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The use of 'sex' and 'gender' in medical research.

There is a widespread practice of using 'sex' and 'gender' interchangeably. The World Health Organization considers that they are not. It defines sex as a set of chromosome-dependent biological variables that show unique hormone profiles and anatomy. Conversely, gender refers to socially constructed sex attributions with differential roles, behavioral expressions, identity, etc. Researchers and institutions have proposed guidelines to ensure that good science is not compromised by ideologies, media or social pressures, morality, religion or economic interests. Sex differences are immune to any ideology or socio-cultural interest, because they are governed by biologically determined genetic parameters. Considering men and women to be alike is very valuable from a moral or social perspective, but ignoring differences could be wrong and unacceptable from a biomedical perspective. The organization of health and/or research systems that does not consider the different morbidity, evolution or treatment response depending on sex would generate biases and mistakes. To work on medical innovation with a gender perspective should need to take sex differences into account and integrate them properly, recognizing diversity. The controversy is not just about sex or gender, but about sex and gender and how they may influence each other. Maintaining a scientific and academic approach will help both to advance science and enrich laws and/or ideologies.

Association between genital mycoplasmas (Ureaplasma urealyticum and Mycoplasma hominis) and HIV infection: a systematic review and meta-analysis.

Several studies have reported the occurrence of genital mycoplasmas (Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, and Mycoplasma fermentans) among human immunodeficiency virus (HIV)-infected patients, but findings are conflicting. The aim of this systematic review and meta-analysis was to assess the association of U. urealyticum and M. hominis with HIV infection. We searched seven databases to retrieve articles reporting the prevalence of genital mycoplasmas among HIV-infected patients. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated and displayed by forest plots. Cochran Q and I2 statistics were applied to assess heterogeneity. In addition, a funnel plot with an Egger's test was performed to evaluate potential publication bias. Of the 1123 articles identified, 12 studies met the inclusion criteria and were included in this meta-analysis. Our results revealed that HIV-infected patients had higher colonization rates by U. urealyticum and M. hominis (single infection) than the control group (OR = 1.526; 95% CI: 1.202-1.937; p = 0.001 and OR = 2.610; 95% CI: 1.890-3.604; p = 0,000, respectively). However, coinfection seemed to be not associated with HIV infection (OR = 1.311; 95% CI: 0.744-2.311; p = 0.348). A subgroup analysis showed that study design and geographical origin were a source of heterogeneity in the studies that reported coinfection among HIV-infected patients. However, there was no statistical evidence of publication bias. Our study revealed that genital mycoplasmas were more frequent in HIV-infected patients than healthy individuals, resulting from a decline of natural immunity due to HIV. More effort should be dedicated to the screening, prevention, and treatment of genital mycoplasmas, to curb the spread of HIV.

The use of the brief symptom inventory among youth living with HIV: a scoping review.

The brief symptom inventory (BSI), a 53-item measure that assesses psychological distress, is a popular tool for measuring mental health symptoms among youth living with HIV (YLH) in the United States (US); however, it has been used inconsistently with this population. This scoping review summarizes discrepancies in the use of the BSI to identify opportunities to improve systematism and make recommendations for clinicians and researchers, and highlights correlates of psychological distress among YLH as measured by the BSI. Databases searched included PsycINFO, PubMed, and CENTRAL. Eligible studies that assessed psychological distress using the BSI among YLH, were conducted in the US, and were written in English. Of the 237 articles identified, 57 were selected for inclusion. Studies investigated associations between BSI scores and several variables, including pre- versus post-highly active antiretroviral therapy (ART) era, ART adherence, sexual risk behavior, substance use, stigma, social support, self-efficacy, mode of HIV infection, and sexual orientation. There was variation in BSI elements used as outcome measures, sample age ranges, and reporting of mean scores and cutoff t-scores. 89.5% (n = 51) of studies did not report which BSI norms were used in their data analysis, and 68.4% of studies (n = 39) did not report the cut-off t-score value used. Variability in study objectives restricted this study to a scoping review rather than a meta-analysis. Generalizability to non-US settings is another limitation. More consistency in how the BSI is used among YLH is needed to accurately identify distress among YLH and provide tailored interventions to address their unique challenges.

HIV patients' bone loss before and after antiretroviral treatment and its possible mechanisms.

HIV infection has been reported to cause bone loss and a higher risk of fracture. Under normal conditions, bone metabolism is regulated by mesenchymal cells, osteoclasts differentiated from mononuclear macrophages, osteoblasts, and their expression of regulatory factors, such as receptor activator of nuclear factor-kappa B ligand (RANKL), M-SCF, and transforming growth factor-beta. The balance between bone resorption and osteogenesis depends on the balance between osteoclasts and osteoblasts. In addition, some immune cells, such as B-cells, T-cells, and other non-immune cells expressing RANKL, can contribute to osteoporosis under inflammatory conditions. HIV proteins consist of three types: regulatory proteins, accessory proteins, and structural proteins, which contribute to HIV-mediated bone loss partly by upregulating NF-κB expression, tumor necrosis factor alpha content, and release of inflammatory cytokines. Even worse, although antiretroviral therapy has reduced HIV infection mortality and successfully transformed acquired immunodeficiency syndrome into a chronic disease, its impact on bone loss should not be overlooked, especially when the drug contains tenofovir. This review analyzes some reports focusing on the overall osteolytic situation due to imbalances in osteogenesis and bone resorption due to HIV infection and antiviral therapy. The intrinsic mechanism of bone loss provides a reference for researchers to analyze the risk factors for HIV patients complicated with bone loss and helps clinicians to provide ideas for the intervention and prevention of bone loss during clinical treatment and chronic disease management of HIV patients.

The management of polypharmacy in people living with HIV

Antiretroviral therapy (ART) has modified the prognosis of HIV which has evolved into a chronic condition. People living with HIV (PLWH) are living longer presenting an increased number of comorbidities leading to polypharmacy. Literature on the prevalence, associated factors, drug-drug interactions (DDIs), effects on ART-outcomes, geriatric conditions, and nutritional status together with health-interventions aimed to reduce it is presented in this review. A literature search was conducted on the MEDLINE database for all relevant English- and Spanish-language studies since 2006. Studies providing data of interest were identified and ordered in groups: (i) prevalence and associated factors (n = 37), (ii) DDIs (n = 19), (iii) Effects on ART-outcomes (n = 12), (iv) Effects on health conditions (n = 13), and (V) Health-interventions to assess and/or reduce it (n = 9). Polypharmacy occurs in 9-91% of PLWH (2.6-19.5% affected by severe polypharmacy). Main factors associated with polypharmacy are older age, a higher number of comorbidities, frailty, deteriorated renal function, and previous hospitalizations. DDIs were present in 19.15-84% of cases (1.3-12.2% for the most severe types). Mainly involved non-ART drugs were antihypertensives, statins, antithrombotic agents, corticosteroids, divalent cations, and antiacids. Polypharmacy can affect ART selection, adherence, and outcomes and has been related to some geriatric conditions such as falls, frailty, and poor nutritional status. Potentially prescribing issues are present in up to 87.9% of cases according to the STOPP-START and Beers criteria and some pharmacist-led interventions have been shown to reduce it. Considering these findings, polypharmacy should be considered a clinical concern in this population and treatment-optimization programs are needed to reduce its burden.