Is vitamin D deficiency involved in the immune reconstitution inflammatory syndrome?

<p>Abstract</p> <p>Background</p> <p>About 20–30% of persons with HIV infection, especially those living in countries with limited resources, experience an immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral treatment. The active form of vitamin D, 1,25-dihydroxyvitamin D, is a key player in the clearance of pathogens and influences the level of inflammation and macrophage activation.</p> <p>Presentation of the hypothesis</p> <p>We hypothesize that low availability of 1,25-dihydroxyvitamin D, either due to vitamin D deficiency or due to polymorphisms in the vitamin D receptor or in its activating/inactivating enzymes, contributes to the appearance of IRIS. Furthermore, drug interactions with the enzymatic pathways of vitamin D could favour the development of IRIS.</p> <p>Testing the hypothesis</p> <p>Our hypothesis could be explored by a case-control study to assess the prevalence of vitamin D deficiency in HIV-infected patients on antiretroviral treatment who develop and do not develop IRIS.</p> <p>Implications of the hypothesis</p> <p>If the role of vitamin D in IRIS is confirmed, we would be able to screen patients at risk for IRIS by screening for vitamin D deficiency. After confirmation by means of a clinical trial, vitamin D supplementation could be a cheap and safe way to reduce the incidence of IRIS.</p

HIV Viral Load Monitoring in Resource-Limited Regions: Optional or Necessary?

Although it is a standard practice in high-income countries, determination of the human immunodeficiency virus (HIV) load is not recommended in developing countries because of the costs and technical constraints. As more and more countries establish capacity to provide second-line therapy, and as costs and technological constraints associated with viral load testing decrease, the question of whether determination of the viral load is necessary deserves attention. Viral load testing could increase in importance as a guide for clinical decisions on when to switch to second-line treatment and on how to optimize the duration of the first-line treatment regimen. In addition, the viral load is a particularly useful tool for monitoring adherence to treatment, performing sentinel surveillance, and diagnosing HIV infection in children aged <18 months. Rather than considering viral load data to be an unaffordable luxury, efforts should be made to ensure that viral load testing becomes affordable, simple, and easy to use in resource-limited setting

¿Estamos Alfabetizando Digitalmente a los Ciudadanos ante el Contínuo Cambio Tecnológico?

Las tecnologías de la información y de la comunicación (TICs) están produciendo transformaciones en las diferentes actividades de nuestra sociedad. Como parte de este cambio continuamente se desarrollan nuevas aplicaciones y utilitarios que presentan diferentes interfases y opciones en sus menús; esto lleva a que algunas organizaciones opten por el entrenamiento de los usuarios en las nuevas herramientas. El presente artículo plantea una metodología de capacitación donde el usuario descubre un procedimiento lógico ante una nueva interfase, tomando en cuenta los elementos necesarios para garantizar la auto capacitación en versiones subsiguientes. La propuesta incluye integrar el logro de las competencias requeridas con el otorgar alguna certificación en ofimática. Esta propuesta busca romper la brecha digital y aumentar la velocidad de la inserción de los usuarios en las nuevas TICs (disminuyendo costos) mediante el "aprender por uno mismo" y el "aprender haciendo". Postulamos que para "aprender" ofimática es más importante que en los programas de adiestramiento se considere "el aprendizaje de los conceptos" y el análisis de los pasos lógicos que se deben realizar para usar el aplicativo o sistema operativo, cualquiera sea el preferido por el usuario. Esto permite identificar procesos en el uso de los aplicativos con el mismo sentido lógico que en aquellos en los cuales no ha participado la tecnología

Short and long term retention in antiretroviral care in health facilities in rural Malawi and Zimbabwe.

Despite the successful scale-up of ART services over the past years, long term retention in ART care remains a major challenge, especially in high HIV prevalence and resource-limited settings. This study analysed the short (<12 months) and long (>12 months) term retention on ART in two ART programmes in Malawi (Thyolo district) and Zimbabwe (Buhera district)