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HIV Cohort (hiv + cohort)

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Medical Sciences100%

Terms modified by HIV Cohort

  • hiv cohort study
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    Selected Abstracts

    Lipoatrophy among HIV-infected patients is associated with higher levels of depression than lipohypertrophy

    HIV MEDICINE, Issue 9 2008
    HM Crane
    Objectives We sought to determine the association between body morphology abnormalities and depression, examining lipoatrophy and lipohypertrophy separately. Methods An observational cross-sectional study of 250 patients from the University of Washington HIV Cohort was carried out. Patients completed an assessment including measures of depression and body morphology. We used linear regression analysis to examine the association between lipoatrophy or lipohypertrophy and depression. Analysis of variance was used to examine the relationship between mean depression scores and lipoatrophy and lipohypertrophy in 10 body regions. Results Of 250 patients, 76 had lipoatrophy and 128 had lipohypertrophy. Mean depression scores were highest among patients with moderate-to-severe lipoatrophy (16.4), intermediate among those with moderate-to-severe lipohypertrophy (11.7), mild lipohypertrophy (9.9) and mild lipoatrophy (8.5), and lowest among those without body morphology abnormalities (7.7) (P=0.002). After adjustment, mean depression scores for subjects reporting moderate-to-severe lipoatrophy were 9.2 points higher (P<0.001), scores for subjects with moderate-to-severe lipohypertrophy were 4.8 points higher (P=0.02), and scores for subjects with mild lipohypertrophy were 2.8 points higher (P=0.03) than those for patients without body morphology abnormalities. Facial lipoatrophy was the body region associated with the most severe depression scores (15.5 vs. 8.9 for controls; P=0.03). Conclusions In addition to long-term cardiovascular implications, body morphology has a more immediate effect on depression severity. [source]

    CD4 cell count and initiation of antiretroviral therapy: trends in seven UK centres, 1997,2003

    HIV MEDICINE, Issue 3 2007
    W Stöhr
    Objectives We examined whether the timing of initiation of antiretroviral therapy (ART) in routine clinical practice reflected treatment guidelines, which have evolved towards recommending starting therapy at lower CD4 cell counts. Methods We analysed longitudinal data on 10 820 patients enrolled in the UK Collaborative HIV Cohort (UK CHIC) Study, which includes seven large clinical centres in south-east England. CD4 cell and viral load measurements performed in the period between 1 January 1997 and 31 December 2003 were classified according to whether ART was subsequently initiated or deferred, to estimate the probability of ART initiation by CD4 count and viral load over time. The effect of nonclinical factors (age, sex, ethnicity, and exposure category) was analysed by logistic regression. Kaplan,Meier analysis was used to estimate the proportion of patients who had initiated ART by a particular CD4 count among ,early' presenters (initial CD4 cell count >500 cells/,L). Results There was a tendency to initiate ART at lower CD4 cell counts over time in the years 1997,2000, especially in the range 200,500 cells/,L, with little change thereafter. An estimated 34% of HIV-infected individuals having presented early initiated ART at a CD4 count <200 cells/,L. We also found an independent influence of viral load, which was particularly pronounced for CD4 <350 cells/,L. Use of injection drugs was the only nonclinical factor associated with initiation of ART at lower CD4 cell counts. Conclusions The initiation of ART in the clinics included in this analysis reflected evolving treatment guidelines. However, an unexpectedly high proportion of patients started ART at lower CD4 counts than recommended, which is only partly explained by late presentation. [source]

    Cardiovascular risk evaluation and antiretroviral therapy effects in an HIV cohort: implications for clinical management: the CREATE 1 study

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2010
    M. Aboud
    Summary Aims:, The aim of this study is to determine the cardiovascular disease (CVD) risk profile of a large UK HIV cohort and how highly active antiretroviral therapy (HAART) affects this. Methods:, It is a cross-sectional study within a large inner city hospital and neighbouring district hospital. A total of 1021 HIV positive outpatients representative of the complete cohort and 990 who had no previous CVD were included in CVD risk analysis. We recorded demographics, HAART history and CVD risk factors. CVD and coronary heart disease (CHD) risks were calculated using the Framingham (1991) algorithm adjusted for family history. Results:, The non-CVD cohort (n = 990) was 74% men, 51% Caucasian and 73.1% were on HAART. Mean age was 41 ± 9 years, systolic blood pressure 120 ± 14 mmHg, total cholesterol 4.70 ± 1.05mmol/l, high-density lipoprotein-C 1.32 ± 0.48 mmol/l and 37% smoked. Median CVD risk was 4 (0,56) % in men and 1.4 (0,37) % in women; CHD risks were 3.5 (0,36) % and 0.6 (0,16) %. CVD risk was > 20% in 6% of men and 1% of women and > 10% in 12% of men and 4% of women. CVD risk was higher in Caucasians than other ethnicities; the risk factor contributing most was raised cholesterol. For patients on their first HAART, increased CHD risk (26.2% vs. 6.5%; odds ratio 4.03, p < 0.001) was strongly related to the duration of therapy. Conclusions:, Modifiable risk factors, especially cholesterol, and also duration of HAART, were key determinants of CVD risk. Discussion:, Regular CHD and/or CVD risk assessment should be performed on patients with HIV, especially during HAART therapy. The effect of different HAART regimens on CHD risk should be considered when selecting therapy. [source]

    Diagnosed and undiagnosed HIV-infected populations in Europe

    HIV MEDICINE, Issue 2008
    FF Hamers
    This article aims to build a picture of HIV epidemiology in Europe by combining existing surveillance data to mathematical modelling to achieve observations closer to the dynamic reality of HIV infections across different parts of Europe. In the European Union (EU), where it is estimated that 30% of HIV-infected persons have not been diagnosed, the number of new HIV diagnoses has risen in recent years. However, trends must be interpreted with some caution around the differences and variations in surveillance systems and testing rates among affected populations and regions. By introducing mathematical models, we can build an overall picture from the pieces of information available. We present a mathematical model of the course of infection and the effect of ART which has been developed to fit as closely as possible to observed data from HIV cohorts. The preliminary estimates for the entire WHO European Region are that around 2.3 million people were living with HIV in Europe at the end of 2006, of whom around 50% have not been diagnosed. The model can also be used to assess the potential impact of earlier diagnoses. Observations show how a combination of surveillance data and modelling allows an estimation of the current state of the epidemic in Europe, though further developments in both areas are needed. [source]