Indroduction: National Aids control Organisation in India implementing National AIDS control?program uses WHO’s immunological criteria to screen virological failure. Using immunological criteria to detect virological...Indroduction: National Aids control Organisation in India implementing National AIDS control?program uses WHO’s immunological criteria to screen virological failure. Using immunological criteria to detect virological failure has to be assessed. Predicting virological failure with immunological criteria in resource limited settings had low sensitivity. Factors that influence the outcome are studied. Methods: Retrospective study in tertiary care centre for HIV and TB, Chennai, India. Out of 35,044 on ART between January 2008 and September 2009, 452 suspected immunological failures were referred. 273 screened for virological failure.?Frequency, sensitivity/specificity, positive/negative predictive values, chi-square test, odds-ratio, independent sample t test for viral load greater than 10,000 and 1000 of each immunological criterion using Epi-Info and SPSS version 19. Results: 172 had virological failure (62.09%). Average age of failed was 37.33. Single criteria’s sensitivity was 60 to 84 for detecting virolological failure. Two or more criteria had specificity 55 to 79. Combination of two or more criteria increased odds ratio for virological failure. Positive predictive value was above 63 for all criteria. PPV was above 80 to the criterion all three positive. Conclusions: ART naive patients with >95% adherence the sensitivity of immunological criteria to detect virological failure is three times than earlier studies. Combination of criteria is more significantly associated with virological failure. Odds ratio doubled for two or more combination of criteria. Immunological criteria is affordable/acceptable for screening virological failure, with adherence > 95% and longer the duration of ART.展开更多
AIM:To investigate the significance of pre-transplant neutrophil-lymphocyte ratio(NLR) in determining the prognosis of liver transplant(LT) recipients with acuteon-chronic liver failure(ACLF).METHODS:Data were collect...AIM:To investigate the significance of pre-transplant neutrophil-lymphocyte ratio(NLR) in determining the prognosis of liver transplant(LT) recipients with acuteon-chronic liver failure(ACLF).METHODS:Data were collected from the liver transplantation data bank.The NLR values and other conventional inflammatory markers were evaluated for their ability to predict the prognosis of 153 patients with ACLF after LT.The NLR cut-off value was based on a receiver operating characteristic curve analysis.A Kaplan-Meier curve analysis and univariate and multivariate Cox regression models were used to define the independent risk factors for poor outcomes.RESULTS:The optimal NLR cut-off value was 4.6.Out of 153 patients,83(54.2%) had an NLR ≥ 4.6.The 1-,3-,and 5-year overall survival rates were 94.3%,92.5% and 92.5%,respectively,in the normal NLR group and 74.7%,71.8% and 69.8%,respectively,in patients with high NLRs(P < 0.001).Furthermore,there was a significant difference in infectious complications after LT between the high and normal NLR groups.There were no significant differences for other complications.In the multivariate Cox regression model,a high NLR was defined as a significant predictor of poor outcomes for LT.CONCLUSION:A high NLR is a convenient and available predictor for prognosis of LT patients and can potentially optimize the current criteria for LT in ACLF.展开更多
The early introduction of combination therapy of high-dose corticosteroid and nucleoside analogue is beneficial for the rescue of severe acute exacerbation of chronic hepatitis B.
文摘Indroduction: National Aids control Organisation in India implementing National AIDS control?program uses WHO’s immunological criteria to screen virological failure. Using immunological criteria to detect virological failure has to be assessed. Predicting virological failure with immunological criteria in resource limited settings had low sensitivity. Factors that influence the outcome are studied. Methods: Retrospective study in tertiary care centre for HIV and TB, Chennai, India. Out of 35,044 on ART between January 2008 and September 2009, 452 suspected immunological failures were referred. 273 screened for virological failure.?Frequency, sensitivity/specificity, positive/negative predictive values, chi-square test, odds-ratio, independent sample t test for viral load greater than 10,000 and 1000 of each immunological criterion using Epi-Info and SPSS version 19. Results: 172 had virological failure (62.09%). Average age of failed was 37.33. Single criteria’s sensitivity was 60 to 84 for detecting virolological failure. Two or more criteria had specificity 55 to 79. Combination of two or more criteria increased odds ratio for virological failure. Positive predictive value was above 63 for all criteria. PPV was above 80 to the criterion all three positive. Conclusions: ART naive patients with >95% adherence the sensitivity of immunological criteria to detect virological failure is three times than earlier studies. Combination of criteria is more significantly associated with virological failure. Odds ratio doubled for two or more combination of criteria. Immunological criteria is affordable/acceptable for screening virological failure, with adherence > 95% and longer the duration of ART.
基金Supported by National Natural Science Foundation of China for Innovative Research Group,No.81121002grants from Scientific Research Project of Education Department of Zhejiang Province,No.Y201223762
文摘AIM:To investigate the significance of pre-transplant neutrophil-lymphocyte ratio(NLR) in determining the prognosis of liver transplant(LT) recipients with acuteon-chronic liver failure(ACLF).METHODS:Data were collected from the liver transplantation data bank.The NLR values and other conventional inflammatory markers were evaluated for their ability to predict the prognosis of 153 patients with ACLF after LT.The NLR cut-off value was based on a receiver operating characteristic curve analysis.A Kaplan-Meier curve analysis and univariate and multivariate Cox regression models were used to define the independent risk factors for poor outcomes.RESULTS:The optimal NLR cut-off value was 4.6.Out of 153 patients,83(54.2%) had an NLR ≥ 4.6.The 1-,3-,and 5-year overall survival rates were 94.3%,92.5% and 92.5%,respectively,in the normal NLR group and 74.7%,71.8% and 69.8%,respectively,in patients with high NLRs(P < 0.001).Furthermore,there was a significant difference in infectious complications after LT between the high and normal NLR groups.There were no significant differences for other complications.In the multivariate Cox regression model,a high NLR was defined as a significant predictor of poor outcomes for LT.CONCLUSION:A high NLR is a convenient and available predictor for prognosis of LT patients and can potentially optimize the current criteria for LT in ACLF.
文摘The early introduction of combination therapy of high-dose corticosteroid and nucleoside analogue is beneficial for the rescue of severe acute exacerbation of chronic hepatitis B.
