Growth response to antiretroviral treatment in HIV-infected children: a cohort study from Lilongwe, Malawi

Objective  Malnutrition is common in HIV-infected children in Africa and an indication for antiretroviral treatment (ART). We examined anthropometric status and response to ART in children treated at a large public-sector clinic in Malawi. Methods  All children aged <15 years who started ART between January 2001 and December 2006 were included and followed until March 2008. Weight and height were measured at regular intervals from 1 year before to 2 years after the start of ART. Sex- and age-standardized z-scores were calculated for weight-for-age (WAZ) and height-for-age (HAZ). Predictors of growth were identified in multivariable mixed-effect models. Results  A total of 497 children started ART and were followed for 972 person-years. Median age (interquartile range; IQR) was 8 years (4–11 years). Most children were underweight (52% of children), stunted (69%), in advanced clinical stages (94% in WHO stages 3 or 4) and had severe immunodeficiency (77%). After starting ART, median (IQR) WAZ and HAZ increased from −2.1 (−2.7 to −1.3) and −2.6 (−3.6 to −1.8) to −1.4 (−2.1 to −0.8) and −1.8 (−2.4 to −1.1) at 24 months, respectively (P < 0.001). In multivariable models, baseline WAZ and HAZ scores were the most important determinants of growth trajectories on ART. Conclusions  Despite a sustained growth response to ART among children remaining on therapy, normal values were not reached. Interventions leading to earlier HIV diagnosis and initiation of treatment could improve growth response.

Die gestempelten Bronze-Gewichte aus Himera

Bei Ausgrabungen in der antiken griechischen Stadt Himera an der Nordküste Siziliens wurden zwei Bronzegewichte gefunden. Beide zeigen eine Beprägung , die dasselbe Prägebild wie die Rückseite zeitgleicher Litraprägungen aus Himera wiedergeben. Im Jahr 2010 erschien im Münzhandel zudem ein zuvor unveröffentlichtes Bronzegewicht, beprägt mit einem Hemilitron-Rückseitenstempel aus Himera. Anhand dieser gestempelten Bronzegewichte können – unter Einbezug weiterer Quellen – die im letzten Viertel des 5. Jhs. v. Chr. in Himera üblichen Gewichtssysteme für Bronze nachgezeichnet werden: Neben einer überregionalen, kanonischen Bronze-Litra, die bereits früher im 5. Jh. v. Chr. von ca. 108 g auf ca. 216 g im Gewicht verdoppelt worden war, scheint ein regionaler Litrafuß zu ca. 50 g etabliert gewesen zu sein. Dieser den frühesten Bronzemünzen von Himera, Selinunt und Akragas zugrundeliegende Litrafuß existierte auch dann noch, als die Münzen bereits in stark reduziertem Gewicht geprägt wurden.

[Smoking and digestive tract: a complex relationship. Part 2: Intestinal microblota and cigarette smoking]

The digestive tract is colonized from birth by a bacterial population called the microbiota which influences the development of the immune system. Modifications in its composition are associated with problems such as obesity or inflammatory bowel diseases. Antibiotics are known to influence the intestinal microbiota but other environmental factors such as cigarette smoking also seem to have an impact on its composition. This influence might partly explain weight gain which is observed after smoking cessation. Indeed there is a modification of the gut microbiota which becomes similar to that of obese people with a microbiotical profile which is more efficient to extract calories from ingested food. These new findings open new fields of diagnostic and therapeutic approaches through the regulation of the microbiota.