The advent of highly active antiretroviral therapy (HAART) has decreased the morbidity and mortality of HIV but has been associated, in some studies, with an increased metabolic burden and vascular injuries in Caucasians, Asians and people of African origin. However, there is now controversy surrounding the cardiometabolic consequences of HAART as it has been proven that HIV infection alone causes increased visceral fat accumulation, diabetes, insulin resistance and HIV-induced vasculopathy. In some case reports, early timing of HAART altered the evolution of the latter, which includes cerebrovascular injuries, peripheral vascular disease, aortic lesions, vasculitis and hypertension. We aimed here to evaluate the metabolic and vascular correlates of different durations of HAART in HIV-infected Cameroonian patients attending a certified HIV clinic in this self-resource limited area. This is a single center cohort study carried out at the Yaoundé Central Hospital. We recruited 143 unselected, consecutive HIV-infected patients. Anthropometry, free fat mass (FFM, measured by bioimpedancemetry), lipid profile, fasting blood glucose (FBG), insulin sensitivity (measured using the short insulin tolerance test) and lipids levels were measured. Patients were 72% women distributed in 4 intervals of HAART duration: treatment-naïve (n=28), 1-13 months (n=44), 14-33 months (n=35) and 34-86 months (n=36). Their mean age was 39.5 (SD: 9.8 yrs) and 52% were on a stavudin-containing regimen. Systolic (p=0.04) and diastolic (p=0.03) blood pressures, and prevalence of hypertension (p=0.04) were significantly increased with HAART duration. While hypercholesterolemia (p=0.007), body mass index and waist to hip ratio (both p = 0.02) were also increased with HAART duration, FFM, triglycerides, FBG and insulin sensitivity were unaffected. In a small sized analysis, insulin-resistant patients (lower tertile of KITT) had lower BMI (p=0.009), FFM (p<0.01) and waist circumference than insulin-sensitive patients. Higher blood pressure levels are associated with HAART duration together with hypercholesterolemia, obesity and fat distribution. However, our study did not find a significant relationship between HAART-induced hypertension, FFM and glucose metabolism.

Background Malnutrition is a major global public health issue and its impact on communities and individuals is more dramatic in Sub-Saharan Africa, where it is compounded by widespread poverty and generalized high prevalence of human immunodeficiency virus (HIV). Therefore, malnutrition should be addressed through a multisectorial approach, and malnourished individuals should have access to nutritional rehabilitation molecules that are affordable, accessible, rich in nutrient and efficient. We thus assessed the efficacy of two affordable and accessible nutritional supplements, spirulina platensis versus soya beans among malnourished HIV-infected adults. Methods Undernourished patients, naïve of, but eligible to antiretroviral treatment (ART), aged 18 to 35 years were enrolled and randomly assigned to two groups. The first group received spirulina (Group A) as food supplement and the second received soya beans (Group B). Patients were initiated ART simultaneously with supplements. Food supplements were auto-administered daily, the quantity being calculated according to weight to provide 1.5 g/kg body weight of proteins with 25% from supplements (spirulina and soya beans). Patients were monitored at baseline and followed-up during twelve weeks for anthropometric parameters, body composition, haemoglobin and serum albumin, CD4 count and viral load. Results Fifty-two patients were enrolled (Group A: 26 and Group B: 26). The mean age was 26.4 ± 4.9 years (Group A) and 28.7 ± 4.8 (Group B) with no significant difference between groups ( P = 0.10). After 12 weeks, weight and BMI significantly improved in both groups ( P < 0.001 within each group). The mean gain in weight and BMI in Group A and B were 4.8 vs. 6.5 kg, ( P = 0.68) and 1.3 vs. 1.90 Kg/m 2 , ( P = 0.82) respectively. In terms of body composition, fat free mass (FFM) did not significantly increase within each group (40.5 vs. 42.2 Kg, P = 0.56 for Group A; 39.2 vs. 39.0 Kg, P = 0.22 for Group B). But when compared between the two groups at the end of the trial, FFM was significantly higher in the spirulina group (42.2 vs. 39.0 Kg, P = 0.01). The haemoglobin level rose significantly within groups ( P < 0.001 for each group) with no difference between groups ( P = 0.77). Serum albumin level did not increase significantly within groups ( P < 0.90 vs. P < 0.82) with no difference between groups ( P = 0.39). The increase in CD4 cell count within groups was significant ( P < 0.01 in both groups), with a significantly higher CD4 count in the spirulina group compared to subjects on soya beans at the end of the study ( P = 0.02). Within each group, HIV viral load significantly reduced at the end of the study ( P < 0.001 and P = 0.04 for spirulina and soya beans groups respectively). Between the groups, the viral load was similar at baseline but significantly reduced in the spirulina group at the end of the study ( P = 0.02). Conclusion We therefore conclude in this preliminary study, firstly, that both spirulina and soja improve on nutritional status of malnourished HIV-infected patients but in terms of quality of nutritional improvement, subjects on spirulina were better off than subjects on soya beans. Secondly, nutritional rehabilitation improves on immune status with a consequent drop in viral load but further investigations on the antiviral effects of this alga and its clinical implications are strongly needed.

OBJECTIVE To evaluate day-to-day variations of insulin needs in type 2 diabetic patients with end-stage renal disease (ESRD) on maintenance hemodialysis. RESEARCH DESIGN AND METHODS We developed a 24-h euglycemic clamp in patients who received an average of 2,200 calories in a standardized three-meal and two-snack regimen per day, adjusted to body size and sex. Intravenous insulin was adjusted every 30 min to achieve 5.5 ± 1.1 mmol/l glycemia over 24 h prehemodialysis, during hemodialysis session, and 24 h posthemodialysis in 10 type 2 diabetic patients, aged 55.7 ± 8.7 years with 11.9 ± 4.5 years diabetes duration, undergoing maintenance hemodialysis for 2.3 ± 2.3 years. Insulin requirements were derived from the dose of insulin administered to maintain euglycemia per period of time and day-to-day comparisons performed. RESULTS Mean capillary glycemia was 5.5 ± 0.3 mmol/l prehemodialysis and 5.3 ± 0.2 mmol/l posthemodialysis (P = 0.39). Pre- and posthemodialysis areas under the glucose curve were comparable. This was achieved by infusing 23.6 ± 7.7 IU/24 h prehemodialysis vs. 19.9 ± 4.9 IU/24 h posthemodialysis, indicating a 15.3% decrease posthemodialysis (P = 0.09). Basal insulin needs decreased from 0.4 ± 0.1/h prehemodialysis to 0.3 ± 0.1/h posthemodialysis (P = 0.01). Total boluses were decreased by 2.2 ± 3.1 IU (P = 0.15). Changes in blood urea did not correlate with changes in insulin needs (r = 0.1, P = 0.79). CONCLUSIONS The present study has demonstrated a significant 25% reduction in basal insulin requirements the day after dialysis compared with the day before. No significant change in boluses was observed, and overall the reduction of total insulin requirements was −15% equivalent to −4 IU/day posthemodialysis of marginal statistical significance.

le diagnostic du diabète est basé sur le dosage du glucose plasmatique, mais dans les milieux à ressource limitée, le sang capillaire est utilisé comme alternatif. Le facteur de conversion de 11 % a été suggéré, basé sur des études impliquant une étendue restreinte de concentration circulant du glucose. Il est de savoir s'il s'applique à des étendus plus large. Pour vérifier l'équivalence entre les concentrations mesurées dans le plasma, sang total capillaire et veineux, nous avons développé un protocole comprenant une injection d'insuline suivi d'une perfusion graduée de solution de glucose variant la glycémie de 0,5 à 4,0 g/l. Chez 12 volontaires adultes sains, nous avons collecté simultanément à des cibles prédéfinies (0,80-1,20 g/l, 1,80-2,20 g/l, 2,80-3,20 g/dl, 3,80-4,20 g/l). Nous avons aussi mesuré simultanément, chez 32 patients diabétiques se présentant spontanément avec nos cibles glycémiques prédéfinies, la concentration de glucose sur sang total capillaire, veineux et plasma. Pour les mesures sur sang total veineux et capillaire, nous avons utilisé l'Hemocue 201 et une méthode de glucose oxydase pour le plasma. Nous n'avons pas trouvé de différence statistiquement significative entre les concentrations de glucose sur sang total capillaire et plasma veineux à tous les niveaux des cibles prédéfinies (p > 0,144). Il n y avait pas de différence statistiquement significative en comparant les concentrations de glucose sur sang total veineux et plasma (p > 0,661). Les concentrations de glucose sur plasma et sang total étaient fortement corrélé (rs = 0,953, p Nos résultats ont montré une bonne corrélation mais mauvaise concordance entre les concentrations de glucose sur plasma et sang total. Le diagnostic du diabète avec des échantillons non-plasmatiques devrait être très prudent.