PLoS One

AIM: Metabolic risk factors are poorly documented for the first generation of young adults who have lived with HIV since childhood. We compared their metabolic profile with that of adults of same age from the general population. METHODS: We conducted a cross-sectional analysis of data from two populations: (1) COVERTE (ANRS-CO19), a French national cohort of 18 to 30-year-old patients HIV-infected since childhood, and (2) ENNS, a national cross-sectional population-based household survey on nutrition. Body mass index (BMI), blood pressure, waist circumference, fasting glucose, triglycerides, and HDL-, LDL- and total cholesterol were measured in both studies. Direct standardization on overweight and education level and logistic regression were used to compare the prevalence of metabolic abnormalities between the two populations. RESULTS: Data from 268 patients from COVERTE and 245 subjects from ENNS were analyzed. Tobacco use was similar in both groups. HIV-infected patients had increased mean waist-to-hip ratio and triglycerides to HDL-cholesterol ratio and decreased mean HDL-cholesterol as compared to their counterparts from the general population in both genders. In HIV-infected patients, metabolic syndrome was identified in 13.2% of men (95% confidence interval [CI]: 7.1-19.2) and 10.4% (95% CI: 5.4-15.3) of women versus 10.6% (95%CI: 1.5-19.7) and 1.7% (95%CI: 0-4.1) in subjects from the general population, respectively. CONCLUSION: Young adults infected with HIV since childhood had a higher prevalence of dyslipidemia and metabolically detrimental fat distribution than adults of same age of the general population, supporting close monitoring for cardiometabolic diseases

From training needs assessment to the conception of a training plan proposal

Relatório de estágio de mestrado em Educação (área de especialização em Formação, Trabalho e Recursos Humanos)Falar de educação e de formação implica falar de pessoas e das relações que estas estabelecem entre si. A Escola é o cenário por excelência onde decorrem as aprendizagens formais e com ela concorrem outras instituições, também elas favoráveis ao desenvolvimento de aprendizagens não formais. É o caso dos centros de estudo, tema que nos últimos anos tem vindo a ser investigado por muitos autores que se referem ao mesmo como o “fenómeno das explicações” (Costa, Neto-Mendes, Ventura e Azevedo, 2007; Afonso, 2008). Estes centros de estudo são procurados por muitos Pais que perante o insucesso escolar dos filhos e porque não têm conhecimentos suficientes para os ajudarem, encontram nestes espaços um acompanhamento mais personalizado e que os Professores têm dificuldade em assegurar. Perante a complexidade da questão, é necessário encontrar estratégias que permitam dotar Pais e Professores de competências necessárias ao exercício das suas funções. O presente estudo foi realizado no Centro de Estudo Be Smart and Grow, frequentado por 60 crianças e jovens provenientes de diversas escolas do concelho de Viana do Castelo, e teve como objetivo primordial apresentar uma proposta de um plano de formação concebido para o público-alvo definido: por um lado, os Pais dos 60 utentes do centro de estudos e, por outro lado, os 289 Professores do Agrupamento de Escolas frequentado pela maioria dos utentes. Optou-se por uma metodologia que combinou as abordagens qualitativa e quantitativa, tendo sido a estratégia de pesquisa suportada no estudo de caso. Tendo como ponto de partida os objetivos gerais, procurou-se compreender o posicionamento dos Pais e Professores face à Formação, bem como a perceção que estes têm relativamente às suas necessidades de formação. Para tal, foram aplicados inquéritos por questionário a 60 Pais (respondidos na totalidade) e a 289 Professores, sendo que neste grupo a amostra considerada foi de N = 62 sujeitos (22%). De entre os resultados obtidos, destacamos o facto de haver uma tendência convergente entre ambos os grupos inquiridos no sentido de considerarem a formação importante para a melhoria do desempenho pessoal e profissional. Foi possível também delimitar áreas e temas prioritários a partir das respostas dadas e, a partir delas, apresentar uma proposta de plano de formação para o público-alvo.Talking of education and training implies talking of people and the relationships they establish between each other. The School is a scenario by excellence where formal learning occurs and with it, other instances and spaces compete and therefore are favorable to the non-formal learning development. The study centers case is a theme that has been studied by many authors that refer to it as the “phenomenon of private tutoring” (Costa, Neto-Mendes, Ventura e Azevedo, 2007; Afonso, 2008). Upon children scholar underachievement, these study centers are sought by many parents because they don’t have sufficient knowledge to help them, so they find a more personalized assistance in the study centers that the Teachers have difficulty assuring. Given the question complexity, it is necessary to find strategies that provide Parents and Teachers the needed competences for the exercise of their functions. This study was carried out in the Be Smart and Grow Study Center, where 60 children and teenagers attend from multiple schools in the city of Viana do Castelo, and the primary objective was to present a training plan designed to the defined target audience: the parents of the 60 study center students and, on the other hand, 289 Teachers from the Group of Schools frequented by the majority of the students from the study center. It was decided to use a methodology that combined qualitative and quantitative approaches, having been the research strategy supported in the study case. Having the general objectives as the starting point, it was sought to understand the position of Parents and Teachers face to Training, as well as the perception that they have relatively to their training needs. To do that, surveys by questionnaire were conducted to 60 Parents (answered in its entirety) and to 289 Teachers, being that the considered sample in this group was N=62 subjects (22%). From the obtained results, we highlight the fact that there is convergence tendency between both groups of respondents in the sense of considering training important to the improvement of personal and professional development. Also, it was possible to define areas and priority themes from given answers and, from them, present a training plan proposal to the target audience

HIV-mediated immune aging in young adults infected perinatally or during childhood

International audienceBACKGROUND: HIV-infected patients progressing towards disease present a premature immune aging profile, characterized by the exhaustion of lymphopoiesis. The development of these anomalies may be prevented in young HIV-infected patients owing to their robust immune resources and lymphocyte regeneration capacities.METHODS: An immunomonitoring substudy was designed for young adults aged between 18 and 25 years, living with HIV since childhood included in the national ANRS Co19 COVERTE Cohort. We compared markers associated with immune aging, including the frequency of circulating hematopoietic progenitors and the phenotype of lymphocyte populations, with those of patients infected with HIV in adulthood.RESULTS: HIV-infected young adults displayed decreasing numbers of CD34 hematopoietic progenitors and mature lymphocytes, indicative of general lymphopenia and reminiscent of the alterations found in patients infected in adulthood or uninfected elderly people. This highlights the strong impact of HIV on the immune system despite patient's young age at infection. Immune aging-related alterations were particularly obvious in young patients who presented high viral loads.CONCLUSION: HIV-infected young adults can present increased markers of immune activation and senescence, related to uncontrolled viral replication. This highlights the issue of noncompliance to antiretroviral therapy in patients at a young age, resulting in loss of viral control, premature immunosenescence, and potentially irreversible damage of their lymphopoietic system

Maintenance darunavir/ritonavir monotherapy to prevent perinatal HIV transmission, ANRS-MIE 168 MONOGEST study

International audienceObjectives: Because NRTIs can have fetal toxicities, we evaluated a perinatal NRTI-sparing strategy to prevent perinatal HIV transmission. Our primary objective was to determine the proportion maintaining a viral load (VL) of 50 copies/mL. Neonates received nevirapine prophylaxis for 14 days.Results: Of 89 patients switching to darunavir/ritonavir monotherapy, 4 miscarried before 22 weeks' gestation, 2 changed treatment for elevated liver enzymes without virological failure, and 83 were evaluable for the main outcome. Six had virological failure confirmed on a repeat sample (median VL=193 copies/mL; range 78-644), including two before switching to monotherapy. In these six cases, ART was intensified with tenofovir disoproxil fumarate/emtricitabine. The success rate was 75/83, 90.4% (95% CI, 81.9%-95.7%) considering two patients with VL missing at delivery as failures, and 77/83, 92.8% (95% CI, 84.9%-97.3%) when considering them as successes since both had undetectable VL on darunavir/ritonavir throughout pregnancy. In ITT, the last available VL before delivery was <50 copies/mL in all of the patients. There was no case of perinatal HIV transmission.Conclusions: Darunavir/ritonavir maintenance monotherapy required intensification in nearly 10% of cases. This limits its widespread use, thus other regimens should be evaluated in order to limit exposure to antiretrovirals, particularly NRTIs, during pregnancy