SARS-CoV-2 testing, positivity, and factors associated with COVID-19 among people with HIV across Europe in the multinational EuroSIDA cohort

BACKGROUND

Although people with HIV might be at risk of severe outcomes from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus 2019 [COVID-19]), regional and temporal differences in SARS-CoV-2 testing in people with HIV across Europe have not been previously described.

METHODS

We described the proportions of testing, positive test results, and hospitalizations due to COVID-19 between 1 January 2020 and 31 December 2021 in the EuroSIDA cohort and the factors associated with being tested for SARS-CoV-2 and with ever testing positive.

RESULTS

Of 9012 participants, 2270 (25.2%, 95% confidence interval [CI] 24.3-26.1) had a SARS-CoV-2 polymerase chain reaction test during the study period (range: 38.3% in Northern to 14.6% in Central-Eastern Europe). People from Northern Europe, women, those aged <40 years, those with CD4 cell count <350 cells/mm3 , and those with previous cardiovascular disease or malignancy were significantly more likely to have been tested, as were people with HIV in 2021 compared with those in 2020. Overall, 390 people with HIV (4.3%, 95% CI 3.9-4.8) tested positive (range: 2.6% in Northern to 7.1% in Southern Europe), and the odds of testing positive were higher in all regions than in Northern Europe and in 2021 than in 2020. In total, 64 people with HIV (0.7%, 95% CI 0.6-0.9) were hospitalized, of whom 12 died. Compared with 2020, the odds of positive testing decreased in all regions in 2021, and the associations with cardiovascular disease, malignancy, and use of tenofovir disoproxil fumarate disappeared in 2021. Among study participants, 58.9% received a COVID-19 vaccine (range: 72.0% in Southern to 14.8% in Eastern Europe).

CONCLUSIONS

We observed large heterogeneity in SARS-CoV-2 testing and positivity and a low proportion of hospital admissions and deaths across the regions of Europe.

Pharmacokinetics and Safety of Olaparib in Patients with Advanced Solid Tumours and Renal Impairment

BACKGROUND

Olaparib, a potent oral poly(ADP-ribose) polymerase inhibitor, is partially renally cleared. We investigated the pharmacokinetics and safety of olaparib in patients with mild or moderate renal impairment to provide dosing recommendations.

METHODS

This phase I open-label study assessed the pharmacokinetics, safety and tolerability of single-dose, oral 300-mg olaparib tablets in adults (aged 18-75 years) with solid tumours. Patients had normal renal function, or mild or moderate renal impairment (estimated creatinine clearance ≥ 81, 51-80 or 31-50 mL/min, respectively). Blood was collected for 96 h, and urine samples collected for 24 h post-dose. Patients could continue taking olaparib 300 mg twice daily for a long-term safety assessment.

RESULTS

Overall, 44 patients received one or more doses of olaparib and 38 were included in the pharmacokinetic assessment. Patients with mild renal impairment had an area under the curve geometric least-squares mean ratio of 1.24 (90% confidence interval 1.06-1.47) and a geometric least-squares mean maximum plasma concentration ratio of 1.15 (90% confidence interval 1.04-1.27) vs. those with normal renal function. In patients with moderate renal impairment, the geometric least-squares mean ratio for the area under the curve was 1.44 (90% confidence interval 1.10-1.89) and for the maximum plasma concentration was 1.26 (90% confidence interval 1.06-1.48) vs. those with normal renal function. No new safety signals were detected in patients with mild or moderate renal impairment.

CONCLUSIONS

In patients with mild renal impairment, the small increase in exposure to olaparib was not considered clinically relevant. In patients with moderate renal impairment, exposure to olaparib increased by 44%; thus, these patients should be carefully monitored and the tablet dose should be adjusted to 200 mg twice daily.

CLINICAL TRIALS REGISTRATION

NCT01894256.

Pharmacokinetics and safety of olaparib in patients with advanced solid tumours and mild or moderate hepatic impairment

AIMS

Olaparib, a potent oral poly(ADP-ribose) polymerase inhibitor, is partially hepatically cleared. We investigated the pharmacokinetics (PK) and safety of olaparib in patients with mild or moderate hepatic impairment to provide dosing recommendations.

METHODS

This Phase I open-label study assessed the PK, safety and tolerability of single doses of olaparib 300-mg tablets in patients with advanced solid tumours. Patients had normal hepatic function (NHF), or mild (MiHI; Child-Pugh class A) or moderate (MoHI; Child-Pugh class B) hepatic impairment. Blood was collected for PK assessments for 96 hours. Patients could continue taking olaparib 300 mg twice daily for long-term safety assessment.

RESULTS

Thirty-one patients received ≥1 dose of olaparib and 30 were included in the PK assessment. Patients with MiHI had an area under the curve geometric least-squares mean (GLSmean) ratio of 1.15 (90% confidence interval 0.72, 1.83) and a GLSmean maximum plasma concentration ratio of 1.13 (0.82, 1.56) vs those with NHF. In patients with MoHI, GLSmean ratio for area under the curve was 1.08 (0.66, 1.74) and for maximum plasma concentration was 0.87 (0.63, 1.22) vs those with NHF. For patients with mild or moderate hepatic impairment, no new safety signals were detected.

CONCLUSION

Patients with MiHI or MoHI had no clinically significant changes in exposure to olaparib compared with patients with NHF. The safety profile of olaparib did not differ from a clinically relevant extent between cohorts. No olaparib tablet or capsule dose reductions are required for patients with MiHI or MoHI.

Abstract P6-13-05: Impact of olaparib versus chemotherapy on the use of strong pain medications in gBRCA-mutated HER2-negative metastatic breast cancer and associated patient reported outcomes

Background: Pain is among the most common and distressing symptoms in patients with cancer, frequently requiring treatment with strong pain medication (SPM). The use of SPM may be associated with an adverse health impact arising from SPM-mediated side effects and/or the underlying deterioration causing SPM use. Regardless of cause, delaying the need for or escalation in SPM use would be desirable. The primary aim of this post-hoc analysis was to assess the impact of olaparib on SPM use compared with chemotherapy treatment of physician’s choice (TPC) in patients with gBRCA-mutated HER2-negative metastatic breast cancer in the OlympiAD study (NCT02000622). Further exploratory analyses were performed to understand the association between SPM use and patient-reported outcomes (PRO). Methods: Data on the first use and dose increase in commonly prescribed SPMs, including opioid analgesics and anesthetics, were obtained from concomitant medication data routinely collected up to 30 days post-discontinuation of study drug in OlympiAD. The impact of study treatment on SPM use was assessed using the time from randomization to on-treatment initiation/dose increase of SPMs. The association between SPM use and PRO were assessed via a mixed-model for repeated measures analysis of EORTC QLQ-C30 data, routinely collected up to RECIST progression, with covariates for treatment, and pre- versus post-initiation or increase in SPMs. Differences in the association between SPMs and PRO, and randomized treatment were assessed via an interaction term. All analyses were performed on the full analysis set of the OlympiAD study. Results: 29.3% of olaparib patients and 30.9% of TPC patients had an on-treatment initiation/dose increase in SPMs during study follow-up. The hazard ratio of the time to on-treatment initiation/dose increase in SPMs comparing olaparib with TPC was 0.55 (95% confidence interval 0.33, 0.90; nominal P=0.0174); 77.2% in the olaparib arm and 66.2% in the TPC arm were event free at 6 months. The mean difference in PRO scores comparing post- versus pre-SPM periods across both study arms are presented in Table 1. For all but one of the EORTC scales, there was no statistical evidence of a difference in mean scores by SPM period according to randomized group. For social functioning, TPC patients experienced a -14.9 (-24.82, -5.07; P=0.0031) point change in the post- versus pre-SPM period, compared with 0.6 (-5.39, 4.22; P=0.8104) for olaparib.

Table 1: Mean difference in EORTC QLQ-C30 scales (all randomized patients in OlympiAD)EORTC QLQ-C30 ScaleMean difference post vs pre-SPM (95% CIs; nominal P value)Global health status-3.7 (-8.73; 1.42; P=0.1576)Functioning (decrease equates to worsening)Physical-4.6 (-8.03; -1.08; P=0.0103)Role-7.6 (-13.25; -1.92; P=0.0088)Emotional-4.3 (-8.72; 0.14; P=0.0580)Cognitive-2.4 (-6.72; 2.01; P=0.2894)Social-7.8 (-13.28; -2.25; P=0.0059)Symptoms (increase equates to worsening)Fatigue3.9 (-1.17; 9.05; P=0.1306)Pain6.7 (1.25; 12.23; P=0.0163)Nausea/vomiting4.1 (0.56; 7.69; P=0.0233)Dyspnea4.3 (-1.28; 9.92; P=0.1300)Appetite loss6.3 (0.33; 12.36; P=0.0386)Insomnia2.2 (-3.96; 8.34; P=0.4848)Constipation4.5 (-0.54; 9.57; P=0.0796)Diarrhea-2.9 (-7.37; 1.49; P=0.1935)Financial difficulties5.7 (-0.23; 11.70; P=0.0597)

Conclusions: Olaparib appears associated with a delay in the use of, or escalation in, SPM versus TPC. Across study arms, SPM use was associated with a decrement in EORTC QLQ-C30 pain score, as well as worsening in role, physical and social functioning, and symptoms of appetite loss, and nausea and vomiting. These results support the relevance of SPM as an indicator of deterioration in PRO. Further research on the impact of SPM on PRO in breast cancer is required.

Citation Format: Chantal Merens, Wendy Bannister, Sven Bergner, Robert Hettle, Charles McCrea, Susan McCutcheon, Arnold Degboe. Impact of olaparib versus chemotherapy on the use of strong pain medications in gBRCA-mutated HER2-negative metastatic breast cancer and associated patient reported outcomes [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-13-05.

Abstract PD4-03: OlympiAD extended follow-up for overall survival and safety: Olaparib versus chemotherapy treatment of physician’s choice in patients with a germline BRCA mutation and HER2-negative metastatic breast cancer

Background: In the OlympiAD study, olaparib showed a clinically meaningful benefit in progression-free survival compared with chemotherapy treatment of physician’s choice (TPC) in patients with a germline BRCA1 and/or BRCA2 mutation (BRCAm) and HER2-negative metastatic breast cancer (mBC; Robson N Engl J Med 2017). Final prespecified median overall survival (OS) at 64% data maturity was 19.3 months with olaparib versus 17.1 months with TPC (Robson Ann Oncol 2019). At this time, 26 patients continued to receive olaparib, with none continuing to receive TPC as assigned. After consenting to a protocol amendment, post hoc follow-up of patients for survival status and serious adverse events continued.

Patients and methods: OlympiAD is a Phase III, randomized, controlled, open-label trial (NCT02000622). Patients with a germline BRCAm and HER2-negative mBC who had received ≤2 prior lines of chemotherapy for mBC were randomized to olaparib tablets (300 mg twice daily) or predeclared TPC (capecitabine, vinorelbine or eribulin). Extended OS and safety follow-up were exploratory endpoints; the study was not powered to detect an OS benefit or treatment effect between subgroups. The overall hazard ratio (HR) was estimated using a stratified log-rank test, and a single Cox proportional hazards model was used for analyses in prespecified subgroups.

Results: Of patients randomized to olaparib (n=205) or TPC (n=97), 160 (78.0%) and 80 patients (82.5%) respectively had withdrawn from the study (majority due to death), and seven and eight patients, respectively, did not participate in the extended follow-up. At data cut-off (March 3, 2019), 223 patients had died (73.8% data maturity), 24 (11.7%) patients from the olaparib arm and nine patients (9.3%) from the TPC arm were continuing the study off treatment, no patients were continuing to receive TPC as assigned. Fourteen patients (6.8%) were continuing olaparib at this time; in this small number of patients at baseline their median age was 42.5 years, 42.9% had not received prior chemotherapy for mBC, 57.1% were TNBC, 50.0% had a BRCA1 mutation, 42.9% had liver metastasis and 57.1% had ≥2 metastatic sites. Median follow-up was 18.9 months in the olaparib arm and 15.5 months in the TPC arm (40.7 and 29.2 months in censored patients, respectively). OS and landmark analyses for the overall population and prespecified key subgroups are reported in the Table. Of patients who discontinued study treatment, 2.0% in the olaparib arm and 11.3% in the TPC arm received subsequent PARP inhibitors, and 42.4% and 48.5%, respectively, received subsequent platinum chemotherapy. Median total study treatment duration was 251 days in the olaparib arm versus 105 days in the TPC arm, with 8.8% of olaparib patients receiving treatment for &gt;3 years versus no TPC patients. During the extended follow-up period, there were no new serious adverse events suspected to be related to olaparib treatment, including no reports of myelodysplastic syndrome/acute myeloid leukemia.

Table. Overall survivalNo. of events (%)Median OS (months)HR (95% CI)Survival (%)12 months24 months36 months48 monthsOverall populationOlaparib (N=205)150 (73.2)19.30.84 (0.63–1.12)72.739.027.918.9TPC (N=97)73 (75.3)17.169.239.121.214.2ER/PgR positiveOlaparib (N=103)68 (66.0)21.80.79 (0.53–1.19)80.246.735.623.1TPC (N=49)36 (73.5)21.376.548.129.117.4TNBCOlaparib (102)82 (80.4)17.40.87 (0.59–1.29)65.131.220.215.4TPC (N=48)37 (77.1)14.961.629.711.911.9No prior chemotherapy for mBC (first line)Olaparib (N=59)39 (66.1)22.60.54 (0.32–0.92)76.048.140.824.6TPC (N=28)22 (78.6)14.765.426.912.812.8With prior chemotherapy for mBC (second or third line)Olaparib (N=146)111 (76.0)18.81.00 (0.72–1.40)71.435.222.417.1TPC (N=69)51 (73.9)17.270.844.124.714.8With prior platinumOlaparib (N=60)47 (78.3)17.20.74 (0.45–1.25)64.430.216.816.8TPC (N=26)22 (84.6)13.357.228.612.3NCWithout prior platinumOlaparib (N=145)103 (71.0)20.30.86 (0.62–1.21)76.142.532.420.4TPC (N=71)51 (71.8)19.673.943.125.516.3CI, confidence interval; ER, estrogen receptor; HR, hazard ratio; NC, not calculable; PgR, progesterone receptor; TNBC, triple-negative breast cancer

Conclusions: Total treatment duration was more than double for olaparib versus TPC, with no new safety findings over long-term treatment. With extended follow-up, OS did not differ significantly between treatment arms; however, continued OS benefit was suggested for olaparib versus chemotherapy for patients in the first-line setting for mBC.

Citation Format: Mark Robson, Seock-Ah Im, Elżbieta Senkus, Binghe Xu, Susan Domchek, Norikazu Masuda, Suzette Delaloge, Wei Li, Nadine Tung, Anne Armstrong, Wendy Bannister, Carsten Goessl, Allison Allen, Pierfranco Conte. OlympiAD extended follow-up for overall survival and safety: Olaparib versus chemotherapy treatment of physician’s choice in patients with a germline BRCA mutation and HER2-negative metastatic breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD4-03.

Patient-reported outcomes in patients with a germline BRCA mutation and HER2-negative metastatic breast cancer receiving olaparib versus chemotherapy in the OlympiAD trial

BACKGROUND

The phase III OlympiAD study (NCT02000622) showed a statistically significant progression-free survival benefit with olaparib versus chemotherapy treatment of physician's choice (TPC) in patients with a germline BRCA mutation and human epidermal growth factor receptor 2-negative metastatic breast cancer. From this study, we report the effect of olaparib on health-related quality of life (HRQoL).

METHODS

Patients were randomised 2:1 to olaparib monotherapy (300 mg twice daily) or single-agent TPC. The primary HRQoL end-point was mean change from baseline in the two-item global health status/QoL score determined from patient-completed European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30-item module (EORTC QLQ-C30) questionnaires and assessed using a mixed model for repeated measures. Symptoms and functioning domains, best overall response and time to deterioration of QoL were also evaluated.

RESULTS

Overall questionnaire compliance rates were 93.2% for olaparib and 76.3% for TPC. Between-treatment global health status/QoL comparison showed a significant improvement in the olaparib arm versus the TPC arm, with mean change of 3.9 (standard deviation 1.2) versus -3.6 (2.2), a difference of 7.5 points (95% confidence interval [CI]: 2.48, 12.44; P = 0.0035). A higher proportion of patients in the olaparib arm showed a best overall response of 'improvement' in global health status/QoL (33.7% vs 13.4%). Median time to global health status/QoL deterioration was not reached in olaparib patients and was 15.3 months for TPC patients (hazard ratio: 0.44 [95% CI: 0.25, 0.77]; P = 0.004). For EORTC QLQ-C30 symptoms and functioning subscales, only nausea/vomiting symptom score was worse in the olaparib arm than in the TPC arm (across all visits compared with baseline).

CONCLUSION

HRQoL was consistently improved for patients treated with olaparib, compared with chemotherapy TPC.

Olaparib does not cause clinically relevant QT/QTc interval prolongation in patients with advanced solid tumours: results from two phase I studies

BACKGROUND

Some therapeutic agents in oncology can be causally associated with specific cardiovascular events including QT/QTc interval prolongation. We investigated the effect of multiple dosing of the oral poly (ADP-ribose)-polymerase (PARP) inhibitor, olaparib (tablet formulation) on QT/QTc interval.

METHODS

Two phase I, open-label, three-part studies (NCT01921140 [study 4] and NCT01900028 [study 7]) were conducted in adults with refractory/resistant advanced solid tumours. In both studies, parts A and B assessed the QT/QTc interval effects of single-dose oral olaparib 100 (study 4) or 300 (study 7) mg and multiple-dose olaparib 300 mg bid for 5 days, respectively, while part C evaluated continued access to olaparib for additional safety analyses. An ANCOVA model tested the primary objective of multiple-dose effects of olaparib on QT interval corrected using Fridericia's formula (QTcF).

RESULTS

Data from 119 and 109 patients were pooled from parts A and B, respectively, for QT/QTc analysis. At pre-dose and up to 12 h post-dose, the upper limits of the 90 % confidence intervals (CIs) for the difference in QTcF least squares means after olaparib multiple dosing versus control (day -1) were <10 ms, suggesting a lack of clinically relevant effect on cardiac repolarization. A slight shortening of QTcF was observed at most time points versus control. QTcF results for the individual studies and single-dose olaparib paralleled the primary multiple-dose pooled analysis, with upper limits of the 90 % CIs < 10 ms.

CONCLUSION

Olaparib tablets administered as multiple or single doses had no clinically significant effect on QT/QTc interval.

Effect of Food on the Pharmacokinetics of Olaparib after Oral Dosing of the Capsule Formulation in Patients with Advanced Solid Tumors

BACKGROUND

The oral, potent poly(ADP-ribose) polymerase (PARP) inhibitor, olaparib, is well tolerated at doses of ≤400 mg twice daily (BID) (administered as capsules), and has shown efficacy in patients with advanced BRCA-mutated ovarian and breast cancer.

METHODS

This Phase I, open-label, randomized trial investigates the effect of food on the pharmacokinetics of olaparib in patients with refractory/resistant advanced solid tumors. In Part A, a three-period crossover study, patients received a single oral dose of olaparib 400 mg (8 × 50 mg capsules) in three prandial states: fasted, a high-fat meal or a standard meal (with a 5-14 day washout). Blood samples for pharmacokinetic (PK) assessments were taken pre-dose and up to 72 h post-dose. After completing Part A, patients could enter Part B, where they would receive olaparib 400 mg BID.

RESULTS

32 patients were randomized; 31 contributed to the PK statistical analysis and entered Part B. The presence of food slowed the rate of absorption (time to maximal plasma concentration [t max] was delayed by ~2 h). Maximum plasma concentration (C max) was increased by 10% following a standard meal and was unchanged with a high-fat meal (ratio of geometric means [90% confidence interval (CI)]: 1.10 [1.02-1.20] for standard and 1.00 [0.92-1.09] for high-fat meal). The extent of olaparib absorption (AUC) was increased by ~20% in the fed state (ratio of geometric means: 1.21 [1.10-1.33] for standard and 1.19 [1.08-1.31] for high-fat meal).

CONCLUSIONS

The presence of food decreased the rate and increased the extent of absorption of olaparib following oral dosing of the capsule formulation. However, the effects of food on olaparib PK were not deemed clinically important, according to predefined criteria. Safety data were consistent with the known safety profile of olaparib.

FUNDING

AstraZeneca.

Factors associated with HIV-1 virological failure in an outpatient clinic for HIV-infected people in Haiphong, Vietnam

The objective of our study was to investigate factors associated with virological failure in 100 consecutive HIV-1 infected Vietnamese adults who initiated antiretroviral therapy (ART) from June 2007 to June 2008. Data were collected from medical records, and a structured questionnaire was used in individual interviews to investigate factors associated with adherence to ART. Plasma HIV viral load was measured at the time of the interview. The median age was 35 years, 35% were women and heterosexual intercourse was the most common mode of HIV transmission (61%). After a median of 14 months since starting ART, 23% had detectable HIV-1 viral load (≥ 400 copies/mL). Patients who had developed a World Health Organization (WHO) clinical stage 4 condition at the time of initiation of ART were more likely to experience virological failure than those in stages 1-3, odds ratio (OR): 5.20 (95% confidence interval [CI] 1.34-20.11), P = 0.017. Patients who reported that their health status was evaluated by a physician at each visit were less likely to experience virological failure, OR: 0.02 (95% CI 0.00-0.24), P = 0.002.

Assisted reproductive therapies and imprinting disorders--a preliminary British survey

BACKGROUND

Recent reports have suggested a higher risk of Beckwith-Wiedemann syndrome (BWS) and Angelman syndrome (AS) after assisted reproductive technologies (ARTs), but it is unclear whether this might also apply to other disorders of genomic imprinting.

METHODS

We contacted families of children with BWS, AS, Prader-Willi syndrome (PWS) and transient neonatal diabetes mellitus (TNDM) to determine use of ART.

RESULTS

A statistically significant increased frequency of ART in children with BWS was confirmed [2.9%, 95% confidence interval (CI) 1.4-6.3% vs 0.8% expected] but there was no significant association with PWS or TNDM. Consideration of the molecular subgroup of BWS and AS suggested the feasibility of association with ART.

CONCLUSIONS

These differences may relate to variations in (i) the molecular mechanisms for disordered imprinting in the different disorders and (ii) the susceptibility of specific imprinting control regions to ART-associated methylation alterations (epimutations).

Comparison of serum FSH and Inhibin B levels between adult male dizygotic and monozygotic twins

BACKGROUND

FSH hypersecretion occurs in mothers of dizygotic (DZ) twins. Twinning is inherited via both sexes and transmitted through the female. FSH hypersecretion may thus occur in male DZ twins.

METHODS

We assayed FSH and its counter-regulatory hormone, Inhibin B, in 108 adult male DZ and 100 monozygotic (MZ) twins (as controls) and compared our results to published norms.

RESULTS

Inhibin B was elevated and higher in DZ compared with MZ twins with similar FSH.

CONCLUSION

The normal FSH: Inhibin B endocrine feedback axis is different in adult male DZ twins. This contributes to the theory that the answer to human DZ twinning lies in the actions of FSH and Inhibin, and in their mutual interaction.

Are Specific Antiretrovirals associated with an Increased Risk of Discontinuation due to Toxicities or Patient/Physician Choice in patients with Hepatitis C Virus Coinfection?

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.

Thymidine Analogue Mutation Profiles: Factors Associated with Acquiring Specific Profiles and their Impact on the Virological Response to Therapy

Background

Studies have suggested that HIV-1 may develop thymidine analogue mutations (TAMs) by one of two distinct pathways – the TAM1 pathway (including mutations 41L, 210W and 215Y) or the TAM2 pathway (including mutations 67N, 70R and 219E/Q) – under the pressure of a not fully suppressive thymidine-analogue-containing regimen.

Methods

Frozen plasma samples stored in the EuroSIDA repository were selected and sent to two central laboratories for genotypic analysis. We considered 733 patients with at least one genotypic test showing ≥1 TAMs (the first of these tests in chronological order was used). TAM1 and TAM2 genotypic profiles were defined in accordance with previous literature. Statistical modelling involved logistic regression and linear regression analysis for censored data.

Results

The observed frequencies of patterns classifiable as TAM1 or TAM2 profiles were markedly higher than the probabilities of falling into these classifications by chance alone. The chance of detecting a TAM2 profile increased by 25% per additional year of exposure to zidovudine. We found that mutations 67N and 184V were not associated with a particular TAM profile. In the presence of TAM2 profiles, the adjusted mean difference in the 6-month viral reduction was 0.96 log10 copies/ml (95% confidence interval: 0.20; 1.73) higher in patients who started stavudine-containing regimens instead of zidovudine-containing regimens.

Conclusions

This study provides evidence that the suggested TAM clustering is a real phenomenon and that it may be driven by which thymidine analogue the patients has used. In patients with TAM2-resistant viruses, stavudine appears to retain greater viral activity than zidovudine.

Epistatic interaction between variations in the angiotensin I converting enzyme and angiotensin II type 1 receptor genes in relation to extent of coronary atherosclerosis

OBJECTIVE

To test the hypothesis that gene-gene interaction of the renin-angiotensin system is associated with an effect on the extent of coronary atherosclerosis.

SETTING AND RESULTS

A cohort of 1162 patients with coronary artery disease were genotyped for genetic polymorphisms in the renin-angiotensin system. Patients carrying the D allele of the angiotensin I converting enzyme (ACE) gene had greater coronary extent scores (defined as the number of coronary segments with 5% to 75% stenosis) than those not carrying this allele (p = 0.006 in non-parametric analysis and p = 0.019 in parametric analysis). This association remained significant after adjusting for age, body mass index, hypertension, and diabetes, which were also significantly associated with coronary extent scores. There was a significant interaction (p = 0.033) between genotypes of ACE and angiotensin II type 1 receptor (AGTR1). The association between the ACE gene D allele and increased coronary extent scores was significant (p = 0.008 in non-parametric and p = 0.027 in parametric analysis) in those carrying the +1166 C allele of the AGTR1 gene, but was absent in those not carrying the AGTR1 gene +1166 C allele.

CONCLUSION

These findings suggest that variation in the ACE and AGTR1 genes and their interaction may not only contribute to susceptibility of coronary artery disease as previously found but also modify the disease process, thus contributing to interindividual differences in severity of the disease.

Independent effects of the -219 G>T and epsilon 2/ epsilon 3/ epsilon 4 polymorphisms in the apolipoprotein E gene on coronary artery disease: the Southampton Atherosclerosis Study

A number of studies have shown that coronary artery disease severity is associated with the epsilon 2/ epsilon 3/ epsilon 4 polymorphism in the coding region of the apolipoprotein E gene. In this study, we investigated whether the severity of the disease was also influenced by a functional polymorphism (-219 G>T) in the promoter of the gene, and if so, whether the effects of the two polymorphisms were independent. A cohort of 1170 patients with angiographically documented coronary artery disease were genotyped for the two polymorphisms. The frequency of the epsilon 4 allele of the epsilon 2/ epsilon 3/ epsilon 4 polymorphism increased linearly with increasing number of diseased vessels, so did the -219T allele of the -219 G>T polymorphism. In the sample as a whole, logistic regression analyses indicated that compared with the G/G genotype, the T/T genotype conferred an odds ratio of 1.598 (95% CI=1.161-2.201, P=0.004) in favor of increased disease severity, and the relationship remained significant after adjustment for epsilon 2/ epsilon 3/ epsilon 4 polymorphism genotypes, plasma cholesterol and triglyceride levels, and other risk factors. The effect of the T/T genotype on disease severity was more significant in patients who did not carry the epsilon 4 allele (OR=1.510, 95% CI=1.028-2.221) than in epsilon 4 allele carriers (OR=1.303, 95% CI=0.619-2.742). There was considerable linkage disequilibrium between the two polymorphisms (rho=0.9, P<0.001). Logistic regression analysis showed that the -219T- epsilon 4 haplotype conferred an odds ratio of 1.488 (95% CI=1.133-1.954). These findings suggest that the -219 G>T and epsilon 2/ epsilon 3/ epsilon 4 polymorphisms, which may affect respectively the quantity and quality of apoE, have independent and possibly additive effects on coronary artery disease severity.

Grading cervical dysplasia with AgNORs using a semiautomated image analysis system

Colposcopic biopsies were classified according to previously established criteria by a group of three pathologists interested in cervical pathology. Ten cases were identified in each of the following five groups: normal, koilocytosis, low grade squamous intraepithelial lesions (CIN 1), high grade squamous intraepithelial lesions (CIN 2) and high grade squamous intraepithelial lesions (CIN 3). The Crocker technique was used to stain the sections cut 3 microns thick. With ths silver stain the nucleolar organizer regions (NORs) are stained black and referred to as AgNORs. It has been shown that malignant and premalignant changes in cells produce an increase in AgNORs. In each case eight images were captured using a 100x oil-immersion objective and stored in a Datacube Maxvideo system as 512 x 480 pixels in an 8-bit grayscale per image. The images were processed using the NeoPath field-of-view computer to detect the AgNORs and nuclei by using grayscale mathematical morphology algorithms. Color overlays of the AgNORs and nuclei were created using segmentation algorithms. The results show that it is possible to differentiate between low grade squamous intraepithelial lesions (CIN 1) and high grade squamous intraepithelial lesions (CIN 2 and CIN 3) taken together; however, there is no difference between low grade squamous intraepithelial lesions (CIN 1) and koilocytosis. The results support the concept that dysplasia cannot be classified effectively into three grades and that low grade squamous intraepithelial lesions (mild dysplasia [CIN 1]) is indistinguishable from koilocytosis.