Acceptability of anal cancer screening tests for women living with HIV in the EVVA study

Background

Anal cancer is potentially preventable through screening. For screening to be implemented, the screening procedures must be acceptable to the affected population. The objective of the present study was to measure the acceptability of currently available anal cancer screening tests in a population of women living with hiv who had experienced the tests.

Methods

The evva study ("Evaluation of Human Immunodeficiency Virus, Human Papillomavirus, and Anal Intraepithelial Neoplasia in Women") is a prospective cohort study of adult women living with hiv in Montreal, Quebec. Participants were screened with cervical or anal hpv testing and cervical or anal cytology every 6 months for 2 years. High-resolution anoscopy (hra) and digital anal rectal examination (dare) were also performed systematically, with biopsies, at baseline and at 2 years. An acceptability questionnaire was administered at the final visit or at study withdrawal.

Results

Of 124 women who completed the acceptability questionnaire, most considered screening "an absolute necessity" in routine care for all women living with hiv [77%; 95% confidence interval (ci): 69% to 84%]. Yearly anal cytology or anal hpv testing was considered very acceptable by 81% (95% ci: 73% to 88%); hra every 2 years was considered very acceptable by 84% (95% ci: 77% to 90%); and yearly dare was considered very acceptable by 87% (95% ci: 79% to 92%). Acceptability increased to more than 95% with a longer proposed time interval. Pain was the main reason for lower acceptability.

Conclusions

Most participating women considered anal cancer screening necessary and very acceptable. Longer screening intervals and adequate pain management could further increase the acceptability of repeated screening.

Early Initiation Rather Than Prolonged Duration of Antiretroviral Therapy in HIV Infection Contributes to the Normalization of CD8 T-Cell Counts

BACKGROUND

CD8 T-cell counts remain elevated in human immunodeficiency virus (HIV) infection even after long-term antiretroviral therapy (ART), which is associated with an increased risk of non-AIDS-related events. We assessed the impact of ART initiation in early versus chronic HIV infection on trajectories of CD8 cell counts over time.

METHODS

Of 280 individuals enrolled during primary HIV infection (PHI), 251 were followed up for 24 months; 84 started ART before 6 months of infection (eART), 49 started between 6 and 24 months, and 118 remained untreated. Plasma HIV viral load (VL), CD4 and CD8 cell counts were assessed at each study visit. CD8 counts were also examined in 182 age-matched HIV-infected individuals who started ART during chronic infection and maintained undetectable plasma VL for ≥5 years.

RESULTS

At PHI baseline, higher CD8 cell counts were associated with more recent infection (P = .02), higher CD4 cell counts (P < .001), and higher VL (P < .001). The CD8 count in the eART group decreased from 797 to 588 cells/µL over 24 months (P < .001), to a level lower than that in untreated PHI (834 cells/µL; P = .004) or in long-term-treated patients with chronic HIV infection (743 cells/µL; P = .047). More prominent CD4 T-cell recovery was observed in the eART group than in the delayed ART group.

CONCLUSIONS

ART initiated in early HIV infection is associated with improved resolution of CD8 T-cell elevation compared with long-term ART initiated in chronic infection. Early ART may help reduce the risk of non-AIDS-related events by alleviating this elevation.

Poly(ethylene-co-butylene)-b-(styrene-ran-maleic anhydride)2 Compatibilizers via Nitroxide Mediated Radical Polymerization

Telechelic poly(ethylene-ran-butylene) initiator terminated with [tert-butyl[1-(diethoxyphosphoryl)-2,2-dimethylpropyl]amino] nitroxide groups (PEB-(SG1)2) was used to initiate the controlled radical copolymerization of maleic anhydride (MA) and styrene (ST). The ST/MA copolymerizations were performed in 1,4-dioxane at 110°C and resulted in PEB-b-P(ST-ran-MA)2 triblock copolymers with relatively narrow molecular weight distributions ( M ¯ m / M ¯ n ≈ 1.5 ) . Gel permeation chromatography (GPC) indicated that the initiator used was ≈93% efficient. The resulting copolymers were then blended as 20 wt.% dispersions in nylon 6 (PA6) at 230°C. With as little as 10 mol.% of MA in the feed to make the PEB-b-P(ST-ran-MA)2, blends were deemed dynamically compatibilized based on the reduced particle size. All of the PEB-b-P(ST-ran-MA)2/PA6 blends resulted in a minor phase particle size D ¯ vs = 0.1 μm while the PEB-b-P(ST)/PA6 blend had D ¯ vs = 1.15 μm (i.e. no MA in the copolymer). Tensile testing revealed yield stresses and strains decreased steadily from pure PA6 to non-reactive PEB-b-P(ST)2/PA6 to PEB-b-P(ST-ran-MA)2/PA6. However, no difference in tensile properties was observed between PEB-b-P(ST-ran-MA)2/PA6 samples made from PEB-b-P(ST-ran-MA)2 copolymer of varying MA content.

Fatigue curves of isokinetic contractions

Sixteen men and 16 women volunteer college students were tested for elbow flexion fatigue curve production on the Orthotron, an isokinetic testing device. Maximal voluntary contractions were obtained repeatedly, each contraction taking approximately 2 seconds to complete, with minimal (500 msec) intertrial rest, to exhaustion. To provide a basis for plotting the isokinetic fatigue curve, the degradation of torque values from initial to final contractions, was expressed as percentage of contraction time. Results obtained following statistical analysis of the data indicated that the isokinetic fatigue curve is: (1) curvilinear; (2) independent of sex differences; and (3) a function of initial strength. Moreover, it was found that the use of 50% of initial strength to denote fatigue in repetitive rhythmic isokinetic work has merit as a conservative estimate.