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Akmatov MK, Hu E, Rüsenberg R, Kollan C, Schmidt D, Kohring C, Holstiege J, Bickel M, Bätzing J. Areas with high HIV prevalence: A spatial analysis of nationwide claims data in Germany. HIV Med 2024; 25:498-503. [PMID: 38072823 DOI: 10.1111/hiv.13601] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/24/2023] [Indexed: 04/05/2024]
Abstract
OBJECTIVE We aimed to identify spatial clusters of high HIV prevalence in Germany. METHODS Using nationwide outpatient claims data comprising information of about 88% of the total German population (N = 72 041 683), we examined spatial variations and spatial clusters of high HIV prevalence at the district level (N = 401). People with HIV were identified using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10 codes) B20, B22, and B24 (HIV disease) documented as 'confirmed'. RESULTS Among 72 041 683 people with statutory health insurance in Germany in 2021, 72 636 had diagnosed HIV, which corresponds to a prevalence of 101 per 100 000 individuals (0.10%). Of these, 56 895 were males (78%). At a district level, the HIV prevalence varied by a factor of 32 between 13 in a rural district in Bavaria and 417 per 100 000 individuals in the German capital, Berlin. The spatial autocorrelation coefficient was 0.24 (p < 0.0001, Global Moran's I). Several high-prevalence spatial clusters of different sizes were identified, mostly located in western Germany. The largest cluster comprised eight districts in the southern part of Hesse, including the city of Frankfurt and the city of Mainz in Rhineland-Palatinate. The second cluster consisted of four districts in North Rhine-Westphalia, including the cities of Cologne and Düsseldorf. Two districts in southern Germany (Mannheim and Ludwigshafen) formed the third cluster. Only urban districts were observed in spatial clusters of high HIV prevalence. CONCLUSIONS The current study identified for the first time spatial clusters with high HIV prevalence in Germany. This understanding is of particular importance when planning the general and specialized medical care of patients with HIV and to support preventive measures.
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Affiliation(s)
- M K Akmatov
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care (Zi), Berlin, Germany
| | - E Hu
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care (Zi), Berlin, Germany
| | - R Rüsenberg
- German Association of Physicians in HIV-Care (dagnä e.V.), Berlin, Germany
| | - C Kollan
- Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - D Schmidt
- Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - C Kohring
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care (Zi), Berlin, Germany
| | - J Holstiege
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care (Zi), Berlin, Germany
| | - M Bickel
- Infektiologikum, Frankfurt am Main, Germany
| | - J Bätzing
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care (Zi), Berlin, Germany
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Lathouwers E, Wong EY, Brown K, Baugh B, Ghys A, Jezorwski J, Mohsine EG, Van Landuyt E, Opsomer M, De Meyer S, De Wit S, Florence E, Vandekerckhove L, Vandercam B, Brunetta J, Klein M, Murphy D, Rachlis A, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Arastéh K, Bickel M, Bogner J, Esser S, Faetkenheuer G, Jessen H, Kern W, Rockstroh J, Spinner C, Stellbrink HJ, Stoehr A, Antinori A, Castelli F, Chirianni A, De Luca A, Di Biagio A, Galli M, Lazzarin A, Maggiolo F, Maserati R, Mussini C, Garlicki A, Gasiorowski J, Halota W, Horban A, Parczewski M, Piekarska A, Belonosova E, Chernova O, Dushkina N, Kulagin V, Ryamova E, Shuldyakov A, Sizova N, Tsybakova O, Voronin E, Yakovlev A, Antela A, Arribas JR, Berenguer J, Casado J, Estrada V, Galindo MJ, Garcia Del Toro M, Gatell JM, Gorgolas M, Gutierrez F, Gutierrez MDM, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Rivero A, Rubio R, Viciana P, De Los Santos I, Clarke A, Gazzard BG, Johnson MA, Orkin C, Reeves I, Waters L, Benson P, Bhatti L, Bredeek F, Crofoot G, Cunningham D, DeJesus E, Eron J, Felizarta F, Franco R, Gallant J, Hagins D, Henry K, Jayaweera D, Lucasti C, Martorell C, McDonald C, McGowan J, Mills A, Morales-Ramirez J, Prelutsky D, Ramgopal M, Rashbaum B, Ruane P, Slim J, Wilkin A, deVente J, De Wit S, Florence E, Moutschen M, Van Wijngaerden E, Vandekerckhove L, Vandercam B, Brunetta J, Conway B, Klein M, Murphy D, Rachlis A, Shafran S, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Gasiorowski J, Halota W, Horban A, Piekarska A, Witor A, Arribas JR, Perez-Valero I, Berenguer J, Casado J, Gatell JM, Gutierrez F, Galindo MJ, Gutierrez MDM, Iribarren JA, Knobel H, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Pulido F, Ricart C, Rivero A, Santos Gil I, Blaxhult A, Flamholc L, Gisslèn M, Thalme A, Fehr J, Rauch A, Stoeckle M, Clarke A, Gazzard BG, Johnson MA, Orkin C, Post F, Ustianowski A, Waters L, Bailey J, Benson P, Bhatti L, Brar I, Bredeek UF, Brinson C, Crofoot G, Cunningham D, DeJesus E, Dietz C, Dretler R, Eron J, Felizarta F, Fichtenbaum C, Gallant J, Gathe J, Hagins D, Henn S, Henry KW, Huhn G, Jain M, Lucasti C, Martorell C, McDonald C, Mills A, Morales-Ramirez J, Mounzer K, Nahass R, Olivet H, Osiyemi O, Prelutsky D, Ramgopal M, Rashbaum B, Richmond G, Ruane P, Scarsella A, Scribner A, Shalit P, Shamblaw D, Slim J, Tashima K, Voskuhl G, Ward D, Wilkin A, de Vente J. Week 48 Resistance Analyses of the Once-Daily, Single-Tablet Regimen Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) in Adults Living with HIV-1 from the Phase III Randomized AMBER and EMERALD Trials. AIDS Res Hum Retroviruses 2020; 36:48-57. [PMID: 31516033 PMCID: PMC6944133 DOI: 10.1089/aid.2019.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/12/2022] Open
Abstract
Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is being investigated in two Phase III trials, AMBER (NCT02431247; treatment-naive adults) and EMERALD (NCT02269917; treatment-experienced, virologically suppressed adults). Week 48 AMBER and EMERALD resistance analyses are presented. Postbaseline samples for genotyping/phenotyping were analyzed from protocol-defined virologic failures (PDVFs) with viral load (VL) ≥400 copies/mL at failure/later time points. Post hoc analyses were deep sequencing in AMBER, and HIV-1 proviral DNA from baseline samples (VL <50 copies/mL) in EMERALD. Through week 48 across both studies, no darunavir, primary PI, or tenofovir resistance-associated mutations (RAMs) were observed in HIV-1 viruses of 1,125 participants receiving D/C/F/TAF or 629 receiving boosted darunavir plus emtricitabine/tenofovir-disoproxil-fumarate. In AMBER, the nucleos(t)ide analog reverse transcriptase inhibitor (N(t)RTI) RAM M184I/V was identified in HIV-1 of one participant during D/C/F/TAF treatment. M184V was detected pretreatment as a minority variant (9%). In EMERALD, in participants with prior VF and genoarchive data (N = 140; 98 D/C/F/TAF and 42 control), 4% had viruses with darunavir RAMs, 38% with emtricitabine RAMs, mainly at position 184 (41% not fully susceptible to emtricitabine), 4% with tenofovir RAMs, and 21% ≥ 3 thymidine analog-associated mutations (24% not fully susceptible to tenofovir) detected at screening. All achieved VL <50 copies/mL at week 48 or prior discontinuation. D/C/F/TAF has a high genetic barrier to resistance; no darunavir, primary PI, or tenofovir RAMs were observed through 48 weeks in AMBER and EMERALD. Only one postbaseline M184I/V RAM was observed in HIV-1 of an AMBER participant. In EMERALD, baseline archived RAMs to darunavir, emtricitabine, and tenofovir in participants with prior VF did not preclude virologic response.
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Affiliation(s)
| | - Eric Y Wong
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | - Bryan Baugh
- Janssen Research & Development LLC, Raritan, New Jersey
| | - Anne Ghys
- Janssen Pharmaceutica NV, Beerse, Belgium
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Krznaric I, Bickel M, Carganico A, De Leuw P, Haberl A, Knecht G, Koegl C, Lauscher P, Schüttfort G, Stephan C, Wolf E, Wolf T. Similar long-term efficacy of dual therapy containing raltegravir and a boosted protease inhibitor versus standard triple therapies in pretreated HIV-1-infected patients in a retrospective, real-life cohort of 14 years. HIV Med 2018; 19:662-667. [PMID: 29971922 DOI: 10.1111/hiv.12636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Raltegravir is used in many antiretroviral combinations, but its use in treatment-experienced patients without knowledge of baseline resistance is discussed controversially as a number of comparative studies have shown a higher rate of virological failure. However, it has been used frequently for the management of treatment failure, as it was the first integrase inhibitor to become available, and thus offered new options for patients with multiple resistance. The strategic use of raltegravir in this setting is examined in this study. METHODS In order to examine the efficacy of raltegravir in second and later lines of antiretroviral combinations, data for 740 patients from three clinical cohorts were analysed with a focus on the combinations that were used. These were stratified into the combination of two nonnucleoside reverse transcriptase inhibitors and raltegravir (2NRTIs + RAL), the combination of a boosted protease inhibitor and raltegravir (bPI + RAL), and other raltegravir-containing combinations. RESULTS The overall rate of virological suppression to < 50 HIV-1 RNA copies/mL was 69.5%. Although the baseline rate of virological suppression was higher for 2NRTIs + RAL than for the other strata, the outcomes were similar for all three groups at weeks 24, 48, 72 and 96. CONCLUSIONS These data indicate that, in a real-life setting, raltegravir can be used with a high virological success rate in treatment-experienced patients, and that the different combinations analysed (2NRTIs + RAL, bPI + RAL and others) show comparable rates of virological suppression.
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Affiliation(s)
- I Krznaric
- Centre for Infectious Diseases, Berlin, Germany
| | - M Bickel
- Infektiologikum (Centre for Infectious Diseases) Frankfurt, Frankfurt, Germany
| | - A Carganico
- Centre for Infectious Diseases, Berlin, Germany
| | - P De Leuw
- Infectious Diseases Division, Department of Internal Medicine II, HIV Center, University Hospital Frankfurt, Frankfurt, Germany
| | - A Haberl
- Infectious Diseases Division, Department of Internal Medicine II, HIV Center, University Hospital Frankfurt, Frankfurt, Germany
| | - G Knecht
- Infektiologikum (Centre for Infectious Diseases) Frankfurt, Frankfurt, Germany
| | - C Koegl
- MUC Research, Munich, Germany
| | | | - G Schüttfort
- Infectious Diseases Division, Department of Internal Medicine II, HIV Center, University Hospital Frankfurt, Frankfurt, Germany
| | - C Stephan
- Infectious Diseases Division, Department of Internal Medicine II, HIV Center, University Hospital Frankfurt, Frankfurt, Germany
| | - E Wolf
- MUC Research, Munich, Germany
| | - T Wolf
- Infectious Diseases Division, Department of Internal Medicine II, HIV Center, University Hospital Frankfurt, Frankfurt, Germany
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Cahn P, Kaplan R, Sax PE, Squires K, Molina JM, Avihingsanon A, Ratanasuwan W, Rojas E, Rassool M, Bloch M, Vandekerckhove L, Ruane P, Yazdanpanah Y, Katlama C, Xu X, Rodgers A, East L, Wenning L, Rawlins S, Homony B, Sklar P, Nguyen BY, Leavitt R, Teppler H, Cahn PE, Cassetti I, Losso M, Bloch MT, Roth N, McMahon J, Moore RJ, Smith D, Clumeck N, Vanderkerckhove L, Vandercam B, Moutschen M, Baril J, Conway B, Smaill F, Smith GHR, Rachlis A, Walmsley SL, Perez C, Wolff M, Lasso MF, Chahin CE, Velez JD, Sussmann O, Reynes J, Katlama C, Yazdanpanah Y, Ferret S, Durant J, Duvivier C, Poizot-Martin I, Ajana F, Rockstroh JK, Faetkanheuer G, Esser S, Jaeger H, Degen O, Bickel M, Bogner J, Arasteh K, Hartl H, Stoehr A, Rojas EM, Arathoon E, Gonzalez LD, Mejia CR, Shahar E, Turner D, Levy I, Sthoeger Z, Elinav H, Gori A, Monforte AD, Di Perri G, Lazzarin A, Rizzardini G, Antinori A, Celesia BM, Maggiolo F, Chow TS, Lee CKC, Azwa RISR, Mustafa M, Oyanguren M, Castillo RA, Hercilla L, Echiverri C, Maltez F, da Cunha JGS, Neves I, Teofilo E, Serrao R, Nagimova F, Khaertynova I, Orlova-Morozova E, Voronin E, Sotnikov V, Yakovlev AA, Zakharova NG, Tsybakova OA, Botes ME, Mohapi L, Kaplan R, Rassool MS, Arribas JR, Gatell JM, Negredo E, Ortega E, Troya J, Berenguer J, Aguirrebengoa K, Antela A, Calmy A, Cavassini M, Rauch A, Stoeckle M, Sheng WH, Lin HH, Tsai HC, Changpradub D, Avihingsanon A, Kiertiburanakul S, Ratanasuwan W, Nelson MR, Clarke A, Ustianowski A, Winston A, Johnson MA, Asmuth DM, Cade J, Gallant JE, Ruane PJ, Kumar PN, Luque AE, Panther L, Tashima KT, Ward D, Berger DS, Dietz CA, Fichtenbaum C, Gupta S, Mullane KM, Novak RM, Sweet DE, Crofoot GE, Hagins DP, Lewis ST, McDonald CK, DeJesus E, Sloan L, Prelutsky DJ, Rondon JC, Henn S, Scarsella AJ, Morales JO, Ramirez, Santiago L, Zorrilla CD, Saag MS, Hsiao CB. Raltegravir 1200 mg once daily versus raltegravir 400 mg twice daily, with tenofovir disoproxil fumarate and emtricitabine, for previously untreated HIV-1 infection: a randomised, double-blind, parallel-group, phase 3, non-inferiority trial. The Lancet HIV 2017; 4:e486-e494. [DOI: 10.1016/s2352-3018(17)30128-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/20/2022]
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Ihle C, Bahrs C, Freude T, Bickel M, Spielhaupter I, Wintermeyer E, Stollhof L, Grünwald L, Ziegler P, Pscherer S, Stöckle U, Nussler A. [Malnutrition in Elderly Trauma Patients - Comparison of Two Assessment Tools]. Z Orthop Unfall 2016; 155:184-193. [PMID: 27685613 DOI: 10.1055/s-0042-116822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: The prevalence of malnutrition in hospitalised patients is reported to be between 16 and 55 % across disciplines. Within hospital care, screening for malnutrition is required. However, in orthopaedics and trauma surgery, there is still no generally accepted recommendation for the methods for such a data survey. In the present study, the following aspects are to be investigated with the help of two established scores: (1) the prevalence of malnutrition in the patient population of geriatric trauma care, and (2) the correlation between methods of data survey. Material and Methods: Between June 2014 and June 2015, a consecutive series of hospitalised trauma patients were studied prospectively with two validated screening instruments to record nutritional status. The study was carried out at a municipal trauma surgery hospital, which is a first level interregional trauma centre as well as a university hospital. The Nutritional Risk Screening (NRS) and the Mini Nutritional Assessment (MNA Short and Long Form) were used. All patients were divided into three age groups: < 65 years, 65-80 years, and > 80 years. The prevalence of malnutrition in geriatric trauma patients and the correlation between the screening instruments were determined. For a better comparison, prescreening and main assessment were applied to all patients. For statistical evaluation, both quantitative and semi-quantitative parameters were used. Furthermore, the Kolmogorov-Smirnov test, Spearman's correlation analysis and the chi-square test were applied. These tests were two-sided and had a level of significance of 5 %. The present study was partially funded by the Oskar-Helene-Heim Foundation. Results: 521 patients (43.8 % women, 56.2 % men), with a mean age of 53.96 ± 18.13 years, were statistically evaluated within the present study. Depending on the method of the data survey, malnutrition (NRS≥3) in geriatric trauma patients varied from 31.3 % (65-80 years) to 60 % (> 80 years). With MNA, 28.8 and 54.3 % of patients were at risk of malnutrition (MNA 17-23.5), while the fractions of patients already suffering from malnutrition (MNA < 17) were 5.4 and 8.6 %, respectively. The correlation between the NRS and MNA total scores increases with the age of the patients. The correlation coefficient for patients under 65 years is r = - 0.380, while among patients aged between 65 and 80, it is r = - 0.481, and for patients over 80 years, there is a medium to strong correlation of r = - 0.638 (each with a Spearman correlation of p < 0.001). For the total population as well as the different age groups, statistically significant correlations were recorded between the categorised scores (chi-square test for linear trend, p < 0.001). Summary: The present study demonstrates high prevalence of malnutrition among the geriatric trauma patients. Because of its easy and rapid application, the NRS has an advantage in clinical use. It was shown that the two methods of data survey were highly correlated.
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Affiliation(s)
- C Ihle
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - C Bahrs
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - T Freude
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - M Bickel
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - I Spielhaupter
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - E Wintermeyer
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - L Stollhof
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - L Grünwald
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - P Ziegler
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - S Pscherer
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - U Stöckle
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - A Nussler
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
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Wolf T, Fuß B, Khaykin P, Berger A, Knecht G, Gute P, Brodt HR, Goepel S, Bickel M, Stuermer M, Stephan C. Improved virological and immunological efficacy of resistance-guided switch in antiretroviral therapy: a Frankfurt HIV cohort analysis. Med Microbiol Immunol 2014; 203:409-14. [PMID: 25148909 DOI: 10.1007/s00430-014-0350-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/29/2014] [Indexed: 12/15/2022]
Abstract
To evaluate the treatment outcome of antiretroviral therapy, depending on the use and utility of a concept of resistance-guided switch, patients from the Frankfurt HIV cohort have been followed for 24 weeks. If available, prior resistance data have been evaluated and patients were grouped into their expected viral response. The data of 354 patients were thus analysed, taking into account the genotypic sensitivity score of the administered medication (> or ≤2). When looking at the proportion of patients who achieved a viral load of <50/ml, the response rates differed significantly better for patients with a favourable resistance scoring as compared to an unfavourable one (71.9 % as compared to 56.0 %, p = 0.008). Interestingly, patients with a favourable resistance score also showed a better immunological response, as measured by median CD4 cell count of 391/µl [interquartal range (IQR) 250-530/µl] against 287/µl (IQR 174-449/µl) and a larger total increase of 141/µl against 38/µl. A significant virological and immunological benefit could be demonstrated for patients of a cohort with resistance-guided antiretroviral therapy adjustments.
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Affiliation(s)
- T Wolf
- Infectious Diseases Unit at Medical Department No. 2, HIVCENTER, Hospital of the Johann Wolfgang Goethe-University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
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Orozco A, Gemmell E, Bickel M, Seymour GJ. IL-1 beta, IL-12 and IL-18 levels in gingival fluid and serum of patients with gingivitis and periodontitis. Aust Dent J 2014. [DOI: 10.1111/j.1834-7819.2007.tb06135.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jung O, Haack HS, Brodt HR, Grützmacher P, Geiger H, Amann K, Gröne HJ, Bickel M. [Changing spectrum of renal disease in HIV infection]. Dtsch Med Wochenschr 2013; 138:1887-91. [PMID: 24022452 DOI: 10.1055/s-0033-1349438] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Renal disease is a common complication in HIV-infected patients. The causes and spectrum of kidney disease among these patients is extensive, including HIV-related and HIV unrelated causes. Our objective was to assess the changes in distribution of renal disease under antiretroviral therapy (ART). PATIENTS AND METHODS Retrospective analysis of all patients from the Frankfurt HIV Cohort (FHC) who underwent renal biopsy because of chronic, progressive renal disease between 1989 and 2012. Two time periods were defined: 1989-2001 (early period) and 2000-2012 (late period). RESULTS 69 HIV-infected patients, mostly Caucasian and male, underwent renal biopsy (early period: 22 patients, late period: 47 patients). During the total observation time immuncomplex-mediated glomerulonephritis (26.1 %), hypertensive (20.3 %) and diabetic nephropathy (20.3 %) were the most frequent causes of chronic renal disease. HIV-associated renal diseases were predominant in the first period, whereas hypertensive and diabetic kidney disease accounted for almost 50 % of cases diagnosed in the late period. Other types of renal disease frequently encountered during the late period include renal AA-amyloidosis and tenofovir-related kidney disease. CONCLUSION The underlying pathology of renal disease in HIV-infected patients is highly variable and evolving. Since the introduction of HAART, renal disease not directly related to HIV has become the predominant cause, reflecting the growing burden of co-morbidities in this aging population.
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Affiliation(s)
- O Jung
- Medizinische Klinik III - Funktionsbereich Nephrologie, Goethe Universität, Frankfurt am Main
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Bickel M, Khaykin P, Stephan C, Schmidt K, Buettner M, Amann K, Lutz T, Gute P, Haberl A, Geiger H, Brodt HR, Jung O. Acute kidney injury caused by tenofovir disoproxil fumarate and diclofenac co-administration. HIV Med 2013; 14:633-8. [PMID: 23980564 DOI: 10.1111/hiv.12072] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The renal elimination of tenofovir (TFV) may be subject to renal drug-drug interactions that may increase the risk of kidney injury. Case reports indicated that diclofenac might increase TFV-associated nephrotoxicity via a drug-drug interaction, leading to an increased intracellular TFV concentration in proximal tubular cells. METHODS A retrospective analysis of data for all patients from the Frankfurt HIV Cohort (FHC) who had diclofenac prescriptions between January 2008 and June 2012 was carried out. RESULTS Among 89 patients with diclofenac use, 61 patients (68.5%) were treated with tenofovir disoproxil fumarate (TDF) and 28 patients (31.5%) were treated with TDF-sparing combination antiretroviral therapy (cART). Thirteen patients (14.6%) developed acute kidney injury (AKI) shortly after initiating diclofenac treatment. AKI occurred exclusively in TDF-treated patients, although all had previously stable renal function. All cases were accompanied by new onset of at least two parameters indicating proximal tubular damage, such as normoglycaemic-glucosuria and hypophosphataemia. TFV-associated nephrotoxicity was demonstrated by renal biopsy in four cases. Additionally, 11.5% of patients on TDF treatment developed new-onset proximal tubular damage, while having a preserved glomerular filtration rate. In contrast, diclofenac did not affect renal function in patients with TDF-sparing cART, as only one case of isolated hypophataemia was observed in these patients. In univariate analysis, risk factors for AKI were TDF-containing cART (P = 0.0076) and pre-existing hypophosphataemia (P = 0.0086). CONCLUSIONS Drug-drug interaction caused by diclofenac could exacerbate TFV-associated nephrotoxicity. Diclofenac should be used with caution in patients on TDF therapy, especially in those with hypophosphataemia. Our findings need to be confirmed in larger studies.
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Affiliation(s)
- M Bickel
- Department of Infectious Disease, Goethe University, Frankfurt/Main, Germany
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10
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Wolf T, Goetsch U, Oremek G, Bickel M, Khaykin P, Haberl A, Bellinger O, Gottschalk R, Brodt HR, Stephan C. Tuberculosis skin test, but not interferon-γ-releasing assays is affected by BCG vaccination in HIV patients. J Infect 2012; 66:376-80. [PMID: 23159357 DOI: 10.1016/j.jinf.2012.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 10/26/2012] [Accepted: 11/06/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Of this study was to compare the results of tuberculin skin test (TST) with two interferon-γ releasing-assays (IGRA) in a cohort of HIV positive patients, to analyze impact of prior Bacille-Calmette-Guérin (BCG)-vaccination. METHODS Prospective cross sectional study, enrolling only asymptomatic adult HIV infected outpatients from a large German University hospital clinic. All participants were simultaneously tested for latent tuberculosis infection (LTBI) by QuantiFERON-TB Gold, T-SPOT.TB and TST. Only individuals with available definite results (positive/negative, indeterminates excluded) from all three test systems and recalling BCG-vaccination status by interview questionnaire were evaluated. RESULTS From 286 study participants, 133 were evaluable; BCG-vaccination history was positive for 18 individuals, and negative for 115. The proportion of individuals with a positive TST was significantly higher for vaccinated (n = 6, 33.3%) than for unvaccinated individuals (n = 13, 11.3%, p = 0.013). There were no significant differences in the proportion of patients with CDC stage C, origin from a TB endemic country or in the CD4 count between the two groups. CONCLUSION TST but not IGRAs interfered significantly with prior BCG vaccination in a cohort of HIV infected individuals from a low prevalence TB country. Therefore IGRA should preferentially be used for LTBI-testing in BCG-vaccinated adult HIV-patients.
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Affiliation(s)
- T Wolf
- Department of Medicine II, Infectious Diseases Unit, Johann Wolfgang Goethe-University Hospital, Theodor Stern Kai 7, 60590 Frankfurt, Germany
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11
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Bickel M, Marben W, Betz C, Khaykin P, Stephan C, Gute P, Haberl A, Knecht G, Wolf T, Brodt HR, Geiger H, Herrmann E, Jung O. End-stage renal disease and dialysis in HIV-positive patients: observations from a long-term cohort study with a follow-up of 22 years. HIV Med 2012; 14:127-35. [PMID: 22994610 DOI: 10.1111/j.1468-1293.2012.01045.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Renal disease is a common and serious complication in HIV-infected patients. METHODS A retrospective cohort analysis for the period 1989-2010 was carried out to determine the prevalence, incidence and risk factors for end-stage renal disease (ESRD). ESRD was defined as initiation of renal replacement therapy. Three time periods were defined: 1989-1996 [pre-highly active antiretroviral therapy (HAART)], 1997-2003 (early HAART) and 2004-2010 (late HAART). RESULTS Data for 9198 patients [78.2% male; 88.9% Caucasian; cumulative observation time 68 084 patient-years (PY)] were analysed. ESRD was newly diagnosed in 35 patients (0.38%). Risk factors for ESRD were Black ethnicity [relative risk (RR) 5.1; 95% confidence interval (CI) 2.3-10.3; P < 0.0001], injecting drug use (IDU) (RR 2.3; 95% CI 1.1-4.6; P = 0.02) and hepatitis C virus (HCV) coinfection (RR 2.2; 95% CI 1.1-4.2; P = 0.03). The incidence of ESRD decreased in Black patients over the three time periods [from 788.8 to 130.5 and 164.1 per 100 000 PY of follow-up (PYFU), respectively], but increased in Caucasian patients (from 29.9 to 41.0 and 43.4 per 100 000 PYFU, respectively). The prevalence of ESRD increased over time and reached 1.9 per 1000 patients in 2010. Mortality for patients with ESRD decreased nonsignificantly from period 1 to 2 (RR 0.72; P = 0.52), but significantly from period 1 to 3 (RR 0.24; P = 0.006), whereas for patients without ESRD mortality decreased significantly for all comparisons. ESRD was associated with a high overall mortality (RR 9.9; 95% CI 6.3-14.5; P < 0.0001). CONCLUSION As a result of longer survival, the prevalence of ESRD is increasing but remains associated with a high mortality. The incidence of ESRD declined in Black but not in Caucasian patients. IDU and HCV were identified as additional risk factors for the development of ESRD.
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Affiliation(s)
- M Bickel
- Department of Infectious Disease, Goethe University, Frankfurt/Main, Germany.
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12
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Bickel M, Morse Z, Okutan HM, Mizutani M, Hiroyasu K. The introduction of implant dentistry in the South Pacific Islands of Fiji. N Z Dent J 2011; 107:60-64. [PMID: 21721339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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13
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Bickel M, von Hentig N, Wieters I, Khaykin P, Nisius G, Haberl A, Stephan C, Herrmann E, Doerr HW, Brodt HR, Allwinn R. Immune Response after Two Doses of the Novel Split Virion, Adjuvanted Pandemic H1N1 Influenza A Vaccine in HIV-1-Infected Patients. Clin Infect Dis 2011; 52:122-7. [DOI: 10.1093/cid/ciq003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Vogel M, Ahlenstiel G, Hintsche B, Fenske S, Trein A, Lutz T, Schürmann D, Stephan C, Khaykin P, Bickel M, Mayr C, Baumgarten A, Buggisch P, Klinker H, John C, Gölz J, Staszewski S, Rockstroh JK. The influence of HAART on the efficacy and safety of pegylated interferon and ribavirin therapy for the treatment of chronic HCV infection in HIV-positive Individuals. Eur J Med Res 2010; 15:102-11. [PMID: 20452894 PMCID: PMC3352215 DOI: 10.1186/2047-783x-15-3-102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective This study was performed to investigate the impact of HAART versus no HAART and nucleoside free versus nucleoside containing HAART on the efficacy and safety of pegylated interferon and ribavirin therapy for the treatment of chronic HCV infection in HIV/HCV co-infected patients. In addition a control group of HCV mono-infected patients undergoing anti-HCV therapy was evaluated. Methods Multicenter, partially randomized, controlled clinical trial. HIV-negative and -positive patients with chronic HCV infection were treated with pegylated interferon alfa-2a and ribavirin (800 - 1200 mg/day) for 24 - 48 weeks in one of four treatment arms: HIV-negative (A), HIV-positive without HAART (B) and HIV-positive on HAART (C). Patients within arm C were randomized to receive open label either a nucleoside containing (C1) or a nucleoside free HAART (C2). Results 168 patients were available for analysis. By intent-to-treat analysis similar sustained virological response rates (SVR, negative HCV-RNA 24 weeks after the end of therapy) were observed comparing HIV-negative and -positive patients (54% vs. 54%, p = 1.000). Among HIV-positive patients SVR rates were similar between patients off and on HAART (57% vs. 52%, p = 0.708). Higher SVR rates were observed in patients on a nucleoside free HAART compared to patients on a nucleoside containing HAART, though confounding could not be ruled out and in the intent-to-treat analysis the difference was not statistically significant (64% vs. 46%, p = 0.209). Conclusions Similar response rates for HCV therapy can be achieved in HIV-positive and -negative patients. Patients on nucleoside free HAART reached at least equal rates of sustained virological response compared to patients on standard HAART.
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Affiliation(s)
- M Vogel
- Department of Internal Medicine I, Rheinische friedrich-Wilhelms-University, Germany
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15
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Wicker S, Rabenau H, Bickel M, Wolf T, Brodt R, Brandt C, Berger A, Doerr H, Lehmann R. Neue Grippe H1N1/2009: Infektionsübertragung auf medizinisches Personal. Dtsch Med Wochenschr 2009; 134:2443-6. [DOI: 10.1055/s-0029-1242012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Bickel M, Bodtländer A, Knecht GK, Stephan C, von Hentig N, Kurowski M, Gute P, Klauke S, Lutz T. Once-daily treatment with saquinavir mesylate (2000 mg) and ritonavir (100 mg) together with a fixed-dose combination of abacavir/lamivudine (600/300 mg) or tenofovir/emtricitabine (245/200 mg) in HIV-1-infected patients. J Antimicrob Chemother 2009; 64:1260-4. [PMID: 19776037 DOI: 10.1093/jac/dkp348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate the feasibility and pharmacokinetics of a once-daily regimen of 2000 mg saquinavir mesylate boosted with 100 mg ritonavir. PATIENTS AND METHODS Patients successfully treated with 1000 mg saquinavir boosted with 100 mg ritonavir twice daily together with two nucleoside or nucleotide reverse transcriptase inhibitors [N(t)RTIs] who were switched to 2000 mg saquinavir with 100 mg ritonavir once daily with unchanged N(t)RTI therapy were analysed. CD4 cells, HIV-RNA PCR and metabolic parameters were compared between baseline and 3, 6, 9 and 12 months after the switch. Saquinavir and ritonavir drug levels were measured before and a median of 3 weeks after switching from twice to once daily at 0, 1, 2, 4, 6, 9, 12 and 24 h after intake of the medication. The area under the serum concentration-time curve from 0 to 24 h (AUC(0-24)) was calculated using the trapezoidal rule. RESULTS Eighteen patients (16 males, median age of 41 years) with a median CD4 cell count of 464 cells/mm(3) were analysed. HIV-RNA PCR remained <500 copies/mL for all patients. After switching from 100 mg twice daily to 100 mg once daily, the AUC(0-24) for ritonavir decreased significantly [21 874 to 10 267 ng.h/mL, geometric mean ratio (GMR) = 0.47; P < 0.001], whereas the AUC(0-24) for saquinavir decreased only marginally from 35 000 to 34 490 ng.h/mL (GMR = 0.99; P = 0.426). The CD4 cell count and the fasting metabolic parameters remained unchanged. CONCLUSIONS Once-daily treatment with ritonavir-boosted saquinavir was well tolerated and resulted in similar saquinavir drug exposure despite much lower ritonavir concentrations when compared with a twice-daily dosing schedule.
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Affiliation(s)
- M Bickel
- HIVCENTER, JW Goethe University Hospital, Theodor Stern Kai 7, Frankfurt, Germany.
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Abstract
BACKGROUND This study evaluated the feasibility of fabricating implant abutments and crowns from pre-sintered feldspathic porcelain blocks using the chair-side CAD/CAM, CEREC3D((R)) system. METHODS Thirty-two implant analogues were divided into two groups. In the control group, prefabricated machined anatomical titanium (Ti) abutments were screw-retained to the analogues. In the test group, machined feldspathic porcelain abutments were cemented on prefabricated machined Ti links and screw-retained to the implant analogues. These feldspathic porcelain abutments were fabricated out of pre-sintered feldspathic porcelain blocks as duplicates of the abutments in the control group using the CAD/CAM, CEREC3D system. Thirty-two feldspathic porcelain crowns, also fabricated out of pre-sintered ceramic blocks, were then cemented with resin cement on all the abutments in both groups. All samples were subsequently subjected to fracture strength testing under static load. An unpaired t-test was used to compare fracture load values between the two groups. RESULTS The test group using feldspathic porcelain abutments and crowns showed statistically significant higher mean fracture strength than the control group with the Ti abutments and feldspathic porcelain crowns. CONCLUSIONS This preliminary study showed that the chair-side CAD/CAM technology can be utilized to fabricate customized ceramic abutments with their associated ceramic crowns using pre-sintered feldspathic porcelain blocks.
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Affiliation(s)
- M A Alfarsi
- College of Dentistry, King Khalid University, Saudi Arabia.
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18
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Bickel M, Eisen J, Stephan C, Crespi CM, Lutz T, Klauke S, Vogl TJ, Jacobi V, Yang OO, Staszewski S, Zangos S. A standardized, comprehensive magnetic resonance imaging protocol for rapid and precise quantification of HIV-1-associated lipodystrophy. HIV Med 2008; 8:413-9. [PMID: 17760732 DOI: 10.1111/j.1468-1293.2007.00487.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Although multiple methods have been proposed, there is no current gold standard for assessing HIV-1-associated lipodystrophy. METHODS HIV-1-infected participants were randomly enrolled and surveyed about changes in the abdomen, thigh, cheek and neck areas. Magnetic resonance imaging (MRI) sequences of these sites were obtained. Participants were grouped according to survey results, and the MRI measurements were compared between groups. RESULTS One hundred participants were included in the study, of whom 79% reported any body fat changes. Persons reporting increased abdominal girth had higher visceral ([mean+/-standard deviation] 142+/-75 vs. 59+/-48 cm2; P<0.0001) and total abdominal adipose tissue than those reporting no change (344+/-119 vs. 201+/-95 cm2; P<0.0001). The amount of localized fat was less for persons reporting sunken cheeks and reduced diameter of the legs compared with those who noted no changes (5.9+/-3.6 vs. 9.3+/-3.8 cm2; P<0.0001, and 35+/-28 vs. 112+/-56 cm2; P<0.0001). Participants reporting increased neck girth had a thicker fat layer in the dorsocervical region compared with those reporting no change (4.0+/-1.8 vs. 2.3+/-1.4 cm; P<0.0002). CONCLUSIONS MRI is a precise method for rapidly surveying body regions affected by HIV-1-associated lipodystrophy. Our proposed protocol provides a rapid, comprehensive survey of these areas, without the need to combine multiple modalities or to expose subjects to radiation.
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Affiliation(s)
- M Bickel
- HIV Medical Treatment and Research Unit, JW Goethe University, Frankfurt, Germany.
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19
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Bickel M, Gute P, Carlebach A, Mueller A, Klauke S. Nevirapine (NVP), tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC) is effective and well tolerated in naïve HIV-1 infected patients. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Wendig A, Stephan C, Khaykin P, Bickel M, Lennemann T, Knecht G, Lutz T, von Hentig N, Staszewski S. Lipometabolic side-effects of three ritonavir-boosted double protease inhibitor regimens without reverse transcriptase inhibitors. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Bickel M, Bodtlaender A, Knecht G, Kurowski M, Klauke S, Lutz T. Once-daily saquinavir (SAQ)/ritonavir (RTV) (2000/100 mg) with abacavir/lamivudine (600/300 mg) or tenofovir/emtricitabine (245/300 mg) in naïve patients. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Baumgardt C, Stephan C, Haberl AE, Brodt HR, Stuermer M, Klauke S, Gute P, Bickel M, Khaykin P, von Hentig N, Staszewski S. Virological and immunological response to three boosted protease inhibitor regimens. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Nguyen K, Rincon JC, Bickel M. Association of strong premature contacts and tooth mobility using T-Scan. Aust Dent J 2007. [DOI: 10.1111/j.1834-7819.2007.tb06161.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Cytokines are of major importance in periodontal disease progression. It is generally agreed that control of the Th1/Th2 balance is central to the immunoregulation of periodontal disease. There is increasing evidence in humans that the stable periodontal lesion is mediated by Th1 cells, while the progressive lesion sees a shift toward Th2 cells. Equally, there is conflicting evidence, mainly in animal models, that bone loss is mediated by Th1 responses, and that Th2 responses are protective. In the presence of IL-12, IL-18 induces Th1 responses while, in the absence of IL-12, it promotes Th2 responses. It is clear, therefore, that since IL-18 has the ability to induce either Th1 or Th2 differentiation, it becomes important to consider its role in periodontal disease. This review endeavors to give an overview of this cytokine and its relevance for periodontal disease.
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Affiliation(s)
- A Orozco
- School of Dentistry, Turbot Street, Brisbane 4000, Australia.
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25
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Bickel M, Zangos S, Jacobi V, Lutz T, Knecht G, Goebel F, Staszewski S, Klauke S. A randomized, open-label study to compare the effects of two different doses of recombinant human growth hormone on fat reduction and fasting metabolic parameters in HIV-1-infected patients with lipodystrophy. HIV Med 2007; 7:397-403. [PMID: 16903985 DOI: 10.1111/j.1468-1293.2006.00399.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 11/30/2022]
Abstract
BACKGROUND Several studies have shown beneficial effects of recombinant human growth hormone (r-hGH) in reducing visceral adipose tissue (VAT) in HIV-1-infected patients with lipodystrophy. METHODS Patients were randomized to r-hGH 4 mg daily (group A) or three times per week (group B) over 12 weeks, followed by a 2 mg daily maintenance dose for 12 weeks. Magnetic resonance imaging (MRI) scans were performed to assess body composition. RESULTS A total of 26 subjects were included in the study. VAT was reduced overall by 35.1 cm(2) (29.5%) at week 12 and by 49 cm(2) (39.9%) at week 24, respectively, compared with baseline (P<0.001 for both comparisons). By week 12, VAT was reduced by 27 and 29% (A vs B; P=0.47) while facial fat was reduced by 3.3 and 2.6 cm(2) in groups A and B, respectively (P=0.96). Over 24 weeks, VAT was reduced by 42 and 38% (P=0.35) and facial fat by 3.2 and 2.4 cm(2) in groups A and B, respectively (P=0.91), compared with baseline. There was a greater increase in high-density lipoprotein (HDL) in group A than in group B (4.9 vs 2.4 mg/dL in week 12 and 7.1 vs -0.4 mg/dL in week 24; P=0.03). Fasting insulin levels increased, whereas glucose and insulin measured in oral glucose tolerance tests remained unchanged. Drug-related side effects were transient and reversible, but more common in group A (67%) than in group B (29%). CONCLUSIONS This study confirms reports that r-hGH effectively reduces VAT, with a relatively small reduction of facial and limb fat.
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Affiliation(s)
- M Bickel
- HIV Treatment and Research Unit, JW Goethe University, Frankfurt, Germany.
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26
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Wolf T, Rickerts V, Staszewski S, Kriener S, Wassmann B, Bug G, Bickel M, Gute P, Brodt HR, Martin H. First case of successful allogeneic stem cell transplantation in an HIV-patient who acquired severe Aplastic Anemia. Haematologica 2007; 92:e56-8. [PMID: 17562594 DOI: 10.3324/haematol.11394] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [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: 11/09/2022] Open
Abstract
We report on the first successful allogeneic stem cell transplantation (SCT) in an HIV-infected patient with severe aplastic anemia (SAA) per- formed at a tertiary care institution. Highly active antiretroviral therapy (HAART) was administered until transplantation and restarted 34 days later with sustained virological response. The patient did however develop a rapid rise in HIV load during the interruption of HAART associated with an acute febrile illness. Due to the extended period between the onset of SAA until SCT, the posttransplant course was complicated by bacterial infections. Stage two skin GvHD, but no AIDS-defining opportunistic diseases were experienced. Neutrophils recovered to >0.5/nL on day +18 and the CD4 count reached 250/microL on day +71 and >500/microL on day +182. The patient is in good condition with an ECOG score of 0 twelve months after transplantation. This report demonstrates the feasibility of allogeneic stem cell transplantation in the HIV setting.
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Affiliation(s)
- T Wolf
- Department of Infectious Diseases, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany.
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27
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Lorenz MW, Stephan C, Harmjanz A, Staszewski S, Buehler A, Bickel M, von Kegler S, Ruhkamp D, Steinmetz H, Sitzer M. Both long-term HIV infection and highly active antiretroviral therapy are independent risk factors for early carotid atherosclerosis. Atherosclerosis 2007; 196:720-6. [PMID: 17275008 DOI: 10.1016/j.atherosclerosis.2006.12.022] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 12/18/2006] [Accepted: 12/21/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is controversy over whether or not chronic HIV infection contributes to atherosclerosis. We investigated the relationship between HIV infection, antiretroviral medication and ultrasound evidence of early atherosclerosis in the context of vascular risk factors. DESIGN A case-control design with 292 HIV-positive subjects and 1168 age- and sex-matched controls. METHODS We assessed vascular risk factors, blood pressure, serum lipids and carotid intima media thickness (IMT) in cases and controls. With multivariate regression models, we investigated the effects of HIV status and antiretroviral medication on IMT. RESULTS The common carotid artery (CCA) IMT value was 5.70% (95% confidence interval [3.08-8.38%], p<0.0001) or 0.044 mm [0.021-0.066 mm] (p=0.0001) higher in HIV-positives, adjusted for multiple risk factors. In the carotid bifurcation (BIF), the IMT values were 24.4% [19.5-29.4%] or 0.250 mm [0.198-0.303 mm] higher in HIV patients (p<0.0001). An investigation of antiretroviral substances revealed higher CCA- and BIF-IMT values in patients receiving combination antiretroviral therapy (HAART). CONCLUSIONS HIV infection and HAART are independent risk factors for early carotid atherosclerosis. Assuming a risk ratio similar to that in large population-based cohorts, the observed IMT elevation suggests that vascular risk is 4-14% greater and the "vascular age" 4-5 years higher in HIV-positive subjects. The underlying mechanisms remain to be clarified.
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Affiliation(s)
- M W Lorenz
- Johann Wolfgang Goethe University Hospital, Department of Neurology, Frankfurt am Main, Germany.
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Orozco A, Gemmell E, Bickel M, Seymour GJ. Interleukin-1 beta, interleukin-12 and interleukin-18 levels in gingival fluid and serum of patients with gingivitis and periodontitis. ACTA ACUST UNITED AC 2006; 21:256-60. [PMID: 16842511 DOI: 10.1111/j.1399-302x.2006.00292.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [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: 11/30/2022]
Abstract
INTRODUCTION Cytokines are of major importance in periodontal disease progression. Interleukin-12 (IL-12) stimulates interferon-gamma production by T helper type 1 (Th1) cells while IL-18 induces Th1 responses when present with IL-12 but Th2 responses in the absence of IL-12. IL-1beta has been correlated with periodontal disease destruction. This study determined the local concentrations of these cytokines in sites of gingivitis and periodontitis. METHODS Gingival crevicular fluid was collected from two sites in each of 10 gingivitis patients and from two gingivitis sites and two periodontitis sites from each of 10 periodontitis patients. Serum samples were also collected. IL-1beta, biologically active IL-12 p70, the IL-12 p40 subunit and IL-18 concentrations were determined by enzyme-linked immunoabsorbent assay. RESULTS IL-1beta and IL-18 concentrations were higher in the gingival crevicular fluid from periodontitis patients than in that from gingivitis patients; IL-18 concentrations were higher than those of IL-1beta. Very little IL-12, either p40 or p70, was detected in the gingival crevicular fluid samples. In the serum, very low levels of cytokines were found. The level of serum IL-12 p40, however, was higher than in the fluid from periodontitis sites of periodontitis patients. CONCLUSION The local production of IL-1beta and IL-18 in the gingival crevicular fluid increased with increasing inflammation and IL-18 was the predominant cytokine at both gingivitis and periodontitis sites. Very little IL-12 was detected with levels decreasing with increasing inflammation. These results suggest that there is an association between severity of periodontal disease and levels of IL-1, IL-12 and IL-18.
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Affiliation(s)
- A Orozco
- School of Dentistry, Brisbane, Qld, Australia.
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Mocroft A, Rockstroh J, Soriano V, Ledergerber B, Kirk O, Vinogradova E, Reiss P, Katlama C, Phillips AN, Lundgren JD, Losso M, Duran A, Vetter N, Karpov I, Vassilenko A, Clumeck N, De Wit S, Poll B, Machala L, Rozsypal H, Sedlacek D, Nielsen J, Lundgren J, Benfield T, Kirk O, Gerstoft J, Katzenstein T, Hansen ABE, Skinhøj P, Pedersen C, Zilmer K, Katlama C, Viard JP, Girard PM, Marc TS, Vanhems P, Pradier C, Dabis F, Dietrich M, Manegold C, Van Lunzen J, Stellbrink HJ, Staszewski S, Bickel M, Goebel FD, Fätkenheuer G, Rockstroh J, Schmidt R, Kosmidis J, Gargalianos P, Sambatakou H, Perdios J, Panos G, Banhegyi D, Mulcahy F, Yust I, Turner D, Burke M, Pollack S, Hassoun G, Sthoeger Z, Maayan S, Vella S, Chiesi A, Arici C, Pristerá R, Mazzotta F, Gabbuti A, Esposito R, Bedini A, Chirianni A, Montesarchio E, Vullo V, Santopadre P, Narciso P, Antinori A, Franci P, Zaccarelli M, Lazzarin A, Finazzi R, Monforte AD, Viksna L, Chaplinskas S, Hemmer R, Staub T, Reiss P, Bruun J, Maeland A, Ormaasen V, Knysz B, Gasiorowski J, Horban A, Prokopowicz D, Wiercinska-Drapalo A, Boron-Kaczmarska A, Pynka M, Beniowski M, Mularska E, Trocha H, Antunes F, Valadas E, Mansinho K, Matez F, Duiculescu D, Streinu-Cercel A, Vinogradova E, Rakhmanova A, Jevtovic D, Mokrás M, Staneková D, González-Lahoz J, Sánchez-Conde M, García-Benayas T, Martin-Carbonero L, Soriano V, Clotet B, Jou A, Conejero J, Tural C, Gatell JM, Miró JM, Blaxhult A, Karlsson A, Pehrson P, Ledergerber B, Weber R, Francioli P, Telenti A, Hirschel B, Soravia-Dunand V, Furrer H, Chentsova N, Barton S, Johnson AM, Mercey D, Phillips A, Johnson MA, Mocroft A, Murphy M, Weber J, Scullard G, Fisher M, Brettle R, Loveday C, Clotet B, Antunes F, Blaxhult A, Clumeck N, Gatell J, Horban A, Johnson A, Katlama C, Ledergerber B, Loveday C, Phillips A, Reiss P, Vella S, Lundgren J, Gjørup I, Kirk O, Friis-Moeller N, Mocroft A, Cozzi-Lepri A, Bannister W, Mollerup D, Podlevkareva D, Olsen CH, Kjær J. Are Specific Antiretrovirals associated with an Increased Risk of Discontinuation due to Toxicities or Patient/Physician Choice in patients with Hepatitis C Virus Coinfection? Antivir Ther 2005. [DOI: 10.1177/135965350501000704] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Liver damage associated with hepatitis C (HCV) may influence the likelihood of experiencing discontinuation due to toxicities or patient/physician choice (TOXPC) in patients taking combination antiretroviral therapy (cART). Little information to address this concern is available from clinical trials as patients with HCV are often excluded. Aims To compare incidence rates of discontinuation due to TOXPC associated with specific antiretrovial drugs in patients with or without HCV. Patients/methods A total of 4929 patients from EuroSIDA under follow-up from January 1999 on a specific nucleoside pair (zidovudine/lamivudine, didanosine/stavudine, stavudine/lamivudine, or other) with a third drug (abacavir, nelfinavir, indinavir, nevirapine, efavirenz, lopinavir/ ritonavir or other boosted-protease inhibitor (PI)-containing regimen) and with known HCV serostatus were studied for the incidence of discontinuation of any nucleoside pair or third drug due to TOXPC. Incidence rate ratios were derived from Poisson regression models. Results In total 1358 patients had HCV (27.5%). During 12 799 person-years of follow-up there were 2141 discontinuations due to TOXPC for nucleoside pairs and 2501 for third drugs. The incidence of discontinuation due to TOXPC was consistently higher in patients with HCV after stratification by nucleoside pair or third drug. After adjustment for CD4+ count, gender, exposure group, time on HAART, region and treatment regimen, there were few differences in the rate of discontinuation due to TOXPC in those with HCV compared with those without for any nucleoside pairs or third drugs. Similar results were seen when concentrating on discontinuation due to toxicities alone. Conclusions Although patients with HCV generally had higher rates of discontinuation due to TOXPC compared with patients without HCV, there was little evidence to suggest that this was associated with any specific nucleoside pair or third drug used as part of cART. Our results do not suggest that any specific component of cART is more poorly tolerated in patients with HCV or that the presence of HCV should influence the choice between antiretrovirals used as part of a cART regimen.
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Affiliation(s)
- Amanda Mocroft
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | | | | | | | - Ole Kirk
- Copenhagen HIV Program, Hvidovre Hospital, Copenhagen, Denmark
| | | | - Peter Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, the Netherlands
| | | | - Andrew N Phillips
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
| | - Jens D Lundgren
- Copenhagen HIV Program, Hvidovre Hospital, Copenhagen, Denmark
| | - M Losso
- Hospital JM Ramos Mejia, Buenos Aires
| | - A Duran
- Hospital JM Ramos Mejia, Buenos Aires
| | - N Vetter
- Pulmologisches Zentrum der Stadt Wien, Vienna
| | - I Karpov
- Belarus State Medical University, Minsk
| | | | - N Clumeck
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | - S De Wit
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | - B Poll
- Saint-Pierre Hospital, Brussels; R Colebunders, Institute of Tropical Medicine, Antwerp
| | | | | | | | | | | | | | - O Kirk
- Hvidovre Hospital, Copenhagen
| | | | | | | | | | | | - K Zilmer
- West-Tallinn Central Hospital, Tallinn
| | - C Katlama
- Hôpital de la Pitié-Salpétière, Paris
| | - J-P Viard
- Hôpital Necker-Enfants Malades, Paris
| | | | | | | | | | | | - M Dietrich
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | - C Manegold
- Bernhard-Nocht-Institut for Tropical Medicine, Hamburg
| | | | | | | | - M Bickel
- JW Goethe University Hospital, Frankfurt
| | | | | | | | | | | | | | | | | | - G Panos
- A Filandras and E Karabatsaki, 1st IKA Hospital, Athens
| | | | | | - I Yust
- Ichilov Hospital, Tel Aviv
| | | | | | | | | | | | - S Maayan
- Hadassah University Hospital, Jerusalem
| | - S Vella
- Istituto Superiore di Sanita, Rome
| | - A Chiesi
- Istituto Superiore di Sanita, Rome
| | | | | | | | - A Gabbuti
- Ospedale S. Maria Annunziata, Florence
| | | | | | | | | | - V Vullo
- Università di Roma La Sapienza, Rome
| | | | | | | | | | | | | | | | | | - L Viksna
- Infectology Centre of Latvia, Riga
| | | | | | - T Staub
- Centre Hospitalier, Luxembourg
| | - P Reiss
- Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam
| | | | | | | | | | | | - A Horban
- Centrum Diagnostyki i Terapii AIDS, Warsaw
| | | | | | | | | | | | - E Mularska
- Osrodek Diagnostyki i Terapii AIDS, Chorzow
| | | | | | | | | | - F Matez
- Hospital Curry Cabral, Lisbon
| | - D Duiculescu
- Spitalul de Boli Infectioase si Tropicale: Dr. Victor Babes, Bucarest
| | | | | | | | - D Jevtovic
- The Institute for Infectious and Tropical Diseases, Belgrade
| | | | | | | | | | | | | | | | - B Clotet
- Hospital Germans Trias i Pujol, Badalona
| | - A Jou
- Hospital Germans Trias i Pujol, Badalona
| | - J Conejero
- Hospital Germans Trias i Pujol, Badalona
| | - C Tural
- Hospital Germans Trias i Pujol, Badalona
| | - JM Gatell
- Hospital Clinic i Provincial, Barcelona
| | - JM Miró
- Hospital Clinic i Provincial, Barcelona
| | | | - A Karlsson
- Karolinska University Hospital, Stockholm
| | - P Pehrson
- Karolinska University Hospital, Huddinge
| | | | | | - P Francioli
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - A Telenti
- Centre Hospitalier Universitaire Vaudois, Lausanne
| | - B Hirschel
- Hospital Cantonal Universitaire de Geneve, Geneve
| | | | | | | | - S Barton
- St. Stephen's Clinic, Chelsea and Westminster Hospital, London
| | - AM Johnson
- Royal Free and University College London Medical School, London (University College Campus)
| | - D Mercey
- Royal Free and University College London Medical School, London (University College Campus)
| | - A Phillips
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - MA Johnson
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - A Mocroft
- Royal Free and University College Medical School, London (Royal Free Campus)
| | - M Murphy
- Medical College of Saint Bartholomew's Hospital, London
| | - J Weber
- Imperial College School of Medicine at St. Mary's, London
| | - G Scullard
- Imperial College School of Medicine at St. Mary's, London
| | - M Fisher
- Royal Sussex County Hospital, Brighton
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Bickel M, Rickerts V, Stephan C, Jacobi V, Rottmann C, Dauer B, Carlebach A, Thalhammer A, Miller V, Staszweski S. The Protease Inhibitor Transfer Study (PROTRA 1): abacavir and efavirenz in combination as a substitute for a protease inhibitor in heavily pretreated HIV-1-infected patients with undetectable plasma viral load. HIV Med 2005; 6:179-84. [PMID: 15876284 DOI: 10.1111/j.1468-1293.2005.00286.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the safety and efficacy of abacavir (ABC) and efavirenz (EFV) instead of a protease inhibitor (PI) in HIV-1-infected subjects treated with two nucleoside reverse transcriptase inhibitors (NRTIs) and one PI with undetectable viral loads (< 50 HIV -1 RNA copies/mL). To be eligible for inclusion, patients had to have a history of viral load < 400 copies/mL for at least 3 months and had to be naive to treatment with nonnucleoside reverse transcriptase inhibitors (NNRTIs) and ABC, but multiple pretreatment and treatment failure were allowed. DESIGN An open-label, single-centre pilot study of duration 48 weeks was conducted. ABC was added to the original treatment with two NRTIs and one PI at baseline, and at week 6 the PI was replaced by EFV. At each study visit, CD4 cell count, viral load [measured by polymerase chain reaction (PCR)] and clinical chemistry were measured. Fasting blood samples were taken at baseline and at weeks 12, 24, 36 and 48 to measure levels of cholesterol [high-density lipoprotein (HDL)/low-density lipoprotein (LDL)], triglycerides, insulin and C-peptide. Additionally, an oral glucose tolerance test (OGTT) was performed. A bioelectric impedance analysis (BIA) and a single slice abdominal and mid-thigh computed tomography (CT) scan were carried out to assess changes in body composition. RESULTS Thirty patients were included in the study. Three patients experienced ABC-hypersensitivity and one patient demonstrated virological failure caused by nonadherence. At week 48, all remaining patients had viral loads < 50 copies/mL with stable CD4 counts. The fasting metabolic parameters and abdominal fat distribution remained unchanged. CONCLUSIONS In heavily pretreated patients, ABC and EFV in combination provide an effective, simplified and well-tolerated alternative to PI treatment.
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Affiliation(s)
- M Bickel
- Department of Infectious Disease, HIV Treatment and Research Unit, JW Goethe University, Frankfurt, Germany.
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Abstract
In the frame of the re-certification measurements of the IAEA-375 soil reference material the activity concentration of four actinoids (U, Th, Pu and Am) was determined. The method is based on microwave digestion or aqua regia leaching, separation by extraction chromatography and alpha-particle counting source preparation by co-precipitation or electro-deposition. This article describes some of the problems encountered during the validation of the sample preparation method and their solutions.
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Affiliation(s)
- C Hill
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg, Geel B-2440, Belgium
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Abstract
This article describes the advantages and disadvantages of several analytical methods used to prepare the alpha-particle source. As a result of this study, a new method combining commercial extraction and ion chromatography prior to a final co-precipitation step is proposed. This method has been applied and validated on several matrices (soil, waters) in the framework of international intercomparisons. The integration of this method in a global procedure to analyze actinoids and radium from a single solution (or digested soil) is also described.
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Affiliation(s)
- J-G Decaillon
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg, Geel B-2440, Belgium.
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van Leth F, Conway B, Laplumé H, Martin D, Fisher M, Jelaska A, Wit FW, Lange JMA, Laplumé H, Lasala MB, Losso MH, Bogdanowicz E, Lattes R, Krolewiecki A, Zala C, Orcese C, Terlizzi S, Duran A, Ebensrteijn J, Bloch M, Russell O, Russell DB, Roth NR, Eu B, Austin D, Gowers A, Quan D, Demonty J, Peleman R, Vandercam B, Vogelaers D, van der Gucht B, van Wanzeele F, Moutschen MM, Badaro R, Grinsztejn B, Schechter M, Uip D, Netto EN, Coelho SS, Badaró F, Pilotto JH, Schubach A, Barros ML, Leite OHM, Kiffer CRV, Wunsch CT, Nunes D, Catalani A, de Cassia Alves LR, Dossin TJ, D'Alló de Oliveira MT, Martini S, Conway B, de Wet JJ, Montaner JSG, Murphy C, Woodfall B, Sestak P, Phillips P, Montessori V, Harris M, Tesiorowski A, Willoughby B, Voigt R, Farley J, Reynolds R, Devlaming S, Livrozet JM, Rozenbaum W, Sereni D, Valantin MA, Lascoux C, Milpied B, Brunet C, Billaud E, Huart A, Reliquet V, Charonnat MF, Sicot M, Esnault JL, Slama L, Staszewski S, Bickel M, Lazanas MK, Stavrianeas N, Mangafas N, Zagoreos I, Kourkounti S, Paparizos V, Botsi C, Clarke S, Brannigan E, Boyle N, Chiriani A, Leoncini F, Montella F, Francesco L, Ambu S, Farese A, Gargiulo M, Di Sora F, Lavria F, Folgori F, Beniowski M, Boron Kaczmarska A, Halota W, Prokopowicz D, Bander DB, Leszuzyszyn-Pynka MLP, Wnuk AW, Bakowska E, Pulik P, Flisiak R, Wiercinska-Drapalo A, Mularska E, Witor A, Antunes F, Sarmento RSE, Doroana M, Horta AA, Vasconcelos O, Andrews SM, Huisamen CB, Johnson D, Martin O, Bekker LG, Maartens G, Wilson D, Visagie CJ, David NJ, Rattley M, Nettleship E, Martin DJ, Keyser V, Moraites TM, Moorhouse MA, Pitt JA, Orrell CJ, Bester C, Parboosing R, Moodley P, Gathiram V, Woolf D, Bernasconi E, Magenta L, Cardiello P, Kroon E, Ungsedhapand C, Fisher M, Wilkins EGL, Stockwell E, Day J, Daintith RS, Perry N, Timaeus C, Intosh-Roffet JM, Powell A, Youle M, Tyrer M, Madge S, Drinkwater A, Cuthbertson Z, Carroll A, Becker S, Katner H, Rimland D, Saag MS, Thompson M, Witt M, Aguilar MM, LaVoy A, Illeman M, Guerrero M, Gatell J, Belsey E, Hirschel B, Potarca A, Cronenberg M, Kreekel L, Meester R, Khodabaks J, Botma HJ, Esrhir N, Farida I, Feenstra M, Jansen K, Klotz A, Mulder M, Ruiter G, Bass CB, Pluymers E, de Vlegelaer E, Leeneman (VCL) R, Carlier H, van Steenberge E, Hall D. Quality of Life in Patients Treated with First-Line Antiretroviral Therapy Containing Nevirapine And/Or Efavirenz. Antivir Ther 2004. [DOI: 10.1177/135965350400900512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To assess whether differences in safety profiles between nevirapine (NVP) and efavirenz (EFV), as observed in the 2NN study, translated into differences in ‘health related quality of life’ (HRQoL). Design A sub-study of the 2NN study, with antiretro-viral-naive patients randomly allocated to NVP (once or twice daily), EFV or NVP+EFV, in addition to stavudine and lamivudine. Methods Comparing differences in changes of HRQoL over 48 weeks as measured with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire, using analysis of variance. Results The 2NN study enrolled 1216 patients. No validated questionnaires were available for 244 patients, and 55 patients had no HRQoL data at all, leaving 917 patients eligible for this sub-study. A total of 471 (51%) had HRQoL measurements both at baseline and week 48. The majority (69%) of patients without HRQoL measurements did, however, complete the study. The change in the physical health score (PHS) was 3.9 for NVP, 3.4 for EFV and 2.4 for NVP+EFV ( P=0.712). For the mental health score (MHS) these values were 6.1, 7.0 and 3.9, respectively ( P=0.098). A baseline plasma HIV-1 RNA concentration (pVL) ≥100 000 copies/ml and a decline in pVL (per log10) were independently associated with an increase of PHS. An increase of MHS was only associated with pVL decline. Patients experiencing an adverse event during follow-up had a comparable change in PHS but a significantly smaller change in MHS, compared with those without an adverse event. Conclusions First-line ART containing NVP and/or EFV leads to an improvement in HRQoL. The gain in HRQoL was similar for NVP and EFV, but slightly lower for the combination of these drugs.
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Affiliation(s)
| | - Frank van Leth
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Brian Conway
- University of British Columbia, Vancouver, BC, Canada
| | - Hector Laplumé
- Hospital Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Des Martin
- Toga Laboratories, Edenvale, South Africa
| | - Martin Fisher
- Brighton and Sussex University Hospitals, Brighton, UK
| | - Ante Jelaska
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Conn., USA
| | - Ferdinand W Wit
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep MA Lange
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Affiliation(s)
- Nicolas Delaleu
- Department of Geriatric and Special Care Dentistry, University of Zurich, Switzerland
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Altzitzoglou T, Sibbens G, Bickel M, Bohnstedt A, Decaillon JG, Hill C, Holmes L. Characterisation of reference materials for radioactivity with assigned values traceable to the SI units. Appl Radiat Isot 2004; 61:395-9. [PMID: 15177377 DOI: 10.1016/j.apradiso.2004.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Institute for Reference Materials and Measurements participates in an IAEA co-ordinated project to upgrade Analytical Quality Control Services intercomparison materials to reference materials. The principal objective is to ensure that assigned property values are traceable to the International System of Units. General principles and practical mechanisms for achieving this traceability are described.
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Affiliation(s)
- T Altzitzoglou
- European Commission, DG Joint Research Centre, Institute for Reference Materials and Measurements Retieseweg 111, Geel B-2440, Belgium.
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Abstract
An international comparison for plutonium isotopic composition measurement, known as the Pu-2000 exercise, was organized by the ESARDA NDA-WG (European Safeguards Research and Development Association, Working Group on Techniques and Standards for Non-Destructive Assay). The aim of this comparison was to test X- and gamma-ray spectrometry methods over a large range of isotopic ratios. These methods are based on the complex analysis of several X- and gamma-rays in the KX region of the plutonium spectrum and also in the 120-700 keV energy range. The results obtained by the participants with their corresponding uncertainties are presented in this document and compared to the declared values. The main conclusions of the work are also given. No important bias due to an inadequate knowledge of the nuclear data for plutonium isotopes was observed.
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Affiliation(s)
- J Morel
- Laboratoire National Henri Becquerel, CEA-DIMRI-BNM, CEA-Saclay, Bât 602, BP52, Gif-sur-Yvette, Cedex 91191, France.
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Bickel M, Gossel M, Geisen K, Jaehne G, Lang HJ, Rosenburg R, Sandow J. Analysis of the anorectic efficacy of HMR1426 in rodents and its effects on gastric emptying in rats. Int J Obes (Lond) 2003; 28:211-21. [PMID: 14663491 DOI: 10.1038/sj.ijo.0802540] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Pharmacodynamics of HMR1426 in rodents. SUBJECTS Male and female rats and male mice. MEASUREMENTS 24 h feed consumption was measured. From the time curves IC(50) values of HMR1426 were calculated. Microanalysis of feeding behavior was determined. Macronutrient preference was measured, by offering rats three different diets. Gastric emptying was measured after liquid gastric loads or solid meals. In rats with gastric cannulas, milk consumption was measured with closed or open cannulas. Diabetes-related parameters and thyroid hormones were measured. RESULTS HMR1426 inhibited feed consumption dose-dependently in rodents. Microstructural analysis of feeding after HMR1426 differed from central acting anorectics. HMR1426 inhibited consumption of fat- and carbohydrate-enriched diets. Gastric emptying was dose- and time-dependently delayed. Gastric emptying correlated with the time course of the anorectic effect. In sham-fed rats, HMR1426 had no anorectic effect with open cannulas. Anorectic effect occurred with closed cannulas. We proved that HMR1426 is not a CCK(A) agonist. CONCLUSION The correlation between anorectic properties of HMR1426 and gastric emptying suggests that gastric emptying may cause the anorectic properties of HMR1426. The differences in microstructural feeding behavior between HMR1426 and centrally active anorectics makes it unlikely that HMR1426 acts via the CNS. Evidence for a peripheral mode of action is derived from sham-fed rats with open gastric fistula. When the milk fed was drained, HMR1426 was ineffective. HMR1426 is not a CCK(A) agonist. The molecular action of HMR1426 causing gastric emptying and its anorectic properties are under investigation.
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Affiliation(s)
- M Bickel
- Aventis Pharma Deutschland GmbH, Pharmacology, DI & A. Metabolic Diseases, Frankfurt am Main, Germany.
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Abstract
Analyses of cytokines mediating inflammatory reactions are key to understanding the etiopathology of various diseases. This study investigated differences in cytokine gene expression between pulps from healthy virgin teeth and from symptomatic vital teeth with severe caries lesions in a group of young, healthy individuals. The mRNA levels of IL-1alpha, IL-1beta, IL-6, IL-8, and IL-18 were measured concomitantly by quantitative real-time RT-PCR. IL-1alpha and IL-1beta were not expressed at significantly higher levels in symptomatic versus clinically healthy pulps, while the difference was significant for the other cytokines (log-rank test, P<0.05). A concordance test for independence revealed significant correlation between IL-1alpha and IL-1beta, and between IL-6, IL-8, and IL-18 mRNA levels (P<0.05). The cytokine-specific differences revealed a differential significance of gene expression in cytokine regulation. The hypothesis that increase of cytokine mRNA expression is part of host reaction in pulpitis was corroborated by our observation.
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Affiliation(s)
- Matthias Zehnder
- Division of Endodontics, School of Dental and Oral Surgery, Columbia University, New York, NY, USA.
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39
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Baum BJ, Scott J, Bickel M, Gombos G, Greenspan JS, Guo W, Park NH, Purdell-Lewis D, Ranney R, Schwarz E, Seymour G, Uoshima K. 5.3 Global challenges in research and strategic planning. Eur J Dent Educ 2002; 6 Suppl 3:179-184. [PMID: 12390276 DOI: 10.1034/j.1600-0579.6.s3.24.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Health sciences research is experiencing dramatic progress. How can dental schools throughout the world best make these research advances relevant for dental students, as well as providing them with the means to assess and utilize the research advances that will occur in the future? This complex question presents a critical challenge to the dental educational community. Research is clearly integral to the mission of dental education. By providing dental students with active learning strategies, dental educators can inculcate the ability for independent scientific thinking and thereby develop reflective as well as technically competent practitioners. However, there is a shortage of well-trained individuals to fill faculty and research positions in certain parts of the world. Global networks for mutual information exchange are imperative to overcome resource limitations in individual institutions, as is dedicated funding for research in the dental educational setting.
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Phillips AN, Miller V, Sabin C, Cozzi Lepri A, Klauke S, Bickel M, Doerr HW, Hill A, Staszewski S. Durability of HIV-1 viral suppression over 3.3 years with multi-drug antiretroviral therapy in previously drug-naive individuals. AIDS 2001; 15:2379-84. [PMID: 11740188 DOI: 10.1097/00002030-200112070-00005] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [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: 11/26/2022]
Abstract
BACKGROUND Relatively little is known about the long-term durability of viral suppression in individuals initially achieving a viral load of less than 50 copies/ml within 24 weeks of starting antiretroviral therapy, nor the extent to which therapy interruption accounts for the loss of suppression. METHODS We intensely followed all 336 antiretroviral-naive patients attending the Goethe Universitat Clinic who began multi-drug combination regimens and in whom a viral load of less than 50 copies/ml was achieved within 24 weeks, in order to assess the risk of viral load rebound. Inspection of case notes allowed the distinction of viral rebound according to whether there was an associated complete interruption of therapy. RESULTS A total of 61 patients experienced viral rebound during 543.1 person-years of follow-up, giving a 25.3% risk of rebound by 3.3 years from first achieving viral suppression. However, for 47 of the patients with viral rebound there was an associated documented complete interruption of antiretroviral therapy, mostly as a result of co-morbidities, leaving 14 who appear to represent a failure of the virological efficacy of therapy (viral breakthrough; 5.2% risk by 3.3 years). The risk of viral breakthrough declined with the increased duration of suppression (P = 0.01). CONCLUSION The intrinsic virological effectiveness of multi-drug antiretroviral therapy in previously drug-naive individuals appears to be such that viral suppression, once achieved, can be maintained for several years in patients not interrupting therapy. The major challenge is to develop regimens that can be taken consistently and safely for such long periods of time.
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Affiliation(s)
- A N Phillips
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK
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41
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Suppes T, Leverich GS, Keck PE, Nolen WA, Denicoff KD, Altshuler LL, McElroy SL, Rush AJ, Kupka R, Frye MA, Bickel M, Post RM. The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. J Affect Disord 2001; 67:45-59. [PMID: 11869752 DOI: 10.1016/s0165-0327(01)00432-3] [Citation(s) in RCA: 299] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Since recent NIMH Bipolar Disorder Workshops highlighted the dearth of longitudinal and controlled studies of bipolar illness, the Stanley Foundation Bipolar Network (SFBN) has recruited a large cohort of patients with bipolar disorder to begin to address these issues. This report describes the demographics and course of illness characteristics of this study population. METHODS The first 261 outpatients to be diagnosed by the Structured Clinical Interview for DSM-IV (SCID) and complete a detailed patient and a brief clinician questionnaire are described. All patients met DSM-IV criteria for bipolar I (n=211), bipolar II (n=42), or NOS (n=5) or schizoaffective (n=3), bipolar type. Chi-square and t-tests were used to examine statistically significant associations among important demographic and descriptive items. RESULTS The general demographic and illness characteristics were similar to those in many bipolar clinical samples and not dissimilar from those reported in epidemiological surveys. The majority of patients had been hospitalized, with almost half reporting a worsening of illness over time, and two-thirds were not asymptomatic between episodes. First treatment for patients had been delayed by an average of 10 years from illness onset (by SCID). Almost a third of patients had attempted suicide at least once, and 30% reported current suicidal ideation at study entry. A total of 62% reported moderate to severe impact of the illness on occupational functioning. Early onset bipolar illness (< or =17 years old) was associated with increased frequency of mood switches, worsening course of illness, and history of early abuse (physical, verbal, or sexual). CONCLUSION The SFBN represents a sample of predominantly BP I patients largely recruited from the community who will be followed in detail longitudinally, participate in clinical trials, and thus help advance our understanding and treatment of this life-threatening medical disorder. While there is a broad range of illness characteristics and severity, the majority of patients have been severely impacted by their illness despite the availability of multiple conventional treatment approaches in the community. These data further underscore the need for development of new and earlier treatment interventions. LIMITATION The SFBN population is limited by the lack of random selection and represents a cohort willing to be treated and followed intensively in academic tertiary referral centers. While its characteristics are similar to many clinical study populations, the generalizability to non-clinic populations remains uncertain.
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Affiliation(s)
- T Suppes
- The Stanley Foundation Bipolar Network, 5430 Grosvenor Lane, Suite 200, Bethesda, MD 20814, USA.
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42
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Lottaz D, Beleznay Z, Bickel M. Inhibition of ATP-binding cassette transporter downregulates interleukin-1beta-mediated autocrine activation of human dermal fibroblasts. J Invest Dermatol 2001; 117:871-6. [PMID: 11676825 DOI: 10.1046/j.0022-202x.2001.01451.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/20/2022]
Abstract
Fibroblasts constitute an important source of cytokines during inflammatory processes in the skin. Interleukin-1 is a potent, pleiotropic cytokine that is induced in activated human dermal fibroblasts. Interleukin-1 further induces many inflammatory mediators, including the chemokine interleukin-8. As fibroblasts express both interleukin-1 and the interleukin-1 receptor complex, the cellular response may be enhanced by autocrine activation. Interleukin-1alpha and interleukin-1beta lack a signal peptide and are translocated at the plasma membrane using an alternative secretory pathway, which may involve ATP-binding cassette transporter proteins. We hypothesize that inhibition of this pathway prevents secretion of interleukin-1, thereby downregulating interleukin-1-dependent autocrine induction of interleukin-8. We used the ATP-binding cassette 1 transporter inhibitor glybenclamide, which has been previously shown to block interleukin-1beta secretion in human monocytes. Using enzyme-linked immunosorbent assay, we assessed the effect of glybenclamide on interleukin-8 production in human dermal fibroblasts. In interleukin-1beta-transfected human dermal fibroblasts, interleukin-8 was induced through an autocrine activity of interleukin-1beta. Glybenclamide disabled this activation loop and significantly reduced interleukin-8. In human dermal fibroblasts that were stimulated with tumor necrosis factor alpha to reach high interleukin-1 expression levels, glybenclamide similarly suppressed interleukin-8. In contrast, glybenclamide did not affect interleukin-8 production in cells stimulated with interleukin-1 only. Glybenclamide did not affect caspase-1 in fibroblasts, which was expressed as an inactive precursor form, irrespective of treatments with tumor necrosis factor alpha and/or glybenclamide. Using overexpressing, interleukin-1-transfected COS-1 cells, inhibition of interleukin-1alpha and interleukin-1beta secretion was directly demonstrated on Western blots. These results are consistent with glybenclamide preventing externalization of interleukin-1 and subsequent autocrine induction of interleukin-8 in human dermal fibroblasts. Acting through such a mechanism, ATP-binding cassette transporter inhibitors may downregulate inflammation locally.
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Affiliation(s)
- D Lottaz
- Laboratory of Oral Cell Biology, University of Bern, Switzerland
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43
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Abstract
BACKGROUND Cytokines play an important rôle in controlling inflammatory processes and tissue homeostasis. Periodontitis, as any other chronic inflammatory disease, results from a disarrangement of host factors, mainly cytokines and the initiating agent. Modulation of the cytokines is not only controlled by the host but also by infecting bacteria and their products. AIM In the present study, we examined the cytokine mRNA expression profiles in six patients, each presenting sites affected with (1) severe progressive periodontitis, (2) chronic, but stable periodontal lesions, and (3) with healthy sites. Analysis using a quantitative RT-PCR included IFN-gamma, IL-1beta, IL-2, IL-4, IL-5, IL-6, and TNF-alpha. MATERIAL AND METHODS 6 patients with chronic periodontitis were following treatment observed for a period of six years for local sites staying healthy, local sites with periodontal pathology but without signs of progression of attachment loss and sites with verified progression were biopsied. The biopsies were lyzed and analyzed for levels of cytokine mRNAs. RESULTS Results revealed considerable variation not only between patients, but also between individual sites. Each patient's site has thus to be looked at as an independent entity. CONCLUSIONS The local action of cytokines, which is heavily dependent on recruitment, interaction and activation of immunocompetent cells can explain the site-specific nature of cytokine expression. Cytokine data from individual sites together with the local clinical status and data from the literature demonstrate the complexity of periodontal disease pathogenesis. To gain insight to specific mechanisms further studies are needed.
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Affiliation(s)
- M Bickel
- Laboratory of Oral Cell Biology, University of Bern, 3010 Bern, Switzerland.
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44
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Abstract
Interleukin-1 (IL-1) is one of the most important proinflammatory cytokines, regulating immunological and inflammatory processes. It induces a very efficient and self-amplifying cytokine-network. The action of IL-1 must, therefore, be under tight control. Soluble IL-1 receptor was thought to be an efficient negative regulator of the IL-1 signaling system. However, recent studies in vitro and in vivo demonstrate that soluble IL-1 receptor can act as an agonist as well, inducing intracellular signaling events. This feature of soluble IL-1 receptor adds a new level of complexity to our understanding of ligand-receptor cross-talk and cell-to-cell communication.
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Affiliation(s)
- B Spörri
- ZLB Bioplasma AG, Research and Development, CH-3000 22, Bern, Switzerland.
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45
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Ledergerber B, Mocroft A, Reiss P, Furrer H, Kirk O, Bickel M, Uberti-Foppa C, Pradier C, D'Arminio Monforte A, Schneider MM, Lundgren JD. Discontinuation of secondary prophylaxis against Pneumocystis carinii pneumonia in patients with HIV infection who have a response to antiretroviral therapy. Eight European Study Groups. N Engl J Med 2001; 344:168-74. [PMID: 11188837 DOI: 10.1056/nejm200101183440302] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with human immunodeficiency virus (HIV) infection and a history of Pneumocystis carinii pneumonia are at high risk for relapse if they are not given secondary prophylaxis. Whether secondary prophylaxis against P. carinii pneumonia can be safely discontinued in patients who have a response to highly active antiretroviral therapy is not known. METHODS We analyzed episodes of recurrent P. carinii pneumonia in 325 HIV-infected patients (275 men and 50 women) in eight prospective European cohorts. Between October 1996 and January 2000, these patients discontinued secondary prophylaxis during treatment with at least three anti-HIV drugs after they had at least one peripheral-blood CD4 cell count of more than 200 cells per cubic millimeter. RESULTS Secondary prophylaxis was discontinued at a median CD4 cell count of 350 per cubic millimeter; the median nadir CD4 cell count had been 50 per cubic millimeter. The median duration of the increase in the CD4 cell count to more than 200 per cubic millimeter after discontinuation of secondary prophylaxis was 11 months. The median follow-up period after discontinuation of secondary prophylaxis was 13 months, yielding a total of 374 person-years of follow-up; for 355 of these person-years, CD4 cell counts remained at or above 200 per cubic millimeter. No cases of recurrent P. carinii pneumonia were diagnosed during this period; the incidence was thus 0 per 100 patient-years (99 percent confidence interval, 0 to 1.2 per 100 patient-years, on the basis of the entire follow-up period, and 0 to 1.3 per 100 patient-years, on the basis of the follow-up period during which CD4 cell counts remained at or above 200 per cubic millimeter). CONCLUSIONS It is safe to discontinue secondary prophylaxis against P. carinii pneumonia in patients with HIV infection who have an immunologic response to highly active antiretroviral therapy.
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Affiliation(s)
- B Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.
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Abstract
Human dermal fibroblasts (HDF) undergo activation and secrete cytokines when cocultured with T cells. Here, we identify potent activators of HDF among human peripheral CD2(+)-lymphocytes. Populations with strong HDF activating capacity consisted essentially of cells with a natural killer (NK) surface marker phenotype (CD3(-), CD4(-), CD8(-), CD56(+)). Addition of these cells to HDF resulted in rapid increase of intracellular free calcium concentrations as an early rapid cell activation signal. Upregulation of mRNA encoding for the inflammatory cytokines IL-1 beta and IL-6 as well as for chemokines IL-8 and MCP-1 was detected after cells were cocultured. Elevated concentrations of IL-6 and IL-8 were found in coculture supernatants of HDF and NK-cells. Skin-homing NK cells leaving the blood-stream during an inflammatory skin reaction might therefore represent potent activators of local inflammatory cytokine and chemokine production.
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Affiliation(s)
- K M Müller
- Laboratory of Oral Cell Biology, University of Bern, 3010 Bern, Switzerland
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47
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Rickerts V, Bickel M, Tews J, Jacobi V, Staszewski S. A case of lipodystrophy after the initiation of zidovudine, lamivudine and efavirenz in an asymptomatic HIV-1-infected patient. HIV Med 2000; 1:164-5. [PMID: 11737346 DOI: 10.1046/j.1468-1293.2000.00021.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- V Rickerts
- Klinikum der Johann Wolfgang Goethe-Universität, Zentrum der Inneren Medizin, Infektionsambulanz, Haus 68, Theodor-Stern-Kai 7, Frankfurt, Germany
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Abstract
The first part of comparison study was based on the properties of different sorbents. These included different forms of manganese oxides, and specific organic ion-exchangers: HYPHAN and POLYORGS. In order to provide reproducible samples with moderate presence of possible interferences, spiked tap water was used for this first set of experiments. Results indicate that the sorption of Th, U, Pu and Am varies for different forms of manganese oxides. These variations are attributed to different physico-chemical properties of the oxides. HYPHAN was limited in its sorption to Th and U. The manganese oxide dissolved rapidly and the radiochemical separation procedure was quick and simple using extraction chromatography techniques. The radionuclides in the water samples were determined by ICP-MS and/or alpha spectrometry.
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Torres J, Llauradó M, Rauret G, Bickel M, Altzitzoglou T, Pilviö R. Determination of 90Sr in aquatic organisms by extraction chromatography: method validation. Anal Chim Acta 2000. [DOI: 10.1016/s0003-2670(00)00834-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Zhang WJ, Marx SK, Laue C, Hyder A, Juergensen A, Bickel M, Schrezenmeir J. HOE 077 reduces fibrotic overgrowth around the barium alginate microcapsules. Transplant Proc 2000; 32:206-9. [PMID: 10701026 DOI: 10.1016/s0041-1345(99)00938-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- W J Zhang
- Institute of Physiology and Biochemistry, Federal Research Centre, Kiel, Germany
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