Challenges in management and treatment outcomes of HIV among adolescents and young adults in a county hospital in Kenya

Objective: To evaluate the challenges in management of HIV among adolescents and young adults (AYA) aged 10-24 years and their treatment outcomes in terms of viral load suppression. Design: Cross sectional study with primary and secondary data. Setting: Secondary level health facility in sub-Saharan Africa. Subjects: Data on treatment outcomes was obtained from 106 subjects through abstraction from files. Primary data on challenges in management was obtained from in-depth interviews on 18 subjects, one focused group discussion with seven participants and 10 key informant interviews. Main Outcome Measures: Viral load suppression after at least six months of treatment. Results: Out of 106 eligible adolescents, records on viral suppression were only available for 60 (56.7%). For those who had available records, 85 (80%) had achieved viral suppression, with viral load <1000 copies per ml. Of those who had achieved viral suppression, 80 (75%) had undetectable levels. The viral suppression was associated with the type of treatment, adherence to medication and follow-up status [p= <0.0001, p= <0.0001, p= <0.002,] respectively. The main themes on challenges in management identified from the interviews and focused group discussion were psychosocial and difficulty in taking medication as follows: Conclusions: The main challenges in the management of HIV within this population are psychosocial and medication-use related. Viral suppression was associated with first line of treatment, adherence to medication and active follow up status

A multinational study distinguishing Alzheimer's and healthy patients using cerebrospinal fluid tau/Aβ42 cutoff with concordance to amyloid positron emission tomography imaging.

INTRODUCTION: Changes in cerebrospinal fluid (CSF) tau and amyloid β (Aβ)42 accompany development of Alzheimer's brain pathology. Robust tau and Aβ42 immunoassays were developed to establish a tau/Aβ42 cutoff distinguishing mild-to-moderate Alzheimer's disease (AD) subjects from healthy elderly control (HC) subjects. METHODS: A CSF tau/Aβ42 cutoff criteria was chosen, which distinguished the groups and maximized concordance with amyloid PET. Performance was assessed using an independent validation cohort. RESULTS: A tau/Aβ42 = 0.215 cutoff provided 94.8% sensitivity and 77.7% specificity. Concordance with PET visual reads was estimated at 86.9% in a ∼50% PET positive population. In the validation cohort, the cutoff demonstrated 78.4% sensitivity and 84.9% specificity to distinguish the AD and HC populations. DISCUSSION: A tau/Aβ42 cutoff with acceptable sensitivity and specificity distinguished HC from mild-to-moderate AD subjects and maximized concordance to brain amyloidosis. The defined cutoff demonstrated that CSF analysis may be useful as a surrogate to imaging assessment of AD pathology

A multinational study distinguishing Alzheimer's and healthy patients using cerebrospinal fluid tau/Aβ42 cutoff with concordance to amyloid positron emission tomography imaging

Introduction Changes in cerebrospinal fluid (CSF) tau and amyloid β (Aβ)42 accompany development of Alzheimer\u27s brain pathology. Robust tau and Aβ42 immunoassays were developed to establish a tau/Aβ42 cutoff distinguishing mild-to-moderate Alzheimer\u27s disease (AD) subjects from healthy elderly control (HC) subjects. Methods A CSF tau/Aβ42 cutoff criteria was chosen, which distinguished the groups and maximized concordance with amyloid PET. Performance was assessed using an independent validation cohort. Results A tau/Aβ42 = 0.215 cutoff provided 94.8% sensitivity and 77.7% specificity. Concordance with PET visual reads was estimated at 86.9% in a ∼50% PET positive population. In the validation cohort, the cutoff demonstrated 78.4% sensitivity and 84.9% specificity to distinguish the AD and HC populations. Discussion A tau/Aβ42 cutoff with acceptable sensitivity and specificity distinguished HC from mild-to-moderate AD subjects and maximized concordance to brain amyloidosis. The defined cutoff demonstrated that CSF analysis may be useful as a surrogate to imaging assessment of AD pathology