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Admase A, Joshi S, Borse R, Deshpande P, Kulkarni V, Khaire S, Thakur R, Chavan A, Nimkar S, Mave V, Marbaniang I. Challenges with the use of Xpert HPV as a screening tool for oral HPV among people living with HIV (PLHIV): experiences from Pune, India. BMC Infect Dis 2023; 23:233. [PMID: 37069524 PMCID: PMC10108491 DOI: 10.1186/s12879-023-08210-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND People living with HIV (PLHIV) are at higher risk for human papillomavirus (HPV)-related oropharyngeal cancers compared to the general population. Xpert HPV test is a polymerase chain reaction (PCR) assay capable of rapid HPV detection. Performing the assay requires minimal intervention by laboratory personnel. Its use could improve oropharyngeal cancer screening among PLHIV living in low-and middle-income countries (LMICs) with limited diagnostic capacities. However, Xpert HPV performance for oral samples has not been evaluated. Here, we describe our experience with Xpert HPV and compare its results with traditional PCR, for oral samples. METHODS Oral samples from 429 PLHIV receiving care at a tertiary care hospital affiliated antiretroviral therapy center in Pune, India were used. Samples were collected either after a 30s oral rinse and gargle (n = 335) or in combination with cytobrush scraping of the oral mucosa (n = 91). Unsuccessful tests were those that generated an invalid or error result on Xpert HPV. Successful tests were those that generated a positive or negative result. Kappa statistic was used to compare concordance between Xpert HPV and traditional real-time PCR results. RESULTS There were 29.8% (n = 127) unsuccessful tests, of which 78.7% (n = 100) were invalid and 21.3% (n = 27) were error results. Adding cytobrush scraping to oral rinse as a collection procedure did not significantly reduce the proportion of unsuccessful tests (p = 0.9). For successful tests, HPV positivity on Xpert was 0.3% (n = 1/299). Kappa statistic was 0.11, indicating poor agreement between Xpert HPV and traditional PCR results. CONCLUSIONS Presently, Xpert HPV appears to have limited use for oral HPV detection among PLHIV using oral samples. More research to improve the diagnostic capabilities of Xpert HPV for oral samples among PLHIV is needed.
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Affiliation(s)
- Abigail Admase
- Zanvyl Kreiger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Samir Joshi
- Department of Otorhinolaryngology and Head & Neck Surgery, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Rohidas Borse
- Department of Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Prasad Deshpande
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Samir Khaire
- Department of Dentistry, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Rahul Thakur
- Department of Otorhinolaryngology and Head & Neck Surgery, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Smita Nimkar
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
- Center for Infectious Diseases in India, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India.
- Department of Epidemiology, McGill University, McGill College, Suite 1200, Montreal, QC, Canada.
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Riche CT, Reif LK, Nguyen NT, Alakiu GR, Seo G, Mathad JS, McNairy ML, Cordeiro AA, Kinikar A, Walsh KF, Deschamps MM, Nerette S, Nimkar S, Kayange N, Jaka H, Mwaisungu HM, Morona D, Peter TY, Suryavanshi N, Fitzgerald DW, Downs JA, Hokororo A. "Mobilizing our leaders": A multi-country qualitative study to increase the representation of women in global health leadership. PLOS Glob Public Health 2023; 3:e0000646. [PMID: 36962949 PMCID: PMC10021821 DOI: 10.1371/journal.pgph.0000646] [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] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/21/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Women play an essential role in health care delivery, and it is vital that they have equal representation in health leadership for equity, innovation, and the strengthening of health systems globally. Yet women remain vastly underrepresented in global health leadership positions, providing a clear example of the deeply rooted power imbalances that are central to the calls to decolonize global health. We conducted a multi-country study in Haiti, Tanzania, India, and the USA to examine gender-based challenges to career advancement for women in the global health workforce. Quantitative data on the type and prevalence of gender-based challenges has been previously reported. In this study, we analyze qualitative data collected through focus group discussions and in-depth interviews to understand women's experiences of gender-based obstacles to career advancement, their perceptions of underlying drivers, and perspectives on effective solutions. Guided by an adaptation of the Social Action Theory, we conducted focus group discussions and in-depth interviews with women at 4 major academic centers for clinical care and research in Haiti, India, Tanzania, and the United States. In total, 85 women participated in focus groups and 15 also participated in in-depth interviews. Discussions and interviews were conducted in the local language, by an experienced local facilitator unaffiliated with the participating institution, between 2017 and 2018. Discussions were recorded, transcribed, and translated. Data were analyzed by interpretive phenomenological methods for emergent themes. Three transcendent themes on gender-based challenges were identified: 1) cultural power imbalance, referring to the prevailing norms and engrained assumptions that women are less capable than men and that women's primary responsibility should be to their families; 2) institutional power imbalance, referring to the systematic gender bias upheld by existing leadership and power structures, and ranging from exclusion from career development opportunities to sexual harassment and assault; and 3) restricted agency, referring to women's limited ability to change their circumstances because of unequal cultural and institutional structures. Participants also described local, actionable solutions to address these barriers. These included: 1) formal reporting systems for sexual harassment and assault; 2) peer support and mentorship; and 3) accessible leadership training and mandatory gender equity training. Participants proposed feasible strategies to address gender-based challenges that could improve women's retention in health careers and foster their rise to leadership. Increasing the representation of women in global health leadership positions responds directly to efforts to decolonize global health and is integral to strengthening health systems and improving health outcomes for women and children worldwide.
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Affiliation(s)
- Claudia T Riche
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Lindsey K Reif
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Natalie T Nguyen
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - G Rinu Alakiu
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Grace Seo
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Jyoti S Mathad
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Margaret L McNairy
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Alexandra A Cordeiro
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Aarti Kinikar
- BJ Government Medical College and Sassoon Hospital, Pune, India
| | - Kathleen F Walsh
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Marie Marcelle Deschamps
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Sandy Nerette
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Smita Nimkar
- BJ Government Medical College-Johns Hopkins University Clinical Trials Unit, Pune, India
| | - Neema Kayange
- Department of Pediatrics, Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Hyasinta Jaka
- Department of Medicine, Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Department of Internal Medicine, Mwanza College of Health and Allied Sciences, Mwanza, Tanzania
| | - Halima M Mwaisungu
- Department of Medical Ethics, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Domenica Morona
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Thandiwe Yvonne Peter
- Department of Administration, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Nishi Suryavanshi
- BJ Government Medical College-Johns Hopkins University Clinical Trials Unit, Pune, India
| | - Daniel W Fitzgerald
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Jennifer A Downs
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
- Department of Medicine, Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Adolfine Hokororo
- Department of Pediatrics, Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Salvi S, Raichur P, Kadam D, Sangle S, Gupte N, Nevrekar N, Patil S, Chavan A, Nimkar S, Marbaniang I, Mave V. Virological failure among people living with HIV receiving second-line antiretroviral therapy in Pune, India. BMC Infect Dis 2022; 22:951. [PMID: 36528762 PMCID: PMC9758821 DOI: 10.1186/s12879-022-07894-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The number of people receiving second-line antiretroviral therapy (ART) has increased as global access to ART has expanded. Data on the burden and factors associated with second-line ART virologic failure (VF) from India remain limited. METHODS We conducted cross-sectional viral load (VL) testing among adults (≥ 18 years) who were registered at a publicly funded ART center in western India between 2014 and 2015 and had received second-line ART for at least 6 months. Sociodemographic and clinical characteristics were abstracted from routinely collected programmatic data. Logistic regression evaluated factors associated with VF (defined as VL > 1000 copies/mL). RESULTS Among 400 participants, median age was 40 years (IQR 34-44), 71% (285/400) were male, and 15% (59/400) had VF. Relative to participants without VF, those with VF had lower median CD4 counts (230 vs 406 cells/mm3, p < 0.0001), lower weight at first-line failure (49 vs 52 kg, p = 0.003), were more likely to have an opportunistic infection (17% vs 3%, p < 0.0001) and less likely to have optimal ART adherence (71% vs 87%, p = 0.005). In multivariable analysis, VF was associated with opportunistic infection (aOR, 4.84; 95% CI, 1.77-13.24), lower CD4 count (aOR 4.15; 95% CI, 1.98-8.71) and lower weight at first-line failure (aOR, 2.67; 95% CI, 1.33-5.34). CONCLUSIONS We found second-line VF in about a sixth of participants in our setting, which was associated with nearly fivefold increased odds in the context of opportunistic infection. Weight could be a useful clinical indicator for second-line VF.
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Affiliation(s)
- Sonali Salvi
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Priyanka Raichur
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Dileep Kadam
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Shashikala Sangle
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Nikhil Gupte
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Neetal Nevrekar
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Sandesh Patil
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Amol Chavan
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Smita Nimkar
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Ivan Marbaniang
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology, McGill University, Montreal, QC Canada
| | - Vidya Mave
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
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Marbaniang I, Borse R, Sangle S, Kinikar A, Chavan A, Nimkar S, Suryavanshi N, Mave V. Development of shortened HIV-related stigma scales for young people living with HIV and young people affected by HIV in India. Health Qual Life Outcomes 2022; 20:119. [PMID: 35909172 PMCID: PMC9340676 DOI: 10.1186/s12955-022-02030-9] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/27/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND HIV-related stigma is associated with poor quality of life and poor healthcare-seeking behaviours in young people living with HIV (YPLHIV) and young people affected by HIV (YPAHIV). India has an estimated 120,000 YPLHIV and 4 million YPAHIV, but efforts to measure HIV-related stigma in them are sparse, impeded by the lack of measuring instruments. Here, we describe the development of the Pune HIV-Stigma Scale (PHSS) and modified-PHSS to measure HIV-related stigma among YPLHIV and YPAHIV, respectively, in India. METHODS We used data from a mental health study for YPLHIV and YPAHIV aged 15-25 years, conducted at Byramjee Jeejeebhoy Government Medical College & Sassoon General Hospitals, Pune, India, between August 2018 and June 2021. Findings from multiple confirmatory factor analyses and cognitive interviews guided the development of the 12-item PHSS. The modified-PHSS was developed by confirming the structure of the PHSS for YPAHIV. Convergent validity with Center for Epidemiological Studies Depression (CES-D) and UCLA Loneliness scales was assessed using Spearman's correlation coefficients. RESULTS Model fit indices were good for both the PHSS (χ2 = 65.0, df = 48, p value: 0.052; root mean square error of approximation (RMSEA): 0.054; comparative fit index (CLI): 0.980; Tucker-Lewis index (TLI): 0.972; and standardized root mean square residual (SRMR): 0.067), and the modified-PHSS (χ2 = 56.9, df = 48, p value: 0.176; RMSEA: 0.045; CLI: 0.983; TFI: 0.976, and SRMR: 0.078). Spearman's correlation coefficients indicated low to moderate convergent validity (ρ: 0.03-0.52) across different subscales of the PHSS and modified-PHSS. Cronbach's alpha for the PHSS was 0.82 and for the modified-PHSS 0.81. CONCLUSION We developed the first scales to measure HIV-related stigma among YPLHIV and YPAHIV in India. These concise scales can facilitate measurement of HIV-related stigma more frequently in research studies. We recommend that they be tested in different Indian languages.
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Affiliation(s)
- Ivan Marbaniang
- Byramjee-Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology, McGill University, 2001 McGill College, Suite 1200, Montreal, QC H3A 1G1 Canada
| | - Rohidas Borse
- Department of Medicine, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Shashikala Sangle
- Department of Medicine, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Aarti Kinikar
- Department of Paediatrics, Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Amol Chavan
- Byramjee-Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Smita Nimkar
- Byramjee-Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Nishi Suryavanshi
- Byramjee-Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Vidya Mave
- Byramjee-Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
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Marbaniang I, Joshi S, Sangle S, Khaire S, Thakur R, Chavan A, Gupte N, Kulkarni V, Deshpande P, Nimkar S, Mave V. Smokeless tobacco use and oral potentially malignant disorders among people living with HIV (PLHIV) in Pune, India: Implications for oral cancer screening in PLHIV. PLoS One 2022; 17:e0270876. [PMID: 35788753 PMCID: PMC9255739 DOI: 10.1371/journal.pone.0270876] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 06/17/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION In India, smokeless tobacco (SLT) is a predominant form of tobacco used among people living with HIV (PLHIV). Despite SLT being a risk factor for oral potentially malignant disorders (OPMDs), no prior studies have quantified the association of OPMDs with SLT use among PLHIV. This limits the planning of preventive and control strategies for oral cancer among PLHIV, who are at higher risk for the disease. METHODS We enrolled 601 PLHIV and 633 HIV-uninfected individuals in an oral cancer screening study at BJ Government Medical College, Pune, India. Oral cavity images were collected using an m-Health application and reviewed by three clinicians. Participants with two clinician positive diagnoses were deemed to have suspected OPMDs. Prevalence ratios (PRs) were used to quantify the association between suspected OPMDs and SLT use among PLHIV. PRs for current SLT users, across HIV status and use duration were also estimated. Corrected PRs were obtained by modifying the maximum likelihood estimation. Models were adjusted for age, smoking, alcohol use and CD4 counts. RESULTS Of those enrolled, 61% were men, median age was 36 years (IQR: 28-44), and 33% currently use SLT. Proportion of current SLT users was similar across PLHIV and HIV-uninfected groups but use duration for current SLT use was higher among PLHIV(p<0.05). Among PLHIV, current SLT users had a 5-times (95% CI:3.1-7.0) higher prevalence of suspected OPMDs, compared to non-users. Relative to HIV uninfected individuals with the same SLT use duration, significant associations with suspected OPMDs were seen for PLHIV with<10 use years (PR: 3.5, 95% CI: 1.5-8.1) but not for PLHIV with≥10 use years (PR: 1.3, 95% CI: 0.9-1.8). CONCLUSION PLHIV that are current SLT users are at high risk of OPMDs and potentially oral cancer. The development of strategies for screening, early detection, and management of OPMDs must be considered for this group.
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Affiliation(s)
- Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
- Department of Epidemiology, McGill University, Montreal, Québec, Canada
- * E-mail:
| | - Samir Joshi
- Department of Otorhinolaryngology and Head & Neck Surgery, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Shashikala Sangle
- Department of Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Samir Khaire
- Department of Dentistry, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Rahul Thakur
- Department of Otorhinolaryngology and Head & Neck Surgery, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
- Center for Clinical Global Health Education, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Prasad Deshpande
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Smita Nimkar
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
- Center for Clinical Global Health Education, Johns Hopkins University, Baltimore, Maryland, United States of America
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Chebrolu P, Sangle S, Nimkar S, Salvi S, Chavan A, Kulkarni V, Shere D, Deshpande P, Brown TT, Mathad JS, Marbaniang I, Mave V. Inflammatory profile associated with insulin resistance in non-overweight versus overweight people living with HIV in Pune, Western India. Diabetes Metab Syndr 2022; 16:102551. [PMID: 35777254 PMCID: PMC9912190 DOI: 10.1016/j.dsx.2022.102551] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND People living with HIV have greater diabetes (T2DM) than the general population despite lower prevalence of overweight/obesity. Both insulin resistance (IR), a T2DM precursor, and HIV are independently associated with chronic inflammation. Inflammation may be a pathophysiological link explaining IR in people living with HIV who are not overweight but is not well understood. AIMS To study the association between inflammation and IR in non-overweight and overweight people living with HIV. METHODS In a cohort of adult people living with HIV with undetectable viral load in Pune, India, we measured fasting insulin, glucose, and 9 inflammatory markers. IR was defined as HOMA-IR ≥2, and non-overweight as BMI ≤23 kg/m2. We used modified Poisson regression to evaluate the association between inflammatory markers and IR in overweight and non-overweight. RESULTS Of 288 participants, 66% (n = 189) were non-overweight. Among non-overweight, prevalence of IR was 34% (n = 65). Each doubling of MCP-1 and leptin was associated with IR on univariate analysis (prevalence ratio (PR) 1.29, 95%CI 1.07-1.53, p < 0.01; PR 1.13 95%CI 1.01-1.26, p = 0.03). Leptin remained associated with IR after adjustment for age, MCP-1, gender, cholesterol, and waist circumference (adjusted PR 1.20 95%CI 1.06-1.36, p < 0.01). Among overweight, prevalence of IR was 69% and no markers were associated with IR. CONCLUSIONS One in 3 non-overweight people living with HIV in India with controlled viremia have IR. Leptin was associated with IR among non-overweight people living with HIV and may provide insight into the pathophysiology of metabolic disease in this population.
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Affiliation(s)
- Puja Chebrolu
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
| | | | - Smita Nimkar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
| | - Sonali Salvi
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Amol Chavan
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
| | - Vandana Kulkarni
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
| | - Dhananjay Shere
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
| | - Prasad Deshpande
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
| | - Todd T Brown
- Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jyoti S Mathad
- Department of Medicine and Obstetrics & Gynecology, Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Ivan Marbaniang
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India; Department of Epidemiology, McGill University, Montreal, QC, Canada
| | - Vidya Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site (BJGMC-JHU CRS), Pune, India
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Baidya A, Sangle S, Marbaniang I, Kulkarni V, Deshpande P, Nimkar S, Chavan A, Salvi S, Lokhande R, Kadam D, Gupta A, Mave V, Gupte A. Clinical and Immunological Markers of Pulmonary Impairment among People with HIV(PWH) in India. Open Forum Infect Dis 2022; 9:ofac233. [PMID: 35836747 PMCID: PMC9274441 DOI: 10.1093/ofid/ofac233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 02/02/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite antiretroviral therapy, chronic lung diseases remain an important source of morbidity and mortality in people with HIV (PWH). We sought to identify clinical and immunological markers of pulmonary impairment among PWH in India. Methods Two hundred ten adult PWH receiving antiretroviral therapy (ART) were prospectively evaluated for 3 years. Plasma concentrations of interleukin (IL)-6, IL-10, tumor necrosis factor alpha, D-dimer, C-reactive protein, soluble (s)CD14, and sCD163 were measured at enrollment. We used multivariable linear and logistic regression to measure the association of baseline and time-varying clinical and immunological variables with spirometry-defined chronic obstructive pulmonary disease (COPD), restrictive spirometry pattern (RSP), preserved ratio impaired spirometry (PRISm), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC) during the third year of follow-up. Results After adjusting confounders, females were 7 times more likely to have RSP (95% CI, 2.81 to 17.62; P < .001) and 22 times more likely to have PRISm (95% CI, 7.42 to 69.92; P < .001) compared with men. Higher IL-6 concentrations were associated with lower FEV1 z-scores (β, −0.14 per log-higher; 95% CI, −0.29 to 0.008; P = .06) and higher odds of COPD (adjusted odds ratio [aOR], 2.66 per log-higher; 95% CI, 1.16 to 6.09; P = .02). Higher D-dimer concentrations were associated with lower FVC z-scores (β, −0.40 per log-higher; 95% CI, −0.78 to −0.01; P = .04). Conversely, higher IL-10 concentrations were associated with lower odds of PRISm (aOR, 0.76 per log-higher; 95% CI, 0.59 to 0.99; P = .04). Conclusions Female sex, higher concentrations of IL-6 and D-dimer, and lower concentrations of IL-10 were associated with pulmonary impairment in adult PWH receiving ART in India.
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Affiliation(s)
- Anurima Baidya
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ivan Marbaniang
- Department of Epidemiology, McGill University, Montreal, QC, Canada
- Johns Hopkins India, Pune, India
| | | | | | | | | | - Sonali Salvi
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Rahul Lokhande
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Dileep Kadam
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vidya Mave
- Johns Hopkins India, Pune, India
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Akshay Gupte
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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8
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Paradkar MS, Devaleenal D B, Mvalo T, Arenivas A, Thakur KT, Wolf L, Nimkar S, Inamdar S, Giridharan P, Selladurai E, Kinikar A, Valvi C, Khwaja S, Gadama D, Balaji S, Yadav Kattagoni K, Venkatesan M, Savic R, Swaminathan S, Gupta A, Gupte N, Mave V, Dooley KE. Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial. Clin Infect Dis 2022; 75:1594-1601. [PMID: 35291004 PMCID: PMC9617573 DOI: 10.1093/cid/ciac208] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Received: 12/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. METHODS TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). RESULTS Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). CONCLUSIONS In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. CLINICAL TRIALS REGISTRATION NCT02958709.
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Affiliation(s)
- Mandar S Paradkar
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India
| | - Bella Devaleenal D
- Department of Clinical Research, Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, India
| | - Tisungane Mvalo
- UNC Project Malawi, Lilongwe, Malawi,Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ana Arenivas
- Section of Neuropsychology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Lisa Wolf
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Smita Nimkar
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India
| | - Sadaf Inamdar
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India
| | - Prathiksha Giridharan
- Department of Clinical Research, Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, India
| | | | - Aarti Kinikar
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Department of Pediatrics, BJ Government Medical College, Pune, India
| | - Chhaya Valvi
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Department of Pediatrics, BJ Government Medical College, Pune, India
| | - Saltanat Khwaja
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India
| | | | - Sarath Balaji
- Department of Clinical Research, Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, India
| | - Krishna Yadav Kattagoni
- Department of Clinical Research, Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, India
| | - Mythily Venkatesan
- Department of Clinical Research, Indian Council of Medical Research–National Institute for Research in Tuberculosis, Chennai, India
| | - Radojka Savic
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Amita Gupta
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nikhil Gupte
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vidya Mave
- BJ Government Medical College–Johns Hopkins Clinical Research Site, Pune, India,Johns Hopkins India, Pune, India,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly E Dooley
- Correspondence: K. Dooley, Johns Hopkins University School of Medicine, 600 N Wolfe St, Osler 527, Baltimore, MD 21287 ()
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9
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Nimkar S, Joshi S, Kinikar A, Valvi C, Devaleenal DB, Thakur K, Bendre M, Khwaja S, Ithape M, Kattagoni K, Paradkar M, Gupte N, Gupta A, Suryavanshi N, Mave V, Dooley KE, Arenivas A. Mullen Scales of Early Learning Adaptation for Assessment of Indian Children and Application to Tuberculous Meningitis. J Trop Pediatr 2021; 67:fmaa034. [PMID: 32620972 PMCID: PMC8496186 DOI: 10.1093/tropej/fmaa034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/04/2023]
Abstract
INTRODUCTION Tuberculous meningitis (TBM) results in significant morbidity and mortality among children worldwide. Associated neurocognitive complications are common but not well characterized. The Mullen Scales of Early Learning (MSEL), a well-established measure for assessment of neurodevelopment, has not yet been adapted for use in India. This study's goal was to adapt the MSEL for local language and culture to assess neurocognition among children in India, and apply the adapted measure for assessment of children with TBM. METHODS Administration of MSEL domains was culturally adapted. Robust translation procedures for instructions took place for three local languages: Marathi, Hindi and Tamil. Multilingual staff compared instructions against the original version for accuracy. The MSEL stimuli and instructions were reviewed by psychologists and pediatricians in India to identify items concerning for cultural bias. RESULTS MSEL stimuli unfamiliar to children in this setting were identified and modified within Visual Reception, Fine-Motor, Receptive Language and Expressive Language Scales. Item category was maintained for adaptations of items visually or linguistically different from those observed in daily life. Adjusted items were administered to six typically developing children to determine modification utility. Two children diagnosed with confirmed TBM (ages 11 and 29 months) were evaluated with the adapted MSEL before receiving study medications. Skills were below age-expectation across visual reception, fine motor and expressive language domains. CONCLUSIONS This is the first study to assess children with TBM using the MSEL adapted for use in India. Future studies in larger groups of Indian children are warranted to validate the adapted measure.
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Affiliation(s)
- Smita Nimkar
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
- Department of Health and Biomedical Sciences, Symbiosis International (Deemed) University, Lavale, Pune, India
| | - Suvarna Joshi
- Department of Health and Biomedical Sciences, Symbiosis International (Deemed) University, Lavale, Pune, India
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Aarti Kinikar
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Chhaya Valvi
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - D Bella Devaleenal
- Department of Clinical Research, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Kiran Thakur
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Manjushree Bendre
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - Saltanat Khwaja
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - Mahesh Ithape
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - Krishna Kattagoni
- Department of Clinical Research, ICMR - National Institute for Research in Tuberculosis, Chennai, India
| | - Mandar Paradkar
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - Nikhil Gupte
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amita Gupta
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nishi Suryavanshi
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
| | - Vidya Mave
- Clinical Trial Unit, Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research Site, Pune, India
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly E Dooley
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ana Arenivas
- Department of Rehabilitation Psychology and Neuropsychology, The Institute for Rehabilitation and Research (TIRR) Memorial Hermann, Houston, TX, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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10
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Raichur P, Salvi SP, Sangle S, Chavan A, Nimkar S, Gawande G, Rewari B, Mathad J, Mcintire K, Gupta A, Marbaniang I, Mave V. Trends and Sex Differences in Access to HIV Care with Scale Up of National HIV Treatment Guidelines in Pune, India. J Int Assoc Provid AIDS Care 2021; 19:2325958220931735. [PMID: 32573318 PMCID: PMC7313325 DOI: 10.1177/2325958220931735] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Test and treat is the current global standard, yet sex differences persist in access to HIV care. We assessed the differences in presentation and antiretroviral therapy (ART) uptake by sex and ART-eligibility period among ART-naive adults registered at a public ART center in India. Four ART eligibility periods were defined by programmatically determined CD4 criteria (periods I-IV: CD4 <200, <350, ≤500 cells/μL, and any CD4) between January 2005 and December 2017. Of 23 957 participants, 12 510 were male. Men consistently presented with lower median CD4 count (period I-IV, P < .05) and higher median age (period I-III, P < .001) than women. From period I to IV, median age increased in women (P < .0001), ART initiation time decreased in both sexes (P < .001), and median CD4 remained <200 cells/µL in men. Advanced HIV disease and increasing age at presentation are persistent sex-specific trends which warrant innovative HIV testing strategies in both sexes.
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Affiliation(s)
- Priyanka Raichur
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Sonali Pankaj Salvi
- Department of Medicine, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Shashikala Sangle
- Department of Medicine, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Smita Nimkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Gajanan Gawande
- Department of Medicine, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Bharat Rewari
- National AIDS Control Organisation, New Delhi, New Delhi, India
| | - Jyoti Mathad
- Department of Medicine, Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Katherine Mcintire
- Department of Medicine and Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Department of Medicine and Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Department of Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Department of Medicine and Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
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11
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Nimkar S, Kinikar A, Chavan A, Sangle S, Rewari B, Gupta A, Mave V, Marbaniang I. High prevalence of late presentation of ART-naïve perinatally infected children for care in Pune, India. AIDS Care 2020; 32:1415-1420. [PMID: 32070118 PMCID: PMC7431379 DOI: 10.1080/09540121.2020.1727407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/14/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
Delayed presentation to care of perinatally infected children in India continues to be a hindrance to achieving the "end pediatric HIV by 2020" goal. In this study, we characterize this issue by describing the prevalence, risk factors and temporal trends of delayed presentation to care of perinatally infected, antiretroviral therapy (ART) - naïve children using programmatic data from a tertiary care center in western India. Delayed presentation was defined as children presenting in moderate or severe WHO immunodeficiency categories. Of 269 children eligible for inclusion in the analysis, the median age at presentation was 4 years (IQR: 3-6 years) and prevalence of delayed presentation was 52%. Multivariable logistic regression identified domicile distance ≥20km from the ART center (OR: 2.2, 95% CI: 1.02-4.7) to be a risk factor for delayed presentation. An inverse association with increasing age (OR: 0.8, 95% CI: 0.7-0.9) was also seen. The proportion of children with delayed presentation between 2006 and 2016 remained unchanged (p = 0.36), although the median age at presentation over the same time period increased significantly (p < 0.001). Our results indicate the urgency of identifying strategies to improve linkage of perinatally infected ART-naïve children to care, earlier than what is currently observed.
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Affiliation(s)
- Smita Nimkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | - Bharatbhushan Rewari
- Former National Programme Officer, National AIDS Control Organization, New Delhi, India
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
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12
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Suryavanshi N, Kadam A, Dhumal G, Nimkar S, Mave V, Gupta A, Cox SR, Gupte N. Mental health and quality of life among healthcare professionals during the COVID-19 pandemic in India. Brain Behav 2020; 10:e01837. [PMID: 32918403 PMCID: PMC7667343 DOI: 10.1002/brb3.1837] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has placed healthcare professionals (HCP) in stressful circumstances with increased patient loads and a high risk of exposure. We sought to assess the mental health and quality of life (QoL) of Indian HCPs, the fourth highest-burden country for COVID-19. METHOD Using snowball sampling, we conducted an online survey in May 2020 among HCPs. Data were collected on demographics, depression, and anxiety using validated tools, quality of life, and perceived stressors. Multivariable logistic regression and principal component analysis were performed to assess risk factors associated with mental health symptoms. FINDINGS Of 197 HCPs assessed, 157 (80%) were from Maharashtra, 130 (66%) from public hospitals, 47 (24%) nurses, 66 (34%) physicians, 101 (52%) females, and 81 (41%) ≤30 years. Eighty-seven percent provided direct COVID-19 care with 43% caring for >10 patients/day. A large proportion reported symptoms of depression (92, 47%), anxiety (98, 50%), and low QoL (89, 45%). Odds of combined depression and anxiety were 2.37 times higher among single HCPs compared to married (95% CI: 1.03-4.96). Work environment stressors were associated with 46% increased risk of combined depression and anxiety (95% CI: 1.15-1.85). Moderate to severe depression and anxiety were independently associated with increased risk of low QoL [OR: 3.19 (95% CI: 1.30-7.84), OR: 2.84 (95% CI: 1.29-6.29)]. CONCLUSION Our study demonstrated a high prevalence of symptoms of depression and anxiety and low QoL among Indian HCPs during the COVID-19 pandemic. There is an urgent need to prevent and treat mental health symptoms among frontline HCPs.
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Affiliation(s)
- Nishi Suryavanshi
- Lakshya, Society for Public Health Education and Research, Pune, India.,Johns Hopkins University, Center for Clinical Global Health Education, Pune, India
| | - Abhay Kadam
- Lakshya, Society for Public Health Education and Research, Pune, India.,Johns Hopkins University, Center for Clinical Global Health Education, Pune, India
| | - Gauri Dhumal
- Lakshya, Society for Public Health Education and Research, Pune, India.,Johns Hopkins University, Center for Clinical Global Health Education, Pune, India
| | - Smita Nimkar
- Lakshya, Society for Public Health Education and Research, Pune, India.,Johns Hopkins University, Center for Clinical Global Health Education, Pune, India
| | - Vidya Mave
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Amita Gupta
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Samyra R Cox
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Nikhil Gupte
- Lakshya, Society for Public Health Education and Research, Pune, India.,Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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13
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Marbaniang I, Sangle S, Nimkar S, Zarekar K, Salvi S, Chavan A, Gupta A, Suryavanshi N, Mave V. The burden of anxiety among people living with HIV during the COVID-19 pandemic in Pune, India. BMC Public Health 2020; 20:1598. [PMID: 33097028 PMCID: PMC7582417 DOI: 10.1186/s12889-020-09656-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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] [Received: 07/19/2020] [Accepted: 10/07/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction Globally, India has the third largest population of people living with HIV (PLHIV) and the second highest number of COVID-19 cases. Anxiety is associated with antiretroviral therapy (ART) nonadherence. It is crucial to understand the burden of anxiety and its sources among Asian Indian PLHIV during the COVID pandemic, but data are limited. Methods During the first month of government mandated lockdown, we administered an anxiety assessment via telephone among PLHIV registered for care at a publicly funded antiretroviral therapy (ART) center in Pune, India. Generalized anxiety was defined as GAD-7 score ≥ 10. Sociodemographic and clinical variables were compared by anxiety status (GAD-7 score ≥ 10 vs GAD-7 score < 10). Qualitative responses to an open-ended question about causes of concern were evaluated using thematic analysis. Results Among 167 PLHIV, median age was 44 years (IQR 40–50); the majority were cisgender women (60%) and had a monthly family income < 200 USD (81%). Prior history of tuberculosis and other comorbidities were observed in 38 and 27%, respectively. Overall, prevalence of generalized anxiety was 25% (n = 41). PLHIV with GAD-7 score ≥ 10 had fewer remaining doses of ART than those with lower GAD-7 scores (p = 0.05). Thematic analysis indicated that concerns were both health related and unrelated, and stated temporally. Present concerns were often also projected as future concerns. Conclusions The burden of anxiety was high during COVID lockdown in our population of socioeconomically disadvantaged PLHIV in Pune and appeared to be influenced by concerns about ART availability. The burden of anxiety among PLHIV will likely increase with the worsening pandemic in India, as sources of anxiety are expected to persist. We recommend the regular use of short screening tools for anxiety to monitor and triage patients as an extension of current HIV services.
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Affiliation(s)
- Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Jai Prakash Narayan Road, Maharashtra, 411001, Pune, India. .,Department of Epidemiology, McGill University, Purvis Hall, 1020 Pine Avenue, Montreal, QC, H3G 1A2, Canada.
| | - Shashikala Sangle
- Department of General Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Smita Nimkar
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Jai Prakash Narayan Road, Maharashtra, 411001, Pune, India
| | - Kanta Zarekar
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Jai Prakash Narayan Road, Maharashtra, 411001, Pune, India
| | - Sonali Salvi
- Department of General Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Jai Prakash Narayan Road, Maharashtra, 411001, Pune, India
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Jai Prakash Narayan Road, Maharashtra, 411001, Pune, India.,Department of Medicine and Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Jai Prakash Narayan Road, Maharashtra, 411001, Pune, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Jai Prakash Narayan Road, Maharashtra, 411001, Pune, India.,Department of Medicine and Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
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14
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Marbaniang I, Sangle S, Nimkar S, Zarekar K, Salvi S, Chavan A, Gupta A, Suryavanshi N, Mave V. The burden of anxiety among people living with HIV during the COVID-19 pandemic in Pune, India. RESEARCH SQUARE 2020:rs.3.rs-45412. [PMID: 36575764 PMCID: PMC9793829 DOI: 10.21203/rs.3.rs-45412/v2] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction : Globally, India has the third largest population of people living with HIV (PLHIV) and the second highest number of COVID-19 cases. Anxiety is associated with antiretroviral therapy (ART) nonadherence. It is crucial to understand the burden of anxiety and its sources among Asian Indian PLHIV during the COVID pandemic, but data are limited. Methods: During the first month of government mandated lockdown, we administered an anxiety assessment via telephone among PLHIV registered for care at a publicly funded antiretroviral therapy (ART) center in Pune, India. Generalized anxiety was defined as GAD-7 score ≥10. Sociodemographic and clinical variables were compared by anxiety status (GAD-7 score≥10 vs GAD-7 score<10). Qualitative responses to an open-ended question about causes of concern were evaluated using thematic analysis. Results : Among 167 PLHIV, median age was 44 years (IQR 40-50); the majority were cisgender women (60%) and had a monthly family income <200 USD (81%). Prior history of tuberculosis and other comorbidities were observed in 38% and 27%, respectively. Overall, prevalence of generalized anxiety was 25% (n=41). PLHIV with GAD-7 score ≥10 had fewer remaining doses of ART than those with lower GAD-7 scores (p=0.05). Thematic analysis indicated that concerns were both health related and unrelated, and stated temporally. Present concerns were often also projected as future concerns. Conclusions : The burden of anxiety was high during COVID lockdown in our population of socioeconomically disadvantaged PLHIV in Pune and appeared to be influenced by concerns about ART availability. The burden of anxiety among PLHIV will likely increase with the worsening pandemic in India, as sources of anxiety are expected to persist. We recommend the regular use of short screening tools for anxiety to monitor and triage patients as an extension of current HIV services.
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Affiliation(s)
- Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
| | | | - Smita Nimkar
- Byramjee Jejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
| | - Kanta Zarekar
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
| | | | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
| | | | - Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
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15
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Marbaniang I, Sangle S, Nimkar S, Zarekar K, Salvi S, Chavan A, Gupta A, Suryavanshi N, Mave V. The burden of anxiety among people living with HIV during the COVID-19 pandemic in Pune, India. Res Sq 2020:rs.3.rs-45412. [PMID: 32818219 PMCID: PMC7430601 DOI: 10.21203/rs.3.rs-45412/v1] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction Globally, India has the third largest population of people living with HIV (PLHIV) and the second highest number of COVID-19 cases. Anxiety is associated with antiretroviral therapy (ART) nonadherence. It is crucial to understand the burden of anxiety and its sources among Asian Indian PLHIV during the COVID pandemic, but data are limited. Methods During the first month of government mandated lockdown, we administered an anxiety assessment via telephone among PLHIV registered for care at a publicly funded antiretroviral therapy (ART) center in Pune, India. Generalized anxiety was defined as GAD-7 score ≥10. Sociodemographic and clinical variables were compared by anxiety status (GAD-7 score≥10 vs GAD-7 score<10). Qualitative responses to an open-ended question about causes of concern were evaluated using thematic analysis. Results Among 167 PLHIV, median age was 44 years (IQR 40-50); the majority were cisgender women (60%) and had a monthly family income <200 USD (81%). Prior history of tuberculosis and other comorbidities were observed in 38% and 27%, respectively. Overall, prevalence of generalized anxiety was 25% (n=41). PLHIV with GAD-7 score ≥10 had fewer remaining doses of ART than those with lower GAD-7 scores (p=0.05). Thematic analysis indicated that concerns were both health related and unrelated, and stated temporally. Present concerns were often also projected as future concerns. Conclusions The burden of anxiety was high during COVID lockdown in our population of socioeconomically disadvantaged PLHIV in Pune and appeared to be influenced by concerns about ART availability. The burden of anxiety among PLHIV will likely increase with the worsening pandemic in India, as sources of anxiety are expected to persist. We recommend the regular use of short screening tools for anxiety to monitor and triage patients as an extension of current HIV services.
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Affiliation(s)
- Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
| | | | - Smita Nimkar
- Byramjee Jejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
| | - Kanta Zarekar
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
| | | | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
| | | | - Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site
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16
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Naik S, Robinson ML, Alexander M, Chandanwale A, Sambarey P, Kinikar A, Bharadwaj R, Sapkal GN, Chebrolu P, Deshpande P, Kulkarni V, Nimkar S, Mave V, Gupta A, Mathad J. Intensified Short Symptom Screening Program for Dengue Infection during Pregnancy, India. Emerg Infect Dis 2020; 26:738-743. [PMID: 32186485 PMCID: PMC7101120 DOI: 10.3201/eid2604.191476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Mosquitoborne diseases (e.g., malaria, dengue, and chikungunya) are endemic to India and pose diagnostic challenges during pregnancy. We evaluated an intensified short symptom screening program in India to diagnose dengue during pregnancy. During October 2017–January 2018, we screened pregnant women during antenatal surveillance for symptoms of mosquitoborne diseases (fever only, fever with conjunctivitis, fever with rash, or all 3 symptoms) within the previous 15 days. Of 5,843 pregnant women screened, 52 were enrolled and tested for dengue, chikungunya, and Zika viruses by using a Trioplex real-time reverse transcription PCR. Of 49 who had complete results, 7 (14%) were dengue positive. Of these ocular pain was seen in 4 (57%) and conjunctivitis in 7 (100%). Intensified symptom screening using conjunctivitis, in addition to rash, in pregnant women with fever might improve dengue case detection and can be included in routine symptom screening during pregnancy.
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17
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Gupte AN, Kadam D, Sangle S, Rewari BB, Salvi S, Chavan A, Nimkar S, Golub J, Gupte N, Gupta A, Marbaniang I, Mave V. Incidence of tuberculosis in HIV-infected adults on first- and second-line antiretroviral therapy in India. BMC Infect Dis 2019; 19:914. [PMID: 31664933 PMCID: PMC6820927 DOI: 10.1186/s12879-019-4569-z] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/16/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Programmatic data on the baseline risk of tuberculosis in people living with HIV (PLHIV) are needed to evaluate long-term effectiveness of the ongoing isoniazid preventive therapy (IPT) roll-out in India. METHODS We estimated the incidence rate and risk factors of tuberculosis disease in adult PLHIV initiating first- and second-line anti-retroviral therapy (ART) prior to widespread IPT in a public ART center in Pune, India. RESULTS 4067 participants contributing 5205.7 person-years of follow-up on first-line ART and 871 participants contributing 1031.7 person-years of follow-up on second-line ART were included in the analysis. The incidence rate of tuberculosis was 4.39 cases (95%CI 3.86-5.00) per 100 person-years on first-line ART and 1.64 cases (95%CI 1.01-2.63) per 100 person-years on second-line ART (p < 0.001). After adjusting for competing risks, male sex (aSHR = 1.33, 95%CI 1.02-1.74, p = 0.03), urban residence (aSHR = 1.53, 95%CI 1.13-2.07, p = 0.006) and CD4+ counts < 350 cells/mm3 (aSHR = 3.06 vs CD4 > 350 cells/mm3, 95%CI 1.58-5.94, p < 0.001) at ART initiation were associated with higher risk of tuberculosis independent of ART regimen. CONCLUSION Risk of tuberculosis was lower in PLHIV receiving second-line ART compared to first-line ART. Prioritizing IPT in PLHIV with low CD4+ counts, urban residence and in males may further mitigate the risk of tuberculosis during ART.
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Affiliation(s)
- Akshay N Gupte
- Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 521, Baltimore, MD, 21287, USA.
| | - Dileep Kadam
- Byramjee-Jeejeebhoy Medical College, Pune, India
| | | | - Bharat B Rewari
- Former National Programme Office, National AIDS Control Organization, New Delhi, India
| | - Sonali Salvi
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - Amol Chavan
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - Smita Nimkar
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - Jonathan Golub
- Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 521, Baltimore, MD, 21287, USA
| | - Nikhil Gupte
- Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 521, Baltimore, MD, 21287, USA
| | - Amita Gupta
- Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 521, Baltimore, MD, 21287, USA
| | - Ivan Marbaniang
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - Vidya Mave
- Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 521, Baltimore, MD, 21287, USA
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18
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Marbaniang I, Sangle S, Salvi S, Kulkarni V, Shere D, Deshpande P, Nimkar S, Gupta A, Mave V. High prevalence of insulin resistance and occurrence prior to hyperinsulinemia threshold among people living with HIV in Pune, India. Diabetes Metab Syndr 2019; 13:1813-1819. [PMID: 31235099 PMCID: PMC6597186 DOI: 10.1016/j.dsx.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/11/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Diabetes prevalence in HIV is not well characterized for India, despite the high burden of both individual diseases. Epidemiology of insulin resistance (IR): a precursor to diabetes, and its associated risk factors are also poorly understood in Asian Indian people living with HIV (PLHIV). We assessed the prevalence of diabetes and IR in Pune, India and the associated risk factors for IR. METHODS Cross-sectional analysis of adult (≥18 years) PLHIV receiving care at Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India (BJGMC- SGH). Proportions and medians of PLHIV characteristics by diabetes status and IR were described. Homeostatic Model Assessment (HOMA) index value ≥2 was used to define IR. Line of least squares assessed the relationship between IR and hyperinsulinemia. Association between sociodemographic, clinical factors with IR was determined using logistic regression. RESULTS Of 485 enrollees, 47% were men, median age was 40 years (IQR: 35-46), median CD4 counts were 389 cells/mm3 (246-609). Thirty-five percent were centrally obese, 75% were adherent to WHO recommended physical activity guidelines. Prevalence of diabetes, prediabetes, IR were 9%, 16% and 38%, respectively. Twenty-nine percent non-diabetics had IR and it occurred much prior to the threshold for hyperinsulinemia. IR was associated with the use of ART drugs (OR: 6.6, 95% CI: 2.9-15.2 and 5.4, 95% CI: 2.2-13.6 for first- and second line ART respectively) and central obesity (OR:1.9, 95% CI: 1.1-3.4). CONCLUSIONS One fourth of the study population was diabetic or prediabetic and more than a third had IR. Better understanding of diabetes disease progression in relation to IR and the effect of physical activity on central obesity among Asian Indian PLHIV is mandated.
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Affiliation(s)
- Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India.
| | - Shashikala Sangle
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Sonali Salvi
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Dhananjay Shere
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Prasad Deshpande
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Smita Nimkar
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India
| | - Amita Gupta
- Johns Hopkins School of Medicine, Baltimore, USA
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins School of Medicine, Baltimore, USA
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19
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Mathad JS, Reif LK, Seo G, Walsh KF, McNairy ML, Lee MH, Hokororo A, Kinikar A, Riche CT, Deschamps MM, Nerette S, Nimkar S, Kayange N, Jaka H, Joseph G, Morona D, Peter TY, Suryavanshi N, Fitzgerald DW, Downs JA. Female global health leadership: data-driven approaches to close the gender gap. Lancet 2019; 393:521-523. [PMID: 30739680 PMCID: PMC7391058 DOI: 10.1016/s0140-6736(19)30203-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/22/2018] [Accepted: 01/03/2019] [Indexed: 11/21/2022]
Affiliation(s)
- Jyoti S Mathad
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA; General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Lindsey K Reif
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Grace Seo
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Kathleen F Walsh
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA; General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Margaret L McNairy
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA; General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Myung Hee Lee
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Adolfine Hokororo
- Department of Pediatrics, Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College and Sassoon Government Hospital, Pune, India
| | - Claudia T Riche
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Marie M Deschamps
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Sandy Nerette
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Smita Nimkar
- Johns Hopkins University Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune India
| | - Neema Kayange
- Department of Pediatrics, Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Hyasinta Jaka
- Department of Medicine, Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Glory Joseph
- Department of Pediatrics, Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Domenica Morona
- Department of Parasitology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Thandiwe Yvonne Peter
- Department of Administration, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Nishi Suryavanshi
- Johns Hopkins University Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune India
| | - Daniel W Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA; Department of Medicine, Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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20
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Ehlman M, Nimkar S, Nolan B, Thomas P, Caballero C, Snow T. NURSING HOME STAFF KNOWLEDGE ABOUT DEMENTIA: THE IMPACT OF TEEPA SNOW’S POSITIVE APPROACH® TO CARE CERTIFICATION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2572] [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)
| | | | | | - P Thomas
- University of Southern Indiana School of Nursing and Health Professions
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21
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Nimkar S, Valvi C, Kadam D, Rewari BB, Kinikar A, Gupte N, Suryavanshi N, Deluca A, Shankar A, Golub J, Bollinger R, Gupta A, Marbaniang I, Mave V. Loss to follow-up and mortality among HIV-infected adolescents receiving antiretroviral therapy in Pune, India. HIV Med 2018; 19:395-402. [PMID: 29573312 DOI: 10.1111/hiv.12605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES India has the highest number of HIV-infected adolescents in Asia, but little is known about their treatment outcomes. We assessed rates and factors associated with loss to follow-up (LTFU) and mortality among Indian adolescents. METHODS The analysis included adolescents (10-19 years old) starting antiretroviral therapy (ART) between 2005 and 2014 at BJ Government Medical College, Pune, India. LTFU was defined as missing more than three consecutive monthly visits. The competing-risks method was used to calculate subdistribution hazard ratios (SHRs) of predictors for LTFU, with death as the competing risk. Cox proportional hazard models were used to identify predictors of mortality. RESULTS Of 717 adolescents starting ART, 402 with complete data were included in the analysis. Of these, 61% were male and 80% were perinatally infected, and the median baseline CD4 count was 174 cells/μL. LTFU and mortality rates were 4.4 and 4.9/100-person years, respectively. Cumulative LTFU incidence increased from 6% to 15% over 6 years. Age ≥ 15 years [adjusted SHR (aSHR) 2.44; 95% confidence interval (CI) 1.18-5.02] was a risk factor for LTFU. Cumulative mortality increased from 9.5% to 17.9% over 6 years. World Health Organization (WHO) stages III and IV [adjusted hazard ratio (aHR) 2.26; 95% CI: 1.14-4.48] and an increase in CD4 count by 100 cells/μL (aHR: 0.59; 95% CI: 0.43-0.83) were associated with mortality. CONCLUSIONS A third of adolescents had been lost to follow-up or died by follow-up year 6. Older age was a risk factor for LTFU and advanced clinical disease for death. Strategies to improve retention counselling for older adolescents and closer clinical monitoring of all adolescents must be considered.
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Affiliation(s)
- S Nimkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - C Valvi
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - D Kadam
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - B B Rewari
- National AIDS Control Organization, New Delhi, India
| | - A Kinikar
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - N Gupte
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - A Deluca
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Shankar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Golub
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - R Bollinger
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Gupta
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - I Marbaniang
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - V Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Mave V, Chandanwale A, Kinikar A, Khadse S, Kagal A, Gupte N, Suryavanshi N, Nimkar S, Koli H, Khwaja S, Bharadwaj R, Joshi S, Horng H, Benet LZ, Ramachandran G, Dooley KE, Gupta A, Gandhi M. Isoniazid hair concentrations in children with tuberculosis: a proof of concept study. Int J Tuberc Lung Dis 2018; 20:844-7. [PMID: 27155191 PMCID: PMC4889729 DOI: 10.5588/ijtld.15.0882] [Citation(s) in RCA: 5] [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: 11/10/2022] Open
Abstract
Assessing treatment adherence and quantifying exposure to anti-tuberculosis drugs among children is challenging. We undertook a 'proof of concept' study to assess the drug concentrations of isoniazid (INH) in hair as a therapeutic drug monitoring tool. Children aged <12 years initiated on a thrice-weekly treatment regimen including INH (10 mg/kg) for newly diagnosed tuberculosis were enrolled. INH concentrations in hair were measured using liquid chromatography-tandem mass spectrometry at 1, 2, 4 and 6 months after initiating anti-tuberculosis treatment. We found that INH hair concentrations in all children on thrice-weekly INH were detectable and displayed variability across a dynamic range.
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Affiliation(s)
- V Mave
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Chandanwale
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - A Kinikar
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Khadse
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - A Kagal
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - N Gupte
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Suryavanshi
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Nimkar
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - H Koli
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Khwaja
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - R Bharadwaj
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - S Joshi
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India
| | - H Horng
- University of California, San Francisco, California, USA
| | - L Z Benet
- University of California, San Francisco, California, USA
| | - G Ramachandran
- National Institute of Research in Tuberculosis, Chennai, India
| | - K E Dooley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Gupta
- Byramjee-Jeejeebhoy Medical College Clinical Trials Unit, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Gandhi
- University of California, San Francisco, California, USA
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23
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Mave V, Kinikar A, Kagal A, Nimkar S, Koli H, Khwaja S, Bharadwaj R, Gerona R, Wen A, Ramachandran G, Kumar H, Bacchetti P, Dooley KE, Gupte N, Gupta A, Gandhi M. Isoniazid concentrations in hair and plasma area-under-the-curve exposure among children with tuberculosis. PLoS One 2017; 12:e0189101. [PMID: 29216273 PMCID: PMC5720757 DOI: 10.1371/journal.pone.0189101] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/17/2017] [Indexed: 11/21/2022] Open
Abstract
We measured hair and plasma concentrations of isoniazid among sixteen children with tuberculosis who underwent personal or video-assisted directly observed therapy and thus had 100% adherence. This study therefore defined typical isoniazid exposure parameters after two months of treatment among fully-adherent patients in both hair and plasma (plasma area under the concentration-time curve, AUC, estimated using pharmacokinetic data collected 0, 2, 4, and 6 hours after drug administration). We found that INH levels in hair among highly-adherent individuals did not correlate well with plasma AUC or trough concentrations, suggesting that each measure may provide incremental and complementary information regarding drug exposure in the context of TB treatment.
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Affiliation(s)
- Vidya Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Aarti Kinikar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Anju Kagal
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Smita Nimkar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Hari Koli
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Sultanat Khwaja
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Renu Bharadwaj
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Roy Gerona
- University of California San Francisco, San Francisco, United States of America
| | - Anita Wen
- University of California San Francisco, San Francisco, United States of America
| | | | - Hemanth Kumar
- National Institute of Research in Tuberculosis, Chennai, India
| | - Peter Bacchetti
- University of California San Francisco, San Francisco, United States of America
| | - Kelly E. Dooley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Nikhil Gupte
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Amita Gupta
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Monica Gandhi
- University of California San Francisco, San Francisco, United States of America
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24
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Mave V, Nimkar S, Prasad H, Kadam D, Meshram S, Lokhande R, Gupte N, Jain D, Gupta A, Golub JE. Tuberculosis screening among persons with diabetes mellitus in Pune, India. BMC Infect Dis 2017; 17:388. [PMID: 28577535 PMCID: PMC5457599 DOI: 10.1186/s12879-017-2483-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 05/22/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics. Screening for TB among people with DM is now recommended in India. METHODS People with DM seeking care at a large public sector tertiary care hospital clinic in Pune, India, were screened for TB from June 2015 to May 2016. All consenting people with DM were screened for TB at each clinic visit using a five-item, WHO-recommended questionnaire and those with TB symptoms and/or risk factors were tested for active TB using sputum smear microscopty, Xpert® MTB/RIF and TB culture. Categorical data and continuous variables were summarized using descriptive statistics. The x 2 test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively. RESULTS Among 630 adults approached for screening, median age was 60 (interquartile range (IQR), 57-64) years and 350 (56%) were females. Median hemoglobin A1c (HbA1c) was 8.7% (IQR, 6.7-9.9) and 444 (70.5%) were poorly controlled DM (HbA1c > 7). Forty-four (7%) had prior history of TB but the proportion with TB risk factors at screening was low (<5%). While 18% of participants reported any TB symptoms, none of these patients were diagnosed with culture confirmed TB. CONCLUSIONS Our study failed to yield any active TB cases using a WHO-recommended questionnaire among people with DM. High TB risk populations among people with DM must be identified if TB screening is to be feasible in settings such as India where the DM epidemic continues to rise.
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Affiliation(s)
- Vidya Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India. .,Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Smita Nimkar
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India
| | - Haridas Prasad
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Dileep Kadam
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Sushant Meshram
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Rahul Lokhande
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - Nikhil Gupte
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Divyashri Jain
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India
| | - Amita Gupta
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, 1st Floor, Pathology Museum, Jai Prakash Narayan Road, Pune, Maharashtra, 411001, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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25
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Raval G, Kanade S, Nimkar S, Nadgiri V, Sahu P, Kadam D, Khadse S, Mave V, Gupte N, Gupta A, Shankar A, Suryavanshi N. Erratum to: Challenges to Disclosure of HIV Status to Perinatally Infected Children: A Study of Caregiver Perspectives in Pune, India [J Pediatr Infect Dis 2014;9:71–84]. J PEDIAT INF DIS-GER 2015. [DOI: 10.1055/s-0035-1560036] [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: 10/23/2022]
Affiliation(s)
- Gauri Raval
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Savita Kanade
- Clinical Trials Unit, Byramjee-Jeejeebhoy Medical College, Pune, India
| | - Smita Nimkar
- Clinical Trials Unit, Byramjee-Jeejeebhoy Medical College, Pune, India
| | - Vaishali Nadgiri
- Clinical Trials Unit, Byramjee-Jeejeebhoy Medical College, Pune, India
| | - Prassana Sahu
- Clinical Trials Unit, Byramjee-Jeejeebhoy Medical College, Pune, India
| | - Deelip Kadam
- Byramjee-Jeejeebhoy Medical College, Pune, India
| | | | - Vidya Mave
- Clinical Trials Unit, Byramjee-Jeejeebhoy Medical College, Pune, India
| | - Nikhil Gupte
- Clinical Trials Unit, Byramjee-Jeejeebhoy Medical College, Pune, India
| | - Amita Gupta
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Anita Shankar
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Nishi Suryavanshi
- Clinical Trials Unit, Byramjee-Jeejeebhoy Medical College, Pune, India
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26
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Raval G, Kanade S, Nimkar S, Nadgiri V, Sahu P, Kadam D, Khadse S, Mave V, Gupte N, Gupta A, Shankar A, Suryavanshi N. Challenges to disclosure of HIV status to perinatally infected children: A study of caregiver perspectives in Pune, India. J PEDIAT INF DIS-GER 2015. [DOI: 10.3233/jpi-140418] [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: 11/15/2022]
Affiliation(s)
- Gauri Raval
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Savita Kanade
- Byramjee-Jeejeebhoy Medical College, Clinical Trials Unit, Pune, India
| | - Smita Nimkar
- Byramjee-Jeejeebhoy Medical College, Clinical Trials Unit, Pune, India
| | - Vaishali Nadgiri
- Byramjee-Jeejeebhoy Medical College, Clinical Trials Unit, Pune, India
| | - Prassana Sahu
- Byramjee-Jeejeebhoy Medical College, Clinical Trials Unit, Pune, India
| | - Deelip Kadam
- Byramjee-Jeejeebhoy Medical College, Pune, India
| | | | - Vidya Mave
- Byramjee-Jeejeebhoy Medical College, Clinical Trials Unit, Pune, India
| | - Nikhil Gupte
- Byramjee-Jeejeebhoy Medical College, Clinical Trials Unit, Pune, India
| | - Amita Gupta
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anita Shankar
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nishi Suryavanshi
- Byramjee-Jeejeebhoy Medical College, Clinical Trials Unit, Pune, India
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Venkatraman S, Kong J, Nimkar S, Wang QM, Aubé J, Hanzlik RP. Design, synthesis, and evaluation of azapeptides as substrates and inhibitors for human rhinovirus 3C protease. Bioorg Med Chem Lett 1999; 9:577-80. [PMID: 10098667 DOI: 10.1016/s0960-894x(99)00049-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [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: 10/27/2022]
Abstract
A series of azapeptides was prepared and assessed as inhibitors of the human rhinovirus 3C protease. Boc-VLFaQ-OPh was a slow-turnover substrate that gave transient (ca. 1-2 h) inhibition as it underwent hydrolysis. Boc-VLFaG-OPh gave very slow but essentially irreversible inhibition.
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Affiliation(s)
- S Venkatraman
- Department of Medicinal Chemistry, The University of Kansas, Lawrence 66045-2506, USA
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28
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Kong JS, Venkatraman S, Furness K, Nimkar S, Shepherd TA, Wang QM, Aubé J, Hanzlik RP. Synthesis and evaluation of peptidyl Michael acceptors that inactivate human rhinovirus 3C protease and inhibit virus replication. J Med Chem 1998; 41:2579-87. [PMID: 9651162 DOI: 10.1021/jm980114+] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [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: 02/08/2023]
Abstract
Human rhinovirus, the chief cause of the common cold, contains a positive-sense strand of RNA which is translated into a large polyprotein in infected cells. Cleavage of the latter to produce the mature viral proteins required for replication is catalyzed in large part by a virally encoded cysteine proteinase (3Cpro) which is highly selective for -Q approximately GP- cleavage sites. We synthesized peptidyl derivatives of vinylogous glutamine or methionine sulfone esters (e.g., Boc-Val-Leu-Phe-vGln-OR: R = Me, 1; R = Et, 2) and evaluated them as inhibitors of HRV-14 3C protease (3Cpro). Compounds 1 and 2 and several related tetra- and pentapeptide analogues rapidly inactivated 3Cpro with submicromolar IC50 values. Electrospray mass spectrometry confirmed the expected 1:1 stoichiometry of 3Cpro inactivation by 1, 2, and several other analogues. Compound 2 also proved to be useful for active site titration of 3Cpro, which has not been possible heretofore because of the lack of a suitable reagent. In contrast to 1, 2, and congeners, peptidyl Michael acceptors lacking a P4 residue have greatly reduced or negligible activity against 3Cpro, consistent with previously established structure-activity relationships for 3Cpro substrates. Hydrolysis of the P1 vinylogous glutamine ester to a carboxylic acid also decreased inhibitory activity considerably, consistent with the decreased reactivity of acrylic acids vs acrylic esters as Michael acceptors. Incorporating a vinylogous methionine sulfone ester in place of the corresponding glutamine derivative in 1 also reduced activity substantially. Compounds 1 and 2 and several of their analogues inhibited HRV replication in cell culture by 50% at low micromolar concentrations while showing little or no evidence of cytotoxicity at 10-fold higher concentrations. Peptidyl Michael acceptors and their analogues may prove useful as therapeutic agents for pathologies involving cysteine proteinase enzymes.
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Affiliation(s)
- J S Kong
- Department of Medicinal Chemistry, University of Kansas, Lawrence, Kansas 66045-2506, USA
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29
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Nimkar S, Sarma DD, Krishnamurthy HR. Erratum: Electronic structure of NaCuO2. Phys Rev B Condens Matter 1993; 48:17650. [PMID: 10008396 DOI: 10.1103/physrevb.48.17650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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30
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Nimkar S, Sarma DD, Krishnamurthy HR, Ramasesha S. Mean-field results of the multiple-band extended Hubbard model for the square-planar CuO2 lattice. Phys Rev B Condens Matter 1993; 48:7355-7363. [PMID: 10006901 DOI: 10.1103/physrevb.48.7355] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Stevens VL, Nimkar S, Jamison WC, Liotta DC, Merrill AH. Characteristics of the growth inhibition and cytotoxicity of long-chain (sphingoid) bases for Chinese hamster ovary cells: evidence for an involvement of protein kinase C. Biochim Biophys Acta 1990; 1051:37-45. [PMID: 2297538 DOI: 10.1016/0167-4889(90)90171-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Long-chain bases are potent inhibitors of protein kinase C and cellular processes mediated by this enzyme. However, when added to cells they usually cause some degree of growth inhibition and cytotoxicity and it is unclear whether this reflects inhibition of protein kinase C or nonspecific detergent effects of these amphipathic compounds. This study examined the effects of sphinganine on Chinese hamster ovary (CHO) cells to gain more insight into these possibilities. Sphinganine concentrations between 0.75 and 4 microM resulted in a combination of growth inhibition and cytotoxicity that correlated with protein kinase C inhibition by five criteria: (1) the effective concentrations were comparable to those for protein kinase C inhibition in vitro and in other intact cells; (2) the structural specificity for the long-chain base moiety paralleled the potency of protein kinase C inhibition; (3) sphinganine blocked changes in protein phosphorylation patterns that occurred in response to phorbol 12-myristate 13-acetate (and vice versa); whereas (4) a mutant cell line that exhibited increased resistance to sphinganine cytotoxicity lacked both phorbol ester- and sphinganine-induced phosphorylation changes and differed somewhat in the behavior of protein kinase C assayed in vitro; and (5) sphinganine did not appear to be acting as a detergent (except at higher concentrations) nor as a lysosomotrophic agent. While the complexity of this cellular behavior mandates caution in interpreting these results, they suggest that the cytotoxicity and growth inhibition may be a consequence of protein kinase C inhibition.
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Affiliation(s)
- V L Stevens
- Department of Biochemistry, Emory University, Atlanta, GA
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33
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Merrill AH, Nimkar S, Menaldino D, Hannun YA, Loomis C, Bell RM, Tyagi SR, Lambeth JD, Stevens VL, Hunter R. Structural requirements for long-chain (sphingoid) base inhibition of protein kinase C in vitro and for the cellular effects of these compounds. Biochemistry 1989; 28:3138-45. [PMID: 2742830 DOI: 10.1021/bi00434a004] [Citation(s) in RCA: 214] [Impact Index Per Article: 6.1] [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: 01/02/2023]
Abstract
Sphingosine, sphinganine, and other long-chain (sphingoid) bases inhibit protein kinase C in vitro and block cellular responses to agonists that are thought to act via this enzyme. To gain further insight into the mechanism of this inhibition, a series of long-chain analogues differing in alkyl chain length (11-20 carbon atoms), stereochemistry, and headgroup were examined for (a) inhibition of protein kinase C activity in vitro, (b) the neutrophil respiratory burst in response to phorbol myristate acetate (PMA), (c) the PMA-induced differentiation of HL-60 cells, and (d) the growth of Chinese hamster ovary cells. In every instance, the effects were maximal with the 18-carbon homologues, which are the same length as the predominant naturally occurring long-chain base (sphingosine). The lower potency of the shorter chain homologues was partially due to decreased uptake by cells. Small differences were obtained with the four stereoisomers of sphingosine (i.e., D and L forms of erythro- and threo-sphingosine), with N-methyl derivatives of the different sphingosine homologues, and with simpler alkylamines (e.g., stearylamine). The potency of the different headgroup analogues may be affected by the degree of protonation at the assay pH. The pKa of sphingosine was measured to be 6.7; the pKa varied among the analogues. These findings establish that the major structural features required for inhibition of protein kinase C and cellular processes dependent on this enzyme are the presence of a free amino group and an aliphatic side chain and that other groups have more subtle effects.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A H Merrill
- Department of Chemistry, Emory University School of Medicine, Atlanta, Georgia 30322
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34
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Merrill AH, Wang E, Mullins RE, Jamison WC, Nimkar S, Liotta DC. Quantitation of free sphingosine in liver by high-performance liquid chromatography. Anal Biochem 1988; 171:373-81. [PMID: 3407935 DOI: 10.1016/0003-2697(88)90500-3] [Citation(s) in RCA: 281] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Conditions were established for the extraction of free sphingosine from liver and the separation and quantitation of this and other long-chain (sphingoid) bases (e.g., sphingosine, sphinganine, phytosphingosine, and homologs) by reverse-phase high-performance liquid chromatography (HPLC). The long-chain bases were extracted with chloroform and methanol and then treated with base to remove interfering lipids. After preparation of the o-phthalaldehyde derivatives, the long-chain bases could be separated using C18 columns eluted isocratically with methanol:5 mM potassium phosphate, pH 7.0 (90:10). The HPLC analyses took 15 to 20 min per sample and had lower limits of detection in the picomole range. Quantitation was facilitated by using a 20-carbon long-chain base homolog as an internal standard. The utility of the method was demonstrated with rat liver, providing the first quantitation of free sphingosine in this tissue of approximately 7 nmol/g wet wt.
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Affiliation(s)
- A H Merrill
- Department of Biochemistry, Emory University, Atlanta, Georgia 30322
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