scholarly journals Association between CD4, CD4/CD8 ratio and viral blips among virally suppressed HIV patients – a joint disease progression and time-to-event model

2021 ◽  
Author(s):  
Ngah Kuan Chow ◽  
Sabariah Noor Harun ◽  
Amer Hayat Khan
Keyword(s):  
Risk Factors ◽  
Disease Progression ◽  
Recovery Rate ◽  
Significant Risk ◽  
Hiv Treatment ◽  
Joint Disease ◽  
Care Plan ◽  
Hiv Positive ◽  
Time To Event ◽  
Term Care

Aim Viral blips that occur among virally suppressed HIV-positive patients suggest immune activation and inflammation and associated with slower CD4 count and CD4/CD8 ratio normalisation. With the advances in HIV treatment, lifestyle and comorbidities begin to be a concern despite successful antiretroviral therapy. We reported a study incorporating the effect of CD4 and CD4/CD8 ratio normalisation on viral blips in joint disease progression (DP) and time-to-event (TTE) model. Methods A total of 152 HIV-positive patients receiving efavirenz therapy were recruited. Joint DP and TTE models on viral blip were developed for CD4 and CD4/CD8 ratio separately. Risk factors, such as smoking status, pack-year and comorbidity scores, were included in the analysis. Results Gompertz model best described the CD4 and CD4/CD8 ratio DP models, while viral blips data were fitted with the Cox proportional hazard model. History of opportunistic infections and changing of antiretroviral regimen significantly affect the baseline CD4 and CD4/CD8 ratio. Comorbidity score was significant in both CD4 (asymptote CD4) and CD4/CD8 ratio DP model (recovery rate). Increase in cumulative pack-year resulted in lower CD4/CD8 ratio recovery rate (β -0.02, 95%CI: -0.03 to -0.01; p<0.001). Active smokers with slow CD4 or CD4/CD8 ratio normalisation associated with more viral blips. Conclusion CD4 and CD4/CD8 ratio are significant risk factors of viral blips and potential markers of non-AIDS related morbidities in virally suppressed patients. Early identification of high-risk group with repeated viral load testing, lifestyle modification and comorbidities management should be emphasised in the HIV treatment long-term care plan.

scholarly journals Central Blood Pressure and Chronic Kidney Disease Progression

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Debbie L. Cohen ◽  
Raymond R. Townsend
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Disease Progression ◽  
Pulse Wave ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Chronic Kidney Disease Progression ◽  
Patients At Risk ◽  
Kidney Disease Progression

Hypertension, diabetes, and proteinuria are well-recognized risk factors for progressive kidney function loss. However, despite excellent antihypertensive and antidiabetic drug therapies, which also often lower urinary protein excretion, there remains a significant reservoir of patients with chronic kidney disease who are at high risk for progression to end-stage kidney disease. This has led to the search for less traditional cardiovascular risk factors that will help stratify patients at risk for more rapid kidney disease progression. Among these are noninvasive estimates of vascular structure and function. Arterial stiffness, manifested by the pulse wave velocity in the aorta, has been established in a number of studies as a significant risk factor for kidney disease progression and cardiovascular endpoints. Much less well studied in chronic kidney disease are measures of central arterial pressures. In this paper we cover the physiology behind the generation of the central pulse wave contour and the studies available using these approaches and conclude with some speculations on the rationale for why measurements of central pressure may be informative for the study of chronic kidney disease progression.

scholarly journals Characterization of direct and/or indirect genetic associations for multiple traits in longitudinal studies of disease progression

2021 ◽  
Author(s):  
Myriam Brossard ◽  
Andrew D. Paterson ◽  
Osvaldo Espin-Garcia ◽  
Radu V. Craiu ◽  
Shelley B. Bull
Keyword(s):  
Risk Factors ◽  
Disease Progression ◽  
Complex Traits ◽  
Measurement Errors ◽  
Joint Model ◽  
Alternative Methods ◽  
Joint Analysis ◽  
Multiple Time ◽  
Time To Event ◽  
Subject Specific

When quantitative longitudinal traits are risk factors for disease progression, endogenous, and/or subject to random errors, joint model specification of multiple time-to-event and multiple longitudinal traits can effectively identify direct and/or indirect genetic association of single nucleotide polymorphisms (SNPs) with time-to-event traits. Here, we present a joint model that integrates: i) a linear mixed model describing the trajectory of each longitudinal trait as a function of time, SNP effects and subject-specific random effects, and ii) a frailty Cox survival model that depends on SNPs, longitudinal trajectory effects, and a subject-specific frailty term accounting for unexplained dependency between time-to-event traits. Inference is based on a two-stage approach with bootstrap joint covariance estimation. We develop a hypothesis testing procedure to identify direct and/or indirect SNP association with each time-to-event trait. Motivated by complex genetic architecture of type 1 diabetes complications (T1DC) observed in the Diabetes Control and Complications Trial (DCCT), we show by realistic simulation study that joint modelling of two time-to-T1DC (retinopathy, nephropathy) and two longitudinal risk factors (HbA1c, systolic blood pressure) reduces bias and improves identification of direct and/or indirect SNP associations, compared to alternative methods ignoring measurement errors in intermediate risk factors. Through analysis of DCCT, we identify two SNPs with indirect associations with multiple time-to-T1DC traits and obtain similar conclusions using alternative formulations of time-dependent HbA1c effects on T1DC. In total, joint analysis of multiple longitudinal and multiple time-to-event traits provides insight into etiology of complex traits.

Resident Aggression and Abuse in Assisted Living

2016 ◽  
Vol 37 (8) ◽  
pp. 947-964 ◽  
Author(s):  
Gilbert Gimm ◽  
Syeda Chowdhury ◽  
Nicholas Castle
Keyword(s):  
Risk Factors ◽  
Assisted Living ◽  
Significant Risk ◽  
Future Research ◽  
Assisted Living Facilities ◽  
Care Providers ◽  
Term Care ◽  
Older Americans ◽  
Residential Care Facilities ◽  
Level Data

This article estimates the prevalence and identifies risk factors of resident aggression and abuse in assisted living facilities. We conducted multivariate analyses of resident-level data from an analytic sample of 6,848 older Americans in the 2010 National Survey of Residential Care Facilities. Nationwide, 7.6% of assisted living residents engaged in physical aggression or abuse toward other residents or staff in the past month, 9.5% of residents had exhibited verbal aggression or abuse, and 2.0% of resident engaged in sexual aggression or abuse toward other residents or staff. Dementia and severe mental illness were significant risk factors for all three types of resident aggression and abuse. Resident aggression and abuse in assisted living facilities is prevalent and warrants greater attention from policy makers, researchers, and long-term care providers. Future research is needed to support training and prevention efforts to mitigate this risk.

scholarly journals Epidemiological Profile and Risk Factors for Acquiring HBV and/or HCV in HIV-Infected Population Groups in Nepal

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Manjula Bhattarai ◽  
Jagat Bahadur Baniya ◽  
Nirmal Aryal ◽  
Bimal Shrestha ◽  
Ramanuj Rauniyar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Migrant Workers ◽  
Sex Workers ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Hiv Positive ◽  
Hiv Viral Load ◽  
Population Groups ◽  
Epidemiological Profile ◽  
Hcv Coinfection

HBV and HCV infections are widespread among the HIV-infected individuals in Nepal. The goals of this study were to investigate the epidemiological profile and risk factors for acquiring HBV and/or HCV coinfection in disadvantaged HIV-positive population groups in Nepal. We conducted a retrospective study on blood samples from HIV-positive patients from the National Public Health Laboratory at Kathmandu to assay for HBsAg, HBeAg, and anti-HCV antibodies, HIV viral load, and CD4+ T cell count. Among 579 subjects, the prevalence of HIV-HBV, HIV-HCV, and HIV-HBV-HCV coinfections was 3.62%, 2.93%, and 0.34%, respectively. Multivariate regression analysis indicated that spouses of HIV-positive migrant labourers were at significant risk for coinfection with HBV infection, and an age of >40 years in HIV-infected individuals was identified as a significant risk factor for HCV coinfection. Overall our study indicates that disadvantaged population groups such as intravenous drug users, migrant workers and their spouses, female sex workers, and men who have sex with HIV-infected men are at a high and persistent risk of acquiring viral hepatitis. We conclude that Nepalese HIV patients should receive HBV and HCV diagnostic screening on a regular basis.

scholarly journals Awareness of cervical cancer among women attending an HIV treatment centre: a cross-sectional study from Morocco

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e020343 ◽  
Author(s):  
Essaada Belglaiaa ◽  
Tiatou Souho ◽  
Latifa Badaoui ◽  
Michel Segondy ◽  
Jean-Luc Prétet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Pap Smear ◽  
Cross Sectional Study ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk ◽  
Treatment Centre

ObjectiveTo explore awareness about cervical cancer among Moroccan women attending an HIV treatment centre in Laâyoune city, Morocco.DesignA cross-sectional study was conducted from April to June 2017 using a knowledge test regarding cervical cancer, its risk factors and its prevention.SettingHIV treatment centre at the Hospital of Moulay Hassan Ben Elmehdi in Laâyoune city, Morocco.ParticipantsOne hundred and twenty-three HIV-positive women aged 19 years and older were recruited to this study.ResultsA total of 115 women were eligible to participate in the study. The average age was 34.9±10.2 years. Few women (20%) had heard about cervical cancer and its screening, the majority (17.4%) having received information from mass media. The vast majority (79.1%) of respondents had no knowledge of cervical cancer risk factors, and 80.8% did not know any symptoms of cervical cancer. Only 13% had undergone a Pap smear test. The main reason for not seeking Pap smear was the absence of symptoms (47%).ConclusionOur study documents poor awareness of cervical cancer. Given that the HIV-positive population is at increased risk of cervical cancer, health education programmes should be promoted to increase awareness of cervical cancer as well as access and participation in cervical cancer screening.

scholarly journals Risk Factors for Fecal Colonization With Multiple Distinct Strains ofEscherichia coliAmong Long-Term Care Facility Residents

2009 ◽  
Vol 30 (5) ◽  
pp. 491-493 ◽  
Author(s):  
Ebbing Lautenbach ◽  
Pam Tolomeo ◽  
Nicole Black ◽  
Joel N. Maslow
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Significant Risk ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
E Coli ◽  
Multiple Strains

Of 49 long-term care facility residents, 21 (43%) were colonized with 2 or more distinct strains ofEscherichia coli.There were no significant risk factors for colonization with multiple strains ofE. coli.These results suggest that future efforts to efficiently identify the diversity of colonizing strains will be challenging.

scholarly journals Factors Affecting the Prognosis of Children with Medulloblastoma: A Single Institution Retrospective Analysis of 40 Cases

2017 ◽  
Vol 3 (1) ◽  
pp. 16-27
Author(s):  
Jianzhong Yu ◽  
We Shi ◽  
Hao Li
Keyword(s):  
Risk Factors ◽  
Disease Progression ◽  
Cox Regression ◽  
Molecular Subtype ◽  
Postoperative Radiotherapy ◽  
Significant Risk ◽  
Postoperative Treatment ◽  
Karnofsky Performance Scale ◽  
Cox Regression Analysis ◽  
Factors Associated

Few studies have investigated the factors associated with the prognosis of children with medulloblastoma. This retrospective observational study evaluated the association of molecular subtype, clinical characteristics, and pathological types with the outcomes of children with medulloblastoma. This study included 40 patients with medulloblastoma who underwent surgical resection at the Affiliated Children's Hospital of Fudan University between January 2004 and June 2014. The primary outcome was overall survival (OS). Risk factors associated with survival, disease progression, and recurrence were analyzed by univariate Cox regression analysis; the identified significant risk factors were further analyzed by Kaplan-Meier survival curves. Immunohistochemistry analysis of Yes-associated protein 1 (YAP1) and GRB2-associated protein 1 (GAB1) was used for medulloblastoma subtype identification; 20% of tumors were the WNT subtype, and 32.5% were the SHH subtype, with the remainder being non-SHH/WNT. Factors associated with OS included M stage, calcification, cerebrospinal fluid fistula, postoperative treatment (radiotherapy, chemotherapy, or both), postoperative Karnofsky Performance Scale score, and molecular subtype (P < 0.044). Patients with the WNT subtype had better survival outcomes (hazard ratio [HR] = 0.16, 95% confidence interval [CI]: 0.05–0.58). Number of symptoms, M stage, and postoperative radiotherapy were associated with disease progression (P ≤ 0.033). The risk of recurrence increased with advanced M stage (HR = 30.71; 95% CI: 3.92—240.44, P = 0.001). Patients receiving both chemotherapy and radiotherapy were less likely to have a recurrence (P = 0.040). Molecular subtyping of medulloblastoma was more predictive of survival than histopathology in patients undergoing adjuvant therapy.

scholarly journals The Incidence and Risk Factors for Pregnancy Among HIV-Positive Adolescents Enrolled in a Large HIV Treatment Program in Western Kenya from 2005-2014

2017 ◽  
Vol 30 (2) ◽  
pp. 305-306
Author(s):  
Heather Millar ◽  
Alfred Keter ◽  
Gerald Bove ◽  
Edith Apondi ◽  
Alice Kaaria ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Program ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Western Kenya

scholarly journals Cardiovascular Disease and Cardiovascular Disease Risk in HIV-Positive Populations in the Asian Region

2017 ◽  
Vol 11 (1) ◽  
pp. 52-66 ◽  
Author(s):  
Rimke Bijker ◽  
Jun Yong Choi ◽  
Rossana Ditangco ◽  
Sasisopin Kiertiburanakul ◽  
Man Po Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Hiv Positive ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Asian Region

Introduction: Cardiovascular diseases (CVD) are becoming more prevalent in HIV-infected populations as they age largely due to improved treatment outcomes. Assessment of CVD risk and CVD risk factors in HIV-positive populations has focused on high income settings, while there are limited studies evaluating CVD in HIV-positive populations in the Asian region. Materials and Methods: We provided an overview of the prevalence and incidence of CVD and its risk factors in adult HIV-positive populations, and of the strategies currently in place for CVD management in the Asian region. Results: Studies from the Asian region showed that CVD and CVD risk factors, such as dyslipidaemia, elevated blood glucose, obesity and smoking, are highly prevalent in HIV-positive populations. A number of studies suggested that HIV infection and antiretroviral therapy may contribute to increased CVD risk. National HIV treatment guidelines provide some directions regarding CVD risk prevention and management in the HIV-infected population, however, they are limited in number and scope. Conclusion: Development and consolidation of guidelines for integrated CVD and HIV care are essential to control the burden of CVD in HIV-positive populations. To inform guidelines, policies and practice in the Asian region, research should focus on exploring appropriate CVD risk screening strategies and estimating current and future CVD mortality and morbidity rates.

scholarly journals Decreasing incidence of pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya between 2005 and 2017: A retrospective cohort study.

2020 ◽  
Author(s):  
Heather Christine Millar ◽  
Alfred K. Keter ◽  
Beverly S. Musick ◽  
Edith Apondi ◽  
Juddy Wachira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Program ◽  
High Risk Group ◽  
Hiv Treatment ◽  
Pregnancy Rates ◽  
Hiv Care ◽  
Hiv Positive ◽  
Western Kenya ◽  
Associated Risk Factors

Abstract Background: The objective of this study was to estimate the prevalence, incidence and risk factors for pregnancy among HIV-positive adolescents in a large HIV treatment program in western Kenya. Methods: The Academic Model Providing Access to Healthcare (AMPATH) program is a partnership between Moi University, Moi Teaching and Referral Hospital and a consortium of 11 North American academic institutions. AMPATH currently provides care to 85,000 HIV-positive individuals in western Kenya. Included in this analysis were adolescents aged 10-19 enrolled in AMPATH between January 2005 and February 2017. Socio-demographic, behavioural, and clinical data at baseline and time-updated antiretroviral treatment (ART) data were extracted from the electronic medical records and summarized using descriptive statistics. Follow up time was defined as time of inclusion in the cohort until the date of first pregnancy or age 20, loss to follow up, death, or administrative censoring. Adolescent pregnancy rates and associated risk factors were determined. Results: There were 8565 adolescents eligible for analysis. Median age at enrolment in HIV care was 14.0 years. Only 17.7% had electricity at home and 14.4% had piped water, both indicators of a high level of poverty. 12.9% (1104) were pregnant at study inclusion. Of those not pregnant at enrolment, 5.6% (448) became pregnant at least once during follow-up. Another 1.0% (78) were pregnant at inclusion and became pregnant again during follow-up. The overall pregnancy incidence rate was 21.9 per 1000 woman years or 55.8 pregnancies per 1000 women. Between 2005 and 2017, pregnancy rates have decreased. Adolescents who became pregnant in follow-up were more likely to be older, to be married or living with a partner and to have at least one child already and less likely to be using family planning. Conclusions: A considerable number of these HIV-positive adolescents presented at enrolment into HIV care as pregnant and many became pregnant as adolescents during follow-up. Pregnancy rates remain high but have decreased from 2005 to 2017. Adolescent-focused sexual and reproductive health and ante/postnatal care programs may have the potential to improve maternal and neonatal outcomes as well as further decrease pregnancy rates in this high-risk group.

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