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Find video protocols related to scientific articles indexed in Pubmed.
Psychiatric Diagnoses among an HIV-Infected Outpatient Clinic Population.
J Int Assoc Provid AIDS Care
PUBLISHED: 10-29-2014
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As individuals with HIV infection are living longer, the management of psychiatric disorders has increasingly been incorporated into comprehensive care. Individuals were recruited from an outpatient HIV clinic to assess the prevalence and related associations of current psychiatric disorders and biomarkers. Of the 201 participants who completed the interviews, the median age was 43.5 years, and the majority was male and African American. Most were receiving HIV therapy and 78% of those had achieved virologic suppression. Prevalent psychiatric diagnoses included major depressive disorder, generalized anxiety, and agoraphobia. Alcohol and cocaine/crack abuse and dependence were common substance use disorders. Current receipt of HIV therapy was less common among those diagnosed with generalized anxiety disorder. Agoraphobia was the only disorder associated with unsuppressed viral load. Psychiatric and substance use disorders are highly prevalent among an urban HIV clinic population, although we identified few associations between psychiatric diagnoses and HIV diseases status.
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Impact of Poor Retention in HIV Medical Care on Hepatitis B Vaccination.
J Int Assoc Provid AIDS Care
PUBLISHED: 10-11-2014
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We identified factors associated with complete hepatitis B vaccination of patients with HIV.
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Current Practices of Screening for Incident Hepatitis C Virus (HCV) Infection Among HIV-Infected, HCV-Uninfected Individuals in Primary Care.
Clin. Infect. Dis.
PUBLISHED: 09-03-2014
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?Human immunodeficiency virus (HIV)-infected, hepatitis C virus (HCV)-uninfected patients are at risk for incident HCV infection, but little is known about screening practices for incident HCV among HIV-infected individuals in HIV primary care clinics.
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HIV-related metabolic comorbidities in the current ART era.
Infect. Dis. Clin. North Am.
PUBLISHED: 08-25-2014
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Despite effective antiretroviral therapy (ART), HIV-infected individuals have residual chronic immune activation that contributes to the pathogenesis of HIV infection. This immune system dysregulation is a pathogenic state manifested by very low naïve T-cell numbers and increased terminally differentiated effector cells that generate excessive proinflammatory cytokines with limited functionality. Immune exhaustion leaves an individual at risk for accelerated aging-related diseases, including renal dysfunction, atherosclerosis, diabetes mellitus, and osteoporosis. We highlight research that clarifies the role of HIV, ART, and other factors that contribute to the development of these diseases among HIV-infected persons.
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Intranasal seasonal influenza vaccine and a TLR-3 agonist, rintatolimod, induced cross-reactive IgA antibody formation against avian H5N1 and H7N9 influenza HA in humans.
Vaccine
PUBLISHED: 08-13-2014
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The intranasal use of rintatolimod, a specific TLR-3 agonist, combined with trivalent seasonal influenza vaccine generated cross-protection against highly pathogenic H5N1 avian influenza in mice. The purpose of this clinical trial is to assess the safety and impact of rintatolimod on intranasal influenza vaccine in healthy adults. During Stage I of this Phase I/II clinical trial, 12 volunteers were immunized intranasally with 3 doses of FluMist seasonal influenza vaccine on Days 0, 28, and 56 followed by intranasal rintatolimod (50 ?g, 200 ?g, or 500 ?g) 3 days later. Parotid saliva and nasal wash samples were collected at baseline and on Days 25, 53, 84, and 417. The samples were tested for IgA and IgG specific antibodies (Ab) directed against the homologous FluMist viral hemagglutinins (HAs). In addition, viral specific responses against influenza A HAs were tested for IgA Ab cross-reactivity against 3 H5 clades: HA (H5N1) A/Indonesia/5/2005, HA (H5N1) A/Hong Kong/483/97 and HA (H5N1) A/Vietnam/1194/2004, as well as, two H7 strains, HA (H7N9) A/Shanghai/2/2013 and HA (H7N3) A/chicken/Jalisco/CPA1. The combination of the intranasal FluMist along with the rintatolimod generated specific secretory IgA responses of at least 4-fold over baseline against at least one of the homologous vaccine strains included in the vaccine in 92% of the vaccinees. Additionally, this vaccination strategy induced cross-reactive secretory IgA against highly pathogenic avian influenza virus strains H5N1, H7N9, and H7N3 with pandemic potential for humans. The combination of rintatolimod and FluMist was well-tolerated.
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Metabolic complications of HIV infection and its therapies.
Top Antivir Med
PUBLISHED: 08-08-2014
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Non-AIDS morbidity and mortality are increasingly common in the HIV-infected population. Chronic inflammation and immunosenescence result in early onset of conditions associated with aging, including atherosclerosis and frailty. Risk for non-AIDS-related morbidity is also related to the metabolic effects of antiretroviral therapy and the increased prevalence of traditional cardiovascular and other risk factors in the HIV-infected population. Risk reduction is centered on maintaining full viral suppression and aggressively implementing measures to reduce standard modifiable risk factors. This article summarizes a presentation by Edgar Turner Overton, MD, at the IAS-USA continuing education program held in New York, New York, in October 2013.
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Bone alterations associated with HIV.
Curr HIV/AIDS Rep
PUBLISHED: 07-28-2014
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HIV infection and initiation of antiretroviral therapy (ART) have been consistently associated with decreased bone mineral density (BMD), with growing evidence linking HIV to an increased risk of fracture. This is especially concerning with the expanding number of older persons living with HIV. Interestingly, recent data suggest that HIV-infected children and youth fail to achieve peak BMD, possibly increasing their lifetime risk of fracture. Elucidating the causes of the bone changes in HIV-positive persons is challenging because of the multifactorial nature of bone disease in HIV, including contribution of the virus, immunosuppression, ART toxicity, and traditional osteoporosis risk factors, such as age, lower weight, tobacco, and alcohol use. Thus, practitioners must recognize the risk of low BMD and fractures and appropriately screen patients for osteoporosis if risk factors exist. If fractures do occur or elevated fracture risk is detected through screening, treatment with bisphosphonate medications appears safe and effective in the HIV+population.
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Preliminary outcomes of a pilot physical therapy program for HIV-infected patients with chronic pain.
AIDS Care
PUBLISHED: 07-26-2014
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Chronic pain in HIV-infected individuals is common and often undertreated. Physical therapy (PT) is an evidence-based nonpharmacologic treatment for chronic pain. Our objective is to present the results of a pilot PT program in an HIV pain/palliative care clinic, which is embedded within a Ryan White-funded multidisciplinary HIV primary care clinic. Medical records of HIV-infected patients participating in a PT program between November 2012 and July 2013 were retrospectively reviewed. Pain scores on a 0-10 scale and cost data were collected and analyzed. Among 43 patients referred, 27 collectively attended 86 sessions. Median age of enrolled patients was 54 (IQR 49-58). Sixteen (59%) were African-American and 20 (77%) had an undetectable HIV viral load. Mean pain score at initial visit was 6.5 (SD = 1.1). The average session-level decrease was 2.6 (SD = 1.7) and patient-level decrease was 2.5 (SD = 1.2). The largest payors were Medicare managed care (28%), Medicaid (21%), and Ryan White grant-related funds (18%). When the first four months of the program are excluded to account for slow start-up, the program's monthly net revenue during the remaining five months was $163. We present preliminary data from a low-cost pilot PT program integrated into an HIV clinic in a primary care setting associated with clinically significant improvements in pain. Further investigation into the implementation of such programs is essential.
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Persistent HIV-related stigma among an outpatient US clinic population.
Int J STD AIDS
PUBLISHED: 05-16-2014
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Summary Despite advancements in the public's understanding of HIV infection, felt stigma towards individuals living with HIV persists. Stigma has been associated with adverse health outcomes, including poor adherence to care, and increased participation in HIV transmission risk behaviours. We evaluated the level of felt stigma and its relationship to other psychosocial and medical factors among a sample of 201 individuals with HIV engaged in care. The overall mean stigma score, as measured by the Reece Stigma Scale, was 21.7 (SD 8.7). In univariate analysis, felt stigma scores were higher among women, African Americans, younger participants, and individuals with less education. Higher felt stigma scores were also found among individuals who reported having fair to poor overall health, moderate to severe symptoms of depression and anxiety, and those with a current diagnosis of alcohol dependence, generalised anxiety disorder, agoraphobia, pain disorder, and current smokers. Higher felt stigma scores were independently associated with individuals with anxiety symptoms. These analyses highlight that stigma persists among individuals with HIV and may play an important role in HIV care. The relationship between psychiatric disorders and psychosocial factors highlights an opportunity to develop interventions that will address these common comorbidities and reduce stigma.
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Beliefs, experience, and interest in pharmacotherapy among smokers with HIV.
Am J Health Behav
PUBLISHED: 03-18-2014
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To examine beliefs, prior use, and interest in using pharmacotherapy among people living with HIV/AIDS (PLWHA).
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Improving cervical cancer screening rates in an urban HIV clinic.
AIDS Care
PUBLISHED: 03-13-2014
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Human immunodeficiency virus (HIV)-infected women are at increased risk of invasive cervical cancer; however, screening rates remain low. The objectives of this study were to analyze a quality improvement intervention to increase cervical cancer screening rates in an urban academic HIV clinic and to identify factors associated with inadequate screening. Barriers to screening were identified by a multidisciplinary quality improvement committee at the Washington University Infectious Diseases clinic. Several strategies were developed to address these barriers. The years pre- and post-implementation were analyzed to examine the clinical impact of the intervention. A total of 422 women were seen in both the pre-implementation and post-implementation periods. In the pre-implementation period, 222 women (53%) underwent cervical cancer screening in the form of Papanicolaou (Pap) testing. In the post-implementation period, 318 women (75.3%) underwent cervical cancer screening (p < 0.01). Factors associated with lack of screening included fewer visits attended (pre: 4.2 ± 1.5; post: 3.4 ± 1.4; p < 0.01). A multidisciplinary quality improvement intervention was successful in overcoming barriers and increasing cervical cancer screening rates in an urban academic HIV clinic.
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Depression severity is associated with increased risk behaviors and decreased CD4 cell counts.
AIDS Care
PUBLISHED: 01-30-2014
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Depression is a common comorbidity among HIV-infected individuals. We studied the relationship between depressive symptoms, risk behaviors (risky-sexual behavior, tobacco, alcohol, and illicit drug use) and HIV outcomes. This cross-sectional study conducted in 2009 at the Washington University HIV Clinic included screening for depression with patient health questionnaire, survey of sexual behavior, illicit drug, alcohol, and tobacco use within 30 days. Sociodemographics, plasma HIV RNA levels, CD4 cell counts, and sexually transmitted disease test results were obtained from medical records. Multivariate logistic and linear regression models were used to assess the association between depressive symptoms severity and risk behaviors, HIV outcomes and combination antiretroviral therapy (cART) adherence. A total of 624 persons completed the assessment of whom 432 (69%) were male and 426 (68%) African-American. The median CD4 cell count was 410 cells/mm(3) and 479 persons (77%) were on cART of whom 112 (23%) had HIV RNA level > 400 copies/mL. Overall, 96 (15%) had symptoms of major depressive disorder. Depressive symptom severity was associated with increased likelihood of high-risk drinking (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1-5.1), current tobacco use (OR, 1.8; 95% CI, 1.1-2.9), illicit drug use (OR, 1.7; 95% CI, 1.0-2.8), and risky-sexual behavior (OR, 1.5; 95% CI, 0.8-2.7). Suboptimal cART adherence (visual analog scale < 95%) was also associated with depressive symptoms severity (p < 0.05). After adjustment for age, sex, race, receipt of cART, and cART adherence, depressive symptoms severity was independently associated with lower CD4 cell count (p < 0.05) but not with higher HIV RNA level (p = 0.39). Depression adversely affects HIV-infected individuals, requiring greater effort at utilizing multidisciplinary interventions.
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Metabolic consequences of HIV: pathogenic insights.
Curr HIV/AIDS Rep
PUBLISHED: 01-07-2014
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With the advances in antiretroviral therapy (ART), HIV infection has been transformed into a chronic medical condition that can be effectively managed like diabetes or hypertension. For HIV care providers, the focus of care for many patients has shifted from prevention of opportunistic infection and AIDS-related conditions to age-related cardiometabolic comorbidities, including cardiovascular disease, diabetes, obesity, and frailty. Numerous reports have highlighted that these diseases are occurring at an earlier age among HIV-infected persons. However, there is an ongoing debate regarding the role of HIV infection, ART, and other factors that may underlie the accelerated occurrence of these diseases. Herein, we review the epidemiology of the US HIV epidemic with regards to several metabolic comorbidities and address mechanisms that likely contribute to the current nature of HIV disease.
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Pilot study of pioglitazone and exercise training effects on basal myocardial substrate metabolism and left ventricular function in HIV-positive individuals with metabolic complications.
HIV Clin Trials
PUBLISHED: 12-17-2013
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Individuals with HIV infection and peripheral metabolic complications have impaired basal myocardial insulin sensitivity that is related to left ventricular (LV) diastolic dysfunction. It is unknown whether interventions shown to be effective in improving peripheral insulin sensitivity can improve basal myocardial insulin sensitivity and diastolic function in people with HIV and peripheral metabolic complications.
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Pain is Independently Associated with Impaired Physical Function in HIV-Infected Patients.
Pain Med
PUBLISHED: 10-09-2013
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Human immunodeficiency virus (HIV)-infected patients in the current treatment era can achieve normal life expectancies but experience a high degree of medical and psychiatric comorbidity. Impaired physical function and pain, often in the context of mood disorders and substance abuse, are common in HIV-infected patients. The objective of this study was to investigate the relationship of pain, a modifiable condition, to functional impairment in HIV-infected patients, independent of mood disorders and substance abuse.
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Identifying Risk Factors for HIV-Associated Neurocognitive Disorders Using the International HIV Dementia Scale.
J Neuroimmune Pharmacol
PUBLISHED: 09-19-2013
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HIV-associated neurocognitive disorders (HAND) persist despite great advancements in combination antiretroviral therapy (cART). The gold standard for diagnosing cognitive impairment consists of a time-consuming neuropsychological battery of tests given by a trained neuropsychologist, however in the outpatient HIV clinic this is not feasible. The International HIV Dementia Scale (IHDS) was developed to help identify individuals with cognitive impairment in the outpatient setting. The IHDS is moderately sensitive for detecting more symptomatic forms of HAND but sensitivity has been shown to be poor in mild impairment. The IHDS has not been evaluated in developed countries in large cohort populations. We conducted a prospective cross-sectional study of only HIV+ individuals in an urban clinic and evaluated the prevalence of HAND and associated risk factors for cognitive impairment using the IHDS. A total of 507 HIV+ individuals participated in the study of which the majority were male (65 %) and African American (68 %); and 41 % had cognitive impairment. On multivariate analysis, African American race (p?=?2.21), older age (p?=?1.03), high school education or less (p?=?2.03) and depression (p?=?1.05) were associated with cognitive impairment. The high prevalence of HAND in this group suggests that more severe forms of HAND persist despite cART. Identified risk factors were non-HIV-related and suggest that environmental and sociodemographic factors have a significant impact on cognitive functioning and should be given more attention. The IHDS should be further evaluated in large cohort HIV+ and HIV- populations in the United States, as there remains a significant need to identify an effective brief screening tool for cognitive impairment.
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Parks as a Tool for HIV Management.
J Int Assoc Provid AIDS Care
PUBLISHED: 09-03-2013
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Access to parks improves overall health outcomes in the general population. Given that HIV infection has become a chronic disease to manage, among populations engaged in medical care, parks may be promoted as physical activity opportunities in order to manage chronic comorbid conditions. We conducted a cross-sectional examination of the relationships between sociodemographic and biomedical characteristics to park proximity among 635 individuals receiving outpatient HIV care. The data collected included HIV-related biomarkers, depression, and diagnoses of other chronic diseases. The total acres of parks an individual is exposed within one-quarter mile from their home were assessed. The cohort included 635 individuals (67% men, 73% black, and 21% white, mean age 42 years). Unemployment was negatively associated with park availability. Park proximity was not associated with depression or HIV biomarkers. As yet, little effort has been committed to promoting park usage as a low-cost, sustainable method to addressing comorbidities among individuals with HIV.
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Relationships among HIV infection, metabolic risk factors, and left ventricular structure and function.
AIDS Res. Hum. Retroviruses
PUBLISHED: 05-06-2013
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Our objective was to determine if the presence of metabolic complications (MC) conveyed an additional risk for left ventricular (LV) dysfunction in people with HIV. HIV? and HIV? men and women were categorized into four groups: (1) HIV? with MC (43±7 years, n=64), (2) HIV? without MC (42±7 years, n=59), (3) HIV? with MC (44±8 years, n=37), or (4) HIV? controls without MC (42±8 years, n=41). All participants underwent two-dimensional (2-D), Doppler, and tissue Doppler echocardiography. Overall, the prevalence of systolic dysfunction (15 vs. 4%, p=0.02) and LV hypertrophy (9 vs. 1%, p=0.03) was greater in HIV? than in HIV? participants. Participants with MC had a greater prevalence of LV hypertrophy (10% vs. 1%). Early mitral annular velocity during diastole was significantly (p<0.005) lower in groups with MC (HIV?/MC?: 11.6±2.3, HIV?/MC?: 12.0±2.3 vs. HIV?/MC?: 12.4±2.3, HIV?/MC?: 13.1±2.4 cm/s) and tended to be lower in groups with HIV (p=0.10). However, there was no interaction effect of HIV and MC for any systolic or diastolic variable. Regardless of HIV status, participants with MC had reduced LV diastolic function. Although both the presence of MC and HIV infection were associated with lower diastolic function, there was no additive negative effect of HIV on diastolic function beyond the effect of MC. Also, HIV was independently associated with lower systolic function. Clinical monitoring of LV function in individuals with metabolic risk factors, regardless of HIV status, is warranted.
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The Alzheimers disease-8 and Montreal Cognitive Assessment as screening tools for neurocognitive impairment in HIV-infected persons.
J. Neurovirol.
PUBLISHED: 01-24-2013
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The diagnosis of human immunodeficiency virus (HIV)-associated neurocognitive impairment is time-intensive and often omitted in busy outpatient settings. Brief screening tools are needed. The Montreal Cognitive Assessment (MoCA) and the Alzheimers disease (AD)-8 have been used in neurodegenerative disorders. We evaluated the sensitivity and specificity of these brief screening tools in HIV-infected persons. The AD-8, MoCA, and formal neuropsychological testing were administered to 200 HIV-infected patients who were followed at a single institution. Normalized scores on formal neuropsychological testing were used to define neurocognitive impairment. The sensitivity and specificity of the MoCA and AD-8 were assessed to diagnose the impairment. Neurocognitive impairment was highly prevalent in this cohort: 127 persons (64 %) were diagnosed with neurocognitive impairment based on formal testing. Using the AD-8 and MoCA, 113 (57 %) and 101 (51 %) persons were identified with neurocognitive impairment, respectively. The sensitivity and specificity of MoCA were 63 % and 71 %, respectively. The sensitivity and specificity of AD-8 were 61 % and 51 %, respectively. Our findings highlight that brief screening tools correlate with formal neuropsychological testing. However, the sensitivities of these screening tools are lower than desired. Nevertheless, given their ease in administration, these tools could assist as a first line for identifying individuals who may subsequently require formal neuropsychological testing.
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Serostatus disclosure among adults with HIV in the era of HIV therapy.
AIDS Patient Care STDS
PUBLISHED: 11-22-2011
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Serostatus disclosure is an important component of secondary HIV prevention with potential benefits for both the individual by experiencing increased social support and society by reducing HIV transmission risk behaviors. This cross-sectional study assessed disclosure patterns to sex partners, family members, and friends by sociodemographic and HIV-related factors among an urban, Midwestern U.S. HIV clinic population (n = 809); a majority of whom were African American and male with a mean age of 41 years. Almost three quarters (n = 596) of the sample was currently receiving HIV therapy, with 68% (n = 404) successfully suppressing their HIV viral loads. Among sexually activity individuals, 97% reported disclosing their serostatus to sex partners. This high rate of disclosure to sex partners suggests that social desirability may play a role in this self-reported measure. Approximately half of the sample (n = 359) disclosed to at least one family member and 60% (n = 474) disclosed to at least one friend. Disclosing to family members occurred more often among participants who were unemployed and endorsed depressive disorder symptoms (p < 0.05 for all). Disclosing to friends occurred more frequently among women, Caucasians and those who completed higher levels of education (p < 0.001 for all). HIV disclosure and disease severity were unassociated. Given the chronic nature of HIV care, additional research is needed to develop interventions to facilitate timely disclosure of HIV serostatus.
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Performances on the CogState and standard neuropsychological batteries among HIV patients without dementia.
AIDS Behav
PUBLISHED: 08-31-2011
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HIV-associated neurocognitive disorders remain prevalent but challenging to diagnose particularly among non-demented individuals. To determine whether a brief computerized battery correlates with formal neurocognitive testing, we identified 46 HIV-infected persons who had undergone both formal neurocognitive testing and a brief computerized battery. Simple detection tests correlated best with formal neuropsychological testing. By multivariable regression model, 53% of the variance in the composite Global Deficit Score was accounted for by elements from the brief computerized tool (P < 0.01). These data confirm previous correlation data with the computerized battery. Using the five significant parameters from the regression model in a Receiver Operating Characteristic curve, 90% of persons were accurately classified as being cognitively impaired or not. The test battery requires additional evaluation, specifically for identifying persons with mild impairment, a state upon which interventions may be effective.
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Transmitted drug-resistant HIV type 1 remains prevalent and impacts virologic outcomes despite genotype-guided antiretroviral therapy.
AIDS Res. Hum. Retroviruses
PUBLISHED: 08-30-2011
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Trends in transmitted drug resistance-associated mutations (TDRM) in HIV-1infection vary depending on geographic and cohort characteristics. The impact of TDRM among patients receiving fully active combination antiretroviral therapy (cART) is poorly characterized. This was a retrospective study of 801 HIV-1-infected treatment-naive patients from 2001 to 2009 who had pre-cART genotype resistance test results available. The prevalence of TDRM was compared for each year strata. Multivariate Cox proportional hazards regression models were used to assess factors associated with virologic failure at 48 weeks. TDRM was detected in 136 (17%) patients with ?2 class TDRM in 20 patients. K103N/S was the most frequent (n=77). There were no changes in the prevalence of mutations over time (P(trend)=0.67). Six hundred and eleven patients were started on cART. Virologic failure occurred in 38% of those with TDRM and 24% of those without (p<0.01). In multivariate analysis, nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance was associated with a 1.5-fold increased risk of virologic failure. TDRM remains common among treatment-naive HIV-1-infected patients, affecting one in six patients. Transmission of NNRTI drug resistance was associated with risk of virologic failure despite initiation of genotype-guided cART.
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Effects of human immunodeficiency virus and metabolic complications on myocardial nutrient metabolism, blood flow, and oxygen consumption: a cross-sectional analysis.
Cardiovasc Diabetol
PUBLISHED: 08-26-2011
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In the general population, peripheral metabolic complications (MC) increase the risk for left ventricular dysfunction. Human immunodeficiency virus infection (HIV) and combination anti-retroviral therapy (cART) are associated with MC, left ventricular dysfunction, and a higher incidence of cardiovascular events than the general population. We examined whether myocardial nutrient metabolism and left ventricular dysfunction are related to one another and worse in HIV infected men treated with cART vs. HIV-negative men with or without MC.
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Progression of carotid intima-media thickness in a contemporary human immunodeficiency virus cohort.
Clin. Infect. Dis.
PUBLISHED: 08-22-2011
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Persons with human immunodeficiency virus (HIV) infection are at risk for premature cardiovascular disease (CVD). Predictors of atherosclerotic disease progression in contemporary patients have not been well described.
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Effect of abacavir on acute changes in biomarkers associated with cardiovascular dysfunction.
Antivir. Ther. (Lond.)
PUBLISHED: 08-16-2011
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This study examined the effect of abacavir on acute changes in biomarkers associated with cardiovascular dysfunction.
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Cystatin C and baseline renal function among HIV-infected persons in the SUN Study.
AIDS Res. Hum. Retroviruses
PUBLISHED: 05-25-2011
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In the combination antiretroviral therapy (cART) era, renal dysfunction remains common. The Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) (ClinicalTrials.gov number, NCT00146419) is a prospective observational cohort study of HIV-infected adults. At baseline, comprehensive data were collected, including cystatin C and measures of renal function. Univariate and multivariate regression analyses were performed to identify factors associated with baseline renal dysfunction [estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m(2) calculated using the simplified Modification of Diet in Renal Disease equation] and elevated cystatin C (>1.0 mg/liter) in a cross-sectional analysis. Among 670 subjects with complete data (mean age 41 years, mean CD4 cell count 530 cells/mm(3), 79% prescribed cART), the mean eGFR was 96.8 ml/min/1.73 m(2). Forty percent of subjects had renal dysfunction; 3.3% had chronic kidney disease (eGFR < 60 ml/min/1.73 m(2)). Elevated cystatin C was present in 18% of subjects. In multivariate analysis, renal dysfunction was associated with older age, non-Hispanic white race/ethnicity, higher body mass index (BMI), hypertension, higher cystatin C levels, and current prescription of ritonavir. Factors associated with elevated cystatin C included hepatitis C coinfection, hypertension, current smoking, older age, current tenofovir use, detectable plasma HIV RNA, and elevated microalbuminuria. The prevalence of chronic kidney disease (CKD) was low in this contemporary HIV cohort. However, mild to moderate renal dysfunction was common despite the widespread use of cART.
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The Rapidly Evolving Research on Vitamin D Among HIV-Infected Populations.
Curr Infect Dis Rep
PUBLISHED: 02-11-2011
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With ongoing improvement in antiretroviral therapy, mortality among HIV-infected persons has dramatically decreased. For HIV-infected persons who remain engaged in care on suppressive therapy, life expectancy approaches that of the general population. Additionally, we have seen increases in comorbidities traditionally associated with aging: diabetes, hypertension, dyslipidemia, ischemic heart disease, and osteoporosis. Vitamin D deficiency has also been identified as a highly prevalent entity among HIV-infected populations. The association of vitamin D deficiency with several of these comorbidities and its impact on immune function provide the impetus for well-designed studies to evaluate the impact of vitamin D supplementation on HIV disease and antiretroviral therapy. This review summarizes the role of vitamin D in several disease states that are prevalent among HIV populations, with a specific focus on bone health and the interactions with antiretroviral medications.
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Factors associated with non-adherence to antiretroviral therapy in the SUN study.
AIDS Care
PUBLISHED: 02-05-2011
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Adherence of 95% or greater to highly active combination antiretroviral therapy is generally considered necessary to achieve optimal virologic suppression in HIV-infected patients. Understanding factors associated with poor adherence is essential to improve patient compliance, maximize virologic suppression, and reduce morbidity and mortality.
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Perceptions of alcohol risk among individuals living with HIV.
AIDS Care
PUBLISHED: 01-11-2011
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The documented prevalence of alcohol use among individuals with HIV is higher than reported among the general public. Little is known about how populations with HIV perceive the risks of alcohol use and what they consider to be safe levels of consumption. This qualitative study was conducted to increase understanding of the situations and environments in which alcohol is consumed and to explore the perceptions of risks among individuals with HIV, who were engaged in medical care and using alcohol regularly. Nineteen qualitative semi-structured individual interviews were conducted. The major themes that arose from these analyses were patterns of alcohol use, perceptions of risk based on the type of alcohol used, and the impact alcohol had on health. Findings suggest that alcohol is used regularly with little perception of risk; alcohol is perceived to have little effect on health and HIV progression; and providers rarely discuss alcohol use with patients. Future research includes assessment of alcohol use and the delivery of brief interventions to improve general health and HIV-related outcomes.
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Low vitamin D among HIV-infected adults: prevalence of and risk factors for low vitamin D Levels in a cohort of HIV-infected adults and comparison to prevalence among adults in the US general population.
Clin. Infect. Dis.
PUBLISHED: 01-11-2011
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we explored serum 25-hydroxyvitamin D (25[OH]D) levels and associated factors for insufficiency or deficiency in an adult human immunodeficiency virus (HIV) cohort and compared 25(OH)D levels with those in the general US population.
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A review of premature frailty in HIV-infected persons; another manifestation of HIV-related accelerated aging.
Curr Aging Sci
PUBLISHED: 01-06-2011
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HIV-related immunological and multisystem accelerated aging contributes to the premature occurrence of age-related comorbidities. Such non-AIDS-defining comorbidities include cardiovascular disease, dyslipidemia, osteoporosis and frailty, and are of increasing importance with improved survival on antiretrovirals. This review will describe the underlying pathogenesis of HIV-related accelerated aging and will thereafter focus on frailty, a clinical concept which has only recently been studied in the HIV field.
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High Prevalence of Echocardiographic Abnormalities among HIV-infected Persons in the Era of Highly Active Antiretroviral Therapy.
Clin. Infect. Dis.
PUBLISHED: 12-09-2010
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in the era of highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV)-infected persons have higher cardiovascular disease risk. Little is known about asymptomatic abnormalities in cardiac structure and function in this population.
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Exercise training augments the peripheral insulin-sensitizing effects of pioglitazone in HIV-infected adults with insulin resistance and central adiposity.
Am. J. Physiol. Endocrinol. Metab.
PUBLISHED: 10-19-2010
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The prevalence and incidence of insulin resistance and type 2 diabetes mellitus (DM) are higher in people treated for human immunodeficiency virus-1 (HIV) infection than in the general population. Identifying safe and effective interventions is a high priority. We evaluated whether the peroxisome proliferator-activated receptor-? agonist pioglitazone with exercise training improves central and peripheral insulin sensitivity more than pioglitazone alone in HIV-infected adults with insulin resistance and central adiposity. Forty-four HIV-infected adults with baseline insulin resistance and central adiposity were randomly assigned to 4 mo of pioglitazone (30 mg/day) with or without supervised, progressive aerobic, and resistance exercise training (1.5-2 h/day, 3 days/wk). The hyperinsulinemic euglycemic clamp was used to evaluate alterations in central and peripheral insulin sensitivity. Thirty-nine participants completed the study. Hepatic insulin sensitivity improved similarly in both groups. Exercise training augmented the beneficial effects of pioglitazone on peripheral insulin sensitivity. Greater improvements in peripheral insulin sensitivity were associated with reductions in total body and limb adipose content rather than increases in limb adiposity or pioglitazone-induced increases in adiponectin concentration. We conclude that supplementing pioglitazone with increased physical activity improved insulin sensitivity more effectively than pioglitazone alone in HIV-infected adults with insulin resistance and central adiposity. Pioglitazone alone did not significantly increase limb adipose content. Potential cardiovascular benefits of these interventions in HIV need investigation.
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Bone disease in HIV infection: a practical review and recommendations for HIV care providers.
Clin. Infect. Dis.
PUBLISHED: 09-16-2010
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Low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected subjects. Initiation of antiretroviral therapy is associated with a 2%-6% decrease in BMD over the first 2 years, a decrease that is similar in magnitude to that sustained during the first 2 years of menopause. Recent studies have also described increased fracture rates in the HIV-infected population. The causes of low BMD in individuals with HIV infection appear to be multifactorial and likely represent a complex interaction between HIV infection, traditional osteoporosis risk factors, and antiretroviral-related factors. In this review, we make the point that HIV infection should be considered as a risk factor for bone disease. We recommend screening patients with fragility fractures, all HIV-infected post-menopausal women, and all HIV-infected men ?50 years of age. We also discuss the importance of considering secondary causes of osteoporosis. Finally, we discuss treatment of the more severe cases of bone disease, while outlining the caveats and gaps in our knowledge.
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Aging and HIV infection: a comparison between older HIV-infected persons and the general population.
HIV Clin Trials
PUBLISHED: 06-15-2010
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As HIV-infected persons age, the relative contribution of HIV infection, combination antiretroviral therapy (cART), and the normal aging process to the frequent comorbidities is unknown.
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Comparisons of sexual behaviors and STD prevalence among older and younger individuals with HIV infection.
AIDS Care
PUBLISHED: 05-15-2010
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Knowledge of an HIV-infected individuals sexual behaviors and routine sexually transmitted diseases (STDs) testing greatly facilitates HIV prevention efforts, but current data in older individuals are lacking. This study was developed to compare sexual behaviors and STD prevalence between older HIV-infected individuals and their younger counterparts. We conducted a cross-sectional cohort study of HIV-infected individuals > or =18 years who completed an annual behavioral assessment. A total of 541 individuals completed the assessment. Analyses were performed to examine differences in sexual behaviors and STD prevalence between age groups: younger (18-35 years) (30%), middle-aged (36-49 years) (46%), and older (> or =50 years) (24%). Older individuals were most likely to be male and Caucasian with longest time since HIV diagnosis, greatest receipt of highly active antiretroviral therapy (HAART), and highest rates of HIV RNA <50 copies/mL (all p<0.001). Reports of recent sexual activity decreased with age, younger (56%) vs. middle-aged (43%) vs. older (27%) (p<0.001). The median number of recent sex partners was one (range 1-25) and 68% overall reported using condoms consistently; these parameters did not differ by age group. STD prevalence was 8% (gonorrhea [9], chlamydia [7], and syphilis [20]) and was highest among younger individuals (younger [11%] vs. middle-aged [7%] vs. older [3%]). Our results demonstrated that with older age, sexual activity declines but inconsistent condom use remains commonly reported. Furthermore, STDs were identified among all age groups. This latter finding reinforces the need for secondary prevention efforts among all individuals living with HIV/AIDS.
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Renal and urologic emergencies in the HIV-infected patient.
Emerg. Med. Clin. North Am.
PUBLISHED: 04-24-2010
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Antiretroviral therapy has revolutionized the care of individuals infected with the human immunodeficiency virus (HIV) and has fundamentally altered the scope of the disease. Acute renal failure and chronic kidney disease from medication toxicity and comorbid noninfectious illnesses are just as likely today as end-organ injury from the virus itself. Chronic immunosuppression renders HIV-infected patients vulnerable to any of several unique urological infections not frequently seen in immunocompetent patients. A deeper understanding of renal and urological emergencies in the context of the HIV-infected patient will better prepare the emergency physician to render optimal care to this rapidly expanding and aging patient population.
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The interplay of sociodemographic factors on virologic suppression among a U.S. outpatient HIV clinic population.
AIDS Patient Care STDS
PUBLISHED: 04-20-2010
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Understanding challenges to virologic suppression is essential to optimizing health outcomes among individuals with HIV. This cross-sectional behavioral assessment was conducted among 514 individuals presenting at an urban U.S. HIV clinic between June and September 2007. The majority of the sample was African American and male, with a mean age of 42 years. Most of the sample was receiving highly active antiretroviral therapy (HAART), and the majority of those had suppressed viral loads (HIV viral loads less than 400 copies per milliliter). By logistic regression analyses, African American/other minorities had 2.9 increased odds, those less than high school degree had 2.3 increased odds, those who were receiving ritonavir-boosted protease inhibitor therapy had 1.4 increased odds, and those who had expressed symptoms indicative of depressive disorders had 2.5 increased odds of having unsuppressed viremia as compared to Caucasians, those with more education, receiving non-nucleoside reverse transcriptase inhibitor-based therapy, and who had minimal depressive symptoms, respectively. These findings signify the importance of individualized interventions to enhance virologic suppression, both based on medication choices and individual characteristics.
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Sexual behaviors and results of bacterial sexually transmitted infections testing among frail HIV-infected individuals.
J Int Assoc Physicians AIDS Care (Chic)
PUBLISHED: 01-15-2010
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The impact of premature frailty in HIV-infected individuals on the prevalence of sexual behaviors and sexually transmitted infections (STIs) is unknown.
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HIV and aging: two converging epidemics.
Mo Med
PUBLISHED: 09-17-2009
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With the aging of the Human immunodeficiency virus (HIV) epidemic, we are now faced with unprecedented and complex challenges, which need to be addressed in order to maximize care of the older HIV-infected population. Older persons have greater comorbidity than their younger counterparts. The compound effects of HIV infection, its treatment and increasing age on the incidence and prevalence of cardiovascular disease, malignancies, cognitive impairment, depression and frailty are of increasing concern.
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A review of nucleoside reverse transcriptase inhibitor use to prevent perinatal transmission of HIV.
Expert Opin Drug Saf
PUBLISHED: 09-01-2009
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Worldwide, women comprise > 50% of all people living with HIV and the vast majority of these women are of childbearing age. In fact, a significant proportion of these women are identified as HIV-infected during pregnancy. Preventing perinatal transmission has been one of the greatest prevention successes of the HIV epidemic with < 2% of live births resulting in an HIV-infected infant. The strategic use of combination antiretroviral therapy has been a critical component of this reduction. With more antiretroviral agents available for HIV, the appropriate selection of therapy is often based on provider familiarity with the various agents. Although benefits of antiretroviral use in pregnancy tremendously outweigh the risks, concerns regarding short- and long-term toxicity in mothers and their children, in addition to the risk of the development of HIV resistance, remain subjects of discussion. The choice of antiretroviral backbone is supported by extensive data showing efficacy in the prevention of HIV vertical transmission. Co-formulated zidovudine/lamivudine is the most commonly used combination in pregnancy. Long-term consequences of in utero exposure to antiretroviral agents are not fully understood. In this article, we review the data regarding nucleoside reverse transcriptase inhibitors with a focus on tenofovir.
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Frailty among HIV-infected persons in an urban outpatient care setting.
J. Infect.
PUBLISHED: 07-13-2009
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Frailty among HIV-infected persons is increasingly recognized but data are limited. We aimed to determine frailty prevalence, predictors and clinical significance in this population.
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The study to understand the natural history of HIV and AIDS in the era of effective therapy (SUN Study).
Am. J. Epidemiol.
PUBLISHED: 02-27-2009
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Treatment of human immunodeficiency virus (HIV) infection with highly active combination antiretroviral therapy has increased survival and shifted the spectrum of HIV-associated morbidity and mortality from opportunistic infections toward a variety of other medical conditions. The prospective cohort Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN Study) monitors the clinical course of HIV-infected individuals treated with combination antiretroviral therapy in 4 US cities. Every 6 months, clinical assessments, medical record abstraction, audio computer-assisted self-interview, and neurocognitive measurements are completed and blood and urine specimens are banked centrally. At enrollment and periodically thereafter, additional techniques such as anal cytology, dual energy x-ray absorptiometry, carotid ultrasonography, echocardiography, and abdominal and cardiac computed tomography are performed. From March 2004 through June 2006, 700 participants were enrolled; median age was 41 years, 76% were men, 58% were non-Hispanic white, 62% were men who have sex with men, 78% were taking combination antiretroviral therapy (of whom 86% had an HIV viral load of <400 copies/mL), and median CD4+ T-lymphocyte count was 459 cells/mm(3) (interquartile range: 324-660). The SUN Study provides a wealth of data that will inform and improve the clinical management of HIV-infected individuals in the modern era.
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Efavirenz outperforms boosted atazanavir among treatment-naive HIV-1-infected persons in routine clinical care.
J Int Assoc Provid AIDS Care
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Effectiveness of antiretroviral therapy (ART) in a routine clinical care may result different from the clinical trials. We assessed the virologic outcomes in treatment-naive persons who received either efavirenz (EFV) or atazanavir/ritonavir (ATV/r) with a backbone of tenofovir/emtricitabine (TDF/FTC) as their combination ART (cART).
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Safety, immunogenicity, and surrogate markers of clinical efficacy for modified vaccinia Ankara as a smallpox vaccine in HIV-infected subjects.
J. Infect. Dis.
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Human immunodeficiency virus (HIV)-infected persons are at higher risk for serious complications associated with traditional smallpox vaccines. Alternative smallpox vaccines with an improved safety profile would address this unmet medical need.
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Effect of darunavir on lipid profile in HIV-infected patients.
HIV Clin Trials
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Highly active antiretroviral therapy regimens, consisting of a ritonavir-boosted protease inhibitor (PI) and 2 nucleoside reverse transcriptase inhibitors, are established first-line regimens for HIV-infected patients. However, a common adverse effect in patients receiving PIs is dyslipidemia, characterized by increases in plasma levels of triglycerides, low-density lipoprotein cholesterol, and total cholesterol (TC). These lipid changes, as well as other well-described risk factors, may predispose patients to the development of cardiovascular disease, an important comorbidity, especially as the lifespan of HIV-infected patients has increased dramatically in recent years. Among PIs, ritonavir-boosted atazanavir (ATV/r) and, more recently, ritonavir-boosted darunavir (DRV/r) have demonstrated potent antiviral efficacy with more favorable lipid profiles than other PIs. This review provides an overview of the lipid effects of DRV/r. Studies with DRV/r in healthy volunteers and in both treatment-naïve and -experienced patients have demonstrated that changes in tri-glycerides and TC are comparable to those seen with ATV/r.
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Disparities in prevalence of key chronic diseases by gender and race/ethnicity among antiretroviral-treated HIV-infected adults in the US.
Antivir. Ther. (Lond.)
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Certain sociodemographic subgroups of HIV-infected patients may experience more chronic disease than others due to behavioural risk factors, advanced HIV disease or complications from extended use of combination antiretroviral therapy (cART), but recent comparative data are limited.
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Reduced diastolic function and left ventricular mass in HIV-negative preadolescent children exposed to antiretroviral therapy in utero.
AIDS
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Abnormalities in left ventricular morphology and function have been reported in HIV-negative infants exposed to antiretroviral therapy (ART) in utero that persists throughout preschool age. The objective of this study was to determine if these abnormalities persist, resolve, or worsen during preadolescence.
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18FDG PET-CT imaging detects arterial inflammation and early atherosclerosis in HIV-infected adults with cardiovascular disease risk factors.
J Inflamm (Lond)
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Persistent vascular inflammation has been implicated as an important cause for a higher prevalence of cardiovascular disease (CVD) in HIV-infected adults. In several populations at high risk for CVD, vascular 18Fluorodeoxyglucose (18FDG) uptake quantified using 3D-positron emission-computed tomography (PET-CT) has been used as a molecular level biomarker for the presence of metabolically active proinflammatory macrophages in rupture-prone early atherosclerotic plaques. We hypothesized that 18FDG PET-CT imaging would detect arterial inflammation and early atherosclerosis in HIV-infected adults with modest CVD risk.
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Screening anxiety in the HIV clinic.
AIDS Behav
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Individuals with HIV experience fluctuating levels of distress throughout the course of their infection. This cross-sectional study was conducted to examine the prevalence of and associations between anxiety symptoms, sociodemographic, and biomedical markers among individuals presenting for care. A total of 635 individuals were screened, the majority of whom was male and African American. Younger individuals, African Americans, individuals with less education, and those who were unemployed were more likely to express more severe anxiety symptoms. Individuals who were not currently receiving antiretroviral therapy (ART) were 1.61 times more likely to experience higher anxiety symptoms. Among individuals receiving ART, higher levels of anxiety were associated with less adherence, higher viral loads and lower CD4 cell counts. Current smokers were 1.66 times more likely to have higher rates of anxiety. When controlling for these significant factors, younger, unemployed, and less educated individuals were more likely to express more severe anxiety symptoms. These findings highlight the importance of screening and management of anxiety as an integral component of HIV care.
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Routine brief risk-reduction counseling with biannual STD testing reduces STD incidence among HIV-infected men who have sex with men in care.
Sex Transm Dis
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We evaluated whether routine biannual sexually transmitted disease (STD) testing coupled with brief risk-reduction counseling reduces STD incidence and high-risk behaviors.
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Metabolic effects of darunavir/ritonavir versus atazanavir/ritonavir in treatment-naive, HIV type 1-infected subjects over 48 weeks.
AIDS Res. Hum. Retroviruses
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We assessed metabolic changes for darunavir/ritonavir (DRV/r) once daily (qd) versus atazanavir/ritonavir (ATV/r) qd with fixed-dose tenofovir/emtricitabine. This was a phase 4, multicenter, open-label, randomized exploratory study. Treatment-naive, HIV-1-infected adults received DRV/r 800/100 mg qd or ATV/r 300/100 mg qd, both with emtricitabine/tenofovir 200/300 mg qd. Primary end point: change in triglyceride levels from baseline to week 12. Secondary end points: week 12 and week 48 changes in lipid parameters, insulin sensitivity, inflammatory/coagulation/bacterial translocation biomarkers, viral load, CD4(+) cell count, and week 48 changes in adipose tissue distribution and subjects perceptions of body changes. In the DRV/r arm, 32/34 and 29/34 subjects completed weeks 12 and 48, respectively; in the ATV/r arm, 30/31 and 25/31 subjects completed weeks 12 and 48, respectively. Small changes in lipid parameters from baseline to weeks 12 and 48 were observed in both arms. Differences were noted between arms in mean changes in total cholesterol (DRV/r, 20.3 mg/dl; ATV/r, 4.6 mg/dl) and apolipoprotein A1 (DRV/r, 10.7 mg/dl; ATV/r, -0.7 mg/dl) at week 12. At week 48, no clinically relevant differences between arms were noted for changes in any lipid parameter, fasting glucose, or insulin sensitivity. Biomarkers generally decreased and efficacy parameters improved in both arms over 48 weeks. Changes in adipose tissue were small and comparable between arms. Subjects perceptions of body changes generally improved in both study arms. This first pilot comparison in HIV-1-infected subjects suggests that DRV/r has a metabolic profile similar to ATV/r over 48 weeks of treatment. Further randomized studies are warranted.
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Prevalence and risk factors associated with herpes simplex virus-2 infection in a contemporary cohort of HIV-infected persons in the United States.
Sex Transm Dis
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We compared the herpes simplex virus type 2 (HSV-2) seroprevalence in a contemporary HIV cohort with the general US population and determined risk factors for HSV-2 infection among HIV-infected persons.
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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.