Health outcomes of asymptomatic HIV-infected pregnant women initiating antiretroviral therapy at different baseline CD4 counts in Ethiopia

Objective: To compare health outcomes following initiation of antiretroviral therapy (ART) for asymptomatic HIV-infected pregnant women at different CD4 levels. Methods: We analyzed data from 706 asymptomatic HIV-infected Ethiopian women initiating ART during pregnancy between February 2012 and October 2016. The outcomes evaluated were CD4 gain, CD4 normalization (CD4 count ≥750 cells/mm3) and occurrence of HIV-related clinical events after twelve months of treatment. Result: On average, CD4 count (cells/mm3) increased from 391 (95% CI: 372–409) at baseline to 523 (95% CI: 495–551) after twelve months of treatment. Rate of CD4 gain was higher among women with baseline CD4 between 350 and 499 compared to CD4 ≥500 (207 versus 6, p < 0.001). But women with baseline CD4 between 350 and 499 could not catch up with women with CD4 ≥500. Women with baseline CD4 ≥500 had significantly higher likelihood of achieving CD4 normalization as compared to those with CD4 between 350 and 499 (AOR = 0.32, 95% CI: 0.13–0.76). No strong evidence of differential risk in the occurrence of HIV-related clinical events. Conclusion: Starting ART for asymptomatic HIV-infected women with CD4 count ≥500 cells/mm3 was beneficial to preserve or recover immunity after 12 months of treatment in a resource limited setting. Keywords: HIV, Antiretroviral drugs, ART, Clinical outcom

Pregnancy outcome among HIV-infected women on different antiretroviral therapies in Ethiopia:a cohort study

Objective: The objective of the study was to compare pregnancy outcomes according to maternal antiretroviral treatment (ART) regimens. Design: A retrospective cohort study. Participants and settings: Clinical data was extracted from ART exposed pregnancies of HIV-infected Ethiopian women attending antenatal care follow-up in public health facilities in Addis Ababa between February 2010 and October 2016. Outcomes: The primary outcomes evaluated were preterm birth, low birth weight and small-for-gestational-age. Results: A total 1663 of pregnancies exposed to ART were included in the analyses. Of these pregnancies, 17% resulted in a preterm birth, 19% in low birth weight and 32% in a small-for-gestational-age baby. Compared with highly active antiretroviral therapy (HAART) initiated during pregnancy, zidovudine monotherapy was less likely to result in preterm birth (adjusted OR 0.35, 95% CI 0.19 to 0.64) and low birth weight (adjusted OR 0.48, 95% CI 0.24 to 0.94). We observed no differential risk of preterm birth, low birth weight and small-for-gestational-age, when comparing women who initiated HAART during pregnancy to women who initiated HAART before conception. The risk for preterm birth was higher in pregnancies exposed to nevirapine-based HAART (adjusted OR 1.44, 95% CI 1.06 to 1.96) compared with pregnancies exposed to efavirenz-based HAART. Comparing nevirapine-based HAART with efavirenz-based HAART indicated no strong evidence of increased risk of low birth weight or small-for-gestational-age. Conclusions: We observed a higher risk of preterm birth among women who initiated HAART during pregnancy compared with zidovudine monotherapy. Pregnancies exposed to nevirapine-based HAART also had a greater risk of preterm births compared with efavirenz-based HAART

Grip strength in men and women aged 50–79 years is associated with non-vertebral osteoporotic fracture during 15 years follow-up: The Tromsø Study 1994–1995

Under embargo until: 2020-10-25Summary In 50–79-year-olds who participated in the Tromsø Study (1994–1995), the risk of non-vertebral osteoporotic fractures during 15 years follow-up increased by 22% in men and 9% in women per 1 SD lower grip strength. The strongest association was observed in men aged 50–64 years. Introduction We aimed to explore whether low grip strength was associated with increased risk of non-vertebral osteoporotic fracture in the population-based Tromsø Study 1994–1995. Methods Grip strength (bar) was measured by a Martin Vigorimeter and fractures were retrieved from the X-ray archives at the University Hospital of North Norway between 1994 and 2010. At baseline, weight and height were measured, whereas information on the other covariates were obtained through self-reported questionnaires. Cox regression was used to estimate the hazard ratio (HR) of fracture in age- and gender-specific quintiles of grip-strength, and per 1 SD lower grip strength. Similar analyses were done solely for hip fractures. Adjustments were made for age, height, body mass index (BMI), marital status, education, smoking, physical activity, use of alcohol, self-perceived health, and self-reported diseases. Results In 2891 men and 4002 women aged 50–79 years, 1099 non-vertebral osteoporotic fractures—including 393 hip fractures—were sustained during the median 15 years follow-up. Risk of non-vertebral osteoporotic fracture increased with declining grip strength: hazard ratios per SD decline was 1.22 (95% CI 1.05–1.43) in men and 1.09 (95% CI 1.01–1.18) in women. HR for fracture in lower vs. upper quintile was 1.58 (95% CI 1.02–2.45) in men and 1.28 (95% CI 1.03–1.59) in women. The association was most pronounced in men aged 50–64 years with HR = 3.39 (95% CI 1.76–6.53) in the lower compared to the upper quintile. Conclusions The risk of non-vertebral osteoporotic fracture increased with declining grip-strength in both genders, particularly in men aged 50–64 years.acceptedVersio

Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study

Higher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–rural differences in short‐ and long‐term mortality in Norwegian hip fracture patients and their potential associations with sociodemographic variables, and to investigate possible urban–rural differences in excess mortality in hip fracture patients compared with the general population. Data were provided from the NOREPOS hip fracture database, the 2001 Population and Housing Census, and the National Registry. The urbanization degree in each municipality was determined by the proportion of inhabitants living in densely populated areas (rural: 2/3). Age‐adjusted mortality rates and standardized mortality ratios were calculated for hip fracture patients living in rural, semirural, and urban municipalities. A flexible parametric model was used to estimate age‐adjusted average and time‐varying HRs by category of urbanization with the rural category as reference. Among 96,693 hip fracture patients, urban residents had higher mortality than their rural‐dwelling counterparts. The HR of mortality in urban compared with rural areas peaked during the first 1 to 2 years postfracture with a maximum HR of 1.20 (95% CI, 1.10 to 1.30) in men and 1.15 (95% CI, 1.08 to 1.21) in women. The differences were significant during approximately 5 years after fracture. Adjusting for sociodemographic variables did not substantially change the results. However, absolute 30‐day mortality was not significantly different between urban and rural residents, suggesting that health‐care quality immediately postfracture does not vary by urbanization. The novel findings of a higher long‐term mortality in urban hip fracture patients might reflect disparities in health status or lifestyle, differences in posthip fracture health care or rehabilitation, or a combination of several factors

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

A bridge to change: Experiences of participation in “VINN”— a motivational program for convicted women

The objective of this study was to examine women’s perceptions after participation in a motivational and gender-sensitive program (VINN) and to explore what was experienced as helpful. The qualitative data consisted of reports and transcriptions from 13 group interviews with 65 participants on probation or imprisoned in Sweden, Denmark, Russia, Estonia and Norway. The data were analysed according to systematic text condensation. The participants’ perceptions could be grouped into the following clusters: confidence and trust, deeper understanding, change and future hopes. The women appreciated the collaborative atmosphere focusing on quality of life, autonomy, strengths, coping and resources. The most beneficial experiences reported, regardless of country, were that their personal repertoires of actions were expanded during their participation, and their confidence in their ability to desist from crime and substance abuse in the future increased. The results support the program’s salutogenic approach combined with motivational interviewing as a bridge to change. Future research should investigate whether the participants report sustainability of the changes

Emotional distress and sense of coherence in women completing a motivational program in five countries. A prospective study

Purpose – The purpose of this paper is to investigate changes in, and associations between, sense of coherence (SOC) and emotional distress in women who participated in an accredited motivational program (VINN) in correctional institutions in five countries. Design/methodology/approach – A prospective study with a pre- and post-test design included 316 participants from Sweden, Estonia, Denmark, Russia and Norway. Global emotional distress was measured by the Hospital Anxiety and Depression Scale. SOC was measured using the 13-item Orientation to Life Questionnaire. One-way analysis of variance and multilevel regression models were used in the statistical analyses. Findings – An increase in SOC was associated with a decrease in emotional distress. Emotional distress decreased significantly −3.80 points (95 percent CI (−4.61, −2.97)), and SOC significantly improved from pre- to post-measurement by 1.82 points (95 percent CI (0.72, 2.92)), regardless of country and correctional institution. Practical implications – The results add new knowledge regarding a coherent theoretical foundation of a motivational program for women. The ability of a program promoting health is important for researchers, health-care workers and facilitators delivering programs for women in correctional facilities. An increase in SOC can act as a protective factor in order to manage stressors and risk factors among women serving in correctional facilities. Originality/value – The present study indicates that enhancing women’s coping resources and providing income alternatives to crime is fundamental to their capacity to desist from criminal behavior

Pregnancy outcome among HIV-infected women on different antiretroviral therapies in Ethiopia: A cohort study

Objective The objective of the study was to compare pregnancy outcomes according to maternal antiretroviral treatment (ART) regimens. Design A retrospective cohort study. Participants and settings Clinical data was extracted from ART exposed pregnancies of HIV-infected Ethiopian women attending antenatal care follow-up in public health facilities in Addis Ababa between February 2010 and October 2016. Outcomes The primary outcomes evaluated were preterm birth, low birth weight and small-for-gestational-age. results A total 1663 of pregnancies exposed to ART were included in the analyses. Of these pregnancies, 17% resulted in a preterm birth, 19% in low birth weight and 32% in a small-for-gestational-age baby. Compared with highly active antiretroviral therapy (HAART) initiated during pregnancy, zidovudine monotherapy was less likely to result in preterm birth (adjusted OR 0.35, 95% CI 0.19 to 0.64) and low birth weight (adjusted OR 0.48, 95% CI 0.24 to 0.94). We observed no differential risk of preterm birth, low birth weight and small-for-gestational-age, when comparing women who initiated HAART during pregnancy to women who initiated HAART before conception. The risk for preterm birth was higher in pregnancies exposed to nevirapine-based HAART (adjusted OR 1.44, 95% CI 1.06 to 1.96) compared with pregnancies exposed to efavirenzbased HAART. Comparing nevirapine-based HAART with efavirenz-based HAART indicated no strong evidence of increased risk of low birth weight or small-for-gestationalage. Conclusions We observed a higher risk of preterm birth among women who initiated HAART during pregnancy compared with zidovudine monotherapy. Pregnancies exposed to nevirapine-based HAART also had a greater risk of preterm births compared with efavirenz-based HAART

Differences in Growth of HIV-exposed Uninfected Infants in Ethiopia According to Timing of In-utero Antiretroviral Therapy Exposure

Background: There are concerns about the adverse effect of in-utero exposure to antiretroviral therapy (ART) on the growth of HIV exposed-uninfected (HEU) infants. We compared growth of HEU-infants according to the timing and type of ART exposure. Methods: A retrospective cohort study was conducted by abstracting clinical data from HIV-infected mothers and HEU-infants in Addis Ababa, Ethiopia between February 2013 and October 2016. Mixed-effects linear models were used to compare changes in weight and length and cox proportional hazard models were used to evaluate stunting (length-for-age z score <−2.0) and underweight (weight-for-age z score <−2.0). Results: A total of 624 HEU-infants were included in the analyses. Infants exposed to ART from conception had a lower rate of change in length [β = −0.54, 95% confidence interval (CI): −1.00 to −0.08] the first 3 months of life, as compared with infants exposed from late pregnancy. Risk of stunting was 51.9 per 100 person-years and risk of underweight was 26.7 per 100 person-years. Exposure to ART from conception was associated with a higher rate of stunting as compared with exposure from late pregnancy (adjusted hazard ratio = 1.95, 95% CI: 1.27–2.99). Infants born to mothers with advanced disease had a higher incidence of underweight compared with infants born to mothers with early-stage disease adjusted hazard ratio = 1.99, 95% CI: 1.32–3.03). Conclusions: In HEU-infants, exposure to ART from conception was associated with decrease growth during early infancy and higher incidence of stunting compared with treatment exposure later in pregnancy. Close monitoring of HEU-infants’ growth and prompt nutritional intervention is essential