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Itchy scalp
Based on the patient’s history, the FP suspected that this was a case of either head lice or seborrhea. He put on gloves to examine the hair and found nits (eggs) glued to the hair. There was an especially high density of them behind her ears (which is always a good place to begin the exam for head lice). The nits were pearly as expected, but no live adult head lice were found.
The FP was aware that nits are far more numerous than adult head lice. The scalp itself was unremarkable and there was no seborrhea. While it is possible to look at nits under a microscope to see if there are live larvae inside, the history of 2 weeks of symptoms without treatment was sufficient to assume that this was an active case of head lice, rather than dead or hatched nits from a previous case.
The mother confirmed that the child hadn’t been treated for head lice in the past and claimed that she washed her daughter's hair every night. The FP explained that any child in school or around other children can easily get head lice—regardless of their personal hygiene habits. The FP asked if it was okay to check the mother’s hair, and found a few nits behind her ears, as well.
There are many treatment options for head lice, including 2 nonprescription products that cost less than $15 each: 1% permethrin cream rinse (Nix) and pyrethrins with piperonyl butoxide (RID) shampoo. There are also more expensive prescription products, including malathion 0.5%, benzyl alcohol 5% lotion, spinosad, and ivermectin 0.5% lotion. A 2001 Cochrane review found no evidence that any one pediculicide was better than another.1 However, the review only included studies of permethrin, synergized pyrethrin, and malathion.
In this case, the mother chose to buy the over-the-counter 1% permethrin cream rinse for herself and her daughter. While the FP was not able to examine the patient’s father or older brother, he did suggest that they all do the treatment simultaneously to avoid one family member remaining infested (and then reinfesting the rest of the family).
1. Dodd CS. Interventions for treating headlice. Cochrane Database Syst Rev. 2001;CD001165.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ, Usatine R. Lice. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 570-574.
To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/
You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com
Based on the patient’s history, the FP suspected that this was a case of either head lice or seborrhea. He put on gloves to examine the hair and found nits (eggs) glued to the hair. There was an especially high density of them behind her ears (which is always a good place to begin the exam for head lice). The nits were pearly as expected, but no live adult head lice were found.
The FP was aware that nits are far more numerous than adult head lice. The scalp itself was unremarkable and there was no seborrhea. While it is possible to look at nits under a microscope to see if there are live larvae inside, the history of 2 weeks of symptoms without treatment was sufficient to assume that this was an active case of head lice, rather than dead or hatched nits from a previous case.
The mother confirmed that the child hadn’t been treated for head lice in the past and claimed that she washed her daughter's hair every night. The FP explained that any child in school or around other children can easily get head lice—regardless of their personal hygiene habits. The FP asked if it was okay to check the mother’s hair, and found a few nits behind her ears, as well.
There are many treatment options for head lice, including 2 nonprescription products that cost less than $15 each: 1% permethrin cream rinse (Nix) and pyrethrins with piperonyl butoxide (RID) shampoo. There are also more expensive prescription products, including malathion 0.5%, benzyl alcohol 5% lotion, spinosad, and ivermectin 0.5% lotion. A 2001 Cochrane review found no evidence that any one pediculicide was better than another.1 However, the review only included studies of permethrin, synergized pyrethrin, and malathion.
In this case, the mother chose to buy the over-the-counter 1% permethrin cream rinse for herself and her daughter. While the FP was not able to examine the patient’s father or older brother, he did suggest that they all do the treatment simultaneously to avoid one family member remaining infested (and then reinfesting the rest of the family).
1. Dodd CS. Interventions for treating headlice. Cochrane Database Syst Rev. 2001;CD001165.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ, Usatine R. Lice. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 570-574.
To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/
You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com
Based on the patient’s history, the FP suspected that this was a case of either head lice or seborrhea. He put on gloves to examine the hair and found nits (eggs) glued to the hair. There was an especially high density of them behind her ears (which is always a good place to begin the exam for head lice). The nits were pearly as expected, but no live adult head lice were found.
The FP was aware that nits are far more numerous than adult head lice. The scalp itself was unremarkable and there was no seborrhea. While it is possible to look at nits under a microscope to see if there are live larvae inside, the history of 2 weeks of symptoms without treatment was sufficient to assume that this was an active case of head lice, rather than dead or hatched nits from a previous case.
The mother confirmed that the child hadn’t been treated for head lice in the past and claimed that she washed her daughter's hair every night. The FP explained that any child in school or around other children can easily get head lice—regardless of their personal hygiene habits. The FP asked if it was okay to check the mother’s hair, and found a few nits behind her ears, as well.
There are many treatment options for head lice, including 2 nonprescription products that cost less than $15 each: 1% permethrin cream rinse (Nix) and pyrethrins with piperonyl butoxide (RID) shampoo. There are also more expensive prescription products, including malathion 0.5%, benzyl alcohol 5% lotion, spinosad, and ivermectin 0.5% lotion. A 2001 Cochrane review found no evidence that any one pediculicide was better than another.1 However, the review only included studies of permethrin, synergized pyrethrin, and malathion.
In this case, the mother chose to buy the over-the-counter 1% permethrin cream rinse for herself and her daughter. While the FP was not able to examine the patient’s father or older brother, he did suggest that they all do the treatment simultaneously to avoid one family member remaining infested (and then reinfesting the rest of the family).
1. Dodd CS. Interventions for treating headlice. Cochrane Database Syst Rev. 2001;CD001165.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ, Usatine R. Lice. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 570-574.
To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/
You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com
Non–vitamin K antagonist oral anticoagulants for planned atrial fibrillation cardioversions
Clinical question: How does edoxaban compare with enoxaparin-warfarin in patients with nonvalvular atrial fibrillation undergoing cardioversion?
Background: Studies on non–vitamin K antagonist oral anticoagulants (NOACs) for patients with nonvalvular atrial fibrillation undergoing cardioversion are limited.
Study design: Multicenter, prospective, randomized trial.
Setting: Nineteen countries at 239 study sites.
Synopsis: This trial compared edoxaban with enoxaparin-warfarin. The study was stratified by cardioversion approach, anticoagulant experience, selected edoxaban dose, and region. There were 2,199 patients, mean age was 64, mean CHA2DS2-VASc score was 2.6, and mean therapeutic time on warfarin was 70.8%.
The primary efficacy endpoint was a composite of stroke, systemic emboli, myocardial infarction, and cardiovascular mortality, which occurred in 5 (1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin-warfarin group (odds ratio, 0.46; 95% CI, 0.12-1.43).
The primary safety endpoint was major and clinically relevant nonmajor bleeding for patients receiving at least one dose of the study drug, occurring in 16 (1%) of 1,067 patients given edoxaban versus 11 (1%) of 1,082 patients given enoxaparin-warfarin (OR, 1.48; 95% CI, 0.64-3.55).
Bottom line: In patients with nonvalvular atrial fibrillation undergoing cardioversion, edoxaban had low rates of major bleeding and thromboembolism similar to enoxaparin-warfarin therapy.
Citation: Goette A, Merino JL, Ezekowitz MD, et al. Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. Lancet. 2016;388(10055):1995-2003.
Dr. Fernandez de la Vara is an instructor at the University of Miami Miller School of Medicine and chief medical resident at the University of Miami Hospital.
Clinical question: How does edoxaban compare with enoxaparin-warfarin in patients with nonvalvular atrial fibrillation undergoing cardioversion?
Background: Studies on non–vitamin K antagonist oral anticoagulants (NOACs) for patients with nonvalvular atrial fibrillation undergoing cardioversion are limited.
Study design: Multicenter, prospective, randomized trial.
Setting: Nineteen countries at 239 study sites.
Synopsis: This trial compared edoxaban with enoxaparin-warfarin. The study was stratified by cardioversion approach, anticoagulant experience, selected edoxaban dose, and region. There were 2,199 patients, mean age was 64, mean CHA2DS2-VASc score was 2.6, and mean therapeutic time on warfarin was 70.8%.
The primary efficacy endpoint was a composite of stroke, systemic emboli, myocardial infarction, and cardiovascular mortality, which occurred in 5 (1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin-warfarin group (odds ratio, 0.46; 95% CI, 0.12-1.43).
The primary safety endpoint was major and clinically relevant nonmajor bleeding for patients receiving at least one dose of the study drug, occurring in 16 (1%) of 1,067 patients given edoxaban versus 11 (1%) of 1,082 patients given enoxaparin-warfarin (OR, 1.48; 95% CI, 0.64-3.55).
Bottom line: In patients with nonvalvular atrial fibrillation undergoing cardioversion, edoxaban had low rates of major bleeding and thromboembolism similar to enoxaparin-warfarin therapy.
Citation: Goette A, Merino JL, Ezekowitz MD, et al. Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. Lancet. 2016;388(10055):1995-2003.
Dr. Fernandez de la Vara is an instructor at the University of Miami Miller School of Medicine and chief medical resident at the University of Miami Hospital.
Clinical question: How does edoxaban compare with enoxaparin-warfarin in patients with nonvalvular atrial fibrillation undergoing cardioversion?
Background: Studies on non–vitamin K antagonist oral anticoagulants (NOACs) for patients with nonvalvular atrial fibrillation undergoing cardioversion are limited.
Study design: Multicenter, prospective, randomized trial.
Setting: Nineteen countries at 239 study sites.
Synopsis: This trial compared edoxaban with enoxaparin-warfarin. The study was stratified by cardioversion approach, anticoagulant experience, selected edoxaban dose, and region. There were 2,199 patients, mean age was 64, mean CHA2DS2-VASc score was 2.6, and mean therapeutic time on warfarin was 70.8%.
The primary efficacy endpoint was a composite of stroke, systemic emboli, myocardial infarction, and cardiovascular mortality, which occurred in 5 (1%) patients in the edoxaban group versus 11 (1%) in the enoxaparin-warfarin group (odds ratio, 0.46; 95% CI, 0.12-1.43).
The primary safety endpoint was major and clinically relevant nonmajor bleeding for patients receiving at least one dose of the study drug, occurring in 16 (1%) of 1,067 patients given edoxaban versus 11 (1%) of 1,082 patients given enoxaparin-warfarin (OR, 1.48; 95% CI, 0.64-3.55).
Bottom line: In patients with nonvalvular atrial fibrillation undergoing cardioversion, edoxaban had low rates of major bleeding and thromboembolism similar to enoxaparin-warfarin therapy.
Citation: Goette A, Merino JL, Ezekowitz MD, et al. Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. Lancet. 2016;388(10055):1995-2003.
Dr. Fernandez de la Vara is an instructor at the University of Miami Miller School of Medicine and chief medical resident at the University of Miami Hospital.
Older adults can sustain asymptomatic cervical fractures
HOLLYWOOD, FLA. –
The 4-year review found that 21% of older patients with a confirmed C-spine fracture reported no pain on history or physical exam, and that 76% of these fractures needed treatment – twin findings suggesting that asymptomatic neck fractures may be undiagnosed and untreated in this population.
The 183-patient study also found no significant pain differences between age groups: The silent injuries were just as common among 55-year-olds as among 65-year-olds, Christopher Healey, MD, said at the annual scientific assembly of the Eastern Association for the Surgery of Trauma.
“I guess we can say, ‘55 is the new 65,’ when it comes to this injury,” said Dr. Healey of the Iowa Methodist Medical Center, Des Moines. “In our study the rate of a pain-free neck fracture in 55-year-olds was equivalent to that in their older counterpoints, so they also represent a group at increased risk.”
Dr. Healey and his colleagues conducted a 4-year review of trauma patients aged 55 years and older who were treated for a C-spine fracture. All of the patients had a Glasgow Coma 
There were no differences in the mechanism of injury between the pain-free and pain-positive groups. The most common source of injury was a fall from the person’s own height (39% vs. 49%), followed by a high fall (21% vs. 19%). Motor vehicle crashes came in third (37% vs. 30%), with other methods of injury accounting for about 3% of each group.
The level of fracture was widely dispersed among both groups and not associated with pain. Asymptomatic fractures occurred at C1 and C2 vertabrae (about 13%); C3 (26%); C4 (10%); C5 (12%); and C6 and C7 (30%).
Perhaps surprisingly, patients who didn’t report pain had significantly higher Injury Severity Scores (15 vs. 10). They were also significantly more likely to have injuries to other body regions (71% vs. 47%), including the head (22% vs. 16%), thorax/abdomen (39% vs. 20%), and extremities (33% vs. 20%).
A third of those with a pain-free fracture had breaks at multiple levels. Their hospital stays were significantly longer than were those of patients with painful fractures (7 vs. 5 days).
These findings of more severe injuries in the asymptomatic group led Dr. Healey to suggest that distracting pain might be playing a part in the phenomenon.
When the group was split into 10-year age increments, asymptomatic fractures occurred in about 20% of each group from 55-64 years up to 85 years and older.
The majority of both groups required treatment (91% with pain; 76% asymptomatic), Dr. Healey said. The most common treatment in each group was a cervical collar (61% with pain vs. 46% asymptomatic ). A cervical-thoracic-lumbar-sacral orthosis brace was used in 8% of those with pain and 11% of the asymptomatic patients.
Invasive procedures were performed in just as many of the asymptomatic patients as in those who had pain. These included vertebral fusion (11% asymptomatic vs. 9% with pain) and cervical halo (8% vs. 13%).
The lesson here, Dr. Healey concluded, is that pain is not always a reliable indicator of neck injury in older patients. “Older adults can break their neck and have no pain at all. This is concerning, because the presence or absence of neck pain is a major component in many clearance protocols for C-spine trauma. This begs the question whether we should be treating our older patients by general adult guidelines. I would advocate the development of trauma guidelines that are specific for the older or geriatric patient.”
Dr. Healey had no financial disclosures.
HOLLYWOOD, FLA. –
The 4-year review found that 21% of older patients with a confirmed C-spine fracture reported no pain on history or physical exam, and that 76% of these fractures needed treatment – twin findings suggesting that asymptomatic neck fractures may be undiagnosed and untreated in this population.
The 183-patient study also found no significant pain differences between age groups: The silent injuries were just as common among 55-year-olds as among 65-year-olds, Christopher Healey, MD, said at the annual scientific assembly of the Eastern Association for the Surgery of Trauma.
“I guess we can say, ‘55 is the new 65,’ when it comes to this injury,” said Dr. Healey of the Iowa Methodist Medical Center, Des Moines. “In our study the rate of a pain-free neck fracture in 55-year-olds was equivalent to that in their older counterpoints, so they also represent a group at increased risk.”
Dr. Healey and his colleagues conducted a 4-year review of trauma patients aged 55 years and older who were treated for a C-spine fracture. All of the patients had a Glasgow Coma
There were no differences in the mechanism of injury between the pain-free and pain-positive groups. The most common source of injury was a fall from the person’s own height (39% vs. 49%), followed by a high fall (21% vs. 19%). Motor vehicle crashes came in third (37% vs. 30%), with other methods of injury accounting for about 3% of each group.
The level of fracture was widely dispersed among both groups and not associated with pain. Asymptomatic fractures occurred at C1 and C2 vertabrae (about 13%); C3 (26%); C4 (10%); C5 (12%); and C6 and C7 (30%).
Perhaps surprisingly, patients who didn’t report pain had significantly higher Injury Severity Scores (15 vs. 10). They were also significantly more likely to have injuries to other body regions (71% vs. 47%), including the head (22% vs. 16%), thorax/abdomen (39% vs. 20%), and extremities (33% vs. 20%).
A third of those with a pain-free fracture had breaks at multiple levels. Their hospital stays were significantly longer than were those of patients with painful fractures (7 vs. 5 days).
These findings of more severe injuries in the asymptomatic group led Dr. Healey to suggest that distracting pain might be playing a part in the phenomenon.
When the group was split into 10-year age increments, asymptomatic fractures occurred in about 20% of each group from 55-64 years up to 85 years and older.
The majority of both groups required treatment (91% with pain; 76% asymptomatic), Dr. Healey said. The most common treatment in each group was a cervical collar (61% with pain vs. 46% asymptomatic ). A cervical-thoracic-lumbar-sacral orthosis brace was used in 8% of those with pain and 11% of the asymptomatic patients.
Invasive procedures were performed in just as many of the asymptomatic patients as in those who had pain. These included vertebral fusion (11% asymptomatic vs. 9% with pain) and cervical halo (8% vs. 13%).
The lesson here, Dr. Healey concluded, is that pain is not always a reliable indicator of neck injury in older patients. “Older adults can break their neck and have no pain at all. This is concerning, because the presence or absence of neck pain is a major component in many clearance protocols for C-spine trauma. This begs the question whether we should be treating our older patients by general adult guidelines. I would advocate the development of trauma guidelines that are specific for the older or geriatric patient.”
Dr. Healey had no financial disclosures.
HOLLYWOOD, FLA. –
The 4-year review found that 21% of older patients with a confirmed C-spine fracture reported no pain on history or physical exam, and that 76% of these fractures needed treatment – twin findings suggesting that asymptomatic neck fractures may be undiagnosed and untreated in this population.
The 183-patient study also found no significant pain differences between age groups: The silent injuries were just as common among 55-year-olds as among 65-year-olds, Christopher Healey, MD, said at the annual scientific assembly of the Eastern Association for the Surgery of Trauma.
“I guess we can say, ‘55 is the new 65,’ when it comes to this injury,” said Dr. Healey of the Iowa Methodist Medical Center, Des Moines. “In our study the rate of a pain-free neck fracture in 55-year-olds was equivalent to that in their older counterpoints, so they also represent a group at increased risk.”
Dr. Healey and his colleagues conducted a 4-year review of trauma patients aged 55 years and older who were treated for a C-spine fracture. All of the patients had a Glasgow Coma
There were no differences in the mechanism of injury between the pain-free and pain-positive groups. The most common source of injury was a fall from the person’s own height (39% vs. 49%), followed by a high fall (21% vs. 19%). Motor vehicle crashes came in third (37% vs. 30%), with other methods of injury accounting for about 3% of each group.
The level of fracture was widely dispersed among both groups and not associated with pain. Asymptomatic fractures occurred at C1 and C2 vertabrae (about 13%); C3 (26%); C4 (10%); C5 (12%); and C6 and C7 (30%).
Perhaps surprisingly, patients who didn’t report pain had significantly higher Injury Severity Scores (15 vs. 10). They were also significantly more likely to have injuries to other body regions (71% vs. 47%), including the head (22% vs. 16%), thorax/abdomen (39% vs. 20%), and extremities (33% vs. 20%).
A third of those with a pain-free fracture had breaks at multiple levels. Their hospital stays were significantly longer than were those of patients with painful fractures (7 vs. 5 days).
These findings of more severe injuries in the asymptomatic group led Dr. Healey to suggest that distracting pain might be playing a part in the phenomenon.
When the group was split into 10-year age increments, asymptomatic fractures occurred in about 20% of each group from 55-64 years up to 85 years and older.
The majority of both groups required treatment (91% with pain; 76% asymptomatic), Dr. Healey said. The most common treatment in each group was a cervical collar (61% with pain vs. 46% asymptomatic ). A cervical-thoracic-lumbar-sacral orthosis brace was used in 8% of those with pain and 11% of the asymptomatic patients.
Invasive procedures were performed in just as many of the asymptomatic patients as in those who had pain. These included vertebral fusion (11% asymptomatic vs. 9% with pain) and cervical halo (8% vs. 13%).
The lesson here, Dr. Healey concluded, is that pain is not always a reliable indicator of neck injury in older patients. “Older adults can break their neck and have no pain at all. This is concerning, because the presence or absence of neck pain is a major component in many clearance protocols for C-spine trauma. This begs the question whether we should be treating our older patients by general adult guidelines. I would advocate the development of trauma guidelines that are specific for the older or geriatric patient.”
Dr. Healey had no financial disclosures.
Key clinical point: Older trauma patients can present with pain-free cervical fractures. Major finding: Cervical fractures were asymptomatic in 21% of the study group; of these, 76% required treatment.
Data source: The 4-year retrospective study comprised 183 older patients with confirmed cervical fractures.
Disclosures: Dr. Healey had no financial disclosures.
Cutaneous eruption reported in pregnant woman with locally acquired Zika virus
Zika presented in a young, pregnant Florida woman as erythematous follicular macules and papules on the trunk and arms, scattered tender pink papules on the palms, and a few petechiae on the hard palate, according to a Jan. 11 report in the New England Journal of Medicine.
The report advises how Zika virus may present during pregnancy. “Medical providers on the front line should be aware of the constellation of symptoms in patients reporting travel to endemic areas, including areas in Southern Florida, where other non–travel-associated cases have been confirmed,” wrote investigators led by Lucy Chen, MD, of the University of Miami (N Engl J Med. 2017 Jan 11. doi: 10.1056/NEJMc1610614).
Zika virus RNA was detected in the woman’s urine and serum specimens with the use of reverse-transcriptase polymerase chain reaction and persisted for 2 weeks in urine samples and for 6 weeks in serum samples. On histopathology, skin lesions revealed a mild perivascular lymphocytic infiltration in the upper dermis, admixed with some neutrophils. Liver and renal functions were normal.
Fetal ultrasonography performed on the day of presentation showed an estimated fetal weight of 644 g (53rd percentile), an estimated head circumference of 221 mm (63rd percentile), and normal intracranial anatomy. Fevers and rash subsided after 3 days of supportive care. Screening for measles, varicella, rubella, syphilis, Epstein-Barr virus, influenza, hepatitis B, hepatitis C, mumps, and dengue was unrevealing.
An initial IgM test on July 7 was negative; seroconversion occurred 1 week after presentation and remained positive through delivery.
A full-term infant weighing 2,990 g was delivered vaginally. Neonatal ultrasonography and magnetic resonance imaging of the head showed a normal head size and intracranial anatomy, with no calcifications. Placental tissue was negative for Zika virus, and neonatal laboratory testing revealed no evidence of infection.
The case was confirmed by the Miami-Dade County Department of Health as the first non–travel-associated Zika infection in the United States.
The investigators reported having no relevant financial disclosures.
Zika presented in a young, pregnant Florida woman as erythematous follicular macules and papules on the trunk and arms, scattered tender pink papules on the palms, and a few petechiae on the hard palate, according to a Jan. 11 report in the New England Journal of Medicine.
The report advises how Zika virus may present during pregnancy. “Medical providers on the front line should be aware of the constellation of symptoms in patients reporting travel to endemic areas, including areas in Southern Florida, where other non–travel-associated cases have been confirmed,” wrote investigators led by Lucy Chen, MD, of the University of Miami (N Engl J Med. 2017 Jan 11. doi: 10.1056/NEJMc1610614).
Zika virus RNA was detected in the woman’s urine and serum specimens with the use of reverse-transcriptase polymerase chain reaction and persisted for 2 weeks in urine samples and for 6 weeks in serum samples. On histopathology, skin lesions revealed a mild perivascular lymphocytic infiltration in the upper dermis, admixed with some neutrophils. Liver and renal functions were normal.
Fetal ultrasonography performed on the day of presentation showed an estimated fetal weight of 644 g (53rd percentile), an estimated head circumference of 221 mm (63rd percentile), and normal intracranial anatomy. Fevers and rash subsided after 3 days of supportive care. Screening for measles, varicella, rubella, syphilis, Epstein-Barr virus, influenza, hepatitis B, hepatitis C, mumps, and dengue was unrevealing.
An initial IgM test on July 7 was negative; seroconversion occurred 1 week after presentation and remained positive through delivery.
A full-term infant weighing 2,990 g was delivered vaginally. Neonatal ultrasonography and magnetic resonance imaging of the head showed a normal head size and intracranial anatomy, with no calcifications. Placental tissue was negative for Zika virus, and neonatal laboratory testing revealed no evidence of infection.
The case was confirmed by the Miami-Dade County Department of Health as the first non–travel-associated Zika infection in the United States.
The investigators reported having no relevant financial disclosures.
Zika presented in a young, pregnant Florida woman as erythematous follicular macules and papules on the trunk and arms, scattered tender pink papules on the palms, and a few petechiae on the hard palate, according to a Jan. 11 report in the New England Journal of Medicine.
The report advises how Zika virus may present during pregnancy. “Medical providers on the front line should be aware of the constellation of symptoms in patients reporting travel to endemic areas, including areas in Southern Florida, where other non–travel-associated cases have been confirmed,” wrote investigators led by Lucy Chen, MD, of the University of Miami (N Engl J Med. 2017 Jan 11. doi: 10.1056/NEJMc1610614).
Zika virus RNA was detected in the woman’s urine and serum specimens with the use of reverse-transcriptase polymerase chain reaction and persisted for 2 weeks in urine samples and for 6 weeks in serum samples. On histopathology, skin lesions revealed a mild perivascular lymphocytic infiltration in the upper dermis, admixed with some neutrophils. Liver and renal functions were normal.
Fetal ultrasonography performed on the day of presentation showed an estimated fetal weight of 644 g (53rd percentile), an estimated head circumference of 221 mm (63rd percentile), and normal intracranial anatomy. Fevers and rash subsided after 3 days of supportive care. Screening for measles, varicella, rubella, syphilis, Epstein-Barr virus, influenza, hepatitis B, hepatitis C, mumps, and dengue was unrevealing.
An initial IgM test on July 7 was negative; seroconversion occurred 1 week after presentation and remained positive through delivery.
A full-term infant weighing 2,990 g was delivered vaginally. Neonatal ultrasonography and magnetic resonance imaging of the head showed a normal head size and intracranial anatomy, with no calcifications. Placental tissue was negative for Zika virus, and neonatal laboratory testing revealed no evidence of infection.
The case was confirmed by the Miami-Dade County Department of Health as the first non–travel-associated Zika infection in the United States.
The investigators reported having no relevant financial disclosures.
Antiplatelet agents reduce preterm birth risk in some groups
The use of antiplatelet agents in pregnant women at risk for preeclampsia reduces the risk of spontaneous preterm birth by about 7%, while moderate to very preterm birth at less than 34 weeks of gestation is reduced by 14%.
Those are key findings from a meta-analysis of data from 17 trials that evaluated the effect of antiplatelet agents to reduce preeclampsia.
In an effort to evaluate the efficacy of low-dose aspirin for the prevention of spontaneous preterm birth in women at risk for preeclampsia and to explore the effect in prespecified subgroups, the researchers assessed results from the Perinatal Antiplatelet Review of International Studies Individual Participant Data meta-analysis, which comprised 31 studies that randomized women to low-dose aspirin/dipyridamole or placebo/no treatment as a primary preventive strategy for preeclampsia.
For the current study, researchers from the Netherlands and Australia analyzed data from 17 of the 31 trials that supplied data on type of delivery (spontaneous, compared with indicated birth), which included a total of 28,797 women. The study’s primary endpoints were spontaneous preterm birth at less than 37 weeks, less than 34 weeks, and less than 28 weeks of gestation (Obstet Gynecol. 2017;129:327-36).
Compared with women who received placebo/no treatment, women assigned to antiplatelet treatment had a lower risk of spontaneous preterm birth at less than 37 weeks’ gestation (relative risk, 0.93) and at less than 34 weeks of gestation (RR, 0.86). The relative risk of having a spontaneous preterm birth at less than 37 weeks was even lower for those who had a previous pregnancy (RR, 0.83).
The number needed to treat to prevent 1 case of spontaneous preterm birth at less than 37 weeks’ gestation was 139. The number needed to treat was 242 for spontaneous preterm birth at less than 34 weeks’ gestation.
The researchers noted certain limitations of the analysis, including the potential for the possibility of inconsistency in the definition of spontaneous preterm birth between studies. “Because antiplatelet agents in pregnancy are a low-cost and safe intervention, we suggest that antiplatelet agents may also be a promising intervention for women at high risk for a spontaneous preterm birth, especially in high-risk women with a previous pregnancy,” they wrote. “The current study provides clinicians with the best available evidence to counsel women regarding who might benefit from this intervention.”
The researchers reported having no potential conflicts of interest. Dr. van Vliet was supported by a travel grant of the Dutch Ter Meulen Fund of the Royal Netherlands Academy of Arts and Sciences.
The use of antiplatelet agents in pregnant women at risk for preeclampsia reduces the risk of spontaneous preterm birth by about 7%, while moderate to very preterm birth at less than 34 weeks of gestation is reduced by 14%.
Those are key findings from a meta-analysis of data from 17 trials that evaluated the effect of antiplatelet agents to reduce preeclampsia.
In an effort to evaluate the efficacy of low-dose aspirin for the prevention of spontaneous preterm birth in women at risk for preeclampsia and to explore the effect in prespecified subgroups, the researchers assessed results from the Perinatal Antiplatelet Review of International Studies Individual Participant Data meta-analysis, which comprised 31 studies that randomized women to low-dose aspirin/dipyridamole or placebo/no treatment as a primary preventive strategy for preeclampsia.
For the current study, researchers from the Netherlands and Australia analyzed data from 17 of the 31 trials that supplied data on type of delivery (spontaneous, compared with indicated birth), which included a total of 28,797 women. The study’s primary endpoints were spontaneous preterm birth at less than 37 weeks, less than 34 weeks, and less than 28 weeks of gestation (Obstet Gynecol. 2017;129:327-36).
Compared with women who received placebo/no treatment, women assigned to antiplatelet treatment had a lower risk of spontaneous preterm birth at less than 37 weeks’ gestation (relative risk, 0.93) and at less than 34 weeks of gestation (RR, 0.86). The relative risk of having a spontaneous preterm birth at less than 37 weeks was even lower for those who had a previous pregnancy (RR, 0.83).
The number needed to treat to prevent 1 case of spontaneous preterm birth at less than 37 weeks’ gestation was 139. The number needed to treat was 242 for spontaneous preterm birth at less than 34 weeks’ gestation.
The researchers noted certain limitations of the analysis, including the potential for the possibility of inconsistency in the definition of spontaneous preterm birth between studies. “Because antiplatelet agents in pregnancy are a low-cost and safe intervention, we suggest that antiplatelet agents may also be a promising intervention for women at high risk for a spontaneous preterm birth, especially in high-risk women with a previous pregnancy,” they wrote. “The current study provides clinicians with the best available evidence to counsel women regarding who might benefit from this intervention.”
The researchers reported having no potential conflicts of interest. Dr. van Vliet was supported by a travel grant of the Dutch Ter Meulen Fund of the Royal Netherlands Academy of Arts and Sciences.
The use of antiplatelet agents in pregnant women at risk for preeclampsia reduces the risk of spontaneous preterm birth by about 7%, while moderate to very preterm birth at less than 34 weeks of gestation is reduced by 14%.
Those are key findings from a meta-analysis of data from 17 trials that evaluated the effect of antiplatelet agents to reduce preeclampsia.
In an effort to evaluate the efficacy of low-dose aspirin for the prevention of spontaneous preterm birth in women at risk for preeclampsia and to explore the effect in prespecified subgroups, the researchers assessed results from the Perinatal Antiplatelet Review of International Studies Individual Participant Data meta-analysis, which comprised 31 studies that randomized women to low-dose aspirin/dipyridamole or placebo/no treatment as a primary preventive strategy for preeclampsia.
For the current study, researchers from the Netherlands and Australia analyzed data from 17 of the 31 trials that supplied data on type of delivery (spontaneous, compared with indicated birth), which included a total of 28,797 women. The study’s primary endpoints were spontaneous preterm birth at less than 37 weeks, less than 34 weeks, and less than 28 weeks of gestation (Obstet Gynecol. 2017;129:327-36).
Compared with women who received placebo/no treatment, women assigned to antiplatelet treatment had a lower risk of spontaneous preterm birth at less than 37 weeks’ gestation (relative risk, 0.93) and at less than 34 weeks of gestation (RR, 0.86). The relative risk of having a spontaneous preterm birth at less than 37 weeks was even lower for those who had a previous pregnancy (RR, 0.83).
The number needed to treat to prevent 1 case of spontaneous preterm birth at less than 37 weeks’ gestation was 139. The number needed to treat was 242 for spontaneous preterm birth at less than 34 weeks’ gestation.
The researchers noted certain limitations of the analysis, including the potential for the possibility of inconsistency in the definition of spontaneous preterm birth between studies. “Because antiplatelet agents in pregnancy are a low-cost and safe intervention, we suggest that antiplatelet agents may also be a promising intervention for women at high risk for a spontaneous preterm birth, especially in high-risk women with a previous pregnancy,” they wrote. “The current study provides clinicians with the best available evidence to counsel women regarding who might benefit from this intervention.”
The researchers reported having no potential conflicts of interest. Dr. van Vliet was supported by a travel grant of the Dutch Ter Meulen Fund of the Royal Netherlands Academy of Arts and Sciences.
FROM OBSTETRICS & GYNECOLOGY
Key clinical point:
Major finding: Compared with women who received placebo/no treatment, women assigned to antiplatelet treatment had a lower risk of spontaneous preterm birth at less than 37 weeks’ gestation (RR, 0.93) and at less than 34 weeks of gestation (RR, 0.86).
Data source: Results from 17 studies that randomized 28,797 women to low-dose aspirin/dipyridamole or placebo/no treatment as a primary preventive strategy for preeclampsia.
Disclosures: The researchers reported having no potential conflicts of interest. Dr. van Vliet was supported by a travel grant of the Dutch Ter Meulen Fund of the Royal Netherlands Academy of Arts and Sciences.
Type 2 risk increases with number of GDM pregnancies
In women with prior mild gestational diabetes, subsequent pregnancies did not increase the frequency of metabolic syndrome but did increase the risk of type 2 diabetes, according to a review of 426 women 5-10 years after a GDM pregnancy.
The risk of diabetes was greatest if additional pregnancies were also complicated by mild gestational diabetes mellitus (GDM).
The investigators assessed women 5-10 years after they participated in a mild GDM treatment study. The goal was to assess the impact of subsequent pregnancies on cardiometabolic risks. GDM is a known risk factor for type 2 diabetes and metabolic syndrome, but it hasn’t been clear until know how subsequent pregnancies influence the risk, said investigators led by Michael Varner, MD, a professor at the University of Utah School of Medicine, Salt Lake City (Obstet Gynecol 2017;129:273-80).
Echoing previous studies of mild GDM, about a third of the women had metabolic syndrome at follow-up, but the number of subsequent pregnancies didn’t seem to make a difference. Among the 212 women with no additional pregnancies, 34% had metabolic syndrome; among the 143 with one pregnancy, 33% had metabolic syndrome; and among the 71 with two or more, 30% had metabolic syndrome, as defined by American Heart Association and National Heart, Lung, and Blood Institute criteria.
“Although we observed a high overall frequency of metabolic syndrome in our cohort, our data suggest that subsequent pregnancies do not increase a woman’s risk of developing metabolic syndrome,” Dr. Varner and his colleagues said.
However, subsequent pregnancies did affect diabetes risk; 5.2% of women with no additional pregnancies had diabetes at follow-up, versus 10.5% of women with one additional pregnancy and 11.3% of those with two or more. The risk of diabetes was greatest if a subsequent pregnancy was complicated by GDM (relative risk, 3.75; 95% confidence interval, 1.60-8.82), as was the case for about a third of the women who had additional pregnancies.
“The association with diabetes was driven mostly by subsequent pregnancy complicated with GDM,” the investigators said.
The findings “could be consistent with either a stronger genetic or an environmental predisposition to type II diabetes, [but] could also represent confounders that were not measured in this prospective observational follow-up study. ... Our data are limited ... by the fact that we do not know how many patients had metabolic syndrome at the time of the index pregnancy,” they said.
At follow-up during Feb. 2012-Sept. 2013, women with no additional pregnancies were a median 38 years old; women who had one pregnancy were a median of 35 years, and those with two or more a median of 33 years. The interval from participation in the parent study to participation in the follow-up study was 7 years in women with no or one additional pregnancy, and 8 years for women with two or more. There were no other significant differences among the groups. The average body mass index was about 29 kg/m2; 59% of the women were Hispanic.
The National Institutes of Health funded the work. The authors had no disclosures.
In women with prior mild gestational diabetes, subsequent pregnancies did not increase the frequency of metabolic syndrome but did increase the risk of type 2 diabetes, according to a review of 426 women 5-10 years after a GDM pregnancy.
The risk of diabetes was greatest if additional pregnancies were also complicated by mild gestational diabetes mellitus (GDM).
The investigators assessed women 5-10 years after they participated in a mild GDM treatment study. The goal was to assess the impact of subsequent pregnancies on cardiometabolic risks. GDM is a known risk factor for type 2 diabetes and metabolic syndrome, but it hasn’t been clear until know how subsequent pregnancies influence the risk, said investigators led by Michael Varner, MD, a professor at the University of Utah School of Medicine, Salt Lake City (Obstet Gynecol 2017;129:273-80).
Echoing previous studies of mild GDM, about a third of the women had metabolic syndrome at follow-up, but the number of subsequent pregnancies didn’t seem to make a difference. Among the 212 women with no additional pregnancies, 34% had metabolic syndrome; among the 143 with one pregnancy, 33% had metabolic syndrome; and among the 71 with two or more, 30% had metabolic syndrome, as defined by American Heart Association and National Heart, Lung, and Blood Institute criteria.
“Although we observed a high overall frequency of metabolic syndrome in our cohort, our data suggest that subsequent pregnancies do not increase a woman’s risk of developing metabolic syndrome,” Dr. Varner and his colleagues said.
However, subsequent pregnancies did affect diabetes risk; 5.2% of women with no additional pregnancies had diabetes at follow-up, versus 10.5% of women with one additional pregnancy and 11.3% of those with two or more. The risk of diabetes was greatest if a subsequent pregnancy was complicated by GDM (relative risk, 3.75; 95% confidence interval, 1.60-8.82), as was the case for about a third of the women who had additional pregnancies.
“The association with diabetes was driven mostly by subsequent pregnancy complicated with GDM,” the investigators said.
The findings “could be consistent with either a stronger genetic or an environmental predisposition to type II diabetes, [but] could also represent confounders that were not measured in this prospective observational follow-up study. ... Our data are limited ... by the fact that we do not know how many patients had metabolic syndrome at the time of the index pregnancy,” they said.
At follow-up during Feb. 2012-Sept. 2013, women with no additional pregnancies were a median 38 years old; women who had one pregnancy were a median of 35 years, and those with two or more a median of 33 years. The interval from participation in the parent study to participation in the follow-up study was 7 years in women with no or one additional pregnancy, and 8 years for women with two or more. There were no other significant differences among the groups. The average body mass index was about 29 kg/m2; 59% of the women were Hispanic.
The National Institutes of Health funded the work. The authors had no disclosures.
In women with prior mild gestational diabetes, subsequent pregnancies did not increase the frequency of metabolic syndrome but did increase the risk of type 2 diabetes, according to a review of 426 women 5-10 years after a GDM pregnancy.
The risk of diabetes was greatest if additional pregnancies were also complicated by mild gestational diabetes mellitus (GDM).
The investigators assessed women 5-10 years after they participated in a mild GDM treatment study. The goal was to assess the impact of subsequent pregnancies on cardiometabolic risks. GDM is a known risk factor for type 2 diabetes and metabolic syndrome, but it hasn’t been clear until know how subsequent pregnancies influence the risk, said investigators led by Michael Varner, MD, a professor at the University of Utah School of Medicine, Salt Lake City (Obstet Gynecol 2017;129:273-80).
Echoing previous studies of mild GDM, about a third of the women had metabolic syndrome at follow-up, but the number of subsequent pregnancies didn’t seem to make a difference. Among the 212 women with no additional pregnancies, 34% had metabolic syndrome; among the 143 with one pregnancy, 33% had metabolic syndrome; and among the 71 with two or more, 30% had metabolic syndrome, as defined by American Heart Association and National Heart, Lung, and Blood Institute criteria.
“Although we observed a high overall frequency of metabolic syndrome in our cohort, our data suggest that subsequent pregnancies do not increase a woman’s risk of developing metabolic syndrome,” Dr. Varner and his colleagues said.
However, subsequent pregnancies did affect diabetes risk; 5.2% of women with no additional pregnancies had diabetes at follow-up, versus 10.5% of women with one additional pregnancy and 11.3% of those with two or more. The risk of diabetes was greatest if a subsequent pregnancy was complicated by GDM (relative risk, 3.75; 95% confidence interval, 1.60-8.82), as was the case for about a third of the women who had additional pregnancies.
“The association with diabetes was driven mostly by subsequent pregnancy complicated with GDM,” the investigators said.
The findings “could be consistent with either a stronger genetic or an environmental predisposition to type II diabetes, [but] could also represent confounders that were not measured in this prospective observational follow-up study. ... Our data are limited ... by the fact that we do not know how many patients had metabolic syndrome at the time of the index pregnancy,” they said.
At follow-up during Feb. 2012-Sept. 2013, women with no additional pregnancies were a median 38 years old; women who had one pregnancy were a median of 35 years, and those with two or more a median of 33 years. The interval from participation in the parent study to participation in the follow-up study was 7 years in women with no or one additional pregnancy, and 8 years for women with two or more. There were no other significant differences among the groups. The average body mass index was about 29 kg/m2; 59% of the women were Hispanic.
The National Institutes of Health funded the work. The authors had no disclosures.
Key clinical point:
Major finding: The risk of diabetes was greatest if a subsequent pregnancy was complicated by GDM (RR, 3.75; 95% CI, 1.60-8.82).
Data source: Review of subsequent pregnancies in 426 women 5-10 years after a GDM pregnancy
Disclosures: The National Institutes of Health funded the work. The authors had no disclosures.
177Lu-Dotatate for advanced midgut neuroendocrine tumors
177Lu-Dotatate, a radionuclide related to octreotide, reduced the risk of disease progression or death by 79% in a phase III trial involving 229 adults with advanced, progressive midgut neuroendocrine tumors, investigators reported in the New England Journal of Medicine.
“The response rate of 18% in the 177Lu-Dotatate group (as compared with 3% in the control group) is also notable, given that response rates above 5% have not been observed in large randomized clinical trials of other systemic therapies in this patient population,” said Jonathan R. Strosberg, MD, of the Moffitt Cancer Center, Tampa, and his associates.
All the study participants had metastatic disease that progressed despite first-line treatment using octreotide LAR; 80% had also undergone surgical resection, and nearly half had received some other form of systemic therapy before entering this study. The primary tumor site was the ileum in most patients, and most also had metastases in the liver, the lymph nodes, or both, “typically in the mesentery or retroperitoneum.”
The primary efficacy endpoint – the estimated rate of progression-free survival at month 20 – was 65.2% in the intervention group, compared with 10.8% in the control group. This represents a 79% lower risk of disease progression or death with 177Lu-Dotatate. An interim analysis of overall survival (an endpoint that cannot be determined definitively until more time has passed) showed a 60% lower risk of death in the intervention group than in the control group. Treatment response rates were 18% and 3%, respectively, Dr. Strosberg and his associates reported (New Engl J Med. 2017 Jan 12. doi:10.1056/NEJMoa1607427).
177Lu-Dotatate was administered together with a renal-protection agent, and there has been no evidence of renal toxic effects to date. Rates of low-grade hematologic toxicities were low. The most common adverse effects were nausea and vomiting, which were largely attributed to the renal-protection agent, as well as fatigue, asthenia, abdominal pain, and diarrhea. Adverse events leading to premature withdrawal from the trial developed in more of the control group (9%) than of the intervention group (6%).
177Lu-Dotatate, a radionuclide related to octreotide, reduced the risk of disease progression or death by 79% in a phase III trial involving 229 adults with advanced, progressive midgut neuroendocrine tumors, investigators reported in the New England Journal of Medicine.
“The response rate of 18% in the 177Lu-Dotatate group (as compared with 3% in the control group) is also notable, given that response rates above 5% have not been observed in large randomized clinical trials of other systemic therapies in this patient population,” said Jonathan R. Strosberg, MD, of the Moffitt Cancer Center, Tampa, and his associates.
All the study participants had metastatic disease that progressed despite first-line treatment using octreotide LAR; 80% had also undergone surgical resection, and nearly half had received some other form of systemic therapy before entering this study. The primary tumor site was the ileum in most patients, and most also had metastases in the liver, the lymph nodes, or both, “typically in the mesentery or retroperitoneum.”
The primary efficacy endpoint – the estimated rate of progression-free survival at month 20 – was 65.2% in the intervention group, compared with 10.8% in the control group. This represents a 79% lower risk of disease progression or death with 177Lu-Dotatate. An interim analysis of overall survival (an endpoint that cannot be determined definitively until more time has passed) showed a 60% lower risk of death in the intervention group than in the control group. Treatment response rates were 18% and 3%, respectively, Dr. Strosberg and his associates reported (New Engl J Med. 2017 Jan 12. doi:10.1056/NEJMoa1607427).
177Lu-Dotatate was administered together with a renal-protection agent, and there has been no evidence of renal toxic effects to date. Rates of low-grade hematologic toxicities were low. The most common adverse effects were nausea and vomiting, which were largely attributed to the renal-protection agent, as well as fatigue, asthenia, abdominal pain, and diarrhea. Adverse events leading to premature withdrawal from the trial developed in more of the control group (9%) than of the intervention group (6%).
177Lu-Dotatate, a radionuclide related to octreotide, reduced the risk of disease progression or death by 79% in a phase III trial involving 229 adults with advanced, progressive midgut neuroendocrine tumors, investigators reported in the New England Journal of Medicine.
“The response rate of 18% in the 177Lu-Dotatate group (as compared with 3% in the control group) is also notable, given that response rates above 5% have not been observed in large randomized clinical trials of other systemic therapies in this patient population,” said Jonathan R. Strosberg, MD, of the Moffitt Cancer Center, Tampa, and his associates.
All the study participants had metastatic disease that progressed despite first-line treatment using octreotide LAR; 80% had also undergone surgical resection, and nearly half had received some other form of systemic therapy before entering this study. The primary tumor site was the ileum in most patients, and most also had metastases in the liver, the lymph nodes, or both, “typically in the mesentery or retroperitoneum.”
The primary efficacy endpoint – the estimated rate of progression-free survival at month 20 – was 65.2% in the intervention group, compared with 10.8% in the control group. This represents a 79% lower risk of disease progression or death with 177Lu-Dotatate. An interim analysis of overall survival (an endpoint that cannot be determined definitively until more time has passed) showed a 60% lower risk of death in the intervention group than in the control group. Treatment response rates were 18% and 3%, respectively, Dr. Strosberg and his associates reported (New Engl J Med. 2017 Jan 12. doi:10.1056/NEJMoa1607427).
177Lu-Dotatate was administered together with a renal-protection agent, and there has been no evidence of renal toxic effects to date. Rates of low-grade hematologic toxicities were low. The most common adverse effects were nausea and vomiting, which were largely attributed to the renal-protection agent, as well as fatigue, asthenia, abdominal pain, and diarrhea. Adverse events leading to premature withdrawal from the trial developed in more of the control group (9%) than of the intervention group (6%).
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Key clinical point: 177Lu-Dotatate cuts the risk of disease progression or death by 79% in patients with advanced progressive midgut neuroendocrine tumors.
Major finding: The primary efficacy endpoint – the estimated rate of progression-free survival at month 20 – was 65.2% in the intervention group, compared with 10.8% in the control group.
Data source: An international, open-label phase III randomized clinical trial involving 229 adults followed for a median of 14 months.
Disclosures: This study was sponsored by Advanced Accelerator Applications. Dr. Strosberg reported having no relevant financial disclosures; his associates reported ties to numerous industry sources.
Ibrutinib continues to wow in CLL/SLL
SAN DIEGO – More than 90% of the first patients with previously untreated chronic lymphocytic leukemia who received ibrutinib in an early study are alive and without disease progression 5 years later, investigators reported.
Among 31 treatment-naive patients with chronic lymphocytic leukemia/small lymphocytic leukemia (CLL/SLL) who were started on the Bruton’s tyrosine kinase inhibitor ibrutinib (Imbruvica) in the phase Ib/II PCYC-1102/1103 study, the 5-year progression-free survival (PFS) rate was 92%, with the median PFS not reached. Estimated 5-year overall survival (OS) among these patients was also 92%, with the median not reached, Susan O’Brien, MD, of the University of California, Irvine, reported at the annual meeting of the American Society of Hematology.
The 5-year PFS rate for patients with relapsed/refractory disease who had received a median of four prior lines of therapy before starting on single-agent ibrutinib was 43%, with a median PFS of 52 months. In this group, the overall survival (OS) rate was 57%, with the median not reached.
“At 5 years of follow-up, there are very durable responses in treatment-naive and relapsed refractory patients. You saw that, in the treatment-naive group, there is, in fact, only one patient who has progressed so far,” Dr. O’Brien said.
In a separate study, investigators from the phase III RESONATE-2 trial reported updated safety and efficacy data showing that in first-line therapy for patients aged 65 years and older with CLL/SLL with active disease, ibrutinib was associated with significantly better PFS at 24 months, compared with chlorambucil.
In this study by Dr. O’Brien and colleagues, 31 patients with previously untreated CLL/SLL and 101 patients with relapsed/refractory disease (progression or no objective response within 24 months of starting on chemoimmunotherapy) were treated with oral ibrutinib once daily at doses of 420 mg or 840 mg until disease progression or unacceptable toxicity.
After 5 years of follow-up, 20 of the 31 treatment-naive patients (65%) and 30 of the 101 relapsed/refractory patients (30%) remained on ibrutinib therapy. The primary reasons for discontinuation among relapsed/refractory patients included progressive disease in 33%, adverse events in 21%, and investigator decision in 11%.
Best response rates in treatment-naive patients were 87% (29% complete response, 55% partial response, 3% partial response-L) and 89% in relapsed/refractory patients (10%, 76%, and 3%, respectively).
An analysis of survival by IGHV (immunoglobulin heavy chain variable) mutational status in patients with relapsed/refractory disease showed a 53% 5-year PFS rate among patients with mutated IGHV and a median PFS of 63 months, compared with 38% and 43 months for patients with unmutated IGHV. Respective 5-year overall survival rates were 66% (median OS, 63 months) and 55% (median not reached).
In an analysis of survival outcomes by chromosomal abnormalities detected by FISH (fluorescent in situ hybridization) among patients with relapsed/refractory disease, median PFS and OS rates were highest among patients with the 13q deletion, at 91% for both PFS and OS, compared with 80% for each in patients with trisomy 12, 33% and 61% for patients with deletion 11q, and 19% and 32% for patients with deletion 17p. In patients with no chromosomal abnormalities, the 5-year PFS rate was 66% (median not reached), and the 5-year OS rate was 83% (median not reached).
Among patients with complex karyotype, 90% of whom had relapsed refractory disease, the 5-year PFS rate was 36% (median 33 months), and the OS rate was 46% (median 57 months). In contrast, respective PFS and OS rates for patients without complex karyotype were 69% and 84%, with the median not reached in either survival category.
In multivariate analysis, only deletion 17p was identified as a significant predictor of PFS and OS.
Grade 3 or greater treatment-emergent adverse events occurred mostly frequently in the first year of therapy and declined thereafter. The most common grade 3 or greater events were hypertension, (26% of all patients), pneumonia (22%), neutropenia (17%), and atrial fibrillation (9%).
Paul M. Barr, MD, of the University of Rochester presented updated data from RESONATE-2, comparing ibrutinib with chlorambucil in patients 65 and older with newly diagnosed, active CLL/SLL.
At a median follow-up of 29 months, the rates of 2-year PFS were 89% for patients treated with ibrutinib (median PFS not reached) vs. 34% for chlorambucil (median PFS 15 months). This translated into a hazard ratio for ibrutinib of 0.121 (P less than .0001). The benefit of ibrutinib occurred without regard to IGHV status, and ibrutinib continues to demonstrate an OS benefit over chlorambucil with longer follow-up and crossover. Overall survival at 24 months was 95% for patients treated with ibrutinib (included 55 patients who were crossed over from chlorambucil) vs. 84% for patients treated with chlorambucil only.
“The depth of the responses has improved over time, now with 18% of patients achieving a CR with ibrutinib, and lastly, ibrutinib remains tolerable in this elderly population, with 79% of patients that are continuing on therapy,” Dr. Barr said.
Both studies were funded by Pharmacyclics. Dr. Barr and Dr. O’Brien disclosed serving as consultants to the company, and Dr. O’Brien further disclosed honoraria and research funding from Pharmacyclics.
SAN DIEGO – More than 90% of the first patients with previously untreated chronic lymphocytic leukemia who received ibrutinib in an early study are alive and without disease progression 5 years later, investigators reported.
Among 31 treatment-naive patients with chronic lymphocytic leukemia/small lymphocytic leukemia (CLL/SLL) who were started on the Bruton’s tyrosine kinase inhibitor ibrutinib (Imbruvica) in the phase Ib/II PCYC-1102/1103 study, the 5-year progression-free survival (PFS) rate was 92%, with the median PFS not reached. Estimated 5-year overall survival (OS) among these patients was also 92%, with the median not reached, Susan O’Brien, MD, of the University of California, Irvine, reported at the annual meeting of the American Society of Hematology.
The 5-year PFS rate for patients with relapsed/refractory disease who had received a median of four prior lines of therapy before starting on single-agent ibrutinib was 43%, with a median PFS of 52 months. In this group, the overall survival (OS) rate was 57%, with the median not reached.
“At 5 years of follow-up, there are very durable responses in treatment-naive and relapsed refractory patients. You saw that, in the treatment-naive group, there is, in fact, only one patient who has progressed so far,” Dr. O’Brien said.
In a separate study, investigators from the phase III RESONATE-2 trial reported updated safety and efficacy data showing that in first-line therapy for patients aged 65 years and older with CLL/SLL with active disease, ibrutinib was associated with significantly better PFS at 24 months, compared with chlorambucil.
In this study by Dr. O’Brien and colleagues, 31 patients with previously untreated CLL/SLL and 101 patients with relapsed/refractory disease (progression or no objective response within 24 months of starting on chemoimmunotherapy) were treated with oral ibrutinib once daily at doses of 420 mg or 840 mg until disease progression or unacceptable toxicity.
After 5 years of follow-up, 20 of the 31 treatment-naive patients (65%) and 30 of the 101 relapsed/refractory patients (30%) remained on ibrutinib therapy. The primary reasons for discontinuation among relapsed/refractory patients included progressive disease in 33%, adverse events in 21%, and investigator decision in 11%.
Best response rates in treatment-naive patients were 87% (29% complete response, 55% partial response, 3% partial response-L) and 89% in relapsed/refractory patients (10%, 76%, and 3%, respectively).
An analysis of survival by IGHV (immunoglobulin heavy chain variable) mutational status in patients with relapsed/refractory disease showed a 53% 5-year PFS rate among patients with mutated IGHV and a median PFS of 63 months, compared with 38% and 43 months for patients with unmutated IGHV. Respective 5-year overall survival rates were 66% (median OS, 63 months) and 55% (median not reached).
In an analysis of survival outcomes by chromosomal abnormalities detected by FISH (fluorescent in situ hybridization) among patients with relapsed/refractory disease, median PFS and OS rates were highest among patients with the 13q deletion, at 91% for both PFS and OS, compared with 80% for each in patients with trisomy 12, 33% and 61% for patients with deletion 11q, and 19% and 32% for patients with deletion 17p. In patients with no chromosomal abnormalities, the 5-year PFS rate was 66% (median not reached), and the 5-year OS rate was 83% (median not reached).
Among patients with complex karyotype, 90% of whom had relapsed refractory disease, the 5-year PFS rate was 36% (median 33 months), and the OS rate was 46% (median 57 months). In contrast, respective PFS and OS rates for patients without complex karyotype were 69% and 84%, with the median not reached in either survival category.
In multivariate analysis, only deletion 17p was identified as a significant predictor of PFS and OS.
Grade 3 or greater treatment-emergent adverse events occurred mostly frequently in the first year of therapy and declined thereafter. The most common grade 3 or greater events were hypertension, (26% of all patients), pneumonia (22%), neutropenia (17%), and atrial fibrillation (9%).
Paul M. Barr, MD, of the University of Rochester presented updated data from RESONATE-2, comparing ibrutinib with chlorambucil in patients 65 and older with newly diagnosed, active CLL/SLL.
At a median follow-up of 29 months, the rates of 2-year PFS were 89% for patients treated with ibrutinib (median PFS not reached) vs. 34% for chlorambucil (median PFS 15 months). This translated into a hazard ratio for ibrutinib of 0.121 (P less than .0001). The benefit of ibrutinib occurred without regard to IGHV status, and ibrutinib continues to demonstrate an OS benefit over chlorambucil with longer follow-up and crossover. Overall survival at 24 months was 95% for patients treated with ibrutinib (included 55 patients who were crossed over from chlorambucil) vs. 84% for patients treated with chlorambucil only.
“The depth of the responses has improved over time, now with 18% of patients achieving a CR with ibrutinib, and lastly, ibrutinib remains tolerable in this elderly population, with 79% of patients that are continuing on therapy,” Dr. Barr said.
Both studies were funded by Pharmacyclics. Dr. Barr and Dr. O’Brien disclosed serving as consultants to the company, and Dr. O’Brien further disclosed honoraria and research funding from Pharmacyclics.
SAN DIEGO – More than 90% of the first patients with previously untreated chronic lymphocytic leukemia who received ibrutinib in an early study are alive and without disease progression 5 years later, investigators reported.
Among 31 treatment-naive patients with chronic lymphocytic leukemia/small lymphocytic leukemia (CLL/SLL) who were started on the Bruton’s tyrosine kinase inhibitor ibrutinib (Imbruvica) in the phase Ib/II PCYC-1102/1103 study, the 5-year progression-free survival (PFS) rate was 92%, with the median PFS not reached. Estimated 5-year overall survival (OS) among these patients was also 92%, with the median not reached, Susan O’Brien, MD, of the University of California, Irvine, reported at the annual meeting of the American Society of Hematology.
The 5-year PFS rate for patients with relapsed/refractory disease who had received a median of four prior lines of therapy before starting on single-agent ibrutinib was 43%, with a median PFS of 52 months. In this group, the overall survival (OS) rate was 57%, with the median not reached.
“At 5 years of follow-up, there are very durable responses in treatment-naive and relapsed refractory patients. You saw that, in the treatment-naive group, there is, in fact, only one patient who has progressed so far,” Dr. O’Brien said.
In a separate study, investigators from the phase III RESONATE-2 trial reported updated safety and efficacy data showing that in first-line therapy for patients aged 65 years and older with CLL/SLL with active disease, ibrutinib was associated with significantly better PFS at 24 months, compared with chlorambucil.
In this study by Dr. O’Brien and colleagues, 31 patients with previously untreated CLL/SLL and 101 patients with relapsed/refractory disease (progression or no objective response within 24 months of starting on chemoimmunotherapy) were treated with oral ibrutinib once daily at doses of 420 mg or 840 mg until disease progression or unacceptable toxicity.
After 5 years of follow-up, 20 of the 31 treatment-naive patients (65%) and 30 of the 101 relapsed/refractory patients (30%) remained on ibrutinib therapy. The primary reasons for discontinuation among relapsed/refractory patients included progressive disease in 33%, adverse events in 21%, and investigator decision in 11%.
Best response rates in treatment-naive patients were 87% (29% complete response, 55% partial response, 3% partial response-L) and 89% in relapsed/refractory patients (10%, 76%, and 3%, respectively).
An analysis of survival by IGHV (immunoglobulin heavy chain variable) mutational status in patients with relapsed/refractory disease showed a 53% 5-year PFS rate among patients with mutated IGHV and a median PFS of 63 months, compared with 38% and 43 months for patients with unmutated IGHV. Respective 5-year overall survival rates were 66% (median OS, 63 months) and 55% (median not reached).
In an analysis of survival outcomes by chromosomal abnormalities detected by FISH (fluorescent in situ hybridization) among patients with relapsed/refractory disease, median PFS and OS rates were highest among patients with the 13q deletion, at 91% for both PFS and OS, compared with 80% for each in patients with trisomy 12, 33% and 61% for patients with deletion 11q, and 19% and 32% for patients with deletion 17p. In patients with no chromosomal abnormalities, the 5-year PFS rate was 66% (median not reached), and the 5-year OS rate was 83% (median not reached).
Among patients with complex karyotype, 90% of whom had relapsed refractory disease, the 5-year PFS rate was 36% (median 33 months), and the OS rate was 46% (median 57 months). In contrast, respective PFS and OS rates for patients without complex karyotype were 69% and 84%, with the median not reached in either survival category.
In multivariate analysis, only deletion 17p was identified as a significant predictor of PFS and OS.
Grade 3 or greater treatment-emergent adverse events occurred mostly frequently in the first year of therapy and declined thereafter. The most common grade 3 or greater events were hypertension, (26% of all patients), pneumonia (22%), neutropenia (17%), and atrial fibrillation (9%).
Paul M. Barr, MD, of the University of Rochester presented updated data from RESONATE-2, comparing ibrutinib with chlorambucil in patients 65 and older with newly diagnosed, active CLL/SLL.
At a median follow-up of 29 months, the rates of 2-year PFS were 89% for patients treated with ibrutinib (median PFS not reached) vs. 34% for chlorambucil (median PFS 15 months). This translated into a hazard ratio for ibrutinib of 0.121 (P less than .0001). The benefit of ibrutinib occurred without regard to IGHV status, and ibrutinib continues to demonstrate an OS benefit over chlorambucil with longer follow-up and crossover. Overall survival at 24 months was 95% for patients treated with ibrutinib (included 55 patients who were crossed over from chlorambucil) vs. 84% for patients treated with chlorambucil only.
“The depth of the responses has improved over time, now with 18% of patients achieving a CR with ibrutinib, and lastly, ibrutinib remains tolerable in this elderly population, with 79% of patients that are continuing on therapy,” Dr. Barr said.
Both studies were funded by Pharmacyclics. Dr. Barr and Dr. O’Brien disclosed serving as consultants to the company, and Dr. O’Brien further disclosed honoraria and research funding from Pharmacyclics.
AT ASH 2016
Key clinical point: Long-term follow-up of two studies shows a progression-free and overall survival advantage with ibrutinib in chronic lymphocytic leukemia/small lymphocytic leukemia.
Major finding: 5-year PFS and OS rates were 92% for treatment-naive patients with CLL/SLL treated with ibrutinib.
Data source: Phase Ib/II study and randomized phase III study of ibrutinib for treatment-naive and relapsed/refractory CLL/SLL.
Disclosures: Both studies were funded by Pharmacyclics. Dr. Barr and Dr. O’Brien disclosed serving as consultants to the company; Dr. O’Brien disclosed honoraria and research funding from the company.
Perfect attendance
A few years ago I audited a college course on leadership taught by Angus King (I-ME), former governor and now independent Senator from Maine. He emphasized that an important characteristic of effective leaders is that they show up for work. They are there, present, on the scene. Attempting to lead in absentia is seldom successful. Knowledge gathered firsthand can be critical when it’s decision-making time. And the connectedness fostered by the leader’s physical presence can bolster morale in a crisis.
Being a parent is more complex than simply being a leader, but showing up is just as important to being a good parent as it is to being an effective leader. Most parents already believe that “being there” is important, and feel guilty when they have obligations that prevent them from maintaining a perfect attendance record.
Common sense also may suggest to parents that their presence is less important as their children get older. Certainly, the behavior of most teenagers would suggest that adolescents couldn’t care less whether their parents were at home or vacationing in the Bahamas. However, this is one of those situations where appearances may be deceiving. The author of an opinion piece in the New York Times presents some compelling evidence that in fact, adolescents place a higher value on their parents’ presence than the common stereotype of teenage behavior would suggest (”What Do Teenagers Want? Potted Plants Parents,” By Lisa Damour, Dec. 14, 2016).
Citing her own experience as a psychologist in private practice in Ohio and several recent studies from the psychology literature, the author observes that “sheer proximity confers a benefit [to the adolescent’s psychological health] over and above feeling of closeness or connectedness between parent and child.” At present there is no explanation for this benefit of just being there for your teenage child. But it may be that a parental presence, even if it is silent, provides a stable base and comfort zone that the adolescent can return to as he or she tests the ability to function independently in the world outside of the family.
I suspect that most of you have observed this counter-intuitive phenomenon in which teenagers who give every outward appearance of wanting nothing to do with their parents actually would like to have at least one parent be at home. They just don’t want to be hovered over. Ninety-nine percent of the time the parent will receive no positive feedback for just being there like a “potted plant” to use Ms. Damour’s analogy.
The problem is how to get this message to parents early enough in their parenting trajectory that they can adjust work schedules and priorities to be home with their adolescents. It was not unusual for new parents to ask for my thoughts as they were considering various day care and work schedule options for their infants. If I thought they were really going to take my advice seriously I would add, “You know you should also be thinking ahead when she is a teen. She won’t ask, but she probably would like it if you were home in the afternoon when she gets home from school.”
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including “How to Say No to Your Toddler.” Email him at [email protected].
A few years ago I audited a college course on leadership taught by Angus King (I-ME), former governor and now independent Senator from Maine. He emphasized that an important characteristic of effective leaders is that they show up for work. They are there, present, on the scene. Attempting to lead in absentia is seldom successful. Knowledge gathered firsthand can be critical when it’s decision-making time. And the connectedness fostered by the leader’s physical presence can bolster morale in a crisis.
Being a parent is more complex than simply being a leader, but showing up is just as important to being a good parent as it is to being an effective leader. Most parents already believe that “being there” is important, and feel guilty when they have obligations that prevent them from maintaining a perfect attendance record.
Common sense also may suggest to parents that their presence is less important as their children get older. Certainly, the behavior of most teenagers would suggest that adolescents couldn’t care less whether their parents were at home or vacationing in the Bahamas. However, this is one of those situations where appearances may be deceiving. The author of an opinion piece in the New York Times presents some compelling evidence that in fact, adolescents place a higher value on their parents’ presence than the common stereotype of teenage behavior would suggest (”What Do Teenagers Want? Potted Plants Parents,” By Lisa Damour, Dec. 14, 2016).
Citing her own experience as a psychologist in private practice in Ohio and several recent studies from the psychology literature, the author observes that “sheer proximity confers a benefit [to the adolescent’s psychological health] over and above feeling of closeness or connectedness between parent and child.” At present there is no explanation for this benefit of just being there for your teenage child. But it may be that a parental presence, even if it is silent, provides a stable base and comfort zone that the adolescent can return to as he or she tests the ability to function independently in the world outside of the family.
I suspect that most of you have observed this counter-intuitive phenomenon in which teenagers who give every outward appearance of wanting nothing to do with their parents actually would like to have at least one parent be at home. They just don’t want to be hovered over. Ninety-nine percent of the time the parent will receive no positive feedback for just being there like a “potted plant” to use Ms. Damour’s analogy.
The problem is how to get this message to parents early enough in their parenting trajectory that they can adjust work schedules and priorities to be home with their adolescents. It was not unusual for new parents to ask for my thoughts as they were considering various day care and work schedule options for their infants. If I thought they were really going to take my advice seriously I would add, “You know you should also be thinking ahead when she is a teen. She won’t ask, but she probably would like it if you were home in the afternoon when she gets home from school.”
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including “How to Say No to Your Toddler.” Email him at [email protected].
A few years ago I audited a college course on leadership taught by Angus King (I-ME), former governor and now independent Senator from Maine. He emphasized that an important characteristic of effective leaders is that they show up for work. They are there, present, on the scene. Attempting to lead in absentia is seldom successful. Knowledge gathered firsthand can be critical when it’s decision-making time. And the connectedness fostered by the leader’s physical presence can bolster morale in a crisis.
Being a parent is more complex than simply being a leader, but showing up is just as important to being a good parent as it is to being an effective leader. Most parents already believe that “being there” is important, and feel guilty when they have obligations that prevent them from maintaining a perfect attendance record.
Common sense also may suggest to parents that their presence is less important as their children get older. Certainly, the behavior of most teenagers would suggest that adolescents couldn’t care less whether their parents were at home or vacationing in the Bahamas. However, this is one of those situations where appearances may be deceiving. The author of an opinion piece in the New York Times presents some compelling evidence that in fact, adolescents place a higher value on their parents’ presence than the common stereotype of teenage behavior would suggest (”What Do Teenagers Want? Potted Plants Parents,” By Lisa Damour, Dec. 14, 2016).
Citing her own experience as a psychologist in private practice in Ohio and several recent studies from the psychology literature, the author observes that “sheer proximity confers a benefit [to the adolescent’s psychological health] over and above feeling of closeness or connectedness between parent and child.” At present there is no explanation for this benefit of just being there for your teenage child. But it may be that a parental presence, even if it is silent, provides a stable base and comfort zone that the adolescent can return to as he or she tests the ability to function independently in the world outside of the family.
I suspect that most of you have observed this counter-intuitive phenomenon in which teenagers who give every outward appearance of wanting nothing to do with their parents actually would like to have at least one parent be at home. They just don’t want to be hovered over. Ninety-nine percent of the time the parent will receive no positive feedback for just being there like a “potted plant” to use Ms. Damour’s analogy.
The problem is how to get this message to parents early enough in their parenting trajectory that they can adjust work schedules and priorities to be home with their adolescents. It was not unusual for new parents to ask for my thoughts as they were considering various day care and work schedule options for their infants. If I thought they were really going to take my advice seriously I would add, “You know you should also be thinking ahead when she is a teen. She won’t ask, but she probably would like it if you were home in the afternoon when she gets home from school.”
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including “How to Say No to Your Toddler.” Email him at [email protected].
HIV research update: Late December 2016
A great volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
Liver stiffness is very accurate for predicting liver-related events in HIV-infected patients with chronic hepatitis C infection, according to a Spanish study.
A study in the journal AIDS found that HIV/HCV coinfection is associated with a greater homeostasis model assessment of insulin resistance, even after controlling for demographic, lifestyle, and metabolic factors. The authors said sCD163, a marker of monocyte/macrophage activation which appears independent of intestinal epithelial damage and inflammation, partly explains this association.
Liver stiffness (LS) identifies HIV/HCV-coinfected patients with compensated cirrhosis with a very low risk of portal hypertensive gastrointestinal bleeding, according to a recent study, and as a result upper gastrointestinal endoscopy may be safely spared in patients with LS less than 21 kPa.
A study in HIV Medicine found that MicroRNA-155 levels in the peripheral blood of HIV-1–infected patients are increased and associated with T-cell activation, and therefore miR-155 is a potential biomarker of the immune response following HIV-1 infection.
A study in AIDS Care found no major differences between rural and urban South Carolina residents at the various stages of engagement in HIV care, using the HIV continuum of care model.
Investigators said identification of a cytokine signature specific for the preseroconversion stage of primary HIV infection may help to understand the earliest HIV pathogenic events and identify new potential targets for immunotherapy aimed at modulating the cytokine response to HIV infection.
Intimate partner violence is linked to less HIV testing uptake among high-risk, HIV-negative women in Atlanta, according to researchers at Emory University.
In HIV-positive women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, a recent study found, suggesting that women with HIV infection who desire multiple children may proceed safely and confidently with subsequent pregnancies.
An estimated 29% of HIV care providers had not adopted recommendations to initiate antiretroviral therapy regardless of patient CD4 count, barring contraindications or barriers to treatment, according to a study in JAIDS. The leading reasons for deferring ART included patient refusal and adherence concerns.
Baseline vitamin D deficiency decreased the effectiveness of rosuvastatin in HIV-positive adults, according to a recent study, and researchers said vitamin D supplementation may be warranted for deficient patients initiating statin therapy.
A European study found HIV/HCV–coinfected patients with a favorable virologic response to PEG-interferon + ribavirin treatment had reduced risk of all-cause and liver-related death, while there was no difference in risk of non–liver-related death when comparing responders and nonresponders.
Unlike the prevalences in the general U.S. population, there was no difference in smoking prevalence for female versus male persons living with HIV (both greater than 50%) indicating that HIV infection status was associated with a greater relative increase in smoking for women than men, according to results of a recent study.
[email protected]
On Twitter @richpizzi
A great volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
Liver stiffness is very accurate for predicting liver-related events in HIV-infected patients with chronic hepatitis C infection, according to a Spanish study.
A study in the journal AIDS found that HIV/HCV coinfection is associated with a greater homeostasis model assessment of insulin resistance, even after controlling for demographic, lifestyle, and metabolic factors. The authors said sCD163, a marker of monocyte/macrophage activation which appears independent of intestinal epithelial damage and inflammation, partly explains this association.
Liver stiffness (LS) identifies HIV/HCV-coinfected patients with compensated cirrhosis with a very low risk of portal hypertensive gastrointestinal bleeding, according to a recent study, and as a result upper gastrointestinal endoscopy may be safely spared in patients with LS less than 21 kPa.
A study in HIV Medicine found that MicroRNA-155 levels in the peripheral blood of HIV-1–infected patients are increased and associated with T-cell activation, and therefore miR-155 is a potential biomarker of the immune response following HIV-1 infection.
A study in AIDS Care found no major differences between rural and urban South Carolina residents at the various stages of engagement in HIV care, using the HIV continuum of care model.
Investigators said identification of a cytokine signature specific for the preseroconversion stage of primary HIV infection may help to understand the earliest HIV pathogenic events and identify new potential targets for immunotherapy aimed at modulating the cytokine response to HIV infection.
Intimate partner violence is linked to less HIV testing uptake among high-risk, HIV-negative women in Atlanta, according to researchers at Emory University.
In HIV-positive women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, a recent study found, suggesting that women with HIV infection who desire multiple children may proceed safely and confidently with subsequent pregnancies.
An estimated 29% of HIV care providers had not adopted recommendations to initiate antiretroviral therapy regardless of patient CD4 count, barring contraindications or barriers to treatment, according to a study in JAIDS. The leading reasons for deferring ART included patient refusal and adherence concerns.
Baseline vitamin D deficiency decreased the effectiveness of rosuvastatin in HIV-positive adults, according to a recent study, and researchers said vitamin D supplementation may be warranted for deficient patients initiating statin therapy.
A European study found HIV/HCV–coinfected patients with a favorable virologic response to PEG-interferon + ribavirin treatment had reduced risk of all-cause and liver-related death, while there was no difference in risk of non–liver-related death when comparing responders and nonresponders.
Unlike the prevalences in the general U.S. population, there was no difference in smoking prevalence for female versus male persons living with HIV (both greater than 50%) indicating that HIV infection status was associated with a greater relative increase in smoking for women than men, according to results of a recent study.
[email protected]
On Twitter @richpizzi
A great volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
Liver stiffness is very accurate for predicting liver-related events in HIV-infected patients with chronic hepatitis C infection, according to a Spanish study.
A study in the journal AIDS found that HIV/HCV coinfection is associated with a greater homeostasis model assessment of insulin resistance, even after controlling for demographic, lifestyle, and metabolic factors. The authors said sCD163, a marker of monocyte/macrophage activation which appears independent of intestinal epithelial damage and inflammation, partly explains this association.
Liver stiffness (LS) identifies HIV/HCV-coinfected patients with compensated cirrhosis with a very low risk of portal hypertensive gastrointestinal bleeding, according to a recent study, and as a result upper gastrointestinal endoscopy may be safely spared in patients with LS less than 21 kPa.
A study in HIV Medicine found that MicroRNA-155 levels in the peripheral blood of HIV-1–infected patients are increased and associated with T-cell activation, and therefore miR-155 is a potential biomarker of the immune response following HIV-1 infection.
A study in AIDS Care found no major differences between rural and urban South Carolina residents at the various stages of engagement in HIV care, using the HIV continuum of care model.
Investigators said identification of a cytokine signature specific for the preseroconversion stage of primary HIV infection may help to understand the earliest HIV pathogenic events and identify new potential targets for immunotherapy aimed at modulating the cytokine response to HIV infection.
Intimate partner violence is linked to less HIV testing uptake among high-risk, HIV-negative women in Atlanta, according to researchers at Emory University.
In HIV-positive women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, a recent study found, suggesting that women with HIV infection who desire multiple children may proceed safely and confidently with subsequent pregnancies.
An estimated 29% of HIV care providers had not adopted recommendations to initiate antiretroviral therapy regardless of patient CD4 count, barring contraindications or barriers to treatment, according to a study in JAIDS. The leading reasons for deferring ART included patient refusal and adherence concerns.
Baseline vitamin D deficiency decreased the effectiveness of rosuvastatin in HIV-positive adults, according to a recent study, and researchers said vitamin D supplementation may be warranted for deficient patients initiating statin therapy.
A European study found HIV/HCV–coinfected patients with a favorable virologic response to PEG-interferon + ribavirin treatment had reduced risk of all-cause and liver-related death, while there was no difference in risk of non–liver-related death when comparing responders and nonresponders.
Unlike the prevalences in the general U.S. population, there was no difference in smoking prevalence for female versus male persons living with HIV (both greater than 50%) indicating that HIV infection status was associated with a greater relative increase in smoking for women than men, according to results of a recent study.
[email protected]
On Twitter @richpizzi