CD4 cell count-guided treatment interruption: be smart and wait for more evidence.
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Biomedical subjects
Publications and source records attributed to Roberto Arduino.
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T-1249 is a 39-aa synthetic peptide that inhibits fusion of human immunodeficiency virus (HIV) to the host target cell. A 14-day open-label, phase 1/2 dose-escalation monotherapy study of the safety and antiretroviral activity of T-1249 was performed on 115 HIV-1-infected adults. At baseline, the majority of the patients had advanced HIV disease (baseline median CD4(+) cell count, 57 cells/microL) and had extensive pretreatment (i.e., pre-T-1249) experience with antiretroviral medications (median, 11 antiretroviral drugs). Patients received T-1249 monotherapy by subcutaneous injection, for 14 days, at doses ranging from 6.25 to 192 mg/day. T-1249 was generally well tolerated, and no dose-limiting toxicity was identified. Injection-site reactions were the most commonly reported adverse event (57%). Dose-dependent decreases in plasma HIV-1 RNA load were observed; the median maximum change from baseline across dose groups ranged from -0.29 log(10) copies/mL (95% confidence interval [CI], -0.43 to -0.05 log(10) copies/mL) for the lowest dose to -1.96 log(10) copies/mL (95% CI, -2.02 to -1.37 copies/mL) for the highest dose. These results indicate that T-1249 is a potent new therapeutic agent for HIV-1 infection.
This study examined the feasibility of using cellular telephones to improve access to smoking cessation counseling in a low-income, HIV-positive population. Two pilot studies were conducted: (a). A survey of interest and barriers in participating in a smoking cessation intervention (n=49) and (b). a cellular telephone smoking cessation intervention in which participants were provided with free cellular telephones and received six telephone counseling sessions over a 2-week period (n=20). A primary care clinic serving a multiethnic, medically indigent, HIV-positive population served as the setting. Demographics and smoking status were assessed by self-report and expired-air carbon monoxide testing. In study 1, participants reported multiple barriers to participating in a smoking cessation intervention, including transportation, transience, and telephone availability. However, they also reported a high level of interest in participating in a smoking cessation intervention, with the greatest interest in a cellular telephone intervention. In study 2, 19 of the 20 participants successfully completed 2 weeks of smoking cessation counseling with a 93% (106 of 114 calls) contact rate. A total of 19 participants made a quit attempt, and the 2-week end of treatment point-prevalence abstinence rate was 75%. The provision of cellular telephones allowed for the implementation of a proactive telephone smoking cessation intervention providing an underserved population with access to care. Cellular telephones also may provide unique benefits because of the intensity of counseling and support provided as well as the ability to provide counseling in real-world, real-time situations (in vivo counseling).