Dose adjustment of the non-nucleoside reverse transcriptase inhibitors during concurrent rifampicin-containing tuberculosis therapy: one size does not fit all

Importance of the field: HIV/tuberculosis (TB) co-infection is common and associated with high mortality. Simultaneous highly active antiretroviral therapy during TB treatment is associated with substantial survival benefit but drug–drug interactions complicate NNRTI dosing. Areas covered in this review: We reviewed the impact of rifampicin-containing TB therapy on the NNRTIs pharmacokinetics and clinical outcome. PubMed database was searched from 1966 to July 2009 using the terms efavirenz, rifampicin, nevirapine, pharmacokinetics, pharmacogenetics, HIV, TB, CYP2B6, CYP3A4 and metabolism. References from identified articles and abstracts from meetings were also reviewed. What the reader will gain: A comprehensive review of the literature on this subject including pharmacokinetic and clinical studies. Most studies were small, observational or underpowered to detect the true effect of rifampicin on NNRTI-based therapy. None of the studies were controlled for genetic factors and there were limited data on children. Take home message: There were insufficient data to make definitive recommendations about dose adjustment of the NNRTIs during rifampin-containing therapy. Current data suggest that the standard dose of efavirenz or nevirapine is adequate in most HIV/TB co-infected adults. However, more research is needed in pediatric populations as well as to define role of drug–gene interactions

Internet forums following a miscarriage: a place for women in particular pain?

International audienceObjective: Miscarriage is a frequent event, but one which might be particularly difficult to cope with. The main aim of this study was to explore the features of the women using Internet forums following a miscarriage. Methods: A sample of 211 women who experienced miscarriage and who use the Internet completed an online questionnaire. Sociodemographic data were gathered and three scales were completed: the Hospital Anxiety and Depression Scale, the Texas Grief Inventory adjusted to miscarriage and the Dyadic Adjustment Scale. Results: Our results show that these women reported a great amount of pain compared to a more standard sample. Interestingly, our findings show that while women reported wishing to be supported, only a few of them sought such support. Conclusion: Further study focusing on support for women who experience miscarriage must be developed and Internet-based programmes are warranted

Fate of antibiotics, steroid hormones and multiple endocrine activities during biological treatment of swine manure under anaerobic and aerobic/anoxic conditions

International audienceLittle information exists on the fate of antibiotics, hormones and their associated endocrine activity during manure treatment processes. Thus, the aim of this study was to assess the fate of such emerging pollutants and multiple endocrine activities during manure treatment coupling anaerobic digestion and aerobic/anoxic conditions under mesophilic conditions. The thermophilic anaerobic digestion was also studied. The endocrine activities tested include estrogenic (ER), dioxin-like (AhR), peroxisome proliferator receptor gamma (PPAR ), pregnane X (PXR) and androgenic (AR) activities. Our results showed that antibiotics and steroid hormones were recalcitrant to biodegradation under anaerobic conditions in both mesophilic and thermophilic temperatures. In contrast, antibiotic and hormone removal reached between 76 to 95 % when anaerobic digestion was coupled to aerobic/anoxic treatment. In absence of anaerobic predigestion, hormone removal in aerobic/anoxic conditions was about 40 %; it suggests that the anaerobic predigestion could favour the further elimination of hormones in the anaerobic/anoxic process. The estrogenic activity was mainly removed in the aerobic/anoxic (71%) compartment. The dioxin-like activity appeared to be more recalcitrant to degradation. No others endocrine activities were detected