To assess the evolution of triglyceride (TG) levels in HIV-infected patients receiving stable potent antiretroviral therapy treated with N-3 polyunsaturated fatty acids (PUFAs), a prospective double-blind randomized design for a reliable assessment of TG evolution was performed. One hundred twenty-two patients with TG levels >2 g/L and < or =10 g/L after a 4-week diet (baseline TG: 4.5 +/- 1.9 g/L) were randomized for 8 weeks to N-3 PUFAs (2 capsules containing 1 g of fish oil 3 times daily, n = 60), or placebo (1 g of paraffin oil capsules, n = 62). An 8-week open-label phase of N-3 PUFAs followed. Evaluation criteria were TG percent change at week 8, percentage of responders (normalization or > or =20% TG decrease), and safety issues. Ten patients with baseline TG levels >10 g/L were not randomized and received N-3 PUFAs as open treatment. The difference (PUFA - placebo) in TG percent change at week 8 was -24.6% (range: -40.9% to -8.4%; P = 0.0033), the median was -25.5% in the PUFA group versus 1% in the placebo group, and mean TG levels at week 8 were 3.4 +/- 1.8 g/L and 4.8 +/- 3.1 g/L, respectively. TG levels were normalized in 22.4% (PUFA) versus 6.5% (placebo) of patients (P = 0.013) with a > or =20% reduction in 58.6% (PUFA) versus 33.9% (placebo) of patients (P = 0.007). Under the open-label phase of N-3 PUFAs, the decrease in TG levels was sustained at week 16 for patients in the PUFA group (mean TG: 3.4 +/- 1.7 g/L), whereas a 21.2% decrease in TG levels occurred for patients in the placebo group (mean TG: 3.3 +/- 1.4 g/L). No significant differences were observed between groups in the occurrence of adverse events. The median TG change at week 8 was -43.6% (range: Q1-Q3; 95% CI: -66.5% to -4.6%) for patients with baseline TG levels >10 g/L. The difference in mean total cholesterol between groups (PUFA - placebo) at week 8 was -8.5% (P = 0.0117). This study demonstrated the efficacy of PUFAs to lower elevated TG levels in treated HIV-infected hypertriglyceridemic patients. N-3 PUFAs have a good safety profile.

Compared with our previous studies, the proportion of NRTI- and first-generation NNRTI-related TDR has continued to decline in French seroconverters. However, subtype B-infected MSM could drive the spread of resistant HIV strains. Finally, we suggest preferring PI- or II- to NNRTI-based combinations to treat PHI patients.

Several subjective markers restrict the referral of patients from local hospitals to liver transplant centres. Their advancement to this second step is thus markedly weakened by initial subjectivity. The development of objective guidelines for local hospital physicians to assist them with their initial decision-making on LT is now necessary.

This meta-analysis examined the association between self-esteem and suicidal thoughts and behaviors (STBs) from childhood to late adulthood and tested several study and sample characteristics as potential moderators of this association. We included effect sizes from 120 articles. The meta-analytic results showed that individuals reporting lower self-esteem were at a higher risk for also reporting STBs, as indicated by negative associations between self-esteem and STBs. This global conclusion was robust across various sample and study characteristics and can be drawn for those studies that assessed STBs and self-esteem on metric scales and for those studies that examined mean differences in self-esteem between groups with vs. without STBs (r = -.421 and d = -0.798 for ideation, r = -.258 and d = -0.875 for behavior, r = -.411 and d = -1.610 for the combination of thoughts and behaviors). The meta-analysis identified evidence gaps, including the need for more studies on the association between suicidal behavior and self-esteem, studies on the association between STBs and self-esteem in the second half of life, and more longitudinal studies. Overall, this meta-analysis provides a more nuanced understanding of the relationship between self-esteem and STBs and contributes to the existing literature on suicide prevention.

The pharmacokinetics of molsidomine were investigated in six healthy volunteers and in seven patients with alcoholic cirrhosis. After a 2 mg oral dose, molsidomine elimination half‐life was prolonged in cirrhotic patients (13.1 +/‐ 10.0 h vs 1.2 +/‐ 0.2 h, P less than 0.01) because of a decrease in its apparent plasma clearance (CL/F) (39.8 +/‐ 31.9 ml h‐1 kg‐1 in patients with cirrhosis vs 590 +/‐ 73 ml h‐1 kg‐1 in volunteers). The elimination half‐life of the active metabolite, linsidomine (SIN‐1) was also prolonged in cirrhotic patients (7.5 +/‐ 5.4 h vs 1.0 +/‐ 0.19 h, P less than 0.05). The AUC values of both molsidomine and linsidomine were increased in the cirrhotic group, but the increase in the former was considerably greater than in the latter as shown by the significant decrease of the ratio AUClinsidomine/AUCmolsidomine × 100 (4.5 +/‐ 6.1 in cirrhotic patients vs 23.5 +/‐ 3.4 in healthy volunteers, P less than 0.001). These results suggest that liver cirrhosis profoundly alters the pharmacokinetics and metabolism of molsidomine.