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14.12.2013
Susceptibility to periodontal disease (PD) has been convincingly demonstrated to be in part determined by genetic predisposition (1, 2). All publications reporting HLA-A, -B, -Cw, -DR, and -DQ antigen frequency in Caucasian patients with periodontal disease compared with controls were identified by electronic search of Medline (1966-2004) using a combination of subject headings and text words relating to the terms "periodontal disease\", "periodontitis", "periodontosis", "chronic", "adult", "early-onset", "aggressive", "juvenile", "rapidly", "progressive", "HLA" and "MHC". According to the selection criteria out of 18 case control studies 12 were suitable for meta-analysis (Table 1).
Tab 1: Studies on HLA associations in different forms of periodontal disease included in the meta-analysis. Meta-analysis of all HLA antigen frequencies in chronic periodontitis revealed no positive associations, however HLA-A2 turned out to have a significantly negative association with a decreased odds ratio (Table 2 & Fig. Tab 2: Combined analysis of HLA-antigen frequencies in patients with chronic periodontitis.
Tab 3: Combined analysis of HLA-antigen frequencies in patients with aggressive periodontitis. There is not enough data to demonstrate whether the associations of HLA-A9 and -B5 in aggressive periodon-titis were caused by association of only one or both of their split antigens (HLA-A23, -A24 and HLA-B51, -B52).
This meta-analysis shows evidence that aggressive periodontitis among Caucasians is associated with HLA-A9 and -B15. Michalowicz BS, Diehl SR, Gunsolley JC, Sparks BS, Brooks CN, Koertge TE, Califano JV, Burmeister JA, Schenkein HA: Evidence of a substantial genetic basis for risk of adult periodontitis. Mantel N, Haenszel W: Statistical aspects of the analysis of data from retrospective studies of disease. Cullinan MP, Sachs J, Wolf E, Seymour GJ: The distribution of HLA-A and -B antigens in patients and their families with periodontosis. Klouda PT, Porter SR, Scully C, Corbin SA, Bradley BA, Smith R, Davies RM: Association between HLA-A9 and rapidly progressive periodontitis. Alley CS, Reinhardt RA, Maze CA, DuBois LM, Wahl TO, Duckworth WC, Dyer JK, Petro TM: HLA-D and T lymphocyte reactivity to specific periodontal pathogens in type 1 diabetic periodontitis. Shapira L, Eizenberg S, Sela MN, Soskolne A, Brautbar H: HLA A9 and B15 are associated with the generalized form, but not the localized form, of early-onset periodontal diseases.
Kaslick RS, West TL, Chasens AI, Terasaki PI, Lazzara R, Weinberg S: Association between HL-A2 antigen and various periodontal diseases in young adults. Firatli E, Kantarci A, Cebeci I, Tanyeri H, Sonmez G, Carin M, Tuncer O: Association between HLA antigens and early onset periodontitis. Cross Validated is a question and answer site for people interested in statistics, machine learning, data analysis, data mining, and data visualization. Multiple imputation was performed due to missingness in the data (GCS 14% missing, rcteyemi 46% missing). My question relates to the result of the summary function relative to the above anova results. I am not sure exactly why I have significant p-values but an odds ratio whose confidence interval traps 1 for the following variables? I understand that the OR is calculated for continuous variables by comparing the 75th to the 25th percentile. I would show ORs and CLs but have a footnote stating the reason they are not necessarily consistent with the general tests of association.
Is there any resource, package or guidance for computing an "average model" or averaging the summary statistics over the completed datasets for reporting confidence intervals?
Thank you, I'll take a look and will add any additional computation to this post to share with others.
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Persons using assistive technology might not be able to fully access information in this file. After the civil war with North Sudan ended in 2005, displaced residents began returning to Juba. Juba, resulting in 6,329 suspected infections as of June 2006, with sporadic cases continuing throughout the year. PhD, Div of Emergency and Environmental Health Svcs, National Center for Environmental Health, CDC. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. This conversion might result in character translation or format errors in the HTML version.
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Despite this increase, ensuring adherence to HIV treatment remains challenging in all countries. The aim of this systematic review and meta-analysis was to investigate the relationship between the employment status of HIV-infected individuals and ART adherence using updated data and a larger patient sample, which included more information from middle- and low-income countries. We searched the Medline, Embase and Cochrane Central Register of Controlled Trials databases for the period January 1980 to September 2014 (Box 1). Two reviewers evaluated the eligibility of the studies identified and a third reviewer provided arbitration if there was a discrepancy.
The meta-analysis was performed using the DerSimonian and Laird random-effects model to obtain a pooled estimate for the odds ratio (OR) and the associated 95% confidence interval (CI).25 The model was chosen since it takes into account both within- and between-study variability, as between-study heterogeneity was anticipated. Twenty-seven studies, involving 8008 patients (92%), included participants who were already receiving ART. The association between being employed and adhering to ART was observed to change over time, i.e.


Overall, we found that patients with HIV infections who were employed were 27% more likely to adhere to ART than those who were unemployed.
Despite mutual reinforcement between employment and ART adherence, it can be difficult for individuals to maintain adherence.
Unexpectedly, we found no evidence that gender had a significant influence on the association between employment status and ART adherence. Our finding that the association between being employed and adhering to ART declined over time may reflect changes in ART regimens, such as the trend towards once-daily dosing, reductions in the pill burden and side-effects,67,68 better access to treatment for both employed and unemployed individuals or a drop in the cost of HIV medications.1 Further research is needed to determine whether this finding is specific to the studies we included or whether it signifies a true decrease in the association over time. Our review was unable to address all pertinent questions on the association between employment status and optimal adherence to HIV treatment. Due to their central role in immune response against periodontopathogenic bacteria HLA antigens have been the subject of several investigations. It was not possible to evaluate deviations of HLA antigen frequencies between generalized and localized forms of aggressive periodontitis as only one study suitable for meta-analysis clearly defined criteria for localized aggres-sive periodontitis.
Non-linear restricted cubic spline modelling of Year and ISS may explain the discordance between OR and p-value but what about the binary variable Other? I am just concerned that reviewers and readers may be confused by the (to a typical medical professional) conflicting statistical results. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 503 Parran Hall, 130 DeSoto Street, Pittsburgh, PA 15261, United States of America (USA).b. In addition, we used a narrative literature review approach to analyse and summarize information on HIV treatment, particularly on adherence, from a range of sources including UNAIDS secretariat reports, scientific conference abstracts and other grey literature.
Heterogeneity among studies was assessed by inspecting forest plots of the odds ratios from each study and by using the I‡2 test for heterogeneity, with a 10% level of statistical significance, and the I2 statistic, with which a value of 50% represented moderate heterogeneity. Twenty-three studies, involving 8171 patients (94%), defined adherence as receiving 95% or more of prescribed doses in a given period. This is in agreement with the results of our previous meta-analysis19 and of others5 who reported that one of the barriers to ART adherence in both developed and developing countries was financial constraints, which may be considered a proxy for unemployment. The observational nature of the data a€“ 85% of the studies included had a cross-sectional design a€“ limited our ability to draw causal inferences and our findings may be affected by reverse causation bias or by other unknown confounding factors that were not adjusted for. We conducted comprehensive searches of databases to ensure that all relevant, published studies were identified.
Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators.
Adherence to nonnucleoside reverse transcriptase inhibitor-based HIV therapy and virologic outcomes. Adherence to highly active antiretroviral therapy assessed by pharmacy claims predicts survival in HIV-infected South African adults. Heterosexual HIV-1 infectiousness and antiretroviral use: systematic review of prospective studies of discordant couples. Socioeconomic status (SES) as a determinant of adherence to treatment in HIV infected patients: a systematic review of the literature. An evidence-based review of treatment-related determinants of patientsa€™ nonadherence to HIV medications. Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: prospective assessment with implications for enhancing compliance.
Evaluation of the Patient Medication Adherence Questionnaire as a tool for self-reported adherence assessment in HIV-infected patients on antiretroviral regimens. Consequences and determinants of adherence to antiretroviral medication: results from Adult AIDS Clinical Trials Group protocol 370.
Highly active antiretroviral therapy adherence and its determinants in selected hospitals from south and central Ethiopia.
Psychological distress and adherence to highly active anti-retroviral therapy (HAART) in Uganda: a pilot study.
Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil.
Factors affecting adherence of antiretroviral treatment among AIDS patients in an Ethiopian tertiary university teaching hospital.
Clinic attendance for medication refills and medication adherence amongst an antiretroviral treatment cohort in Uganda: a prospective study. A two-site hospital-based study on factors associated with nonadherence to highly active antiretroviral therapy. Predictors of nonadherence to highly active antiretroviral therapy among HIV-infected South Indians in clinical care: implications for developing adherence interventions in resource-limited settings. Risk factors for medication non-adherence in an HIV infected population in the Dominican Republic. Factors associated with non-adherence to highly active antiretroviral therapy in Nairobi, Kenya.
The association between depression and adherence to antiretroviral therapy in HIV-positive patients, KwaZulu-Natal, South Africa. Effect of nutritional factors on adherence to antiretroviral therapy among HIV-infected adults: a case control study in Northern Ethiopia.
Nonadherence factors and sociodemographic characteristics of HIV-infected adults receiving antiretroviral therapy in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
Adherence to highly active antiretroviral therapy in a tertiary care hospital in West Bengal, India. Factors associated with adherence to antiretroviral therapy in HIV-infected patients in Kathmandu District, Nepal.
Perceived quality of the psychosocial environment and well-being in employed and unemployed older adults: the importance of latent benefits and environmental vitamins. Homelessness as a structural barrier to effective antiretroviral therapy among HIV-seropositive illicit drug users in a Canadian setting.


A review of the role of food insecurity in adherence to care and treatment among adult and pediatric populations living with HIV and AIDS. Employment status is associated with both physical and mental health quality of life in people living with HIV. Differences in normal activities, job performance and symptom prevalence between patients not yet on antiretroviral therapy and patients initiating therapy in South Africa.
In a study of a population cohort in South Africa, HIV patients on antiretrovirals had nearly full recovery of employment.
Contrasting reasons for discontinuation of antiretroviral therapy in workplace and public-sector HIV programs in South Africa. Gender and the use of antiretroviral treatment in resource-constrained settings: findings from a multicenter collaboration.
Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011.
Treatment simplification in HIV-infected adults as a strategy to prevent toxicity, improve adherence, quality of life and decrease healthcare costs.
Lower pill burden and once-daily antiretroviral treatment regimens for HIV infection: a meta-analysis of randomized controlled trials. The high polymorphism of the HLA system results in differences of peptid binding capability and subsequently individual immune reaction and degree of responsiveness to antigenic peptids (Fig. In the group of patients with aggressive periodontitis meta-analysis resulted in significantly positive associations of HLA-A9 and -B15 with increased odds ratios, whereas HLA-A2 and -B5 had significantly negative associations with lower frequencies of these markers among the patients (Table 3 & Fig.
In contrast, the negative association of HLA-B5 in aggressive periodontitis has not been noted before and might present a resistance factor for aggressive periodontitis. Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, England.c. Overall, 24 studies, involving 7484 of 8743 patients (86%), were cross-sectional, whereas the other four were prospective cohort studies. In addition, 22 studies, involving 7755 patients (89%), used self-report questionnaires to assess adherence, whereas three used pharmacy refill data, one used the pill count, one used the blood drug concentration and one used a combination of methods. However, the risk of selection bias due to inadequate confirmation or consideration of confounding variables was low in 16 studies but high in 12: 16 studies adjusted for major confounding variables during the analysis phase, whereas the remaining 12 reported unadjusted associations between employment status and adherence to ART. One difference from our previous report is that the magnitude and strength of the association between being employed and adhering to ART were highest in studies from low-income countries. The most frequently cited reason for treatment discontinuation among these individuals was harassment and discrimination by line managers who refused to grant time off from work for clinic attendance. Additionally, we found significant heterogeneity across the studies, which suggests that a substantial percentage of the variability in effect estimates was due to heterogeneity rather than to sampling errors, i.e. We also carried out meta-regression analyses to determine whether any particular study-level factor explained the results or could account for the observed variations between studies.
Publications, in which diagnostic criteria and definition of controls were not clearly described, were excluded.
Moreover, our results confirm the formerly published negative association of HLA-A2 both in aggressive and chronic periodontitis suggesting a protective role for HLA-A2 towards periodontitis. Eight studies, involving 1775 patients (20%), were carried out in the United States, three each were carried out in Ethiopia, India and South Africa and two were carried out in Uganda. The risk of detection bias due to inadequate outcome assessment was low in the six studies that assessed adherence using objective measures and high in the remaining 22, which used self-report questionnaires. There was evidence of substantial statistical heterogeneity between the results of all studies (I2: 77%). For public sector employees, the main reasons included relocation away from HIV care providers and having insufficient money for transportation to clinical facilities.63 These findings suggest there is a considerable need to promote awareness of the importance of ART adherence and to develop employment arrangements among both employers and employees that encourage adherence.
In performing this comprehensive and robust review of the existing literature, we identified gaps in the current literature on determinants of ART adherence. Studies on chronic periodontitis compared to controls with unknown periodontal status, were excluded. Two studies (18, 19) were excluded because of not reproducible statistical calculation of the presented HLA antigen frequencies.
Interestingly, the HLA associations of HLA-A2 and -B5 in aggressive perio-dontitis showed homogenous effects between all studies (Fig. The risk of attrition bias due to inadequate outcome data handling was low in 24 studies, unclear in two and high in the two studies in which more than 20% of patients were lost to follow-up. The leave-one-study-out sensitivity analysis showed that no single study had an undue influence on the pooled estimate.
Much of the heterogeneity observed may be explained by differences in the adherence threshold, study sample size and study design. The results of the more or less significantly associated HLA antigens are, however, not conclusive because the studies vary in terms of the number of investigated HLA antigens, the number and selection criteria of patients and controls as well as their ethnic origin. In studies on aggressive periodontitis controls with unknown periodontal status were accepted as the low incidence of aggressive periodontitis in Caucasian population is statistically negligable. We used the I‡2 test to subgroup differences and reported the P-value for interaction between pooled OR and study-level characteristics. Nevertheless, even when there is substantial heterogeneity, meta-analysis is regarded as preferable for data synthesis to qualitative or narrative interpretation since these approaches can lead to misleading conclusions that should not be generalized beyond the scope of the analysis.69 The ability to draw conclusions from quantitative data is an important feature of meta-analyses and its absence is one reason for avoiding narrative interpretations without a data synthesis. We used a variance-weighted, least-squares regression approach to estimate the effect of the year of publication (i.e. It is worth noting that the heterogeneity observed in the current study appears to be the norm rather than the exception in meta-analyses of ART adherence.14,15 An additional potential limitation is that none of the studies included compared treatment adherence across different types of occupation.
Further, we found evidence for a small study effect and it is possible that the observed magnitude of the association between being employed and adhering to ART could have been inflated by studies with small sample sizes.



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