Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure

In an environment where the availability of resources sought by a forager varies greatly, individual foraging is likely to be associated with a high risk of failure. Foragers that learn where the best sources of food are located are likely to develop risk aversion, causing them to avoid the patches that are in fact the best; the result is sub-optimal behaviour. Yet, foragers living in a group may not only learn by themselves, but also by observing others. Using evolutionary agent-based computer simulations of a social foraging game, we show that in an environment where the most productive resources occur with the lowest probability, socially acquired information is strongly favoured over individual experience. While social learning is usually regarded as beneficial because it filters out maladaptive behaviours, the advantage of social learning in a risky environment stems from the fact that it allows risk aversion to be circumvented and the best food source to be revisited despite repeated failures. Our results demonstrate that the consequences of individual risk aversion may be better understood within a social context and suggest one possible explanation for the strong preference for social information over individual experience often observed in both humans and animals.

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Viral Load for HIV Treatment Failure Management: A Report of Eight Drug-Resistant Tuberculosis Cases Co-Infected with HIV Requiring Second-Line Antiretroviral Treatment in Mumbai, India

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.13-0526 ◽

2013 ◽

Vol 89 (6) ◽

pp. 1233-1234

Author(s):

Aristomo Andries ◽

Mrinalini Das ◽

Petros Isaakidis ◽

Peter Saranchuk

Keyword(s):

Viral Load ◽

Treatment Failure ◽

Antiretroviral Treatment ◽

Hiv Treatment ◽

Drug Resistant ◽

Second Line ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis

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Relapsed Hodgkin Lymphoma in Older Patients: A Comprehensive Analysis From the German Hodgkin Study Group

Journal of Clinical Oncology ◽

10.1200/jco.2013.49.8246 ◽

2013 ◽

Vol 31 (35) ◽

pp. 4431-4437 ◽

Cited By ~ 42

Author(s):

Boris Böll ◽

Helen Goergen ◽

Nils Arndt ◽

Julia Meissner ◽

Stefan W. Krause ◽

...

Keyword(s):

High Risk ◽

Older Patients ◽

Prognostic Score ◽

Treatment Strategies ◽

Study Group ◽

Line Treatment ◽

Second Line ◽

First Line ◽

Early Relapse ◽

Risk Patients

Purpose Progression or relapse of Hodgkin lymphoma (HL) is common among older patients. However, prognosis and effects of second-line treatment are thus far unknown. Patients and Methods We investigated second-line treatment and survival in older patients with progressive or relapsed HL. Patients treated within German Hodgkin Study Group first-line studies between 1993 and 2007 were screened for refractory disease or relapse (RR-HL). Patients with RR-HL age ≥ 60 years at first-line treatment were included in this analysis. Results We identified 105 patients (median age, 66 years); 28%, 31%, and 41% had progressive disease, early relapse, or late relapse, respectively. Second-line treatment strategies included intensified salvage regimens (22%), conventional polychemotherapy and/or salvage-radiotherapy with curative intent (42%), and palliative approaches (31%). Median overall survival (OS) for the entire cohort was 12 months; OS at 3 years was 31% (95% CI, 22% to 40%). A prognostic score with risk factors (RFs) of early relapse, clinical stage III/IV, and anemia identified patients with favorable and unfavorable prognosis (≤ one RF: 3-year OS, 59%; 95% CI, 44% to 74%; ≥ two RFs: 3-year OS, 9%; 95% CI, 1% to 18%). In low-risk patients, the impact of therapy on survival was significant in favor of the conventional polychemotherapy/salvage radiotherapy approach. In high-risk patients, OS was low overall and did not differ significantly among treatment strategies. Conclusion OS in older patients with RR-HL can be predicted using a simple prognostic score. Poor outcome in high-risk patients cannot be overcome by any of the applied treatment strategies. Our results might help to guide treatment decisions and evaluate new compounds in these patients.

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A study on adverse drug reactions in patients on antiretroviral therapy in a tertiary care hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20183917 ◽

2018 ◽

Vol 7 (10) ◽

pp. 1882

Author(s):

Praveena Gungam ◽

Y. Sunil Kumar Yadav ◽

Sunil Junapudi

Keyword(s):

Adverse Drug Reactions ◽

Antiretroviral Treatment ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Outpatient Setting ◽

Care Hospital ◽

Second Line ◽

Drug Reactions ◽

Longitudinal Observational Study ◽

Prospective Longitudinal

Background: Besides unparalleled advantages, exceptionally dynamic antiretroviral treatment is additionally connected with extensive variety of potential adverse drug reactions (ADRs), which prevents treatment adherence. The present study is intended to screen and monitor the event of ADRs to different antiretroviral treatment (ART) regimens in a tertiary care ART setup.Methods: A prospective, longitudinal observational study was done in the outpatient setting of nodal ART center, Osmania General Hospital. A sum of 525 patients on different ART regimens were examined for ADRs more than year and a half. Adverse event history, prescription history and other significant subtle elements were captured. Causality and seriousness of each announced ADR were surveyed.Results: 37.33% patients of aggregate members gave a sum of 330 ADRs. Patients from zidovudine-based regimens presented with majority of ADRs such as anemia, central nervous system (CNS), and gastrointestinal (GI) side effects. Tenofovir-based regimens were, be that as it may, observed to be somewhat more secure. The blend with Efavirenz was related with significant CNS reactions while that of Nevirapine was related with rash and pigmentation of nails. Atazanavir supported second-line regimens were quite connected with expanded serum lipid levels taken after by other GI and CNS unfavourable impacts. Expanded liver compounds were found in atazanavir-based second-line ART.Conclusions: The study enables to obtain in sequence on the incidence and pattern of ADRs associated with various antiretroviral regimens, thereby reducing its occurrence and protecting the patient population from avoidable harm. Need of intensive monitoring for ADRs in ARTs along these lines is by all accounts an order.

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Radiotherapy after Prostatectomy

Tumori Journal ◽

10.1177/030089160208800602 ◽

2002 ◽

Vol 88 (6) ◽

pp. 445-452 ◽

Cited By ~ 2

Author(s):

Giuseppe Sanguineti ◽

Paola Franzone ◽

Laura Culp ◽

Michela Marcenaro ◽

Salvina Barra ◽

...

Keyword(s):

High Risk ◽

Radical Prostatectomy ◽

Adjuvant Radiotherapy ◽

Potential Role ◽

Specific Antigen ◽

Salvage Treatment ◽

Salvage Radiotherapy ◽

Risk Of Failure

Aims and background The role of radiotherapy after prostatectomy is controversial. This paper tries to give some guidelines for everyday practice through an analysis of literature data. Methods The potential role of radiotherapy in the adjuvant and salvage setting is discussed. We also report and interpret available literature data for both settings. Results As regards an increase in or detectable prostate-specific antigen (PSA) after radical prostatectomy, about 40–50% of patients are rendered bNED with local salvage radiotherapy, but only 10–50% are long-term (5 years) biochemically controlled. A timely salvage treatment is crucial to optimize control probability. As regards adjuvant radiotherapy for undetectable postoperative PSA in patients at high risk of failure as judged on pathology, results are more encouraging. Recent data report bNED rates ≥70% at 5 years. Conclusions Although results are far from satisfactory, salvage radiotherapy should be considered for every patient with an increased or detectable PSA after surgery. Adjuvant radiotherapy seems preferable to salvage radiotherapy for patients at high (>30%) risk of failure.

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Women’s Issues

10.1093/med/9780199392742.003.0035 ◽

2017 ◽

Author(s):

Sara Gorman ◽

Judith Currier ◽

Elise Hall ◽

Julia del Amo

Keyword(s):

High Risk ◽

Hiv Prevention ◽

Hiv Infection ◽

Antiretroviral Treatment ◽

Gender Based Violence ◽

Course Of Illness ◽

The Third ◽

Effective Interventions ◽

Gender Based ◽

Living With Hiv

This chapter explores some of the unique challenges that often put women at higher risk of HIV infection and that create a course of illness that may differ from that found in men living with HIV. The first portion of the chapter discusses manifestations of HIV infection and the course of infection in women. It also addresses the particular issues associated with antiretroviral treatment (ART) and women, and the interactions between ART and depression in women. The chapter then goes on to broach an important topic that puts many women at high risk for HIV infection: gender-based violence, as well as some of the key, albeit limited, research on effective interventions for gender-based violence and HIV prevention. The third part of the chapter addresses issues related specifically to HIV and pregnancy, including vertical transmission. Finally, the chapter concludes with a discussion of a relatively neglected topic, HIV and menopause.

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P04.09 Patterns of care and impact on survival of first salvage therapy in high-risk grade II gliomas following initial temozolomide

Neuro-Oncology ◽

10.1093/neuonc/noz126.104 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii30-iii30

Author(s):

A Pellerino ◽

L Bello ◽

M Conti Nibali ◽

F Bruno ◽

F Mo ◽

...

Keyword(s):

High Risk ◽

Salvage Therapy ◽

Molecular Data ◽

Low Grade ◽

Second Line ◽

Wild Type ◽

Second Line Chemotherapy ◽

Second Surgery ◽

Grade Ii ◽

Line Chemotherapy

Abstract BACKGROUND Initial chemotherapy with temozolomide (TMZ) may provide benefit in high-risk low-grade gliomas. To date, no standard treatment is validated at first progression. The aim of this retrospective study was to investigate the optimal salvage therapy after the first progression and the factors that influence the PFS and overall survival (OS). MATERIAL AND METHODS we evaluated 71 patients with an histological diagnosis of grade II glioma according to WHO 2016 classification, who were included in a phase II AINO (Italian Association for Neuro-Oncology) trial, and progressed following initial chemotherapy with TMZ. Molecular data were available in all patients: 32 (45.1%) patients were oligodendrogliomas IDH 1/2 mutated and 1p19q codeleted, 11 (15.5%) were diffuse astrocytomas IDH mutant, and 28 (39.4%) were diffuse astrocytomas IDH wild-type. Thirty-five (49.3%) patients were MGMT methylated. Median follow up was 144 months (range 23–180). RESULTS thirty-one patients (43.7%) underwent second surgery, 24 patients (33.8%) second-line chemotherapy (rechallenge with TMZ or nitrosoureas), and 16 patients (22.5%) radiotherapy with a median PFS of 58 months (IC 95% 49–116). The association between prognostic factors and type of salvage therapy revealed a prevalence of younger age (≤ 45 years), non-enhancing tumor and location in eloquent area among patients treated with second surgery or chemotherapy, while aolder age (> 45 years) and contrast-enhancing tumors prevailed among patients receiving radiotherapy. Overall, median PFS was 60 months after second surgery (IC95% 43–116) and chemotherapy (IC95% 51–69), and 38 months after radiotherapy (IC95% 15–64) (p 0.09). No significant benefit in length of PFS was achieved in oligodendrogliomas undergoing second surgery (60 months) as compared with oligodendrogliomas treated with radiation or chemotherapy (58 months, p 0.11). PFS of diffuse astrocytomas IDH wild-type following second surgery (53 months) did not differ from that of patients treated with adjuvant treatments (65 months, p 0.28). Overall, median OS from the first salvage therapy was 117 months (IC95% 93 - 123+): 120 months (IC95% 108–140+) after second surgery, 94 months (IC95% 75–117+) after chemotherapy, and 62 months (IC95% 27–112) after radiotherapy (p 0.04). Median OS (123 months, IC95% 106–154) was prolonged in oligodendrogliomas receiving second surgery as compared to those receiving radiotherapy or chemotherapy (93 months, IC 95% 61–112, p 0.07), while median OS in diffuse astrocytomas IDH wild-type did not differ between those who received second surgery or radiotherapy or chemotherapy. CONCLUSION: W hen feasible, reoperation as first salvage treatment following initial TMZ in grade II gliomas seems to offer a probability of a longer OS as compared with second-line chemotherapy or radiotherapy, and this could hold true especially for oligodendrogliomas.

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