Impact du paludisme sur l’infection par le VIH

Malaria and HIV are two major public health issues, especially in sub-Saharan Africa. HIV infection increases the incidence of clinical malaria, inversely correlated with the degree of immunodepression. The effect of malaria on HIV infection is not as well established. Malaria, when fever and parasitemia are high, may be associated with transient increases in HIV viral load. The effect of subclinical malaria on HIV viral load is uncertain. During pregnancy, placental malaria is associated with higher plasma and placental HIV viral loads, independently of the severity of immunodeficiency. However, the clinical impact of these transient increases of HIV viral load remains unknown. Although some data suggests that malaria might enhance sexual and mother-to-child transmissions, no clinical study has confirmed this. Nevertheless pregnant women and children with malaria-induced anemia are also exposed to HIV through blood transfusions. Integrated HIV and malaria control programs in the regions where both infections overlap are necessary.     

Prevalence of cardiomyopathy in HIV infection: prospective study on 158 HIV patients

BACKGROUND: There is evidence that the human immunodeficiency virus (HIV) may affect the heart and left ventricular dysfunction appears to be common. OBJECTIVE: This was the first study in Morocco to investigate the frequency of cardiomyopathy in patients infected with HIV. METHODS: We made a prospective echocardiographic study of 158 patients starting in September 2004 (88 men and 70 women, mean age 34 [5.4] years) with positive HIV serology and a clinical diagnosis of HIV infection according to CDC criteria and 80 seronegative control subjects. Patients were classified as AIDS group (90 patients) and HIV group (+) (68 patients) and HIV (-) (80 subjects). RESULTS: Twenty-eight out of 156 (17.7%) cases of cardiomyopathy were found, distributed in 24 out of 90 (26.6%) in the AIDS group and four out of 68 (2.8%) in the HIV+group (p<0.01) and none in the HIV (-) group. Left ventricular diastolic dysfunction was noted among 88 out of 158 (55.7%) infected patients. There was a significant increase of cardiomyopathy in patients with HIV infection and decreased CD4 (less than 100 per millimetre cube; n=16 [57%]) compared to those with CD4 between 100 and 200 per millimetre cube; n=6 (21.42%) (p=0.03). CONCLUSION: Echocardiography was a useful technique for the early detection of cardiac dysfunction in asymptomatic HIV positive carriers and AIDS patients. The frequency is related to HIV infection stage and CD4+ counts. Left ventricular diastolic dysfunction can precede systolic dysfunction and may be a useful technique for the early detection of cardiac dysfunction.     

Management of severe imported malaria in adults

Severe malaria accounts for approximately 10% of all cases of imported malaria in France; cases are mainly due to Plasmodium falciparum, while other Plasmodium species are possible but uncommon (P. vivax, P. knowlesi, P. malariae, and P. ovale). On the basis of WHO criteria for endemic areas, the French criteria defining severe imported malaria in adults have been progressively adapted to the European healthcare level. Management of severe imported malaria is a diagnostic and treatment emergency and must be initially conducted in the intensive care unit. Anti-infective treatment is now based on intravenous artesunate, which must be available in every hospital of the country likely to receive severe imported malaria patients. Intravenous quinine is thus used as a second-line treatment and is restricted to limited indications. Critical care management of organ failure is essential, particularly in patients presenting with very severe malaria. To date, no adjunctive therapy (including exchange transfusion) has demonstrated clear beneficial effects.     

Imported severe malaria in adults: a retrospective study of ten cases admitted to intensive care units in Casablanca

INTRODUCTION: We report a retrospective study in the medical intensive care unit of the Casablanca Ibn-Rochd University hospital. MATERIAL AND METHODS: All patients over 14 years of age with falciparum malaria, who were admitted to ICUs between 1996 and 2001, were included. The main epidemiological features, criteria of admission, treatment, and outcome were investigated. RESULTS: Ten patients were included for severe imported malaria. The mean age was 32+/-4 years. All patients had acquired falciparum malaria in sub-Saharan Africa. Chemoprophylaxis was inadequate in all patients. The mean time from symptom onset to treatment initiation was 9+/-2 days. Criteria of admission were impaired consciousness (7), acute renal failure (4), and respiratory distress (3). The most worrying factors were the severity of consciousness disorders, the acute respiratory distress syndrome, the metabolic acidosis, and the refractory shock. All patients presented with nosocomial respiratory infection related to Gram-negative bacilli, in the evolution. All patients received quinine therapy with loading dose and symptomatic treatment. Five patients died. CONCLUSION: The lethality of severe imported malaria is still high despite optimal management in ICUs. Improving chemoprophylaxis and an earlier diagnosis may reduce significantly the mortality rate.     

Association between chronic hepatitis C infection and metabolic syndrome: A meta-analysis

BackgroundHepatitis C virus (HCV) infected patients have been found to be more susceptible to metabolic syndrome (MetS), but the results remain unclear and lack of a meta-analysis.MethodsDatabases including PubMed, Web of Science, EMBASE and the Cochrane Library were searched to identify all studies concerning HCV and MetS. Funnel plots combined with Begg's tests and Egger's tests were used to analysis the possible publication bias. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to access the effect of HCV infection on the risk of MetS.ResultsEight articles, involving a total of 57387 HCV patients were included. HCV infection was significantly associated with an increased incidence of MetS (OR = 1.73; 95% CI, 1.19–2.52). After adjustment according to the sensitivity analysis, one included article was removed to decrease the publication bias and high heterogeneity, of which the results showed that HCV infection was still associated with an increased incidence of MetS (OR = 1.93; 95% CI, 1.39–2.68).ConclusionsHCV patients tend to have a significant increased risk for MetS, but more large-scale studies are needed to confirm this and explore the exact mechanism.     

Diagnosis of imported malaria in France

The need for diagnosis of imported malaria is frequent in France. Diagnosis biological tools are different, according methods, sensitivity, interpretation and costs. Strategies for their use could be stratified according locally available methods, and experience of the practician.     

穿孔素与艾滋病病毒感染

在HIV感染中,CTL是控制HIV感染细胞免疫应答中重要的效应细胞,主要通过穿孔素介导的颗粒胞吐途径,特异性清除HIV感染细胞,在HIV原发感染期对于快速消除病毒血症起关键作用,但是CTL仍不能彻底清除HIV。近年来有关穿孔素与HIV感染的相关性研究日益受到国内外学者的关注,此文将对穿孔素介导细胞毒效应的分子机制、穿孔素在HIV感染中作用的研究进展作一简要综述。     

Spontaneous spleen rupture in the course of malaria

The spontaneous rupture of malarial spleen is an uncommon complication. It usually occurs to a child and a recent expatriate. Its diagnosis is misleading into a context of infection. A 28-year-old European man, newly affected to Gabon, under chimioprophylactic drugs by chloroquine and proguanil, has been hospitalized in September 2000 because of an acute attack of malaria to Plasmodium falciparum. After four days treatment by quinine, he presented an abdominal pain with a Sub capsular Haematoma of the spleen confirmed by Scanner. The evolution was favourable under conservative treatment. The spontaneous rupture of malarial spleen is caused by Plasmodium vivax and falciparum. Twenty cases are reported in the literature. Conservative management permits to preserve the role of the spleen in immune response especially of the child and of people who regularly travel to endemic zone.     

艾滋病感染诊断治疗服务链的研究进展

艾滋病感染后从检测诊断到实施抗病毒治疗,再到治疗成功抑制病毒复制,是一个环环相扣的医疗服务过程,称之为艾滋病感染诊断治疗服务链。沿着该服务链的各阶段接受诊疗服务的感染者人数逐级衰减。减少该服务链的各阶段间衰减,使得最大比例的艾滋病感染者实现病毒抑制,则是控制艾滋病传播流行的有效策略。本文综述了国际和国内艾滋病诊断治疗服务链的研究进展,为我国推动到2020年实现艾滋病感染诊断90%、治疗90%和有效90%提出了建议。     

Switching from abacavir/lamivudine plus nevirapine to abacavir/lamivudine/dolutegravir in virologically controlled HIV-infected adults (SWAD study)

IntroductionThe metabolic pathways of dolutegravir suggest a potential predator effect of nevirapine on dolutegravir pharmacokinetics and switching from a nevirapine- to a dolutegravir-containing regimen could lead to a lower and suboptimal exposure to dolutegravir several weeks after the switch in case of persistent inducer effect.Patients and methodProspective, pilot, single-arm, open-label, non-comparative, bicentric study to evaluate the pharmacokinetics, virologic outcomes, safety, and patient satisfaction of switching from abacavir/lamivudine and nevirapine to a single tablet of abacavir/lamivudine/dolutegravir. The primary endpoint was the maintenance of virologic suppression (HIV-1 RNA < 50 copies/mL) at week 12. Secondary endpoints were virologic suppression at week 48, safety and tolerability, patient satisfaction, and pharmacokinetic interaction between nevirapine and dolutegravir. Fifty-three adults on stable abacavir/lamivudine and nevirapine regimen for a median duration of 6 years and virologically suppressed for 9.6 years were included.ResultsDolutegravir reached steady state by week 4/week 12 when expected by day 5/day 10. All subjects maintained plasma HIV-RNA ? 50 copies/mL at week 12 and week 48. Abacavir/lamivudine/dolutegravir was well-tolerated, with two cases of serious adverse events deemed unrelated to study drugs (coronary syndrome in both cases), and one discontinuation for renal impairment at week 24 with a slight improvement after dolutegravir discontinuation. Level of treatment satisfaction remained high after the switch.ConclusionThe transient predator effect of nevirapine on dolutegravir had no clinical consequences after switching from nevirapine to dolutegravir, neither on safety nor maintenance of virologic suppression. It also had no consequences on patient satisfaction.     

New use of primaquine for malaria

Primaquine is the only available drug to treat Plasmodium vivax liver stages (hypnozoites). It has been used for more than five decades and is now included in an increasing number of clinical guidelines. The major concern is induced hemolysis when administered to glucose-6-phosphate-dehydrogenase deficient patients. Primaquine could be used for causal prophylaxis during and after exposure or for presumptive antirelapse therapy (PART) in case of high exposure to P. vivax. A radical cure is used to avoid relapse for patients with a confirmed bloodstream infection with P. vivax or P. ovale. In France, primaquine is not approved for prevention and treatment and its use requires a specific temporary authorization.     

CKD-EPI equation: A suitable Glomerular Filtration Rate estimate for drug dosing in HIV-infected patients

Objectives

To evaluate concordance between glomerular filtration rate (GFR) estimates (Cockcroft and Gault, modification of diet in renal diseases, chronic kidney disease epidemiology study group equations) for drug dosing in HIV-infected patients.

Impact of peer education on HIV infection in Zimbabwe

The Zimbabwe AIDS Prevention Project (ZAPP) conducted a randomized trial to investigate the effectiveness of peer education in preventing HIV infection. Initial research revealed that if health education could successfully promote a reduction in the number of sex partners and condom use, HIV risk could be greatly reduced. In 1993, ZAPP began enrolling men working at 40 factories in a study. The men were tested for sexually transmitted diseases (STD) and HIV every six months and had access to a ZAPP clinic for counseling, testing, and STD treatment. In June 1994, ZAPP randomly chose 20 factories to receive an additional peer education intervention. Educators were trained for a week and were given refresher courses every six months. Comparison of the incidence of HIV between the control and intervention groups was measured by determining incidence for all individuals and by comparing overall incidence at each factory. Of the 2219 men who were HIV negative after the introduction of peer education, 78% completed one follow-up, and HIV incidence was 2.52%/year. Controlling for time enrolled in the program revealed that the peer education resulted in significantly fewer new HIV infections. Because the voluntary testing and counseling were available at factories with control and intervention programs, this study exposed the independent impact of peer education. It is concluded that peer education, condom distribution, and treatment of STDs should be the cornerstone of HIV prevention policies.     

不同营养方式对肝移植术后感染率的影响

目的 :对比不同营养方式下肝移植术后细菌、真菌感染率 ,与感染直接相关的病死率和感染部位分布等情况 ,寻找肝移植术后降低感染率方面更恰当的营养方式。　方法 :对 132例术前营养评估为中、重度营养不良的原位肝移植病人按时间段分为两组 ,第 1组 6 3例 ,术后实行全胃肠外营养 (TPN) 1周 ;第 2组 6 9例 ,术后第 2天起采取部分肠内营养 (EN)加肠外营养 (PN) ,再逐步向完全EN(TEN)过渡 ,比较两组病人细菌和真菌感染率、与感染直接相关的病死率和感染部位分布比例。　结果 :EN加PN组较TPN组病人肝移植术后真菌、细菌、肠道真菌和原发性血行细菌感染率均明显下降 (P <0 .0 5 ) ;EN加PN组与感染直接相关的病死率较TPN组有下降 ,但两组无显著差异(P >0 .0 5 )。　结论 :对于术前合并中、重度营养不良的病人 ,肝移植术后早期应用EN加PN ,再逐步向TEN过渡的方法在预防感染方面明显优于TPN。     

凉山州艾滋病感染相关特征随时间变化趋势

目的 分析凉山州艾滋病感染相关特征随着时间变化的趋势,根据分析结果,提出今后艾滋病检测发现、干预等的建议。方法 从中国疾病预防控制信息系统艾滋病综合防治信息系统,下载凉山州截至2014年底的历史卡片数据库。用Excel2007按现住址、终审时间的统计规则对下载的数据库进行整理,用SPSS18.0分析数据。结果 凉山州的报告病例呈逐年增长趋势。检测来源各年均以强制/劳教戒毒人员/其他羁押人员检测、其他就诊者检测、检测咨询为主,检测来源各年份差异有统计学意义。感染途径各年均以注射毒品传播为主且呈逐年下降的趋势;母婴传播、同性传播、异性传播逐年上升;报告病例20岁以上以注射毒品传播为主,50岁以上病例以异性传播为主,20岁以下以母婴传播为主;男性以注射毒品传播为主,女性以异性传播为主,感染途径各年份、年龄段、性别间差异有统计学意义。结论 凉山州的艾滋病疫情呈快速上升趋势,感染相关特征随时间均有变化,还须进一步拓宽检测来源。