Research Brief 10-02-HNP

Despite the knowledge and information available about HIV, stigma is still present. The affects of stigma are real and tangible. Globally HIV positive people are marginalized and often dread that their HIV status will adversely affect them socially. The belief that HIV-infected people are somehow deviant, or misconceptions about the mode of transmission fuels anxiety, fear, and distrust, which translates into barriers to adequate health care, emotional distress, and actions that can have adverse affects on health outcomes. When working with HIV-infected individuals and those at risk of becoming infected with HIV, the impact of stigma can be crippling to research. Stigma associated with HIV has had a significant role in the ability to recruit and retain eligible study subjects for a nutrition based HIV study, Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children (HNP). While this study specifically focused on HIV-infected women living in Kenya, the generalization gathered could be extrapolated to other populations. It is recommended that similar studies conduct focus groups with the study population prior to piloting, to ensure stakeholder input and an understanding of the particular challenges and concerns within a local context. Future studies should also employ individuals known in the community that the population trusts to assist with recruitment. Finally, factors that identify study staff, or associate subjects with the study should be minimal to reduce the risk of disclosing a subject’s HIV status.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID

Research Brief 08-02-HNP

Preliminary evidence suggests that improved nutrition early in human immunodeficiency virus (HIV) infection may delay progression to acquired immunodeficiency syndrome (AIDS) and delay the initiation or improve the effectiveness of antiretroviral drug therapy (ART). The scientific community has evolved in its appreciation of the value of food as an integral component of comprehensive care for individuals with HIV infection and AIDS. It is now well recognized that those who are food insecure and malnourished are more likely to fail drug treatment regimens. Body mass index (BMI) < 18 at the initiation of ART is strongly predictive of death. In addition, weight loss during the first four weeks of ART is also associated with death. A higher BMI is protective and is associated with better responses with ART. Patient response to nutrition intervention, however, may be confounded by the stage of HIV progression and other infections. That is, those who are in the earlier stages of the disease may respond better to aggressive nutrition intervention. The HIV Nutrition Project (HNP), "Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children," will evaluate the effect of protein quality and micronutrients found in meat on the health and nutritional well-being of women living with HIV in rural Kenya and the health and development of their children. By means of a randomized nutrition feeding intervention, researchers will study if the inclusion of meat added as an ingredient to a biscuit, when compared to soy or wheat, will best protect the immune system and prevent severe infection, prevent the loss of body mass and enhance the quality of life. These women are not yet receiving antiretroviral drugs and therefore not yet experiencing metabolic inefficiencies associated with AIDS.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID

Research Brief 08-01-HNP

Many of the 28 million people with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) estimated to be living in sub-Saharan Africa also suffer from malnutrition. Reproductive-aged women, their infants and young children are among the most vulnerable to malnutrition and progression of HIV to AIDS. As seen in eastern and southern Africa, mortality is increased in the malnourished. The HIV Nutrition Project (HNP) researchers will be evaluating the effect of protein quality and micronutrients found in meat on the health and nutritional well-being of women living with HIV in rural Kenya and the health and development of their children. By means of a randomized nutrition feeding intervention, the study will determine if meat in the diets of HIV-infected women and their children (1) protects the immune system and prevents severe infection, (2) prevents the loss of lean body mass, enhancing the quality of life among these drug naive women and enabling women to carry out their activities of daily living, and (3) supports the growth and development of their vulnerable children when compared to those given supplements with the same amount of energy, but with either soya or wheat protein. The intervention food with beef protein provides significantly more vitamin B12, lysine and bio-available iron and zinc when compared to the soya and wheat supplements. Deficiencies of these nutrients may hasten HIV disease progression.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID

Research Brief 08-03-HNP

In sub-Saharan Africa, an estimated 28 million people are living with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). In 2001, Moi University in Eldoret, Kenya joined with Kenya’s second national referral hospital, Moi Teaching and Referral Hospital (MTRH) and Indiana University (IU) to establish the Academic Model Providing Access To Healthcare (AMPATH). AMPATH’s missions were to (1) provide high-quality patient care; (2) educate patients and health care providers; and (3) establish a laboratory for clinical research in HIV/AIDS (http://medicine.iupui.edu/kenya/hiv.aids.html). Leveraging the power of an academic medical partnership, AMPATH has quickly become one of the largest and most comprehensive HIV/AIDS control systems in sub-Saharan Africa, providing a comprehensive system of care that has been described as a model of sustainable development (Tobias, 2006). Delivery of services occurs in the public sector through hospitals and health centers run by Kenya’s Ministry of Health. AMPATH currently implements prevention activities that touch the lives of millions of persons in a wide geographic area. The research arm of AMPATH, created to facilitate and manage the international research agenda being generated by Kenyan and US faculty, includes the Global Livestock CRSP’s HIV Nutrition Project (HNP), “Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children,” which is a collaborative initiative between AMPATH and faculty from Moi University, Indiana University and the University of California, Los Angeles.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID

The NGC 7129 Young Stellar Cluster: A Combined Spitzer, MMT, and 2MASS Census of Disks, Protostars, and Outflows

We present the analysis of seven band (1.2 to 8 micron) ground and space-based imaging of the NGC 7129 young stellar cluster from FLAMINGOS on MMT, 2MASS, and the Infrared Array Camera (IRAC) on the Spitzer Space Telescope. An analysis of the H-[4.5] vs. J-H colors reveals 84 objects with circumstellar disks. Of these, 42 are located within the cluster core, a 0.5 pc (100'') radius region of enhanced stellar surface density. From a luminosity and extinction limited sample of the stars within the cluster core boundary we have determined that 54% +/- 14% have circumstellar disks. Finally, we report the detection of several resolved outflows in the IRAC 4.5 micron mosaic.Comment: 13 pages, 4 figures. Accepted to the Spitzer special issue of ApJS. The full-resolution preprint can be obtained from http://astro.pas.rochester.edu/~rguter/preprints/gutermuth_ngc7129_a.tar.g

Regulatory and effector B cell cytokine production in patients with relapsing granulomatosis with polyangiitis

Background: B cells are capable of producing regulatory and effector cytokines. In patients with granulomatosis with polyangiitis (GPA), skewing of the pro- and anti-inflammatory cytokine balance may affect the risk of relapse. This study aimed to investigate differences in B cell cytokine production in patients with relapsing GPA and in controls, and determine whether this can aid in relapse prediction. Methods: Thirteen GPA patients with an upcoming relapse were matched with non-relapsing patients and healthy controls in a retrospective design. The B cell subset distribution was determined from peripheral blood. Cryopreserved peripheral blood mononuclear cells were cultured and intracellular B cell production of regulatory (IL10) and effector (TNF alpha, IFN gamma IL2, IL6) cytokines was assessed. Finally, serum markers associated with B cell activation (sCD27) and migration (CCL19) were determined. Results: GPA patient samples exhibited significantly lower percentages of TNF alpha+B cells than controls, an effect that was most pronounced in patients about to relapse. B cell capacity for IL10 production was similar in patients and controls. No significant differences were observed for cytokine production in relapsing and non-relapsing GPA patients. TNFa production correlated strongly with IL2, IFN gamma and the percentage of memory B cells. No change in effector cytokines occurred before relapse, while the percentage of IL10+B cells significantly decreased. GPA patients in remission had increased serum levels of CCL19 and sCD27, and sCD27 levels increased upon active disease. Conclusions: While differences in effector B cell cytokine production were observed between patients and controls, monitoring this in GPA did not clearly distinguish patients about to relapse. Prospective measurements of the regulatory cytokine IL10 may have potential for relapse prediction. Memory B cells appear mainly responsible for effector cytokine production. Increased migration of these cells could explain the decreased presence of TNF alpha+B cells in the circulation

Morbidity and nutrition status of rural drug-naïve Kenyan women living with HIV

This paper describes morbidity in a group of HIV-positive drug-naïve rural women in western Kenya. A total of 226 drug-naïve HIV-positive women were evaluated for baseline morbidity, immune function, and anthropometry before a food-based nutrition intervention. Kenyan nurses visited women in their homes and conducted semi-structured interviews regarding symptoms and physical signs experienced at the time of the visit and during the previous week and physical inspection. Blood and urine samples were examined for determination of immune function (CD4, CD8, and total lymphocyte counts), anaemia, malaria, and pregnancy status. Intradermal skin testing with tuberculin (PPD), candida, and tetanus toxoid antigens was also performed to evaluate cell-mediated immunity. Anthropometry was measured, and body mass index (BMI) was calculated. Seventy-six per cent of the women reported being sick on the day of the interview or within the previous week. Illnesses considered serious were reported by 13.7% of women. The most frequent morbidity episodes reported were upper respiratory tract infections (13.3%), suspected malaria (5.85%), skeletal pain (4.87%), and stomach pain (4.42%). The most common morbidity signs on physical inspection were respiratory symptoms, most commonly rhinorrhea and coughing. Confirmed malaria and severe diarrhea were significantly associated with a higher BMI

Age Differences in the Association of Obstructive Sleep Apnea Risk with Cognition and Quality of Life

Using a sample of 2925 stroke-free participants drawn from a national population-based study, we examined cross-sectional associations of obstructive sleep apnea risk (OSA) with cognition and quality of life and whether these vary with age, while controlling for demographics and co-morbidities. Included participants from the REasons for Geographic And Racial Differences in Stroke Study were aged 47-93. OSA risk was categorized as high or low based on responses to the Berlin Sleep Questionnaire. Cognitive function was assessed with standardized fluency and recall measures. Depressive symptoms were assessed with the four-item Center for Epidemiologic Studies Depression Scale. Health-related Quality of Life (HRQoL) was assessed with the Medical Outcomes Study Short Form-12 (SF-12). MANCOVA statistics were applied separately to the cognitive and quality of life dependent variables while accounting for potential confounders (demographics, co-morbidities). In fully adjusted models, those at high risk for OSA had significantly lower cognitive scores (Wilks’ Lambda = 0.996, F(3, 2786) = 3.31, p < .05) and lower quality of life (depressive symptoms and HRQoL) (Wilks’ Lambda = 0.989, F(3, 2786) = 10.02, p < .0001). However, some of the associations were age-dependent. Differences in cognition and quality of life between those at high and low obstructive sleep apnea risk were most pronounced during middle age, with attenuated effects after age 70

The Swift X-ray flaring afterglow of GRB 050607

The unique capability of the Swift satellite to perform a prompt and autonomous slew to a newly detected Gamma-Ray Burst (GRB) has yielded the discovery of interesting new properties of GRB X-ray afterglows, such as the steep early lightcurve decay and the frequent presence of flares detected up to a few hours after the GRB trigger. We present observations of GRB 050607, the fourth case of a GRB discovered by Swift with flares superimposed on the overall fading X-ray afterglow. The flares of GRB 050607 were not symmetric as in previously reported cases, showing a very steep rise and a shallower decay, similar to the Fast Rise, Exponential Decay that are frequently observed in the gamma-ray prompt emission. The brighter flare had a flux increase by a factor of approximately 25,peaking for 30 seconds at a count rate of approximately 30 counts s-1, and it presented hints of addition short time scale activity during the decay phase. There is evidence of spectral evolution during the flares. In particular, at the onset of the flares the observed emission was harder, with a gradual softening as each flare decayed. The very short time scale and the spectral variability during the flaring activity are indicators of possible extended periods of energy emission by the GRB central engine. The flares were followed by a phase of shallow decay, during which the forward shock was being refreshed by a long-lived central engine or by shells of lower Lorentz factors, and by a steepening after approximately 12 ks to a decay slope considered typical of X-ray afterglows.Comment: 23 pages, 5 figures, Accepted by the Astrophysical Journa