Biomedical subjects

Lars E Eriksson

Publications and source records attributed to Lars E Eriksson.

5 recordsLinked to original sources

PubMed2005

The two-year impact of first generation protease inhibitor based antiretroviral therapy (PI-ART) on health-related quality of life.

BACKGROUND: Protease inhibitor based antiretroviral therapy (PI-ART) was introduced in 1996 and has greatly reduced the incidence of HIV-related morbidity and mortality in the industrialised world. PI-ART would thus be expected to have a positive effect on health-related quality of life (HRQL). On the other hand, HRQL might be negatively affected by strict adherence requirements as well as by short and long-term adverse effects. The aim of this study was to assess the influence of two years of first generation PI-ART on HRQL in patients with a relatively advanced state of HIV-infection. Furthermore, we wanted to investigate the relation between developments in HRQL and viral response, self-reported adherence and subjective experience of adverse effects in patients with PI-ART. METHODS: HRQL was measured by the Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL). Sixty-three items from the SWED-QUAL forms two single-item and 11 multi-item dimension scales. For this study, two summary SWED-QUAL scores (physical HRQL composite score and emotional HRQL composite score) were created through a data reduction procedure. At the 2-year follow-up measurement (see below), items were added to measure adherence and subjective experience of adverse effects. Demographic and medical data were obtained from specific items in the questionnaires and from the medical files. Seventy-two patients who were among the first to receive PI-ART (indinavir or ritonavir based) responded to the questionnaire before the start of PI-ART. Of these, 54 responded to the same instrument after two years of treatment (13 had died, four had changed clinic and one did not receive the questionnaire). RESULTS: The main findings were that the emotional HRQL deteriorated during two years of PI-ART, while the physical HRQL remained stable. Multiple linear regression analyses showed that experience of adverse effects contributed most to the deterioration of emotional HRQL. CONCLUSION: In this sample of patients with relatively advanced state of HIV-infection, our data suggested that a negative development of physical HRQL had been interrupted by the treatment and that the emotional dimension of HRQL deteriorated during two years after start of PI-ART. Subjective experience of adverse effects made a major contribution to the decrease in emotional HRQL. The results underline the importance of including HRQL measures in the evaluation of new life prolonging therapies.

Adult↗

PubMed2005

CD4 cell-monitored treatment interruption in patients with a CD4 cell count > 500 x 106 cells/l.

BACKGROUND: Little is known about CD4 cell count changes in patients with high CD4 cell counts who interrupt antiretroviral therapy, especially in those with a nadir of 250-350 x 10 cells/l. METHODS: Data derived from 139 patients from seven prospective cohorts who had > 12 months highly active antiretroviral therapy (HAART), CD4 cell count nadir of > 250 x 10 cells/l and at pre-interruption of > 500 x 10 cells/l. Endpoint was time to CD4 cell count < 350 x 10 cells/l or reinitiation of treatment. RESULTS: At interruption, the median CD4 cell count was 800 x 10 cells/l, median viral load was 1.7 log10 copies/ml. At the time of analysis, 63 (45.3%) had resumed therapy or experienced < 350 x 10 cells/l CD4 cells over a median interruption of 75 weeks. Of these, 33 (52.4%) experienced a decline to < 350 x 10 cells/l and 30 (47.6%) restarted therapy before their CD4 cell count had fallen below this level. In 43 patients with CD4 cell nadir of 251-350 x 10 cells/l, median time to therapy resumption or CD4 cell count < 350 x 10 cells/l was 61 weeks. Higher CD4 cell count nadir, longer duration of viral load suppression on therapy, and higher viral load level at interruption were independently associated with longer time to restart therapy. The risk of clinical events was 5 per 1000 person-years of follow-up. CONCLUSIONS: Patients who started therapy with CD4 cell count of 250-350 x 10 cells/l and who later interrupted therapy appear able to remain off therapy with a CD4 cell count > 350 x 10 cells/l for a substantial period of time.

Adult↗

PubMed2005

Why do nurses at a university hospital want to quit their jobs?

The aim of the study was to investigate to what extent the registered nurses at a university hospital intend to quit their present jobs and the reasons for this. A total of 833 nurses at a university hospital responded to two mailed, work-environment questionnaires (Quality Work Competence and Huddinge University Hospital Model Questionnaire). About 54% (n = 449) intended to quit and 35% (n = 155) had already taken steps to do so. Main reasons were dissatisfaction with the salary (65%), psychologically strenuous and stressful work (32%), a wish to 'try something new' (28%) and limited opportunities to make a professional career (19%). Nurses who intended to quit ('quitters') rated a higher work tempo (P < 0.001), experienced an increased work-related exhaustion (P < 0.001) and a lower quality of patient care (P < 0.01). They also perceived to a lower degree that their competence was made good use of (P < 0.001) and that they had fewer opportunities of developing their own competence (P < 0.001) and making a professional career. They were less satisfied with the support from their superiors for participating in nursing research and developing projects (P < 0.001). Finally, the 'quitters' knew to a significantly lesser extent (P < 0.001) why they had the actual salary they had, what the salary was based on and what to do to improve it. However, it was found that the hospital still had a 'core group' of highly motivated and dedicated nurses with an unusually high amount of mental energy left. All findings regarding the 'quitters' are factors amenable to interventions.

Adult↗

PubMed2003

A multiplex real-time PCR for quantification of HIV-1 DNA and the human albumin gene in CD4+ cells.

We have established a simple system for measuring HIV-1 DNA load in CD4+ cells. In a multiplex configuration, a conserved region in the HIV-1 pol gene and a section of the human albumin gene were simultaneously amplified to estimate the number of HIV-1 DNA copies per cellular genome. An established Epstein-Barr virus (EBV) standard system was used to calibrate the HIV-1 quantification. Our multiplex PCR system was tested on different in vitro developed HIV-1 strains and on longitudinal samples from eight patients. The system was able to amplify both in vitro and in vivo samples of various genetic compositions. In all eight patients, HIV-1 DNA was detected and ranged between 0.17 and 51x10-3 copies per CD4+ cell and could be monitored longitudinally, including long-term PI-ART and STI. The measured HIV-1 DNA load may be used to select the best time for the institution or re-institution of therapy.

Base Sequence↗

PubMed2003

HIV type 1 DNA development during long-term supervised therapy interruption.

We studied the pattern of HIV-1 DNA development and the association to other HIV-related factors during long-term supervised therapy interruption (LT-STI). Fifteen patients were treated with long-time protease inhibitor-based antiretroviral therapy (PI-ART). They had HIV-1 RNA at <50 copies/ml over 33.4 (SD 9.5) months and CD4(+) cell counts of 875 (SD 415) x 10(6)/liter. A real-time polymerase chain reaction, amplifying fragments of the HIV-1 pol gene and the human albumin gene simultaneously, was used to quantify HIV-1 DNA molecules in CD4(+) cells. The quantity of HIV-1 DNA in CD4(+) cells increased during LT-STI in all 15 patients, with an average doubling time of 2 months. Tentatively, three patterns were observed: rapid initial increase with subsequent stabilizing levels, rapid continuous increase, and slow increase. The HIV-1 DNA slope was positively related to the HIV-1 RNA maximum and steady state level and the baseline HIV-1 DNA value. It was inversely related to the decrease in CD4(+) cells both before the start of PI-ART and during the LT-STI. To conclude, HIV-1 DNA persists in infected CD4(+) cells despite long-term effective PI-ART and will increase after therapy interruption. The most important clinical predictor of long-term STI failure was the rapid CD4(+) cell decline before PI-ART. In patients with a steep pre-PI-ART slope it may be prudent to continue treatment and not initiate therapy interruption.

Anti-HIV Agents↗