Limited effect of highly active antiretroviral therapy among HIV-positive injecting drug users on the population level

There is evidence that HIV-positive injecting drug users benefit less than other risk groups from highly active antiretroviral therapy that has been available since 1996. In this multicentre European study the impact of the availability of highly active antiretroviral therapy on the progression rates to AIDS and death among injecting drug users with a documented date of HIV seroconversion is studied. After highly active antiretroviral therapy became available the risk of AIDS and death for injecting drug users decreased by 28% and 36%, which is less than has been reported for other risk group

Spread of Hepatitis C Virus among European Injection Drug Users Infected with HIV: A Phylogenetic Analysis

To describe the spread of hepatitis C virus (HCV) among HCV/human immunodeficiency virus (HIV)-coinfected injection drug users (IDUs), the molecular epidemiology of HCV was studied among 108 IDUs from 7 European countries. Phylogenetic analysis based on the NS5B region showed great sequence variation of HCV within each country and no clear phylogenetic clustering by geographic region. The most prevalent subtypes were 1a and 3a, but the percentage of genotype 4 was also relatively high, ranging from 7% in northern Europe to 24% in southern Europe. Genotype 4 consisted mainly of subtype 4d and has entered the majority of the IDU populations studied. The significantly lower evolutionary distances within subtype 4d suggest that this subtype may have entered the European IDU population relatively recently. In conclusion, HCV exchange between European IDU populations has occurred on a large scale, and, overall, country-specific clustering for HCV was less than that shown for HI

Tuberculosis risk varies with the duration of HIV infection: a prospective study of European drug users with known date of HIV seroconversion

Background: It is not known whether the risk of active tuberculosis disease varies with the length of time that individuals are infected with HIV. Objective: To study how, independently of CD4 T cell count, the risk of tuberculosis varies with the duration of HIV infection. Methods: Using Poisson regression analysis, the incidence of and risk factors for tuberculosis were studied in 683 injecting drug users (IDU) with a documented date of HIV seroconversion followed in seven cohorts in six European countries until 1998. Results: Overall incidence was 11.5/1000 person-years. Adjusted for CD4 T cell count and geographic region, the risk ratio (RR) for tuberculosis (both pulmonary and extrapulmonary), compared with the first 3 years of HIV infection, was 2.8 for years 4 to 6 of HIV infection [95% confidence interval (CI), 1.3-6.3], 1.2 for year 7 to 9 (95% Cl, 0.3-4.2) and 4.6 after 9 years (95% Cl, 1.4-15.0). The adjusted RR for geographic region was 13.1 (95% Cl, 4.3-40.0) for Amsterdam and 15.8 (95% Cl, 4.8-52.0) for the Valencian region of Spain compared with all other sites combined. Conclusion: The risk of tuberculosis is increased relatively early in HIV infection (year 4 to 6) and also later (after year 9) with possibly a relatively silent period between. As expected, IDU in Southern Europe have a substantially higher risk of tuberculosis than IDU in Northern and Central Europe. Amsterdam forms an exception for Northern Europe, with very high incidence rates. (C) 2003 Lippincott Williams Wilkin

Context matters: Agronomic field monitoring and participatory research to identify criteria of farming system sustainability in South-East Asia.

International audienceIn the mountainous areas of South-East Asia, family farms have shifted from subsistence to input-intensified and market-oriented maize-based farming systems, resulting in a substantial increase in farm income, but also in new environmental threats: deforestation, biodiversity loss, soil erosion, herbicide leaching and soil fertility degradation. In this typical case study of cash-strapped farms, where the balance between socio-economic and environmental dimensions of sustainability is complex, we used participatory methods (serious games and Q-methodology), combined with agronomic field monitoring, to identify relevant farm and field-level criteria for sustainability assessment.Serious games at farm level showed that short-term socio-economic dimensions prevailed over environmental dimensions in farmers' objectives. However, farmers also greatly valued their capacity to transfer a viable farm to the next generation and avoid herbicide use. Serious games at field level showed that some farmers were willing to preserve soil fertility for future generations. The agronomic field monitoring showed that maize yield deviations from potential water-limited yield were primarily due to weed infestation favoured by low sowing density, due to uncontrolled moto-mechanized crop establishment. This technical failure at the beginning of the maize cycle led to herbicide overuse, poor returns on investment for fertilizer, and increased exposure to soil erosion.Combining the perspectives of scientists and farmers led to the following set of locally-relevant criteria: i) at farm level: farm income, diversity of activities, farmer autonomy, farmer health, workload peaks, soil fertility transfer between agroecological zones in the landscape, rice and forage self-sufficiency; ii) at field level: resource use efficiency, soil fertility, erosion and herbicide risks, susceptibility to pests, weeds and climate variability, biodiversity, land productivity, economic performance, labour productivity and work drudgery. Our approach helped to identify key relevant sustainability criteria and could be useful for designing alternatives to current maize-based cropping systems, and contributed to informing priority-setting for institutional development and agricultural policies in the region