Publications

BACKGROUND

For patients with compensated cirrhosis, transcatheter arterial embolization with and without additive chemotherapy has been shown to improve survival. The aim of this study was to compare periprocedural complications in a population with hepatitis C virus-related hepatocellular carcinoma to evaluate for differences in complications by severity of liver disease.

METHODS

Patients with unresectable hepatocellular carcinoma treated by transcatheter arterial embolization with or without additive chemotherapy procedures from 2003 to 2006 were retrospectively reviewed and compared by Child-Pugh (CP) class. A total of 141 embolizations were done in 76 patients.

RESULTS

Complication rates were seen in 27% of CP class A and 17% of CP class B patients. There was no significant difference in the grade of complications between the 2 groups or between procedure types. Survival rate was dependent on the degree of liver dysfunction (3-year CP class A, 49%; CP class B, 13%; P = .0048).

CONCLUSION

Embolization procedures to treat hepatitis C virus-related hepatocellular carcinoma can be performed safely with low morbidity and mortality rates, even in patients with a compromised hepatic reserve.

OBJECTIVES

To determine the prevalence of free medication sample use in the United States and analyze the effects of socioeconomic status and drug safety actions.

DESIGN

Cross-sectional study.

SETTING

United States from 1999 to 2005.

PARTICIPANTS

Survey respondents representative of the civilian noninstitutionalized population.

INTERVENTION

Analysis of data from the Medical Expenditure Panel Survey, a nationally representative longitudinal household survey.

MAIN OUTCOME MEASURES

Identification of a medication as being provided as a sample at least once during a study year.

RESULTS

An annual average of 5.1% (range 4.4% in 2005 to 5.8% in 2002) of all prescription medications were provided as a sample at least once during a year, with 18.3% of all Americans who received at least one prescription drug receiving at least one drug as a sample. On multivariate analysis, sample use was greater among young (18-30 years) non-Hispanic whites and the uninsured but had minimal independent association with income. The proportion of sample use among users of hormone replacement therapy and cyclooxygenase-2 inhibitors remained relatively constant even as total use of these drugs declined after Food and Drug Administration regulatory action.

CONCLUSION

Use of medication samples is common in the U.S. population. After adjusting for health insurance, sample use was not associated with income and samples were less frequently provided to racial/ethnic minorities and to the elderly. The putative economic benefits of free samples do not appear to go to patients with the greatest financial need. Drug regulatory actions did not have a disproportionate effect on provision of drugs as samples.

BACKGROUND

Increasing numbers of HIV-infected children not yet eligible for antiretroviral therapy (ART) are entering health care in Africa. We sought to characterize the risk of short-term disease progression in this population.

METHODS

In a cohort of HIV-infected ART-naive and -ineligible Ugandan children older than 1 year, the rates of clinical/immunologic progression within 2 years were assessed using Kaplan-Meier survival analysis and multivariate Cox proportional-hazards modeling.

RESULTS

Among 192 children (mean age: 6.4 years, CD4%:25), 19% progressed within 2 years by World Health Organization stage 3/4 event (n = 22), death (n = 3), or World Health Organization-defined CD4 threshold for ART initiation (n = 12). Significant univariate predictors were CD4% [hazard ratio (HR) = 2.0 per 10% decrease, P = 0.005], HIV RNA level (HR = 2.4 per log10 increase, P = 0.002), male gender (HR = 2.0, P = 0.04), age < 3 years (HR = 3.7, P = 0.001), CD4 activation (%CD4+ CD38+ HLADR+) (HR = 1.6 per 10% increase, P = 0.05), and CD8 activation (%CD8+ CD38+ HLADR+) (HR = 1.3 per 10% increase, P = 0.05] (HR = 1.3, P = 0.5). In multivariate analysis, CD4% (HR = 2.0, P = 0.034), HIV RNA level (HR = 1.8, P = 0.013), and age < 3 years (HR = 3.0, P = 0.008) were independently predictive. Children with HIV RNA >10 copies per milliliter and CD4% <25 had progression rates of 29% (1 year) and 34% (2 years).

CONCLUSIONS

Even with frequent CD4 monitoring, HIV-infected Ugandan children experienced significant clinical events while ineligible for ART per WHO 2006 guidelines.