Jornal de AIDS e Pesquisa Clínica

Background: It is now widely accepted that the antiretroviral first line-treatment basis in HIV-1 infected children is a combination of 2 nucleoside reverse transcriptase inhibitors and 1 protease inhibitor or 1 non NRTI. However, after few months or years, some patients presented with virological failure. Objective: Using a “real life conditions” cohort, we aimed to study the median duration of Viral Controlled Replication (VCR) and the factors associated with failure in infected children. Methods: Thirty six HIV-1 infected patients were followed between September 1996 and September 2010. Children were included starting from the date of initiation of their first successful HAART. Duration of effective VCR was defined as a length, in months, from inclusion to virological failure defined as a HIV-1 PCR-RNA higher than 400 c/ml. Results: The overall median VCR duration was 46.2 months. Duration was significantly shorter in patients: previously exposed to mono therapies, with CD4 count lower than 350 and with PI-based HAART. After adjustment, the negative effect of PI-based HAART regimen compared to nNRTI-based HAART remained significant (HR=5.7 [95%CI=1.43-22.7]). Conclusion: Therefore, retrospective analysis of “real life” condition data in observational cohort may contribute to a better understanding of non optimal virological care.

Highly Active Antiretroviral Therapy (HAART) has increased life expectancy of HIV-infected patients, but may also increase triglyceride and cholesterol levels, triggering lipodystrophy syndrome. Physical activity may prevent or attenuate such adverse effects, but it has not been fully evaluated in HIV-infected patients. This cross-sectional study aimed to investigate the association between physical activity and lipodystrophy syndrome in HIV-infected individuals, 18 years or older. Physical activity was evaluated by the short version of the International Physical Activity Questionnaire. Lipodystrophy was verified by at least two reporting of changes in different parts of the body, or directly assessed, categorized as lipoatrophy or lipohypertrophy. Among 1,240 participants, 46% had lipohypertrophy, which was independently associated with insufficient physical activity in men, but not in women. The prevalence of lipoatrophy was 53.2%. Metabolic parameters were higher among individuals on HAART, in comparison to HAART-naive patients. In conclusion, HAART-naive physically active individuals had lower metabolic profile than among insufficiently active.

This was a qualitative study conducted in one regional and two district hospitals in the rural areas of the Limpopo Province. Its purpose was to explore and describe the perceptions of HIV/AIDS trained professional nurses regarding nursing care that is rendered to PLWHA in their own wards or units. Three rural hospitals of the Limpopo Province, one regional and two district hospitals participated in the study. Purposive sampling was used to select the wards and professional nurses who participated in the study. A total of three focus group discussion were conducted, one at each hospital. Individual interviews were conducted with professional on what they consider to be good and proper nursing care for HIV positive patients. The participants were of the view that nursing care for HIV and AIDS patients should be non-discriminatory, following precautionary measures to protect patient, self and other, giving health education, support and counselling and maintain confidentiality. Knowledge of HIV and AIDS, respect for human dignity, trusting nurse-patient relationship, and confidence in the caring relationship were identified as the main contributory factors to giving good nursing care to HIV-positive patients. To improve the quality of care for PLWHA all nurses working in the wards should have advanced knowledge and skills in the care of HIV and AIDS patients.

Background: In French Guiana, a recent study has shown that a major part of the histoplasmosis incidence temporal fluctuations could be explained by climatic factors and thus postulated that disseminated histoplasmosis cases could be in a large proportion due to new infections. The description of the seasonal pattern of histoplasmosis could potentially help to test this new hypothesis. Patients and methods: A study using prospective data from the French Hospital Database for HIV was conducted in order to determine seasonal variations of the incidence of first cases of disseminated histoplasmosis in HIV persons in Cayenne, French Guiana. Single failure Cox proportional hazards models were used. Results: After adjusting for CD4 counts and antiretroviral treatment, the incidence of disseminated histoplasmosis was significantly higher during the Short Wet Season–Long Dry Season than during the Short Dry Season–Long Wet Season (Adjusted Hazard ratio 1.7 (1.1-2.5), P= 0.01). Conclusion: This result gives both valuable epidemiologic information to clinicians and a supplementary argument in favour of the hypothesis that an important proportion of cases were due to recent exposure. Therefore, the use of a primary prophylaxis must be discussed in French Guiana.

Objective: We aim to evaluate the mechanisms of rosiglitazone-induced fat recovery in HIV+ patients with lipoatrophy on thymidine Nucleoside Reverse Transcriptase Inhibitors (NRTI) sparing regimens. Method: Measures of limb fat (DXA), oxidative stress (F2 isoprostanes) and inflammation [High-sensitivity C - reactive protein (hsCRP), soluble Tumor Necrosis Factor Receptors (sTNFR)-I, sTNFR-II, and interleukin (IL)-6] were performed. Gluteal fat mitochondrial DNA (mtDNA) and peroxisome proliferator-activated receptor (PPAR)-γ RNA [expressed as PPAR-γ/Glyceraldehyde 6-Phosphate Dehydrogenase (GAPDH) RNA ratio] were measured by quantitative PCR. Result: 71 patients on thymidine NRTI-sparing regimens were randomized to rosiglitazone vs. placebo for 48 weeks. Duration off thymidine NRTIs was similar between groups. From week 0-48, limb fat increased significantly (p=0.02) more in the rosiglitazone than in the placebo group. Within both groups, F2-isoprostanes, sTNFR-I and sTNFR-II increased significantly (p ≤ 0.003), hsCRP decreased significantly (≤ 0.02), and IL-6 did not change. No differences were seen between groups in any of the inflammation markers. Fat mtDNA (copies/ cell) increased nonsignificantly: +41(p=0.08) and +29(p=0.38) within rosiglitazone and placebo group; respectively. PPAR-γ/ GAPDH ratio did not change within or between groups. Conclusion: Limb fat improvements seen after rosiglitazone were not associated with changes in mtDNA, oxidative or inflammation markers, or PPAR-γ expression. F2 isoprostanes and some of the inflammation markers worsened over time in these subjects on stable ART, regardless of the rosiglitazone assignment. Thus, lipoatrophy can be in part overcome by a separate pathway independent of mitochondrial DNA depletion, such as PPAR-γ.