Poly-L-lactic acid for treating HIV-associated facial lipoatrophy: a review of the clinical studies.

Facial lipoatrophy can be associated with human immunodeficiency virus (HIV), impacting severely on quality of life. Various treatments have been investigated, including poly-L-lactic acid (PLLA). Four studies have investigated the efficacy of PLLA in the correction of HIV-associated facial lipoatrophy. The studies: VEGA, Chelsea and Westminster, APEX002 and Blue Pacific involved 50, 30, 99 and 99 patients, respectively, exhibiting HIV-associated facial lipoatrophy. Follow-up ranged from 24-96 weeks. Measures of treatment efficacy included ultrasound and subjective measures. Significant, long-lasting increases in dermal thickness were recorded and in all four studies, a subjective improvement was reported by patients and investigators in facial appearance and quality of life. Treatment was well tolerated. Small, non-bothersome subcutaneous papules were the only device-related adverse events observed. PLLA represents a promising treatment option for HIV-associated facial lipoatrophy. The procedure requires minimal "downtime" and provides long-lasting results without the need for invasive surgery.

[An end to poverty]]. / Halte a la pauvrete]

PIP: The African continent is distinguished by a much higher fertility rate than other regions. Fertility in Africa has remained almost constant at slightly over six children per woman on average, while important declines have occurred elsewhere over the past 25 years. High fertility in Africa is often attributed to poor diffusion of family planning, early marriage, and low female educational attainment, but other cultural and economic factors are involved. The significant decline of infant mortality over the past several decades has produced growth rates never before observed. Africa's very young populations may be at the origin of uncontrollable political disorder, as young persons with bleak prospects fall easy prey to ethnic, religious, and political extremism. Demographic growth has become an additional barrier to development. High fertility is tolerated or encouraged as constituting a cultural trait, but the resulting population growth is not a cultural trait. Demographic pressure has increased environmental problems in many regions. It is estimated that over ten million rural residents of the Sahel have been affected by soil degradation. The per capita availability of arable land fell from one-half to one-third hectare between 1965 and 1987. Shortages of firewood and water have become more common. The relationship between demographic growth, environmental crisis, and poverty in the countryside depends on other factors such as production techniques, modes of access to land and water, and the degree of security of land tenure. Population pressure was not the initial factor that disturbed the balance of the traditional societies, but it exacerbated the effects of other forces such as the introduction of cash crops and monetarization of the economy. Rural exodus and accelerated urban migration have been prompted in large part by the higher incomes and greater availability of services of all types in the cities. Achieving control of fertility in Africa will require stabilization of rural populations, territorial management, and reduction of disparities between rural and urban areas.^ieng

[AIDS and the Third World]. / SIDA et tiers monde.

PIP: A survey of existing knowledge about the etiology, treatment, prevention, and epidemiology of HIV infection and AIDS is presented, with particular emphasis on Africa and the Third World. A brief introduction argues that the impact of AIDS in Africa is likely to be especially severe because of poverty and lack of development. The 1st chapter discusses the HIV virus and its mode of attack on the body's immune system, describes related retroviruses, explains and diagrams how the ELISA, Western Blot, and other diagnostic tests work, and describes the common signs and symptoms of the various stages of HIV infection. The 2nd chapter assesses the prospects for development of a vaccine, the difficulty of determining the lethality of HIV infection after only a few years of experience, and the efficacy of AZT, alpha interferon, and other possible treatments. Existing epidemiologic data, the divergent transmission pattern in different world regions and their recent trends, high risk behavior, the probable future course of the epidemic, and possible social and economic effects of the epidemic are discussed in chapter 3. The following chapter discusses AIDS prevention campaigns, safer sex, condom use, and IEC campaigns for the public, with examples from Kenya, Uganda, Rwanda, the US, and elsewhere. Chapter 5 focuses on the epidemic in Africa. Topics covered include the possible African origin of HIV, the deficiencies of existing epidemiologic data, AIDS control programs in Africa, and special problems in Africa related to the possibility of infection during lactation and the possible dangers of vaccinating children seropositive for HIV. The next chapter sketches a general strategy for AIDS prevention and outlines the role of WHO. The final chapter assesses knowledge of the level of infection in Latin America, the Middle East, Asia and the Pacific, North America, and Western and Eastern Europe.^ieng