Quality of life among individuals with HIV starting antiretroviral therapy in diverse resource-limited areas of the world.

As Antiretroviral Therapy (ART) is scaled up in low- and middle-income countries, it is important to understand Quality of Life (QOL) correlates including disease severity and person characteristics and to determine the extent of between-country differences among those with HIV. QOL and medical data were collected from 1,563 of the 1,571 participants at entry into a randomized clinical trial of ART conducted in the U.S. (n = 203) and 8 resource-limited countries (n = 1,360) in the Caribbean, South America, Asia, and Africa. Participants were interviewed prior to initiation of ART using a modified version of the ACTG SF-21, a health-related QOL measure including 8 subscales: general health perception, physical functioning, role functioning, social functioning, cognitive functioning, pain, mental health, and energy/fatigue. Other measures included demographics, CD4+ lymphocyte count, plasma HIV-1 RNA viral load. Higher quality of life in each of the 8 QOL subscales was associated with higher CD4+ lymphocyte category. General health perception, physical functioning, role functioning, and energy/fatigue varied by plasma HIV-1 RNA viral load categories. Each QOL subscale included significant variation by country. Only the social functioning subscale varied by sex, with men having greater impairments than women, and only the physical functioning subscale varied by age category. This was the first large-scale international ART trial to conduct a standardized assessment of QOL in diverse international settings, thus demonstrating that implementation of the behavioral assessment was feasible. QOL indicators at study entry varied with disease severity, demographics, and country. The relationship of these measures to treatment outcomes can and should be examined in clinical trials of ART in resource-limited settings using similar methodologies.

Sex-associated differences in pre-antiretroviral therapy plasma HIV-1 RNA in diverse areas of the world vary by CD4(+) T-cell count.

BACKGROUND: Sex differences in the natural history of HIV infection may vary between resource-rich and resource-limited settings. METHODS: Baseline characteristics from a randomized clinical trial of treatment-naive subjects conducted at sites in Africa, Asia, the Caribbean, and North and South America were analysed to determine if there were significant differences by sex. RESULTS: Of the 1,571 participants, 740 (47.1%) were women. Women had higher mean screening CD4(+) T-cell counts (mean 15 cells higher; P<0.001), lower mean haemoglobin and creatinine clearance, a lower mean baseline HIV-1 viral load (4.85 log(10) versus 5.05 log10 copies/ml; P<0.001) and were less likely to have a prior AIDS diagnosis than men. The sex difference in viral load was related to CD4(+) T-cell count; however, it was independent of country and persisted within the strata with CD4(+) T-cell count <200 cells/mm³. CONCLUSIONS: Women in resource-limited settings have lower levels of plasma HIV-1 RNA and appear to present for enrolment into clinical trials at an earlier stage of disease than men. The biological basis for lower viral load in women compared to men remains unexplained. It will be important to determine if the sex differences observed at baseline impact clinical outcomes once the PEARLS clinical trial is completed.

Environmental stability and heritability estimates for grain yield and test weight in triticale.

Hexaploid triticale has many advantages over both parental species for both grain and forage production in certain environments. Additional information on environmental stability and heritability would be desirable to develop appropriate selection strategies in the production of superior widely-adapted cultivars. The grain yield of 22 diverse genotypes grown at four ecologically-distinct geographical locations [Quincy, FL, USA (approximate geographical coordinates (AGC) = 30 degreesN 84 degreesW, approximate elevation (AE) = 58 m), Plains, GA, USA (AGC = 32 degreesN 84 degreesW, AE = 76 m), Bozeman, MT USA (AGC = 45 degreesN 111 degreesW, AE = 1458 m), and Aberdeen, ID, USA (AGC = 42 degreesN 112 degreesW, AE = 1360 m)] was measured in two years with winter and spring planting dates only at Bozeman and Aberdeen. Test weight (grain weight in a given volume) was determined for two years at Bozeman and Aberdeen at both planting dates and one year at Quincy. Stability analyses indicated that significant (P < 0.01) variation in means, regression coefficients, and deviation mean squares of the genotypes were present for both characters. Realized heritability (h2) estimates were as follows: grain yield ranged from -0.02 to 0.80 with a mean of 0.57; test weight ranged from 0.63 to 1.05 with a mean of 0.93. The results indicated that substantial genetic variation is present and selection for widely-adapted cultivars would be effective for both characters especially test weight.

Double-blind, placebo-controlled study of single-dose metergoline in depressed patients with seasonal affective disorder.

A role for serotonin in season affective disorder (SAD) has been explored with a variety of serotonergic pharmacologic agents. The authors initially hypothesized that metergoline, a nonspecific serotonin antagonist, would exacerbate depressive symptoms. In a small, open-label pilot study, the authors observed the opposite effect. They decided to follow up on this finding with this formal study. The study followed a double-blind, randomized cross-over design. Sixteen untreated, depressed patients with SAD received single oral doses of metergoline 8 mg and of placebo, spaced 1 week apart. Fourteen patients were restudied after 2 weeks of light treatment. Depression ratings using the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder Version were performed at baseline and at 3 and 6 days after each intervention. These data were analyzed by baseline-corrected repeated measures with analysis of variance. In the off-lights condition, severity of depression was diminished after metergoline compared with placebo administration (p = 0.001). Patient daily self-ratings suggested that the peak effect occurred 2 to 4 days after study drug administration. In contrast, after 2 weeks of treatment with bright artificial light, metergoline did not demonstrate a significant effect on mood. These data suggest that single doses of metergoline may have antidepressant effects that last several days. Possible mechanisms include 5-hydroxytryptamine(2) receptor downregulation and dopamine agonism.