispanic adults infected with or at risk of infection with the human immunodeficiency virus and hepatitis C virus. J Viral Hepat 2008; 15:878-87. [PMID: 19087226 PMCID: PMC2784594 DOI: 10.1111/j.1365-2893.2008.01021.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Both the human immunodeficiency (HIV) and hepatitis C (HCV) viruses have been associated with insulin resistance (IR). However, our understanding of the prevalence of IR, the underlying mechanisms and predisposing factors is limited, particularly among minority populations. We conducted a study of 333 Hispanic adults including: 76 HIV monoinfected, 62 HCV monoinfected, 97 HIV/HCV co-infected and 98 uninfected controls with a specific focus on HCV infection and liver injury as possible predictors of IR. IR was measured using the Quantitative Insulin Sensitivity Check Index (QUICKI). The majority (55-69%) of participants in all groups had QUICKI values <0.350. Body mass index was associated with IR in all groups. Triglycerides were associated with IR in the uninfected control group only (-1.83, SE = 0.58, P = 0.0022). HCV was associated with IR in participants infected with HIV (-0.012, SE = 0.0046, P = 0.010). Liver injury, as measured by score to assess liver injury (FIB-4) score, was significantly associated with IR independently of HCV infection (-0.0035, SE = 0.0016, P = 0.027). In the HIV/HCV co-infected group, treatment with nucleoside reverse-transcriptase (RT) inhibitors plus non-nucleoside RT inhibitors (-0.021, SE = 0.080, P = 0.048), but not protease inhibitors (-0.000042, SE = 0.0082, P = 0.96) was associated with IR. HCV infection and antiretroviral agents, including nucleoside RT inhibitor plus non-nucleoside RT inhibitor treatment are contributors to IR in HIV infection. Liver injury, as measured by the FIB-4 score, is a predictor of IR independently of HCV infection.
Collapse
Affiliation(s)
- Carmen Castaneda-Sceppa
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- Bouve College of Health Sciences, Northeastern University, Boston, MA
| | - Odilia I. Bermudez
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA
| | - Christine Wanke
- Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA
| | - Janet E. Forrester
- Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA
| |
Collapse
|
44
|
Wanke C. Editorial Commentary:The Effect of Reducing the Dose of Stavudine on Body Composition, Bone Density, and Markers of Mitochondrial Toxicity in HIV‐Infected Subjects: Answers and Questions. Clin Infect Dis 2008; 46:1297-8. [DOI: 10.1086/529383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
45
|
Abstract
OBJECTIVE We conducted a randomized placebo-controlled trial to examine the effects of metformin on visceral adipose tissue (VAT), appendicular fat, lipid profile and insulin sensitivity in HIV-infected persons with central adiposity and mild insulin resistance. METHODS Forty-eight HIV-infected men and women with a self-reported increase in abdominal girth and an abnormal waist-to-hip ratio were randomly assigned in double-blind fashion to receive metformin 1500 mg or placebo daily for 24 weeks. Persons with diabetes were excluded. The following measures were obtained at baseline and 24 weeks: single-slice computed tomography (CT) scan, dual-energy X-ray absorptiometry (DEXA), lipid profile and oral glucose tolerance test. RESULTS The median fasting insulin concentration of all participants was 12.3 microU/mL. The percentage change in VAT was not significantly different between the metformin and placebo groups in univariate analysis and linear regression analysis adjusting for age, height, baseline VAT and insulin area under the curve (10.1% vs 3.2%; P=0.58). Metformin was associated with a significant decrease in appendicular fat mass compared with placebo (-686.0 vs 161.0 g; P=0.03). There was no significant change in lipid profile or insulin sensitivity between the two groups at 24 weeks. CONCLUSION Metformin should be used with caution in the treatment of HIV lipodystrophy, and, if used, should be reserved for persons with adequate peripheral fat and marked insulin resistance.
Collapse
Affiliation(s)
- R Kohli
- Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA 02111, USA.
| | | | | | | |
Collapse
|
46
|
Isaac R, Jacobson D, Wanke C, Hendricks K, Knox TA, Wilson IB. Declines in dietary macronutrient intake in persons with HIV infection who develop depression. Public Health Nutr 2008; 11:124-31. [PMID: 17582240 DOI: 10.1017/s1368980007000067] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundThe effect of depression on dietary intake has not, to our knowledge, been examined in persons with HIV infection.MethodsWe conducted a longitudinal analysis of participants in the Nutrition for Healthy Living Study (NFHL). We measured changes in dietary macronutrient intake in participants who developed depression and, using multiple regression analysis, compared the changes with a control group of patients who did not become depressed.ResultsNinety patients developed depression during the observation period, and we compared these with 152 non-depressed controls. The two groups had similar age and body mass index (BMI) at baseline, but those who developed depression were more likely to be female, less educated and had lower incomes. After adjustment, compared with non-depressed participants, those who developed depression had significantly greater decreases in the following daily intakes: total energy (−341 kcal, P = 0.006), protein (−12.3 g, P = 0.02), total fat (−18.5 g, P = 0.008), carbohydrate (−36.8 g, P = 0.02), total fibre (−4.3 g, P = 0.001) and saturated fat (−6.7 g, P = 0.01). There were no significant differences in the daily intakes of simple sugars and long-chain n−3 fatty acids, or BMI.ConclusionDepression is associated with decreases in total daily energy intake and in six of the eight dietary components we measured. Clinicians should be aware that depression-associated nutritional deficiencies may complicate the care of persons with HIV.
Collapse
Affiliation(s)
- Rita Isaac
- 1Nutrition/Infection Unit, Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA, USA
| | | | | | | | | | | |
Collapse
|
47
|
Saghayam S, Kumarasamy N, Sundaram M, Solomon S, Shivaji G, Mayer K, Wanke C. Metabolic syndrome among patients initiating HAART and outcome in Southern India. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
48
|
Wachtman L, Gualtieri L, Wanke C, Shannon R, Mansfield K. Viral and host correlates of serum resistin in simian AIDS. AIDS Res Hum Retroviruses 2008; 24:34-42. [PMID: 18275346 DOI: 10.1089/aid.2007.0154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Resistin is an adipocytokine with a proposed dual role in metabolism and inflammation. In light of the ability to promote inflammatory responses, adipocytokines may prove key factors in modulating the host response to HIV. This study utilizes the simian immunodeficiency virus (SIV) model of HIV/AIDS to investigate changes in serum resistin levels following dietary intervention and SIV infection and determine associations with measures of body composition and disease severity. Resistin levels, body composition (n = 34), and insulin resistance (n = 16) were determined in healthy rhesus macaques. A subset of animals (n = 8) was placed on an atherogenic diet (AD) and subsequently inoculated with SIVmac239. Longitudinal measures of serum resistin, cytokines, viral load, lymphocyte subsets, and body composition were obtained. In healthy macaques consuming a standard diet, resistin levels correlated positively with total fat mass (r = 0.49; p < 0.01) and tissue fat percent (r = 0.53; p < 0.01) but failed to associate with measures of insulin resistance. In contrast, a negative correlation was noted between these measures of adiposity and resistin following SIV inoculation (r = -0.27; p < 0.05 and r = -0.24; p < 0.05, respectively). Viral load correlated positively with serum resistin (r = 0.32; p < 0.01). Serum levels of MCP-1 and sTNF RII demonstrated no correlation with resistin in normal animals on a standard diet, while a significant positive correlation was observed following SIV infection (r = 0.52; p < 0.0001 and r = 0.59; p < 0.0001, respectively). Findings indicate a fundamental difference in the relationship between resistin and body composition following SIV infection and suggest that elevations in resistin parallel measures of disease severity including loss of body fat and viral replication.
Collapse
Affiliation(s)
- L.M. Wachtman
- Harvard Medical School, New England Regional Primate Research Center, Southborough, Massachusetts 01772
| | - L. Gualtieri
- Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts 02111
| | - C. Wanke
- Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, Massachusetts 02111
| | - R. Shannon
- University of Massachusetts School of Medicine, Worcester, Massachusetts 01605
| | - K.G. Mansfield
- Harvard Medical School, New England Regional Primate Research Center, Southborough, Massachusetts 01772
| |
Collapse
|
49
|
Rao Ajjampur SS, Asirvatham JR, Muthusamy D, Gladstone BP, Abraham OCM, Mathai D, Ward H, Wanke C, Kang G. Clinical features & risk factors associated with cryptosporidiosis in HIV infected adults in India. Indian J Med Res 2007; 126:553-557. [PMID: 18219083 PMCID: PMC2673507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND & OBJECTIVE Cryptosporidiosis is a leading cause of protracted, life threatening diarrhoea in HIV infected patients. Although data on prevalence are available for Indian patients, no information on risk factors for transmission exists. We therefore undertook this study to identify risk factors for transmission of cryptosporidiosis in HIV infected adults. METHODS Both symptomatic (diarrhoeal) and asymptomatic HIV infected patients were screened for cryptosporidiosis. All Cryptosporidium spp. positive cases were enrolled in the study and interviewed to record socio-demographic information, water supply and animal contact. Data were analysed to study clinical features and potential association with species and genotype. RESULTS Of the 28 cryptosporidial infections identified on screening 111 HIV positive patients with diarrhoea, 10 (35.7%) had chronic diarrhoea, 14 (50%) had associated fever and 8 (28.6%) had nausea. Symptomatic patients had a significantly higher number of co-infections with other enteric parasites (P=0.04) than 20 asymptomatics of 423 HIV positive individuals screened. Eleven of 17 (64%) patients with potentially zoonotic infections had diarrhoea. Patients with zoonotic species (64%) also tended to have fever more frequently than those infected with C. hominis (58%). Association between area of residence, rural or urban, water source and contact with animals and acquisition of cryptosporidiosis was not statistically significant. INTERPRETATION & CONCLUSION Cryptosporidiosis is an important cause of morbidity in HIV infected individuals in India, resulting in chronic diarrhoea. Risk factors for potentially zoonotic transmission of cryptosporidiosis were described in this study, but larger studies need to be done for a clearer understanding of the transmission dynamics of different cryptosporidial species in developing countries.
Collapse
Affiliation(s)
- S S Rao Ajjampur
- Department of Gastrointestinal Sciences, Christian Medical College Vellore,India
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Sansevero MR, Houser R, Phelan G, Wanke C, Tang A, Hendricks K. Nonvitamin, nonmineral dietary supplementation in HIV-positive people. Nutr Clin Pract 2007; 22:679-87. [PMID: 18042957 DOI: 10.1177/0115426507022006679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many consumers with chronic diseases attempt to take control of their health by using dietary supplements. The objective of this study was to describe current nonvitamin, nonmineral (NVNM) supplement use of HIV-infected persons in the Nutrition for Healthy Living (NFHL) cohort, the financial burden that buying these supplements might pose to this population, and to review current literature on potential interactions between NVNM supplements. METHODS At baseline visit, participants were educated by a registered dietitian on keeping a complete 3-day food record (including all supplements) for 2 weekdays and 1 weekend day. Seventy-two subjects reported consumption of NVNM supplements, and their food records were reviewed in detail. RESULTS Each of the 72 subjects in this study used a mean of 6 NVNM supplements, which may have been in the form of a pill, powder, bar, or liquid. The 6 most common were glutamine (51%), N-acetyl-cysteine (36%), fish oil (33%), alpha-lipoic acid (32%), acetyl-l-carnitine (28%), and coenzyme Q10 (28%). Participants were also taking an average of 4 vitamin/mineral supplements; the 6 most common were multivitamin/multimineral (83%), vitamin E (51%), vitamin C (47%), vitamin B complex (43%), calcium (29%), and selenium (28%). CONCLUSIONS With a total of 107 different types of NVNM supplements, our estimated cost examples indicated a weekly supplement regimen cost of between $25 and $40 dollars. According to literature review, taking an NVNM supplement may involve some risk because many components have not been studied and these products are not tightly regulated.
Collapse
Affiliation(s)
- Mara R Sansevero
- Cambridge Health Alliance at Cambridge hospital, Cambridge, MA 02139, USA.
| | | | | | | | | | | |
Collapse
|