Advances in antiretroviral therapy. Highlights of the 11th Conference on Retroviruses and Opportunistic Infections, February 8-11, 2004, San Francisco, California, USA.

Antiretroviral therapy was focus of many of the studies reported at the 11th CROI. This year, data on new drugs, refinements in the management of treatment-naive and treatment-experienced persons, the impact of drug resistance (particularly following exposure to a single dose of nevirapine), and the growing experience with antiretrovirals in the developing world were the dominant themes. This reviews summarizes new information relevant to clinicians and clinical researchers.

Preventable factors in childhood that lead to insulin resistance, diabetes mellitus and the metabolic syndrome: the EarlyBird diabetes study 1.

For a decade or more, poor nutrition during gestation, expressed as low weight at birth, was held to be the factor responsible for insulin resistance later in life. Birth weights, however, are rising and insulin resistant states, such as diabetes mellitus, faster still. Alternative explanations are needed to explain insulin resistance in contemporary industrialised populations.

Girls at five are intrinsically more insulin resistant than boys: The Programming Hypotheses Revisited--The EarlyBird Study (EarlyBird 6).

Objective: Recent studies of type 2 diabetes in young populations consistently show a predominance of affected girls over boys. Girls are more insulin resistant than boys. We aimed in the present report to establish how much of the sex difference in insulin resistance is intrinsic.

Testing the accelerator hypothesis: the relationship between body mass and age at diagnosis of type 1 diabetes.

Objective: Previous reports have predicted greater risk of type 1 diabetes among people who were heavier as young children. The Accelerator Hypothesis predicts earlier onset in heavier people, without necessarily a change in risk, and views type 1 and type 2 diabetes as the same disorder of insulin resistance, set against different genetic backgrounds. Insulin resistance is a function of fat mass, and increasing body weight in the industrialized world has been accompanied by earlier presentation (i.

Internal jugular vein thrombosis associated with hemodialysis catheters.

Purpose: To determine the prevalence of internal jugular vein thrombosis among patients undergoing hemodialysis in whom tunneled dialysis catheters were placed by interventional radiologists and to evaluate potential risk factors for thrombosis, such as the number of catheters inserted per patient through the right internal jugular vein, catheter type and material, total catheter days, and catheter-associated infection.

Materials And Methods: Ultrasonographic (US) evaluation of the right internal jugular vein was performed by interventional radiologists in 143 patients with a history of dialysis catheter placement. The examination focused on the detection of right internal jugular vein thrombosis, with or without occlusion.

Antiretroviral Therapy: When and What to Start-- An American Perspective.

The major US treatment guidelines recently recommended starting antiretroviral therapy (ART) later in the course of HIV infection due to an increasing awareness of the difficulties associated with these regimens. Most of the data to support this change come from observational cohort studies. When deciding to start ART, a number of patient-specific factors and other issues should be considered.

The use of phage display to distinguish insulin autoantibody (IAA) from insulin antibody (IA) idiotypes.

Aim/hypothesis: Radiobinding assays (RBA) are unable to differentiate insulin autoantibodies (IAA) from insulin antibodies (IA). We sought to establish whether random peptide phage display might generate reagents with which to distinguish IAA idiotopes from IA idiotopes.

Methods: Two insulin-binding sera were used to select phagotopes from a phage library.

Assessing radiology resident reporting skills.

Purpose: To develop an Objective Structured Clinical Examination for assessing the reporting skills of radiology residents.

Materials And Methods: The approach used in this study derives from performance-based assessment, that is, tests in which actual performance of a skill is observed and measured. For this task, 29 radiology residents and five faculty members (n = 34) independently dictated reports regarding a set of 20 cases with radiographs in 1 hour.

The relative contributions of birth weight, weight change, and current weight to insulin resistance in contemporary 5-year-olds: the EarlyBird Study.

For more than a decade, the fetal programming hypothesis has taught that insulin resistance and its associated metabolic disturbances result from poor gestational environment, for which low birth weight is a surrogate. Low birth weight, however, is now uncommon in industrialized societies. We have investigated the relevance of birth weight, "catch-up" weight, and current weight to insulin resistance in 300 contemporary British children.

Technical reliability of the CSA activity monitor: The EarlyBird Study.

Purpose: To evaluate the technical performance of the CSA accelerometer-based activity monitor.

Methods: Twenty-three CSA monitors were subjected to intra- and inter-instrument variability tests by controlled trials using a motorized turntable. The CSA monitor measures change in acceleration, and precision was tested by producing sinusoidal variations in speed around two fixed baseline speeds (fast and medium).

Causes of insulin resistance in childhood.

The increasing incidence of type 2 diabetes worldwide is causing concern. Genetic and environmental influences have been put forward to explain the origins of this disease, but perhaps the most convincing contributory factor is high body weight. The authors review the literature on the subject to identify some of the predisposing factors influencing healthcare practitioners' concerns about the issue.

Type 2 diabetes in children.

The prevalence of type 2 diabetes mellitus is increasing in children and is reaching epidemic proportions in some western countries. Sue Howdle and Terry Wilkin examine the extent of the problem, the disease process, screening, prevention and management of type 2 diabetes.

Accelerometers identify inactive and potentially obese children (EarlyBird 3).

Accelerometers revealed a fivefold variation in physical activity among healthy 5 year old children. They singled out habitually inactive children, most of them girls, who did little, whether at school or over the weekend. Accelerometers are of potential value in identifying, from an early age, children at risk of becoming obese.

Polycystic ovary syndrome and fat distribution: the central issue?

This review discusses the role of central obesity in polycystic ovary syndrome. There is increasing evidence that intraabdominal or visceral fat is either causative or a very early effect of polycystic ovary syndrome. The clinical implications of this are discussed.

Variation within the type 2 diabetes susceptibility gene calpain-10 and polycystic ovary syndrome.

Variation within the calpain-10 gene (CAPN10) has been proposed to account for linkage to type 2 diabetes on chromosome 2q in Mexican-Americans, and associations with diabetes have been reported in several other populations. Given the epidemiological, physiological, and genetic overlap between type 2 diabetes and polycystic ovary syndrome (PCOS), CAPN10 represents a strong candidate gene for a role in PCOS susceptibility. Using both family based and case-control association resources (146 parent-offspring trios; 185 additional PCOS cases; 525 control subjects, all of European ancestry), we sought association between CAPN10 variation and PCOS, focusing on four single nucleotide polymorphism (SNP) variants (SNP-44, SNP-43; SNP-19; SNP-63).