Vital status of pre-ART and ART patients defaulting from care in rural Malawi

OBJECTIVES: To ascertain the outcome of pre-Antiretroviral therapy (ART) and ART patients defaulting from care and investigate reasons for defaulting. METHODS: Patients defaulting from HIV care in Chiradzulu between July 2004 and September 2007 were traced at last known home address. Deaths and moves were recorded, and patients found alive were interviewed. Defaulting was defined as missed last appointment by more than 1 month among patients of unknown vital status. RESULTS: A total of 1637 individuals were traced (54%-88% of eligible), 981 pre-ART and 656 ART patients. Of 694 pre-ART patients found, 49% had died (51% of adults and 38% of children), a median of 47 days after defaulting, and 14% had moved away. Of 451 ART patients found, 54% had died (54% of adults and 50% of children), a median of 52 days after defaulting, and 20% had moved away. Overall, 221 patients were interviewed (90% of those found alive), 42% had worked outside the district in the previous year; 49% of pre-ART and 19% of ART patients had not disclosed their HIV status to other household members. Main reasons for defaulting were stigma (43%), care dissatisfaction (34%), improved health (28%) and for ART discontinuation, poor understanding of disease or treatment (56%) and drug side effects (42%). CONCLUSION: This study in a rural African HIV programme reveals the dynamics related to health service access and use, and it provides information to correct programme mortality estimates for adults and children

Immunovirological outcomes and resistance patterns at 4 years of antiretroviral therapy use in HIV-infected patients in Cambodia

Objectives  To report immunovirological outcomes and resistance patterns in adults treated with triple combination antiretroviral therapy (cART) for 4 years in an HIV programme of Phnom Penh, Cambodia. Methods  It is a longitudinal study and cross-sectional evaluation of adults receiving cART for 4 years. CD4 cell counts and HIV-1 RNA were quantified, and resistance patterns were determined. Drug-related toxicity was assessed by clinicians and through laboratory testing. Results  After 4 years of cART start, the cumulative probability of retention in care was 0.80 and survival among patients not lost to follow-up was 0.85. A total of 349 patients (98% of eligible) participated in the cross-sectional evaluation. Ninety per cent were receiving first-line therapy, 29% stavudine- and 58% zidovudine-containing regimens (compared with 94% and 3% at cART initiation). Ninety-three per cent of patients were clinically asymptomatic, and severe lipodystrophy and dyslipidemia were diagnosed in 7.2% and 4.0%, respectively. Good treatment adherence was reported by 83% of patients. Median CD4 T-cell count was 410 cells/μl [IQR 290-511], and 90% of patients had >200 cells/μl. Only 15 (4%) patients had detectable HIV viral load (eight had <200 CD4 cells/μl), five had thymidine analogue mutations, and nine were resistant to two drug classes. In an intention-to-treat analysis, 26.1% (95% CI 22.0-30.5) of patients had failed first-line therapy. Conclusions  In this Cambodian cohort of adults who started cART at an advanced stage of HIV disease, we observed good clinical and immunovirological outcomes and self-reported treatment adherence at 4 years of therapy

Treatment Initiation, Program Attrition and Patient Treatment Outcomes associated with Scale-up and Decentralization of HIV care in rural Malawi

To describe patient antiretroviral therapy (cART) outcomes associated with intensive decentralization of services in a rural HIV program in Malawi

Treatment Initiation, Program Attrition and Patient Treatment Outcomes associated with Scale-up and Decentralization of HIV care in rural Malawi

To describe patient antiretroviral therapy (cART) outcomes associated with intensive decentralization of services in a rural HIV program in Malawi

Evaluation of a 5-year programme to prevent mother-to-child transmission of HIV infection in Northern Uganda

Prevention of mother-to-child transmission (PMTCT) is essential in HIV/AIDS control. We analysed 2000-05 data from mother-infant pairs in our PMTCT programme in rural Uganda, examining programme utilization and outcomes, HIV transmission rates and predictors of death or loss to follow-up (LFU). Out of 19,017 women, 1,037 (5.5%) attending antenatal care services tested HIV positive. Of these, 517 (50%) enrolled in the PMTCT programme and gave birth to 567 infants. Before tracing, 303 (53%) mother-infant pairs were LFU. Reasons for dropout were infant death and lack of understanding of importance of follow-up. Risk of death or LFU was higher among infants with no or incomplete intrapartum prophylaxis (OR = 1.90, 95% CI 1.07-3.36) and of weaning age <6 months (OR 2.55, 95% CI 1.42-4.58), and lower in infants with diagnosed acute illness (OR 0.30, 95% CI 0.16-0.55). Mother-to-child HIV cumulative transmission rate was 8.3%, and 15.5% when HIV-related deaths were considered. Improved tracking of HIV-exposed infants is needed in PMTCT programmes where access to early infant diagnosis is still limited

Oscillatory patterns in redox gradient materials through wireless bipolar electrochemistry. The dynamic wave-like case of copper bipolar oxidation

Altres ajuts: ICN2 is funded by the CERCA program/Generalitat de Catalunya.Bipolar electrochemistry allows the development of processes in a wireless manner, with reactions occurring at the induced anodes and cathodes of an immersed conducting material in the electrolyte. As a result, a gradient oxidation state may appear along the main axis field on the surface or bulk of the material depending on the type of reaction available at each induced potential. Redox intercalation gradients have been observed, metal anodization, or deposition, and also reactions at the electrolyte in the nearby environment of the poles induced. The complex oxidation of copper and interconversion between phases formed yields in this work an oscillating redox gradient, thanks to the great resistance change when the oxidized phases are formed. Parallel stripes containing mainly CuO, CuO, and Cu(OH) with large resistance are formed perpendicular to the electric field, forming a sequence of secondary dipoles in intermediate Cu stripes, that depends on the external voltage applied, and that oscillates in time at the same spatial coordinates. With longer times, copper solubilizes at the larger induced potential zones, probably as Cu(OH) . A simple finite element electrostatic model defines the complex potential waves induced in the piece. The resulting dynamics offer an example of the complexity of order in unwired conducting materials in wet media, either in catalysis, bioelectrodes, electronics, photovoltaics, or energy storage

Second-line antiretroviral therapy in resource-limited settings: the experience of Médecins Sans Frontières

OBJECTIVES: To describe the use of second-line protease-inhibitor regimens in Médecins Sans Frontières HIV programmes, and determine switch rates, clinical outcomes, and factors associated with survival. DESIGN/METHODS: We used patient data from 62 Médecins Sans Frontières programmes and included all antiretroviral therapy-naive adults (> 15 years) at the start of antiretroviral therapy and switched to a protease inhibitor-containing regimen with at least one nucleoside reverse transcriptase inhibitor change after more than 6 months of nonnucleoside reverse transcriptase inhibitor first-line use. Cumulative switch rates and survival curves were estimated using Kaplan-Meier methods, and mortality predictors were investigated using Poisson regression. RESULTS: Of 48,338 adults followed on antiretroviral therapy, 370 switched to a second-line regimen after a median of 20 months (switch rate 4.8/1000 person-years). Median CD4 cell count at switch was 99 cells/microl (interquartile ratio 39-200; n = 244). A lopinavir/ritonavir-based regimen was given to 51% of patients and nelfinavir-based regimen to 43%; 29% changed one nucleoside reverse transcriptase inhibitor and 71% changed two nucleoside reverse transcriptase inhibitors. Median follow-up on second-line antiretroviral therapy was 8 months, and probability of remaining in care at 12 months was 0.86. Median CD4 gains were 90 at 6 months and 135 at 12 months. Death rates were higher in patients in World Health Organization stage 4 at antiretroviral therapy initiation and in those with CD4 nadir count less than 50 cells/microl. CONCLUSION: The rate of switch to second-line treatment in antiretroviral therapy-naive adults on non-nucleoside reverse transcriptase inhibitor-based first-line antiretroviral therapy was relatively low, with good early outcomes observed in protease inhibitor-based second-line regimens. Severe immunosuppression was associated with increased mortality on second-line treatment

Incidence of Tuberculosis in HIV-Infected Patients Before and After Starting Combined Antiretroviral Therapy in 8 Sub-Saharan African HIV Programs.

SETTIN

Isla de calor nocturna de una ciudad mediterránea de interior: Inca (Mallorca)

A new study of the urban heat island phenomenon applied to the Mallorcan city of Inca is presented, with the aim of expanding and verifying the results of previous works. Using the mobile transect method, measurements have been made in four respective seasons of the meteorological year: winter, autumn, summer and spring. The results confirm nocturnal heat islands that show temperature differences of up to 5.7º C between the central sector of the city and its rural surroundings. The urban anthropogenic activity in Inca, the reduced width of certain streets, the height of the buildings and the atmospheric stability, are combined factors that play in favor of this differential thermal increase, more pronounced in cold ambient conditions (autumn and winter) than of hot (spring and summer). The results are useful for urban planning works with environmental criteria.Se presenta un nuevo estudio del fenómeno de isla de calorurbana en la ciudad mallorquina de Inca, con el objetivo de ampliar y verificar los resultados de los trabajos precedentes. A partir del método delos transectos móviles, se han realizado mediciones en cuatro estacionesdel año meteorológico: invierno, otoño, verano y primavera. Los resultados confirman islas de calor nocturnas que manifiestan diferencias de temperatura de hasta 5,7º C –otoño– entre el sector central de la ciudad y suentorno rural. La actividad antropogénica urbana en Inca, la anchura reducida de ciertas calles, los edificios altos, la escasez de cubierta vegetal y la estabilidad atmosférica, son factores combinados que juegan a favorde este incremento térmico diferencial, aparentemente más acusado en condiciones de frío ambiental que en condiciones de calor. Los resultados son de utilidad para trabajos de planificación urbana con criterios de sostenibilidad ambiental