Risk Factors for High Early Mortality in Patients on Antiretroviral Treatment in a Rural District of Malawi.

OBJECTIVES: Among adults started on antiretroviral treatment (ART) in a rural district hospital (a) to determine the cumulative proportion of deaths that occur within 3 and 6 months of starting ART, and (b) to identify risk factors that may be associated with such mortality. DESIGN AND SETTING: A cross-sectional analytical study set in Thyolo district, Malawi. METHODS: Over a 2-year period (April 2003 to April 2005) mortality within the first 3 and 6 months of starting ART was determined and risk factors were examined. RESULTS: A total of 1507 individuals (517 men and 990 women), whose median age was 35 years were included in the study. There were a total of 190 (12.6%) deaths on ART of which 116 (61%) occurred within the first 3 months (very early mortality) and 150 (79%) during the first 6 months of initiating ART. Significant risk factors associated with such mortality included WHO stage IV disease, a baseline CD4 cell count under 50 cells/mul and increasing grades of malnutrition. A linear trend in mortality was observed with increasing grades of malnutrition (chi for trend = 96.1, P </= 0.001) and decreasing CD4 cell counts (chi for trend = 72.4, P </= 0.001). Individuals who were severely malnourished [body mass index (BMI) < 16.0 kg/m] had a six times higher risk of dying in the first 3 months than those with a normal nutritional status. CONCLUSIONS: Among individuals starting ART, the BMI and clinical staging could be important screening tools for use to identify and target individuals who, despite ART, are still at a high risk of early death

Evaluation of a systematic substitution of zidovudine for stavudine-based HAART in a program setting in rural Cambodia

Mexico AIDS Conference 200

De l'utilité des objets flottants dans le cadre d'un dispositif « groupe fratrie » destiné à des frères et soeurs d'enfants porteurs de troubles du spectre de l'autisme

International audienceIn a perspective combining a complementary systemic and psychodynamic approach, thisarticle presents a study focusing on siblings' experience of children with autism spectrumdisorder. In order to meet their specific needs, as part of a French health and social structure named “Centre de Ressources Autisme”, a plan designated “siblings group” was created for 3 years. It included two age groups with children from 5 to 11 and teenagers from 12 to 17, and was facilitated by two clinical psychologists. During the sessions and with supervisions carried out in the course of a research action, floating objects were offered to create a group dynamic and therefore allow the children or teenagers to elaborate and reveal more easily their emotions and difficulties. This study is concluded by a clinical case, which describes the construction, staging and repercussions of afloating object adapted to this population.Dans une perspective combinant approche systémique et psychodynamique de manière complémentaire, cet article présente une étude portant sur le vécu des frères et soeurs d'enfants porteurs de troubles du spectre de l'autisme. Afin de répondre à leurs besoins spécifiques, un dispositif nommé « groupe fratrie » a été mis en place durant 3 ans dans le cadre d'un Centre Ressources Autisme. Comprenant deux groupes d'âges d'enfants de 5 à 11 ans et d'adolescents âgés de 12 à 17 ans, il a été coanimé par deux psychologues cliniciennes. Au fil des séances et à l'aide de supervisions réalisées dans le cadre d'une recherche action, des objets flottants ont été proposés pour créer une dynamique de groupe et ainsi permettre aux enfants / adolescents d'élaborer et d'exprimer plus aisément leurs émotions et leurs difficultés. Cette étude est ponctuée par une vignette clinique, dans laquelle est décrite la construction, la mise en scène et les répercussions d'un objet flottant adapté à cette population

An algorithm to optimize viral load testing in HIV-positive patients with suspected first-line antiretroviral therapy failure in Cambodia.

OBJECTIVE: To develop an algorithm for optimal use of viral load testing in patients with suspected first-line antiretroviral treatment (ART) failure. METHODS: Data from a cohort of patients on first-line ART in Cambodia were analyzed in a cross-sectional way to detect markers for treatment failure. Markers with an adjusted likelihood ratio 1.5 were retained to calculate a predictor score. The accuracy of a 2-step algorithm based on this score followed by targeted viral load testing was compared with World Health Organization criteria for suspected treatment failure. RESULTS: One thousand eight hundred three viral load measurements of 764 patients were available for analysis. Prior ART exposure, CD4 count below baseline, 25% and 50% drop from peak CD4 count, hemoglobin drop of > or =1 g/dL, CD4 count or=2 had the best combination of sensitivity and specificity and required confirmatory viral load testing for only 9% of patients. World Health Organization criteria had a similar sensitivity but a lower specificity and required viral load testing for 24.9% of patients. CONCLUSION: An algorithm combining a predictor score with targeted viral load testing in patients with an intermediate probability of failure optimizes the use of scarce resources

Baseline characteristics, response to and outcome of antiretroviral therapy among patients with HIV-1, HIV-2 and dual infection in Burkina Faso.

In an urban district hospital in Burkina Faso we investigated the relative proportions of HIV-1, HIV-2 and HIV-1/2 among those tested, the baseline sociodemographic and clinical characteristics, and the response to and outcome of antiretroviral therapy (ART). A total of 7368 individuals (male=32%; median age=34 years) were included in the analysis over a 6 year period (2002-2008). The proportions of HIV-1, HIV-2 and dual infection were 94%, 2.5% and 3.6%, respectively. HIV-1-infected individuals were younger, whereas HIV-2-infected individuals were more likely to be male, have higher CD4 counts and be asymptomatic on presentation. ART was started in 4255 adult patients who were followed up for a total of 8679 person-years, during which time 469 deaths occurred. Mortality differences by serotype were not statistically significant, but were generally worse for HIV-2 and HIV-1/2 after controlling for age, CD4 count and WHO stage. Among severely immune-deficient patients, mortality was higher for HIV-2 than HIV-1. CD4 count recovery was poorest for HIV-2. HIV-2 and dually infected patients appeared to do less well on ART than HIV-1 patients. Reasons may include differences in age at baseline, lower intrinsic immune recovery in HIV-2, use of ineffective ART regimens (inappropriate prescribing) by clinicians, and poor drug adherence

Combined Bacterial Meningitis and Infective Endocarditis: When Should We Search for the Other When Either One is Diagnosed?

Auteurs groupes collaboratifs AEPEI study group & the COMBAT study groupInternational audienc