Weight gain at 3 months of antiretroviral therapy is strongly associated with survival: evidence from two developing countries

BACKGROUND: In developing countries, access to laboratory tests remains limited, and the use of simple tools such as weight to monitor HIV-infected patients treated with antiretroviral therapy should be evaluated. METHODS: Cohort study of 2451 Cambodian and 2618 Kenyan adults who initiated antiretroviral therapy between 2001 and 2007. The prognostic value of weight gain at 3 months of antiretroviral therapy on 3-6 months mortality, and at 6 months on 6-12 months mortality, was investigated using Poisson regression. RESULTS: Mortality rates [95% confidence interval (CI)] between 3 and 6 months of antiretroviral therapy were 9.9 (7.6-12.7) and 13.5 (11.0-16.7) per 100 person-years in Cambodia and Kenya, respectively. At 3 months, among patients with initial body mass index less than or equal to 18.5 kg/m (43% of the study population), mortality rate ratios (95% CI) were 6.3 (3.0-13.1) and 3.4 (1.4-8.3) for those with weight gain less than or equal to 5 and 5-10%, respectively, compared with those with weight gain of more than 10%. At 6 months, weight gain was also predictive of subsequent mortality: mortality rate ratio (95% CI) was 7.3 (4.0-13.3) for those with weight gain less than or equal to 5% compared with those with weight gain of more than 10%. CONCLUSION: Weight gain at 3 months is strongly associated with survival. Poor compliance or undiagnosed opportunistic infections should be investigated in patients with initial body mass index less than or equal to 18.5 and achieving weight gain less than or equal to 10%

Positive Outcomes of HAART at 24 Months in HIV-Infected Patients in Cambodia.

OBJECTIVES: African and Asian cohort studies have demonstrated the feasibility and efficacy of HAART in resource-poor settings. The long-term virological outcome and clinico-immunological criteria of success remain important questions. We report the outcomes at 24 months of antiretroviral therapy (ART) in patients treated in a Médecins Sans Frontières/Ministry of Health programme in Cambodia. METHODS: Adults who started HAART 24 +/- 2 months ago were included. Plasma HIV-RNA levels were assessed by real-time polymerase chain reaction. Factors associated with virological failure were analysed using logistic regression. RESULTS: Of 416 patients, 59.2% were men; the median age was 33.6 years. At baseline, 95.2% were ART naive, 48.9% were at WHO stage IV, and 41.6% had a body mass index less than 18 kg/m. The median CD4 cell count was 11 cells/microl. A stavudine-lamivudine-efavirenz-containing regimen was initiated predominantly (81.0%). At follow-up (median 23.8 months), 350 (84.1%) were still on HAART, 53 (12.7%) had died, six (1.4%) were transferred, and seven (1.7%) were lost to follow-up. Estimates of survival were 85.5% at 24 months. Of 346 tested patients, 259 (74.1%) had CD4 cell counts greater than 200 cells/microl and 306 (88.4%) had viral loads of less than 400 copies/ml. Factors associated with virological failure at 24 months were non-antiretroviral naive, an insufficient CD4 cell gain of less than 350 cells/microl or a low trough plasma ART concentration. In an intention-to-treat analysis, 73.6% of patients were successfully treated. CONCLUSION: Positive results after 2 years of advanced HIV further demonstrate the efficacy of HAART in the medium term in resource-limited settings

Stability and accuracy of Runge-Kutta based split-explicit time-stepping algorithms for free-surface ocean models

International audienceBecause of the Boussinesq assumption employed in the vast majority of oceanic models, the acoustic waves are filtered and the fast dynamics corresponds to the external gravity-wave propagation which is much faster than other (internal) processes. The fast and slow dynamics are traditionally split into separate subproblems where the fast motions are nearly independent of depth. It is thus natural to model these motions with a two-dimensional (barotropic) system of equations while the slow processes are modeled with a three-dimensional (baroclinic) system. However such splitting is inexact, the barotropic mode is not strictly depth-independent meaning that the separation of slow and fast modes is non-orthogonal, even in the linear case. A consequence is that there are some fast components contained in the slow motions which induce instabilities controlled by time filtering of the fast mode. In this talk we present an analysis of the stability and accuracy of the barotropic–baroclinic mode splitting in the case where the baroclinic mode is integrated using a Runge-Kutta scheme and the barotropic mode is integrated explicitly (i.e. the so-called split-explicit approach). By referring to the theoretical framework developed by Demange et al. (2019), the analysis is based on an eigenvector decomposition using the true (depth-dependent) barotropic mode. We investigate several strategies to achieve stable integrations whose performance is assessed first on a theoretical ground and then by idealized linear and nonlinear numerical experiments

A spectrograph instrument concept for the Prime Focus Spectrograph (PFS) on Subaru Telescope

We describe the conceptual design of the spectrograph opto-mechanical concept for the SuMIRe Prime Focus Spectrograph (PFS) being developed for the SUBARU telescope. The SuMIRe PFS will consist of four identical spectrographs, each receiving 600 fibers from a 2400 fiber robotic positioner at the prime focus. Each spectrograph will have three channels covering in total, a wavelength range from 380 nm to 1300 nm. The requirements for the instrument are summarized in Section 1. We present the optical design and the optical performance and analysis in Section 2. Section 3 introduces the mechanical design, its requirements and the proposed concepts. Finally, the AIT phases for the Spectrograph System are described in Section 5.Comment: 8 pages, 5 figures, submitted to "Ground-based and Airborne Instrumentation for Astronomy IV, Ian S. McLean, Suzanne K. Ramsay, Hideki Takami, Editors, Proc. SPIE 8446 (2012)

Rapid polymyxin NP test for the detection of polymyxin resistance mediated by the MCR-1/MCR-2 genes

The Rapid Polymyxin NP test has been recently developed to rapidly detect polymyxin resistance in Enterobacteriaceae. Here we evaluated this test for detecting MCR- 1/MCR-2-producing Enterobacteriaceae using a collection of 70 non-redundant strains either recovered from the environment, animals, or humans. Sensitivity and specificity were found to be 100%

Physiological traits of Penicillium glabrum strain LCP 08.5568, a filamentous fungus isolated from bottled aromatised mineral water

International audiencePenicillium glabrum is an ubiquitous fungus distributed world wide. This fungus is a frequent contaminant in the food manufacturing industry. Environmental factors such as temperature, water activity and pH have a great influence on fungal development. In this study, a strain of P. glabrum referenced to as LCP 08.5568, has been isolated from a bottle of aromatised mineral water. The effects of temperature, aw and pH on radial growth rate were assessed on Czapeck Yeast Agar (CYA) medium. Models derived from the cardinal model with inflection (Rosso et al., 1993 An unexpected correlation between cardinal temperatures of microbial growth highlighted by a new model. J Theor. Bio. 162, 447-463) were used to fit the experimental data and determine for each factor, the cardinal parameters (minimum, optimum and maximum). Precise characterisation of the growth conditions for such a fungal contaminant, has an evident interest to understand and to prevent spoilage of food products

Water masses as a unifying framework for understanding the Southern Ocean Carbon Cycle

International audienceThe scientific motivation for this study is to understand the processes in the ocean interior controlling carbon transfer across 30° S. To address this, we have developed a unified framework for understanding the interplay between physical drivers such as buoyancy fluxes and ocean mixing, and carbon-specific processes such as biology, gas exchange and carbon mixing. Given the importance of density in determining the ocean interior structure and circulation, the framework is one that is organized by density and water masses, and it makes combined use of Eulerian and Lagrangian diagnostics. This is achieved through application to a global ice-ocean circulation model and an ocean biogeochemistry model, with both components being part of the widely-used IPSL coupled ocean/atmosphere/carbon cycle model. Our main new result is the dominance of the overturning circulation (identified by water masses) in setting the vertical distribution of carbon transport from the Southern Ocean towards the global ocean. A net contrast emerges between the role of Subantarctic Mode Water (SAMW), associated with large northward transport and ingassing, and Antarctic Intermediate Water (AAIW), associated with a much smaller export and outgassing. The differences in their export rate reflects differences in their water mass formation processes. For SAMW, two-thirds of the surface waters are provided as a result of the densification of thermocline water (TW), and upon densification this water carries with it a substantial diapycnal flux of dissolved inorganic carbon (DIC). For AAIW, principal formatin processes include buoyancy forcing and mixing, with these serving to lighten CDW. An additional important formation pathway of AAIW is through the effect of interior processing (mixing, including cabelling) that serve to densify SAMW. A quantitative evaluation of the contribution of mixing, biology and gas exchange to the DIC evolution per water mass reveals that mixing and, secondarily, gas exchange, effectively nearly balance biology on annual scales (while the latter process can be dominant at seasonal scale). The distribution of DIC in the northward flowing water at 30° S is thus primarily set by the DIC values of the water masses that are involved in the formation processes