First-Line Antiretroviral Treatment Outcome in a Patient Presenting an HIV-1/2 Multiclass Drug Resistant Infection.

First-line antiretroviral treatment outcome in a patient presenting an HIV-1/2 multiclass drug resistant infection.

Filed under: Addiction Rehab

J Int AIDS Soc. 2012; 15(6): 18224
Castro E, Recordon-Pinson P, Papuchon J, Vetter B, Shah C, Schupbach J, Fleury H, Cavassini M

Background: With the expansion of HIV-2 epidemic beyond African countries, co-infection with HIV-1 becomes a global challenge. We have recently identified an HIV-1/2 dual infection with both viruses bearing multiclass drug resistance in an untreated patient [1]. We now present the patient’s combined antiretroviral treatment (cART) outcome after 6 months follow-up. Patient and Methods: Clinical samples were obtained upon informed consent from a 23-year-old man living in Guinea-Bissau until March 2011 when he moved to Switzerland. As previously reported [1], HIV-1/2 co-infection was confirmed by HIV-1 PCR (21.000 copies/ml) and total HIV-1/2 viremia (4.351 nU/ml) by product-enhanced reverse transcriptase (PERT) assay. The patient denied previous HIV testing or exposure to antiretroviral drugs. Dual infection consisted of HIV-1 CRF02_AG bearing resistance mutations M184V/V90I and HIV-2 clade A, harboring K65R/D67N mutations as amplified from proviral-DNA. Baseline CD4 +?T-cell count was 408 cell/mm(3). We initiated cART in accordance to drug resistance mutations (see below). Treatment compliance was assessed with an electronic pillbox device and drug-plasma concentrations. Clinical and laboratory follow up were done at weeks 2, 4, 9, 12 and 24. Results: cART was initiated with tenofovir/emtricitabine (TDF/FTC), boosted-darunavir (DRV/r) and raltegravir(RAL). Treatment compliance was fluctuant during the first 3 months after which it remained stable with an average monthly intake of 92%. Antiretroviral drug-plasma concentrations were traced at percentile 25th. HIV-1 viremia became undetectable at week 12. Additionally, HIV-2 viremia was retrospectively assessed by real-time RT-PCR at two independent laboratories showing undetectable values across the study period including baseline. Thus, baseline viremia, as assessed by the PERT test for particle-associated reverse transcriptase activity was due to HIV-1 alone. CD4?+?T-cell count was 559 cell/mm(3) at week 24. Laboratory assessments showed a neutrophile drop to 0.96 at week 4, fully restored at week 9. Conclusion: This case of HIV-1/2 dual infection underscores the importance of assessing genotypic analysis of both viruses ahead to treatment choice. It also highlights viral load platforms constraints when it comes to clinical monitoring of HIV-1/2 co-infection in western settings. Overall, first-line salvage treatment was well tolerated and suppressed HIV-1 resistant clade allowing recovery of CD4(+) T-cell count.
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Chronic Olanzapine Administration in Rats: Effect of Route of Administration on Weight, Food Intake and Body Composition.

Filed under: Addiction Rehab

Pharmacol Biochem Behav. 2012 Dec 9;
Mann S, Chintoh A, Giacca A, Fletcher P, Nobrega J, Hahn M, Remington G

Atypical antipsychotics are associated with increased risk of weight gain, and researchers have turned to rodent models to better understand underlying mechanisms. Weight gain has been inconsistent in these studies though, possibly related to the rapid metabolism of antipsychotics in rodents. This study investigates olanzapine, an atypical antipsychotic with high liability for weight gain in humans, administered to rats by continuous infusion via osmotic minipump versus daily subcutaneous (s.c.) or intraperitoneal (i.p.) injections. We examined body weight, food intake and body composition for olanzapine (7.5 mg/kg/day) versus placebo (N=8/group) in female Sprague-Dawley rats using the 3 routes of administration over 14 days. For olanzapine treated animals, weight gain was significantly greater in the minipump sample compared to both s.c. and i.p. injection. Twice as many animals (i.e. 75%) gained >7% body weight compared to either daily s.c. or i.p. injections. Olanzapine treated animals consumed more kilocalories than vehicle, and the minipump group consumed more than either daily injection group although the difference with the s.c. sample was nonsignificant. Significantly more visceral fat was amassed in olanzapine treated animals versus vehicle, again greatest in the minipump sample, although differences between groups did not reach significance. The magnitude of increase across all groups fits with other evidence suggesting change in body composition may represent a more sensitive measure than body weight in assessing antipsychotic related changes. We conclude that the rodent model is tenable in evaluating the effects of antipsychotics on weight/body composition.
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[Academic presentation of neurology and psychiatry of Keijo Imperial University at annual meetings].

Filed under: Addiction Rehab

Seishin Shinkeigaku Zasshi. 2012; 114(10): 1180-6
Kanekawa H

The origin of Keijo Imperial University, Medical School, Psychiatry course, and presentation at the Annual Meetings of the Japanese Society of Psychiatry and Neurology and The Japanese Society of Psychiatry and Neurology were investigated from its establishment to 1945. Keijo was the name used for the capital city of Korea, Seoul, when Korea was under Japanese rule. We believe the Keijo Imperial University evolved out of the Governor-General of Korea Hospital and Keijo Medical Professional School. The first Professor at the University was Shinji Suitsu, who studied under Shuzo Kure. He visited Shizuoka prefecture when he collaborated in Kure’s “Actual situation and statistical observation on home custody of mental patients” (1918). This was confirmed by photographic materials from this time. The year after the visit to Shizuoka, Suitsu was sent to the Korean Peninsula. In 1913, Suitsu established the Department of Psychiatry at the Governor-General of Korea Hospital, and the institution had 500 tsubo (approximately 1,650 m2) of land within Keijo (Seoul), with floor space of 160 tsubo (approximately 528 m2) and 24 beds. Treatments were performed by Suitsu, an assistant, and 8-9 nurses. The number of hospitalized patients was 30-50 patients per year. Cells had floor heating. Keijo Imperial University was established in 1924, and was called Jodai. In 1925, Suitsu retired from his Professorship of Psychiatry at Keijo Medical Professional School. Suitsu was from Kyoto Imperial University, and had studied abroad. In 1925, Suitsu’s father-in-law, and a long-time friend of Shuzo Kure, Seiji Yamane, passed away. The professor who took up the position after Suitsu was Kiyoji Kubo, who was originally supposed to go to Hokkaido Imperial University. When the medical school was established at Keijo Imperial University in 1926, Kubo was offered a professorship there. Jodai was under the jurisdiction of the Governor-General of Korea, and not the Ministry of Education. Later, professors and assistant professors and assistants of Jodai lectured in Mental Science at Keijo Medical Professional School. There was insufficient funding to run two Medical Departments within Seoul, and therefore the staff were transferred to Jodai, from which they supported the Medical Professional School. Jodai hospital was expanded to 222 beds with a total of 35 physicians, including the hospital director, medical officers, and professors. Members of the Medical Department, including professors of Psychiatry, although not near one another, reported homework and submitted subjects for speeches at every annual meeting. Starting from Manjiro Sugihara’s “Supplementary knowledge of induced insanity,” the Japanese Society of Psychiatry and Neurology (original article, 1929), there is a record of 35 presentations at conferences and published papers, and each person engaged in their own study in this environment. In 1936, Kiyoji Kubo reported his homework on drug addiction at the 35th Annual Meeting of the Japanese Society of Psychiatry and Neurology. This report was on morphine addiction, which was common in the Korean Peninsula at the time, and was presented in “Psychiatria et Neurologia Japonica” with the title “Morphine Addiction.” In 1941, Michio Watanabe became the second professor following Kiyoji Kubo, and held this position until the end of the war in 1945. Academic publications of the Japanese Society of Psychiatry and Neurology consist of 15 papers/original articles, 19 summaries of annual meetings and abstracts, and 1 report of homework from an annual meeting. These publications dealt with induced insanity, symptomatic psychosis, sleep disorder, epidemiology, alcohol and morphine addiction, and schizophrenia.
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