Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand.

OBJECTIVE: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. DESIGN: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. METHODS: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. RESULTS: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean. CONCLUSION: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

Comparisons of Gait Variability and Symmetry in Healthy Runners, Runners with a History of Lower Limb Injuries, and Runners with a Current Lower Limb Injury

Background: Running is a cyclic movement and requires a bilateral symmetry between the lower limbs to reduce injury risk, and the assessment of side-to-side differences is often performed to detect functional deficits. Objectives: The purpose was to study side-to-side differences using clinical and running performance assessments in healthy runners (HR), runners with a history of lower limb injuries (RHI), and runners with a current lower limb injury. Methods: Forty-three runners were recruited with 14 participants being allocated to the HR group, 13 to the RHI group, and 16 to the RLI group. Peak vertical ground reaction force (GRF), midfoot pressure, foot rotation, and gait variability were recorded using a Zebris FDM-T treadmill analysis system, and participants were also assessed using the navicular drop test. Dependent t-tests were used to determine if any differences existed between the lower limbs within each group. One-way ANOVAs were then used to investigate the side-to-side differences between the three groups. Results: Significant differences were seen in navicular drop height between lower limbs within both the HR (p=0.02) and RHI (p=0.009) groups, and side-to-side differences in foot rotation were greatest in the RLI group (~34%) compared to both the RHI (~30.5%) and HR (~24%) groups. The lateral variability of the centre of pressure was greatest in the RLI group (37.1mm) compared to the RHI (28.9mm) and HR (22.2mm) groups. Conclusion: Centre of pressure variability may help identify runners at a greater risk of lower limb injury. Side-to-side differences should be expected to progressively decrease from the injured stage, through the recovery and return to sport phases. Target goals of less than 34% side-to-side difference for foot rotation and 37.1mm for lateral centre of pressure variability may be used to help the decision making process when considering a return to running practice

Kualitas Nutrisi Aneka Tepung Dan Kue Talam Berbasis Bahan Pangan Pulau Enggano Dengan Penambahan Lactobacillus Plantarum B110 [Nutrition Quality of Various Flour and Talam Cake Based on Enggano Island Food Material Added with Lactobacillus Plantarum B110]

Nine foodstuffs from Enggano island were processed to flour as wheat flour alternative. To increase flour quality and its derivative product, Lactobacillus-plantarum B110 was added those flour and talam cake made from such flour. They were forest cassava (Dioscorea sp.), ararut sago (Marantha arundinacea), tacca (Tacca Leontopetaloides), egg taro (Alocasia sp.), oil taro (Alocasia sp.), gadung (Dioscorea hispida), gogo rice (Oryza sativa), corn (Zea mays), and belinjo (Gnetum gnemon). The quality assessment consisted of HCN detection (qualitative), nutrition contents (proximate analysis), acid (titration method), glucose (GOD-POD kit), and organoleptic tests (20 panelists). The results show that acid and glucose contents of the nine flours increased after L. plantarum B110 addition. Acid content of the flours was 0.0144-0.2475%, while glucose was 0.056-0.449%. Carbohydrate, energy and acid contents of L. plantarum B110 talam cake were higher than control, which those were 34.13%, 190.33 cal/100gr, 0.00082%, while protein, lipid, water, ash were 1.75%, 5.22%, 57.9 %, 1.01%, respectively. The talam cake was accepted by panelists with values: 5.50 (taste), 5.6 (colour), 4.55 (flavour), 4.00 (texture), 4.35 (homogeneous). It was concluded that the flour and talam cake quality increased with addition of L. plantarum B110

Prevalence, risk factors, and impact of isolated antibody to hepatitis b core antigen and occult hepatitis b virus infection in hiv-1-infected pregnant women

Background. Prevalence and risk factors for isolated antibody to hepatitis B core antigen (anti-HBc) and occult hepatitis B virus (HBV) infection are not well known in human immunodeficiency virus type 1 (HIV-1)-infected pregnant women. It is unclear if women with occult infections are at risk of transmitting HBV to their infants. Methods. HIV-1-infected and HBV surface antigen (HBsAg)-negative pregnant women were tested for anti-body to HBsAg (anti-HBs) and anti-HBc using enzyme immunoassay. Women with isolated anti-HBc were assessed for occult HBV infection, defined as HBV DNA levels >15 IU/mL, using the Abbott RealTime HBV DNA assay. Infants born to women with isolated anti-HBc and detectable HBV DNA were tested at 4 months of age for HBV DNA. Logistic regression analysis was used to identify factors associated with isolated anti-HBc and occult HBV infection. Results. Among 1812 HIV-infected pregnant women, 1682 were HBsAg negative. Fourteen percent (95% confidence interval [CI], 12%-15%) of HBsAg-negative women had an isolated anti-HBc that was independently associated with low CD4 count, age >35 years, birth in northern Thailand, and positive anti-hepatitis C virus serology. Occult HBV infection was identified in 24% (95% CI, 18%-30%) of women with isolated anti-HBc, representing 2.6% (95% CI, 1.9%-3.5%) of HIV-1-infected pregnant women, and was inversely associated with HIV RNA levels. None of the women with isolated anti-HBc and occult HBV infection transmitted HBV to their infants. Conclusions. HIV-1-infected pregnant women with isolated anti-HBc and occult HBV infection have very low HBV DNA levels and are thus at very low risk to transmit HBV to their infants