Incidence of cancer and overall risk of mortality in individuals treated with raltegravir-based and non-raltegravir-based combination antiretroviral therapy regimens

Objectives: There are currently few data on the long-term risk of cancer and death in individuals taking raltegravir (RAL). The aim of this analysis was to evaluate whether there is evidence for an association. Methods: The EuroSIDA cohort was divided into three groups: those starting RAL-based combination antiretroviral therapy (cART) on or after 21 December 2007 (RAL); a historical cohort (HIST) of individuals adding a new antiretroviral (ARV) drug (not RAL) to their cART between 1 January 2005 and 20 December 2007, and a concurrent cohort (CONC) of individuals adding a new ARV drug (not RAL) to their cART on or after 21 December 2007. Baseline characteristics were compared using logistic regression. The incidences of newly diagnosed malignancies and death were compared using Poisson regression. Results: The RAL cohort included 1470 individuals [with 4058 person-years of follow-up (PYFU)] compared with 3787 (4472 PYFU) and 4467 (10 691 PYFU) in the HIST and CONC cohorts, respectively. The prevalence of non-AIDS-related malignancies prior to baseline tended to be higher in the RAL cohort vs. the HIST cohort [adjusted odds ratio (aOR) 1.31; 95% confidence interval (CI) 0.95–1.80] and vs. the CONC cohort (aOR 1.89; 95% CI 1.37–2.61). In intention-to-treat (ITT) analysis (events: RAL, 50; HIST, 45; CONC, 127), the incidence of all new malignancies was 1.11 (95% CI 0.84–1.46) per 100 PYFU in the RAL cohort vs. 1.20 (95% CI 0.90–1.61) and 0.83 (95% CI 0.70–0.99) in the HIST and CONC cohorts, respectively. After adjustment, there was no evidence for a difference in the risk of malignancies [adjusted rate ratio (RR) 0.73; 95% CI 0.47–1.14 for RALvs. HIST; RR 0.95; 95% CI 0.65–1.39 for RALvs. CONC] or mortality (adjusted RR 0.87; 95% CI 0.53–1.43 for RALvs. HIST; RR 1.14; 95% CI 0.76–1.72 for RALvs. CONC). Conclusions: We found no evidence for an oncogenic risk or poorer survival associated with using RAL compared with control groups.Peer reviewe

Establishing a hepatitis C continuum of care among HIV/hepatitis C virus-coinfected individuals in EuroSIDA

Objectives The aim of the study was to establish a methodology for evaluating the hepatitis C continuum of care in HIV/hepatitis C virus (HCV)-coinfected individuals and to characterize the continuum in Europe on 1 January 2015, prior to widespread access to direct-acting antiviral (DAA) therapy. Methods Stages included in the continuum were as follows: anti-HCV antibody positive, HCV RNA tested, currently HCV RNA positive, ever HCV RNA positive, ever received HCV treatment, completed HCV treatment, follow-up HCV RNA test, and cure. Sustained virological response (SVR) could only be assessed for those with a follow-up HCV RNA test and was defined as a negative HCV RNA result measured > 12 or 24 weeks after stopping treatment. Results Numbers and percentages for the stages of the HCV continuum of care were as follows: anti-HCV positive (n = 5173), HCV RNA tested (4207 of 5173; 81.3%), currently HCV RNA positive (3179 of 5173; 61.5%), ever HCV RNA positive (n = 3876), initiated HCV treatment (1693 of 3876; 43.7%), completed HCV treatment (1598 of 3876; 41.2%), follow-up HCV RNA test to allow SVR assessment (1195 of 3876; 30.8%), and cure (629 of 3876; 16.2%). The proportion that achieved SVR was 52.6% (629 of 1195). There were significant differences between regions at each stage of the continuum (P <0.0001). Conclusions In the proposed HCV continuum of care for HIV/HCV-coinfected individuals, we found major gaps at all stages, with almost 20% of anti-HCV-positive individuals having no documented HCV RNA test and a low proportion achieving SVR, in the pre-DAA era.Peer reviewe

Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

Peer reviewe

Exploring the environmental strategy of big energy companies to drive sustainability

The purpose of this research is to provide an in-depth evaluation of the environmental strategy of the biggest energy companies to drive sustainability, i.e., for both business and the environment as a collective entity. Rooted in the theory of Corporate Social Responsibility (CSR), a secondary data analysis was conducted on the top five energy companies (i.e., British Petroleum (BP), Exxon Mobil, Gazprom, Sinopec and Saudi Aramco) as published by Enercom (2016) to investigate their approach to sustainable development. To do so, each company's environmental strategy was evaluated in order to gain a clear understanding of their implemented procedures for sustainable development towards future. This research paper gives an insight in to the main energy companies' impact on nature and assesses how sustainable their strategies are towards environmental issues. Through this evaluation, we clearly identified how climate change forces companies to be responsible towards society, the economy, and the environment. This study's finding contributes to the present body of knowledge and highlights how the big energy companies have taken responsibility for their actions towards environmental issues

Overcoming Geographical Constraints: A Diagnostic and Therapeutic Challenge of Amebic Liver Abscess in a Non-Endemic Region

Bogusz Aksak-W&aogon;s, Malwina Karasi&nacute;ska-Cie&sacute;lak, Mi&lstrok;osz Parczewski Department of Infectious, Tropical Diseases and Acquired Immunodeficiency, Pomeranian Medical University in Szczecin, Szczecin, PolandCorrespondence: Bogusz Aksak-W&aogon;s, Email [email protected]: This case report provides data on unique challenges related to amoebiasis diagnostics and treatment in non-endemic regions. The presented case report is focused a 28-year-old male patient of Indian origin, temporarily living in Poland, who was diagnosed with an amoebic liver abscess. The patient presented with a range of non-specific symptoms including shortness of breath, chest pain, and fever. The differential diagnosis included cardio-pulmonary diseases, a range of tropical diseases such as malaria or typhoid fever, bacterial abscesses, and malignancies, necessitating a comprehensive, multi-modal diagnostic approach. This approach included an extensive review of patient history, physical examination, and various laboratory and imaging investigations. A further challenge in this case was the unavailability of standard cysticidal treatments in Poland, which required individualized therapeutic strategy. Despite these obstacles, the patient was successfully treated using an alternative regimen of intravenous metronidazole, ceftriaxone, doxycycline, chloroquine, and finally, trimethoprim/sulfamethoxazole (treatment with metronidazole was used as a base drug, due to the lack of typical cysticidal treatment, an alternative treatment was added: chloroquine is a recommended drug used in the treatment of pregnant patients, in addition, doxycycline showed in vitro activity against Entamoeba histolytica). This therapeutic journey underscored the value of adaptability in treatment protocols, particularly in regions where certain resources may not be readily available. This case report underlines the importance of broadening the differential diagnosis in non-endemic regions to include tropical diseases, particularly in the context of increasing global travel and migration. It also highlights the significance of employing comprehensive diagnostic strategies and adaptable treatment protocols in such scenarios. In addition, the report reiterates the need for global collaboration and education among healthcare providers to effectively manage tropical diseases, especially in non-endemic regions. Through its exploration of the complexities associated with diagnosing and managing amebiasis in a non-endemic region, this report offers valuable insights to clinicians worldwide.Keywords: amoebiasis, non endemic region, abscess, tropical diseas

A microfabricated wedge-shaped adhesive array displaying gecko-like dynamic adhesion, directionality and long lifetime

Gecko adhesion has become a paradigmatic example of bio-inspired engineering, yet among the many gecko-like synthetic adhesives (GSAs), truly gecko-like performance remains elusive. Many GSAs have previously demonstrated one or two features of the gecko adhesive. We present a new wedge-shaped GSA that exhibits several gecko-like properties simultaneously: directional features; zero force at detachment; high ratio of detachment force to preload force; non-adhesive default state; and the ability to maintain performance while sliding, even after thousands of cycles. Individual wedges independently detach and reattach during sliding, resulting in high levels of shear and normal adhesion during drag. This behaviour provides a non-catastrophic failure mechanism that is desirable for applications such as climbing robots where sudden contact failure would result in serious falls. The effects of scaling patch sizes up to tens of square centimetres are also presented and discussed. Patches of 1 cm2 had an adhesive pressure of 5.1 kPa while simultaneously supporting 17.0 kPa of shear. After 30 000 attachment/detachment cycles, a patch retained 67 per cent of its initial adhesion and 76 per cent of its initial shear without cleaning. Square-based wedges of 20 μm and 50 μm are manufactured in a moulding process where moulds are fabricated using a dual-side, dual-angle lithography process on quartz wafers with SU-8 photoresist as the mould material and polydimethylsiloxane as the cast material