A Systematic Review and Meta-Analysis on the Impact of Statin Treatment in HIV Patients on Antiretroviral Therapy.

The rate of new human immunodeficiency virus (HIV) infections globally is alarming. Although antiretroviral therapy (ART) improves the quality of life among this group of patients, ARTs are associated with risk of cardiovascular diseases (CVD). Moreover, virally suppressed patients still experience immune activation associated with HIV migration from reservoir sites. Statins are widely recommended as therapeutic agents to control ART-related CVD; however, their impacts on the cluster of differentiation (CD)4 count and viral load are inconsistent. To assess the effect of statins on markers of HIV infections, immune activation and cholesterol, we thoroughly reviewed evidence from randomised controlled trials. We found 20 relevant trials from three databases with 1802 people living with HIV (PLHIV) on statin-placebo treatment. Our evidence showed no significant effect on CD4 T-cell count standardised mean difference (SMD): (-0.59, 95% confidence intervals (CI): (-1.38, 0.19), p = 0.14) following statin intervention in PLHIV on ART. We also found no significant difference in baseline CD4 T-cell count (SD: (-0.01, 95%CI: (-0.25, 0.23), p = 0.95). Our findings revealed no significant association between statins and risk of viral rebound in PLHIV with undetectable viral load risk ratio (RR): (1.01, 95% CI: (0.98, 1.04), p = 0.65). Additionally, we found a significant increase in CD8+CD38+HLA-DR+ T-cells (SMD (1.10, 95% CI: (0.93, 1.28), p < 0.00001) and CD4+CD38+HLA-DR+ T-cells (SMD (0.92, 95% CI: (0.32, 1.52), p = 0.003). Finally, compared to placebo, statins significantly reduced total cholesterol (SMD: (-2.87, 95% CI: (-4.08, -1.65), p < 0.0001)). Our results suggest that the statin lipid-lowering effect in PLHIV on ART may elevate immune activation without influencing the viral load and CD4 count. However, due to the limited evidence synthesised in this meta-analysis, we recommend that future powered trials with sufficient sample sizes evaluate statins' effect on CD4 count and viral load, especially in virally suppressed patients.

High prevalence but lack of awareness of hypertension in South Africa, particularly among men and young adults.

Cardiovascular disease (CVD) is a leading cause of death in South Africa (SA) and high blood pressure (BP) is the primary risk factor. However, hypertension prevalence is high, BP control is poor and CV events occur at a younger age than in Europe or America. Increasing screening, raising awareness and improving management of hypertension are critical to prevent CVD in SA. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high BP. As part of the MMM campaign, in SA (2017, 2018, 2019 and 2021), BP measurements and a cross-sectional survey of volunteers aged ≥ 18years were performed. Of 11,320 individuals (age 36.6 ± 16.8years) screened, 29.7% had hypertension (systolic BP/diastolic BP ≥ 140/90 mmHg or antihypertensive medication use) and the prevalence was higher (p < 0.0001) in men (35.6%) than in women (26.3%). Of those with hypertension, only 54.3% were aware and 46.8% were receiving antihypertensive medication, and 53.7% of these had controlled BP. In men with hypertension, awareness (45.2%, treatment (38.2%) and controlled BP on antihypertensive medication (45.2%) were lower (p < 0.0001) than in women (awareness: 60.8%; treatment: 53.5%; controlled BP: 58.3%). In young participants (age < 40years), 15.6% had hypertension, 18.6% of these were on treatment but 76.0% were not aware, and only 57.7% had controlled BP. The high prevalence of hypertension, but low levels of awareness, treatment, and BP control in SA, especially in young adults and men, highlight the need for systematic BP screening programmes and improvements in education and management of hypertension.

Changing Patient Perceptions of MTM: Determining an Effective Method of Education.

BACKGROUND: Medication Therapy Management (MTM) is a vital resource in reducing medication nonadherence, yet many individuals who are eligible for MTM services are unaware of what MTM is and how to enroll. Little is known about how to best educate patients on MTM services and its benefits. OBJECTIVE: To determine the difference between in-person education community education versus brochure community education on MTM services on perceptions of and enrollment in MTM services. METHODS: A pre-post quasi experimental study, where patients were allocated to receive information about MTM through an educational brochure or an in-person education session and completed survey assessments pre- and post-intervention, was conducted at a federally-qualified health center. Patients who were ages 18 years or older, MTM-eligible, and had received no prior MTM service were eligible to participate. Changes in patient perceptions of and enrollment in MTM from pre- to post-intervention were assessed by survey instruments developed for this study. RESULTS: A total of 35 patients (brochure=25, in-person=10) were recruited for this study. Most participants (94.2%) either reported having never heard of MTM or not being sure if they had heard of MTM. There were no significant between-group differences on pre-survey questions or pre-post within-group changes (p>0.05). There were significant between-group differences on 11 post-assessment questions and MTM enrollment (p<0.05), with the in-person education group showing improved perceptions and greater enrollment. CONCLUSION: Patients remain largely unaware of MTM services; there is a need for education to increase awareness. Even though educating patients in a face-to-face context had a more positive impact on perceptions of MTM and enrollment in MTM, more research is needed regarding the best educational methods as it was difficult for patients to find time to attend an educational session.

Transcription factor activation in response to cutaneous injury: role of AP-1 in reepithelialization.

Reepithelialization is the process responsible for restoring an intact epidermis following cutaneous injury. A change in the activity of keratinocytes is required for reepithelialization to occur, and this is likely to be regulated by the altered expression of effector genes, mediated by transcription factors. The injury itself provides a stimulus for transcription factor activation either directly due to mechanical stress, or via paracrine mechanisms such as the release of growth factors from damaged cells. Members of the activator protein-1 family, in particular c-fos and c-jun, have been the most widely studied wound-induced transcription factors. The signal transduction pathways linking cellular injury to activator protein-1 stimulation appear to involve an increase in intracellular Ca2+ and activation of mitogen-activated protein kinases. Given that a number of genes involved in the reepithelialization of wounds are regulated by activator protein-1, a distinct role for this transcription factor in reepithelialization is beginning to emerge. This article reviews the evidence for activator protein-1 involvement in reepithelialization, with particular focus on the activation of this transcription factor in response to wounding, the second messenger/kinase pathways involved, and the modulation of downstream genes that have the capacity to regulate keratinocyte function.