Search

Introduction: Although dolutegravir (DTG) is deemed stable, safe, cost‐effective, and clinically beneficial, it also carries the risk of side effects, including observed weight gain among patients on DTG‐based antiretroviral therapy (ART) regimens. We compared weight changes among adults (≥18 years) initiating tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, and efavirenz (TEE) regimens and those switching from TEE to TLD (TEE‐to‐TLD switchers) in three large primary care facilities in South Africa Methods: We conducted a retrospective longitudinal record review using patient medical records, extracting relevant demographic and clinical data from October 2018 to June 2021 from randomly selected adults who initiated TLD or TEE (initiators) and adult TEE‐to‐TLD switchers. We assessed weight, body mass index (BMI), and percentage weight changes for both groups and fitted linear regression and generalized linear models to determine factors associated with weight and BMI change and percentage weight change ≥10%, respectively, among treatment initiators. We fitted linear mixed‐effect models among TEE‐to‐TLD switchers to consider repeated measures. Results: Of 860 initiators, 450 (52.3%) initiated on TEE and 410 (47.7%) on TLD, with median follow‐up of 1.4 years and 1.0 year, respectively. At initiation, 43.3% on TEE and 40.8% on TLD were overweight or obese. TLD initiators had an adjusted higher mean weight gain of 1.6 kg (p < 0.001) and mean BMI gain of 0.51 kg/m2 (p < 0.001) than TEE initiators. Independent risk factors for higher mean weight and BMI included age ≥50 years, male, on ART for >12 months, initial BMI of <18.5 kg/m2, and CD4 counts <200 cells/μL. Of 298 TEE‐to‐TLD switchers, 36.6% were overweight or obese at TEE initiation. Comparing before and after TLD switch, TEE‐to‐TLD switchers had an adjusted mean weight of 1.2 kg less while on TLD (p = 0.026). Being overweight and CD4 counts >350 cells/μL were independent risk factors for lower weight gain after TLD switch. Conclusions: We report more weight gain among TLD than among TEE initiators, although to a lesser extent than previously reported. TEE‐to‐TLD switchers experienced less weight gain after TLD switch; return to health before receiving TLD may be a contributory factor. The current findings are reassuring for those switching to a DTG‐based regimen [ABSTRACT FROM AUTHOR]

Objective: While the international donor community has spent millions on human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) prevention through educational programmes, the quality of information in educational curricula is rarely analyzed. This study analyzes the content of prevention programmes, focusing on informational accuracy. Design: Curricula for this study were collected using a snowball sampling technique in which we first contacted bi-lateral donors, the country's national AIDS coordinating agency, and the Ministry of Education to find out which organizations and agencies were actively working in the country and implementing HIV curricular interventions. Our final data set included 24 curricula: seven school-based, 15 adult-based, and two multi-purpose curricula (manuals or modules used in conjunction with other curricula or independently). Using Senderowitz and Kirby's (2006)1 standards for curricula content as a guide, each curriculum was coded independently by two reviewers, who noted specific lines, sections, or images of the curriculum which were problematic. Setting: Ghana. Method: Documentary analysis of 24 curricula that are designed to teach youth and adults about HIV/AIDS. Results: We find one or more problems in each curriculum, including: (1) factual errors and omitted information; (2) oversimplified facts; (3) promotion of fear-based abstinence; (4) confusing condom information; (5) a presentation of infection as women's problem; and (6) misrepresentation of individual risk. Conclusion: Even with increased financial resources being directed at HIV prevention and treatment, the quality of information found in school-based and adult prevention curricula remains poor. This analysis calls into question the effect of these interventions in "socially vaccinating" against new infections. (Contains 2 tables, 3 figures, and 1 note.)

Background: Papillary renal-cell carcinoma, which accounts for 15 to 20% of renal-cell carcinomas, is a heterogeneous disease that consists of various types of renal cancer, including tumors with indolent, multifocal presentation and solitary tumors with an aggressive, highly lethal phenotype. Little is known about the genetic basis of sporadic papillary renal-cell carcinoma, and no effective forms of therapy for advanced disease exist., Methods: We performed comprehensive molecular characterization of 161 primary papillary renal-cell carcinomas, using whole-exome sequencing, copy-number analysis, messenger RNA and microRNA sequencing, DNA-methylation analysis, and proteomic analysis., Results: Type 1 and type 2 papillary renal-cell carcinomas were shown to be different types of renal cancer characterized by specific genetic alterations, with type 2 further classified into three individual subgroups on the basis of molecular differences associated with patient survival. Type 1 tumors were associated with MET alterations, whereas type 2 tumors were characterized by CDKN2A silencing, SETD2 mutations, TFE3 fusions, and increased expression of the NRF2-antioxidant response element (ARE) pathway. A CpG island methylator phenotype (CIMP) was observed in a distinct subgroup of type 2 papillary renal-cell carcinomas that was characterized by poor survival and mutation of the gene encoding fumarate hydratase (FH)., Conclusions: Type 1 and type 2 papillary renal-cell carcinomas were shown to be clinically and biologically distinct. Alterations in the MET pathway were associated with type 1, and activation of the NRF2-ARE pathway was associated with type 2; CDKN2A loss and CIMP in type 2 conveyed a poor prognosis. Furthermore, type 2 papillary renal-cell carcinoma consisted of at least three subtypes based on molecular and phenotypic features. (Funded by the National Institutes of Health.).