While stigma associated with HIV infection is well recognised, there is limited information on the impact of HIV-related stigma between men who have sex with men and within communities of gay men. The consequences of HIV-related stigma can be personal and community-wide, including impacts on mood and emotional well-being, prevention, testing behaviour, and mental and general health. This review of the literature reports a growing division between HIV-positive and HIV-negative gay men, and a fragmentation of gay communities based along lines of perceived or actual HIV status. The literature includes multiple references to HIV stigma and discrimination between gay men, men who have sex with men, and among and between many gay communities. This HIV stigma takes diverse forms and can incorporate aspects of social exclusion, ageism, discrimination based on physical appearance and health status, rejection and violence. By compiling the available information on this understudied form of HIV-related discrimination, we hope to better understand and target research and countermeasures aimed at reducing its impact at multiple levels.
BackgroundThe costs of combination antiretroviral therapy (cART) for HIV, consisting of separate, particularly generic, components (multiple-tablet regimens, MTR) are generally much lower than those of single-tablet regimens (STR) comprising the same active ingredients.ObjectivesTo assess whether patients would be willing to take MTR, once-daily, instead of STR, with the goal of reducing general healthcare costs. In addition, we aimed to examine whether willingness was associated with particular patient characteristics.MethodsData from the ATHENA cohort database in The Netherlands of adult HIV-1-infected patients in care and taking cART ≥6 months were used to select 1000 potential participants for an online patient survey on patient preferences and satisfaction. Participants were asked whether they would be willing to take three pills with the equivalent active ingredients simultaneously instead of STR to reduce costs. Multivariate logistic regression was used to examine associations between patient characteristics and willingness to take MTR instead of STR.ResultsForty-seven percent (n = 152) of the 322 respondents answered ‘yes’ and 26 % (n = 83) answered ‘maybe’ when asked whether they would be willing to take three pills with the equivalent active ingredients simultaneously to reduce costs. Non-Dutch patients were significantly more likely to answer ‘no’ (OR: 2.49; 95 % CI: 1.17–5.30) or ‘maybe’ (OR: 2.63; 95 % CI: 1.24–5.60). Answering ‘no’ was less common among patients who had been taking cART ≥15 years (OR: 0.23; 95 % CI: 0.09–0.58). Commonly reported concerns included the dosing frequency, efficacy and tolerability of MTR.ConclusionsHIV-infected patients do not necessarily oppose the decision to prescribe MTR instead of STR to reduce healthcare costs. However, the potential trade-off in terms of convenience should be carefully weighed against the projected savings.
Background
Gastric aspiration is a significant cause of acute lung injury and acute respiratory distress syndrome. Environmental risk factors, such as a diet high in pro-inflammatory advanced glycation end-products (AGEs), may render some patients more susceptible to lung injury after aspiration. We hypothesized that high dietary AGEs increase its pulmonary receptor, RAGE, producing an amplified pulmonary inflammatory response in the presence of high mobility group box 1 (HMGB1), a RAGE ligand and an endogenous signal of epithelial cell injury after aspiration.
Materials and Methods
CD-1 mice were fed either a low AGE (LAGE) or high AGE (HAGE) diet for 4 weeks. After aspiration injury with acidified small gastric particles, bronchial alveolar lavage (BAL) and whole-lung tissue samples were collected at 5 minutes, 1 hour, 5 hours, and 24 hours post-injury. RAGE, soluble RAGE (sRAGE), HMGB1, cytokine and chemokine concentrations, albumin levels, neutrophil influx, and lung myeloperoxidase (MPO) activity were measured.
Results
We observed that HAGE-fed mice exhibited greater pulmonary RAGE levels before aspiration and increased BAL sRAGE levels after aspiration compared to LAGE-fed mice. Lavage HMGB1 levels rose immediately after aspiration, peaking at 1 hour, and strongly correlated with sRAGE levels in both dietary groups. HAGE-fed mice demonstrated higher cytokine and chemokine levels with increased pulmonary MPO activity over 24 hours versus LAGE-fed mice.
Conclusions
This study indicates that high dietary AGEs can increase pulmonary RAGE, augmenting the inflammatory response to aspiration in the presence of endogenous damage signals such as HMGB1.
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