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Siita: mamusepelo
(2010)
Background: Published estimates of mortality and progression to AIDS as children with HIV approach adulthood are limited. We describe rates and risk factors for death and AIDS-defining events in children and adolescents after initiation of combination antiretroviral therapy (cART) in 17 middle- and high-income countries, including some in Western and Central Europe (W&CE), Eastern Europe (Russia and Ukraine), and Thailand.
Methods and findings: Children with perinatal HIV aged <18 years initiating cART were followed until their 21st birthday, transfer to adult care, death, loss to follow-up, or last visit up until 31 December 2013. Rates of death and first AIDS-defining events were calculated. Baseline and time-updated risk factors for early/late (≤/>6 months of cART) death and progression to AIDS were assessed. Of 3,526 children included, 32% were from the United Kingdom or Ireland, 30% from elsewhere in W&CE, 18% from Russia or Ukraine, and 20% from Thailand. At cART initiation, median age was 5.2 (IQR 1.4–9.3) years; 35% of children aged <5 years had a CD4 lymphocyte percentage <15% in 1997–2003, which fell to 15% of children in 2011 onwards (p < 0.001). Similarly, 53% and 18% of children ≥5 years had a CD4 count <200 cells/mm3 in 1997–2003 and in 2011 onwards, respectively (p < 0.001). Median follow-up was 5.6 (2.9–8.7) years. Of 94 deaths and 237 first AIDS-defining events, 43 (46%) and 100 (42%) were within 6 months of initiating cART, respectively. Multivariable predictors of early death were: being in the first year of life; residence in Russia, Ukraine, or Thailand; AIDS at cART start; initiating cART on a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen; severe immune suppression; and low BMI-for-age z-score. Current severe immune suppression, low current BMI-for-age z-score, and current viral load >400 c/mL predicted late death. Predictors of early and late progression to AIDS were similar. Study limitations include incomplete recording of US Centers for Disease Control (CDC) disease stage B events and serious adverse events in some countries; events that were distributed over a long time period, and that we lacked power to analyse trends in patterns and causes of death over time.
Conclusions: In our study, 3,526 children and adolescents with perinatal HIV infection initiated antiretroviral therapy (ART) in countries in Europe and Thailand. We observed that over 40% of deaths occurred ≤6 months after cART initiation. Greater early mortality risk in infants, as compared to older children, and in Russia, Ukraine, or Thailand as compared to W&CE, raises concern. Current severe immune suppression, being underweight, and unsuppressed viral load were associated with a higher risk of death at >6 months after initiation of cART.
Objectives: To prospectively evaluate lung ultrasound in comparison with radiography and computed tomography (CT) for detecting HIV-related lung diseases.
Methods: Ultrasound examinations in HIV-positive patients were evaluated by three raters; available conventional imaging was evaluated by another rater. Results were compared with each other and the definite diagnosis. Interrater reliability was calculated for each finding.
Results: Eighty HIV-positive patients received lung ultrasound examinations; 74 received conventional imaging. The overall sensitivity was 97.5% for CT, 90.7% for ultrasound and 78.1% for radiography. The most common diagnoses were Pneumocystis jirovecii pneumonia (21 cases) and bacterial pneumonia (17 cases). The most frequent and sensitive ultrasonographic findings were interstitial abnormalities indicated by B-lines, independent of the aetiology. Interrater reliability was high for interstitial abnormalities (ICC=0.82). The interrater reliability for consolidations and effusion increased during the study (r=0.88 and r=0.37, respectively).
Conclusions: Ultrasound is a fast, reliable and sensitive point-of-care tool, particularly in detecting interstitial lung disease, which is common in HIV-associated illness. It does not effectively discriminate between different aetiologies. A longer learning period might be required to reliably identify consolidations and effusions.
Die in den 1990er Jahren erneuerte sozialwissenschaftliche Debatte um Staatsbürgerschaft (citizenship) als ein Verhältnis von Nation, Staat und Individuum, das über rein rechtliche Arrangements hinausgeht und auch Fragen der politischen und kulturellen Zugehörigkeit im weiteren Sinn betrifft, hat seit fünf bis zehn Jahren auch die Literatur- und Kulturwissenschaften erreicht, mit eigenen Schwerpunktsetzungen und Konzepten. Eines dieser Konzepte, das des sexual citizenship, ist das Thema der kulturwissenschaftlichen Magisterarbeit "We Will Be Citizens: The Notion of Citizenship in Tony Kushner's Angels in America and Larry Kramer's The Normal Heart". Kramer's The Normal Heart (1985) und Kuschner's Angels in America (1993/95) werden als Beispiele für Theaterstücke der 'ersten' und 'zweiten' Generation, die sich mit der AIDS-Krise der 1980er Jahre auseinandersetzen analysiert; dabei, so das zentrale Argument, geht es in beiden Stücken darum, die Auseinandersetzung mit AIDS und die formulierte Kritik an der unzureichenden Reaktion der Reagan-Administration auf die AIDS-Krise im Kontext von Neuverhandlungen von sexual citizenship zu lesen, also als Neuverhandlung der Rechte und gesellschaftlichen Teilhabemöglichkeit für als von der 'sexuellen Norm abweichend' definierte Personengruppen, im Kontext der Stücke vor allem homosexuelle Männer. Dabei wird citizenship klar als ein kulturelles Konzept definiert und macht dadurch auch die Bedeutung kultureller Produktionen (z.B. Literatur) für die Debatten deutlich: "Citizenship is not only to be understood as a political issue, but also as socially and materially constructed and culturally coded. If we understand culture as the ways of doing things and of organizing society, then the negotiations of citizenship take place, among other ways, through culture" (5). Die Diskussion des Themas beginnt mit einer zielgerichteten Skizze der theoretischen Debatten um sexual citizenship, der Rolle von AIDS für diese Debatten (Kap. 2) und einer Übersicht über die AIDS-Krise der 1980er Jahre (Kap. 3). Dabei stellt er mit Sontag, Yingling und Isin die Konstruktionen von Alterität – krank/gesund, self/other, citizen/non-citizen – die die Diskussion prägen, in den Vordergrund der Analyse. In den beiden folgenden Kapitel (4 und 5) werden die beiden Stücke mit Blick auf die jeweilige Aushandlung von sexual citizenship diskutiert; für Kramers Stück wird dabei das Thema schwule Identität, eine auf Aktivismus hin ausgerichtete Agenda und das Plädoyer für gesellschaftliche Anerkennung hervorgestellt, während bei der Analyse von Kuschners Text dessen Inszenierung von 'Geschichte' und ideologischer Kritik im Vordergrund steht. Den Abschluss bildet ein Vergleich der beiden Stücke in Hinsicht auf ihre jeweilige Agenda und deren Umsetzung. The Normal Heart, verfolgt insgesamt eine eher assimilatorische Sto߬richtung, die versucht, Homosexualität zu 'norm(alis)ieren', während Angels, radikaler, die Konstruktionen von sexuellen Normen hinterfragt und ein Recht auf Differenz proklamiert (z.B. S. 69).
The present work comprises different projects within the scope of public health. In detail, they all aim at combating the high-burden diseases HIV/AIDS, malaria and tuberculosis more effectively. Since there was, and still is, no harmonization between the existing biowaiver guidelines, the biowaiver dissolution test conditions by WHO and FDA were compared against each other using drug products, which had already demonstrated BE to the comparator in vivo. Thereby it could be shown that the dissolution conditions proposed by the WHO are more appropriate for granting biowaivers than those of the FDA. Further, the applicability of the WHO dissolution test conditions was investigated using the APIs ethambutol, isoniazid and pyrazinamide (all BCS Class III) as model compounds. These investigations demonstrated that the concept of the biowaiver proved to work properly, i.e. leading to no false positive BE decision and an acceptable incidence of false negative BE decisions. In addition, four new biowaiver monographs were published addressing important APIs in the treatment of HIV/AIDS and malaria. Before these efforts, there were only a very few biowaiver monographs available for antiviral or antimalarial APIs, i.e. the database of biowaiver monographs has been clearly improved. The last part of the present work dealt with the extension of the biowaiver concept to related areas such as the WHO Prequalification of Medicines Programme. Investigations revealed that the biowaiver tools are generally eligible for prequalification of drug products containing ethambutol, isoniazid, pyrazinamide, or lamivudine to prove BE between an appropriate comparator and the test candidate. By contrast, some APIs are excluded from the biowaiver procedure. In conclusion, the implementation of the biowaiver tools for prequalification of biowaivable APIs is, along with BCS-based biowaiver approval of new generics, an important step towards making essential, high-quality drug products more cost-effective and, as a consequence, more accessible for a larger percentage of the population. In that way, the treatment conditions for those in need living in the developing countries can be improved enormously, so that those who are poor do not have to receive poor treatment. The quality standard of essential medicines will increase worldwide, thereby helping to combat the high-burden diseases better and, in turn, lead to an improvement of the global health status.
Mananna owiirattavelela SIDA
(2010)
SIDA : ungaichenkhe tani
(2010)