Assessment of Population-Based HIV RNA Levels in a Rural East African Setting Using a Fingerprick-Based Blood Collection Method

ABSTRACT Ten subjects received 600 to 1,200 mg of the human immunodeficiency virus type 1 (HIV-1) protease inhibitor ritonavir per day. Following 2 weeks of therapy, plasma HIV RNA levels decreased by a mean of 1.57 (range, 0.89 to 1.96) log units. With continued therapy, HIV RNA levels began to rise in eight subjects. The initial rise in plasma RNA levels was temporally associated with the development and quantitative increase in the V82 resistance mutation. Doubling times of the V82A mutant virus were estimated to be 2.4 to 4.8 days. An L63P/A mutation was commonly present at baseline even in subjects with a durable virologic response. The concomitant acquisition of an L63P/A mutation with the V82A/F mutation at the time when plasma RNA levels rebounded suggests a role for the L63P/A mutation in improving the fitness of the V82A/F mutation. Subsequent additional genotypic changes at codons 54 and 84 were often associated with further increases in plasma RNA levels. Ongoing viral replication in the presence of drugs resulted in the appearance of additional genotypic changes, including the L90M saquinavir resistance mutation, and decreased phenotypic susceptibility. The relative fitness of the protease V82A ritonavir resistance mutation and reverse transcriptase T215Y/F zidovudine resistance mutation following drug withdrawal were estimated to be 96 to 98% that of the wild type. Durability of the virologic response was associated with plasma RNA levels at the nadir. A virologic response beyond 60 days was not observed unless plasma HIV RNA levels were suppressed below 2,000 copies/ml, consistent with estimates from V82A doubling times for selection of a single resistance mutation to dominate the replicating population.

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Prevalência de hiperglicemia em idosos: um estudo de base populacional

Scientia Medica ◽

10.15448/1980-6108.2016.4.25246 ◽

2016 ◽

Vol 26 (4) ◽

pp. 25246

Author(s):

Felipe Zancan Espanhol ◽

Rita de Cássia S. M. De Oliveira ◽

Gustavo Paes Silvano ◽

André Luciano Manoel ◽

Laise Rodrigues Silveira ◽

...

Keyword(s):

Skin Color ◽

Elderly Population ◽

Fasting Glucose ◽

Fasting Blood Glucose ◽

Simple Random Sampling ◽

The Elderly ◽

Population Based ◽

Blood Collection ◽

Cross Sectional ◽

Family History Of Diabetes

Aims: To evaluate the prevalence of hyperglycemia and associated factors in the elderly population of a municipality in southern Brazil.Methods: Cross-sectional population-based study, carried out with the elderly (≥60 years) living in the city of Tubarão, state of Santa Catarina, Brazil, from September 2010 to May 2011. Participants were selected by simple random sampling. The elderly were registered by the Community Health Agents of the Family's Health Strategy Program. Sociodemographic data (age, gender, skin color, marital status, employment status and education), behavioral data (physical activity, alcohol use and smoking) and clinical data (obesity, drug use and family history of diabetes) were recorded. After answering these questions the participants were scheduled to attend the clinic for blood collection and anthropometric measurements. The prevalence of hyperglycemia was assessed from fasting blood glucose tests, and individuals with values ≥126 mg/dL or use of hypoglycemic drugs were considered hyperglycemic. To assess the association between the variables of interest, the chi-square test was applied. The pre-determined confidence interval was of 95% and the error α of 5%.Results: Eight hundred thirty-three elderly patients were included, and 220 were considered hyperglycemic according to the methodology criteria (prevalence of 26.4%). Of the patients included in the hyperglycemia group, 190 were using oral hypoglycemic drugs, and of these, 112 had also fasting glucose ≥126 mg/dL, while in 78 fasting glucose was <126 mg/dL. Also in the hyperglycemia group, 30 patients had fasting glucose ≥126 mg/dL and were not on hypoglycemic treatment. Having parents diagnosed with diabetes and being obese were associated with the presence of hyperglycemia.Conclusions: This study suggests that a large portion of the elderly population have fasting hyperglycemia, requiring a wider evaluation for diabetes mellitus.

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Proposed Plasma Ammonia Reference Intervals in a Reference Group of Hospitalized Term and Preterm Neonates

The Journal of Applied Laboratory Medicine ◽

10.1093/jalm/jfz001 ◽

2020 ◽

Vol 5 (2) ◽

pp. 363-369

Author(s):

Theresa Madigan ◽

Darci R Block ◽

William A Carey ◽

Bethany D Kaemingk ◽

Robin Patel

Keyword(s):

Gestational Age ◽

Reference Group ◽

Reference Intervals ◽

Preterm Neonates ◽

Blood Collection ◽

Blood Draw ◽

Inborn Errors ◽

Term Infants ◽

Collection Method ◽

Plasma Ammonia

Abstract Background Plasma ammonia is commonly measured in the diagnostic evaluation of hospitalized newborns, but reference values are not well defined. Methods We prospectively enrolled newborns admitted to the level III/IV neonatal intensive care unit and level II intermediate special care nursery from January 2017 to January 2018. Infants with inborn errors of metabolism or liver disease were excluded. Plasma ammonia concentrations were measured once within the first week of life and evaluated by sex, gestational age, timing of the draw, blood collection method, and type of nutrition. Reference intervals were calculated. Results 127 neonates were included; one third (34%) were term infants born at ≥37 weeks gestation, and two thirds (66%) were born preterm at <37 weeks gestation. Median plasma ammonia concentrations were 32 μmol/L (range <10 to 86 μmol/L). Median ammonia concentrations were higher among preterm compared to term infants (35 vs. 28 μmol/L, p = 0.0119), and term female compared to term male infants (34 vs. 26 μmol/L, p = 0.0228). There was no difference in median ammonia concentrations between female and male preterm infants, based on gestational age within the preterm group, timing of the blood draw, presence of hyperbilirubinemia, blood collection method, or type of nutritional intake. Conclusions Plasma ammonia concentrations among newborns are higher than the expected adult concentrations and may vary by gestational age and sex. Blood collection method, type of nutrition, hyperbilirubinemia, and timing of the draw do not impact concentrations. We propose a reference limit of ≤82 μmol/L for newborns less than one week of age.

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HIV-1 RNA Levels in an African Population-Based Cohort and Their Relation to CD4 Lymphocyte Counts and World Health Organization Clinical Staging

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/00126334-199910010-00009 ◽

1999 ◽

Vol 22 (2) ◽

pp. 167 ◽

Cited By ~ 2

Author(s):

Dilys Morgan ◽

Alleluiah Rutebemberwa ◽

Samuel Malamba ◽

Amanda Ross ◽

James Whitworth ◽

...

Keyword(s):

World Health Organization ◽

Population Based ◽

African Population ◽

World Health ◽

Clinical Staging ◽

Cd4 Lymphocyte ◽

Health Organization ◽

Hiv 1 ◽

Rna Levels

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Differences in HIV RNA levels before the initiation of antiretroviral therapy among 1864 individuals with known HIV-1 seroconversion dates

AIDS ◽

10.1097/01.aids.0000131395.14339.f5 ◽

2004 ◽

Vol 18 (12) ◽

pp. 1697-1705 ◽

Cited By ~ 38

Author(s):

Giota Touloumi ◽

Nikos Pantazis ◽

Abdel G Babiker ◽

Sarah A Walker ◽

Olga Katsarou ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Hiv Rna ◽

Hiv 1 ◽

Rna Levels

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Accuracy of a Commercial Real‐Time Polymerase Chain Reaction–Based System for Measurement of HIV RNA Levels around the Limit of Quantification of the Assay

Clinical Infectious Diseases ◽

10.1086/598990 ◽

2009 ◽

Vol 48 (11) ◽

pp. 1630-1631 ◽

Cited By ~ 3

Author(s):

Alessandra Amendola ◽

Maria Grazia Milia ◽

Valeria Ghisetti ◽

Carla Brega ◽

Paola Zaccaro ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Real Time ◽

Chain Reaction ◽

Limit Of Quantification ◽

Hiv Rna ◽

Polymerase Chain ◽

Rna Levels

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A Prediction Model of Pretreatment HIV RNA Levels in Naïve Thai HIV-infected Patients: An Application for Resource-limited Settings

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1097 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S434-S434

Author(s):

Nisha Pongpech ◽

Anchalee Avihingsanon ◽

Romanee Chaiwarith ◽

Pacharee Kantipong ◽

David Boettiger ◽

...

Keyword(s):

Prediction Model ◽

Predictive Value ◽

Cd4 Count ◽

High Rate ◽

First Line ◽

Data Set ◽

Factors Associated ◽

Hiv Rna ◽

Hiv Exposure ◽

Rna Levels

Abstract Background The use of abacavir (ABC) and rilpivirine (RPV) in the first-line regimen for naïve HIV-infected patients with pretreatment HIV RNA >100,000 copies/mL is not recommended due to a high rate of treatment failure. If a model could accurately predict pretreatment HIV RNA levels, it would be a useful tool for the selection ABC or RPV in the first-line regimen. Methods Thai HIV-infected adults enrolled in the TREAT Asia HIV Observational Database (TAHOD) and additional patients of Ramathibodi Hospital were eligible if they had an HIV RNA result at the time of antiretroviral therapy initiation. Factors associated with pretreatment HIV RNA <100,000 copies/mL were determined by logistic regression. Based on the results of the final model, a prediction model was created. Results A total of 1,223 patients were included in the analysis. Among those in the derivation data set, median [interquartile range (IQR)] age was 36.3 (30.5–42.9) years, median (IQR) CD4 count was 122 (39–216) cells/mm3, and pretreatment HIV RNA was 100,000 (32,449–229,777) copies/mL. Factors associated with pretreatment HIV RNA <100,000 copies/mL were anemia [odds ratio (OR) 2.05 vs. no anemia; 95% confidence interval (CI) 1.28–3.27], CD4 count >200 cells/mm3 (OR 3.00 vs. CD4 count <200 cells/mm3; 95% CI 2.08–4.33), and non-heterosexual HIV exposure (OR 1.61 vs. heterosexual HIV exposure; 95% CI 1.07–2.43). No AIDS-defining illness (11.5), no anemia (18.5), age <35 years (11), CD4 count >200 cells/mm3 (27), duration of HIV infection >1 year (9), and weight >50 years (11) were included in the clinical prediction tool scores. A score ≥45 yielded a sensitivity of 45.3%, specificity of 76.7%, positive predictive value of 68.1%, and negative predictive value of 56.1% among patients in the derivation. The area under the receiver-operator characteristic curve was 0.655 (95% CI 0.614- 0.696) and 0.600 (95% CI 0.533–0.667) in the derivation and validation patients, respectively. Conclusion Our final prediction model had poor sensitivity and specificity for predicting HIV RNA <100,000 copies/mL. Further study on a larger population with a greater diversity of data variables available is necessary to improve the model. Pretreatment HIV RNA remains necessary before ABC or RPV initiation for naïve Thai HIV-infected patients. Disclosures All authors: No reported disclosures.

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