Екологія: наукова сутність, об'єкти досліджень, завдання

Розкрита суть чотирьох основних розділів екології: аутекології, демекології, синекології та екосистемології; описані об’єкти, предмет і завдання останньої. Визначена роль розумової і виробничої діяльности людства як зовнішнього збурювального чинника щодо живих систем і як організатора соціосфери. Обґрунтовані завдання екосистемології у теперішніх геосоціальних умовах.The matters of the four main divisions in ecology, such as autecology, demecology, synecology and ecosystemology have been uncovered. The objects, subjects and assignments of the latter were described too. A part of mankind’s mental and industrial activities, which are outside disturbing factors for biosystems and sociosphere organisers, has been determined. The assignments of ecosystemology within present geosocial condition were well grounded in the article

Adherence to antiretroviral therapy assessed by drug level monitoring and self-report in cameroon

OBJECTIVES: To compare adherence to antiretroviral therapy using drug level monitoring and self-report and to explore the relation between these 2 methods and viral load measurements. METHODS: Sixty patients received a fixed-dose combination of nevirapine, stavudine, and lamivudine in a clinical study in Cameroon. Adherence was assessed every 6 months until month 36 by nevirapine minimal plasma concentration and self-report. Plasma HIV-1 viral load was determined at the same time. Analyses included 159 complete observations. RESULTS: The proportion of patients labeled as "adherent" was significantly lower using nevirapine monitoring (88.7%, 95% confidence interval [CI]: 82.7 to 93.2) than self-report (97.5%, CI: 93.7 to 99.3; P = 0.002). Virologic failure was associated with the nevirapine concentration (adjusted odds ratio [aOR] = 4.43; P = 0.018) but not with the self-reported adherence (aOR = 0.84; P = 0.9). As compared with the virologic outcome, the sensitivity of nevirapine level monitoring for predicting inadequate adherence was 20.5%, the specificity was 91.7%, the positive predictive value was 44.4%, and the negative predictive value was 78.0%. For self-report, the respective values were 2.6%, 97.5%, 25.0%, and 75.5%. CONCLUSIONS: Drug level monitoring provided a more reliable estimate of adherence than self-report. This method could be used in research settings. Operational research is required to define how to improve the accuracy of the self-report method because it is the most feasible method in clinical practice

Nevirapine versus Efavirenz for patients co-infected with HIV and Tuberculosis: A Randomised Non-Inferiority Trial

BACKGROUND: In countries with a high incidence of HIV and tuberculosis co-infection, nevirapine and efavirenz are widely used as antiretroviral therapy but both interact with antituberculosis drugs. We aimed to compare efficacy and safety of a nevirapine-based antiretroviral therapy (started at full dose) with an efavirenz-based regimen in co-infected patients. METHODS: We did a multicentre, open-label, randomised, non-inferiority trial at three health centres in Maputo, Mozambique. We enrolled adults (≥18 years) with tuberculosis and previously untreated HIV infection (CD4 cell counts <250 cells per μL) and alanine aminotransferase and total bilirubin concentrations of less than five times the upper limit of normal. 4-6 weeks after the start of tuberculosis treatment, we randomly allocated patients (1:1) with central randomisation, block sizes of two to six, and stratified by site and CD4 cell count to nevirapine (200 mg twice daily) or efavirenz (600 mg once daily), plus lamivudine and stavudine. The primary endpoint was virological suppression at 48 weeks (HIV-1 RNA <50 copies per mL) in all patients who received at least one dose of study drug (intention-to-treat population); death and loss to follow-up were recorded as treatment failure. The non-inferiority margin for the difference of efficacy was 10%. We assessed efficacy in intention-to-treat and per-protocol populations and safety in all patients who received study drug. This study is registered with ClinicalTrials.gov, number NCT00495326. FINDINGS: Between October, 2007, and March, 2010, we enrolled 285 patients into each group. 242 (85%) patients in the nevirapine group and 233 (82%) patients in the efavirenz group completed follow-up. In the intention-to-treat population, 184 patients (64·6%, 95% CI 58·7-70·1) allocated nevirapine achieved virological suppression at week 48, as did 199 patients (69·8%, 64·1-75·1) allocated efavirenz (one-sided 95% CI of the difference of efficacy 11·7%). In the per-protocol population, 170 (70·0%, 63·8-75·7) of 243 patients allocated nevirapine achieved virological suppression at week 48, as did 194 (78·9%, 73·2-83·8) of 246 patients allocated efavirenz (one-sided 95% CI 15·4%). The median CD4 cell count at randomisation was 89 cells per μL. 15 patients substituted nevirapine with efavirenz and six patients substituted efavirenz with nevirapine. 20 patients allocated nevirapine (7%) had grade 3-4 increase of alanine aminotransferase compared with 17 patients allocated efavirenz (6%). Three patients had severe rash after receipt of nevirapine (1%) but no patients did after receipt of efavirenz. 18 patients in the nevirapine group died, as did 17 patients in the efavirenz group. INTERPRETATION: Although non-inferiority of the nevirapine-regimen was not shown, nevirapine at full dose could be a safe, acceptable alternative for patients unable to tolerate efavirenz. FUNDING: French Research Agency for HIV/AIDS and hepatitis (ANRS)

Articles Nevirapine versus efavirenz for patients co-infected with HIV and tuberculosis: a randomised non-inferiority trial

Summary Background In countries with a high incidence of HIV and tuberculosis co-infection, nevirapine and efavirenz are widely used as antiretroviral therapy but both interact with antituberculosis drugs. We aimed to compare effi cacy and safety of a nevirapine-based antiretroviral therapy (started at full dose) with an efavirenz-based regimen in coinfected patients

Pre-existing immunity to SARS-CoV-2 before the COVID-19 pandemic era in Cameroon: A comparative analysis according to HIV-status

BackgroundThe lower burden of COVID-19 in tropical settings may be due to preexisting cross-immunity, which might vary according to geographical locations and potential exposure to other pathogens. We sought to assess the overall prevalence of SARS-CoV-2 antibodies and determine SARS-CoV-2 seropositivity according to HIV-status before the COVID-19 pandemic era. MethodsA cross-sectional and comparative study was conducted at the Chantal BIYA International Reference Centre (CIRCB) on 288 stored plasma samples (163 HIV-positive versus 125 HIV-negative); all collected in 2017-2018, before the COVID-19 pandemic era. Abbott Panbio (TM) COVID-19 IgG/IgM assay was used for detecting SARS-CoV-2 immunoglobulin G (IgG) and M (IgM). Among people living with HIV (PLHIV), HIV-1 viral load and TCD4 cell count (LTCD4) were measured using Abbott Real Time PCR and BD FACSCalibur respectively. Statistical analyses were performed, with pResultsThe median [IQR] age was 25 [15-38] years. Overall seropositivity to SARS-CoV-2 antibodies was 13.5% (39/288) of which 7.3% (21) was IgG, 7.3% (21) IgM and 1.0% (3) IgG/IgM. According to HIV-status in the study population, SARS-CoV-2 seropositivity was 11.0% (18/163) among HIV-positive versus 16.8% (21/125) among HIV-negative respectively, p=0.21. Specifically, IgG was 6.1% (10/163) versus 8.8% (11/125), p=0.26; IgM was 5.5% (9/163) versus 9.6%, (12/125), p=0.13 and IgG/IgM was 0.6% (1/163) versus 1.6% (2/125) respectively. Among PLHIV, SARS-CoV-2 seropositivity according to CD4 count was 9.2% (&gt;= 500 cells/mu L) versus 1.8% (200-499 cells/mu L), (OR=3.5; p=0.04) and 0.6% (&lt;200 cells/mu L), (OR=17.7; p&lt;0.01). According to viral load, SARS-CoV-2 seropositivity was 6.7% (&gt;= 40 copies/mL) versus 4.9% (&lt;40 copies/mL), (OR= 3.8; p&lt;0.01). ConclusionBefore COVID-19 in Cameroon, cross-reactive antibodies to SARS-CoV-2 were in circulation, indicating COVID-19 preexisting immunity. This preexisting immunity may contribute in attenuating disease severity in tropical settings like Cameroon. Of relevance, COVID-19 preexisting immunity is lower with HIV-infection, specifically with viral replication and poor CD4-cell count. As poor CD4-count leads to lower cross-reactive antibodies (regardless of viral load), people living with HIV appear more vulnerable to COVID-19 and should be prioritized for vaccination

Hepatotoxicity and effectiveness of a Nevirapine-based antiretroviral therapy in HIV-infected patients with or without viral hepatitis B or C infection in Cameroon

Background: Coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV) in HIV-infected patients receiving a commonly used nevirapine-based antiretroviral therapy is a major concern for African clinicians owing to its high prevalence, the infrequent testing and treatment of viral hepatitis, and the impact of liver disease on the tolerability and effectiveness of anti-HIV treatment. We compared the hepatotoxicity and the immunological, virological and clinical effectiveness of a nevirapine-based antiretroviral therapy between patients infected with HIV only and patients coinfected with hepatitis B or C virus in Cameroon. Methods: A retrospective cohort study was conducted among HIV-1-infected patients. Plasma HBV DNA and HCV RNA were tested in positive or indeterminate samples for HBsAg or HCV antibodies, respectively. All patients received nevirapine and lamivudine plus stavudine or zidovudine. Results: Of 169 HIV-1-infected patients with a median baseline CD4 count of 135 cells/mm(3) (interquartile range [IQR] 67 218), 21% were coinfected with HBV or HCV. In coinfected patients, the median viral load was 2.47 x 107 IU/mL for HBV (IQR 3680-1.59 x 10(8)) and 928 000 IU/mL for HCV (IQR 178 400-2.06 x 10(6)). Multivariate analyses showed that the risk of hepatotoxicity was 2-fold higher in coinfected patients (p < 0.01). The response to antiretroviral therapy was however comparable between monoinfected and coinfected patients in terms of CD4 cell count increase (p = 0.8), HIV-1 viral load below 400 copies/mL (p = 0.9), death (p = 0.3) and death or new AIDS-defining event (p = 0.1). Nevirapine was replaced by a protease inhibitor in 4 patients owing to hepatotoxicity. Conclusion: This study suggests that the nevirapine-based antiretroviral therapy could be used safely as first-line treatment in patients with low CD4 cell count in Africa despite frequent coinfections with HBV or HCV and infrequent testing of these infections. Although testing for HBV and HCV should be systematically performed before initiating antiretroviral therapy, transaminases elevations at baseline or during treatment should be a decisive argument for testing when hepatitis status is unknown

Women experience a better long-term immune recovery and a better survival on HAART in Lao People's Democratic Republic.

<p>Abstract</p> <p>Background</p> <p>In April 2003, Médecins Sans Frontières launched an HIV/AIDS programme to provide free HAART to HIV-infected patients in Laos. Although HIV prevalence is estimated as low in this country, it has been increasing in the last years. This work reports the first results of an observational cohort study and it aims to identify the principal determinants of the CD4 cells evolution and to assess mortality among patients on HAART.</p> <p>Methods</p> <p>We performed a retrospective database analysis on patients initiated on HAART between 2003 and 2009 (CD4<200cells/μL or WHO stage 4). We excluded from the analysis patients who were less than 16 years old and pregnant women. To explore the determinants of the CD4 reconstitution, a linear mixed model was adjusted. To identify typical trajectories of the CD4 cells, a latent trajectory analysis was carried out. Finally, a Cox proportional-hazards model was used to reveal predictors of mortality on HAART including appointment delay greater than 1 day.</p> <p>Results</p> <p>A total of 1365 patients entered the programme and 913 (66.9%) received an HAART with a median CD4 of 49 cells/μL [IQR 15–148]. High baseline CD4 cell count and female gender were associated with a higher CD4 level over time. In addition, this gender difference increased over time. Two typical latent CD4 trajectories were revealed showing that 31% of women against 22% of men followed a high CD4 trajectory. In the long-term, women were more likely to attend appointments without delay. Mortality reached 6.2% (95% CI 4.8-8.0%) at 4 months and 9.1% (95% CI 7.3-11.3%) at 1 year. Female gender (HR=0.17, 95% CI 0.07-0.44) and high CD4 trajectory (HR=0.19, 95% CI 0.08-0.47) were independently associated with a lower death rate.</p> <p>Conclusions</p> <p>Patients who initiated HAART were severely immunocompromised yielding to a high early mortality. In the long-term on HAART, women achieved a better CD4 cells reconstitution than men and were less likely to die. This study highlights important differences between men and women regarding response to HAART and medical care, and questions men’s compliance to treatment.</p

Les os des personnes infectées par le VIH sont-ils si fragiles?

Impact of HIV infection on bone is now well established, with a high prevalence of osteoporosis and osteopenia and an increase of fracture risk, up to 5 fold for hip fractures. Beyond the usual risk factors frequently reported in this population, HIV infection itself and antiretroviral treatment, especially tenofovir, are involved in the pathophysiology of bone loss. Vitamin D deficiency is frequent and should be corrected. Fracture risk can be assessed based on clinical risk factors, the FRAX tool and bone mineral density measurement by DXA. Treatment in patients at increased risk of fracture is based on the same principles as in the general population, with mainly bisphosphonates

COVID-19 outbreak investigation and response in a penitentiary setting: the experience of a prison in Italy, February to April 2020

Prisons are high-risk settings for COVID-19 and present specific challenges for prevention and control. We describe a COVID-19 outbreak in a large prison in Milan between 20 February and 30 April 2020. We performed a retrospective analysis of routine data collected during the COVID-19 emergency in prison. We analysed the spatial distribution of cases and calculated global and specific attack rates (AR). We assessed prevention and control measures. By 30 April 2020, 57 confirmed COVID-19 cases and 66 clinically probable cases were recorded among a population of 1,480. Global AR was 8.3%. The index case was a custodial officer. Two clusters were detected among custodial staff and healthcare workers. On 31 March, a confirmed case was identified among detained individuals. COVID-19 spread by physical proximity or among subgroups with cultural affinity, resulting in a cluster of 22 confirmed cases. Following index case identification, specific measures were taken including creation of a multidisciplinary task-force, increasing diagnostic capacity, contact tracing and dedicated isolation areas. Expanded use of personal protective equipment, environmental disinfection and health promotion activities were also implemented. Outbreaks of COVID-19 in prison require heightened attention and stringent comprehensive measures

Projet pilote pour l'accès au dépistage et à la prise en charge du col de l'utérus dans le district de santé d'Akonolinga : Difficultés et perspectives

International audienceLe cancer du col de l'utérus est le 2 e cancer le plus fréquent chez la femme camerounaise, il est responsable d'environ 1120 décès par an. Ces chiffres pourraient être réduits grâce au dépistage systématique avec prise en charge appropriée des cas détectés. Il est donc nécessaire de proposer des stratégies alternatives à l'examen cytologique recommandé qui nécessite plusieurs consultations et qui est difficilement accessible au plan financier. OBJECTIFS Présenter la stratégie adoptée et les difficultés de mise en oeuvre d'un service innovant de dépistage et de prise en charge du cancer du col dans le district de santé d'Akonolinga. METHODOLOGIE Une salle de consultation gynécologique opérationnelle à Akonolinga depuis 21 mois (mars 2017 à novembre 2018), propose un dépistage du cancer du col aux femmes de 25 ans et plus (8495 femmes en âge de se faire dépister dans le district de santé) par inspection visuelle à l'acide acétique et au lugol (méthode recommandée par l'OMS pour les pays à ressources limitées). Les femmes dépistées négatives sont revues après 3 ans. En cas de positivité, une biopsie du col est réalisée et acheminée à Yaoundé pour histopathologie. Dans un 1 er temps la prise en charge reposait sur une surveillance semestrielle des dysplasies de bas grade faute de matériel pour la thermoablation, une résection des lésions à l'anse diathermique face à des dysplasies de haut grade et une hystérectomie pour les cancer-micro-invasifs. L'acquisition du WISAP en Octobre 2018 pour le traitement immédiat des lésions par thermoablation a permis d'améliorer la qualité du suivi des patientes par une approche « test and treat » pour les lésions VIA/VILI positives. Un triage par screening du HPV est prévu pour Juin 2019. Après 21 mois d'activité, 276 femmes âgées entre 25 et 55 ans se sont faites dépistées, soit 3% de la cible. Ce faible taux est lié à une sensibilisation communautaire insuffisante, au manque d'implication de certains personnels de santé du district, en plus de l'éloignement géographique de certaines populations. Des VIA/VILI réalisés, 27 % se sont avérés positifs. Néanmoins seul 53 % des analyses histopathologiques ont été réalisées car la subvention des frais d'examen dans leur totalité ne date que de Juillet 2018 (près de 50 % des femmes étaient sans-emploi). On recense 3 cas de cancers invasifs (1,1%), 2 de cancers micro-invasifs (0,7%), 20 cas de dysplasies cervicales confirmés dans la population dépistées soit 13,8 % (7 de haut grade et 13 de bas grade). A ce stade, seul 19 % des femmes dépistées positives ont été traitées car le « test and treat » n'étant effectif que depuis Octobre 2018, plusieurs patientes ont été perdues de vue malgré la relance de celles-ci par appel téléphonique. WISAP® Exemple de VIA Positives Exemple de VILI Positives Exemple de col après résection à l'anse diathermique Exemple de col après thermoablation 73% 27% PROPORTION DES DÉPISTAGES POSITIFS APRES INSPECTION VISUELLE (VIA/VILI) VIA/VILI néga-tifs VIA/VILI positifs 3% 97% PROPORTION DU DEPISTAGE DU CANCER DU COL DE L'UTERUS DANS LA VILLE D'AKONOLINGA ENTRE JANVIER 2017 ET NOVEMBRE 2018 pourcentage de femmes dépistées pourcentage de femmes non dépis-tées 19% 81% PROPORTION DES PATIENTES PRESENTANT UN VIA/VILI POSITIF AYANT ETE TRAITEES patientes traitées patientes non trai-tées CONCLUSION Malgré une stratégie innovante nous observons des difficultés dans la mise en oeuvre: le manque d'adhésion à la démarche du dépistage dû aux connaissances limitées de la pathologie, le coût financier de la prise en charge et la non disponibilité du plateau technique dans son entièreté durant les premiers mois d'activité. Néanmoins les résultats obtenus révèlent l'ampleur du problème dans cette communauté et témoigne de l'importance de l'action menée. La mise sur pied d'un plan de sensibilisation ciblé, l'implication d'un maximum d'acteurs de la santé, en plus de la subvention du coût de la prise en charge ainsi que l'acquisition de l'ensemble du matériel (déjà effectif), sont les mesures qui permettront d'atteindre l'objectif de prévention de la maladie