Family physicians and HIV infection.

OBJECTIVE: We aimed to describe the current and desired involvement of family physicians (FPs) in the treatment of HIV patients (screening practices, potential training and patient follow-up) to reduce the duration and frequency of their hospital treatment. MATERIAL AND METHODS: We conducted a descriptive cross-sectional survey between 2011 and 2012 with the support of COREVIH (Regional Coordinating Committee on HIV). We sent a self-assessment questionnaire to all FPs of the Pays de la Loire region to enquire about their HIV screening practices and expectations for the management of HIV patients. RESULTS: A total of 871 FPs completed the questionnaire (response rate: 30.4%). A total of 54.2% said to provide care to HIV patients; the mean number of HIV patients per FP was estimated at 1.4. With regard to HIV screening, 12.2% systematically suggest an HIV serology to their patients and 72.7% always suggest it to pregnant women. About 45.4% of responding FPs said to be willing to manage HIV patients (clinical and biological monitoring, compliance checks and prescription renewal). FPs mainly reported the lack of training and the low number of HIV patients as a barrier to their further involvement in the management of HIV patients. CONCLUSION: The responding FPs provide care to very few HIV patients. They are, however, willing to be more involved in the routine care of these patients. Medical training provided by COREVIH would help improve HIV screening. The management of HIV patients could thus be handed over to willing FPs.

Monoclonal antibody production in semi-continuous serum- and protein-free culture. Effect of glutamine concentration and culture conditions on cell growth and antibody secretion.

We have recently shown that the semi-continuous cultivation of a mouse hybridoma line in spinner flasks, with a basal defined medium (BDM) devoid of serum and protein, increases the secretion of the immunoreactive monoclonal antibody (MAb) by a factor of ca. 2.4, compared to culture in flasks with serum-containing medium (Schneider, 1989). To further optimise MAb production, we have now investigated the composition of BDM and the mode of cultivation. Hybridoma cells were inoculated at 0.3 x 10(6) cells/ml in 200 ml of BDM containing 4, 6 or 8 mM glutamine; after 3-4 days (when the cell density reached greater than or equal to 10(6) cells/ml) 20, 40, 60 or 100% of the culture medium were replaced daily by fresh nutritive BDM with or without 33, 66 or 100% cell recycling. Daily, over a total period of 15-16 days, viable cells were counted and the concentration of the MAb, of glucose and glutamine (the main nutrients) and of lactate, alanine and ammonia (the main metabolites) were assayed. These experiments indicate that to provide optimal cell growth and MAb production: (i) the concentration of glutamine in the nutritive medium should be maintained at 8 mM, otherwise it falls on some days to 0 with a significant amount of cell death; at 25 mM, glucose concentration is not a limiting factor, whatever the culture conditions; (ii) with a semi-continuous mode of cultivation, a perfusion rate of 40%/day appears optimal; without cell recycling, a rate of 20% does not provide enough nutrients and/or does not remove enough metabolites, whereas a rate of 60% washes over the cells; with cell recycling, rates of 60 (moderately) or 100% (considerably) increase cellular metabolism without concurrent augmentation of MAb secretion; (iii) the recycling of the cells increases the mean cell densities and the rate of production of the MAb, as well as the rate of consumption of nutrients and of production of metabolites; recycling of 33-66% is optimal, since the total recycling progressively raises the number of dead cells and debris; (iv) there are maximal values for cell densities (ca. 2.5 X 10(6) cells/ml) and MAb production (ca. 26 micrograms/10(6) cells X day) as well as for nutrient consumption and metabolite production (except with a very high perfusion rate).(ABSTRACT TRUNCATED AT 400 WORDS)