Antiretroviral Therapy Uptake,Attrition, Adherence and Outcomes among HIV-Infected Female Sex Workers: A Systematic Review and Meta-Analysis

Purpose

We aimed to characterize the antiretroviral therapy (ART) cascade among female sex workers (FSWs) globally.

Methods

We systematically searched PubMed, Embase and MEDLINE in March 2014 to identify studies reporting on ART uptake, attrition, adherence, and outcomes (viral suppression or CD4 count improvements) among HIV-infected FSWs globally. When possible, available estimates were pooled using random effects meta-analyses (with heterogeneity assessed using Cochran''s Q test and I² statistic).

Results

39 studies, reporting on 21 different FSW study populations in Asia, Africa, North America, South America, and Central America and the Caribbean, were included. Current ART use among HIV-infected FSWs was 38% (95% CI: 29%–48%, I² = 96%, 15 studies), and estimates were similar between high-, and low- and middle-income countries. Ever ART use among HIV-infected FSWs was greater in high-income countries (80%; 95% CI: 48%–94%, I² = 70%, 2 studies) compared to low- and middle-income countries (36%; 95% CI: 7%–81%, I² = 99%, 3 studies). Loss to follow-up after ART initiation was 6% (95% CI: 3%–11%, I² = 0%, 3 studies) and death after ART initiation was 6% (95% CI: 3%–11%, I² = 0%, 3 studies). The fraction adherent to ≥95% of prescribed pills was 76% (95% CI: 68%–83%, I² = 36%, 4 studies), and 57% (95% CI: 46%–68%, I² = 82%, 4 studies) of FSWs on ART were virally suppressed. Median gains in CD4 count after 6 to 36 months on ART, ranged between 103 and 241 cells/mm³ (4 studies).

Conclusions

Despite global increases in ART coverage, there is a concerning lack of published data on HIV treatment for FSWs. Available data suggest that FSWs can achieve levels of ART uptake, retention, adherence, and treatment response comparable to that seen among women in the general population, but these data are from only a few research settings. More routine programme data on HIV treatment among FSWs across settings should be collected and disseminated.     

Lymphoblast Oxidative Stress Genes as Potential Biomarkers of Disease Severity and Drug Effect in Friedreich's Ataxia

There is no current approved therapy for the ultimately lethal neuro- and cardio-degenerative disease Friedreich''s ataxia (FA). Finding minimally-invasive molecular biomarkers of disease progression and drug effect could support smaller, shorter clinical trials. Since we and others have noted a deficient oxidative stress response in FA, we investigated the expression of 84 genes involved in oxidative stress, signaling, and protection in control and FA lymphoblasts ranging from 460 to 1122 GAA repeats. Several antioxidant genes responded in a dose-dependent manner to frataxin expression at the mRNA and protein levels, which is inversely correlated with disease progression and severity. We tested the effect of experimental Friedreich’s ataxia therapies dimethyl fumarate (DMF) and type 1 histone deacetylase inhibitor (HDACi) on biomarker mRNA expression. We observed that exposure of lymphoblasts to DMF and HDACi dose-dependently unsilenced frataxin expression and restored the potential biomarkers NCF2 and PDLIM1 expression to control levels. We suggest that in addition to frataxin expression, blood lymphoblast levels of NCF2 and PDLIM1 could be useful biomarkers for disease progression and drug effect in future clinical trials of Friedreich’s ataxia.     

Unstable dynamics of a periodically driven oscillator in the presence of noise

Two qualitatively different unstable dynamical behaviours are shown to arise from the application of a periodic input to a simple mathematical model of an oscillator in the presence of noise. Rhythms similar to quasiperiodic dynamics may arise when there is a low amplitude periodic input, while with high amplitude inputs, patterns with irregular skipped or intercalated beats are found. These two qualitatively different types of unstable dynamics are similar to those observed in the respiratory activity of mechanically ventilated cats. A number of numerical simulations are performed to illustrate the quantitative properties of the two unstable patterns and to show how the quantitative properties can be compared with experimental data.     

恶性肿瘤中溶骨因子的分离鉴定

某些源自外胚层的骨外实体瘤,它们并未浸润至骨组织,但可引起血钙显著增高,提示这些肿瘤可能分泌体液因子作用于骨导致溶骨。我们从人膀胱癌、大鼠乳腺癌(Walker 256)及7.12-Dimethyl Benz[α]anthracene诱发的小鼠鳞癌的提取液中初步分离鉴定了一种溶骨因子。肿瘤提取液经ultrogel层析,发观仅有一溶骨活性峰(~(45)Ca自乳鼠顶骨培养中的释出率),相当于表观分子量15,000道尔顿。此溶骨活性峰与PGE2生成的活性峰相平行,两者均能被Indomethacin及煮沸所抑制。在膀胱癌及鳞癌中,溶骨活性峰还与刺激大鼠成骨肉瘤细胞腺苷酸环化酶的活性相平行。实验结果表明此溶骨因子不同于其它已知能引起溶骨的因子。     

Aspects of neural plasticity in the central nervous system—IV. Chemical anatomical studies on the aging brain

Some effects of aging processes on the neurochemical features of central transmitter-identified neuronal populations have been investigated by means of immunocytochemistry and receptor autoradiographic techniques coupled with image analysis. A selective decrease of tyrosine hydroxylase immunoreactivity in the ventrolateral region of the arcuate nucleus in aged rats was observed. The level and turnover (recovery after irreversible blockade of monoamine receptors with the peptide coupling agent N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline) of 2-adrenergic ([³H]paraaminoclonidine binding) and D2 dopamine ([³H]spiperone binding) receptors were reduced in most regions of the rat brain. Peptide receptors showed a more complex pattern of change, since while μ opiate receptors (preferentially labeled with [³H]etorphine binding) were reduced in the old animals, δ opiate ([³H]DSTLenkephalin binding) receptors were affected only in certain areas. The effect of irreversible blockade of monoamine receptors on μ and δ opiate receptors was also studied in young adult and aged rats. A δ but not μ opiate receptor up-regulation was observed after monoamine receptor blockade in the young adult animals. This effect was greatly reduced in the n. caudatus-putamen, n. accumbens and tuberculum olfactorium of the old animals.     

Properties of amino-terminal parathyroid hormone-related peptides modified at positions 11–13

Biological properties of amino-terminal PTHrP analogues modified in the region 11–13 were examined using ROS 17/2.8 cells. [Leu¹¹,D-Trp¹²,Arg¹³,Tyr³⁶]PTHrP(1–36)amide had a 17-fold lower binding affinity for the receptor (apparent K_d: 5 × 10⁻⁸ M) than [Tyr³⁶]PTHrP(1–36)amide or [Arg^11,13,Tyr³⁶]PTHrP(1–36)amide (apparent K_d for both: 2 × 10⁻⁹ M). Moreover, it is only a weak partial agonist despite completely inhibiting radioligand binding. [Leu¹¹,D-Trp¹²,Arg¹³,Tyr³⁶,Cys³⁸]PTHrP(7–38) and PTHrP(7–34)amide had similar receptor affinities (apparent K_ds: 5 × 10⁻⁸ M and 8 × 10⁻⁸ M), while that of [Nle^8,18,Tyr³⁴]bPTH(7–34)amide was more than 10-fold lower (apparent K_d: 2 × 10⁻⁶ M). These changes in biological properties suggest that high affinity receptor binding requires both amino- and carboxyl-terminal domains of the PTHrP(1–36) sequence and/or intramolecular interactions which are impaired by the D-Trp substitution for Gly¹².