bluuebunny/crossref_metadata_2025_split huggingface dataset:
Een terughoudende praktijk
Authors: Spithoven Remco 
Published: November 2014

A practice of restraint. About the practical challenges of fighting back the fear of crime
Despite the international scientific inconclusiveness about the nature of the fear of crime, the strategic layer of the Dutch government aims to reduce the fear of crime in general by 2017. But their policy-goals were not accompanied with a plan how to realize them. Meanwhile, local practitioners claim to be in search of practical tools and substantive support how to fight back the public’s fear of crime. This study was aimed to feed the discussion with a constructive and realistic input from both the practitioners and the scientific view. The research question was: ‘What do local practitioners do against the public’s fear of crime and how can these activities be improved?’ 36 local practitioners from Dutch local municipalities, the police force and the public prosecutor were interviewed. Schön’s idea of the ‘reflective practitioner’ (1983) was the underlying argument to make practical knowledge about reducing the fear of crime explicit. The respondents from both institutional layers of local ‘policy advise’ and ‘policy implementation’ were quite reluctant about fighting back the public’s fear of crime. They aim to reduce the fear of crime in a doubtful and indirect way. Because many sources of the public’s fear of crime were unknown to them or were not in the reach of their professional activities. In this way, the interviewed local practitioners approach strongly aligned with the advice of international scientists to be reluctant and realistic about fighting back the public’s fear of crime. We advised an approach of ‘local fear of and worry about crime’ in dialog between international science and the interviewed local Dutch practitioners. The results of it will probably not contribute to quantitative policy goals at the national level, but rather to custom fit, qualitative improvements on the local level. This will probably be the most effective way to fight back the few tractable elements that make up the fear of crime.
Juliette Jourdain-Dumont. Métier : infirmière de colonie
Authors: Simard Jean 
Published: November 2014

Dans les années 1930, le gouvernement du Québec ouvre des territoires à la colonisation pour favoriser l’établissement de familles touchées par la grande crise économique. Pour accompagner ces familles, le gouvernement crée des dispensaires qu’il confie à des « infirmières de colonie » pour faire les accouchements et fournir un service médical de première ligne, comme la vaccination et même de petites chirurgies. 174 postes furent ainsi créés dans la plupart des régions du Québec. Juliette Jourdain-Dumont fut l’une de ces infirmières qui exerça le métier à la dure dans le village de Saint-Dominique-du-Rosaire, près d’Amos, en Abitibi. De 1949 à 1952, elle y a fait 295 accouchements, sans en rater aucun. Elle raconte ici sa vie qui fut, à l’entendre et à la lire, une suite de joies que les inévitables difficultés aidaient simplement à préparer.
CD4+ cell count recovery in naïve patients initiating cART, who achieved and maintained plasma HIV‐RNA suppression
Authors: Costagliola Dominique , Lacombe Jean‐Marc , Ghosn Jade , Delaugerre Constance , Pialoux Gilles , Cuzin Lise , Launay Odile , Ménard Amélie , de Truchis Pierre , Mary‐Krause Murielle , Weiss Laurence , Delfraissy Jean‐François 
Published: November 2014

IntroductionA key objective of combined antiretroviral therapy (cART) is to reach and maintain high CD4 cell counts to provide long‐term protection against AIDS‐defining opportunistic infections and malignancies, as well as other comorbidities. However, a high proportion of patients present late for care. Our objective was to assess CD4 cell count recovery up to seven years in naïve patients initiating cART with at least three drugs in usual clinical care.MethodsFrom the French Hospital Database on HIV, we selected naïve individuals initiating cART from 2000 with at least two years of follow‐up. Participants were further required to have achieved viral load suppression by six months after initiating cART and were censored in case of virological failure. We calculated the proportion of patients (Kaplan‐Meier estimates) who achieved CD4 recovery to >500/mm3 according to baseline CD4 cell count.ResultsA total of 15,025 patients were analyzed with a median follow‐up on ART of 65.5 months (IQR: 42.3–96.0). At cART initiation, the median age was 38.6 years (IQR: 32.2–46.0), 9734 (64.8%) were men, median CD4 cell count was 239 (IQR: 130–336) and 2668 (17.8%) had a prior AIDS event. Results are presented in the Table 1.
KM estimates of achieving a CD4 cell count >500/mm3 over time according to baseline CD4 cell count at cART initiation

Baseline CD4+cell count, Median (IQR)
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7

CD4<200 (n=5909), 100 [39–156]
8% (7–9)
21% (20–22)
33% (31–34)
43% (42–45)
52% (50–54)
60% (58–61)
61% (59–62)

200≤CD4<350 (n=5751), 269 [235–305]
40% (39–42)
61% (60–62)
73% (72–74)
81% (580–82)
85% (84–86)
88% (87–89)
90% (89–91)

350≤CD4<500 (n=2252), 404 [374–443]
74% (72–76)
87% (85–88)
91% (90–92)
94% (93–95)
95% (93–96)
96% (95–98)
97% (95–98)

ConclusionsThis study shows that CD4 cell counts continue to increase seven years after cART initiation, whatever the baseline CD4 cell count. Failing to achieve CD4 recovery with continuous viral load suppression is rare for naïve patients initiating cART in routine clinical practice, but takes substantially longer in patients who initiate antiretroviral therapy at low CD4 cell counts.
Socio‐economic factors and virological suppression among people diagnosed with HIV in the United Kingdom: results from the ASTRA study
Authors: Burch Lisa , Smith Colette , Anderson Jane , Sherr Lorraine , Rodger Alison , O'Connell Rebecca , Gilson Richard , Elford Jonathan , Phillips Andrew , Speakman Andrew , Johnson Margaret , Lampe Fiona 
Published: November 2014

IntroductionIn the United Kingdom, rates of virological suppression on antiretroviral therapy (ART) are very high, but there remain a small but significant number of people on ART with detectable viraemia. The impact of socio‐economic factors on virological suppression has been little studied.Materials and MethodsWe used data from ASTRA, a cross‐sectional, questionnaire study of >3000 individuals from 8 clinics in the United Kingdom in 2011–2012, linked to clinical records to address this question. Included participants had received ART for >6 months with a recorded current viral load (VL) (latest at the time of questionnaire). Participants provided data on demographic factors: gender, sexual orientation, ethnicity and age; and socio‐economic factors: UK birth/English reading ability, employment, housing, education and financial hardship. To assess non‐adherence, participants were asked if in the past 3 months, they had missed ART for ≥2 days at a time. Virological suppression was defined as VL≤50 cps/mL. For each socio‐economic factor, we calculated prevalence ratios using modified Poisson regression, first adjusting for demographic factors, then also for non‐adherence.ResultsA total of 2445 people fulfilled the inclusion criteria (80% male, 69% MSM, median age: 46 years, median CD4 count: 556 cells/mm3); 10% (234/2445) had VL>50 cps/mL. After adjusting for demographic factors, non‐fluent English, not being employed, not home owning, education below university level and increasing financial hardship were each associated with higher prevalence of VL>50 cps/mL. Additional adjustment for non‐adherence largely attenuated each association, but did not fully explain them (see Table 1). After adjustment for non‐adherence and demographic factors, younger age was also associated with VL>50 cps/mL: for each additional 10 years an individual was 0.80 (95% CI 0.70–0.92) times as likely to have VL>50 cps/mL (p=0.0019). Adjusted prevalence ratios for VL>50cps/mL were 0.91 (0.62–1.34) for women and 1.25 (0.85–1.84) for non‐MSM men versus MSM, and 1.29 (0.92–1.80) for white versus non‐white people.ConclusionsAmong people on ART in the United Kingdom, the proportion with detectable VL is low. Poorer socio‐economic status is associated with increased probability of virological non‐suppression. It is likely that much of this association is mediated through difficulties in taking ART. Emphasis should be put on aiding the adherence of people in these higher risk groups.
Real‐world medication persistence with single versus multiple tablet regimens for HIV‐1 treatment
Authors: Sweet Donna , Song Jinlin , Zhong Yichen , Signorovitch James 
Published: November 2014

IntroductionAdherence to antiretroviral (ARV) treatment for HIV‐1 is crucial to achieving optimal clinical outcomes. Simplification of regimens with once‐daily single‐tablet regimens (STRs) can improve adherence compared to multi‐tablet regimens (MTRs). This study compared real‐world persistence (a proxy for treatment effectiveness and adherence) between HIV‐1 infected patients receiving STRs versus MTRs.Materials and MethodsAdult HIV‐1 infected patients starting their first observed ARV regimen (with at least six prior months of no ARV treatment) were identified in the MarketScan claims database (10/2008–03/2014). Persistence was measured as the time from the index regimen start date to the end of the first 90‐day gap between fills for any ARV in the index regimen, or to the start date of an ARV not in the index regimen. Persistence was described using Kaplan–Meier curves and compared using log‐rank tests, and Cox proportional hazards models adjusted for age, gender, insurance type, region, employment status, Charlson Comorbidity Index, other comorbidities, hospitalizations, emergency room visits and office visits. STRs were further stratified by regimen.ResultsA total of 3257 patients (37%) initiated MTRs, and 5484 (63%) initiated STRs, including 4409 on efavirenz (EFV)/tenofovir (TDF)/emtricitabine (FTC), 484 on rilpivirine (RPV)/TDF/FTC, and 591 on elvitegravir (EVG)/cobicistat (COBI)/TDF/FTC. Median persistence was 45.0 months for STRs versus 15.2 months for MTRs (P<0.001; Figure 1). Median persistence was not reached for RPV/TDF/FTC or EVG/COBI/TDF/FTC; 31 months after RPV/TDF/FTC approval for the treatment of HIV‐1 infection, more than 65% of patients who started on it remained persistent, and 19 months after EVG/COBI/TDF/FTC approval, more than 72% of patients who started on it remained persistent. Compared with MTRs, STRs had an approximately 50% lower hazard of discontinuation (adjusted hazard ratio [HR]=0.54, 95% CI 0.50–0.58). EVG/COBI/TDF/FTC and RPV/TDF/FTC had significantly longer unadjusted and adjusted persistence compared with EFV/TDF/FTC (Figure 2, Table 1).ConclusionsAmong HIV‐1 infected patients, the use of STRs was associated with longer regimen persistence compared with MTRs. Among STRs, EVG/COBI/TDF/FTC and RPV/TDF/FTC were associated with significantly longer persistence than EFV/TDF/FTC.
Patient preferences for characteristics of antiretroviral therapies: results from five European countries
Authors: Gazzard Brian , Ali Shehzad , Muhlbacher Axel , Ghafouri Neda , Maggiolo Franco , Golics Catherine , Nozza Silvia , Jose Fuster Maria , Antela Antonio , Jacques Parienti Jean , Dang Nathalie , Ronot Bregigeon Sylvie , Benzie Andrew , Murray Miranda 
Published: November 2014

IntroductionPatient preference to antiretroviral therapy (ART) characteristics should be a key consideration in treatment decisions. ART options exist for people living with HIV (PLWH), however concerns remain related to PLWH satisfaction with current ARTs. The current study examines patient preferences and the strength of preferences for treatment characteristics associated with ART.Materials and MethodsPatients’ preferences to ART were explored using a discrete choice experiment (DCE). Seven defined treatment characteristics (each with three categories) were identified from a literature review, input from experts, PLWH and physicians. A total of 1582 PLWH from France, Germany, Spain, Italy and the UK were recruited for the study. An adjusted odds ratio <1 signified lower odds of selecting a treatment with this characteristic category, compared to the reference category, independently of other characteristics.ResultsThe patient preference analyses showed that participants preferred treatments with a rapid reduction in viral load (OR=0.78; 95% CI 0.74–0.81) and CD4 count (OR=0.86; 95% CI=0.82–0.89). Participants had a strong preference for avoiding diarrhoea (Odds ratio, OR=0.36 95% CI=0.33–0.38) and long term health problems (OR=0.30, 95% CI=0.28–0.32). Convenience related issues related to restrictions on taking drugs because of food or drug interactions were important to avoid (OR=0.80, 95% CI=0.76–0.83 and OR=0.72 95% CI=0.69–0.76 respectively). Participants also had a strong preference to avoid drugs which limited the effectiveness of future treatments (OR=0.70, 95% CI=0.67–0.73).ConclusionsAvoidance of diarrhoea and long‐term complications were the most important drivers of patient choice. This study, from a large sample of European patients, demonstrates the importance to patients when different aspects of HIV treatment are considered simultaneously.
Comparison of oxidative stress markers in HIV‐infected patients on efavirenz or atazanavir/ritonavir‐based therapy
Authors: Estrada Vicente , Monge Susana , Gómez‐Garre Dulcenombre , Sobrino Paz , Berenguer Juan , Ignacio Bernardino Jose , Santos Jesús , Moreno Zamora Ana , Martínez Esteban , Ramón Blanco Jose 
Published: November 2014

IntroductionChronic low‐grade inflammation and immune activation may persist in HIV patients despite effective antiretroviral therapy (ART). These abnormalities are associated with increased oxidative stress (OS). Bilirubin (BR) may have a beneficial role in counteracting OS. Atazanavir (ATV) inhibits UGT1A1, thus increasing unconjugated BR levels, a distinctive feature of this drug. We compared changes in OS markers in HIV patients on ATV/r versus efavirenz (EFV)‐based first‐line therapies.Materials and MethodsCohort of the Spanish Research Network (CoRIS) is a multicentre, open, prospective cohort of HIV‐infected patients naïve to ART at entry and linked to a biobank. We identified hepatitis C virus/hepatitis B virus (HCV/HBV) negative patients who started first‐line ART with either ATV/r or EFV, had a baseline biobank sample and a follow‐up sample after at least nine months of ART while maintaining initial regimen and being virologically suppressed. Lipoprotein‐associated Phospholipase A2 (Lp‐PLA2), Myeloperoxidase (MPO) and Oxidized LDL (OxLDL) were measured in paired samples. Marker values at one year were interpolated from available data. Multiple imputations using chained equations were used to deal with missing values. Change in the OS markers was modelled using multiple linear regressions adjusting for baseline marker values and baseline confounders. Correlations between continuous variables were explored using Pearson's correlation tests.Results145 patients (97 EFV; 48 ATV/r) were studied. Mean (SD) baseline values for OS markers in EFV and ATV/r groups were: Lp‐PLA2 [142.2 (72.8) and 150.1 (92.8) ng/mL], MPO [74.3 (48.2) and 93.9 (64.3) µg/L] and OxLDL [76.3 (52.3) and 82.2 (54.4) µg/L]. After adjustment for baseline variables patients on ATV/r had a significant decrease in Lp‐PLA2 (estimated difference −16.3 [CI 95%: −31.4, −1.25; p=0.03]) and a significantly lower increase in OxLDL (estimated difference −21.8 [−38.0, −5.6; p<0.01] relative to those on EFV, whereas no differences in MPO were found. Adjusted changes in BR were significantly higher for the ATV/r group (estimated difference 1.33 [1.03, 1.52; p<0.01]). Changes in BR and changes in OS markers were significantly correlated.ConclusionsIn virologically suppressed patients on stable ART, OS was lower in ATV/r‐based regimens compared to EFV. We hypothesize these changes could be in part attributable to increased BR plasma levels.
Association between lipid genetic and immunological status in chronically HIV‐infected patients
Authors: Echeverría Patricia , Guardiola Montse , González Marta , Carles Vallvé Joan , Puig Jordi , Bonjoch Anna , Clotet Bonaventura , Ribalta Josep , Negredo Eugenia 
Published: November 2014

IntroductionPolymorphisms in some host genes have a significant impact on susceptibility to HIV‐1 infection and rate of disease progression [1, 2]. The purpose of the current sub‐study was to find out the relationship between polymorphisms in genes involved in the lipid metabolism and the CD4/CD8 T‐cell counts.MethodsSub‐study of a cross‐sectional, observational study conducted in 468 patients with HIV infection attended at the outpatient clinic to investigate individual genetic predisposition to atherogenic dyslipidemia (AD). All patients were genetically characterized and all polymorphisms were in Hardy–Weinberg equilibrium. Thirteen polymorphisms were selected from nine genes: APOA5 (rs662799 and rs3135506); APOC3 (rs5128 and rs4520); LPL (rs328 and rs268); CETP (rs708272); HL (rs1800588); MTP (rs1800591); APOE (rs7412 and rs429358); LRP5 (rs7116604); and VLDLR (rs1454626). Lipid and lipoprotein parameters, CD4 and CD8 T‐cell counts and plasma HIV‐RNA were determinate. The statistical analysis was performed using SPSS statistical software version 19 (SPSS Inc., Chicago, IL, USA).ResultsWe studied 468 HIV‐infected patients (men, 77%), with a mean (SD) age of 45.9 (19.7) years. The mean CD4 T‐cell count and nadir CD4 was 547 (459) and 193 (159) cells/µL, respectively; 78.7% of participants were virologically suppressed. Patients carrying rs3135506 in the APOA5 gene presented a 9% increase in circulating TG levels (p=0.002) and 10% decrease in HDLc levels (p=0.005). Such association of APOA5 towards dyslipidemia was accompanied by a 21% decrease of the CD4 T‐cell count (p=0.024) and a 19% increase in CD8 T‐cell count (p=0.002) in carriers of the rare allele in the APOA5 rs662799 polymorphism adjusted by age and gender. Patients carrying the rare allele in rs5128 (APOC3) had a 16% decrease in circulating CD4 T cells (p=0.029); patients carrying rs1800591 (MTP) had a 29% decrease in CD4 T cells and 14% decrease in CD8 T cells (p=0.018 and p=0.008, respectively); patients carrying the rare allele rs1800588 in HL had a 11% increase in CD4 T cells (p=0.043); and carriers of the rs145626 in the VLDLR gene had 10% decrease in CD4 circulating T cells (p=0.013).ConclusionVariants in genes involved in the development of AD may also influence the immunological host–virus equilibrium in chronically HIV‐infected subjects [2, 3].
The impact of tenofovir disoproxil fumarate on kidney function: four‐year data from the HIV‐infected outpatient cohort
Authors: Monteiro Nadine , Branco Margarida , Peres Susana , Borges Fernando , Mansinho Kamal 
Published: November 2014

IntroductionWith improvements in survival and disease progression in the era of combined antiretroviral therapy, complications such as kidney disease are becoming increasingly prevalent in HIV‐infected patients. Tenofovir disoproxil fumarate (TDF) has been associated with nephrotoxicity, including decline in glomerular filtration rate, proximal tubular damage and acute kidney injury.ObjectiveCharacterize kidney safety of TDF‐containing antiretroviral treatment (ART) regimens in HIV‐infected patients.MethodsNon‐controlled, observational, retrospective study was based on the clinical files registry of HIV patients who started TDF between January and December 2008. We assessed outpatients followed at a single Portuguese center. Demographic, clinical, virological and immunological data at baseline were collected. Serum creatinine, estimated glomerular filtration rate (eGFR) and creatinine clearance (CrCL) were assessed at baseline, after six months and every year up to four years. CrCL and eGFR were calculated by Cockroft–Gault and Modification of Diet in Renal Disease equations, respectively.ResultsA total of 176 patients (71.6% males) with a mean age of 43 years were enrolled. Ninety‐six (52%) were ART‐naive patients at TDF initiation. At baseline 12.5% had hypertension, 4% diabetes, 25% chronic hepatitis C and 9% chronic hepatitis B infections; 58% had normal renal function (eGFR ≥90 ml/min/1.73 m2), 36% had mild (eGFR 60‐89 ml/min/1.73 m2) renal dysfunction and 2.3% had moderate (eGFR 30‐59 ml/min/1.73 m2) renal dysfunction at initiation of TDF. Eighty‐three (47%) patients were on protease inhibitors and the remaining on NNRTIs containing regimens. During 48 months follow‐up, 5% experienced moderate renal dysfunction and 1.7% severe renal dysfunction. Twenty‐one (12%) patients met the definition criteria of rapid decline of renal function (annual decline of eGFR ≥3 ml/min/1.73 m2 in two consecutive years). The development of kidney events was associated with age above 50 years, presence of comorbidities and advanced stage HIV infection (p>0.05 in univariate analysis).ConclusionsThese data reveal a favourable renal safety profile of TDF, during a four‐year follow‐up. Screening for kidney disease markers, regular follow‐up and control and prevention of risk factors for renal failure are crucial for adequate management of HIV‐infected patients.
Relationship between body mass index and bone mineral density in HIV‐infected patients referred for DXA
Authors: Pinnetti Carmela , Federico Lupi , Lorenzini Patrizia , Domenico Chiappetta , Rita Bellagamba , Laura Loiacono , Zaccarelli Mauro , Cicalini Stefania , Libertone Raffaella , Giannetti Alberto , Mosti Silvia , Busi Rizzi Elisa , Antinori Andrea , Ammassari Adriana 
Published: November 2014

IntroductionReduced bone mass density (BMD) is a frequent observation in HIV‐infected persons. Relationship between body mass index (BMI), weight, height and BMD was reported for many populations. In particular, BMI has been found to be inversely related to the risk of osteoporosis.MethodsThis is a cross‐sectional, monocentric study where all HIV‐infected patients referred to first DXA scan in clinical routine during 2010–2013 were included. Osteopenia and osteoporosis were defined by T‐ score <−1 and <−2.5, respectively. Patients were categorized according to WHO BMI classification: underweight <18.5 kg/m2; normal weight 18.5–24.9 kg/m2; over weight 25–29.9 kg/m2; obese >30 kg/m2. Statistical analysis was carried using logistic regression.ResultsA total of 918 patients were included: median age 49 years (IQR, 44–55); 59.4% male; 93% Caucasian. Median anthrometric characteristics were: 68 kg (IQR, 59–78); 1.7 m (IQR, 1.6–1.75); 23.5 kg/m2 (IQR, 21.4–26.2). Underweight was found in 5%, normal weight in 61%, overweight in 26% and obesity in 8% of patients. According to T‐scores, 110 (11.2%) patients were osteoporotic and 502 (54.7%) had osteopenia. In the femoral neck area, the prevalence of osteoporosis was slightly lower (5.7%) than lumbar spine site (9.2%). Agreements between sites of T‐scores for the diagnosis of osteoporosis were 26 and 172 and 346 for osteopenia and normal BMD values, respectively. T‐scores at femoral neck or lumbar spine positively correlated with BMI (p<0.001) (Figure 1). Among predictors of osteopenia/osteoporosis, univariable analysis showed: older age (p<0.0001); lower weight (p<0.0001); increasing height (p<0.002). Patients underweight had a higher risk of osteopenia (p=0.02) as well as of osteoporosis (p=0.003). Patients with BMI above normal had a reduced risk of low BMD (osteopenia p<0.0001; osteoporosis p<0.03). Controlling for calendar year, gender, ethnicity, and age, BMI was confirmed as risk factor if below normal (AdjOR of osteopenia 2.42 [95% CI 1.16–5.07] p=0.02; AdjOR of osteoporosis 3.22 [95% CI 1.60–6.49] p=0.001).ConclusionsOur findings indicate that almost 66% of HIV‐infected patients have subnormal bone mass. Further, as in other patient populations, in the HIV infection also low BMI is an important risk factor for osteopenia/osteoporosis. This finding highlights the compelling need for standardized screening actions, particularly in patients weighting below normal.