Safety and tolerability of combination antiretroviral post-exposure prophylaxis in a population-based setting.
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Anti-HIV Agents↗
Biomedical subjects
Keith Chan
Publications and source records attributed to Keith Chan.
Intensive care unit admission has minimal impact on long-term mortality.
OBJECTIVE: To measure the association between intensive care unit (ICU) admission and both hospital and long-term mortality, separate from the effect of hospital admission alone. DESIGN: Retrospective cohort study. SETTING: All hospitals in British Columbia, Canada, during 3 fiscal years, 1994 to 1996. PATIENTS: A total of 27,103 patients admitted to ICU and 41,308 (5% random sample) patients admitted to hospital but not to ICU. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Although ICU admission was an important factor associated with hospital mortality (odds ratio: 9.12; 95% confidence interval: 8.34-9.96), the association between ICU admission and mortality after discharge was relatively minimal (hazard ratio: 1.21; 95% confidence interval: 1.17-1.27) and was completely overshadowed by the effect of age, gender, and diagnosis. CONCLUSIONS: After controlling for the effect of hospital admission, admission to ICU has minimal independent effect on mortality after discharge.
Adult↗
Prevalence and response to antiretroviral therapy of non-B subtypes of HIV in antiretroviral-naive individuals in British Columbia.
In North America, the B subtype of the major group (M) of HIV-1 predominates. Phylogenetic analysis of HIV reverse transcriptase and protease sequences isolated from 479 therapy-naive patients, first seeking treatment in British Columbia between June 1997 and August 1998, revealed a prevalence of 4.4% non-B virus. A range of different subtypes was identified, including one subtype A, 11 C, two D, five CRF01_AE, and one sample that could not be reliably subtyped. Baseline CD4 courts were significantly lower in individuals harbouring the non-B subtypes (P = 0.02), but baseline viral loads were similar (P = 0.80). In this study, individuals infected with non-B variants did not have a significantly different virological response to therapy after up to 18 months.
Acquired Immunodeficiency Syndrome↗
Azithromycin prophylaxis for Mycobacterium avium complex during the era of highly active antiretroviral therapy: evaluation of a provincial program.
Mycobacterium avium complex (MAC) disease was evaluated in a provincial program of azithromycin prophylaxis. Highly active antiretroviral therapy (HAART) was prescribed to 383 (65%) of 587 patients eligible for MAC prophylaxis (CD4 <75 cells/mm3). By use of an intent-to-treat analysis, MAC disease was observed in 21 of 271 patients who did not receive prophylaxis (incidence rate, 8 events per 100 person-years). MAC events occurred in 10 of 316 patients who received azithromycin (2.37 events per 100 person-years). Localized lymphadenitis compatible with immune reconstitution disease accounted for 23% of all MAC events, in contrast to studies in the pre-HAART era, where almost all cases were disseminated. None of the MAC isolates from the 10 prophylaxis failures were resistant to azithromycin. Azithromycin appeared to be protective against disseminated MAC in patients who were either unresponsive or nonadherent to HAART, but it did not prevent the development of immune reconstitution disease due to MAC.
AIDS-Related Opportunistic Infections↗
Application of a Stable Isotope Technique for the Bioequivalency Study of Two Transdermal Nitroglycerin Systems.
A bioequivalency study of an experimental transdermal nitroglycerin system relative to the commercial Transderm-Nitro 0.4 mg/h system was performed on eight healthy volunteers by using an innovative stable isotope technique. Plasma clearance changes for nitroglycerin (NTG) during patch application were corrected with simultaneously administered intravenous infusion of (15)N-labeled nitroglycerin ((15)N-NTG) solution. The total amount of NTG transdermally absorbed (AUC x CL) during a 22-h application for the experimental system was not statistically different from that for the commercial system (9.7 plus minus 3.3 versus 8.1 plus minus 2.6 mg; p = 0.41). The analysis of residual drug content in the used system revealed that the difference in amounts of NTG delivered from the experimental and commercial systems were not significant (12.2 plus minus 3.1 versus 10.8 plus minus 3.1 mg; p = 0.29). With the isotope-labeled method, the absorption rate was evaluated at each time interval during the system application. The peak concentration values were 0.52 plus minus 0.21 mg h(minus sign1) at 1 h for the experimental system and 0.41 plus minus 0.15 mg h(minus sign1) at 2 h for commercial systems. After the peak concentrations, the absorption rates remained constant for both systems over the 16-h period. There was no statistical difference in absorption between the two systems at any sampling time. In this study, substantial fluctuations in the plasma concentrations of both NTG and (15)N-NTG were observed within and between subjects. In addition, the variability in plasma concentrations of NTG correlated well with that of (15)N-NTG for all participating subjects. The momentary changes of clearance, estimated from (15)N-NTG plasma data, were found to be responsible for the fluctuation of NTG in plasma.
Journal Article↗
Is "3 by 5" enough? Recalculating the global need for antiretroviral treatment.
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Anti-Retroviral Agents↗
Prevalence of activity limitation among persons living with HIV/AIDS in British Columbia.
BACKGROUND: As antiretrovirals increase the life expectancy of persons living with HIV, quality of life issues become more important. Little research has examined the types and levels of activity limitations among HIV-positive populations. The objective of this report is to compare the levels of limitations among HIV-positive persons to the general population. METHODS: The BC Persons With AIDS (BCPWA) Society consists of approximately 3,500 HIV-positive members. A recent survey conducted among BCPWA members included a section assessing activity limitations. Prevalence of limitations in this group was compared to the general population of BC using the National Population Health Survey (NPHS) to calculate standardized prevalence ratios (SPR). RESULTS: Compared to the general BC population, BCPWA members were more likely to be male, aged over 30 years, not to have graduated from high school, unemployed, living alone and having a household income less than $10,000 per year. The SPR for activity limitations among male participants applying the rates of limitation among the general population of BC was 9.4 (8.4-10.6). The SPR for women was 9.9 (7.2-11.1). Using an NPHS rate restricted to individuals who reported a chronic condition, the SPR for males was 6.0 (5.9-6.5) and for females was 7.0 (5.8-8.2). INTERPRETATION: Limitations on activity are prevalent, even when comparing those with high CD4 counts and restricting the standard to those with chronic conditions. These findings suggest that implementation of programs offering support with everyday tasks would be of value in this population.
Acquired Immunodeficiency Syndrome↗
Population health effects of air quality changes due to forest fires in British Columbia in 2003: estimates from physician-visit billing data.
BACKGROUND: Major forest fires near populated areas during 2003 exacted a huge economic toll on communities in British Columbia. We designed a study to examine associations between PM2.5 and PM10 levels and physician visits in two affected communities. METHODS: Measurements of 24-hour averages of particulate matter (PM10 and PM2.5) obtained from the monitoring network of the BC Ministry of Water, Land and Air Protection were used to define weeks where forest fires resulted in increases in ambient PM. Weekly rates of physician visits for respiratory (ICD-9 codes 460-519), cardiovascular (390-459) and mental illnesses (290-319) obtained through the Medical Services Plan of BC, were compared for 2003 and aggregates of the 10 previous years. RESULTS: Both the Kelowna and Kamloops regions experienced five weeks of elevated 24-hour average PM levels, although maximum levels in Kelowna were greater. In the Kelowna region, increases in physician visits for respiratory diseases of between 46 and 78% above 10-year mean rates were observed for three weeks during the forest fire period. Similar effects were not observed in Kamloops. Effects on visits for cardiovascular diseases or mental disorders were not seen in either community. INTERPRETATION: Forest fire smoke was associated with an excess of respiratory complaints in Kelowna area residents. The lack of a similar effect in Kamloops is likely due to the population being exposed to lower levels of PM. The absence of apparent cardiovascular health effects may be due to selective effects of forest fire smoke on respiratory tract disease.
Air Pollution↗