HIV DNA Sequencing to Detect Archived Antiretroviral Drug Resistance.

INTRODUCTION: Proviral HIV DNA integrated within CD4 T-cells maintains an archive of viral variants that replicate during the course of the infection, including variants with reduced drug susceptibility. We considered studies that investigated archived drug resistance, with a focus on virologically suppressed patients and highlighted interpretative caveats and gaps in knowledge. RESULTS: Either Sanger or deep sequencing can be used to investigate resistance-associated mutations (RAMs) in HIV DNA recovered from peripheral blood. Neither technique is free of limitations. Furthermore, evidence regarding the establishment, maintenance, expression and clinical significance of archived drug-resistant variants is conflicting. This in part reflects the complexity of the HIV proviral landscape and its dynamics during therapy. Clinically, detection of RAMs in cellular HIV DNA has a variable impact on treatment outcomes, modulated by the drugs affected, treatment duration and additional determinants of virological failure, including those leading to suboptimal drug exposure. CONCLUSIONS: Sequencing cellular HIV DNA can provide helpful complementary information in treatment-experienced patients with suppressed plasma HIV RNA who require a change of regimen. However, care should be taken when interpreting the results. Presence of RAMs is not necessarily a barrier to treatment success. Conversely, even the most sensitive sequencing techniques will fail to provide a comprehensive view of the HIV DNA archive. To inform treatment decisions appropriately, the overall clinical and treatment history of a patient must always be considered alongside the results of resistance testing. Prospective controlled studies are needed to validate the utility of drug resistance testing using cellular HIV DNA.

The incidence of metabolic syndrome in adolescents with different phenotypes of PCOS.

OBJECTIVES: To evaluate the incidence of metabolic syndrome in Turkish adolescents with different phenotypes of polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: This cross-sectional study was performed on the Youth Center clinic of a tertiary referral hospital in Turkey. Adolescents with PCOS (n = 144) were classified into four phenotype groups according to the presence of oligo/anovulation (O), hyperandrogenism (H), and polycystic ovarian morphology (P) as follows: Phenotype A (O + H + P), Phenotype B (H + O), Phenotype C (H + P), Phenotype D (O + P). The adolescents gave early follicular phase blood samples for endocrine and metabolic tests. The incidence and the presence of parameters of metabolic syndrome were assessed among the four groups. RESULTS: In total, 54.9% of the adolescents with PCOS were overweight and 25.7% had metabolic syndrome. The incidence of metabolic syndrome in Phenotypes A-D were as follows: 39.5%, 20.5%, 26.5%, and 15.2%, respectively. Although body mass index was higher in the Phenotype A group, insulin resistance was similar in all of the phenotype groups. The most common dyslipidemia was low HDL-C levels and this was present in more than half of the adolescents with PCOS. Both body mass index and total testosterone levels were significantly higher in adolescents with metabolic syndrome in comparison to those without metabolic syndrome. CONCLUSIONS: Although low HDL-C levels and insulin resistance are common PCOS findings in adolescents, the metabolic profile seems to be worse in Phenotype A than the other phenotypes. Therefore, screening programs should evaluate patients based on the known risk factors and phenotypes for adolescents with PCOS.

Association between bone mineral density and metabolic syndrome in Turkish women who were postmenopausal.

OBJECTIVE: To investigate the relationship between the parameters of metabolic syndrome and bone mineral density (BMD) at the femoral neck and lumbar spine in Turkish women who were postmenopausal. METHODS: In a retrospective study, the records of patients who were postmenopausal attending the Menopause Outpatient Clinic of a tertiary women's hospital in Ankara, Turkey, between January 1, 2014 and December 31, 2014 were retrieved. Patient's BMD at the lumbar spine and femoral neck were assessed using T-scores, and parameters of metabolic syndrome were evaluated in all patients. RESULTS: The records of 315 patients were retrieved. The mean age of patients was 55.63±6.14years (range 45-71 years). Metabolic syndrome was recorded in 92 (29.2%) patients. Following adjustment for age, patients with metabolic syndrome had higher T-scores at the femoral neck than patients without metabolic syndrome (-0.67±0.1 vs -1.15±0.06; P=0.001); there was no significant difference in T-scores at the lumbar spine (P=0.062). A Spearman correlation analysis of the entire study cohort demonstrated a negative association between high-density lipoprotein cholesterol and BMD at the lumbar spine and femoral neck (r=-0.12 and r=-0.15, respectively). CONCLUSION: Metabolic syndrome could have been partly associated with increased BMD in Turkish women who were postmenopausal.

Long-term survival after total pelvic exenteration in a patient with recurrent cervical carcinoma: A case report.

The management of recurrent cervical cancer depends mainly on previous treatment as well as on the site and extent of recurrence. Pelvic exenteration usually represents the only therapeutic approach with curative intent for women with central pelvic relapse who have previously received irradiation. In the present report, we share our experience regarding survival outcome in a patient with recurrent endocervical carcinoma who underwent total pelvic exenteration.