Fighting malnutrition in Madagascar: from NGO to social enterprise

In Madagascar, more than 50% of children under 5 years of age suffer from chronic malnutrition. The physical and cognitive consequences are irreversible after 24 months. GRET’s Nutrimad program addresses this problem by distributing an enriched flour product—“Koba Aina”—for children between 6 and 24 months. In order to reach the poorest households, it is sold very cheaply via an innovative sales network, the Hotelin-Jazakely (restaurants for babies), set up in the most deprived districts. In parallel, nutritional education campaigns are aimed at the mothers, who are often misinformed about the nutritional needs of their children. The level of maturity attained by the program is such that GRET now plans to continue with it over the long term. A privately-owned company, Nutri’zaza, is due to be created shortly to pursue Nutrimad’s activities, helping the project to achieve the economic viability that it currently lacks. By embedding Nutri’zaza’s work in a social enterprise, GRET hopes to secure the future of the initiative and enable it to expand throughout the country.A Madagascar, plus de 50% des enfants de moins de 5 ans souffrent de malnutrition chronique. Les séquelles physiques et cognitives qui s’ensuivent sont irréversibles après 24 mois. Le programme Nutrimad du GRET lutte contre ce problème par la distribution d’une farine enrichie destinée aux enfants de 6 à 24 mois, la Koba Aina. Afin d’atteindre les ménages les plus démunis, elle est vendue à très bas prix dans un réseau de vente original, les hotelin-jazakely, restaurants pour bébés, implantés dans les quartiers les plus défavorisés. Parallèlement, des actions d’éducation nutritionnelle sont menées auprès des mères : celles-ci méconnaissent souvent les besoins nutritionnels de leurs enfants. Le niveau de maturité atteint par le programme amène désormais le GRET à envisager sa continuation sur le long terme. Une société à capital privé, Nutri’zaza, sera créée prochainement pour continuer les activités de Nutrimad. Le projet pourra ainsi atteindre la viabilité économique qui lui manque aujourd’hui. En inscrivant les activités de Nutri’zaza dans une entreprise sociale, le GRET espère pérenniser cette activité et permettre son expansion dans le pays.En Madagascar, más del 50 % de los niños menores de 5 años padece malnutrición crónica. Las secuelas físicas y cognitivas que provoca son irreversibles a partir de los 24 meses. El programa Nutrimad del GRET combate este problema mediante la distribución de una harina enriquecida destinada a los niños de 6 a 24 meses, la Koba Aina. Para llegar a los hogares más pobres, se vende a un precio muy bajo a través de una red de venta original, los hotelin-jazakely, restaurantes para bebés, instalados en los barrios más desfavorecidos. De forma paralela, se llevan a cabo actividades de educación nutricional entre las madres: estas últimas desconocen a menudo las necesidades nutricionales de sus hijos. El nivel de madurez alcanzado por el programa ha llevado al GRET a considerar su continuación a largo plazo. Próximamente, se creará una sociedad con capital privado, Nutri’zaza, para continuar las actividades de Nutrimad. El proyecto podría así alcanzar una viabilidad económica de la que actualmente carece. Inscribiendo las actividades de Nutri’zaza en el marco de una empresa social, el GRET espera dar continuidad en el tiempo a esta actividad y permitir su expansión a todo el país

Feasibility and efficacy of early lung cancer diagnosis with chest computed tomography in HIV-infected smokers

International audienceOBJECTIVE: Lung cancer screening with chest computed tomography (CT) is beneficial in smokers aged 55 to 74 years. We studied the risks, benefits and feasibility of early lung cancer diagnosis with CT in HIV-infected smokers. DESIGN AND SETTING: French, multicentre, single round chest CT study in France, realized between February 2011 and June 2012. PARTICIPANTS: Patients were HIV-infected smokers at least 40 years, at least 20 pack-years, with a CD4 T-lymphocyte nadir count below 350 cells/μl. INTERVENTION: Single chest CT with a proposed standardized workup algorithm of positive images. MAIN OUTCOME MEASURE: The outcome was the number of histologically proven lung cancers diagnosed by CT with a 2-year follow-up. RESULTS: Median age of the 442 included patients was 49.8 years, 81.6% were under 55 years, 84% were men, median smoking was 30 pack-years, median nadir and last CD4 cell counts were 168 and 574 cells/μl, respectively, and 90% of patients had a plasma HIV RNA below 50 copies/ml. A positive image at baseline was reported in 94 (21%) patients, and 15 (3.4%) patients had 18 invasive procedures with no serious adverse events. Lung cancer was diagnosed in 10 patients (six at early stages), of which nine (2.0%, 95% confidence interval: 0.9-3.8) were CT detected, and eight in patients below 55 years. CONCLUSION: Early lung cancer diagnosis with CT in HIV-infected smokers was feasible, safe, and yielded a significant number of cancers. Lung cancer screening of HIV-infected smokers with an important history of immunodeficiency revealed a substantial number of cancers at younger ages than the targeted range in the general populatio

Is Impact of Statin Therapy on All-Cause Mortality Different in HIV-Infected Individuals Compared to General Population? Results from the FHDH-ANRS CO4 Cohort

French Hospital Database on HIVInternational audienceBackgroundThe effect of statins on all-cause mortality in the general population has been estimated as 0.86 (95%CI 0.79-0.94) for primary prevention. Reported values in HIV-infected individuals have been discordant. We assessed the impact of statin-based primary prevention on all-cause mortality among HIV-infected individuals.MethodsPatients were selected among controls from a multicentre nested case-control study on the risk of myocardial infarction. Patients with prior cardiovascular or cerebrovascular disorders were not eligible. Potential confounders, including variables that were associated either with statin use and/or death occurrence and statin use were evaluated within the last 3 months prior to inclusion in the case-control study. Using an intention to continue approach, multiple imputation of missing data, Cox’s proportional hazard models or propensity based weighting, the impact of statins on the 7-year all-cause mortality was evaluated.ResultsAmong 1,776 HIV-infected individuals, 138 (8%) were statins users. During a median follow-up of 53 months, 76 deaths occurred, including 6 in statin users. Statin users had more cardiovascular risk factors and a lower CD4 T cell nadir than statin non-users. In univariable analysis, the death rate was higher in statins users (11% vs 7%, HR 1.22, 95%CI 0.53-2.82). The confounders accounted for were age, HIV transmission group, current CD4 T cell count, haemoglobin level, body mass index, smoking status, anti-HCV antibodies positivity, HBs antigen positivity, diabetes and hypertension. In the Cox multivariable model the estimated hazard ratio of statin on all-cause mortality was estimated as 0.86 (95%CI 0.34-2.19) and it was 0.83 (95%CI 0.51-1.35) using inverse probability treatment weights.ConclusionThe impact of statin for primary prevention appears similar in HIV-infected individuals and in the general population

Etude de l’établissement des réservoirs VIH lors de la primo-infection et de l’impact des traitements antirétroviraux très précoces sur ces réservoirs

HIV primary infection is a critical period in the establishment of the reservoirs that justifies the initiation of an early treatment. We started a randomised trial to assess the impact of a two-year intense HAART (ANRS147 OPTIPRIM trial: five-drug therapy versus. three-drug therapy) on the blood reservoir; within this this trial, we included some pathophysiological studies. Thus, we show that during the primary infection, viruses have a low genetic diversity in blood and rectal compartments. The reservoir establishes itself as early as the first month of the infection by spreading a homogeneous viral cluster in CD4 T cells subsets, naive T cells (TN), central memories (TCM), transitional memories (TTM), effector memories (TEM), and resting T cells. This results in a disruption of the lymphocyte homeostasis, linked to the low contribution to the reservoir of TN and TCM, which are little differentiated cells with long half-lives. Moreover, we show that, at the time of the primary infection, the majority of patients do not have the ability to develop CD8 T cells responses that could suppress the viral replication, as HIV Controllers patients do. After two years of treatment, we observe that there is no evolution of the viral diversity, but the size of the reservoir is significantly reduced. The abnormalities of the CD4 T cells lymphocyte homeostasis remain, but the very early treatment was able to protect the TN and TCM. The five-drug therapy does not have any additional benefit, but we confirm the idea that early treatment can induce long-term virological control after the discontinuation of the treatment. Our results show that a treatment lasting more than two years would be able to reinforce the reduction of the reservoir. These results should be taken into account in the development of future trials aiming to reduce the reservoir in patients treated at the time of primary infection for a sustainable remission.La primo-infection est un moment critique de l’établissement du réservoir justifiant de l’initiation d’un traitement précoce. Nous avons initié un essai randomisé évaluant l’impact de deux ans d’un traitement antirétroviral intense (essai ANRS147 OPTIPRIM, trithérapie versus pentathérapie) sur le réservoir et avons initié des études physiopathologiques au cours de cet essai. Nous montrons ainsi la faible diversité génétique des virus en primo-infection dans les compartiments sanguins et rectaux. Le réservoir s’établit dès le premier mois de l’infection par diffusion d’un cluster viral homogène au sein des lymphocytaires T CD4 naïfs (TN) et mémoires centrales (TCM), transitionnelles (TTM), effectrices (TEM) quiescents. Il en résulte une perturbation de l’homéostasie lymphocytaire associée à une faible contribution au réservoir des cellules peu différenciées à longue demi-vie, TN et TCM. Par ailleurs nous montrons que la majorité des patients au moment de leur primo-infection n’ont pas la capacité de développer des réponses T CD8 à même de supprimer la réplication virale comme chez les patients HIV Controllers. Après deux ans de traitement, nous observons que la diversité virale n’a pas évolué, par contre la taille du réservoir est fortement réduite. Les anomalies de l’homéostasie lymphocytaire T CD4 persistent, par contre le traitement très précoce a permis de protéger les TN et TCM. Il n’y a pas de bénéfice additionnel d’une pentathérapie mais nous avons validé le concept qu’un traitement précoce permet d’induire un contrôle virologique au long cours après arrêt de traitement. Nos résultats indiquent qu’un traitement plus long que deux ans permettrait de renforcer la diminution du réservoir. Ces résultats seront à prendre en compte pour l’élaboration de futurs essais en primo-infection visant à réduire le réservoir pour une rémission au long cours

Study of the establishment of the HIV-1 reservoirs at the time of the primary infection and impact of a Highly Active Anti-retroviral Therapy on these reservoirs

La primo-infection est un moment critique de l’établissement du réservoir justifiant de l’initiation d’un traitement précoce. Nous avons initié un essai randomisé évaluant l’impact de deux ans d’un traitement antirétroviral intense (essai ANRS147 OPTIPRIM, trithérapie versus pentathérapie) sur le réservoir et avons initié des études physiopathologiques au cours de cet essai. Nous montrons ainsi la faible diversité génétique des virus en primo-infection dans les compartiments sanguins et rectaux. Le réservoir s’établit dès le premier mois de l’infection par diffusion d’un cluster viral homogène au sein des lymphocytaires T CD4 naïfs (TN) et mémoires centrales (TCM), transitionnelles (TTM), effectrices (TEM) quiescents. Il en résulte une perturbation de l’homéostasie lymphocytaire associée à une faible contribution au réservoir des cellules peu différenciées à longue demi-vie, TN et TCM. Par ailleurs nous montrons que la majorité des patients au moment de leur primo-infection n’ont pas la capacité de développer des réponses T CD8 à même de supprimer la réplication virale comme chez les patients HIV Controllers. Après deux ans de traitement, nous observons que la diversité virale n’a pas évolué, par contre la taille du réservoir est fortement réduite. Les anomalies de l’homéostasie lymphocytaire T CD4 persistent, par contre le traitement très précoce a permis de protéger les TN et TCM. Il n’y a pas de bénéfice additionnel d’une pentathérapie mais nous avons validé le concept qu’un traitement précoce permet d’induire un contrôle virologique au long cours après arrêt de traitement. Nos résultats indiquent qu’un traitement plus long que deux ans permettrait de renforcer la diminution du réservoir. Ces résultats seront à prendre en compte pour l’élaboration de futurs essais en primo-infection visant à réduire le réservoir pour une rémission au long cours.HIV primary infection is a critical period in the establishment of the reservoirs that justifies the initiation of an early treatment. We started a randomised trial to assess the impact of a two-year intense HAART (ANRS147 OPTIPRIM trial: five-drug therapy versus. three-drug therapy) on the blood reservoir; within this this trial, we included some pathophysiological studies. Thus, we show that during the primary infection, viruses have a low genetic diversity in blood and rectal compartments. The reservoir establishes itself as early as the first month of the infection by spreading a homogeneous viral cluster in CD4 T cells subsets, naive T cells (TN), central memories (TCM), transitional memories (TTM), effector memories (TEM), and resting T cells. This results in a disruption of the lymphocyte homeostasis, linked to the low contribution to the reservoir of TN and TCM, which are little differentiated cells with long half-lives. Moreover, we show that, at the time of the primary infection, the majority of patients do not have the ability to develop CD8 T cells responses that could suppress the viral replication, as HIV Controllers patients do. After two years of treatment, we observe that there is no evolution of the viral diversity, but the size of the reservoir is significantly reduced. The abnormalities of the CD4 T cells lymphocyte homeostasis remain, but the very early treatment was able to protect the TN and TCM. The five-drug therapy does not have any additional benefit, but we confirm the idea that early treatment can induce long-term virological control after the discontinuation of the treatment. Our results show that a treatment lasting more than two years would be able to reinforce the reduction of the reservoir. These results should be taken into account in the development of future trials aiming to reduce the reservoir in patients treated at the time of primary infection for a sustainable remission

Assessment of Salmonella and Listeria monocytogenes level in ready-to-cook poultry meat: Effect of various high pressure treatments and potassium lactate concentrations

International audienceThe objective of this study was to develop a probabilistic model in order to determine the contamination level of Salmonella and Listeria monocytogenes in ready-to-cook poultry meat, after a high pressure (HP) treatment. The model included four steps: i) Reception of raw meat materials, mincing and mixing meat, ii) Partitioning and packaging into 200-g modified atmosphere packs, iii) High pressure treatment of the meat, and iv) Storage in chilled conditions until the end of the shelf-life. The model excluded the cooking step and consumption at consumer's home as cooking practices and heating times are highly variable. The initial contamination level of Salmonella and L. monocytogenes was determined using data collected in meat primary processing plants. The effect of HP treatment and potassium lactate on microbial reduction was assessed in minced meat, using a full factorial design with three high pressure treatments (200, 350 and 500 MPa), three holding times (2, 8 and 14 min) and two potassium lactate concentrations (0 or 1.8% w/w). The inactivation curves fitted with a Weibull model highlighted that the inactivation rate was significantly dependent on the HP treatment. From the literature, it was established that Salmonella was not able to grow in the presence of lactate, under modified atmosphere and chilled conditions whereas the growth of L. monocytogenes was determined using an existing model validated in poultry (available in Seafood Spoilage and Safety Predictor software, V. 3.1).Once implemented in the Excel add-in @Risk, the model was run using Monte Carlo simulation. The probability distribution of contamination levels was determined for various scenarios. For an average scenario such as an HP treatment of 350 MPa for 8 min, of 200 g minced meat containing 1.8% lactate (pH 6.1; aw 0.96), conditioned under 50% CO2, the prevalence rate of Salmonella and L. monocytogenes, after a 20-day storage at 6 °C was estimated to be 4.1% and 7.1%, respectively. The contamination level was low considering that the product is going to be cooked by the consumer afterwards: the 99th percentile of the distribution was equal to − 2.3 log cfu/g for Salmonella and 0.5 log cfu/g for L. monocytogenes. More generally, the model developed here from raw material reception up to the end of the shelf-life enables to recommend combinations of HP treatment and lactate formulation to guarantee an acceptable microbial concentration before cooking

Questioning the "Ease" in disease: Was living with HIV a burden or boost during the first wave of Covid-19 in France? A qualitative study (COVIDHIV).

IntroductionClinical research has focused on risk factors and treatment for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), particularly in people with a comorbidity including the human immunodeficiency virus (HIV), but little attention has been paid to the care pathway. This article aims to show how living with HIV may have been a biopsychosocial burden or boost in care pathways for Covid-19.MethodPeople living with HIV (PLHIV) from 9 clinical centers were invited to participate in this qualitative study. The sampling was purposive with a maximum variation in their sociodemographic profiles. Semi-structured interviews were conducted until data saturation, then coded for thematic analysis, using an inductive general approach.ResultsWe interviewed 34 PLHIV of which 20 had SARS-COV-2 once. They were 24 males, 26 born in France; median age: 55. Twenty had a CD4 number above 500, and all were on antiretroviral therapy (ART). HIV appeared as a burden when Covid-19 symptoms reminded HIV seroconversion, fear of contamination, and triggered questions about ART effectiveness. HIV was not considered relevant when diagnosing Covid-19, caused fear of disclosure when participants sought SARS-COV-2 testing, and its care in hospitals was disrupted by the pandemic. ART-pill fatigue caused avoidance for Covid-19 treatment. As a boost, living with HIV led participants to observe symptoms, to get advice from healthcare professionals, and screening access through them. Some participants could accept the result of screening or a clinical diagnosis out of resilience. Some could consider ART or another drug prescribed by their HIV specialist help them to recover from Covid-19.ConclusionLiving with HIV could function as a burden and/or a boost in the care pathways for Covid-19, according to patients' relationship to their HIV history, comorbidities and representation of ART. Covid-19 in PLHIV needs further qualitative study to gain a more comprehensive assessment of the pandemic's consequences on their lives and coping strategies

Histogenesis of Merkel Cell Carcinoma: A Comprehensive Review

International audienceMerkel cell carcinoma (MCC) is a primary neuroendocrine carcinoma of the skin. This neoplasia features aggressive behavior, resulting in a 5-year overall survival rate of 40%. In 2008, Feng et al. identified Merkel cell polyomavirus (MCPyV) integration into the host genome as the main event leading to MCC oncogenesis. However, despite identification of this crucial viral oncogenic trigger, the nature of the cell in which MCC oncogenesis occurs is actually unknown. In fact, several hypotheses have been proposed. Despite the large similarity in phenotype features between MCC tumor cells and physiological Merkel cells (MCs), a specialized subpopulation of the epidermis acting as mechanoreceptor of the skin, several points argue against the hypothesis that MCC derives directly from MCs. Alternatively, MCPyV integration could occur in another cell type and induce acquisition of an MC-like phenotype. Accordingly, an epithelial as well as a fibroblastic or B-cell origin of MCC has been proposed mainly based on phenotype similarities shared by MCC and these potential ancestries. The aim of this present review is to provide a comprehensive review of the current knowledge of the histogenesis of MCC

Higher rates of HBsAg clearance with tenofovir-containing therapy in HBV/HIV co-infection

International audienceIntroduction: Achieving functional cure of chronic HBV infection (Hepatitis B surface antigen [HBsAg] clearance, eventually followed by acquisition of anti-hepatitis B surface antigen [Anti-HBs]) in individuals with HIV and HBV infections is a rare event. In this setting, factors related to HBV cure have not yet been fully characterized.Methods: HIV-infected individuals with chronic HBV infection enrolled in the French Dat’AIDS cohort (NCT02898987), who started combined antiretroviral (cART)-anti-HBV treatment were retrospectively analyzed for HBsAg loss and Anti-HBs seroconversion.Results:Overall, 1419 naïve-subjects received three different cART-anti-HBV treatment schedule: (1) 3TC or FTC only (n = 150), (2) TDF with or without 3TC or FTC (n = 489) and (3) 3TC or FTC as first line followed by adding/switching to TDF as second line (n = 780). Individuals were followed-up for a median of 89 months (IQR, 56–118). HBV-DNA was 1, >95%) suggested by Bayesian analysis. Also, TDF-based regimen as first line (OR, 3.03) or second line (OR, 2.95) increased rates of HBsAg clearance compared to 3TC or FTC alone, with a 99% probability.Conclusions: HBsAg clearance rate was low in HIV-HBV co-infected cART-anti-HBV treated individuals, but was slightly improved on TDF-based regimen

CD8 T-cells from most HIV-infected patients lack ex vivo HIV-suppressive capacity during acute and early infection

International audienceThe strong CD8+ T-cell-mediated HIV-1-suppressive capacity found in a minority of HIV-infected patients in chronic infection is associated with spontaneous control of viremia. However, it is still unclear whether such capacities were also present earlier in the CD8+ T cells from non controller patients and then lost as a consequence of uncontrolled viral replication. We studied 50 patients with primary HIV-1-infection to determine whether strong CD8+ T-cell-mediated HIV suppression is more often observed at that time. Despite high frequencies of polyfunctional HIV-specific CD8+ T-cells and a strong CD4+ T-helper response, CD8+ T-cells from 48 patients lacked strong HIV-suppressive capacities ex vivo. This indicates that the superior HIV-suppressive capacity of CD8+ T-cells from HIV controllers is not a general characteristic of the HIV-specific CD8+ T cell response in primary HIV infection