Coronary artery stenosis in Japanese people living with HIV-1 with or without haemophilia.

An extremely high prevalence (12.2%) of moderate-to-severe coronary artery stenosis (CAS) was documented in asymptomatic Japanese haemophiliacs living with HIV-1 (JHLH) in our previous study. The cause of this phenomenon remains unknown. We conducted the CAS screening in people living with HIV-1 without haemophilia (PLWH without haemophilia) to compare the prevalence of CAS in JHLH and PLWH without haemophilia and to identify the risk factors including inflammation markers. Ninety-seven age-matched male PLWH without haemophilia who consulted our outpatient clinic between June and July 2021 were randomly selected, and 69 patients who provided informed consent were screened for CAS using coronary computed tomography angiography (CCTA). The number of JHLH cases was 62 in this study. The prevalence of moderate (> 50%) to severe (> 75%) CAS was significantly higher in JHLH [14/57 (24.6%) vs. 6/69 (8.7%), p = 0.015], and the ratio of CAS requiring urgent interventions was significantly higher [7 (12.3%) vs. 1 (1.4%), p = 0.013] in JHLH than in PLWH without haemophilia. Among the inflammatory markers, serum titres of intercellular adhesion molecule-1 (p < 0.05) and interleukin-6 (p < 0.05) in JHLH were significantly higher than those in PLWH without haemophilia. Although some patient demographics were different in the age-matched study, it might be possible to speculate that intravascular inflammation might promote CAS in JHLH.

Neurocognitive dysfunction and brain FDG-PET/CT findings in HIV-infected hemophilia patients and HIV-infected non-hemophilia patients.

This single-institution cross-sectional study aimed to grasp the prevalence and features of neurocognitive dysfunction in HIV-infected hemophilia patients in Japan. We conducted neuropsychological tests and medical examinations in 56 HIV-infected hemophilia patients who received outpatient treatment at the AIDS Clinical Center, National Center for Global Health and Medicine. A total of 388 HIV-infected non-hemophilia patients who received outpatient treatment at the same institution were included as a control group. To investigate sites responsible for neurocognitive dysfunction in HIV-infected hemophilia patients using brain FDG-PET/CT scans, the accumulation of FDG in each brain region was compared. Approximately 50% of HIV-infected hemophilia patients had neurocognitive dysfunction. The prevalence of asymptomatic neurocognitive impairment was high (34%). Neurocognitive dysfunction was associated with educational level in HIV-infected hemophilia patients. In the symptomatic group, hemophilic arthropathy and history of cerebrovascular disorders were associated with neurocognitive dysfunction. Left temporal lobe function was reduced in the symptomatic group.

Unexpected high prevalence of severe coronary artery stenosis in Japanese hemophiliacs living with HIV-1.

To determine the prevalence of coronary artery stenosis (CAS) in Japanese hemophiliacs living with HIV- 1 (JHLH), a prospective study at AIDS Clinical Center, Tokyo, which provides care and treatment to nearly 10% of the JHLH was conducted. The study subjects were 76 JHLH who visited our clinic and received coronary computed tomography angiography (CCTA) between January through December 2019. CCTA with radiographic contrast media was used for CAS screening. Coronary artery calcium score (CACS) by CCTA, pulse wave velocity (PWV), electrocardiography, echocardiography, and chest radiography were also included to the screening process. Stenosis of 50% or more by CCTA was defined as moderate to severe CAS. All patients diagnosed with moderate to severe CAS were recommended to undergo coronary angiography (CAG). Among the 76 JHLH, 19 were excluded. Among the enrolled 57 patients, only 5 had complained of chest symptoms. Their median age was 47 years (interquartile range: 44-55 years), prevalence of hypertension 42.1%, diabetes mellitus 14.0%, dyslipidemia 38.6%, and smoking history 52.6%. Moderate to severe CAS was diagnosed in 14 patients by CCTA (24.6% of CCTA tested). Twelve patients agreed to undergo CAG. Seven patients were diagnosed as severe CAS by CAG (12.3% of CCTA received), although only 2 (28.6%) had chest symptoms. PWV and CACS were useful and significant non-invasive markers of moderate to severe CAS (p = 0.016, p < 0.001, respectively). In conclusions, our study identified high prevalence of severe CAS among JHLH. We recommend screening of all HIV-1-infected hemophiliacs with PWV and CACS, regardless of chest symptoms.

Non-AIDS-defining malignancies in Japanese hemophiliacs with HIV-1 infection.

Along improvement of prognosis of HIV-1-infected patients due to successful anti-retroviral therapy, main causes of death in the patients have been changing from AIDS to non-AIDS defining malignancies (NADM) recently. However, little is known about the prevalence and incidence of NADM in patients, and especially in HIV-1-infected hemophiliacs. We prospectively conducted NADM screening with FDG-PET, chest CT, upper gastrointestinal endoscopy, tumor markers, and stool occult blood in hemophiliacs with a mean age of 48.9 years. Screening was done twice from December 2016 through March 2019; the first screening was used to calculate prevalence in 69 patients and the second was used to calculate incidence in 56 patients. The first screening revealed 4 cases of malignancies; three were cases of thyroid cancer and one was a case of a neuroendocrine tumor in the pancreas; prevalence was 5.8% (95% CI: 0.2-11.4%). During a mean follow-up of 1.2 years with 68.2 person-years (PYs), cancer was diagnosed in 2 cases (pancreatic and liver cancer) during the second screening. Incidence was 2.99/100 PY. It can be speculated that there might be around 40 cases of undiagnosed NADM currently and 20 cases of new NADM annually in this population, because 718 HIV-1-infected hemophiliacs are surviving in Japan according to the 2018 Nationwide Survey on Coagulation Disorders. Screening for NADM in HIV-1-infected hemophiliacs at other hospitals is strongly recommended.

Impact of non-dietary nutrients intake on misclassification in the estimation of nutrient intake in epidemiologic study.

BACKGROUND: Few previous epidemiologic studies have evaluated the effects of non-dietary nutrient intake, such as supplements, over the counter (OTC) drugs, and prescription drugs containing vitamins or minerals, in examining the relationship between dietary factors and health outcomes. METHODS: To examine the influence of the non-dietary intake of vitamins and calcium on the estimation of nutrient intake, we conducted a cross-sectional study with 1,168 community-dwelling Japanese subjects aged 70 years or older in 2002. The subjects were asked to bring their non-dietary nutrient sources to the examining site. The dietary and non-dietary intakes of vitamins B1, C, E and calcium were obtained and the subjects were grouped into quartiles according to their dietary intake and their dietary plus non-dietary intake. The degree of agreement between these two classifications was examined to estimate the degree of misclassification. RESULTS: Among the subjects who were classified into the highest intake category for vitamin E with dietary intake plus non-dietary nutrient intake, 34.2 % were misclassified into lower category with dietary intake alone. Similarly, intake of vitamin B(1), vitamin C and calcium were misclassified 28.8%, 18.8 %, 6.2 %, respectively. CONCLUSIONS: Our data suggest that estimation of vitamin intake from dietary sources alone would yield a maximum misclassification of one-third, which would lead to misleading conclusions being drawn from epidemiologic studies. In contrast, the degree of misclassification for calcium may be relatively small.

[A case report of a terminally ill patient who died of cancer at home under pain control].

Ninety percent of patients we handle at our visiting nurse group are last stage cancer patients. We report a terminally ill cancer patient who died at home under a high dose of powerful opioids to control pain. The patient was a 69-year-old woman with colorectal cancer. She lived together with her husband and their elder son's family. Even though the patient's condition dramatically shifted time to time, we could maintain a good QOL of the patient till her death at home. After the outpatient chemotherapy treatment began, we confirmed the patient's colorectal cancer had spread to her bones. We started using powerful opioids for pain control and the patient was eventually transferred to home hospice care. Then, the patient suffered a self destruction of the cutis metastasis layer and the disease caused broken bones on her left thigh. We however continued on providing home care service because of the patient's strong desire to stay home even if the family's concern as a care giver had multiplied. We increased the frequency of home visits and telephone calls in order to give medical and spiritual support for both the patient and her family. As a result, we could keep the patient's good QOL up to the time of her death. Based on the experiences through taking care of the patient, we strongly felt that the timing of proper guidance for the peaceful death to the family, a communication method or a communication system and telephone call visits were very important, in addition to controlling the condition of illness in order to keep up a good QOL for both the patient and her family.

The relationship between body mass index and a plasma lipid peroxidation biomarker in an older, healthy Asian community.

PURPOSE: To examine the association between body mass index (BMI) and the plasma level of a lipid peroxidation biomarker in a large sample of elderly healthy Asian population. This cross-sectional study included 1150 community-dwelling Japanese aged 70 years or older in 2002. METHODS: We measured the lipid peroxidation biomarker 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha) using the ELISA method. We also measured the weight and height and calculated the BMI as weight (kg)/height (m)2. RESULTS: After adjustment for potential confounders, the mean +/- SE plasma 8-iso-PGF(2alpha) level was significantly higher in subjects with higher BMI: 21.1 +/- 0.8 pg/ml in those with BMI of 30.0 or more; 20.5 +/- 0.3 pg/ml in those with BMI between 25.0 and 29.9; 20.0 +/- 0.2 pg/ml in those with BMI between 18.5 and 24.9; and 19.0 +/- 0.7 pg/ml in those with BMI of less than 18.5 (p for trend = 0.011). CONCLUSIONS: Our results demonstrated that in the healthy Asian population, there was a modest but significant relationship between BMI and the plasma lipid peroxidation level.