Treatment exhaustion of highly active antiretroviral therapy (HAART) among individuals infected with HIV in the United Kingdon: multicentre cohort study

Objectives: To investigate whether there is evidence that an increasing proportion of HIV infected patients is starting to experience increases in viral load and decreases in CD4 cell count that are consistent with exhaustion of available treatment options. Design: Multicentre cohort study. Setting: Six large HIV treatment centres in southeast England. Participants: All individuals seen for care between 1 January 1996 and 31 December 2002. Main outcome measures: Exposure to individual antiretroviral drugs and drug classes, CD4 count, plasma HIV RNA burden. Results: Information is available on 16 593 individuals (13 378 (80.6%) male patients, 10 340 (62.3%) infected via homosexual or bisexual sex, 4426 (26.7%) infected via heterosexual sex, median age 34 years). Overall, 10 207 of the 16 593 patients (61.5%) have been exposed to any antiretroviral therapy. This proportion increased from 41.2% of patients under follow up at the end of 1996 to 71.3% of those under follow up in 2002. The median CD4 count and HIV RNA burden of patients under follow up in each year changed from 270 cells/mm3 and 4.34 log10 copies/ml in 1996 to 408 cells/mm3 and 1.89 log10 copies/ml, respectively, in 2002. By 2002, 3060 (38%) of patients who had ever been treated with antiretroviral therapy had experienced all three main classes. Of these, around one quarter had evidence of “viral load failure” with all these three classes. Patients with three class failure were more likely to have an HIV RNA burden > 2.7 log10 copies/ml and a CD4 count < 200 cells/mm3. Conclusions: The proportion of individuals with HIV infection in the United Kingdom who have been treated has increased gradually over time. A substantial proportion of these patients seem to be in danger of exhausting their options for antiretroviral treatment. New drugs with low toxicity, which are not associated with cross resistance to existing drugs, are urgently needed for such patients

Where are the children in national hepatitis C policies? A global review of national strategic plans and guidelines

Background and Aims: It is estimated that 3.26 million children and adolescents worldwide have chronic hepatitis C virus (HCV) infection. To date, the global response has focussed on the adult population, but Direct Acting Antiviral (DAA) regimens are now approved for children aged ≥ 3 years. This global review describes the current status of policies on HCV testing and treatment in children, adolescents and pregnant women in WHO Member States. / Methods: We identified national strategic plans (NSPs) and/or clinical practice guidelines (CPGs) for HCV infection from a World Health Organization (WHO) database of national policies from member states as of August 2019. A standardised proforma was used to abstract data on polices or recommendations on testing and treatment in children, adolescents and pregnant women. Analysis was stratified according to the country-income status and results were validated through WHO regional focal points through August 2020. / Results: National HCV policies were available for 122 of the 194 WHO Member States. Of these, the majority (n=71/122, 58%) contained no policy recommendations for either testing or treatment in children or adolescents. Of the 51 countries with policies, 24 had specific policies for both testing and treatment, and were mainly from the European region; 18 countries for HCV testing only (12 from high- or upper-middle income); and 9 countries for treatment only (7 high- or upper-middle income). Twenty-one countries provided specific treatment recommendations: 13 recommended DAA-based regimens for adolescents ≥12 years and six still recommended interferon/ribavirin-based regimens. / Conclusions: There are significant gaps in policies for HCV-infected children and adolescents. Updated guidance on testing and treatment with newly approved DAA regimens for younger age groups is needed, especially in most affected countries

Anti-Trust and Economic Theory: Some Observations from the US Experience

Recent developments in US anti-trust can be characterised as reflecting the uneasy interaction of two quite separate phenomena: first, the increased emphasis on economic analysis as the overriding organising principle of anti-trust policy and on economic efficiency as the primary (perhaps only) relevant goal for anti-trust; second, the long-standing reluctance of the federal judiciary to involve itself in any substantive economic analysis, and the preference, instead, for simple rules of thumb or ‘pigeon holes’ to sort out lawful from unlawful conduct. The result has been that while economics has played a major role, it has not influenced American anti-trust as thoroughly or as uniformly as might have been imagined; rather the extent and the nature of its influence have depended on the degree to which the relevant economics could be reduced to the kind of simple rules or pigeon holes that the judiciary favours. The present paper will illustrate that theme, first by reporting on the two developments separately and then by illustrating their joint influence with reference to two important areas of American anti-trust: predatory conduct and so-called vertical restraints. Finally, a contrast will be made between judicial development in those two areas and recent American merger policy which, it is argued, is carried out largely independently of the judiciary, and hence the opportunities for economics to influence the process are less inhibited by the judicial reluctance to undertake extensive economic analysis

Strategies for Searching the Internet for Orthopedic Surgeons: Tips and Tricks

Internet provides access to large amounts of information quickly, provides a flexible learning platform, and is easily accessible from anywhere, especially with new technologies. Web-based search engines and bibliographic databases, have already become part of a doctor\u27s everyday life. However, even well-published researchers often fail to appreciate the background knowledge required to conduct a good literature search on the internet. Using the right techniques can improve the ability to search for relevant information This chapter briefly outlines the internet as an information resources such as Google, Google Scholar, PubMed, Cochrane for orthopedic surgeons. Also the subsequent sections of the chapter offers combining search engines tips and tricks for a best search that orthopedic surgeons can use to improve their use of web-based information and learning resources

Accounting for unequal access to higher education: the role of social identity factors

Western societies stress the potential for anyone, irrespective of social background, to improve their position within society. However, disadvantaged students face barriers in gaining a good education. Two studies in secondary schools show how perceptions of identity compatibility and anticipated fit influence students’ university choices. It was found that relatively disadvantaged students scored lower on identity compatibility, and that low scores on identity compatibility were associated with lower anticipated fit at a local selective (Study 1) or highly selective (Study 2) university. Anticipated fit, in turn, predicted the type of university to which participants wanted to apply; those who anticipated fitting in more at selective universities were more likely to apply to higher status universities. These relations were significant while controlling for academic achievement. Together, these studies suggest that social identity factors play a relevant role in explaining higher education choices among low-status group members

Life at both ends of the ladder: education-based identification and its association with well-being and social attitudes

Level of formal education is an important divide in contemporary societies; it is positively related to health, well-being, and social attitudes such as tolerance for minorities and interest in politics. We investigated whether education-based identification is a common underlying factor of these education effects. Indeed, education-based identification was stronger among the higher educated, especially for identification aspects that encompass education-based group esteem (i.e., the belief that one’s educational group is worthy and that others think so, too). Furthermore, while group esteem had beneficial effects across educational levels, aspects of identification that were unrelated to group esteem had positive effects for the higher educated but not for the less educated. Thus, the less educated do not benefit from the psychologically nourishing effect of identification that exists for other groups. The stigma and responsibility related to low education could be a common explanation for a wide range of outcomes