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.

Das Werk als Feige und als Figur. Ambivalenzen der Rezeption zwischen Valéry, Mallarmé, "Tel Quel" und Francis Ponge

L’œuvre poétique de Valéry est caractérisée par une esthétique de la perfection, de la pureté et de la clôture. La série ouverte et hétérogène des "Cahiers", en revanche, ne se laisse guère ranger dans la catégorie de l’œuvre. Selon Valéry, la réorientation intellectuelle à la base de cette opposition est due au "choc" subi par la découverte de l’œuvre mallarméenne. Les divers écrits valéryens sur Mallarmé nous servent à reconstruire cette relation ambivalente et nous aident à éclairer sa conception non moins ambivalente de l’œuvre d’art. Nous soutenons que ce ne sont pas ses propres travaux, mais les poésies de Mallarmé qui lui semblaient des œuvres achevées à proprement parler. Pour décrire l’expérience de perfection et d’achèvement que lui fournit la lecture du "Coup de dés", Valéry se sert de la notion de figure qui, entre autres, comporte des associations géométriques. Sous la forme d’un hommage ambivalent, Francis Ponge oppose aux concepts valéryens de figure et d’œuvre d’art une poétique de l’objet matériel et concret qui s’incarne dans "La figue (sèche)", publiée en 1960 comme pièce inaugurale de la revue "Tel Quel".