Skylar Jeremias

Women who have different histories with injectable medications had different views on their level of comfort with long-acting injectable (LAI) 

The researchers said that differences of opinion, especially for patients with a history of illegal drug use, highlight that physicians should take into account patient history with injection drug use prior to making a decision on prescribing an LAI or an oral medication for preexposure prophylaxis (PrEP) or antiretroviral therapy (ART).

Daily administration of oral PrEP and ART can present barriers to adherence to HIV medicines, especially for female patients, on individual, clinical, and sociostructual levels. Women make up 5% of PrEP users in the United States and discontinue treatment quicker than their male counterparts. In addition, only 60% of women living with HIV (WLWH) who take daily oral treatments are suppressed at 12 months, suggesting they are in need of alternatives.

Monthly use of LAI ART and PrEP is currently under FDA review. Presently, there is minimal research on how LAIs affect women. Findings from one study suggest LAIs can increase adherence to HIV medications, while additional research has raised concerns that LAIs could trigger recurrence for people with a history of injectable drug abuse.

To better understand how LAI ART and PrEP therapies can be used by women with a history of injectable medication use, researchers conducted 89 in-depth interviews across 6 

 sites across the United States, of which 59 were with WLWH. The in-person interviews were conducted from November 2017 to October 2018.

Participants had a median age of 51 years, and 96% were women of color. Most women were unemployed (66%), had a yearly salary below $12,000 (59%), and said they would prefer to take LAI PrEP (50%) or ART (56%) instead of daily medication.

More than two-thirds of the women had a history of using injectables, consisting of substance use, having physical comorbidities that require injectable treatments, using birth control, or receiving vaccines.

The researchers developed 4 categories based on the women’s history and perceptions of how others would react based on their experiences:

Episodic injections and had few concerns about LAIs

Frequent injections and would refuse additional ones

History of illegal drug use with differing opinions on whether LAIs might trigger a recurrence

Currently using injectable drugs and had few concerns about LAIs

The most polarizing answers stemmed from the group with a history of drug use who worried LAIs could trigger a relapse. Some participants stressed that needles, and needle-like objects such as mechanical pencils, could be triggers for recovering addicts. Others felt that LAIs were no big deal, because of their experience with needles, especially with self-administering.

“This highlights the importance of patient–provider communication to identify unique needs among women with injection drug use histories,” wrote the authors.

Women who have received episodic injections showed few concerns, because their experience with shots may increase their comfort level with LAIs. Several women commented that LAIs reminded them of birth control options and felt that the injection would take away feelings of panic associated with having to keep track of pills.

Women who receive frequent injections, such as women who have 

 or hepatitis C, expressed that LAIs would add excessive injections to their regimen. One participant noted that even though she is very tolerant to injections, she doesn’t particularly like or want more of them. Some women who receive frequent injections also have aversions to needles, placing a larger burden on caregivers who would have to administer them.

Women who were current users of injectable medicines and had few concerns felt indifferent to LAI therapy and said that appointments every 1 to 2 months felt manageable.

“Rather than a matter of preference for or aversion to needles based on histories of drug use, this response considers how LAIs might fit more seamlessly into the challenging realities of daily life for those who inject drugs,” noted the authors, adding that HIV status did not impact whether women would anticipate someone being wary of LAIs.

The researchers noted that their results are limited in reliability because the data stem from people’s opinions based on personal experiences.

Philbin MM, Parish C, Bergen S, et al. A qualitative exploration of women’s interest in long-acting injectable antiretroviral therapy across six cities in the Women’s Interagency HIV Study: intersections with current and past injectable medication and substance use. 

. 2021;35(1):23-30. doi:10.1089/apc.2020.0164

Articles

A recent study found that women had varying levels of willingness to use long-acting injectable HIV medications, based on their history with intravenous drug use.

Previous Intravenous Drug Use May Impact Women’s Comfort With Injectable HIV Medications

Different types of physical activity, including leisure-time activity, occupational activity, walking, and bicycling, were shown to reduce the risk of 

. This helps to support the recommendation to increase physical activity among the general population.

The results build on well-established evidence that physical activity can help reduce risks of developing 

 disease by adding information of how it can also reduce heart failure risk.

Although previous studies have focused on establishing whether or not physical activity can reduce heart failure risk, results have differed on whether an association exists. Additionally, little research has been done to investigate how specific types and intensities of physical activity affect heart failure. The researchers also said that updating the evidence regarding various physical activities could be used by physicians for heart failure risk assessments.

In the present review, studies published onto the PubMed and Embase databases up until January 14, 2020, were analyzed. Studies included in the analysis had to be prospective cohort, case-cohort, or nested case-control studies that investigated the link between physical activity or cardiorespiratory fitness and heart failure in the general population.

The researchers identified 20,208 records and included 29 prospective studies representing 36 publications; 27 studies from 34 publications were used in the meta-analysis. Twenty-one of these studies addressed different domains of physical activity and 6 had investigated cardiorespiratory fitness, for approximately 73,000 cases and 1.9 million participants. Eleven studies were from the United States, 1 was from Canada, 8 came from Europe, and 1 was an international study. The United States and Europe each had 3 studies that included information on cardiorespiratory fitness and heart failure.

The investigators calculated the summary relative risks (RR) using random effects models. The summary RR for high vs low physical activity was 0.77 (95% CI, 0.70-0.85; I

 = .07). The overall RR ranged from 0.74 (95% CI, 0.68-0.81; I

 < .0001) for leisure-time activity to 0.66 (95% CI, 0.59-0.74; I

For walking and bicycling combined, the overall RR was 0.81 (95% CI, 0.69-0.94; I

 = .001). Walking and walking speed were not observed to have a significant association with heart failure, with the researchers noting that studies in this area were limited.

Occupational activity had an overall RR of 0.90 (95% CI, 0.86-0.95; I

 = .46), and cardiorespiratory fitness had a summary RR of 0.31 (95% CI, 0.19-0.49; I

The summary RR in the dose-response analysis per 20 metabolic equivalent hours per day of total physical activity was 0.89 (95% CI, 0.83-0.95; I

 = .03). For leisure-time activity, the summary RR was 0.71 (95% CI, 0.65-0.78; I

Studies that adjusted for body mass index, 

, and hypertension did not show a significant difference in their results, the investigators said, suggesting that the association between physical activity and heart failure is independent of a person’s weight.

The researchers noted that their results may be influenced by confounding factors; however, a subgroup analysis defined by adjustments in various situational and health-related factors revealed that the association between physical activity and heart failure persisted. Additionally, the investigators said that some of the included studies may have had a publication bias.

studies should investigate the association of different forms of physical activity and subtypes of heart failure, the investigators concluded, and report the results in a way that could be useful in a dose-response meta-analysis. 

Aune D, Schlesinger S, Leitzmann MF, et al Physical activity and the risk of heart failure: a systematic review and dose–response meta‐analysis of prospective studies. 

. Published online December 17, 2020. doi:10.1007/s10654-020-00693-6

A meta-analysis found evidence that different kinds of physical activity can help reduce risk of heart failure for the general population.


Physical Activity Linked to Reduced Risk of Heart Failure

A recent study found a strong association between 

 (PD) onset and certain Mediterranean dietary habits. This is the first study to assess whether diet has a link to PD.

compared the potential effects of 3 diets:

The original Mediterranean diet (OMeDi), which consists of foods rich in antioxidants and fish and encourages followers to reduce their intake of red meat and dairy products

The Greek Mediterranean diet (GMeDi), which uses foods similar to the OMeDi but also promotes the consumption of potatoes and limits poultry intake.

The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, which rewards followers for their intake of leafy greens, certain berries, and poultry and discourages consuming fried foods, sweets, milk, potatoes, and most fruits.

"There is a lack of medications to prevent or delay Parkinson disease, yet we are optimistic that this new evidence suggests nutrition could potentially delay onset of the disease,” said Silke Appel-Cresswell, MD, study author and an associate professor at the Pacific Parkinson's Research Centre, Djavad Mowafaghian Centre for Brain Health, Division of Neurology, University of British Columbia (UBC), in a 

Mediterranean diets have been linked to reduced rates of cancer, cardiovascular disease, Alzheimer disease, and PD. Previous research shows that the MIND diet may reduce Alzheimer disease incidence by 54% and that there is a likely higher cognitive health benefit than the OMeDi. However, this is the first study to examine the effects of the MIND diet in a cohort of patients with PD and compare it with other popular Mediterranean diets.

The researchers gathered self-reported data from 176 participants, 167 of whom had PD and 119 controls. Participants with PD were 68.3% men, with a mean age of 64.9 (8.0) years and a mean disease onset of 6.5 (3.1) years previously. Control participants were 39.3% male, with a mean age of 61.8 (9.9) years. All of the participants were recruited through the Pacific Parkinson’s Research Centre at UBC.

In the cross-sectional study, participants, particularly women, with a high adherence to the MIND diet had a later age of disease onset, experiencing a mean delay of up to 17.4 (range, 15.6-17.4; 

 ≤ .003) years, than men, whose high adherence contributed to a delay of up to 7.4 (range, 3.6-7.4; 

“Although female participants experienced only slightly larger MeDi effect sizes compared with male participants, the average effect size of the MIND diet in women was more than 3 times that of the men and surpassed all MeDi effect sizes, suggesting that its dietary components may be better suited to delaying PD onset than MeDi in a female-specific manner,” wrote the authors.

The MIND diet was the only diet shown to have an interaction between sex and diet score, despite none of the diets used in the analysis differentiating food intake by sex.

"If we understand the sex differences between the MIND diet and Mediterranean diet then we might better understand the sex differences that drive Parkinson's disease in the first place," said Avril Metcalfe-Roach, lead author of the study and a PhD candidate at UBC's Michael Smith Laboratories.

Female participants were often more adherent to the MIND diet compared with their male counterparts, even after taking into account kilocalorie consumption, which the researchers said may indicate that the higher scores for the MIND diet are not due to differences in food volume.

For men, adherence to the GMeDi had the greatest association with disease onset compared with the OMeDi and the MIND diet, leading to delays of 6.2 to 8.4 years (

 = .02-.002). In women, the GMeDi contributed at delays of 8.4 to 9.8 years (

The MIND diet had a weak correlation with age of onset, having delayed disease by just 3.6 to 7.4 years (

 = .21-.01), and it performed similarly to the onset delay associated with the OMeDi, which was 4.6 to 6.4 years (

Study limitations include that the authors’ assumption that dietary habits remained consistent over participants’ lifetimes. They said that future studies should investigate this effect in a larger cohort and should analyze the effect of diet on other PD symptoms, such as gut microbial dysbiosis, disease progression, constipation, and cognition.

Metcalfe-Roach A, Yu AC, Golz E, et al. MIND and Mediterranean diets associated with later onset of Parkinson’s disease. 

. Published online January 6, 2021. doi:10.1002/mds.28464

A study on the effects of Mediterranean diets on Parkinson disease found a strong correlation between food intake and disease onset, while also suggesting a possible link between sex and diet results.


Study Finds That Diet May Delay Onset of Parkinson Disease

Lymphocyte to high-density lipoprotein ratio (LHR) was a better predictor of pulmonary function and more severe airway obstruction in chronic obstructive pulmonary disease (

) than other inflammatory biomarkers, according to a recent study 

International Journal of Chronic Obstructive Pulmonary Disease

. Additionally, lower LHR levels were independently associated with poorer lung function.

“Our preliminary study could provide reference for clinicians to judge rapidly the pulmonary function of COPD patients,” wrote the authors.

Lymphocytes and neutrophils interact to cause inflammation associated with COPD. This can affect the lung parenchyma and peripheral airways, leading to irreversible and progressive airflow limitations for patients with COPD.

Previous research has investigated the neutrophil-lymphocyte ratio (NLR) as a promising marker for systemic inflammation, acute exacerbations, and mortality in patients with COPD. The platelet-lymphocyte ratio (PLR) may also be a potential marker for chronic inflammation and COPD disease severity.

However, NLR and PLR have not been shown to have credible relationships with pulmonary function, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), suggesting that a better biomarker of pulmonary function is needed.

Investigators aimed to establish whether LHR, the ratio of lymphocyte counts to serum high-density lipoprotein (HDL) levels, is correlated with pulmonary function in patients with COPD and compare its predictive ability with that of NLR and PLR.

Between February 2018 and February 2019, investigators conducted a cross-sectional study among 134 patients with COPD who were enrolled from the respiratory ward of the Third Affiliated Hospital of Wenzhou Medical University in Wenzhou, China. After applying inclusion and exclusion criteria, the investigators included 77 patients in the study.

All patients were 40 years or older and had a diagnosis of COPD with a GOLD stage of 2 or higher, as defined in the GOLD guidelines, with symptoms of dyspnea, chronic cough, sputum production, or wheezing. Patients were age- and sex-matched with 77 healthy controls.

Investigators found that patients with COPD had a higher neutrophil count (

< .001), but they had lower levels of lymphocytes (

Further, patients were categorized into 3 groups according to their percentage of forced expiratory volume in 1 second (FEV1%), a measurement of airflow limitation. Groups with more severe airflow limitations were often younger and had lower lymphocyte counts and a lower LHR than the group with more severe limitations (

< .001, respectively). Additionally, HDL levels were higher among patients with more severe limitations (

Investigators said the lower lymphocyte counts could be due to aging, which can lead to increases in cortisol production and a decrease in lymphocyte count; impaired immunity, which can increase the risk of respiratory tract infections that can cause exacerbations; or malnutrition, which is positively correlated with COPD severity and is associated with low lymphocyte counts.

Although patients with a FEV1% of at least 50 had a significantly higher LHR than those with lower FEV1% (FEV1% 30-<50: 

 < .001), no differences in NLR or PLR were observed across the pulmonary function severity groups. Investigators concluded that LHR was positively correlated with FEV1% (

Patients with a low LHR (LHR < 1.42; n = 39) had worse health-related quality of life as measured by the St George’s Respiratory Questionnaire and more severe air flow limitation. Of the patients with a low LHR, 87.2% had poor pulmonary function (FEV1% < 50). In contrast, 65.8% of patients in the high-LHR group (LHR ≥ 1.42; n = 38) had poor lung function (

Investigators said that because their study was a single-center cross-sectional survey limited to a small retrospective cohort and lacked exploration of the cellular and molecular mechanisms that influence the effect of LHR on COPD, more research needs to be conducted in this area.

Huang Y, Jiang B, Maio X, et al. The relationship of lymphocyte to high-density lipoprotein ratio with pulmonary function in COPD. 

. 2020;15:3159-3169. doi:10.2147/COPD.S276372

Investigators found that the ratio of lymphocytes to high-density lipoprotein (HDL) performed better in predicting pulmonary function than the neutrophil-lymphocyte ratio and the platelet-lymphocyte ratio.

Skylar Jeremias

Articles

Previous Intravenous Drug Use May Impact Women’s Comfort With Injectable HIV Medications

Physical Activity Linked to Reduced Risk of Heart Failure

Study Finds That Diet May Delay Onset of Parkinson Disease

Lymphocyte-HDL Ratio Outperforms Other Biomarkers for Predicting Pulmonary Function in COPD