Mesure de l’efficacité et de l’observance du traitement antirétroviral chez des patients infectés par le VIH au Cameroun

Objective

The aim of the study was to identify the most useful clinical criteria to measure effectiveness and adherence to antiretroviral treatment in a rural area of Cameroon.

Patients and method

All patients under antiretroviral therapy followed for at least 3 months at the Tokombéré UPEC hospital were eligible. Therapeutic failure was defined according to clinical criteria including weight, Karnofsky's index, or occurrence of WHO stage IV conditions. The criteria for drug adherence were based on patient statement (drugs taken over the last 4 days) and pharmacy-controlled drug delivery. Patient sociodemographic characteristics were collected via a questionnaire.

Results

Fifty-six patients were included, most of whom were at AIDS stage on treatment initiation. The mean duration of antiretroviral therapy was 1 year. 21, 10, and 19% of patients were in therapeutic failure according to “weight”, “Karnofsky's index”, and “WHO stage IV”, respectively. Non-adherence was reported in 5% of patients according to the declarative method and 20% according to pharmacy controlled drug delivery. Weight modification during treatment was significantly correlated with the evolution of Karnofsky's index (p = 0.03). A significant correlation between therapeutic failure and non-observance was only found when using the weight criterion and the declarative method (p = 0.004).

Conclusion

The effectiveness and adherence to antiretroviral therapy can be evaluated by simple clinical criteria. Using these criteria can be recommended in rural areas until access to biological follow-up becomes available in developing countries.     

Comportements alimentaires de l’enfant et attitudes parentales: le point de vue de la psychologie expérimentale

Children show a clear preference, throughout development, for high energy density foods, and particularly for sweet and/or fat products. Most parents disapprove of this behavior, in the present context of high obesity prevalence and widespread acceptance of thinness as a model. Children’s appetite for such foods has adaptive value, so far as the growing child has not lost his/her ability for energy adjustment. A few studies suggest that excessive control over children’s food choices contributes to a loss of the child’s capacity to energy adjustment. Education models that include both the teaching of rules and adjustments to the child’s requests seem to facilitate the acquisition of adequate eating behaviors, which favor a varied diet and body weight control.     

Manifestations extrahépatiques au cours de l’infection par le GBV-C/HGV

The GBV-C/HGV virus has clearly established transmission modes, mainly blood contamination, and occasionally sexual transmission. It is frequently found among transfused patients, intravenous drug abusers, and hemodialysis patients and often associated with HCV. Its hepatic pathogenicity is very weak, marked by a moderate and transitory cytolysis. Chronic carriage is possible, but does not lead to chronic hepatitis. Carriage can be maintained before the virus disappears. The authors report the case of a patient presenting with pleuropericarditis after a blood transfusion without any other etiology than infection by GBV-C/HGV virus. The possible extrahepatic pathogenicity of the virus is suggested. This hypothesis was rarely put forward.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.     

Lieu de contrôle chez les obèses : traduction et première étude de validation de l’échelle du lieu de contrôle du poids de saltzer

The objectives of this study are to enable the use of the concept of locus of control in the treatment of obese subjects and to verify if the presence of an alimentary disorder influences the belief in the weight’s control. The translation and validation in French is also part of the objective. We translated into French Saltzer’s specific scale of Weight Locus of Control (WLOC: weight locus of control) and then examined it’s validity. Then we compared it on general scales of the place of control (IPC of Levenson and SOC-3 of Paulhus). The subjects were both classified according to the presence of eating disorders (ED). A sample of 46 obese women (IMC>30) was tested, 20 of them without ED, and 26 with, associated to the presence ED, according to the criteria of the DSM-IV.The internal validity of WLOC is rather satisfactory. It correlates negatively with internality (IPC), personal control and interpersonal control (SOC-3). ED at the obese subjects are related on the externality of weight control and the externality of personal control. Obese subjects without ED believe more in weight control by themselves and personal control that the obese subjects with ED (Eating Disorders). Finally the scale of weight locus of control (WLOC) remains the most adapted in the treatment and the study of the obese subject.     

Physiopathologie de l’insulinorésistance dans le muscle squelettique et implication des fonctions mitochondriales

In modern societies, decreased physical activity, nutritional transition and aging contribute to the increase in the prevalence of obesity and its associated pathologies (as cardiovascular diseases and type 2 diabetes). Obesity is tightly correlated with insulin resistance, which appears in the early stages of type 2 diabetes. As skeletal muscle is quantitatively the main tissue involved in glucose transport in response to insulin, muscle insulin resistance is a key step in the etiology of type 2 diabetes. Several alterations of skeletal muscle insulin signaling in various models of obesity or type 2 diabetes have been evidenced and numerous underlying mechanisms have been hypothesized. Among them, muscle lipotoxicity, obesity-induced adipose tissue inflammation and oxidative stress following excess of energetic substrates could be involved, independently or synergically, in the development of muscle insulin resistance. Moreover, mitochondrial alterations have been reported in the skeletal muscle of obese or diabetic patients and animals. This suggests that mitochondrion, through its capacity of regulating cellular fatty acids flux and redox state, may play a key role in obesity-induced skeletal muscle insulin resistance.     

Contribution de la biologie moléculaire et de l’antigénémie galactomannane aspergillaire au diagnostic de l’histoplasmose

We report a case of a pulmonary histoplasmosis in an HIV-positive patient usually living in Cambodia, with a positive Aspergillus galactomannan antigenemia resulting from a cross-reaction, that decreased after antifungal therapy. We discuss the potential interest of the detection of fungal DNA by PCR and Aspergillus galactomannan antigenemia for the diagnosis of histoplasmosis, especially in countries where Histoplasma capsulatum antigen testing is not available.