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Currently, AIDS still kills thousands of people. Researchers move slowly in their draft vaccine against AIDS, there is great hope but no promises can be issued. Today, WHO has issued a new treatment strategy to improve certain aspects of management ...
AIDS or acquired immunodeficiency syndrome is a disease secondary to infection with HIV. It is characterized by the progressive deterioration of the immune defense of the body, leading to the onset of many diseases and opportunistic infections.

The disease AIDS is the final stage of the evolution of HIV infection and moved after several years (between 10 to 15 years). It is at this stage that appear all signs and opportunistic diseases that reflect the weakened immunity such as tuberculosis, Kaposi's sarcoma or herpes infections.

Currently, there is still no specific treatment that can cure AIDS. Retroviral triple therapy have essentially improved the health of many sick people. However, if their effectiveness is discussed, their cost is often a barrier to starting an effective management, especially in developing countries. While the treatment requires regular drug intake and long-term in order to avoid the phenomenon of resistance viruses.

Furthermore, for the prevention, the initiative is launched and vaccine research is still ongoing, but researchers make no promises about it.

Today, new guidelines were issued by the World Health Organization concerning the early management of the disease. If before, the treatment does not usually starts from the knowledge of HIV today, the WHO recommends that all HIV-positive people are treated early, even before the infection lead to AIDS-stage disease. In fact, according to studies validated by WHO, early treatment of people with HIV can lengthen life but also to avoid the facilitation of contamination in others. According to the same recommendations, all persons at risk should also receive specific support such as children under five years of age, pregnant or lactating women with HIV, the partner is HIV positive and HIV-positive people with virus infections Hepatitis B.

HIV positive or negative? We all know these words, often related to AIDS, yet there are several infections that can be detected by serology. But how does it work? The detection of antibodies and antigens information on our immune status ....

What is serology?

Serology is an examination of the blood serum. It is to detect and investigate antibodies to a specific disease present in the serum, while reflecting the immunity of the individual. The study of these antibodies is an indication of the presence of a pathogen in the body. These are antibodies that correspond to specific antigens. These antibodies are called immunoglobulins.

When effect of  serology?

Serology is performed mainly for

screening,

diagnosis (an autoimmune disease, for example),

follow the evolution of a disease,

assessing the efficacy of vaccination.

However, serology can be performed for certain infectious diseases.

The main immunoglobulins involved in the immune response are the immunoglobulin G (IgG), lesimmunoglobulines A (IgA) and immunoglobulin M (IgM). The presence of IgG usually means an old infection. Active infection is usually shown by the existence of IgM.

the result

When serology is positive, it is called an HIV-positive person to infection. Otherwise, it is called a negative person.

Seropositivity means the presence of specific antibodies to an infectious disease in the blood. This antibody may reflect a former contact with the pathogen but may also sign the existence of a progressive disease.

The prevalence of hypercholesterolemia was 13% in children infected with the AIDS virus (HIV) seems to be significantly associated with protease inhibitors, according to a study published in the journal "JAIDS".


Perinatal exposure to HIV affects cholesterol
The team of John Farley followed 1,999 children aged 4 to 19 years of HIV + and having suffered perinatal exposure to the virus, including 1812 were eventually infected.

Among HIV + children, 13% (229) had hypercholesterolemia according to the criteria of the NHANES III using standard for age, sex and ethnicity, compared to 9% of HIV-children.

Similarly, 22% of HIV + had a cholesterol level greater than 2 g / l against 9% and 12% HIV-cholesterol levels greater than 2 g / l against 4% of HIV.

The cholesterol associated with low viral load
A low viral load as a high CD4 count were significantly associated with high cholesterol.

Children who have normal cholesterol levels have higher viral loads (2164 copies / ml) than children with hypercholesterolemia (mean viral load below 400 copies / ml).

Children with a viral load less than 400 copies / ml and present, in this cohort, a three times higher risk of developing high cholesterol.

Each increase of one log 10 RNA corresponds to a decrease in the risk of high cholesterol by 50% and each increase of 100 cells / ml or 10% of CD4 increases the risk of 7% and 21% respectively.

Hypercholesterolemia associated with protease inhibitors
Treatment with protease inhibitors (PIs) is significantly associated with high cholesterol, unlike treatment with nucleoside reverse transcriptase inhibitors (IN). The prevalence of hypercholesterolemia and five times higher in the IP + over-IP (17% vs 3%).

As for non-nucleoside inhibitors (INN), if the prevalence of hypercholesterolemia is greater (16% vs. 11%), it seems, once again, due to the associated IP use.

It is in fact only 2% for INN-/IP- treatments, 6% for INN + / IP, 15% for INN-/IP + and 20% for + / IP + INN. It also increases with the number of IP included in the treatment (20% with at least 2 IP) but instead the duration of treatment did not affect the prevalence.

Finally, adherence to HAART increases the risk of high cholesterol. "Children who have reached the goal virological have the highest prevalence of hypercholesterolemia (24%)," the authors write, which, according to them, the need for careful monitoring lipid.

The youngest, the most affected
In addition, a link appears with the young, which "suggests that neither viremia nor the age of the HIV infection are independent risk factors for high cholesterol," they add.

However, "although it is reassuring to know that high cholesterol is not associated with other cardiovascular risk factors such as obesity or hypertension in children infected with HIV, it is quite alarming to note that are younger patients with a longer duration of exposure, which are most likely to develop high cholesterol, "the authors note.

"The risk of high cholesterol should be considered in the choice of initial antiretroviral therapy, monitoring of lipid is clearly indicated in children infected perinatally treated with IP," they conclude.

Since the advent of HAART, pregnancy is associated with a lower risk of progression of HIV infection, according to a U.S. study published in the Journal of Infectious Diseases.

Circumcision halves the risk of contracting human immunodeficiency virus (HIV), confirms US-Kenyan study published in the edition of the "Journal of Infectious Diseases."

In this study, Jared Baeten and American and Kenyan colleagues followed, between 1993 and 1997, 745 men employed by a trucking company in Mombasa, in which they controlled HIV status and circumcision.

Throughout the investigation, the men were asked about their sexual activity with three different partners (wives, casual partners, prostitutes) and were tested for HIV and other sexually transmitted infections. Then, at the end of study, the researchers calculated the probability of HIV infection in all three groups.

The likelihood of contracting HIV from a single act of intercourse has been estimated at 1 in 160 for all men.

This result is quite unexpected since the only studies on the subject showed a risk of transmission of HIV from one to 1,000 or less, a far from that calculated by the team of Jared Baeten rates. This explains this difference by the fact that, in the study that publishes several types of sex were taken into account, while others were conducted with discordant monogamous couples.

In addition, the authors observed a significant difference between circumcised and uncircumcised men, the latter having a higher risk than twice as likely to be infected, compared to the first (1/80 against 1/200).

This result confirms that obtained in previous studies, but it is only to take account of cultural characteristics that may influence the differences in sexual behavior, differences that may play a role in the risk of infection, the authors note. However, it appears that cultural differences in sexuality have no effect, and only being circumcised or not has an impact on the risk of being infected.

Considering that the rate of HIV transmission from a woman to a man can be more than twice as high if men are circumcised, and it is also significantly higher for multiple relationships are not followed, This may help explain why the virus spreads so rapidly in some parts of Africa and to define new strategies for prevention of infection, the authors conclude.

The advent of HAART has reduced the rate of HIV transmission from a mother to her twins, bringing the observed level in single pregnancies, according to a French study published in Aids.

The Institute of Health recommends looking for lymphogranuloma venereum, whose emergence in France is confirmed in every male patient with signs of proctitis, in a study published in the Weekly Epidemiological Bulletin (BEH) on the theme of infections sexually transmitted diseases and HIV.


Actions to prevent sexually transmitted infections
InVS goes further in its recommendations, and proposes to set up a screening of some sexually transmitted infections, such as syphilis, HPV, HSV and gonorrhea in the clinical management of HIV-positive patients for HIV.

In their study of lymphogranuloma venereum (LGV), Magid Herida and colleagues point out that the STI is the subject of a European warning from the European Surveillance of STI (ESSTI) alleging fifteen cases grouped in Rotterdam. This alert led InVS to conduct investigations in France, which had identified 38 cases and track the clinical history of 14 of them.

A campaign to inform health care professionals most concerned (proctology, infectious disease specialists, dermatologists) was then business, and prevention activities were conducted in the community meeting places, involving the target population.

Finally, the sentinel surveillance system had been strengthened in January 2005, including the distribution of a self-administered questionnaire containing questions about sexual practices that could be at the origin of the LGV.

Confirmation of the emergence of LGV
Little use because of the low response rate, the data from this survey, however, does not allow to speculate on the transmission of LGV, the authors lament.

Only quantitative data collected by the centers participating in the monitoring could therefore be analyzed. They have reported 104 cases of rectal LGV in 2004 and 118 cases in 2005, a number certainly underestimated after InVS.

The shape of the epidemic curve thus refers to the emergence of rectal LGV in France since 2004 and a persistent infection in 2005, the authors conclude, adding that the cases are concentrated mainly in the Ile-de-France.

Those affected are exclusively men who have sex with men, HIV infection for the majority and also with another STI at diagnosis.

All patients were symptomatic with syndromes involving anal rectal discharge, anal or rectal ulceration.

The authors therefore recommend asking early diagnosis of HIV infection in order to avoid complications of untreated LGV and to interrupt the chain of transmission. They advocate the "testing and research of LGV among all male patient with signs of proctitis," all that "patients with rectal LGV are often co-infected with other bacteria."

According to them, "prevention campaigns stressing the need for safe sex remains essential, especially with the gay community."

Three-quarters of HIV-positive women were infected through heterosexual contact, against just over a third of men, according to the assessment of compulsory notification of HIV and virological surveillance.

Mode of transmission of HIV
1843 notifications were recorded by the Institute of Health Surveillance (VS). Only 1301 were analyzed, the detailed results were published in the Weekly Epidemiological Bulletin says InVS in a statement.

Data already allow that the proportion of women has now reached 43% of new diagnoses of HIV infection. Women are screened at 33 and a half years on average, at an earlier age than men (39 and a half years).

More than half of new infections involve people infected through heterosexual intercourse, and 21% homosexual. The IDU is responsible for only 3% of new infectious cases.

Women are much more affected than men by heterosexual contamination: 74% of new cases, almost all cases in which the mode of transmission was documented, have been using this method, against 37.2 % of men. A similar proportion of them was infected through homosexual.

In addition to being a woman, that they are from sub-Saharan Africa also appears to be a risk factor for contracting HIV through heterosexual sex. Nearly half of those infected in this way are of Cameroonian nationality, Congo, Ivory Coast and Congo, against 31% of French nationality.

At diagnosis, 36% of people were in occupation, 39% and 6% inactive unemployed.

In one third of cases, the diagnosis of HIV infection was made after the onset of clinical signs may be associated with an early or late stage of infection. Women were screened in 20% of cases during pregnancy.

The majority of diagnoses related asymptomatic individuals. However, 15% of patients have discovered their HIV status to a non-symptomatic stage AIDS, 12% at the AIDS stage and 8% at the stage of primary infection. Homosexuals are more likely than heterosexuals to discover their condition at the time of primary infection, but less so to discover an asymptomatic stage. Drug users are the category for which screening is most often held at the AIDS stage.

The infection was new in 38.4% of cases, mainly in children under 40 years, homosexuals (58%) and individuals of French origin (50% against 26% for those from sub-Saharan Africa).

Serotyping shows a predominance of HIV-1 from HIV-2, which was found only in 3.2% of those infected. Among the HIV-1 infections, the majority of cases are due to subtype B. This is even more true that those infected are women under the age of 40 years and infected through heterosexual contact. Infections with group O represents only 0.3% of cases documented.

Increased incidence of AIDS through homosexual
After reaching the peak of AIDS in 1994 with nearly 5,800 diagnoses, a dramatic decrease was observed in 1996 and 1997 with the introduction of powerful antiretroviral associations. In 2002, the incidence was close to 1,600 cases in 2002, and the first data collected in 2003 (904 cases) let "fear greater than in previous years under-reporting," the authors fear.

They have in fact, for the first time, found a rise in the incidence of AIDS-related contamination through homosexual compared to previous years, the authors note.

However, new cases registered between 2000 and 2002 are mainly heterosexual AIDS. Moreover, in 2003, a case of AIDS two for a person infected through heterosexual contact, a little more than a quarter way through homosexual and 11% by injection drug use.

As was already mentioned above, the increase in the incidence of cases due to heterosexual transmission is mainly due to a sharp increase in people from sub-Saharan Africa. This upward trend is also observed in the Haitian people.

Half of those with a diagnosis of AIDS was made unaware of their HIV status at diagnosis and 22% knew but had not received antiretroviral treatment before the diagnosis of AIDS. This lack of knowledge was higher among people of sub-Saharan Africa.

Men who have sex, the prevalence of human papillomavirus infection is important for all age groups as it peaked around 30 years before declining among women, say the authors of a study published in the "Journal of Infectious Diseases."

The use of rapid tests for HIV is extended to all providers, including GPs, to generalize the screening the entire population, said Professor Gilles Pialoux, chief of infectious diseases Tenon Hospital, during a press conference in Paris.

Rapid HIV tests allow, from a drop of blood from the fingertip to know their HIV status in less than five minutes. These tests are considered as a means of reforming the screening and reduce the number of people unaware of their HIV status (estimated at 50,000 in France), one of the key objectives of the AIDS Plan 2010-2014.

According to an order, these tests are allowed after an accidental exposure to blood or sexual or suggestive to acute pathology of AIDS stage, during childbirth (when the woman of unknown HIV status or has been exposed to risk since the last screening) or to administer as soon as a preventive treatment of mother to child transmission.

Beyond these four emergency situations, the use of rapid tests will be expanded on the subject, which should lead to a "trivialization of screening," said Gilles Pialoux. The tests can then be used in anonymous testing centers and free (CDAG), as well as the entire system of care, including GPs and emergency departments.

Anyone aged 15 to 70 years may request a screening doctor who will also be encouraged to suggest to his patients. The aim is not only to reduce the number of people with HIV are unaware of their infection, but also to regress delays in diagnosis and therapeutic management, and therefore reduce the risk of transmission.

Until now, "nearly 50% of diagnoses of HIV infection are late diagnosis, an unacceptable level due to limited access to screening," said infectious disease specialist before discussing the too frequent cases of people which is offered testing because of clinical signs of a highly depressed immunity. For those living with HIV, it is a lost opportunity to receive effective treatment.

"Early detection will also reduce the rate of people, estimated at 20%, is not returning for their results a week after a levy in the CDAG," said Gilles Pialoux.