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  • SAGE Publications  (7)
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  • SAGE Publications  (7)
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  • 1
    Online Resource
    Online Resource
    Response to Antiretroviral Therapy among Patients Exposed to Three Classes of Antiretrovirals: Results from the Eurosida Study
    SAGE Publications ; 2002
    In:  Antiviral Therapy Vol. 7, No. 1 ( 2002-01), p. 21-30
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 7, No. 1 ( 2002-01), p. 21-30
    Abstract: There is an increasing proportion of HIV-positive patients exposed to all licensed classes of antiretrovirals, and the response to salvage regimens may be poor. Among over 8500 patients in EuroSIDA, the proportion of treated patients exposed to nucleosides, protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitor (NNRTI) increased from 0% in 1996 to 47% in 2001. Four-hundred-and-thirteen patients, who had failed virologically two highly active antiretroviral therapy (HAART) regimens and experienced all three main drug classes, started a salvage regimen of at least three drugs, in which at least one new PI or NNRTI was included. Median viral load was 4.7 log copies/ml [Interquartile range (IQR) 4.2–5.2], CD4 lymphocyte count 150/mm 3 (IQR 60–274/mm 3 ) and follow-up 14 months. Of these patients, 283 (69%) subsequently experienced at least a 1 log decline in viral load and 202 (49%) achieved a viral load 〈 500 copies/ml. Conversely, the CD4 count halved from the baseline value in 88 (21%), and 45 (11%) experienced a new AIDS-defining disease. In multivariable analyses, a 1 log viral load reduction was related to baseline viral load [relative hazard (RH) 1.27 per 1 log higher; P=0.008], a previous viral load of less than 500 copies/ml (RH 1.69; P=0.002), more recent initiation of the regimen (RH 1.36 per year more recent; P=0.02), number of new drugs in the regimen (RH 1.20 per drug; P=0.02), time since start of antiretroviral therapy (RH 0.94 per extra year; P=0.035) and time spent on HAART with viral load 〉 1000 copies/ml (RH 0.96 per extra month; P=0.0001). Analysis of factors associated with CD4 count decline and new AIDS disease also indicated improved outcomes in more recent times and a tendency for a better response in those starting more new drugs, but no relationship with the total number of drugs. Outcomes in people starting salvage regimens appear to depend on the number of new drugs started but not on the total number of drugs being used.
    Type of Medium: Online Resource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.1177/135965350200700103
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2002
    detail.hit.zdb_id: 2118396-X
    SSG: 15,3
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  • 2
    Online Resource
    Online Resource
    Are Specific Antiretrovirals associated with an Increased Risk of Discontinuation due to Toxicities or Patient/Physician Choice in patients with Hepatitis C Virus Coinfection?
    SAGE Publications ; 2005
    In:  Antiviral Therapy Vol. 10, No. 7 ( 2005-10), p. 779-790
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 10, No. 7 ( 2005-10), p. 779-790
    Abstract: Liver damage associated with hepatitis C (HCV) may influence the likelihood of experiencing discontinuation due to toxicities or patient/physician choice (TOXPC) in patients taking combination antiretroviral therapy (cART). Little information to address this concern is available from clinical trials as patients with HCV are often excluded. Aims To compare incidence rates of discontinuation due to TOXPC associated with specific antiretrovial drugs in patients with or without HCV. Patients/methods A total of 4929 patients from EuroSIDA under follow-up from January 1999 on a specific nucleoside pair (zidovudine/lamivudine, didanosine/stavudine, stavudine/lamivudine, or other) with a third drug (abacavir, nelfinavir, indinavir, nevirapine, efavirenz, lopinavir/ ritonavir or other boosted-protease inhibitor (PI)-containing regimen) and with known HCV serostatus were studied for the incidence of discontinuation of any nucleoside pair or third drug due to TOXPC. Incidence rate ratios were derived from Poisson regression models. Results In total 1358 patients had HCV (27.5%). During 12 799 person-years of follow-up there were 2141 discontinuations due to TOXPC for nucleoside pairs and 2501 for third drugs. The incidence of discontinuation due to TOXPC was consistently higher in patients with HCV after stratification by nucleoside pair or third drug. After adjustment for CD4 + count, gender, exposure group, time on HAART, region and treatment regimen, there were few differences in the rate of discontinuation due to TOXPC in those with HCV compared with those without for any nucleoside pairs or third drugs. Similar results were seen when concentrating on discontinuation due to toxicities alone. Conclusions Although patients with HCV generally had higher rates of discontinuation due to TOXPC compared with patients without HCV, there was little evidence to suggest that this was associated with any specific nucleoside pair or third drug used as part of cART. Our results do not suggest that any specific component of cART is more poorly tolerated in patients with HCV or that the presence of HCV should influence the choice between antiretrovirals used as part of a cART regimen.
    Type of Medium: Online Resource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.1177/135965350501000704
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
    detail.hit.zdb_id: 2118396-X
    SSG: 15,3
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  • 3
    Online Resource
    Online Resource
    Thymidine Analogue Mutation Profiles: Factors Associated with Acquiring Specific Profiles and their Impact on the Virological Response to Therapy
    SAGE Publications ; 2005
    In:  Antiviral Therapy Vol. 10, No. 7 ( 2005-10), p. 791-802
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 10, No. 7 ( 2005-10), p. 791-802
    Abstract: Studies have suggested that HIV-1 may develop thymidine analogue mutations (TAMs) by one of two distinct pathways – the TAM1 pathway (including mutations 41L, 210W and 215Y) or the TAM2 pathway (including mutations 67N, 70R and 219E/Q) – under the pressure of a not fully suppressive thymidine-analogue-containing regimen. Methods Frozen plasma samples stored in the EuroSIDA repository were selected and sent to two central laboratories for genotypic analysis. We considered 733 patients with at least one genotypic test showing ≥1 TAMs (the first of these tests in chronological order was used). TAM1 and TAM2 genotypic profiles were defined in accordance with previous literature. Statistical modelling involved logistic regression and linear regression analysis for censored data. Results The observed frequencies of patterns classifiable as TAM1 or TAM2 profiles were markedly higher than the probabilities of falling into these classifications by chance alone. The chance of detecting a TAM2 profile increased by 25% per additional year of exposure to zidovudine. We found that mutations 67N and 184V were not associated with a particular TAM profile. In the presence of TAM2 profiles, the adjusted mean difference in the 6-month viral reduction was 0.96 log 10 copies/ml (95% confidence interval: 0.20; 1.73) higher in patients who started stavudine-containing regimens instead of zidovudine-containing regimens. Conclusions This study provides evidence that the suggested TAM clustering is a real phenomenon and that it may be driven by which thymidine analogue the patients has used. In patients with TAM2-resistant viruses, stavudine appears to retain greater viral activity than zidovudine.
    Type of Medium: Online Resource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.1177/135965350501000705
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
    detail.hit.zdb_id: 2118396-X
    SSG: 15,3
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    Online Resource
  • 4
    Online Resource
    Online Resource
    Baseline Resistance and Virological Outcome in Patients with Virological Failure who Start a Regimen Containing Abacavir: Eurosida Study
    SAGE Publications ; 2004
    In:  Antiviral Therapy Vol. 9, No. 5 ( 2004-07), p. 787-800
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 9, No. 5 ( 2004-07), p. 787-800
    Abstract: To investigate the ability of several HIV-1 drug-resistance interpretation systems, as well as the number of pre-specified combinations of abacavir-related mutations, to predict virological response to abacavir-containing regimens in antiretroviral therapy-experienced, abacavir-naive patients starting an abacavir-containing regimen in the EuroSIDA cohort. Patients and methods A total of 100 HIV-infected patients with viral load (VL) 〉 500 copies/ml who had a plasma sample available at the time of starting abacavir (baseline) were included. Resistance to abacavir was interpreted by using eight different commonly used systems that consisted of rules-based algorithms or tables of mutations. Correlation between baseline abacavir-resistance mutations and month 6 virological response was performed on this population using a multivariable linear regression model accounting for censored data. Results The baseline VL was 4.36 log 10 RNA copies/ml [interquartile range (IQR): 3.65–4.99 log 10 RNA copies/ml] and the median CD4 cell count was 210 cells/μl (IQR: 67–305 cells/μl). Our patients were pre-exposed to a median of seven antiretrovirals (2–12) before starting abacavir therapy. The median (range) number of abacavir mutations (according to the International AIDS Society-USA) detected at baseline was 3.5 (0–8). Overall, the Kaplan–Meier estimate of the median month 6 VL decline was 0.86 log 10 RNA copies/ml [95% confidence intervals (95% CI): 0.45–1.24]. The VL in those patients ( n=31) who intensified treatment by adding only abacavir decreased by a median 0.20 log 10 RNA copies/ml (95% CI: -0.18; +0.94). The proportion of patients who harboured viruses fully resistant to abacavir among the eight genotypic resistance interpretation algorithms ranged from 12% [Agence Nationale de Recherches sur le SIDA (ANRS)] to 79% [Stanford HIV RT and PR Sequence Database (HIVdb)] . Some interpretation systems showed statistically significant associations between the predicted resistance status and the virological response while others showed no consistent association. The number of active drugs in the regimen was associated with greater virological suppression (additional month 6 VL reduction per additional sensitive drug=0.51, 95% CI: 0.15–0.88, P=0.006); baseline VL was also weakly associated (additional month 6 VL reduction per log 10 higher=0.30, 95% CI: -0.02; +0.62, P=0.06). In contrast, the number of drugs previously received was associated with diminished viral reduction (additional month 6 VL reduction per additional drug=-0.14, 95% CI: -0.28; 0.00, P=0.05). Conclusions Our results revealed a high degree of variability among several genotypic resistance interpretation algorithms currently in use for abacavir. Therefore, the interpretation of genotypic resistance for predicting response to regimens containing abacavir remains a major challenge.
    Type of Medium: Online Resource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.1177/135965350400900509
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2004
    detail.hit.zdb_id: 2118396-X
    SSG: 15,3
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    Online Resource
  • 5
    Online Resource
    Online Resource
    Prevalence of sleep problems in individuals with multiple sclerosis
    SAGE Publications ; 2008
    In:  Multiple Sclerosis Journal Vol. 14, No. 8 ( 2008-09), p. 1127-1130
    Details
    In: Multiple Sclerosis Journal, SAGE Publications, Vol. 14, No. 8 ( 2008-09), p. 1127-1130
    Abstract: Background Sleep disturbance in multiple sclerosis has received little research attention despite the potential influence it may have on disease impact. Objective To estimate the prevalence of sleep disorders in a large community sample of individuals with multiple sclerosis. Methods A cross-sectional self-report survey of 1063 persons with multiple sclerosis. Sleep was assessed using the Women's Health Initiative Insomnia Rating Scale and Medical Outcomes Study Sleep measure. Results The prevalence of sleep problems in multiple sclerosis is significantly higher than in the general population or other chronic diseases and may affect women with multiple sclerosis more than men. Conclusion Sleep disturbance should routinely be evaluated in patients with multiple sclerosis and new interventions developed.
    Type of Medium: Online Resource
    ISSN: 1352-4585 , 1477-0970
    URL: Article
    DOI: 10.1177/1352458508092807
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2008
    detail.hit.zdb_id: 2008225-3
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  • 6
    Online Resource
    Online Resource
    Can UK healthcare workers remotely support medical education in the developing world?: Focus group evaluation
    SAGE Publications ; 2012
    In:  JRSM Short Reports Vol. 3, No. 7 ( 2012-07), p. 1-6
    Details
    In: JRSM Short Reports, SAGE Publications, Vol. 3, No. 7 ( 2012-07), p. 1-6
    Abstract: To evaluate the feasibility of providing regular, live, text-based teaching to medical students and junior doctors in Somaliland using a dedicated case-based medical education website ( www.MedicineAfrica.com ). Design Review of MedicineAfrica database for details of teaching sessions held in Somaliland from December 2008-October 2010 and evaluation of user experiences through focus groups. Setting King's College Hospital, London, UK and Ahmoud University, Borama, Somaliland. Participants Final year medical students, newly graduated interns and second year interns at Ahmoud University, Borama, Somaliland. Main outcome measures Qualitative and quantitative user rating of online case-based tutorials in the context of pre-existing educational opportunities available to them. Results Regular online teaching sessions are received enthusiastically by students and junior doctors and are reported to improve their clinical practice. Conclusions Despite technological limitations in Somaliland, a live text-based teaching service can be delivered effectively and streamlined with local curricula. This represents an alternative to traditional static teaching methodologies currently used in international medical education.
    Type of Medium: Online Resource
    ISSN: 2042-5333
    URL: Article
    DOI: 10.1258/shorts.2012.011171
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 2762955-7
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  • 7
    Online Resource
    Online Resource
    Lateral cutaneous nerve of thigh injury following TEPP laparoscopic inguinal hernia repair
    SAGE Publications ; 2007
    In:  Scottish Medical Journal Vol. 52, No. 4 ( 2007-11), p. 54-54
    Details
    In: Scottish Medical Journal, SAGE Publications, Vol. 52, No. 4 ( 2007-11), p. 54-54
    Abstract: A 40-year-old gentleman underwent a routine TEPP (trans-extraperitoneal) procedure without the use of staples to fix the mesh. He presented with symptoms of lateral cutaneous nerve of the thigh injury. We present this rare complication and its management.
    Type of Medium: Online Resource
    ISSN: 0036-9330 , 2045-6441
    URL: Article
    DOI: 10.1258/rsmsmj.52.4.54e
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2007
    detail.hit.zdb_id: 2141765-9
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