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Transmitted drug resistance, selection of resistance mutations and moderate antiretroviral efficacy in HIV-2: analysis of the HIV-2 Belgium and Luxembourg database
No full textBACKGROUND: Guidelines established for the treatment of HIV-1 infection and genotype interpretation do not apply for HIV-2. Data about antiretroviral (ARV) drug efficacy and resistance mutations is scarce. METHODS: Clinical data about HIV-2 infected patients in Belgium and Luxembourg were collected and the effect of ARV therapy on plasma viral load and CD4 counts were analysed. Viral RNA encoding for protease (PR) and reverse transcriptase (RT) from ARV-naïve and treated patients were sequenced. RESULTS: Sixty-five HIV-2 infected patients were included in this cohort. Twenty patients were treated with 25 different ARV combinations in a total of 34 regimens and six months after the start of ARV therapy, only one third achieved viral load suppression. All of these successful regimens bar one contained protease inhibitors (PIs). Mean CD4 gains in the group of viral load suppressors and the group of patients treated with PI-containing regimens were respectively significantly higher than in the group of non-suppressors and the group of PI-sparing regimens. The most frequent mutations selected under therapy (compared to HIV-2 ROD) were V71I, L90M and I89V within PR. Within RT, they were M184V, Q151M, V111I and K65R. All of these mutations, except K65R and M184V, were also found in variable proportions in ARV-naïve patients. CONCLUSION: Despite a high rate of ARV treatment failure, better virological and immunological results were achieved with PI-containing regimens. The analysis of polymorphic positions and HIV-2 specific mutations selected during therapy showed for the first time that transmission of drug resistant viruses has occurred in Belgium and Luxembourg. The high heterogeneity in ARV combinations reflects a lack of guidelines for the treatment of HIV-2 infection
Validity of photographs for food portion estimation in rural West African setting
No full textOBJECTIVE: To validate food photographs for food portion size estimation of frequently consumed dishes, to be used in a 24-hour recall food consumption study of pregnant women in a rural environment in Burkina Faso. This food intake study is part of an intervention evaluating the efficacy of prenatal micronutrient supplementation on birth outcomes. SUBJECTS: Women of childbearing age (15-45 years). DESIGN: A food photograph album containing four photographs of food portions per food item was compiled for eight selected food items. Subjects were presented two food items each in the morning and two in the afternoon. These foods were weighed to the exact weight of a food depicted in one of the photographs and were in the same receptacles. The next day another fieldworker presented the food photographs to the subjects to test their ability to choose the correct photograph. RESULTS: The correct photograph out of the four proposed was chosen in 55% of 1028 estimations. For each food, proportions of underestimating and overestimating participants were balanced, except for rice and couscous. On a group level, mean differences between served and estimated portion sizes were between -8.4% and 6.3%. Subjects who attended school were almost twice as likely to choose the correct photograph. The portion size served (small vs. largest sizes) had a significant influence on the portion estimation ability. CONCLUSIONS: The results from this study indicate that in a West African rural setting, food photographs can be a valuable tool for the quantification of food portion size on group level
Suivi du premier cas d'infection … Mycobacterium ulcerans confirmé par culture, PCR et génotypage en République du Congo-Brazzaville
No full textThis article presents follow-up data from the first patient in whom Mycobacterium ulcerans infection (MUI) was documented by PCR, genotyping and culture in the Republic of Congo-Brazzaville. Findings show the importance of regular clinical and microbiological evaluation for the disseminated form of the disease. The patient was probably infected in Pointe Noire where MUI has been described but never documented. Culture of specimens collected before antibiotic treatment showed that the bacterium was sensitive to the antibiotics being administered (streptomycin and rifampin) and was identical to isolates from Atlantic-coast regions of West Africa where MUI is endemic. The patient was treated with streptomycin and rifampin for 12 weeks in association with surgery. During treatment clinical examination was performed every day and microbiological analysis every two weeks. The duration of follow-up from the end of specific antibiotic treatment was 26 months. Medical treatment failed to prevent bone involvement and fistulae that were treated by surgery. However medical treatment may have limited dissemination of the disease. Serial microbiological evaluation was useful to detect bone involvement in this patient, but persistent positive gene amplification is not a proof of active disease. This study confirms that MUI is still endemic in the region of Pointe Noire. This finding underlines the need to optimize epidemiologic surveillance, laboratory diagnostic capabilities, and therapeutic management in the Republic of Congo-Brazzaville
Gastos asumidos por la familia durante el ingreso en el hogar
No full textIntroduction Home care as an alternative for primary health care is advantageous in terms of quality of service and governmental resource utilization, but it also represents an expenditure for the family.
Objectives To estimate and to characterize the costs of home care for patients in different geographic areas.
Methods Data on patients under home care conditions from July 2002 to June 2003 in different areas located in Playa municipality, Cruces municipality, Union de Reyes municipality and Fomento municipality were analyzed. Expenditures per patient, per stay day and per most frequent causes of home care were estimated and given in Cuban domestic currency and in foreign currency.
Results Eighty percent or more of the families faced some extra expenditure. Food represented the highest cost in urban areas whereas drugs were the main line of expenditure in rural areas. Transportation cost was an important aspect in the rural setting. The median of expenditure per patient ranged from 109.17 to 31.75 Cuban pesos. Expenditure per stay day ranged from 16. 79 to 3.14 Cuban pesos. Foreign currency cost was not significant.
Conclusions Home care is an additional economic burden for the family, particularly in the metropolitan urban setting. Cost-effectiveness of the prescribed therapeutic schemes as well as availability of diagnostic means in the health area should be in-depth analyzed
Costos directos del ingreso en el hogar en Cuba
No full textIntroduction Home-based care is a primary health care option mainly aimed at improving the patient care and at using available economic resources more effectively. There have been few studies on this care modality that included different geographical settings in Cuba.
Objectives To estimate and to characterize the direct cost of home care in the various geographical areas of the island.
Methods A partial cost study was conducted from 2001 to 2002 in four Cuban geographical areas. Those costs afforded by the national healthcare system and part of those paid by the families were analyzed. The considered items were human resources, waste materials, diagnostic means and drug therapy. Cost per patient and per cause of home care was estimated. The total number of patients cared at home was 837.
Results The cost per patient ranged from nearly 10,00 to 20,00 pesos. The rural setting showed the highest cost in this regard. Items that contributed the most were salary and drug therapy. The difference between cost per patient in a rural area and in the other areas was determined by the kind of treatment. Home-based care accounted for an average family cost, in terms of purchase of drugs, from 7,00 to 18,00 pesos per patient.
Conclusions Home care generated comparable average costs in both rural and urban areas. Respiratory diseases were the most costly and the contribution by the various items was similar regardless of the geographical area and of the cause of home care. As the condition of the patients became more critical, differences in terms of costs between urban and rural areas were observed, and cost increases mainly occurred at the expense of the item "treatment.
Development of a clinical scoring system for the diagnosis of smear-negative pulmonary tuberculosis
No full textThis study developed a clinical score based on clinical and radiographic data for the diagnosis of smear-negative
pulmonary tuberculosis (SNPT). SNPT was defined as a positive culture in Ogawa in a patient with two negative
sputum smears. Data from patients admitted to the emergency ward with respiratory symptoms and negative acidfast
bacilli (AFB) smears was analyzed by means of logistic regression to develop the predictive score.Two hundred
and sixty two patients were included. Twenty patients had SNPT. The variables included in the final model were
hemoptysis, weight loss, age > 45 years old, productive cough, upper-lobe infiltrate, and miliary infiltrate. With
those, a score was constructed. The score values ranged from -2 to 6. The area under the curve for the ROC curve was
0.83 (95% CI 0.74-0.90). A score of value 0 or less was associated with a sensitivity of 93% and a score of more than
4 points was associated with a specificity of 92% for SNPT. Fifty-two point twenty-nine percent of patients had scores
of less than one or more than four, what provided strong evidence against and in favor, respectively, for the diagnosis
of SNPT. The score developed is a cheap and useful clinical tool for the diagnosis of SNPT and can be used to help
therapeutic decisions in patients with suspicion of having SNPT
Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings
No full textThe immune reconstitution infl ammatory syndrome (IRIS) has emerged as an important early complication of
antiretroviral therapy (ART) in resource-limited settings, especially in patients with tuberculosis. However, there are
no consensus case defi nitions for IRIS or tuberculosis-associated IRIS. Moreover, previously proposed case defi nitions
are not readily applicable in settings where laboratory resources are limited. As a result, existing studies on
tuberculosis-associated IRIS have used a variety of non-standardised general case defi nitions. To rectify this problem,
around 100 researchers, including microbiologists, immunologists, clinicians, epidemiologists, clinical trialists, and
public-health specialists from 16 countries met in Kampala, Uganda, in November, 2006. At this meeting, consensus
case defi nitions for paradoxical tuberculosis-associated IRIS, ART-associated tuberculosis, and unmasking
tuberculosis-associated IRIS were derived, which can be used in high-income and resource-limited settings. It is
envisaged that these defi nitions could be used by clinicians and researchers in a variety of settings to promote
standardisation and comparability of data
Aetiological factors and perception of anaemia in Tunisian women of reproductive age
No full textOBJECTIVES: To identify aetiological factors in anaemia and to explore knowledge, perceptions and attitudes towards anaemia. DESIGN: Two cross-sectional surveys and sixteen focus group discussions. SETTING: The two regions with the highest prevalence of anaemia in Tunisia, Greater Tunis (GT) and the South West (SW). SUBJECTS: Two representative samples of 687 (GT) and 729 (SW) women of reproductive age; 108 women were included in focus group discussions. RESULTS: Among anaemic women, 63.4% in the GT region and 80.2% in the SW displayed iron deficiency (ID). Genetic haemoglobinopathies accounted for 10.0% and 3.6% of the cases of anaemia in the two regions, respectively. After adjustment for confounders, the major factors for iron-deficiency anaemia were low dietary Fe intake (OR = 5.0, 95% CI 3.0, 8.4), drinking tea after eating (OR = 3.4, 95% CI 2.0, 5.7) and pica (OR = 2.1, 95% CI 1.1, 3.9). Most of the women related anaemia to the following causes: malnutrition, lack of hygiene, and their heavy workload and responsibilities in the household. Many women connected anaemia with hypotension. Few established a relationship between ID and anaemia. They had confidence in their doctor for treatment, but many complained they were not given sufficient information. Low dietary Fe intake, inappropriate food practices and inadequate perceptions contribute to the aetiology of anaemia in women. CONCLUSIONS: These results point out to the need for a strategy combining food fortification, Fe supplementation for pregnant women, nutritional education for the general public and at-risk specific target groups, and training of health professionals
Biomedical interventions to prevent HIV infection: evidence, challenges, and way forward
No full textIntensive research efforts for more than two decades have not yet resulted in an HIV vaccine of even moderate effectiveness. However, some progress has been made with other biomedical interventions, albeit on the basis of inconsistent levels of evidence. The male condom, if used correctly and consistently, has been proven in observational studies to be very effective in blocking HIV transmission during sexual intercourse; and, in three randomised trials, male circumcision was protective against HIV acquisition among men. Treatment of sexually transmitted infections, a public health intervention in its own right, has had mixed results, depending in part on the epidemic context in which the approach was assessed. Finally, oral and topical antiretroviral compounds are being assessed for their role in reduction of HIV transmission during sexual intercourse. Research on biomedical interventions poses formidable challenges. Difficulties with product adherence and the possibility of sexual disinhibition are important concerns. Biomedical interventions will need to be part of an integrative package that includes biomedical, behavioural, and structural interventions. Assessment of such multicomponent approaches with moderate effects is difficult. Issues to be considered include the nature of control groups and the effect of adherence on the true effectiveness of the intervention