Adherence to antiretroviral therapy in patients enrolled in a comprehensive care program in Cambodia: a 24-month follow-up assessment

BACKGROUND: The long-term maintenance of antiretroviral therapy (ART) remains an important issue, especially in limited-resource settings where additional barriers exist. A cross-sectional study was performed 24 months after ART initiation for patients treated in Cambodia in order to estimate the prevalence and identify determinants of non-adherence. METHODS: Adults receiving ART for 24 +/- 2 months were considered eligible for the study. Self-reported non-adherence was defined according to an algorithm based on six items. The questionnaire also assessed ART-related side effects and HIV disclosure. HIV-1 RNA plasma viral load was measured using real-time PCR. Multivariate rare events logistic regression analysis was used to identify independent factors associated with non-adherence. RESULTS: A total of 346 patients participated in the study. At 24 months, 95% of patients were adherent, 80% had HIV RNA <40 copies/ml and 75% had CD4+ T-cell counts >200 cells/mm3. Virological success was significantly higher in adherent patients than in non-adherent patients (81% versus 56%, P=0.021). Living in a rural area, limited HIV disclosure and perceived lipodystrophy were independently associated with non-adherence. CONCLUSIONS: At 24 months, adherence to ART was high and explained positive virological outcomes. In order to maintain adherence and long-term virological benefits, special attention should be given to patients living in rural areas, those with lipodystrophy-related symptoms and others who express difficulties disclosing their condition to close family members

Randomised pharmacokinetic trial of rifabutin with lopinavir/ritonavir-antiretroviral therapy in patients with HIV-associated tuberculosis in Vietnam.

BACKGROUND: Rifampicin and protease inhibitors are difficult to use concomitantly in patients with HIV-associated tuberculosis because of drug-drug interactions. Rifabutin has been proposed as an alternative rifamycin, but there is concern that the current recommended dose is suboptimal. The principal aim of this study was to compare bioavailability of two doses of rifabutin (150 mg three times per week and 150 mg daily) in patients with HIV-associated tuberculosis who initiated lopinavir/ritonavir-based antiretroviral therapy in Vietnam. Concentrations of lopinavir/ritonavir were also measured. METHODS: This was a randomized, open-label, multi-dose, two-arm, cross-over trial, conducted in Vietnamese adults with HIV-associated tuberculosis in Ho Chi Minh City (Clinical trial registry number NCT00651066). Rifabutin pharmacokinetics were evaluated before and after the introduction of lopinavir/ritonavir -based antiretroviral therapy using patient randomization lists. Serial rifabutin and 25-O-desacetyl rifabutin concentrations were measured during a dose interval after 2 weeks of rifabutin 300 mg daily, after 3 weeks of rifabutin 150 mg daily with lopinavir/ritonavir and after 3 weeks of rifabutin 150 mg three times per week with lopinavir/ritonavir. RESULTS: Sixteen and seventeen patients were respectively randomized to the two arms, and pharmacokinetic analysis carried out in 12 and 13 respectively. Rifabutin 150 mg daily with lopinavir/ritonavir was associated with a 32% mean increase in rifabutin average steady state concentration compared with rifabutin 300 mg alone. In contrast, the rifabutin average steady state concentration decreased by 44% when rifabutin was given at 150 mg three times per week with lopinavir/ritonavir. With both dosing regimens, 2 - 5 fold increases of the 25-O-desacetyl- rifabutin metabolite were observed when rifabutin was given with lopinavir/ritonavir compared with rifabutin alone. The different doses of rifabutin had no significant effect on lopinavir/ritonavir plasma concentrations. CONCLUSIONS: Based on these findings, rifabutin 150 mg daily may be preferred when co-administered with lopinavir/ritonavir in patients with HIV-associated tuberculosis. TRIAL REGISTRATION: ClinicalTrials.gov NCT00651066

Contribution à la mise en place d’indicateurs de suivi de la gestion des risques côtiers en France Métropolitaine : vers un observatoire intégré des risques d’érosion submersion

La zone côtière offre un point de contact entre une nature potentiellement destructrice et une société exposée. Cela est visible par la survenue de dommages liée à l’érosion côtière et la submersion marine, rendant le territoire vulnérable et la gestion de ces risques impérative. À partir d’une approche systémique de la vulnérabilité (vu comme la combinaison des aléas, des enjeux, de la gestion et des représentations), cette contribution détaille la méthode appliquée pour aboutir à une série d’indicateurs de suivi de la gestion des risques côtiers (érosion et submersion marine) en France métropolitaine. Ce travail rentre dans le cadre du projet de recherche OSIRISC, financé par la Fondation de France, qui vise, à terme, à construire un observatoire intégré de la vulnérabilité aux risques d’érosion-submersion.Coastal area is a contact point between hazardous nature and sensitive society, where coastal erosion and marine flooding risks are making the territory vulnerable and the risk management necessary. This contribution draws on systemic vulnerability approach (combination between hazard, issue, management and representation), and it details the indicators development method to monitor the coastal risk management in metropolitan France. This study incorporates to the OSIRISC research project. It aims to build an integrated observatory of vulnerability about coastal risks

Contribution à la mise en place d’indicateurs de suivi de la gestion des risques côtiers en France Métropolitaine : vers un observatoire intégré des risques d’érosion submersion

International audienceCoastal area is a contact point between hazardous nature and sensitive society, where coastal erosion and marine flooding risks are making the territory vulnerable and the risk management necessary. This contribution draws on systemic vulnerability approach (combination between hazard, issue, management and representation), and it details the indicators development method to monitor the coastal risk management in metropolitan France. This study incorporates to the OSIRISC research project. It aims to build an integrated observatory of vulnerability about coastal risks.La zone côtière offre un point de contact entre une nature potentiellement destructrice et une société exposée. Cela estvisible par la survenue de dommages liée à l’érosion côtière et la submersion marine, rendant le territoire vulnérable et la gestion deces risques impérative. À partir d’une approche systémique de la vulnérabilité (vu comme la combinaison des aléas, des enjeux, dela gestion et des représentations), cette contribution détaille la méthode appliquée pour aboutir à une série d’indicateurs de suivi dela gestion des risques côtiers (érosion et submersion marine) en France métropolitaine. Ce travail rentre dans le cadre du projet derecherche OSIRISC, financé par la Fondation de France, qui vise, à terme, à construire un observatoire intégré de la vulnérabilitéaux risques d’érosion-submersion

Ringing bubble rings

Les bulles ne sont pas nécessairement sphériques. Par exemple des bulles toroïdales sont élégamment produites par les Dauphins lors de leurs évolutions aquatiques. Ces bulles sont en mouvement et sont instables, ce qui rendrait leur étude acoustique problématique. Nous avons mis au point une technique pour stabiliser des bulles de n'importe quelle forme, en les piégeant dans des cages polyédriques imprimées en 3D. Ces cages étant munies de larges ouvertures, la bulle est libre d'osciller. Dans une étude précédente, nous avions déjà mesuré la fréquence de résonance de cages simples, cubes et les solides de Platon, et montré que leur résonance est proche de celle de la sphère de même volume (fréquence de Minnaert). Ici nous montrons expérimentalement et théoriquement que  pour les bulles toroïdales  la fréquence de résonance peut être bien plus haute que Minnaert ! C’est le cas lorsque le petit rayon est très petit devant le grand rayon. Par ailleurs, ces bulles offrent la possibilité de façonner le champ acoustique : entre deux tores se faisant face, il existe une distance de séparation pour laquelle le champ acoustique entre elle est plat. Une propriété qui rappelle la propriété de deux spires de Helmoltz en magnétostatique. Enfin nous montrons qu'il est possible de créer des tunnels de champs acoustique uniforme en alignant un grand nombre de tores. En conclusion, ces bulles toriques sont les briques extrêmement prometeuses pour façonner le champ acoustique et créer de nouveaux méta-matériaux

Changes in white muscle transcriptome induced by dietary energy levels in two lines of rainbow trout (Oncorhynchus mykiss) selected for muscle fat content

Energy intake and genetic background are major determinants of muscle fat content in most animals, including man. We combined genetic selection and dietary energy supply to study the metabolic pathways involved in genetic and nutritional control of fat deposition in the muscle of rainbow trout (Oncorhynchus mykiss). Two experimental lines of rainbow trout, selected for lean (L) or fat (F) muscle, were fed with diets containing either 10 or 23 % lipids from the first feeding, up to 6 months. At the end of the trial, trout exhibited very different values of muscle fat content (from 4.2 to 10.1 % wet weight). Using microarrays made from a rainbow trout multi-tissue cDNA library, we analysed the molecular changes occurring in the muscle of the two lines when fed the low-energy or high-energy diet. The results from microarray analysis revealed that eleven metabolism-related genes were differently expressed according to the diet while selection resulted in expression change for twenty-six genes. The most striking observation was the increased level of transcripts encoding the VLDL receptor and fatty acid translocase/CD36 following both the high-fat diet and upward selection for muscle fat content, suggesting that these two genes are relevant molecular markers of fat deposition in the white muscle of rainbow trout

Feeding rainbow trout with a plant based diet from first feeding to spawning does not affect sperm quality

absen

Feeding rainbow trout with a plant based diet from first feeding to spawning does not affect sperm quality

absen

Cost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia.

BACKGROUND: Cryptococcal infection is a frequent cause of mortality in Cambodian HIV-infected patients with CD4+ count ≤100 cells/µl. This study assessed the cost-effectiveness of three strategies for cryptococcosis prevention in HIV-infected patients. METHODS: A MARKOV DECISION TREE WAS USED TO COMPARE THE FOLLOWING STRATEGIES AT THE TIME OF HIV DIAGNOSIS: no intervention, one time systematic serum cryptococcal antigen (CRAG) screening and treatment of positive patients, and systematic primary prophylaxis with fluconazole. The trajectory of a hypothetical cohort of HIV-infected patients with CD4+ count ≤100 cells/µl initiating care was simulated over a 1-year period (cotrimoxazole initiation at enrollment; antiretroviral therapy within 3 months). Natural history and cost data (US$2009) were from Cambodia. Efficacy data were from international literature. RESULTS: In a population in which 81$ 472) with no intervention, 70% (cost $483) with screening, and 72$ 492) with prophylaxis. After one year of follow-up, the cost-effectiveness of screening vs. no intervention was US$180/life year gained (LYG). The cost-effectiveness of prophylaxis vs. screening was$ 511/LYG. The cost-effectiveness of prophylaxis vs. screening was estimated at $1538/LYG if the proportion of patients with CD4+ count ≤50 cells/µl decreased by 75%. CONCLUSION: In a high endemic area of cryptococcosis and HIV infection, serum CRAG screening and prophylaxis are two cost effective strategies to prevent AIDS associated cryptococcosis in patients with CD4+ count ≤100 cells/µl, at a short-term horizon, screening being more cost-effective but less effective than prophylaxis. Systematic primary prophylaxis may be preferred in patients with CD4+ below 50 cells/µl while systematic serum CRAG screening for early targeted treatment may be preferred in patients with CD4+ between 51-100 cells/µl