Pre-ART Levels of Inflammation and Coagulation Markers Are Strong Predictors of Death in a South African Cohort with Advanced HIV Disease

BACKGROUND: Levels of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and D-dimer predict mortality in HIV patients on antiretroviral therapy (ART) with relatively preserved CD4+ T cell counts. We hypothesized that elevated pre-ART levels of these markers among patients with advanced HIV would be associated with an increased risk of death following the initiation of ART. METHODS: Pre-ART plasma from patients with advanced HIV in South Africa was used to measure hsCRP, IL-6 and D-dimer. Using a nested case-control study design, the biomarkers were measured for 187 deaths and two controls matched on age, sex, clinical site, follow-up time and CD4+ cell counts. Odds ratios were estimated using conditional logistic regression. In addition, for a random sample of 100 patients, biomarkers were measured at baseline and 6 months following randomization to determine whether ART altered their levels. RESULTS: Median baseline biomarkers levels for cases and controls, respectively, were 11.25 vs. 3.6 mg/L for hsCRP, 1.41 vs. 0.98 mg/L for D-dimer, and 9.02 vs. 4.20 pg/mL for IL-6 (all p<0.0001). Adjusted odds ratios for the highest versus lowest quartile of baseline biomarker levels were 3.5 (95% CI: 1.9-6.7) for hsCRP, 2.6 (95%CI 1.4-4.9) for D-dimer, and 3.8 (95% CI: 1.8-7.8) for IL-6. These associations were stronger for deaths that occurred more proximal to the biomarker measurements. Levels of D-dimer and IL-6, but not hsCRP, were significantly lower at month 6 after commencing ART compared to baseline (p<0.0001). CONCLUSIONS: Among patients with advanced HIV disease, elevated pre-ART levels of hsCRP, IL-6 and D-dimer are strongly associated with early mortality after commencing ART. Elevated levels of inflammatory and coagulation biomarkers may identify patients who may benefit from aggressive clinical monitoring after commencing ART. Further investigation of strategies to reduce biomarkers of inflammation and coagulation in patients with advanced HIV disease is warranted. TRIAL REGISTRATION: Parent study: ClinicalTrials.gov NCT00342355

After the harvest: investigating the role of food processing in past human societies

Plant processing provides an essential framework for archaeobotanical interpretation since practices of processing lie between the ancient acquisition of plants and the preserved remains of archaeology. Crop-processing stages have received much attention as they contribute towards the interpretation of plants recovered from archaeological sites, linking them to routine human activities that generated these plant remains. Yet, there are many other important aspects of the human past that can be explored through food processing studies that are much less often investigated, e.g. how culinary practices may have influenced resource selection, plant domestication and human diet, health, evolution and cultural identity. Therefore, this special issue of AAS on “Food Processing Studies in Archaeobotany and Ethnobotany” brings together recent pioneering methodological and interpretive archaeobotanical approaches to the study of ancient food processing. This new research, which involves archaeobotany, ethnoarchaeology, ethnobotany and experimental methods, encompasses investigations into dietary choice, cultural traditions and cultural change as well as studies of the functional properties (i.e. performance characteristics) of edible plants, and the visibility as well as dietary benefits and consequences of different food processing methods.Fil: Capparelli, Aylen. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. División Arqueología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Valamoti, Soultana Maria. Aristotle University of Thessaloniki; GreciaFil: Wollstonecroft, Michèle M.. No especifíca

Early intervention in psychosis: Keeping faith with evidence-based health care

Early intervention in psychosis: Keeping faith with evidence-based health car