Prevalence of malnutrition in children under five and school-age children in Milot Valley, Haiti.

OBJECTIVES: This research aims to provide child malnutrition prevalence data from Haiti's Milot Valley to inform the design and implementation of local health interventions. STUDY DESIGN: This cross-sectional study measured underweight, stunting, and wasting/thinness using international growth standards. METHODS: Anthropometric measurements (height/length and weight) were taken on a convenience sample of 358 children aged 0-14 years. Participants were recruited through door-to-door field visits at five recruitment sites in the Milot Valley, including individuals in the waiting area of the Pediatric Outpatient Clinic at Hôpital Sacré Coeur. Caregivers were asked questions about the child's health history, including past and current feeding practices. RESULTS: Combining moderate and severe forms of malnutrition, 14.8% of children under five were stunted, 15.3% were wasted, and 16.1% were underweight. Among children 5-14 years of age, 14.1% were stunted, 7.6% were thin (low body mass index (BMI)-for-age), and 14.5% were underweight. For children under five, 42% of mothers ended exclusive breastfeeding before the recommended six months. CONCLUSION: This study illustrates the local magnitude of childhood malnutrition and can serve as a resource for future child health interventions in the Milot Valley. To fight malnutrition, a multipronged, integrated approach is recommended, combining effective community outreach and monitoring, inpatient and outpatient nutrition therapy, and expanded partnerships with nutrition-related organizations in the region.

The association of HIV viral load with indirect markers of liver injury.

This study assessed the association of HIV RNA with indirect markers of liver injury including FIB-4 index, liver enzymes and platelet counts in a high-risk Hispanic population. The data were derived from a prospective study that included 138 HIV/hepatitis C (HCV)-coinfected and 68 HIV-infected participants without hepatitis C or B co-infection (mono-infected). In unadjusted analyses, detectable HIV viral load (vs undetectable, <400 copies/mL) was associated with a 40% greater odds (OR 1.4, 95% CI: 1.1-1.9, P = 0.016) of FIB-4 > 1.45 in the HIV/HCV-coinfected group and 70% greater odds of FIB-4 > 1.45 (OR 1.7, 95% CI: 1.0-2.8; P = 0.046) in the HIV-mono-infected group. In multivariable analyses, a 1 log(10) increase in HIV RNA was associated with a median increase in FIB-4 of 12% in the HIV/HCV-coinfected group and 11% in the HIV-mono-infected group (P < 0.0001). Among the HIV/HCV-coinfected group, the elevating effect of HIV RNA on FIB-4 was strongest at low CD4 counts (P = 0.0037). Among the HIV-mono-infected group, the association between HIV RNA and FIB-4 was independent of CD4 cell counts. HIV RNA was associated with alterations in both liver enzymes and platelet counts. HIV antiretroviral therapy was not associated with any measure of liver injury examined. This study suggests that HIV may have direct, injurious effects on the liver and that HIV viral load should be considered when these indirect markers are used to assess liver function.

The individual and combined influence of HIV and hepatitis C virus on dyslipidaemia in a high-risk Hispanic population.

OBJECTIVES: To assess the effects of chronic hepatitis C (HCV) and HIV infection on dyslipidaemia in a Hispanic population at high risk of insulin resistance. METHODS: We compared serum lipids and C-reactive protein (CRP) in 257 Hispanic adults including 47 HIV- mono-infected, 43 HCV-mono-infected and 59 HIV/HCV-co-infected individuals as well as 108 healthy controls. We also assessed the effect of HCV on lipid alterations associated with antiretroviral therapy (ART), and the impact of HCV and HIV on the associations among insulin resistance, triglycerides and cholesterol. RESULTS: HCV infection was associated with lower total and low-density lipoprotein (LDL) cholesterol, but not high-density lipoprotein (HDL) cholesterol or triglycerides compared with healthy controls. HIV infection was associated with higher triglycerides and lower HDL, but not total or LDL cholesterol. HCV mitigated the elevation of triglycerides associated with ART. In healthy Hispanic adults, insulin resistance was significantly correlated with higher triglycerides, CRP and lower HDL. HIV infection nullified the association of insulin resistance with triglycerides and HDL, and the association of triglycerides with LDL. HCV infection nullified the association of insulin resistance with triglycerides, HDL and CRP. CONCLUSIONS: HCV co-infection alters the profile of HIV-associated dyslipidaemia. The clinical significance of these findings for cardiovascular complications in HIV merits further study.

Predictors of insulin resistance among Hispanic adults infected with or at risk of infection with the human immunodeficiency virus and hepatitis C virus.

Both the human immunodeficiency (HIV) and hepatitis C (HCV) viruses have been associated with insulin resistance (IR). However, our understanding of the prevalence of IR, the underlying mechanisms and predisposing factors is limited, particularly among minority populations. We conducted a study of 333 Hispanic adults including: 76 HIV monoinfected, 62 HCV monoinfected, 97 HIV/HCV co-infected and 98 uninfected controls with a specific focus on HCV infection and liver injury as possible predictors of IR. IR was measured using the Quantitative Insulin Sensitivity Check Index (QUICKI). The majority (55-69%) of participants in all groups had QUICKI values <0.350. Body mass index was associated with IR in all groups. Triglycerides were associated with IR in the uninfected control group only (-1.83, SE = 0.58, P = 0.0022). HCV was associated with IR in participants infected with HIV (-0.012, SE = 0.0046, P = 0.010). Liver injury, as measured by score to assess liver injury (FIB-4) score, was significantly associated with IR independently of HCV infection (-0.0035, SE = 0.0016, P = 0.027). In the HIV/HCV co-infected group, treatment with nucleoside reverse-transcriptase (RT) inhibitors plus non-nucleoside RT inhibitors (-0.021, SE = 0.080, P = 0.048), but not protease inhibitors (-0.000042, SE = 0.0082, P = 0.96) was associated with IR. HCV infection and antiretroviral agents, including nucleoside RT inhibitor plus non-nucleoside RT inhibitor treatment are contributors to IR in HIV infection. Liver injury, as measured by the FIB-4 score, is a predictor of IR independently of HCV infection.

Drug use and weight loss in HIV-infected Hispanic men.

Weight loss is an independent risk factor for mortality in HIV but the role of drug use in HIV-related weight loss is not well described. We conducted this study to determine the role of drug use in HIV-related weight loss. Men (n=304), all of whom were Hispanic, were recruited into one of three groups: HIV-infected drug users; HIV-non-infected drug users; and HIV-infected non-drug users. Body mass index (BMI) was measured at successive visits. The groups were re-categorized based on self-reported drug use at the current visit into: (1) users of cocaine alone; (2) users of cocaine and opiates; (3) users of opiates alone; (4) former drug users; and (5) those who denied ever using drugs (all HIV-infected). The effect on BMI of the duration of use of the specific drug types was evaluated using repeated-measures analyses. Longer duration of exclusive opiate use or mixed cocaine and opiate use did not affect BMI in the men, regardless of HIV status. Exclusive cocaine use was associated with a decline in BMI among HIV-infected men (-0.070 kg/m(2) per month duration of use; SE=0.033; p=0.037) but not among HIV-uninfected men (0.024 kg/m(2) per month; SE=0.023; p=0.29). Adjustment for marijuana, cigarette and alcohol use in all men, or for CD4 count, viral load or HIV medication use in the HIV-infected men, did not alter the conclusions. We conclude that the use of opiates or combined opiates and cocaine does not increase the risk of weight loss in the presence or absence of HIV infection. Exclusive cocaine use may exacerbate weight loss in HIV-infection.

Fat distribution in relation to drug use, human immunodeficiency virus (HIV) status, and the use of antiretroviral therapies in Hispanic patients with HIV infection.

Human immunodeficiency virus (HIV)-associated fat-redistribution syndrome is still a subject of controversy. There is, as yet, little agreement on the definition, etiology, and prevalence of the syndrome. Many studies have examined medication or disease-related factors. Fewer studies have examined patient-related factors. Illicit drug use is an important risk factor for HIV infection, yet the role of drug use in fat distribution has not been well described. We examined fat distribution, measured by dual energy x-ray absorptiometry, in relation to drug use, smoking, and alcohol use in Hispanic patients with HIV infection and control group of HIV-negative drug users. Our results suggest that neither drug use nor alcohol consumption are predictors of fat distribution. However, among men, smoking was independently associated with less total fat, less trunk fat, and more appendicular fat. The role of patient-specific factors in the etiology of HIV-associated fat-redistribution syndrome warrants further investigation.

Weight and body composition in a cohort of HIV-positive men and women.

OBJECTIVE: At issue is whether weight loss in HIV infection is a cachectic process, characterised by loss of lean body mass with conservation of fat, or a process of starvation. We present data on body composition from 516 persons at different stages of HIV infection as determined by CD4 counts. DESIGN: Cross-sectional analyses of body composition in relation to CD4 count. SETTING: The baseline data from a prospective cohort study of outcomes in HIV/AIDS in relation to nutritional status in Boston, Massachusetts, USA. SUBJECTS: : The first 516 subjects with HIV/AIDS to enroll in the study. RESULTS: Differences in weight in relation to CD4 counts were present only at CD4 counts of 600 or less (slope below : 1.9 kg per 100 CD4 cells, On average, 68% of the difference in weight over CD4 counts was fat (slope: 1.3 kg fat per 100 CD4 cells, CONCLUSIONS: This cross-sectional analysis suggests that weight loss consists principally of fat loss in those persons with adequate fat stores. This observation will need to be confirmed in longitudinal analyses.

Body composition and dietary intake in relation to drug abuse in a cohort of HIV-positive persons.

We examined the relationships between drug abuse, weight, body composition, and dietary intake in persons infected with HIV in a cross-sectional analysis of baseline data from a longitudinal study of nutritional status and HIV. Body composition was measured by bioelectrical impedance analysis. Dietary data were collected by 3-day food records or 24-hour recalls. We analyzed data from 39 current intravenous drug users (IVDU), 103 past intravenous drug users (past-IVDU), 239 users of nonintravenous drugs (users-NIVD), and 61 nonusers (reference category). In the men, there were no differences in weight, body mass index (BMI), or body composition among the drug-use groups. In the women, there was a trend to lower weight and BMI across the drug use categories: IVDU women had lower average weight (-13.7 kg; p = .006), BMI (-5.6 units; p = .003) and less fat mass than non-users (-9.8 kg; p = .0001). In women, drug users had higher weight-adjusted energy intakes than nonusers, whereas in the men both drug using groups, NIVD and IVDU, had higher energy intakes than nonusers. These data suggest that intravenous drug-abuse is associated with lower weight and fat mass in women with HIV infection despite adequate self-reported energy intake.

Prescribing and emergency admissions for heart failure in greater Glasgow.

BACKGROUND: We sought to determine whether there is an association between the rate of prescription of angiotensin-converting enzyme (ACE) inhibitors and the rate of hospitalization for heart failure. METHODS AND RESULTS: We conducted a cross-sectional study linking prescribing data with hospital admission data from 215 primary health care practices in Greater Glasgow, United Kingdom. We obtained numbers of prescriptions of diuretics. ACE inhibitors, and digoxin and numbers of admissions for heart failure. The mean practice rate of diuretic prescription was 0.7 per patient per year, the mean practice rate of ACE inhibitor prescription was 0.06 per patient per year, the mean practice rate of digoxin prescription was 0.09 per patient per year, and the mean practice rate of admission for heart failure was 3.29 per 1,000 patients per year. There was a strong and significant association between the rate of diuretic prescription and the rate of digoxin prescription. There was only a moderate inverse association between the ratio of ACE inhibitor to diuretic prescriptions and the rate of admissions for heart failure. CONCLUSIONS: ACE inhibitors are underused. Rates of diuretic and digoxin prescriptions correlate strongly and are presumably both markers for similar cardiovascular morbidity. There was no evidence that ACE inhibitors modulated the rate of heart failure admissions.

Randomised trial of albendazole and pyrantel in symptomless trichuriasis in children.

BACKGROUND: We aimed to find out whether symptomless infection with Trichuris trichiura is associated with impairment of growth and to assess the effect of a multiple-doses regimen of anthelmintic drugs on the growth of children. METHODS: In a community based trial, 622 Mexican children were randomly allocated one of three treatment regimens: 3 days of albendazole 400 mg daily (high efficacy); one dose of albendazole 400 mg (moderate efficacy); one dose of pyrantel (pyrantel embonate) 11 mg/kg (low efficacy). Growth was monitored for 12 months. Analyses were by intention to treat. FINDINGS: 113 (18%) children were lost to follow-up--34 from the pyrantel group, 45 from the albendazole 400 mg group, and 34 from the albendazole 1200 mg group. Among the 127 children with heavy pretreatment infections, albendazole 1200 mg was better than pyrantel in terms of an increase in arm circumference (mean 0.26 cm, p=0.044). Among the 381 children with low pretreatment levels of infection, changes in weight (mean difference between groups -0.33 kg, p=0.036), arm circumference (-0.18 cm, p=0.0095), and thickness of triceps skinfold (-0.41 mm, p=0.0031) were less in children on albendazole 1200 mg than in those on pyrantel. INTERPRETATION: Symptomless trichuriasis impairs growth and albendazole or pyrantel may affect growth, independently of a therapeutic action on parasites. Possible toxic effects of high-dose albendazole require further investigation.

Measurement of Ascaris lumbricoides infection intensity and the dynamics of expulsion following treatment with mebendazole.

Intensity of Ascaris lumbricoides infection was measured in terms of egg counts and worm burden in children 2-10 years of age. The expulsion of A. lumbricoides with a 3-day treatment of mebendazole occurred over 8 days, beginning on the second day of treatment. Ninety-seven percent of the worms were expelled between the second and seventh days. A rapid means of estimating eggs per gram (epg) by the Kato Katz technique correlated well with the method described by Martin & Beaver (1968). In spite of apparent density dependence in egg production, A. lumbricoides egg counts correlated well with worm burdens. It is concluded that, within the context of community surveys, epg is a reasonable means of identifying heavily infected individuals and that epg can be estimated rapidly by a slight modification to the standard Kato Katz technique.

Predisposition of individuals and families in Mexico to heavy infection with Ascaris lumbricoides and Trichuris trichiura.

Stool specimens from 90% of the population of 2 marginal communities in Coatzacoalcos, Mexico, were examined by the Kato-Katz technique for the estimation of eggs per gram of faeces (epg). Average epg values for Ascaris lumbricoides and Trichuris trichiura were calculated for each family in the community, based on the arithmetic mean epg of family members for each parasite. 39 families were classified as either lightly or heavily infected with A. lumbricoides and infected members were treated with mebendazole. A. lumbricoides expelled following treatment were collected from the children 2-10 years of age, and reinfection was monitored monthly for 6 months. At the end of the reinfection interval, a final stool specimen was collected from all family members and those infected were treated. Again, A. lumbricoides expelled by the children 2-10 years of age were collected. There was a significant correlation between the number of A. lumbricoides expelled by the children at the first and second treatments as well as in epg values before the first and second treatments for both A. lumbricoides and T. trichiura in children (2-10 years) and adults (greater than 19 years). At the family level, there were significant correlations between the values of family mean epg before each treatment for both A. lumbricoides and T. trichiura.

Age-related differences in prevalence and intensity of Trichuris trichiura in sensory impaired children from two schools in Guatemala.

A survey of 102 blind and 218 deaf children in 2 specialized schools in Guatemala revealed distinctly different age-intensity profiles of infection with the intestinal helminth, Trichuris trichiura. In the school for the deaf, intensity (measured as eggs per gram of stool) peaked in the children 7 to 8 years old and dropped to very low average levels in the teenagers. By contrast, in the school for the blind, the intensity of T. trichiura remained low until the early teens. Intensity peaked in the age group 13 to 14 years old, and then decreased in the 15 to 17 years old pupils. Behavioural differences between blind and deaf children, or differences between the schools, may have contributed to this differential pattern of infection.

Clustering of Ascaris lumbricoides and Trichuris trichiura infections within households.

A survey of 428 households in a shanty town in Coatzacoalcos, Mexico, revealed high prevalences of Ascaris lumbricoides and Trichuris trichiura. The data were analysed separately for A. lumbricoides and T. trichiura in order to investigate the spatial distribution of heavy infections through the town. Within each age class, those individuals with egg counts in the upper 20% of the range for that age were classified as "heavily infected". When the data were stratified by household size, it was found that the distribution of "heavily-infected" individuals was not random in the community. "Heavily-infected" individuals were found together in households; fewer household units had a single heavily-infected individual than would be expected by chance. Such a pattern could result either from genetic similarities among family members influencing their ability to mount an effective immunological response to infection, or focal transmission in the vicinity of the home, or both. This result may have important implications for the development of community control programmes.