1
|
Middleton L, Smith J, Chabela A, Howard A, Murrman M, El-Sadr W. Fostering the nursing/midwifery workforce in sub-Saharan Africa. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
2
|
Mantell JE, DiCarlo AL, Remien RH, Zerbe A, Morris D, Pitt B, Nkonyana JP, Abrams EJ, El-Sadr W. 'There's no place like home': perceptions of home-based HIV testing in Lesotho. Health Educ Res 2014; 29:456-469. [PMID: 24599266 PMCID: PMC4021194 DOI: 10.1093/her/cyu004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 01/23/2014] [Indexed: 05/31/2023]
Abstract
HIV testing has the potential to reduce HIV transmission by identifying and counseling individuals with HIV, reducing risk behaviors, linking persons with HIV to care and earlier treatment, and reducing perinatal transmission. In Lesotho, a high HIV prevalence country in which a large proportion of the population has never tested for HIV, home-based testing (HBT) may be an important strategy to increase HIV testing. We identified factors influencing acceptability of HIV prevention strategies among a convenience sample of 200 pregnant or post-partum Basotho women and 30 Basotho men. We first conducted cross-sectional surveys, followed by key informant interviews with all 30 men and focus group discussions with a sub-set of 62 women. In total, 82% of women reported positive perceptions of HBT; women and men viewed HBT as a potential way to increase testing among men and saw the home as a comfortable, supportive environment for testing and counseling couples and families together. Potential barriers to HBT uptake included concerns about confidentiality, privacy, coercion to test, conflict within the family and fear of HIV/AIDS-associated stigma. Participants emphasized community mobilization and education as important elements of HBT.
Collapse
Affiliation(s)
- J E Mantell
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100.
| | - A L DiCarlo
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100.Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - R H Remien
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - A Zerbe
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - D Morris
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - B Pitt
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - J P Nkonyana
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - E J Abrams
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| | - W El-Sadr
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute & Columbia University, 1051 Riverside Dr., Unit 15, New York, NY 10032, USA, Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY 10032, USA, ICAP, Columbia University, Mailman School of Public Health, New York, NY 10032, USA and Department of Disease Control, Lesotho Ministry of Health, Maseru, Lesotho 100
| |
Collapse
|
3
|
Petoumenos K, Reiss P, Ryom L, Rickenbach M, Sabin CA, El-Sadr W, d'Arminio Monforte A, Phillips AN, De Wit S, Kirk O, Dabis F, Pradier C, Lundgren JD, Law MG. Increased risk of cardiovascular disease (CVD) with age in HIV-positive men: a comparison of the D:A:D CVD risk equation and general population CVD risk equations. HIV Med 2014; 15:595-603. [PMID: 24840675 DOI: 10.1111/hiv.12162] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to statistically model the relative increased risk of cardiovascular disease (CVD) per year older in Data collection on Adverse events of anti-HIV Drugs (D:A:D) and to compare this with the relative increased risk of CVD per year older in general population risk equations. METHODS We analysed three endpoints: myocardial infarction (MI), coronary heart disease (CHD: MI or invasive coronary procedure) and CVD (CHD or stroke). We fitted a number of parametric age effects, adjusting for known risk factors and antiretroviral therapy (ART) use. The best-fitting age effect was determined using the Akaike information criterion. We compared the ageing effect from D:A:D with that from the general population risk equations: the Framingham Heart Study, CUORE and ASSIGN risk scores. RESULTS A total of 24 323 men were included in analyses. Crude MI, CHD and CVD event rates per 1000 person-years increased from 2.29, 3.11 and 3.65 in those aged 40-45 years to 6.53, 11.91 and 15.89 in those aged 60-65 years, respectively. The best-fitting models included inverse age for MI and age + age(2) for CHD and CVD. In D:A:D there was a slowly accelerating increased risk of CHD and CVD per year older, which appeared to be only modest yet was consistently raised compared with the risk in the general population. The relative risk of MI with age was not different between D:A:D and the general population. CONCLUSIONS We found only limited evidence of accelerating increased risk of CVD with age in D:A:D compared with the general population. The absolute risk of CVD associated with HIV infection remains uncertain.
Collapse
Affiliation(s)
- K Petoumenos
- AHOD, The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Worm SW, Kamara DA, Reiss P, Fontas E, De Wit S, El-Sadr W, D′Arminio Monforte A, Law M, Phillips A, Ryom L, Dabis F, Weber R, Sabin C, Lundgren JD. Evaluation of HIV Protease Inhibitor Use and the Risk of Sudden Death or Nonhemorrhagic Stroke. J Infect Dis 2012; 205:535-9. [DOI: 10.1093/infdis/jir788] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
5
|
Petoumenos K, Worm S, Reiss P, de Wit S, d'Arminio Monforte A, Sabin C, Friis-Møller N, Weber R, Mercie P, Pradier C, El-Sadr W, Kirk O, Lundgren J, Law M. Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A:D study(*). HIV Med 2011; 12:412-21. [PMID: 21251183 PMCID: PMC3070963 DOI: 10.1111/j.1468-1293.2010.00901.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The aim of the study was to estimate the rates of cardiovascular disease (CVD) events after stopping smoking in patients with HIV infection. METHODS Patients who reported smoking status and no previous CVD prior to enrolment in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study were included in this study. Smoking status is collected at each visit as current smoker (yes/no) and ever smoker (yes/no). Time since stopping smoking was calculated for persons who had reported current smoking during follow-up and no current smoking subsequently. Endpoints were: myocardial infarction (MI); coronary heart disease (CHD: MI plus invasive coronary artery procedure or death from other CHD); CVD (CHD plus carotid artery endarterectomy or stroke); and all-cause mortality. Event rates were calculated for never, previous and current smokers, and smokers who stopped during follow-up. Incidence rate ratios (IRRs) were determined using Poisson regression adjusted for age, sex, cohort, calendar year, family history of CVD, diabetes, lipids, blood pressure and antiretroviral treatment. RESULTS A total of 27 136 patients had smoking status reported, with totals of 432, 600, 746 and 1902 MI, CHD, CVD and mortality events, respectively. The adjusted IRR of CVD in patients who stopped smoking during follow-up decreased from 2.32 within the first year of stopping to 1.49 after >3 years compared with those who never smoked. Similar trends were observed for the MI and CHD endpoints. Reductions in risk were less pronounced for all-cause mortality. CONCLUSION The risk of CVD events in HIV-positive patients decreased with increasing time since stopping smoking. Smoking cessation efforts should be a priority in the management of HIV-positive patients.
Collapse
Affiliation(s)
- K Petoumenos
- AHOD, National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Hirsch-Moverman Y, Bethel J, Colson PW, Franks J, El-Sadr W. Predictors of latent tuberculosis infection treatment completion in the United States: an inner city experience. Int J Tuberc Lung Dis 2010; 14:1104-1111. [PMID: 20819254 PMCID: PMC4477782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Few studies have examined predictors of latent tuberculosis infection (LTBI) treatment completion in inner city populations in the United States. OBJECTIVE To assess LTBI treatment completion rates and predictors in an inner city cohort. METHODS Data from control groups of two sequentially conducted randomized controlled trials of LTBI treatment were analyzed for treatment completion rates. Participants in Study A (n = 191), conducted in 1996-1999, self administered daily isoniazid (INH) for 6-12 months, while participants in Study B (n = 123), conducted in 2002-2005, self administered daily INH for 9 months. RESULTS Overall, 44.6% of participants completed therapy, with significantly higher completion rates in Study B than Study A (37.0% vs. 56.1%, P = 0.001). Marriage and alcohol use were significant predictors of completion (aOR = 2.153, 95%CI 1.301-3.562) and non-completion (aOR = 0.530, 95%CI 0.320-0.877), respectively; multivariate analysis indicated increased completion among married persons of foreign birth and among alcohol users who were homeless. Knowledge of and attitudes to tuberculosis were not significant predictors. CONCLUSIONS The design provided an opportunity to assess predictors of LTBI treatment completion in this inner city population. Social circumstances were the strongest predictors of treatment completion, suggesting that tangible social services may be more effective than educational programs in encouraging treatment completion.
Collapse
Affiliation(s)
- Y Hirsch-Moverman
- Charles P Felton National Tuberculosis Center, International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, New York 10027, USA.
| | | | | | | | | |
Collapse
|
7
|
Wright EJ, Grund B, Robertson K, Brew BJ, Roediger M, Bain MP, Drummond F, Vjecha MJ, Hoy J, Miller C, Penalva de Oliveira AC, Pumpradit W, Shlay JC, El-Sadr W, Price RW. Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons. Neurology 2010; 75:864-73. [PMID: 20702792 DOI: 10.1212/wnl.0b013e3181f11bd8] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To determine factors associated with baseline neurocognitive performance in HIV-infected participants enrolled in the Strategies for Management of Antiretroviral Therapy (SMART) neurology substudy. METHODS Participants from Australia, North America, Brazil, and Thailand were administered a 5-test neurocognitive battery. Z scores and the neurocognitive performance outcome measure, the quantitative neurocognitive performance z score (QNPZ-5), were calculated using US norms. Neurocognitive impairment was defined as z scores <-2 in two or more cognitive domains. Associations of test scores, the QNPZ-5, and impairment with baseline factors including demographics and risk factors for HIV-associated dementia (HAD) and cardiovascular disease (CVD) were determined in multiple regression. RESULTS The 292 participants had a median CD4 cell count of 536 cells/mm(3), 88% had an HIV viral load < or =400 copies/mL, and 92% were taking antiretrovirals. Demographics, HIV, and clinical factors differed between locations. The mean QNPZ-5 score was -0.72; 14% of participants had neurocognitive impairment. For most tests, scores and z scores differed significantly between locations, with and without adjustment for age, sex, education, and race. Prior CVD was associated with neurocognitive impairment. Prior CVD, hypercholesterolemia, and hypertension were associated with poorer neurocognitive performance but conventional HAD risk factors and the CNS penetration effectiveness rank of antiretroviral regimens were not. CONCLUSIONS In this HIV-positive population with high CD4 cell counts, neurocognitive impairment was associated with prior CVD. Lower neurocognitive performance was associated with prior CVD, hypertension, and hypercholesterolemia, but not conventional HAD risk factors. The contribution of CVD and cardiovascular risk factors to the neurocognition of HIV-positive populations warrants further investigation.
Collapse
Affiliation(s)
- E J Wright
- Infectious Diseases Unit, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Petoumenos K, Fontas E, Worm SW, Weber R, De Wit S, Bruyand M, Sabin CA, Reiss P, El-Sadr W, Monforte AD, Friis-Møller N, Lundgren JD, Law MG. O314 Predicting the short-term risk of diabetes in HIV-infected patients in the D:A:D cohort: the D:A:D study group. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-o30] [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
|
9
|
Phanuphak N, Apornpong T, Teeratakulpisarn S, Chaithongwongwatthana S, Taweepolcharoen C, Mangclaviraj S, Limpongsanurak S, Jadwattanakul T, Eiamapichart P, Luesomboon W, Apisarnthanarak A, Kamudhamas A, Tangsathapornpong A, Vitavasiri C, Singhakowinta N, Attakornwattana V, Kriengsinyot R, Methajittiphun P, Chunloy K, Preetiyathorn W, Aumchantr T, Toro P, Abrams EJ, El-Sadr W, Phanuphak P. Nevirapine-associated toxicity in HIV-infected Thai men and women, including pregnant women. HIV Med 2007; 8:357-66. [PMID: 17661843 DOI: 10.1111/j.1468-1293.2007.00477.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [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: 12/17/2022]
Abstract
OBJECTIVES The aim of the study was to determine the incidence of, and risk factors for, nevirapine (NVP)-associated hepatotoxicity and rash in HIV-infected Thai men and women, including pregnant women, receiving NVP-containing highly active antiretroviral therapy (HAART). METHODS NVP-containing HAART was prescribed to eligible men and women enrolled in the Prevention of Mother-To-Child Transmission of HIV (PMTCT) and MTCT-Plus programmes. All pregnant women received zidovudine (ZDV)/lamivudine (3TC)/NVP from >14 weeks of gestational age if their CD4 cell count was <or=200 cells/microL or from >28 weeks if their CD4 cell count was >200 cells/microL. Patients followed for at least 8 weeks after starting HAART or until delivery were included in the analyses. RESULTS Of 409 patients, 244 were pregnant women, 87 were nonpregnant women and 78 were men. Hepatotoxicity occurred in 15.6% of all patients. Men had a significantly higher rate of asymptomatic hepatotoxicity (P=0.021). Pregnant women receiving HAART for PMTCT (92% had CD4 cell counts >250 cells/microL) had a significantly higher rate of symptomatic hepatotoxicity (P=0.0003) than pregnant women receiving HAART for therapy. Rash occurred in 16.1% of all patients. The patients' sex and baseline CD4 cell count were not associated with the risk of hepatotoxicity or rash. NVP was discontinued in 4.2% and 6.8% of patients because of hepatotoxicity and rash, respectively. CONCLUSIONS The incidence of NVP-related hepatotoxicity and rash in Thai adults is similar to incidences reported for other populations. While larger studies are needed, our data support continued use of NVP-containing regimens as first-line treatment in developing countries for HIV-infected patients, including pregnant women. Pregnant women with high CD4 cell counts may experience higher rates of symptomatic hepatotoxicity and thus require careful clinical and laboratory monitoring.
Collapse
Affiliation(s)
- N Phanuphak
- The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Burman W, Weis S, Vernon A, Khan A, Benator D, Jones B, Silva C, King B, LaHart C, Mangura B, Weiner M, El-Sadr W. Frequency, severity and duration of immune reconstitution events in HIV-related tuberculosis. Int J Tuberc Lung Dis 2007; 11:1282-1289. [PMID: 18229435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
SETTING Patients were enrolled in a prospective trial of rifabutin-based tuberculosis (TB) treatment for human immunodeficiency virus related TB. Antiretroviral therapy (ART) was encouraged, but not required. OBJECTIVE To evaluate the frequency, risk factors and duration of immune reconstitution events. DESIGN Patients were prospectively evaluated for immune reconstitution events, and all adverse event reports were reviewed to identify possible unrecognized events. RESULTS Of 169 patients, 25 (15%) developed immune reconstitution events related to TB. All 25 were among the 137 patients who received ART during TB treatment, so the frequency in this subgroup was 18% (25/137). Risk factors for an immune reconstitution event in multivariate analysis were Black race, the presence of extra-pulmonary TB and a shorter interval from initiation of TB treatment to initiation of ART. The most common clinical manifestations were fever (64%), new or worsening adenopathy (52%) and worsening pulmonary infiltrates (40%). Twelve patients (48%) were hospitalized for a median of 7 days, six underwent surgery and 11 had needle aspiration. The median duration of events was 60 days (range 11-442). CONCLUSION Immune reconstitution events were common among patients receiving ART during TB treatment, produced substantial morbidity and had a median duration of 2 months.
Collapse
Affiliation(s)
- W Burman
- Denver Public Health and the University of Colorado Health Sciences Center, Denver, Colorado 80204, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Hirsch-Moverman Y, Tsiouris S, Salazar-Schicchi J, Colson PW, Muttana H, El-Sadr W. Physician attitudes regarding latent tuberculosis infection: international vs. U.S. medical graduates. Int J Tuberc Lung Dis 2006; 10:1178-80. [PMID: 17044214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Tuberculosis in the U.S. is increasingly noted among the foreign-born, with many individuals at risk being managed by international medical graduates (IMGs). We utilized anonymous surveys using hypothetical scenarios to assess and compare the attitudes of IMGs and U.S. medical graduates regarding the treatment of latent tuberculosis infection (LTBI) to identify how attitudes and intentions may influence physician behavior. IMGs were less likely to treat LTBI in almost all scenarios. Educational efforts should focus on IMGs to encourage attitudes more consistent with U.S. guidelines.
Collapse
Affiliation(s)
- Y Hirsch-Moverman
- Charles P Felton National Tuberculosis Center, Division of Infectious Disease, Harlem Hospital & Columbia University, 506 Lenox Ave Room 3101A, New York, NY 10037, USA.
| | | | | | | | | | | |
Collapse
|
12
|
Sarmiento K, Hirsch-Moverman Y, Colson PW, El-Sadr W. Help-seeking behavior of marginalized groups: a study of TB patients in Harlem, New York. Int J Tuberc Lung Dis 2006; 10:1140-5. [PMID: 17044208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
SETTING Harlem Hospital Directly Observed Therapy (DOT) Program, New York City. OBJECTIVE To identify various pathways to tuberculosis (TB) diagnosis, and determine time to diagnosis and reasons for delay, to ensure rapid diagnosis of TB and prompt initiation of appropriate treatment. DESIGN Cross-sectional survey of the help-seeking behavior of TB patients within 2 months of their enrollment into DOT from May 2001 to December 2004. RESULTS The average total delay between symptom onset and a patient's diagnosis of TB was 18 weeks among 39 patients. The average delay to diagnosis attributed to patient delay and health care system delay were 10.5 and 7.5 weeks, respectively. Patients visited on average 1.6 sources of care prior to receiving a TB diagnosis. Foreign-born patients in particular were found to have more complex paths to diagnosis. The most common reason for delaying seeking care reported by patients was that they didn't think it was serious' (29.1%). CONCLUSION There was a substantial time interval between the onset of symptoms and TB diagnosis due to both patient and health care system delay. Foreign-born status, economic and social factors, and missed opportunities for diagnosis by the health care system played important roles in delaying TB diagnoses for the marginalized patients in this study.
Collapse
Affiliation(s)
- K Sarmiento
- Charles P Felton National Tuberculosis Center, Kountz Pavilion at Harlem Hospital Center, 15 West 136th Street, 6th Floor, New York, NY 10037, USA.
| | | | | | | |
Collapse
|
13
|
Abstract
BACKGROUND Tuberculosis (TB) is an important disease in human immunodeficiency virus (HIV) infected children living in regions where TB is endemic. There are limited data on the outcome of culture confirmed TB in HIV infected children. AIMS AND METHODS To describe the outcome on TB therapy and overall mortality in HIV infected children with culture confirmed TB through a retrospective cohort study. RESULTS Eighty seven children, median age 24 months, contributed to 93 TB episodes; six children had two confirmed episodes. Pulmonary disease (PTB) was present in 71 episodes (76.3%), extrapulmonary disease (EPTB) in 43 (46.2%), and of these, both PTB and EPTB were present in 21 (22.6%). There was cure based on bacteriological and/or radiological criteria in 54 episodes (58.1%). Eighteen children died during TB therapy and there were a total of 34 deaths (39.1%). In univariate analysis (n = 87 patients), severe malnutrition, age < or =1 year, and a negative tuberculin skin test were significant risk factors for death during TB therapy. In multivariate survival analysis (n = 87 patients), HIV disease category, severe malnutrition at diagnosis, and lack of cure at the end of TB therapy were significantly associated with overall mortality. CONCLUSION In the absence of antiretroviral therapy, HIV infected children with confirmed TB have poor outcomes on antituberculosis therapy and are at high risk of death during and after completion of antituberculosis therapy, especially due to non-TB related causes. There is an urgent need to optimise and monitor antituberculosis therapy in HIV infected children and to improve access to TB and other preventative therapy.
Collapse
Affiliation(s)
- A C Hesseling
- Desmond Tutu TB Centre, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Salazar-Schicchi J, Jedlovsky V, Ajayi A, Colson PW, Hirsch-Moverman Y, El-Sadr W. Physician attitudes regarding bacille Calmette-Guérin vaccination and treatment of latent tuberculosis infection. Int J Tuberc Lung Dis 2004; 8:1443-7. [PMID: 15636490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVE To investigate the attitudes of international medical graduates (IMGs) about treatment of latent tuberculosis infection (LTBI). DESIGN Anonymous survey among physicians in training, all IMGs from TB endemic countries. Attitudes were assessed through hypothetical scenarios regarding the protective effect of BCG and LTBI treatment. RESULTS Of 77 participants, 72.4% were male, the mean age was 31.4 years, and mean years post-graduation 8. Positive tuberculin skin tests (TSTs) were reported among 64.0%, and 89.6% had received BCG vaccine. Over a quarter of IMGs (27.4%) believed that BCG protects for many years. Only 59.2% believed that LTBI treatment was effective and 16% that the risks of treatment were greater than the benefits. Most would treat BCG-vaccinated patients with positive TST in various scenarios (63-94.7%), with less agreement about treating themselves (49.3%) or their family members (54.2%). For recent converters, more than 80% would recommend LTBI treatment. Over half felt that LTBI treatment should be mandatory for new immigrants with positive TST. CONCLUSIONS IMGs are cautious about LTBI treatment except for recent converters. They are less likely to treat themselves and family members than others. Educational efforts should address discrepancies between these physicians' attitudes and current guidelines for treating LTBI in the US.
Collapse
Affiliation(s)
- J Salazar-Schicchi
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Kountz Pavilion, 15 W 136 St, Sixth Floor, Harlem Hospital & Columbia University, New York, NY 10037, USA.
| | | | | | | | | | | |
Collapse
|
15
|
d'Arminio A, Sabin CA, Phillips AN, Reiss P, Weber R, Kirk O, El-Sadr W, De Wit S, Mateu S, Petoumenos K, Dabis F, Pradier C, Morfeldt L, Lundgren JD, Friis-Møller N. Cardio- and cerebrovascular events in HIV-infected persons. AIDS 2004; 18:1811-7. [PMID: 15316342 DOI: 10.1097/00002030-200409030-00010] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Recent results from the D:A:D Study indicated that the incidence of myocardial infarction (MI) increased by 26% per year of exposure to combination antiretroviral treatment (CART). The present study was performed to investigate whether this risk was similar when including other cardio- and cerebro-vascular disease events (CCVE). DESIGN D:A:D is an international collaboration of 11 cohorts, following 23 468 HIV-infected patients prospectively at 188 clinics in 21 countries situated in Europe, USA and Australia. METHODS The end-point was the occurrence of a first CCVE during prospective follow-up, defined as the first of: acute MI, invasive cardiovascular procedures, stroke, or death from other cardiovascular disease. Relative rates (RR) for CCVE from Poisson regression models and 95% confidence intervals (CI) are reported. All models are adjusted for other risk factors for CCVE, including age, gender, ethnicity, family history, body mass index, and smoking status as well as cohort and HIV transmission group. RESULTS Over 36 145 person-years of follow-up, 207 patients experienced at least one CCVE (23.7% fatal). The first event was MI in 126 patients, invasive cardiovascular procedure in 39 patients, stroke in 38 patients, and death from other cardiovascular disease in four patients. The incidence of first CCVE was 5.7 per 1000 person-years [95% confidence interval (CI) 5.0-6.5] and increased with longer exposure to CART (RR per year of exposure, 1.26; 95% CI, 1.14-1.38; P < 0.0001). CONCLUSION CART increases the risk of CCVD, and this increase is comparable with how CART affects the risk of MI. This finding is consistent with the hypothesis that atherosclerosis is a side-effect of CART.
Collapse
|
16
|
Fontas E, van Leth F, Sabin CA, Friis-Møller N, Rickenbach M, d'Arminio Monforte A, Kirk O, Dupon M, Morfeldt L, Mateu S, Petoumenos K, El-Sadr W, de Wit S, Lundgren JD, Pradier C, Reiss P. Lipid Profiles in HIV‐Infected Patients Receiving Combination Antiretroviral Therapy: Are Different Antiretroviral Drugs Associated with Different Lipid Profiles? J Infect Dis 2004; 189:1056-74. [PMID: 14999610 DOI: 10.1086/381783] [Citation(s) in RCA: 260] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2003] [Accepted: 09/07/2003] [Indexed: 11/03/2022] Open
Abstract
Levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c), as well as the TC:HDL-c ratio, were compared in patients receiving different antiretroviral therapy regimens. Patients receiving first-line regimens including protease inhibitors (PIs) had higher TC and TG levels and TC : HDL-c ratios than did antiretroviral-naive patients; patients receiving 2 PIs had higher levels of each lipid. Ritonavir-containing regimens were associated with higher TC and TG levels and TC : HDL-c ratios than were indinavir-containing regimens; however, receipt of nelfinavir was associated with reduced risk of lower HDL-c levels, and receipt of saquinavir was associated with lower TC : HDL-c ratios. Patients receiving nonnucleoside reverse-transcriptase inhibitors had higher levels of TC and LDL-c than did antiretroviral-naive patients, although the risk of having lower HDL-c levels was lower than that in patients receiving a single PI. Efavirenz was associated with higher levels of TC and TG than was nevirapine.
Collapse
Affiliation(s)
- E Fontas
- Nice Cohort, Infectious Diseases Department, Nice University Hospital, Nice, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Ioannidis JPA, Trikalinos TA, Law M, Carr A, Carr A, Barr D, Cooper DA, Emery S, Grinspoon S, Ioannidis J, Lewis R, Law M, Lichtenstein K, Murray J, Pizzuti D, Powderly WG, Rozenbaum W, Schambelan M, Puls R, Emery S, Moore A, Miller J, Carr A, Belloso WH, Ivalo SA, Clara LO, Barcan LA, Stern LD, Galich AM, Perman MI, Losso M, Duran A, Toibaro J, Baker D, Vale R, McFarlane R, MacLeod H, Kidd J, Genn B, Carr A, Fielden R, Mallal S, French M, Cain A, Skett J, Maxwell D, Mijch A, Hoy J, Pierce A, McCormick C, De Graaf B, Falutz J, Vatistas J, Dion L, Montaner J, Harris M, Phillips P, Montessori V, Valyi M, Stewart W, Walmsley S, Casciaro L, Lundgren J, Andersen O, Gronholdt A, Beguinot I, Mercié P, Chêne G, Reynes J, Cotte L, Rozenbaum W, Nait-Ighil L, Slama L, Nguyen TH, Rousselle C, Viard JP, Roudière L, Maignan A, Burgard M, Mauss S, Schmutz G, Scholten S, Oka S, Fraser H, Ishihara M, Itoh K, Reiss P, van der Valk M, Leunissen P, Nievaard M, van EckSmit B, Kujik CC, Paton N, Peperstraete B, Karim F, Khim CY, Ong S, Gatell J, Martinez E, Milinkovic A, Churchill D, Timaeus C, Maher T, Perry N, Bray A, Moyle G, Baldwin C, Higgs C, Reynolds B, Carpenter C, Bausserman L, Fiore T, DiSpigno M, Cohen C, Hellinger J, Foy K, Hubka S, Riccio B, El-Sadr W, Raghavan S, Chowdury N, de Vries B, Miller S, Hammer S, Crawford M, Chang S, Dobkin J, Quagliarello B, Gallagher D, Punyanitya M, Kessler H, Tenorio A, Kjos S, Falloon J, Lane HC, Rock D, Ehler L, Lichtenstein K, McClain T, Murphy R, Milne P, Powderly W, Aberg J, Klebert M, Conklin M, Ward D, Green L, Stearn B. HIV Lipodystrophy Case Definition using Artificial Neural Network Modelling. Antivir Ther 2003. [DOI: 10.1177/135965350300800511] [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: 11/15/2022]
Abstract
Objective A case definition of HIV lipodystrophy has recently been developed from a combination of clinical, metabolic and imaging/body composition variables using logistic regression methods. We aimed to evaluate whether artificial neural networks could improve the diagnostic accuracy. Methods The database of the case-control Lipodystrophy Case Definition Study was split into 504 subjects (265 with and 239 without lipodystrophy) used for training and 284 independent subjects (152 with and 132 without lipodystrophy) used for validation. Back-propagation neural networks with one or two middle layers were trained and validated. Results were compared against logistic regression models using the same information. Results Neural networks using clinical variables only (41 items) achieved consistently superior performance than logistic regression in terms of specificity, overall accuracy and area under the ROC curve. Their average sensitivity and specificity were 72.4 and 71.2%, as compared with 73.0 and 62.9% for logistic regression, respectively (area under the ROC curve, 0.784 vs 0.748). The discriminating performance of the neural networks was largely unaffected when built excluding 13 parameters that patients may not have readily available. The average sensitivity and specificity of the neural networks remained the same when metabolic variables were also considered (total 60 items) without a clear advantage against logistic regression (overall accuracy 71.8%). The performance of networks considering also body composition variables was similar to that of logistic regression (overall accuracy 78.5% for both). Conclusions Neural networks may offer a means to improve the discriminating performance for HIV lipodystrophy, when only clinical data are available and a rapid approximate diagnostic decision is needed. In this context, information on metabolic parameters is apparently not helpful in improving the diagnosis of HIV lipodystrophy, unless imaging and body composition studies are also obtained.
Collapse
Affiliation(s)
- John PA Ioannidis
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Thomas A Trikalinos
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Division of Clinical Care Research, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass., USA
| | - Matthew Law
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
| | - Andrew Carr
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
- HIV, Immunology and Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Australia
| | - A Carr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - D Barr
- (Forum for Collaborative HIV Research, Baltimore, Md., USA; to September, 2001)
| | - DA Cooper
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (Massachusetts General Hospital, Boston, Mass., USA)
| | - S Grinspoon
- (Massachusetts General Hospital, Boston, Mass., USA)
| | | | - R Lewis
- (Agouron Pharmaceuticals, San Diego, Calif., USA)
| | - M Law
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - K Lichtenstein
- (HIV Outpatient Study/Centres for Diseases Control and Prevention, Denver, Col., USA)
| | - J Murray
- (US Department of Health and Human Services Food and Drug Administration, Washington, DC, USA)
| | - D Pizzuti
- (Bristol-Myers Squibb, Princeton, NJ, USA, representing the European Medicines Evaluation Agency Oversight Committee)
| | - WG Powderly
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - W Rozenbaum
- (Agence Nationale du Researche sur le SIDA, Hôpital Rothschild, Paris, France)
| | - M Schambelan
- (University of California, San Francisco, Calif., USA; to September 2000)
| | - R Puls
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - S Emery
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Moore
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - J Miller
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - A Carr
- (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia)
| | - WH Belloso
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - SA Ivalo
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LO Clara
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LA Barcan
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - LD Stern
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - AM Galich
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - MI Perman
- (Hospital Italiano de Buenos Aires, Buenos Aires)
| | - M Losso
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - A Duran
- (Hospital J M Ramos Mejía, Buenos Aires)
| | - J Toibaro
- (Hospital J M Ramos Mejía, Buenos Aires)
| | | | | | | | | | | | | | - A Carr
- (St Vincent's Hospital, Sydney)
| | | | | | | | - A Cain
- (Royal Perth Hospital, Perth)
| | - J Skett
- (Royal Perth Hospital, Perth)
| | | | - A Mijch
- (Alfred Hospital and Monash University, Melbourne)
| | - J Hoy
- (Alfred Hospital and Monash University, Melbourne)
| | - A Pierce
- (Alfred Hospital and Monash University, Melbourne)
| | - C McCormick
- (Alfred Hospital and Monash University, Melbourne)
| | - B De Graaf
- (Alfred Hospital and Monash University, Melbourne)
| | - J Falutz
- (Montreal General Hospital, Montreal)
| | | | - L Dion
- (Montreal General Hospital, Montreal)
| | | | | | | | | | - M Valyi
- (St Paul's Hospital, Vancouver)
| | | | | | | | - J Lundgren
- (Hvidovre University Hospital, Copenhagen)
| | - O Andersen
- (Hvidovre University Hospital, Copenhagen)
| | | | | | - P Mercié
- (Hôpital Haut-Lévêque, Bordeaux)
| | - G Chêne
- (Hôpital Haut-Lévêque, Bordeaux)
| | - J Reynes
- (Hôpital Gui de Chauliac, Montpellier)
| | - L Cotte
- (Hôpital Gui de Chauliac, Montpellier)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - P Reiss
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M van der Valk
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - P Leunissen
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - M Nievaard
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - B van EckSmit
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - C can Kujik
- (Academic Medical Centre, University of Amsterdam and International AIDS Therapy Evaluation Center, Amsterdam)
| | - N Paton
- (Tan Tock Seng Hospital, Singapore)
| | | | - F Karim
- (Tan Tock Seng Hospital, Singapore)
| | - C Y Khim
- (Tan Tock Seng Hospital, Singapore)
| | - S Ong
- (Tan Tock Seng Hospital, Singapore)
| | - J Gatell
- (Hospital Clinic Provincial de Barcelona)
| | - E Martinez
- (Hospital Clinic Provincial de Barcelona)
| | | | | | | | | | | | - A Bray
- (Sussex Hospital, Brighton)
| | - G Moyle
- (Chelsea and Westminster Hospital, London)
| | - C Baldwin
- (Chelsea and Westminster Hospital, London)
| | - C Higgs
- (Chelsea and Westminster Hospital, London)
| | - B Reynolds
- (Chelsea and Westminster Hospital, London)
| | | | | | - T Fiore
- (Miriam Hospital, Providence, RI)
| | | | - C Cohen
- (Community Research Initiative of New England, Brookline, Mass.)
| | - J Hellinger
- (Community Research Initiative of New England, Brookline, Mass.)
| | - K Foy
- (Community Research Initiative of New England, Brookline, Mass.)
| | - S Hubka
- (Community Research Initiative of New England, Brookline, Mass.)
| | - B Riccio
- (Community Research Initiative of New England, Brookline, Mass.)
| | - W El-Sadr
- (Harlem Hospital Center, New York, NY)
| | | | | | | | - S Miller
- (Harlem Hospital Center, New York, NY)
| | - S Hammer
- (Columbia University, New York, NY)
| | | | - S Chang
- (Columbia University, New York, NY)
| | - J Dobkin
- (Columbia University, New York, NY)
| | | | | | | | - H Kessler
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - A Tenorio
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - S Kjos
- (Rush Presbyterian St Luke's Medical Center, Chicago, Ill.)
| | - J Falloon
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - HC Lane
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - D Rock
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | - L Ehler
- (National Institute of Allergy and Infectious Diseases, Bethesda, Md.)
| | | | - T McClain
- (Denver Infectious Disease Consultants, Denver, Col.)
| | - R Murphy
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - P Milne
- (Northwestern Memorial Hospital, Chicago, Ill.)
| | - W Powderly
- (Washington University School of Medicine, St Louis, Mo.)
| | - J Aberg
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Klebert
- (Washington University School of Medicine, St Louis, Mo.)
| | - M Conklin
- (Washington University School of Medicine, St Louis, Mo.)
| | - D Ward
- (Dupont Circle Physician's Group, Washington, DC)
| | - L Green
- (Dupont Circle Physician's Group, Washington, DC)
| | - B Stearn
- (Dupont Circle Physician's Group, Washington, DC)
| | | | | | | |
Collapse
|
18
|
Law M, Friis-Møller N, Weber R, Reiss P, Thiebaut R, Kirk O, d'Arminio Monforte A, Pradier C, Morfeldt L, Calvo G, El-Sadr W, De Wit S, Sabin CA, Lundgren JD. Modelling the 3-year risk of myocardial infarction among participants in the Data Collection on Adverse Events of Anti-HIV Drugs (DAD) study. HIV Med 2003; 4:1-10. [PMID: 12534953 DOI: 10.1046/j.1468-1293.2003.00138.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To estimate the 3-year risk of myocardial infarction (MI) among participants in the Data Collection on Adverse Events of Anti-HIV Drugs (DAD) study. METHODS Conventional cardiovascular risk equations were applied to baseline data from the DAD study to estimate the 3-year risk of MI. Best estimates were obtained by simply applying the risk equations, with upper and lower limits based on worst case and optimistic case scenarios. Three-year risks of AIDS or death were also estimated based on a prognostic scoring system for patients receiving antiretroviral (ARV) treatment, and on estimated AIDS rates in untreated people with HIV for those patients not on ARVs or if they were to cease ARVs. RESULTS Analyses were based on 17 600 patients (24.3% female) recruited into the DAD study with baseline data and no previous MI. The overall 3-year risk of MI was estimated to be 0.72% (lower limit 0.35, upper limit 1.12%), corresponding to a total predicted 127 (65-197) MIs over a 3-year follow-up period. The risk was much greater for men than women (0.92% vs. 0.07%), with only three (2-8) MIs predicted in women. The 3-year risk of MI was estimated to increase from 0.30% (0.20-0.38%) in ARV naive patients to 1.07% (0.43-1.77%) in patients receiving ARVs from all three drug classes. The estimated 3-year risk of AIDS or death was in the range 6.2% to 11.1% in patients receiving ARVs if they continued treatment, and 22.5% to 29.4% if they ceased ARVs. DISCUSSION These models suggest that although the increase in relative risk of MI as a result of ARV treatment may be as high as threefold in a worst case scenario, the absolute risk is modest with a best estimate of 3-year risk less than or equal to 1% in all groups of patients, and is outweighed by the benefits of ARV treatment in terms of reduced risk of AIDS and death in most patients. As estimates are based on models not validated for people receiving ARV drugs, all estimates should be interpreted cautiously.
Collapse
Affiliation(s)
- M Law
- AHOD, National Centre in HIV Epidemiology and Clinical Research, UNSW, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Ait-Khaled M, Rakik A, Griffin P, Cutrell A, Fischl MA, Clumeck N, Greenberg SB, Rubio R, Peters BS, Pulido F, Gould J, Pearce G, Spreen W, Tisdale M, Lafon S, Bellos NC, Brosgart CL, Jacobson S, Cooley TP, Hicks CB, Kumar P, Kraus PW, El-Sadr W, Pottage JC, Kessler HA, Santana JL, Torres RA, Casado JL, Gatell JM, Ocana I, Pena JM, Fisher MJ, Weber J, White D, West M, Hetherington S, Steel H, Ait-Khaled M, Verity L, Richardson C, Pearce G. Mutations in HIV-1 Reverse Transcriptase during Therapy with Abacavir, Lamivudine and Zidovudine in HIV-1-Infected Adults with No Prior Antiretroviral Therapy. Antivir Ther 2002. [DOI: 10.1177/135965350200700106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To evaluate HIV-1 reverse transcriptase (RT) drug resistance in patients receiving abacavir, lamivudine and zidovudine therapy. Methods In a randomized, double-blind study, 173 anti-retroviral treatment-naive HIV-1-infected adults received abacavir/lamivudine/zidovudine or lamivudine/zidovudine for up to 48 weeks. After week 16, patients could switch to open-label abacavir/lamivudine/zidovudine, and those with plasma HIV-1 RNA (vRNA) >400 copies/ml could add other antiretrovirals. From weeks 16 to 48, samples with vRNA >400 copies/ml were collected for genotyping and phenotyping. Results At baseline, 90% of isolates were wild-type (WT). At week 16, vRNA was >400 copies/ml in seven of 72 (10%) patients receiving abacavir/lamivudine/zidovudine and in 41 of 66 (62%) receiving lamivudine/ zidovudine. At week 16, the genotypes in isolates from the abacavir/lamivudine/zidovudine group were M184V alone ( n=3 cases), WT ( n=3) and M184V plus thymidine analogue mutations (TAMs) ( n=1). The genotypes in isolates from the lamivudine/zidovudine group were M184V alone ( n=37), WT ( n=1) and M184V plus TAMs ( n=3). In the four cases where M184V plus TAMs were detected some mutations were present at baseline. Despite detectable M184V in 74% of patients on lamivudine/zidovudine, addition of abacavir with or without another antiretroviral therapy resulted in a reduction in vRNA, with 42 of 65 (65%) patients having week 48 vRNA <400 copies/ml (intent-to-treat with missing=failure). At week 48, the most common genotype was M184V alone in the abacavir/ lamivudine/zidovudine group (median vRNA 1–2 log10 below baseline), and M184V with or without TAMs in patients originally assigned to lamivudine/zidovudine. At week 48, phenotypic results were obtained for 11 isolates for patients from both arms, and all had reduced susceptibility to lamivudine but all remained sensitive to stavudine, all protease inhibitors and all non-nucleoside reverse transcriptase inhibitors. Three, three and two isolates had reduced susceptibility to abacavir, didanosine and zidovudine, respectively. Conclusions Abacavir retained efficacy against isolates with the M184V genotype alone. TAMs did not develop during 48 weeks of abacavir/lamivudine/zidovudine therapy and were uncommon when abacavir was added after 16 weeks of lamivudine/zidovudine therapy. Limited mutations upon rebound on this triple nucleoside combination allows for several subsequent treatment options.
Collapse
Affiliation(s)
| | | | | | - Amy Cutrell
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Margaret A Fischl
- Department of Medicine, University of Miami School of Medicine, Miami, Fla., USA
| | - Nathan Clumeck
- CHU Saint-Pierre, Clinique des Maladies Infectieuses (PL 5), Brussels, Belgium
| | | | - Rafael Rubio
- Unidad de Infeccion VIH, Hospital 12 de Octubre, Madrid, Spain
| | - Barry S Peters
- Department of Genitourinary Medicine, St Thomas Hospital, London, UK
| | - Federico Pulido
- Unidad de Infeccion VIH, Hospital 12 de Octubre, Madrid, Spain
| | - Jayne Gould
- GlaxoSmithKline Research and Development, Greenford, UK
| | - Gill Pearce
- GlaxoSmithKline Research and Development, Greenford, UK
| | | | | | - Steve Lafon
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - NC Bellos
- Southwestern Infectious Disease Associates, Dallas, Tex., USAg
| | | | - S Jacobson
- East Bay AIDS Center, Berkeley, Calif., USA
| | - TP Cooley
- Boston Medical Center, Boston, Mass., USA
| | - CB Hicks
- Duke University, Durham, NC, USA
| | - P Kumar
- George University Medical Center, Washington, Col., USA
| | - PW Kraus
- Kraus Medical Partners, Los Angeles, Calif., USA
| | - W El-Sadr
- Harlem Hospital, Columbia University, New York, NY, USA
| | - JC Pottage
- Vertex Pharmaceuticals, Cambridge, Mass., USA (formerly with Rush Medical College, Rush Presbyterian-St Luke's Medical Center, Chicago, Ill., USA)
| | - HA Kessler
- Rush Medical College, Rush Presbyterian-St Luke's Medical Center, Chicago, Ill., USA
| | - JL Santana
- San Juan AIDS Institute, Guaynabo, Puerto Rico
| | - RA Torres
- St Vincent's Hospital and Medical Center, New York, NY, USA
| | - JL Casado
- Servicio de Enfermedades Infecciosas, Hospital Ramon y Cajal, Madrid, Spain
| | - JM Gatell
- Servicio Enf, Infecciosas, Hospital Clinic i Provincial, Barcelona, Spain
| | - I Ocana
- Servicio de Patologia Infecciosa, Hospital General, planta baja, Hospital Valle de Hebron, Barcelona, Spain
| | - JM Pena
- Medicina Interna 2 (VIH), Hospital de Reumatologia/Hospital La Paz, Madrid, Spain
| | - MJ Fisher
- MRCP, Royal Sussex County Hospital, Brighton, UK
| | - J Weber
- FRCP, St Mary's Hospital, London, UK
| | - D White
- MRCP, Birmingham Heartlands Hospital, Birmingham, UK
| | - M West
- B Spreen of Glaxo Wellcome
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Cohn DL, Fisher EJ, Peng GT, Hodges JS, Chesnut J, Child CC, Franchino B, Gibert CL, El-Sadr W, Hafner R, Korvick J, Ropka M, Heifets L, Clotfelter J, Munroe D, Horsburgh CR. A prospective randomized trial of four three-drug regimens in the treatment of disseminated Mycobacterium avium complex disease in AIDS patients: excess mortality associated with high-dose clarithromycin. Terry Beirn Community Programs for Clinical Research on AIDS. Clin Infect Dis 1999; 29:125-33. [PMID: 10433575 DOI: 10.1086/520141] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The optimal regimen for treatment of Mycobacterium avium complex (MAC) disease has not been established. Eighty-five AIDS patients with disseminated MAC disease were randomized to receive a three-drug regimen of clarithromycin, rifabutin or clofazimine, and ethambutol. Two dosages of clarithromycin, 500 or 1,000 mg twice daily (b.i.d.), were compared. The Data and Safety Monitoring Board recommended discontinuation of the clarithromycin dosage comparison and continuation of the rifabutin vs. clofazimine comparison. After a mean follow-up of 4.5 months, 10 (22%) of 45 patients receiving clarithromycin at 500 mg b.i.d. had died (70 deaths per 100 person-years) compared with 17 (43%) of 40 patients receiving clarithromycin at 1,000 mg b.i.d. (158 deaths per 100 person-years) (relative risk, 2.43; 95% confidence interval, 1.11-5.34; P = .02). After 10.4 months, 20 (49%) of 41 patients receiving rifabutin had died (81 deaths per 100 person-years) compared with 23 (52%) of 44 patients receiving clofazimine (94 deaths per 100 person-years) (relative risk, 1.20; 95% confidence interval, 0.65-2.19; P = .56). Bacteriologic outcomes were similar among treatment groups. In treating MAC disease in AIDS patients, the maximum dose of clarithromycin should be 500 mg b.i.d.
Collapse
Affiliation(s)
- D L Cohn
- Denver Community Program for Clinical Research on AIDS, Colorado, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Azmeh W, Rhagavan SS, El-Sadr W. Photo quiz. Aberrant fat deposition (benign lipomatosis) in association with highly active antiretroviral therapy. Clin Infect Dis 1999; 28:239, 351. [PMID: 10064237 DOI: 10.1086/515099] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- W Azmeh
- Division of Infectious Diseases, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10037, USA.
| | | | | |
Collapse
|
22
|
Zahnow K, Matts JP, Hillman D, Finley E, Brown LS, Torres RA, Ernst J, El-Sadr W, Perez G, Webster C, Barber B, Gordin FM. Rates of tuberculosis infection in healthcare workers providing services to HIV-infected populations. Terry Beirn Community Programs for Clinical Research on AIDS. Infect Control Hosp Epidemiol 1998; 19:829-35. [PMID: 9831938 DOI: 10.1086/647740] [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: 11/03/2022]
Abstract
OBJECTIVE To assess the prevalence of tuberculosis (TB) or a positive skin test in healthcare workers (HCWs) providing services to human immunodeficiency virus (HIV)-infected individuals and to determine prospectively the incidence of new infections in this population. DESIGN This prospective cohort study enrolled 1,014 HCWs working with HIV-infected populations from 10 metropolitan areas. Purified protein derivative (PPD) tuberculin skin tests were placed at baseline and every 6 months afterwards on those without a history of TB or a positive PPD. Demographic, occupational, and TB exposure data also were collected. SETTING Outpatient clinics, hospitals, private practice offices, and drug treatment programs providing HIV-related healthcare and research programs. PARTICIPANTS A voluntary sample of staff and volunteers from 16 Community Programs for Clinical Research on AIDS units. RESULTS Factors related to prior TB or a positive skin test at baseline included being foreign-born, increased length of time in health care, living in New York City, or previous bacille Calmette-Guerin vaccination. The rate of PPD conversion was 1.8 per 100 person years of follow-up. No independent relation was found between the amount or type of contact with HIV-infected populations and the risk of TB infection. CONCLUSION These data provide some reassurance that caring for HIV-infected patients is not related to an increased rate of TB infection among HCWs in these settings.
Collapse
Affiliation(s)
- K Zahnow
- Division of Infectious Diseases, Veterans' Affairs Medical Center, Washington, DC 20422, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Capps L, Peng G, Doyle M, El-Sadr W, Neaton JD. Sexually transmitted infections in women infected with the human immunodeficiency virus. Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). Sex Transm Dis 1998; 25:443-7. [PMID: 9773440 DOI: 10.1097/00007435-199809000-00012] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [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: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Limited prospective data are available on sexually transmitted infections (STIs) among HIV-infected patients. The incidence and predictors of STIs were assessed among HIV-infected women enrolled in a clinical trial. STUDY DESIGN Prospective cohort of 323 women. RESULTS Sixty-five percent had at least one STI based on history and/or examination at baseline. Most conditions identified at baseline were based on patient history; only 10 of 123 women with no history of an STI (8.1%) had one identified upon examination. During a median follow-up of 2.1 years, 25% developed a new/recurrent STI. Being African-American (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 1.45-12.26), reporting sex with an intravenous drug user as an HIV risk behavior (OR = 2.29, 95% CI: 1.34-3.92), and a history/presence of STIs at baseline (OR = 1.79, 95% CI: 1.01-3.19) were factors associated with significantly increased risk of STI's. CONCLUSIONS A substantial proportion of women developed new STIs during the course of the clinical trial. Prevention efforts should be emphasized among high risk HIV-infected patients.
Collapse
Affiliation(s)
- L Capps
- Department of Medicine, Harlem Hospital, Columbia University College of Physicians and Surgeons, New York, USA
| | | | | | | | | |
Collapse
|
24
|
Frost KR, Bellman P, Cohen CJ, Currier J, Dobkin J, El-Sadr W, Holodniy M, Leonard A, Merrick S, Pinsky L, Rubin D, Vaughn A, Saag M. Controversies in AIDS treatment. Proceedings from CME conference sponsored by Cornell University Medical College and the American Foundation for AIDS Research (AmFAR). November 8, 1997. Question and answer session. AIDS Patient Care STDS 1998; 12:557-66. [PMID: 15462007 DOI: 10.1089/apc.1998.12.557] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K R Frost
- American Foundation for AIDS Research, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Frost KR, Bellman P, Cohen CJ, Currier J, Dobkin J, El-Sadr W, Holodniy M, Leonard A, Merrick S, Pinsky L, Rubin DS, Saag M, Vaughn A. Controversies in AIDS treatment. Proceedings from CME conference sponsored by Cornell University Medical College and the American Foundation for AIDS Research (AmFAR). November 8, 1997. Faculty roundtable discussion. AIDS Patient Care STDS 1998; 12:543-55. [PMID: 15462006 DOI: 10.1089/apc.1998.12.543] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K R Frost
- American Foundation for AIDS Research (AmFAR), USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Gordin FM, Matts JP, Miller C, Brown LS, Hafner R, John SL, Klein M, Vaughn A, Besch CL, Perez G, Szabo S, El-Sadr W. A controlled trial of isoniazid in persons with anergy and human immunodeficiency virus infection who are at high risk for tuberculosis. Terry Beirn Community Programs for Clinical Research on AIDS. N Engl J Med 1997; 337:315-20. [PMID: 9233868 DOI: 10.1056/nejm199707313370505] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.4] [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: 02/04/2023]
Abstract
BACKGROUND Patients with human immunodeficiency virus (HIV) infection and latent tuberculosis are at substantial risk for the development of active tuberculosis. As a public health measure, prophylactic treatment with isoniazid has been suggested for HIV-infected persons who have anergy and are in groups with a high prevalence of tuberculosis. METHODS We conducted a multicenter, randomized, double-blind, placebo-controlled trial of six months of prophylactic isoniazid treatment in HIV-infected patients with anergy who have risk factors for tuberculosis infection. The primary end point was culture-confirmed tuberculosis. RESULTS The study was conducted from November 1991 through June 1996. Over 90 percent of the patients had two or more risk factors for tuberculosis infection, and nearly 75 percent of patients were from greater New York City. After a mean follow-up of 33 months, tuberculosis was diagnosed in only 6 of 257 patients in the placebo group and 3 of 260 patients in the isoniazid group (risk ratio, 0.48; 95 percent confidence interval, 0.12 to 1.91; P=0.30). There were no significant differences between the two groups with regard to death, death or the progression of HIV disease, or adverse events. CONCLUSIONS Even in HIV-infected patients with anergy and multiple risk factors for latent tuberculosis infection, the rate of development of active tuberculosis is low. This finding does not support the use of isoniazid prophylaxis in high-risk patients with HIV infection and anergy unless they have been exposed to active tuberculosis.
Collapse
Affiliation(s)
- F M Gordin
- Medical Service, Veterans Affairs Medical Center, and Georgetown University, Washington, D.C. 20422, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Gordin FM, Nelson ET, Matts JP, Cohn DL, Ernst J, Benator D, Besch CL, Crane LR, Sampson JH, Bragg PS, El-Sadr W. The impact of human immunodeficiency virus infection on drug-resistant tuberculosis. Am J Respir Crit Care Med 1996; 154:1478-83. [PMID: 8912768 DOI: 10.1164/ajrccm.154.5.8912768] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Infection with human immunodeficiency virus (HIV) has been associated with increased rates of single- and multidrug-resistant (MDR) tuberculosis in the New York City area. In order to examine the relationship of HIV infection to drug-resistant tuberculosis in other selected regions of the United States, we established a registry of cases of culture-proven tuberculosis. Data were collected from sites participating in an NIH-funded, community-based HIV clinical trials group. All cases of tuberculosis, regardless of HIV status, which occurred between January 1992 and June 1994 were recorded. Overall, 1,373 cases of tuberculosis were evaluated, including 425 from the New York City area, and 948 from seven other metropolitan areas. The overall prevalence of resistance to one or more drugs was 20.4%, and 5.6% of isolates were resistant to both isoniazid and rifampin (MDR). In the New York City area, HIV-infected patients were significantly more likely than persons not known to be HIV-infected, to have resistance to at least one drug (37% versus 19%) and MDR (19% versus 6%). In other geographic areas, overall drug resistance was 16%, and only 2.2% of isolates were MDR. In multiple logistic regression analyses, HIV infection was shown to be a risk factor for drug-resistant tuberculosis, independent of geographic location, history of prior therapy, age, and race. We concluded that HIV infection is associated with increased rates of resistance to antituberculosis drugs in both the New York City area and other geographic areas. MDR tuberculosis is occurring predominantly in the New York City area and is highly correlated with HIV infection.
Collapse
Affiliation(s)
- F M Gordin
- Division of Infectious Diseases, Department of Veterans Affairs Medical Center, Washington, DC, USA. Terry Beirn Community Programs for Clinical Research on AIDS
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Zolla-Pazner S, William D, El-Sadr W, Marmor M, Stahl R. Quantitation of beta 2-microglobulin and other immune characteristics in a prospective study of men at risk for acquired immune deficiency syndrome. JAMA 1984; 251:2951-5. [PMID: 6371277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Serum samples from 24 patients with acquired immune deficiency syndrome (AIDS) and from 15 patients with an early or milder form of this disease ("suspected AIDS") were found to contain elevated levels of beta 2-microglobulin (beta 2M). Therefore, prospective studies of 40 asymptomatic homosexual men from New York City were undertaken to determine whether quantitation of beta 2M and other immunologic variables was useful in recognizing those in populations at high risk for this disease who have a high probability for experiencing symptoms consistent with AIDS. After 20 to 26 months of follow-up, two of those persons now have AIDS and four have suspected AIDS. All six of these persons had elevated serum beta 2M levels and other immunologic abnormalities when they entered this study. Of those tested, only one other man had an increased level of beta 2M; neither he nor any of the remaining 33 persons in this group developed AIDS.
Collapse
|
29
|
Maslow MJ, Rosenberg A, Pollock AA, Press RA, Silverman D, El-Sadr W, Richmond AS, Simberkoff MS, Rahal JJ. Ceftazidime therapy of infections caused by Enterobacteriaceae and Pseudomonas aeruginosa. J Antimicrob Chemother 1983; 12 Suppl A:213-7. [PMID: 6413486 DOI: 10.1093/jac/12.suppl_a.213] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Sixteen patients with serious Gram-negative bacillary infections were treated with intravenous ceftazidime, 2 g every 8 h. The majority of patients had bacteraemia or pneumonitis or both. Ten patients were cured and six improved. Seven of ten patients infected with Pseudomonas aeruginosa were cured, and three improved. No adverse reactions occurred. Four strains of Ps. aeruginosa became resistant to ceftazidime in patients who were cured or improved clinically. Ceftazidime is effective as single drug therapy for serious Gram-negative infections, including those due to Ps. aeruginosa.
Collapse
|
30
|
|