Liquid Drugs and High Dead Space Syringes May Keep HIV and HCV Prevalence High – A Comparison of Hungary and Lithuania

Despitevery similar political, drug policy and HIV prevention backgrounds, HIV and HCV prevalence is considerably different in Hungary (low HIV and moderate HCV prevalence) and Lithuania (high HCV and moderate HIV prevalence). Wecompared the drug use profile of Hungarian (n = 215) and Lithuanian (n = 300) injecting drug users (IDUs). Overall, compared with IDUs in Hungary, IDUs in Lithuania often injected opiates purchased in liquid form (‘shirka’), used and shared 2-piece syringes (vs. 1-piece syringes) disproportionately more often, were less likely to acquire their syringes from legal sources and had significantly more experience with injected and less experience with non-injected drugs. It may not be liquid drugs per se that contribute to a higher prevalence of HCV and/or HIV, but it is probably factors associated with the injecting of liquid drugs, such as the wide-spread use and sharing of potentially contaminated 2-piece syringes acquired often from non-legal sources, and syringe-mediated drug sharing with 2-piece syringes. Scaling up substitution therapy, especially heroin replacement, combined with reducing the supply of liquid drugs may decrease the prevalence of high-risk injecting behaviours related to the injecting of liquid drugs and drug injecting-related infections among IDUs in Lithuania

Energy efficiency, robustness, and makespan optimality in job-shop scheduling problems

[EN] Many real-world problems are known as planning and scheduling problems, where resources must be allocated so as to optimize overall performance objectives. The traditional scheduling models consider performance indicators such as processing time, cost, and quality as optimization objectives. However, most of them do not take into account energy consumption and robustness. We focus our attention in a job-shop scheduling problem where machines can work at different speeds. It represents an extension of the classical job-shop scheduling problem, where each operation has to be executed by one machine and this machine can work at different speeds. The main goal of the paper is focused on the analysis of three important objectives (energy efficiency, robustness, and makespan) and the relationship among them. We present some analytical formulas to estimate the ratio/relationship between these parameters. It can be observed that there exists a clear relationship between robustness and energy efficiency and a clear trade-off between robustness/energy efficiency and makespan. It represents an advance in the state of the art of production scheduling, so obtaining energy-efficient solutions also supposes obtaining robust solutions, and vice versa.This research has been supported by the Spanish Government under research project MICINN TIN2013-46511-C2-1-P, the European CASES project (No. 294931) supported by a Marie Curie International Research Staff Exchange Scheme Fellowship within the FP7, and the European TETRACOM project (No. 609491) supported by FP7-ICT-2013-10. This research was also supported by the National Science Foundation of China (No. 51175262) and the Jiangsu Province Science Foundation for Excellent Youths under Grant BK2012032.Salido Gregorio, MA.; Escamilla Fuster, J.; Barber Sanchís, F.; Giret Boggino, AS.; Tang, D.; Dai, M. (2015). Energy efficiency, robustness, and makespan optimality in job-shop scheduling problems. AI EDAM. 30(3):300-312. https://doi.org/10.1017/S0890060415000335S300312303Billaut, J.-C., Moukrim, A., & Sanlaville, E. (Eds.). (2008). Flexibility and Robustness in Scheduling. doi:10.1002/9780470611432Nowicki, E., & Smutnicki, C. (2005). An Advanced Tabu Search Algorithm for the Job Shop Problem. Journal of Scheduling, 8(2), 145-159. doi:10.1007/s10951-005-6364-5Agnetis, A., Flamini, M., Nicosia, G., & Pacifici, A. (2010). A job-shop problem with one additional resource type. Journal of Scheduling, 14(3), 225-237. doi:10.1007/s10951-010-0162-4Mouzon, G., Yildirim, M. B., & Twomey, J. (2007). Operational methods for minimization of energy consumption of manufacturing equipment. International Journal of Production Research, 45(18-19), 4247-4271. doi:10.1080/00207540701450013Weinert, N., Chiotellis, S., & Seliger, G. (2011). Methodology for planning and operating energy-efficient production systems. CIRP Annals, 60(1), 41-44. doi:10.1016/j.cirp.2011.03.015Duflou, J. R., Sutherland, J. W., Dornfeld, D., Herrmann, C., Jeswiet, J., Kara, S., … Kellens, K. (2012). Towards energy and resource efficient manufacturing: A processes and systems approach. CIRP Annals, 61(2), 587-609. doi:10.1016/j.cirp.2012.05.002Laborie P. (2009). IBM ILOG CP Optimizer for detailed scheduling illustrated on three problems. Proc. 6th Int. Conf. Integration of AI and OR Techniques in Constraint Programming for Combinatorial Optimization Problems, CPAIOR09.Dahmus J. , & Gutowski T. (2004). An environmental analysis of machining. Proc. ASME Int. Mechanical Engineering Congr. RD&D Exposition, Anaheim, CA.Huang, K.-L., & Liao, C.-J. (2008). Ant colony optimization combined with taboo search for the job shop scheduling problem. Computers & Operations Research, 35(4), 1030-1046. doi:10.1016/j.cor.2006.07.003IBM. (2010). Modeling With IBM ILOG CP Optimizer—Practical Scheduling Examples (white paper). Armonk, NY: IBM Software Group.Kramer L. , Barbulescu L. , & Smith S. (2007). Understanding performance tradeoffs in algorithms for solving oversubscribed scheduling. Proc. 22nd Conf. Artificial Intelligence, AAAI-07, Vancouver.Seow, Y., & Rahimifard, S. (2011). A framework for modelling energy consumption within manufacturing systems. CIRP Journal of Manufacturing Science and Technology, 4(3), 258-264. doi:10.1016/j.cirpj.2011.03.007Li, W., Zein, A., Kara, S., & Herrmann, C. (2011). An Investigation into Fixed Energy Consumption of Machine Tools. Glocalized Solutions for Sustainability in Manufacturing, 268-273. doi:10.1007/978-3-642-19692-8_47Szathmáry, E. (2006). A robust approach. Nature, 439(7072), 19-20. doi:10.1038/439019aFang, K., Uhan, N., Zhao, F., & Sutherland, J. W. (2011). A new approach to scheduling in manufacturing for power consumption and carbon footprint reduction. Journal of Manufacturing Systems, 30(4), 234-240. doi:10.1016/j.jmsy.2011.08.004Gutowski, T., Murphy, C., Allen, D., Bauer, D., Bras, B., Piwonka, T., … Wolff, E. (2005). Environmentally benign manufacturing: Observations from Japan, Europe and the United States. Journal of Cleaner Production, 13(1), 1-17. doi:10.1016/j.jclepro.2003.10.004Garrido A. , Salido M.A. , Barber F. , & López M.A. (2000). Heuristic methods for solving job-shop scheduling problems. Proc. ECAI-2000 Workshop on New Results in Planning, Scheduling and Design, Berlín.Verfaillie G. , & Schiex T. (1994). Solution reuse in dynamic constraint satisfaction problems. Proc. 12th National Conf. Artificial Intelligence, AAAI-94.Dai, M., Tang, D., Giret, A., Salido, M. A., & Li, W. D. (2013). Energy-efficient scheduling for a flexible flow shop using an improved genetic-simulated annealing algorithm. Robotics and Computer-Integrated Manufacturing, 29(5), 418-429. doi:10.1016/j.rcim.2013.04.001Neugebauer, R., Wabner, M., Rentzsch, H., & Ihlenfeldt, S. (2011). Structure principles of energy efficient machine tools. CIRP Journal of Manufacturing Science and Technology, 4(2), 136-147. doi:10.1016/j.cirpj.2011.06.017Mouzon, G., & Yildirim, M. B. (2008). A framework to minimise total energy consumption and total tardiness on a single machine. International Journal of Sustainable Engineering, 1(2), 105-116. doi:10.1080/19397030802257236Bruzzone, A. A. G., Anghinolfi, D., Paolucci, M., & Tonelli, F. (2012). Energy-aware scheduling for improving manufacturing process sustainability: A mathematical model for flexible flow shops. CIRP Annals, 61(1), 459-462. doi:10.1016/j.cirp.2012.03.08

Quantifying unmet prevention needs among MSM in Europe through a multi-site bio-behavioural survey

Introduction: The HIV epidemic represents an important public health issue in Europe particularly among men who have sex with men (MSM). Global AIDS Monitoring indicators (GAM) have been widely and jointly promoted as a set of crucial standardised items to be adopted for monitoring and responding to the epidemic. Methods: The Sialon II study, implemented in 13 European cities (2013-14), was a complex multicentre integrated bio-behavioural cross sectional survey targeted at MSM, with a concomitant collection of behavioural and biological (oral fluid or blood specimens) data. Rigorous sampling approaches for hard-to-reach populations were used (time-location sampling and respondent-driven sampling) and GAM indicators were calculated; sampling frames were adapted to allow weighted estimates of GAM indicators. Results: 4,901 MSM were enrolled. HIV prevalence estimates ranged from 2.4% in Stockholm to 18.0% in Bucharest. When exploring city-level correlations between GAM indicators, prevention campaigns significantly correlated with levels of condom use and level of HIV testing among MSM. Conclusion: The Sialon II project has made an important contribution to the monitoring and evaluation of the HIV epidemic across Europe, integrating the use of GAM indicators within a second generation HIV surveillance systems approach and in participatory collaboration with MSM communities. It influenced the harmonisation of European data collection procedures and indicators via GAM country reporting and contributed essential knowledge informing the development and implementation of strategic, evidence-based HIV prevention campaigns for MSM.publishersversionpublishe

Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Objectives Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. Methods In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). Results A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5\u201374.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. Conclusions Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe