Genital shedding of HIV after scheduled treatment interruption.

This study assessed genital shedding of HIV in patients on intermittent combination antiretroviral therapy (cART) and assessed predictors of having detectable genital HIV RNA in 156 Thai patients with CD4 > 350 cells/µL and HIV RNA ≤50 copies/mL who were randomized to continuous therapy (CT, n = 65) or CD4-guided cART (n = 91). There were 383 matched genital and plasma HIV RNA samples (CT: 158, CD4 guided: 225). In 14 samples collected within eight weeks of treatment interruption, detectable HIV RNA was present in 29% of genital samples and 71% of plasma samples. In 55 samples collected after eight weeks of treatment interruption, detectable HIV RNA was present in 60% of genital samples and 98% of plasma samples. In 110 samples collected up to 96 weeks after treatment re-initiation, detectable genital HIV RNA was found in 8% of samples and all of these were within the first 17 weeks. Independent predictors of detectable genital HIV RNA were increasing age and increasing concentrations of HIV RNA in plasma. These findings support the role of cART in maintaining undetectable HIV RNA in genital secretions.

An effect of hormone replacement therapy on skin thickness in early postmenopausal women.

BACKGROUND: It is well known that dermal thickness, the major component of skin thickness, will decrease progressively after menopause. Bone and dermis share a similar organic constituent (collagen type I). The effect of hormone replacement therapy on bone has been established, whereas, its effects on skin are less well-described. This study was performed to determine the effect of combined estrogen-progestin replacement therapy in a sequential regimen on skin thickness in women during the early postmenopausal period. METHOD: One hundred early postmenopausal women who met the eligibility criteria and had already signed a consent form were non-randomly allocated in two groups. Group A; sixty women who received cyclic hormone replacement therapy in each 28-day cycle for 6 cycles. Group B; forty women who received 1,000 mg of calcium carbonate daily. Skin thickness was measured by ultrasonography before and after treatment and the Student's t-test was used to compare the results. RESULTS: A statistically significant increase in skin thickness over baseline was noted after combined estrogen-progestin replacement therapy had been administered for 24 weeks compared to the control and baseline groups. The skin thickness was also significantly decreased after calcium had been administered for 24 weeks when compared to baseline. CONCLUSION: Skin thickness was increased in early postmenopausal women subjected to hormone replacement therapy with an alternating dose of estrogen and progestin.

Use of depot medroxyprogesterone acetate in Thai adolescents.

Depot medroxyprogesterone acetate (DMPA) has been available for several decades in many parts of the world including Thailand, but few data have been reported concerning adolescents. The aim of the study was to determine the use of DMPA for contraceptive use among Thai adolescents. A cross-sectional study has been designed. A total of 108 adolescents who used DMPA as contraception between January 1, 1996, and December 31, 1997, at King Chulalongkorn Hospital were reviewed by chart. Most of the participants were in late adolescence and average age was 17.6 years of age. Six-month continuation rate was 69.4%, and at 9 months and 1 year were 42.6 and 30.6%, respectively. Irregular bleeding, amenorrhea, and weight gain were the side effects frequently reported. The most common side effect that caused discontinuation within 1 year was irregular bleeding. With prolonged use, the number of cases with irregular bleeding decreased and the duration of bleeding was shortened, whereas the rate of amenorrhea increased. No pregnancy occurred during the study period. In conclusion, DMPA is an effective contraception in adolescents. However, the continuation rate is lower than that for adult women. The main reason for discontinuation is irregular bleeding.

The predictive value of skin thickness in the diagnosis of osteopenia.

Skin and bone share a similar organic constituent (type I collagen) which decreases with time after menopause due to hypoestrogenism. The interdependence of skin and bone atrophy has been reported. This study was conducted to assess the predictive value of an ultrasonographic measurement of skin thickness in the diagnosis of osteopenia (BMD below -1.5 SD.) in perimenopausal and early postmenopausal women. All patients had skin thickness measured by the same radiologist and had a dual-energy X-ray absorptiometry (DEXA) scan of the lumbar spine and the femoral neck. Of the 77 women studied, the mean age was 50.9 +/- 3.0 years. Thirty patients were in perimenopause and 47 in early postmenopause. Mean skin thickness was 2.1 +/- 0.4 mm. Women with a skin thickness of < or = 1.7 mm carried a higher risk for developing osteopenia at the lumbar spine (odds ratio 8.41, 95% confidence interval 2.19-32.35) and the femoral neck (odds ratio 3.88, 95% CI 1.14-13.17). Patients with a skin thickness of > or = 2.4 mm had a lower probability of osteopenia at the lumbar spines (odds ratio 0.17, 95% CI 0.035-0.845) and the femoral neck (odds ratio 0.22, 95% CI 0.055-0.899). In conclusion, a low skin thickness measurement by ultrasonography may be used as an indicator for osteopenia in perimenopausal and early postmenopausal women.

Skin thickness in different menopausal status.

It is well known that skin thickness will decrease in the years after menopause. Women may have climacteric symptoms including those associated with skin alterations as early as during the perimenopausal period. This study was performed to compare the skin thickness of women in their premenopause (N = 31), perimenopause (N = 35) and early postmenopause (N = 46). The mean skin thickness in each group was 2.28 +/- 0.39 mm., 2.18 +/- 0.35 mm. and 2.02 +/- 0.36 mm. respectively. The skin thickness of women in the early postmenopausal group was significantly lower than those in the premenopausal group, but no difference was found between premenopausal and perimenopausal group nor between perimenopausal and early postmenopausal group. Furthermore, we found no correlation between skin thickness and chronological age. In conclusion, the decline in skin thickness of women entering menopause requires a period of time to undergo significant alterations and the study revealed a significant reduction of skin thickness as early as in the course of the early postmenopausal period.