Development and Validation of a Composite Programmatic Assessment Tool for HIV Therapy

Background

We developed and validated a new and simple metric, the Programmatic Compliance Score (PCS), based on the IAS-USA antiretroviral therapy management guidelines for HIV-infected adults, as a predictor of all-cause mortality, at a program-wide level. We hypothesized that non-compliance would be associated with the highest probability of mortality.

Methods and Findings

3543 antiretroviral-naive HIV-infected patients aged ≥19 years who initiated antiretroviral therapy between January 1, 2000 and August 31, 2009 in British Columbia (BC), Canada, were followed until August 31, 2010. The PCS is composed by six non-performance indicators based on the IAS-USA guidelines: (1) having <3 CD4 count tests in the first year after starting antiretroviral therapy; (2) having <3 plasma viral load tests in the first year after starting antiretroviral therapy; (3) not having drug resistance testing done prior to starting antiretroviral therapy; (4) starting on a non-recommended antiretroviral therapy regimen; (5) starting therapy with CD4 <200 cells/mm³; and (6) not achieving viral suppression within 6 months since antiretroviral therapy initiation. The sum of these six indicators was used to develop the PCS score - higher score indicates poorer performance. The main outcome was all-cause mortality. Each PCS component was independently associated with mortality. In the mortality analysis, the odds ratio (OR) for PCS ≥4 versus 0 was 22.37 (95% CI 10.46–47.84).

Conclusions

PCS was strongly associated with all-cause mortality. These results lend independent validation to the IAS-USA treatment guidelines for HIV-infected adults. Further efforts are warranted to enhance the PCS as a means to further improve clinical outcomes. These should be specifically evaluated and targeted at healthcare providers and patients.     

A position paper in support of face transplantation in the blind

Facially disfigured blind patients have historically been considered for face transplantation with skepticism. Although no formal position paper regarding their exclusion has been published to date, functional, social, rehabilitative, and ethical concerns related to blind patients' candidacy for face transplantation may be inferred. The authors provide a summary of these reservations and a counterargument to their assumptions, drawing on outcomes measures reported for face transplant procedures performed to date, and their own institutional experience in performing face transplants on blind patients. The authors therefore provide a rationale for the inclusion of facially disfigured blind patients in face transplantation protocols in the future.     

High-performance liquid chromatography assay for 3 beta-hydroxy-delta 5-C27-steroid oxidoreductase activity in rat liver microsomes

A quantitative HPLC method has been developed for measuring 3 beta-hydroxy-delta 5-C27-steroid oxidoreductase activity in rat liver microsomes. Apparent Km values of 23 and 27 microM were estimated for 5-cholestene-3 beta,7 alpha-diol and NAD+, respectively. A temperature optimum of 45 degrees C was estimated using standard assay conditions. It was observed that feeding cholesterol (2%) or cholestyramine (5%) to rats increased (twofold) specific activity. This method should prove useful in studies of the regulation of bile acid synthesis and complement the HPLC assay technique recently developed for measuring cholesterol 7 alpha-hydroxylase activity.     

Stopped flow microcalorimetry without adiabatic compression: Application to reactions with half-lives between 3 and 50 ms

A stopped flow apparatus with a thermal sensor has been developed with an uptake syringe mechanically coupled to a set of driving syringes that alleviates the pressure-induced temperature change previously observed at the point of stopping the flow. With this effect eliminated we can now study reactions with total reaction times that are close to the response time of the thermistor (7 ms).     

The linear clusters of oogonial cells in the development of telotrophic ovarioles in polyphageColeoptera

Summary During the premetamorphic development of coleopteran telotrophic ovaries the culsters of sister oogonial cells, in which the differentiation of nurse cells and oocytes occurs, are arranged in linear chains. This results from a series of mitoses with the consistent orientation of the spindle parallel to the long axis of the ovariole. As a result of incomplete cytokinesis, the oogonial cells in each sibling cluster are linked to each other by intercellular bridges occupied by fusomes. As a rule, at each cluster division the basal cell (i.e. the oocyte progenitor) starts to divide first. From this cell a wave of mitoses spreads toward the anterior end of the cluster, resulting in a mitotic gradient. It is suggested that the failure of the fusomes in adjacent cells to fuse into one continuous fusome (i.e. polyfusome) allows the spindles to orientate with their long axes parallel to the long axis of the sibling cluster. This would explain why the oogonial divisions in coleopteran telotrophic ovaries generate linear chains of cells rather than the cyst-like arrangement which is typical for polytrophic sibling clusters. Dividing sibling clusters within ovarioles are arranged in bundles. The presence of intercellular bridges between sibling clusters seems to be the underlying cause of this nonrandom distribution of the mitotically active clusters. The transverse bridges have been found to occur between the basal cells as well as between the cells located more anteriorly in adjacent sibling clusters. The transverse bridges are filled with typical fusomes, which in more anterior parts of sibling clusters may fuse with the fusomes of adjacent sister oogonial cells into polyfusomes. The transverse bridges between the basal cells are incorporated in the oocytes. The pattern of sibling cluster formation described in this paper apparently occurs widespread in polyphagous Coleoptera, since it has been found in three relatively distantly related families.     

Analysis of radioactive and nonradioactive purine bases,nucleosides, and nucleotides by high-speed chromatography on a single column

The concentrations of radioactive and nonradioactive purine bases, purine nucleosides, purine mono-, di-, and trinucleotides in acid extracts of fibroblasts were determined by anion-exchange column chromatography. The concentrations of nonradioactive components were determined by computerized integration of the signal from a double-beam uv-detector. The radioactive metabolites were quantitated by high-efficiency, continuous liquid scintillation counting, employing a discrete sample transport system.     

Peritonitis-induced antitumor activity of peritoneal macrophages from uremic patients

The macrophages belong to the effector cells of both nonspecific and specific immune response. These cells generally express little cytotoxicity unless activated. The present work was intended to determine if peritoneal macrophages collected from patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) during episodes of peritonitis were active against human tumor cell lines without further in vitro stimulation. We also compared macrophage antitumor potential with effectiveness of drugs used in cancer therapy (taxol and suramin). Conditioned medium (CM) of macrophages collected during inflammation-free periods did not exhibit cytostatic and cytotoxic activity against both tumor (A549 and HTB44) and non-transformed (BEAS-2B and CRL2190) cells. Exposure of tumor cells to CM of macrophages harvested during peritonitis resulted in significant suppression of proliferation, impairment of viability and induction of apoptosis, in contrast to non-transformed cells, which remained unaffected. The efficacy of CM of inflammatory macrophages as an antitumor agent appeared to be comparable to cytostatic and cytotoxic potency of taxol and suramin or, in the case of HTB44 cells, even higher. The results obtained suggest that activated human macrophages might represent a useful tool for cancer immunotherapy.