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Find video protocols related to scientific articles indexed in Pubmed.
Mortality in patients with giant cell arteritis.
Rheumatology (Oxford)
PUBLISHED: 08-13-2014
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The aim of this study was to examine whether GCA is associated with increased mortality.
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Cohort Profile Update: The Danish HIV Cohort Study (DHCS).
Int J Epidemiol
PUBLISHED: 07-31-2014
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The DHCS is a cohort of all HIV-infected individuals seen in one of the eight Danish HIV centres after 31 December 1994. Here we update the 2009 cohort profile emphasizing the development of the cohort. Every 12-24 months, DHCS is linked with the Danish Civil Registration System (CRS) in order to extract an age- and sex-matched comparison cohort from the general population, as well as cohorts of family members of the HIV-infected patients and of the comparison cohort. The combined cohort is linked with CRS, the Danish Cancer Registry, the Danish National Hospital Registry, the Danish Registry of Causes of Death, the Danish National Prescription Registry, the Attainment Register and the Integrated Database for Labour Market Research to get information on vital status, migration, cancer, hospital contacts, causes of death, dispensed prescriptions, education and employment. Using this design, rates of a range of outcomes have been compared between HIV-infected patients and the comparison cohort, as well as between families of these two cohorts in order to disaggregate the effects of HIV infection and familial/environmental factors. Data can be shared with foreign institutions following approval from the Danish Data Protection Agency. Potential collaborators can contact the study director, Niels Obel (e-mail: niels.obel@regionh.dk).
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Incidence and risk factors for invasive pneumococcal disease in HIV-infected and non-HIV-infected individuals before and after the introduction of combination antiretroviral therapy: persistent high risk among HIV-infected injecting drug users.
Clin. Infect. Dis.
PUBLISHED: 07-17-2014
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Invasive pneumococcal disease (IPD) is an important cause of morbidity among individuals infected with human immunodeficiency virus (HIV). We described incidence and risk factors for IPD in HIV-infected and uninfected individuals.
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Effectiveness of antiretroviral therapy in individuals who for economic reasons were switched from a once-daily single-tablet regimen to a triple-tablet regimen.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 07-02-2014
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To assess the impact on virological outcomes of a switch from branded single-tablet regimen (STR) including tenofovir, efavirenz, and emtricitabine (STR-TEE) to generic triple-tablet regimen (TTR), including tenofovir, efavirenz, and lamivudine (TTR-TEL), which was implemented on April 1, 2011 to obtain economic savings.
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Polymorphism in interleukin-7 receptor ? gene is associated with faster CD4? T-cell recovery after initiation of combination antiretroviral therapy.
AIDS
PUBLISHED: 06-10-2014
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To investigate single-nucleotide polymorphisms (SNPs) in the gene encoding interleukin-7 receptor ? (IL7RA) as predictors for CD4? T-cell change after initiation of combination antiretroviral therapy (cART) in HIV-infected whites.
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Risk of cancer among HIV-infected individuals compared to the background population: impact of smoking and HIV.
AIDS
PUBLISHED: 05-03-2014
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The relative impact of immune deficiency and lifestyle-related factors on risk of cancer in the HIV-infected population is controversial. We aimed to estimate the population-attributable fractions (PAFs) associated with smoking, being HIV-infected and with immune deficiency.
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Employment status in persons with and without HIV infection in Denmark: 1996-2011.
AIDS
PUBLISHED: 04-16-2014
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To estimate annual employment rates and disability retirement rates (DRRs) among HIV-infected individuals and population controls during the period 1996-2011.
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Educational attainment and risk of HIV infection, response to antiretroviral treatment, and mortality in HIV-infected patients.
AIDS
PUBLISHED: 03-28-2014
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To estimate association between educational attainment and risk of HIV diagnosis, response to HAART, all-cause, and cause-specific mortality in Denmark in 1998-2009.
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Long-term mortality after Staphylococcus aureus spondylodiscitis: a Danish nationwide population-based cohort study.
J. Infect.
PUBLISHED: 03-26-2014
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Patients diagnosed with Staphylococcus aureus spondylodiscitis have increased long-term mortality compared with the background population mainly due to infectious, endocrine, cardiovascular, gastrointestinal and alcohol and drug abuse-related diseases.
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Fracture risk in hepatitis C virus infected persons: results from the DANVIR cohort study.
J. Hepatol.
PUBLISHED: 03-06-2014
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The association between Hepatitis C virus (HCV)-infection and fracture risk is not well characterized. We compared fracture risk between HCV-seropositive (HCV-exposed) patients and the general population and between patients with cleared and chronic HCV-infection.
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Plasma plasminogen activator inhibitor-1 predicts myocardial infarction in HIV-1-infected individuals.
AIDS
PUBLISHED: 02-26-2014
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Biomarkers of endothelial dysfunction, inflammation and coagulation are associated with atherosclerosis and cardiovascular disease, but their association and possible predictive value remain controversial among HIV-1-infected individuals. We sought to investigate the association of seven biomarkers with first-time myocardial infarction (MI) in an HIV-1-infected population.
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The origin and emergence of an HIV-1 epidemic: from introduction to endemicity.
AIDS
PUBLISHED: 01-24-2014
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To describe, at patient-level detail, the determining events and factors involved in the development of a country's HIV-1 epidemic.
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Long-term mortality in HIV-positive individuals virally suppressed for >3 years with incomplete CD4 recovery.
Clin. Infect. Dis.
PUBLISHED: 01-22-2014
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Some human immunodeficiency virus (HIV)-infected individuals initiating combination antiretroviral therapy (cART) with low CD4 counts achieve viral suppression but not CD4 cell recovery. We aimed to identify (1) risk factors for failure to achieve CD4 count >200 cells/µL after 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality.
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High risk of pulmonary embolism and deep venous thrombosis but not of stroke in granulomatosis with polyangiitis (Wegener's).
Arthritis Care Res (Hoboken)
PUBLISHED: 01-09-2014
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Objective: To assess the incidence of stroke, pulmonary embolism (PE), and deep venous thrombosis (DVT) in granulomatosis with polyangiitis (GPA; Wegener's). Methods: Patients diagnosed with GPA at a Danish tertiary care centre during 1993-2011 were identified (n=180). Each patient was matched with 19 population-controls (n=3420). Information on hospitalizations for stroke, PE, and DVT was obtained from the Danish National Hospital Register. The occurrence of vascular events in the GPA cohort was compared to that in the control group by calculation of incidence rate ratios (IRR). Results: The median duration of follow-up was 7.2 (interquartile range: 3.1-11.7) years in the GPA cohort. Within the first two years following the diagnosis of vasculitis, the incidence of PE and DVT was substantially increased among the patients (IRR for PE: 25.7 (95% CI: 6.9-96); IRR for DVT: 20.2 (95% CI: 5.1-81)). The incidence of stroke was not increased during this time-interval (IRR: 1.4 (95% CI: 0.3-5.7)). From 2 years after the GPA diagnosis, an increased incidence was found for DVT (IRR: 4.5 (95% CI: 1.7-11.8)) but not for PE (IRR: 1.3 (95% CI: 0.2-9.6)) or stroke (IRR: 1.4 (95% CI: 0.6-3.3)). In the GPA cohort, 70% of the vascular events occurred during phases with active vasculitis. Conclusion: The present study confirms that GPA patients have a markedly increased risk of venous thromboembolism. We did not observe an increased risk of stroke in our cohort. Thus, our observations demonstrate a differential impact of GPA and/or its treatment on the risk of various vascular events. © 2014 American College of Rheumatology.
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Incidence of cervical dysplasia and cervical cancer in women living with HIV in Denmark: comparison with the general population.
J Int AIDS Soc
PUBLISHED: 01-01-2014
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Women living with HIV (WLWH) are reportedly at increased risk of invasive cervical cancer (ICC). WLWH in Denmark attend the National ICC screening program less often than women in the general population. We aimed to estimate the incidence of cervical dysplasia and ICC in WLWH in Denmark.
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Major challenges in clinical management of TB/HIV co-infected patients in Eastern Europe compared with Western Europe and Latin America.
J Int AIDS Soc
PUBLISHED: 01-01-2014
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Rates of both TB/HIV co-infection and multi-drug-resistant (MDR) TB are increasing in Eastern Europe (EE). Data on the clinical management of TB/HIV co-infected patients are scarce. Our aim was to study the clinical characteristics of TB/HIV patients in Europe and Latin America (LA) at TB diagnosis, identify factors associated with MDR-TB and assess the activity of initial TB treatment regimens given the results of drug-susceptibility tests (DST).
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Poor CD4 response despite viral suppression is associated with increased non-AIDS-related mortality among HIV patients and their parents.
AIDS
PUBLISHED: 10-25-2013
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Poor CD4 response to antiretroviral treatment (HAART) is associated with increased mortality. We analyzed the impact of CD4 increase on non-AIDS-related morbidity and on mortality in HIV patients and their parents.
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Increased risk of dialysis and end-stage renal disease among HIV patients in Denmark compared with the background population.
Nephrol. Dial. Transplant.
PUBLISHED: 08-24-2013
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HIV patients have increased risk of impaired renal function. We aimed to estimate the incidence of any renal replacement therapy (aRRT) and start of chronic renal replacement therapy (cRRT) among HIV patients compared with population controls.
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Association study of common genetic variants and HIV-1 acquisition in 6,300 infected cases and 7,200 controls.
PLoS Pathog.
PUBLISHED: 07-01-2013
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Multiple genome-wide association studies (GWAS) have been performed in HIV-1 infected individuals, identifying common genetic influences on viral control and disease course. Similarly, common genetic correlates of acquisition of HIV-1 after exposure have been interrogated using GWAS, although in generally small samples. Under the auspices of the International Collaboration for the Genomics of HIV, we have combined the genome-wide single nucleotide polymorphism (SNP) data collected by 25 cohorts, studies, or institutions on HIV-1 infected individuals and compared them to carefully matched population-level data sets (a list of all collaborators appears in Note S1 in Text S1). After imputation using the 1,000 Genomes Project reference panel, we tested approximately 8 million common DNA variants (SNPs and indels) for association with HIV-1 acquisition in 6,334 infected patients and 7,247 population samples of European ancestry. Initial association testing identified the SNP rs4418214, the C allele of which is known to tag the HLA-B*57:01 and B*27:05 alleles, as genome-wide significant (p = 3.6 × 10(-11)). However, restricting analysis to individuals with a known date of seroconversion suggested that this association was due to the frailty bias in studies of lethal diseases. Further analyses including testing recessive genetic models, testing for bulk effects of non-genome-wide significant variants, stratifying by sexual or parenteral transmission risk and testing previously reported associations showed no evidence for genetic influence on HIV-1 acquisition (with the exception of CCR5?32 homozygosity). Thus, these data suggest that genetic influences on HIV acquisition are either rare or have smaller effects than can be detected by this sample size.
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Travelling with HIV: A cross sectional analysis of Danish HIV-infected patients.
Travel Med Infect Dis
PUBLISHED: 06-22-2013
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We aimed to describe travel patterns, extent of professional pre-travel advice and health problems encountered during travel among HIV-infected individuals.
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Short- and long-term mortality and causes of death in HIV/tuberculosis patients in Europe.
Eur. Respir. J.
PUBLISHED: 06-13-2013
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Mortality of HIV/tuberculosis (TB) patients in Eastern Europe is high. Little is known about their causes of death. This study aimed to assess and compare mortality rates and cause of death in HIV/TB patients across Eastern Europe and Western Europe and Argentina (WEA) in an international cohort study. Mortality rates and causes of death were analysed by time from TB diagnosis (<3 months, 3-12 months or >12 months) in 1078 consecutive HIV/TB patients. Factors associated with TB-related death were examined in multivariate Poisson regression analysis. 347 patients died during 2625 person-years of follow-up. Mortality in Eastern Europe was three- to ninefold higher than in WEA. TB was the main cause of death in Eastern Europe in 80%, 66% and 61% of patients who died <3 months, 3-12 months or >12 months after TB diagnosis, compared to 50%, 0% and 15% in the same time periods in WEA (p<0.0001). In multivariate analysis, follow-up in WEA (incidence rate ratio (IRR) 0.12, 95% CI 0.04-0.35), standard TB-treatment (IRR 0.45, 95% CI 0.20-0.99) and antiretroviral therapy (IRR 0.32, 95% CI 0.14-0.77) were associated with reduced risk of TB-related death. Persistently higher mortality rates were observed in HIV/TB patients in Eastern Europe, and TB was the dominant cause of death at any time during follow-up. This has important implications for HIV/TB programmes aiming to optimise the management of HIV/TB patients and limit TB-associated mortality in this region.
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Educational achievement and economic self-sufficiency in adults after childhood bacterial meningitis.
JAMA
PUBLISHED: 04-25-2013
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To our knowledge, no previous study has examined functioning in adult life among persons who had bacterial meningitis in childhood.
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CD4 decline is associated with increased risk of cardiovascular disease, cancer, and death in virally suppressed patients with HIV.
Clin. Infect. Dis.
PUBLISHED: 04-10-2013
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The clinical implications of a considerable CD4 decline despite antiretroviral treatment and viral suppression are unknown. We aimed to test the hypothesis that a major CD4 decline could be a marker of cardiovascular disease or undiagnosed cancer.
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Statin therapy and mortality in HIV-infected individuals; a Danish nationwide population-based cohort study.
PLoS ONE
PUBLISHED: 03-04-2013
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Recent studies have suggested that statins possess diverse immune modulatory and anti-inflammatory properties. As statins might attenuate inflammation, statin therapy has been hypothesized to reduce mortality in HIV-infected individuals. We therefore used a Danish nationwide cohort of HIV-infected individuals to estimate the impact of statin use on mortality before and after a diagnosis of cardiovascular disease, chronic kidney disease or diabetes.
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Phylogenetics of the Danish HIV epidemic: the role of very late presenters in sustaining the epidemic.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 02-27-2013
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In Denmark, 300 new individuals are diagnosed with HIV every year, despite decades of public health campaigns aimed to raise awareness of potential risk behavior for HIV transmission. It is important to identify the driving forces of the epidemic, to enable more targeted campaigns. The role of very late presenters (VLPs, defined by a CD4 T-cell count of <200 cells/?L at the time of diagnosis) in driving the epidemic is currently not known and was investigated in this study.
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Soluble CD163 does not predict first-time myocardial infarction in patients infected with human immunodeficiency virus: a nested case-control study.
BMC Infect. Dis.
PUBLISHED: 01-29-2013
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Soluble CD163 (sCD163) has been associated with arterial inflammation and non-calcified plaques in human immunodeficiency virus (HIV)-infected individuals and has therefore been suggested as a predictive biomarker of myocardial infarction (MI).
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Anal carcinoma in HIV-infected patients in the period 1995-2009: a Danish nationwide cohort study.
Scand. J. Infect. Dis.
PUBLISHED: 01-07-2013
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Several studies have demonstrated an increased risk of non-AIDS cancers in HIV patients and, for some cancers, also in relatives of HIV patients. We aimed to estimate (1) the risk of anal carcinoma among HIV patients and their parents, and (2) the mortality after a diagnosis of anal carcinoma.
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The HIV epidemic in Greenland--a slow spreading infection among adult heterosexual Greenlanders.
Int J Circumpolar Health
PUBLISHED: 01-04-2013
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We aimed to characterise the HIV epidemic in Greenland and to determine incidence, prevalence, mortality rates (MR) and specific causes of deaths.
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HIV care in the Swedish-Danish HIV cohort 1995-2010, closing the gaps.
PLoS ONE
PUBLISHED: 01-01-2013
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Successful treatment reduces morbidity, mortality and transmission of HIV. We evaluated trends in the treatment status of HIV infected individuals enrolled in care in Sweden and Denmark during the years 1995-2010. Our aim was to assess the proportion of HIV-infected individuals who received services along the continuum of care in Denmark in 2010, and to discuss the findings in relation to the organization of the health care system.
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Socioeconomic status in HCV infected patients - risk and prognosis.
Clin Epidemiol
PUBLISHED: 01-01-2013
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It is unknown whether socioeconomic status (SES) is a risk factor for hepatitis C virus (HCV) infection or a prognostic factor following infection.
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Late presenters, repeated testing, and missed opportunities in a Danish nationwide HIV cohort.
Scand. J. Infect. Dis.
PUBLISHED: 11-08-2011
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We aimed to estimate the incidence and predictors of late presentation among human immunodeficiency virus (HIV)-infected individuals in Denmark.
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Risk of cataract surgery in HIV-infected individuals: a Danish Nationwide Population-based cohort study.
Clin. Infect. Dis.
PUBLISHED: 10-13-2011
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Premature aging has been suggested a risk factor for early death in patients infected with human immunodeficiency virus (HIV). Therefore, the risk of age-related diseases, such as cataracts, should be increased in this population. In a nationwide, population-based cohort study we assessed the risk of cataract surgery in HIV-infected individuals compared with the general population.
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Trends in virological and clinical outcomes in individuals with HIV-1 infection and virological failure of drugs from three antiretroviral drug classes: a cohort study.
Lancet Infect Dis
PUBLISHED: 10-09-2011
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Limited treatment options have been available for people with HIV who have had virological failure of the three original classes of HIV antiretroviral drugs-so-called triple-class virological failure (TCVF). However, introduction of new drugs and drug classes might have improved outcomes. We aimed to assess trends in virological and clinical outcomes for individuals with TCVF in 2000-09.
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Long-term mortality in patients diagnosed with Listeria monocytogenes meningitis: a Danish nationwide cohort study.
J. Infect.
PUBLISHED: 09-25-2011
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To determine the long-term mortality, the causes of death and the incidence of cancer in listeria meningitis patients.
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Long-term mortality in patients with tuberculous meningitis: a Danish nationwide cohort study.
PLoS ONE
PUBLISHED: 09-14-2011
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With high short-term mortality and substantial excess morbidity among survivors, tuberculous meningitis (TBM) is the most severe manifestation of extra-pulmonary tuberculosis (TB). The objective of this study was to assess the long-term mortality and causes of death in a TBM patient population compared to the background population.
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Head and neck cancer in HIV patients and their parents: a Danish cohort study.
Clin Epidemiol
PUBLISHED: 07-20-2011
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The mechanism for the increased risk of head and neck cancer (HNC) observed in HIV patients is controversial. We hypothesized that family-related risk factors increase the risk of HNC why we estimated the risk of this type of cancer in both HIV patients and their parents.
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Effectiveness of treatment with pegylated interferon and ribavirin in an unselected population of patients with chronic hepatitis C: a Danish nationwide cohort study.
BMC Infect. Dis.
PUBLISHED: 06-21-2011
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The effect of peginterferon and ribavirin treatment on chronic hepatitis C virus (HCV) infection has been established in several controlled clinical studies. However, the effectiveness of treatment and predictors of treatment success in routine clinical practice remains to be established. Our aim was to estimate the effectiveness of peginterferon and ribavirin treatment in unselected HCV patients handled in routine clinical practice. The endpoint was sustained virological response (SVR), determined by the absence of HCV RNA 24 weeks after the end of treatment.
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Molecular phylogenetics of transmitted drug resistance in newly diagnosed HIV Type 1 individuals in Denmark: a nation-wide study.
AIDS Res. Hum. Retroviruses
PUBLISHED: 06-16-2011
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Highly active antiretroviral treatment is compromised by viral resistance mutations. Transmitted drug resistance (TDR) is therefore monitored closely, but follow-up studies of these patients are limited. Virus from 1405 individuals diagnosed with HIV-1 in Denmark between 2001 and 2009 was analyzed for TDR, and molecular-epidemiological links and progression of the infection were described based on data from standardized questionnaires, the prospective Danish HIV Cohort Study, and by phylogenetic analysis. Eighty-five individuals were found to be infected with virus harboring mutations resulting in a prevalence of 6.1%, with no changes over time. The main resistance mutations were nucleoside reverse transcriptase inhibitor (NRTI) mutation 215 revertants, as well as nonnucleoside reverse transcriptase inhibitor (NNRTI) mutation 103N/S and protease inhibitor (PI) mutations 90M and 85V. Phylogenetic analysis confirmed 12 transmission chains involving 37 TDR individuals. Of these 21 were also documented epidemiologically. The virus included in the transmission chain carried similar resistance mutations to the TDR index case, whereas controls chains from index cases without TDR were generally without resistance mutations. We observed no difference in progression of the infection between individuals infected with TDR and individuals infected with wild-type HIV-1. The prevalence of TDR is low in Denmark and transmission of dual-drug-resistant HIV-1 is infrequent. The TDR isolates were shown to originate from local patients failing therapy.
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Risk of cerebrovascular events in persons with and without HIV: a Danish nationwide population-based cohort study.
AIDS
PUBLISHED: 06-08-2011
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To assess the risk of cerebrovascular events (CVEs) in HIV-infected individuals and evaluate the impact of proven risk factors, injection drug abuse (IDU), immunodeficiency, HAART and family-related risk factors.
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Incidence, risk factors and mortality of tuberculosis in Danish HIV patients 1995-2007.
BMC Pulm Med
PUBLISHED: 05-23-2011
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Human Immunodeficiency Virus (HIV) infection predisposes to tuberculosis (TB). We described incidence, risk factors and prognosis of TB in HIV-1 infected patients during pre (1995-1996), early (1997-1999), and late Highly Active Antiretroviral Therapy (HAART) (2000-2007) periods.
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[Diffusion-weighted imaging can differentiate cerebral abscesses from tumours of the brain].
Ugeskr. Laeg.
PUBLISHED: 05-13-2011
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Early diagnosis of cerebral abscess, which is decisive for the prognosis, is often complicated by the lack of clinical signs. Conventional computed tomography and magnetic resonance imaging cannot always differentiate a cystic or necrotic tumor from an abscess. An abscess is therefore sometimes misdiagnosed as e.g. a glioblastoma or metastasis. Unfortunately, this is sometimes seen at our department and could maybe have been prevented. Diffusion-weighted imaging and apparent diffusion coefficient facilitate differentiation between cerebral tumor and abscess with a sensitivity of 95.2% (76.2-99.9%) and a specificity of 95.7% (78.1-99.9%).
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Comorbidity acquired before HIV diagnosis and mortality in persons infected and uninfected with HIV: a Danish population-based cohort study.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 04-28-2011
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We aimed to estimate the impact of comorbidity acquired before HIV diagnosis on mortality in individuals infected with HIV.
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Risk of triple-class virological failure in children with HIV: a retrospective cohort study.
Lancet
PUBLISHED: 04-20-2011
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In adults with HIV treated with antiretroviral drug regimens from within the three original drug classes (nucleoside or nucleotide reverse transcriptase inhibitors [NRTIs], non-NRTIs [NNRTIs], and protease inhibitors), virological failure occurs slowly, suggesting that long-term virological suppression can be achieved in most people, even in areas where access is restricted to drugs from these classes. It is unclear whether this is the case for children, the group who will need to maintain viral suppression for longest. We aimed to determine the rate and predictors of triple-class virological failure to the three original drugs classes in children.
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Long-term mortality in children diagnosed with Haemophilus influenzae meningitis: a Danish nationwide cohort study.
Pediatr. Infect. Dis. J.
PUBLISHED: 04-14-2011
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The long-term mortality in children diagnosed with Haemophilus influenzae meningitis is poorly documented.
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Impact of phenotype definition on genome-wide association signals: empirical evaluation in human immunodeficiency virus type 1 infection.
Am. J. Epidemiol.
PUBLISHED: 04-13-2011
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Discussion on improving the power of genome-wide association studies to identify candidate variants and genes is generally centered on issues of maximizing sample size; less attention is given to the role of phenotype definition and ascertainment. The authors used genome-wide data from patients infected with human immunodeficiency virus type 1 (HIV-1) to assess whether differences in type of population (622 seroconverters vs. 636 seroprevalent subjects) or the number of measurements available for defining the phenotype resulted in differences in the effect sizes of associations between single nucleotide polymorphisms and the phenotype, HIV-1 viral load at set point. The effect estimate for the top 100 single nucleotide polymorphisms was 0.092 (95% confidence interval: 0.074, 0.110) log(10) viral load (log(10) copies of HIV-1 per mL of blood) greater in seroconverters than in seroprevalent subjects. The difference was even larger when the authors focused on chromosome 6 variants (0.153 log(10) viral load) or on variants that achieved genome-wide significance (0.232 log(10) viral load). The estimates of the genetic effects tended to be slightly larger when more viral load measurements were available, particularly among seroconverters and for variants that achieved genome-wide significance. Differences in phenotype definition and ascertainment may affect the estimated magnitude of genetic effects and should be considered in optimizing power for discovering new associations.
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HIV-1-related Hodgkin lymphoma in the era of combination antiretroviral therapy: incidence and evolution of CD4? T-cell lymphocytes.
Blood
PUBLISHED: 03-02-2011
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The risk of Hodgkin lymphoma (HL) is increased in patients infected with HIV-1. We studied the incidence and outcomes of HL, and compared CD4? T-cell trajectories in HL patients and controls matched for duration of combination antiretroviral therapy (cART). A total of 40 168 adult HIV-1-infected patients (median age, 36 years; 70% male; median CD4 cell count, 234 cells/?L) from 16 European cohorts were observed during 159 133 person-years; 78 patients developed HL. The incidence was 49.0 (95% confidence interval [CI], 39.3-61.2) per 100,000 person-years, and similar on cART and not on cART (P = .96). The risk of HL declined as the most recent (time-updated) CD4 count increased: the adjusted hazard ratio comparing more than 350 with less than 50 cells/?L was 0.27 (95% CI, 0.08-0.86). Sixty-one HL cases diagnosed on cART were matched to 1652 controls: during the year before diagnosis, cases lost 98 CD4 cells (95% CI, -159 to -36 cells), whereas controls gained 35 cells (95% CI, 24-46 cells; P < .0001). The incidence of HL is not reduced by cART, and patients whose CD4 cell counts decline despite suppression of HIV-1 replication on cART may harbor HL.
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Adherence to national guidelines for initiation of antiretroviral regimens in HIV patients: a Danish nationwide study.
Br J Clin Pharmacol
PUBLISHED: 02-11-2011
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To determine the adherence to the national guidelines for start of highly active antiretroviral treatment (HAART) in HIV infected patients.
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Mortality among patients with cleared hepatitis C virus infection compared to the general population: a Danish nationwide cohort study.
PLoS ONE
PUBLISHED: 02-09-2011
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The increased mortality in HCV-infected individuals partly stems from viral damage to the liver and partly from risk-taking behaviours. We examined mortality in patients who cleared their HCV-infection, comparing it to that of the general population. We also addressed the question whether prognosis differed according to age, substance abuse (alcohol abuse and injection drug use) and comorbidity.
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Incidence and impact on mortality of severe neurocognitive disorders in persons with and without HIV infection: a Danish nationwide cohort study.
Clin. Infect. Dis.
PUBLISHED: 02-04-2011
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The risk of neurocognitive disorders in human immunodeficiency virus (HIV)-infected patients in the era of highly active antiretroviral therapy (HAART) is controversial. We aimed to compare the incidence and impact on mortality of severe neurocognitive disorders (SNCDs) in HIV-infected patients with that of the background population.
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Impact of non-HIV and HIV risk factors on survival in HIV-infected patients on HAART: a population-based nationwide cohort study.
PLoS ONE
PUBLISHED: 02-01-2011
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We determined the impact of three factors on mortality in HIV-infected patients who had been on highly active antiretroviral therapy (HAART) for at least one year: (1) insufficient response to (HAART) and presence of AIDS-defining diseases, (2) comorbidity, and (3) drug and alcohol abuse and compared the mortality to that of the general population.
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Lung cancer in HIV patients and their parents: a Danish cohort study.
BMC Cancer
PUBLISHED: 01-31-2011
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HIV patients are known to be at increased risk of lung cancer but the risk factors behind this are unclear.
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Liver cancer and non-Hodgkin lymphoma in hepatitis C virus-infected patients: results from the DANVIR cohort study.
Int. J. Cancer
PUBLISHED: 01-26-2011
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Hepatitis C virus (HCV)-infection can cause hepatocellular carcinoma (HCC) and most likely non-Hodgkin lymphoma (NHL). No studies have compared the risk of these cancers between patients with chronic and cleared HCV-infection. The aim of this study was to estimate the 10-year risk of HCC and NHL in HCV-infected patients and to compare the risk of these cancers between HCV-infected patients and the general population in Denmark and between patients with chronic and cleared HCV-infection. Nationwide cohorts were used: 11,975 HCV-infected patients in the DANVIR cohort and 71,850 individuals from an age- and gender-matched general population cohort. Within DANVIR, 4,158 patients with chronic HCV-infection and 2,427 patients with cleared HCV-infection were studied. The 10-year risks of HCC and NHL in HCV-infected patients were 1.0% [95% confidence interval (CI): 0.8-1.3%] and 0.1% (95% CI: 0.1-0.2%), respectively. Compared to the general population, HCV-infected patients had a 62.91-fold increased risk of HCC (95% CI: 28.99-136.52), a 29.97-fold increased risk of NHL during the first year of follow-up (95% CI: 6.08-147.84), and a 1.26-fold increased risk of NHL after the first year (95% CI: 0.36-4.41). Chronic HCV-infection was associated with a 4.71-fold increased risk of HCC (95% CI: 1.67-13.32) compared to cleared HCV-infection; 5 and 0 events of NHL occurred in patients with chronic and cleared HCV-infection, respectively. HCC-risk is increased substantially in HCV-infected patients compared to the general population. Chronic as opposed to cleared HCV-infection increases the risk of HCC and perhaps NHL.
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Characterization of HIV-1 from patients with virological failure to a boosted protease inhibitor regimen.
J. Med. Virol.
PUBLISHED: 01-26-2011
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The use of highly active antiretroviral treatment (HAART) regimens with unboosted protease inhibitors (PIs) has resulted in a high level of virological failure primarily due to the development of resistant virus. Current boosted PI regimens combine successfully low-dose ritonavir (r) with a second PI. The aim of the study was to estimate the proportion of patients, in a population based setting, who develop virological failure on a PI/r regimen. Through The Danish HIV Cohort Study 1,007 patients who received PI/r based treatment between 1995 and 2008 were identified. Twenty-three (2.3%) experienced virological failure, of whom 19 (83%) started PI/r treatment before 2001. Patients from Copenhagen (n=19) were selected to study the development of protease (PR) and gag cleavage site (CS) mutations during PI/r treatment and PI plasma levels at the time of virological failure. Three patients (16%) developed major PI resistance mutations. Mutations in the p7/p1 and p1/p6 gag CS only developed in patients with major or minor mutations in PR. Drug concentrations were low or undetectable in 10 out of the 19 patients. In total PR resistance mutations and low drug levels could account for 12 (63%) of the failure cases. In conclusion, virological failure to PI/r is a low and decreasing problem primarily caused by low plasma drug levels and to a lesser extent major PR mutations. Gag CS mutations did not contribute significantly to resistance development and virological failure.
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Predictors of unsafe sex among HIV patients in Denmark: a population-based cohort study.
Scand. J. Infect. Dis.
PUBLISHED: 11-25-2010
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Abstract Background: Sexual transmission continues to be the primary mode of human immunodeficiency virus (HIV) infection in Western Europe. We aimed to describe predictors of unsafe sex and reasons given for such behaviour. Methods: We performed a survey examining sexual risk behaviours and reasons for unsafe sex in a nationwide cohort of adult Danish HIV-1-positive patients. Differences in characteristics between those who practiced safe and unsafe sex were estimated by binary logistic regression. The fraction with detectable viral load was determined in the 2 groups, and reasons for unsafe sex were evaluated. Results: Of 812 eligible patients, a total of 275 (34%) had engaged in unsafe sex with an HIV-negative partner or a partner with unknown HIV status in the previous year. On multivariate analysis, men who have sex with men (MSM) was the only statistically significant risk factor associated with unsafe sex (odds ratio 3.24, 95% confidence interval 1.72-6.12). The main reason for practicing unsafe sex was that the partner did not wish to use a condom (53%). Conclusions: A high proportion of HIV-positive patients engage in unsafe sex, especially MSM. The reasons for unsafe sex are primarily linked to negotiation issues concerning condom use, including assumptions about the sexual partners intent.
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HIV-1 continues to replicate and evolve in patients with natural control of HIV infection.
J. Virol.
PUBLISHED: 10-06-2010
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Elucidating mechanisms leading to the natural control of HIV-1 infection is of great importance for vaccine design and for understanding viral pathogenesis. Rare HIV-1-infected individuals, termed HIV-1 controllers, have plasma HIV-1 RNA levels below the limit of detection by standard clinical assays (<50 to 75 copies/ml) without antiretroviral therapy. Although several recent studies have documented persistent low-grade viremia in HIV-1 controllers at a level not significantly different from that in HIV-1-infected individuals undergoing treatment with combination antiretroviral therapy (cART), it is unclear if plasma viruses are undergoing full cycles of replication in vivo or if the infection of new cells is completely blocked by host immune mechanisms. We studied a cohort of 21 HIV-1 controllers with a median level of viremia below 1 copy/ml, followed for a median of 11 years. Less than half of the cohort carried known protective HLA types (B*57/27). By isolating HIV-1 RNA from large volumes of plasma, we amplified single genome sequences of both pro-rt and env longitudinally. This study is the first to document that HIV-1 pro-rt and env evolve in this patient group, albeit at rates somewhat lower than in HIV-1 noncontrollers, in HLA B*57/27-positive, as well as HLA B*57/27-negative, individuals. Viral diversity and adaptive events associated with immune escape were found to be restricted in HIV-1 controllers, suggesting that replication occurs in the face of less overall immune selection.
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Impact of injecting drug use on response to highly active antiretroviral treatment in HIV-1-infected patients: a nationwide population-based cohort study.
Scand. J. Infect. Dis.
PUBLISHED: 09-15-2010
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The objective of this study was to determine the effect of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-infected patients infected through injecting drug use (injecting drug users, IDUs) compared to patients infected via other routes (non-IDUs). We conducted a nationwide population-based cohort study of all HIV-infected patients who initiated HAART during the study period of 1 January 1995 to 31 December 2007. We compared changes in CD4(+) cell counts, percentage of full viral suppression (< 500 copies/ml) and mortality from start of HAART, as well as differences in initial HAART regimen. Three thousand six hundred and fifteen patients were included in the study, representing 22,804 person-y of observation. A total of 346 (9.6%) were categorized as IDUs. Of IDUs, 55% gained full viral control within the first y after HAART compared to 76% of non-IDUs (p = 0.0002). Absolute CD4(+) cell count and survival were lower for IDUs compared to non-IDUs (adjusted mortality rate ratio 3.6 (95% CI 2.9-4.3)). IDUs were more likely to receive a first regimen based on protease inhibitors (PIs) compared to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens for non-IDUs, and IDUs initiated HAART later than non-IDUs. In conclusion, more than half of the HIV-infected patients in Denmark infected through injecting drug use gained full viral suppression after initiating HAART. Absolute CD4(+) cell count was lower and mortality higher among IDUs than non-IDUs.
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Hepatitis C virus infection and risk of cancer: a population-based cohort study.
Clin Epidemiol
PUBLISHED: 06-24-2010
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Hepatitis C virus (HCV) infection is associated with an increased risk of primary liver cancer; however, 5- and 10-year risk estimates are needed. The association of HCV with non-Hodgkin lymphoma (NHL) is uncertain and the association with other cancers is unknown.
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Long-term mortality in patients diagnosed with pneumococcal meningitis: a Danish nationwide cohort study.
Am. J. Epidemiol.
PUBLISHED: 06-23-2010
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The objective of the study was to determine the long-term mortality and the causes of death in patients diagnosed with pneumococcal meningitis. The authors performed a nationwide, population-based cohort study including all Danish patients diagnosed with pneumococcal meningitis from 1977 through 2006 and alive 1 year after diagnosis. Data were retrieved from medical databases in Denmark. The absolute and relative risks of all-cause and cause-specific death were analyzed by using Kaplan-Meier survival curves, Poisson regression analysis, Cox regression analysis, and cumulative incidence functions. The authors identified 2,131 pneumococcal meningitis patients and an age- and gender-matched, population-based cohort of 8,524 individuals. Compared with the background population, the pneumococcal meningitis patients had an increased long-term mortality varying from an 8-fold increased mortality in the age category 0-<20 years to a 1.5-fold increased mortality in those aged 60-<80 years. The increased risk of death stemmed from neoplasms, liver diseases, and nervous system diseases. The excess mortality due to neoplasms stemmed mainly from a 5-fold increased risk of death due to hematologic neoplasms. To improve survival in patients surviving the acute phase of pneumococcal meningitis, physicians should meticulously screen this patient population for neurologic sequelae and comorbidity predisposing to the disease.
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Increased mortality among persons infected with hepatitis C virus.
Clin. Gastroenterol. Hepatol.
PUBLISHED: 06-09-2010
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The long-term mortality of patients infected with hepatitis C virus (HCV) is not known; few studies have controlled for potential confounders, investigated how mortality changes with age at diagnosis and length of follow-up period, provided absolute risk estimates of death, or analyzed specific causes of death.
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Clinical, virological and immunological responses in Danish HIV patients receiving raltegravir as part of a salvage regimen.
Clin Epidemiol
PUBLISHED: 05-25-2010
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Raltegravir is the first integrase inhibitor approved for treatment of HIV-infected patients harboring multiresistant viruses.
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Impact of injecting drug use on mortality in Danish HIV-infected patients: a nation-wide population-based cohort study.
Addiction
PUBLISHED: 04-21-2010
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To estimate the impact of injecting drug use (IDU) on mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era.
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Long-term mortality in HIV patients virally suppressed for more than three years with incomplete CD4 recovery: a cohort study.
BMC Infect. Dis.
PUBLISHED: 04-19-2010
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The mortality in patients with persistent low CD4 count despite several years of HAART with sustained viral suppression is poorly documented. We aimed to identify predictors for inadequate CD4 cell recovery and estimate mortality in patients with low CD4 count but otherwise successful HAART.
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Genetic and environmental influences on risk of death due to infections assessed in Danish twins, 1943-2001.
Am. J. Epidemiol.
PUBLISHED: 04-07-2010
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Genetic differences have been proposed to play a strong role in risk of death from infectious diseases. The study base of 44,005 included all same-sex twin pairs born in 1870-2001, with both twins alive on January 1, 1943, or those born thereafter. Cause of death was obtained from the Danish Cause of Death Register and was available for 18,359 deaths. The authors classified death due to infections by 3 definitions (narrow, broader, and broadest) and calculated concordance rates for same-sex monozygotic and dizygotic twin pairs. Heritability was estimated by using structural equation models. When the 3 definitions were applied, 211 (1.1%), 1,089 (5.9%), and 2,907 (15.8%) deaths, respectively, were due to infections. The probandwise concordance rates for monozygotic twin pairs were consistently higher than for dizygotic twin pairs regardless of the definition (9% vs. 0% (P = 0.04), 10% vs. 3% (P < 0.01), and 19% vs. 15% (P = 0.07), respectively). For the broader and broadest definitions, heritability was 40% (95% confidence interval: 12, 50) and 19% (95% confidence interval: 3, 35), respectively. The concordance rates were generally low, and, although a genetic influence on the risk of death from infectious diseases could be demonstrated, the absolute effect of the genetic component on mortality was small.
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Risk of myocardial infarction in parents of HIV-infected Individuals: a population-based Cohort Study.
BMC Infect. Dis.
PUBLISHED: 03-04-2010
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Previous studies have indicated an increased risk of myocardial infarction (MI) in HIV infected individuals especially after start of highly active antiretroviral therapy (HAART). It is however controversial whether the increased risk of atherosclerotic disease is exclusively associated with the HIV disease and HAART or whether life-style related or genetic factors also increase the risk in this population. To establish whether the increased risk of myocardial infarction in HIV patients partly reflects an increased risk of MI in their families, we estimated the relative risk of MI in parents of HIV-infected individuals.
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