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Renal safety of tenofovir containing antiretroviral regimen in a Singapore cohort
Arlene C Chua, Ryan M Llorin, Kelvin Lai, Phillipe Cavailler, Hwa Lin Law
AIDS Research and Therapy , 2012, DOI: 10.1186/1742-6405-9-19
Abstract: We conducted a retrospective review of all patients on TDF from July 2007 to December 2009 in our institution and evaluated their renal function. Absolute change of creatinine clearance (CLCr) using Cockroft-Gault equation from baseline was calculated at 6, 12, 18 and 24？months. Overall, 226 patients were included in the study. Ninety percent were male. The median age was 46？yrs old (23–82), median weight was 60？kg (IQR 53.75-68), median CD4 count was 127 cells/mm3 (IQR 38–258) and median CLCr 82.7？mL/min (IQR 71.4-101.7) on initiation of TDF. The median decline of CLCr from baseline was ？3.9？ml/min (IQR ？12.3 to 7.6), and ？3.6？ml/min (IQR ？12.4 to 6.7) at 12 (n？=？102), 24？months (n？=？75) respectively. Eighteen of 226 patients had a decline in renal function to
The Case for Improved Diagnostic Tools to Control Ebola Virus Disease in West Africa and How to Get There
Arlene C. Chua？,Jane Cunningham？,Francis Moussy？,Mark D. Perkins？,Pierre Formenty
PLOS Neglected Tropical Diseases , 2015, DOI: 10.1371/journal.pntd.0003734
Abstract:
Opt-out of Voluntary HIV Testing: A Singapore Hospital's Experience
Arlene C. Chua, Yee Sin Leo, Philippe Cavailler, Christine Chu, Aloysius Ng, Oon Tek Ng, Prabha Krishnan
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0034663
Abstract: Introduction Since 2008, the Singapore Ministry of Health (MOH) has expanded HIV testing by increasing anonymous HIV test sites, as well as issuing a directive to hospitals to offer routine voluntary opt out inpatient HIV testing. We reviewed this program implemented at the end of 2008 at Tan Tock Seng Hospital (TTSH), the second largest acute care general hospital in Singapore. Methods and Findings From January 2009 to December 2010, all inpatients aged greater or equal than 21 years were screened for HIV unless they declined or were not eligible for screening. We reviewed the implementation of the Opt Out testing policy. There were a total of 93,211 admissions; 41,543 patients were included based on HIV screening program eligibility criteria. Among those included, 79% (n = 32,675) opted out of HIV screening. The overall acceptance rate was 21%. Majority of eligible patients who were tested (63%) were men. The mean age of tested patients was 52 years. The opt out rate was significantly higher among females (OR: 1.5, 95%CI: 1.4–1.6), aged >60 years (OR: 2.3, 95%CI: 2.2–2.4) and Chinese ethnicity (OR: 1.7, 95%CI:1.6–1.8). The false positive rate of the HIV screening test is 0.56%. The proportion of patients with HIV infection among those who underwent HIV screening is 0.18%. All16 confirmed HIV patients were linked to care. Conclusion The default opt-in rate of inpatient HIV testing was low at Tan Tock Seng Hospital, Singapore. Efforts to address individual HIV risk perception and campaigns against HIV stigma are needed to encourage more individuals to be tested for HIV.
Accuracy and User-Acceptability of HIV Self-Testing Using an Oral Fluid-Based HIV Rapid Test
Oon Tek Ng, Angela L. Chow, Vernon J. Lee, Mark I. C. Chen, Mar Kyaw Win, Hiok Hee Tan, Arlene Chua, Yee Sin Leo
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0045168
Abstract: Background The United States FDA approved an over-the-counter HIV self-test, to facilitate increased HIV testing and earlier linkage to care. We assessed the accuracy of self-testing by untrained participants compared to healthcare worker (HCW) testing, participants’ ability to interpret sample results and user-acceptability of self-tests in Singapore. Methodology/Principal Findings A cross-sectional study, involving 200 known HIV-positive patients and 794 unknown HIV status at-risk participants was conducted. Participants (all without prior self-test experience) performed self-testing guided solely by visual instructions, followed by HCW testing, both using the OraQuick ADVANCE Rapid HIV 1/2 Antibody Test, with both results interpreted by the HCW. To assess ability to interpret results, participants were provided 3 sample results (positive, negative, and invalid) to interpret. Of 192 participants who tested positive on HCW testing, self-testing was positive in 186 (96.9%), negative in 5 (2.6%), and invalid in 1 (0.5%). Of 794 participants who tested negative on HCW testing, self-testing was negative in 791 (99.6%), positive in 1 (0.1%), and invalid in 2 (0.3%). Excluding invalid tests, self-testing had sensitivity of 97.4% (95% CI 95.1% to 99.7%) and specificity of 99.9% (95% CI: 99.6% to 100%). When interpreting results, 96%, 93.1% and 95.2% correctly read the positive, negative and invalid respectively. There were no significant demographic predictors for false negative self-testing or wrongly interpreting positive or invalid sample results as negative. Eighty-seven percent would purchase the kit over-the-counter; 89% preferred to take HIV tests in private. 72.5% and 74.9% felt the need for pre- and post-test counseling respectively. Only 28% would pay at least USD15 for the test. Conclusions/Significance Self-testing was associated with high specificity, and a small but significant number of false negatives. Incorrectly identifying model results as invalid was a major reason for incorrect result interpretation. Survey responses were supportive of making self-testing available.
HIV-associated neurocognitive disorders (HAND) in a South Asian population - contextual application of the 2007 criteria
Arlene Chua,Lai Gwen Chan,Nagaendran Kandiah
- , 2012, DOI: 10.1136/bmjopen-2011-000662
Abstract: Objectives To estimate the prevalence of HIV-associated neurocognitive disorders (HAND) among HIV patients in a multiethnic South Asian population, describe the pattern of neurocognitive impairment in HAND and the factors associated with HAND. Design A cross-sectional survey of HIV-positive outpatients and inpatients. Setting The sole referral centre for HIV/AIDS treatment in Singapore. Participants Inclusion criteria were HIV positive, age between 21 and 80？years old and at least 3？years of education. Exclusion criteria included concomitant delirium, serious systemic disease or major psychiatric illness. 265 patients did not meet criteria or declined to participate. The final sample size was 132. Outcome measures The primary outcome measure was cognitive impairment based on performance on the Montreal Cognitive Assessment, International HIV Dementia Scale and Instrumental Activities of Daily Living. The secondary outcome measure was the classification of impairment based on the 2007 updated research nosology for HAND. Results The prevalence of HAND was 22.7% of which 70% (15.9% of total) were asymptomatic neurocognitive impairment, 23.3% (5.3% of total) were mild neurocognitive disorder and 6.7% (1.5% of total) were HIV-associated dementia. Increasing age (OR 1.104, 95% CI 1.054 to 1.155, p<0.001), less education (OR 0.78, 95% CI 0.69 to 0.89, p<0.001) and low baseline CD4 count (OR 0.15, 95% CI 0.03 to 0.74, p=0.019) were associated with HAND. Delayed recall, language and abstract thinking were the domains most commonly affected, but impairment in visuospatial ability (RC 3.013, 95% CI 1.954 to 4.073, p<0.001) and attention (RC 2.205, 95% CI 1.043 to 3.367, p<0.001) were most strongly associated with HAND. Conclusion HAND is common among HIV patients in a South Asian sample, most of whom are asymptomatic. Older patients with less education and severe illness at diagnosis are at highest risk of HAND. Delayed recall is most commonly affected, but visuospatial dysfunction is most strongly associated with prevalent HAND
Baseline mapping of Lassa fever virology, epidemiology and vaccine research and development
Alan D. T. Barrett,Arlene Chua,David W. C. Beasley,Gregg N. Milligan,Hoai J. Hallam,Lisa M. Reece,Sergio E. Rodriguez,Steven Hallam,Thomas G. Ksiazek,Vaseeharan Sathiyamoorthy
- , 2018, DOI: 10.1038/s41541-018-0049-5
Abstract: LASV AA Identitie
The Tenofovir Pre-Exposure Prophylaxis Trial in Thailand: Researchers Should Show More Openness in Their Engagement with the Community
Arlene Chua ,Nathan Ford,David Wilson,Paul Cawthorne
PLOS Medicine , 2005, DOI: 10.1371/journal.pmed.0020346
Abstract:
The tenofovir pre-exposure prophylaxis trial in Thailand: researchers should show more openness in their engagement with the community.
Chua Arlene,Ford Nathan,Wilson David,Cawthorne Paul
PLOS Medicine , 2005,
Abstract:
Chiral symmetry breaking with a non-enhanced ghost sector
Arlene C. Aguilar
Physics , 2011,
Abstract: We study chiral symmetry breaking using the quark gap equation supplemented with the infrared-finite gluon propagator and ghost dressing function obtained from large-volume lattice simulations. One of the most important ingredients of this analysis is the non-Abelian quark-gluon vertex, which displays a crucial dependence on the ghost dressing function and the quark-ghost scattering amplitude. The various theoretical ingredients necessary for this construction are reviewed in detail. As a result, we obtain a dynamical quark masses of the order of 300 MeV, which is used to compute phenomenological parameters such as the pion decay constant and the quark condensate.
Chiral symmetry breaking revisited: the gap equation with lattice ingredients
Arlene C. Aguilar
Physics , 2010, DOI: 10.1063/1.3575029
Abstract: We study chiral symmetry breaking in QCD, using as ingredients in the quark gap equation recent lattice results for the gluon and ghost propagators. The Ansatz employed for the quark-gluon vertex is purely non-Abelian, introducing a crucial dependence on the ghost dressing function and the quark-ghost scattering amplitude. The numerical impact of these quantities is considerable: the need to invoke confinement explicitly is avoided, and the dynamical quark masses generated are of the order of 300 MeV. In addition, the pion decay constant and the quark condensate are computed, and are found to be in good agreement with phenomenology.
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