After experiencing treatment failure with a fixed-dose combination of stavudine, lamivudine, and nevirapine, almost all patients have lamivudine and nonnucleoside reverse-transcriptase inhibitor resistance. The options for a second-line regimen are limited for one-half of these patients. In resource-limited settings where availability of antiretroviral agents is limited, strategies for prevention of HIV-1 resistance are crucial. Early detection of virological failure may provide more options and better treatment outcomes.

BackgroundThe elevated levels of inflammatory markers, including C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), and interleukin 6 (IL6) are supposed to be associated with type 2 diabetes mellitus (T2DM). Frequent high glycemic load (GL) consumption, central obesity, and a lack of physical activity are considered to be T2DM risk factors. This study aimed to determine the difference of these inflammatory markers as well as GL in individuals with versus those without T2DM in rural Thais.MethodsA total of 296 participants aged 35–66 living in Sung Noen District, Nakhon Ratchasima Province, Thailand, were recruited. Blood was collected to evaluate blood glucose levels, lipid profiles, and inflammatory markers. A Semi-food frequency questionnaire was utilized to assess GL followed by socioeconomic and anthropometric assessment. Statistical analysis was subsequently performed.ResultsElevated CRP and IL6 levels were associated with increased risk of developing T2DM [OR (95% CI): 7.51 (2.11, 26.74) and 4.95 (1.28, 19.11)], respectively. There was a trend towards increased risk of T2DM with elevated TNF-α levels [OR (95% CI): 1.56 (0.39, 6.14)]. GL correlated significantly with fasting blood glucose (r = 0.289, P = 0.016), suggesting that it is involved in T2DM in this study group.ConclusionIn this study, CRP, IL6, and TNF-α associated with T2DM. Our findings suggested that these inflammatory markers, especially CRP, may initiate T2DM.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-017-0189-z) contains supplementary material, which is available to authorized users.

The linkage of obesity, inflammation, and type 2 diabetes mellitus (T2DM) has been extensively investigated for over a decade. However, the association between inflammatory biomarkers, including C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α), and T2DM is still inconsistent and limited. Thus, this study is aimed at elucidating the association between inflammatory marker levels and the risk of developing T2DM in many aspects. Among 296 subjects enrolled in 2013, 248 non-T2DM subjects who were completely reinvestigated in 2014 and 2015 were included in a 2-year retrospective analysis. Multivariate logistic regression was performed to evaluate the association of baseline inflammatory marker levels and variation with incidence of T2DM. After the 2-year follow-up, 18.6% of total subjects had developed T2DM. The risk of developing T2DM was significantly increased in subjects with a high level of baseline CRP (OR=4.02, 95% CI: 1.77-9.12, P=0.001), and a stronger impact was found with the combination of high CRP and IL-6 levels (OR=5.11, 95% CI: 1.27-20.49, P=0.021). One-year inflammatory marker variation analysis also revealed the significant association of elevated TNF-α and risk of developing T2DM (OR=4.88, 95% CI: 1.01-23.49, P=0.048). In conclusion, besides consideration of CRP levels alone, our findings suggested that IL-6 outstandingly plays a contributing role in T2DM progression and elevated TNF-α levels over time could be a potential predictor of T2DM.

ObjectiveTo determine the incidence and risk factors of rash associated with efavirenz in HIV-infected patients with preceding nevirapine-associated rash. MethodsA retrospective cohort study was conducted in HIV-infected patients diagnosed with nevirapineassociated rash who subsequently received efavirenz between July 2003 and January 2005. Patients were followed up for 3 months after receiving efavirenz. Possible risk factors, including demographics, previous opportunistic infections, CD4 cell count, viral load, severity of nevirapineassociated rash and concurrent drugs, were studied and compared between those who had (group A) and did not have (group B) rash associated with efavirenz. ResultsA total of 122 patients (52.5% male) were included in the study, with a mean age of 38.2 years. Median (and interquartile range) CD4 cell count and viral load were 55 (20-167) cells/mL and 86 150 (35 321-700 750) HIV-1 RNA copies/mL, respectively. Of the 122 patients, 10 (8.2%) developed rash associated with efavirenz and all required discontinuation of efavirenz. The baseline characteristics of group A (10 patients) and group B (112 patients) were similar. Median (and interquartile range) time from nevirapine discontinuation to efavirenz initiation was 12 (9-21) days in group A and 11 (7-21) days in group B (P 5 0.765). None of the risk factors investigated was associated with developing rash associated with efavirenz. The preceding development of severe nevirapineassociated rash had a trend towards a higher rate in group A than in group B (20.0% vs 10.7%; odds ratio 5 2.08; 95% confidence interval 0.39-10.97; P 5 0.322). ConclusionsThe majority (490%) of HIV-infected patients with CD4 counts o200 cells/mL who had preceding nevirapine-associated rash could tolerate efavirenz well. Efavirenz may be an option for subsequent use in these patients, particularly in those who had preceding nevirapine-associated rash.Keywords: efavirenz, HIV, incidence, nevirapine, rash, risk factor IntroductionHighly active antiretroviral therapy (HAART) has been widely used for treatment of patients with advanced HIV infection, and has been successful in achieving immune restoration and thus reducing morbidity and mortality [1][2][3]. Nevirapine (NVP) and efavirenz (EFV) are nonnucleoside reverse transcriptase inhibitors (NNRTIs) that have been shown to have high antiretroviral efficacy [4][5][6]. NNRTI-based HAART regimens are preferred because of their high efficacy and tolerability and lower long-term toxicity [7][8][9]. In developing countries, NVP-based HAART has been widely used because it is more readily available than other types of HAART. Skin rash is the most frequently observed adverse event associated with NVP, manifesting as a diffuse maculopapular rash or erythematous rash with or without constitutional symptoms. The risk of rash of any severity is greatest in the first 6 weeks of treatment [10]. Generally, the rash is mild and transient. However, a more severe rash including extensive maculopapular rash, serum sickness-like rea...