Anti-HIV Activity of Cucurbitacin-D against Cigarette Smoke Condensate-Induced HIV Replication in the U1 Macrophages.

Chemodietary agents are emerging as promising adjuvant therapies in treating various disease conditions. However, there are no adjuvant therapies available to minimize the neurotoxicity of currently existing antiretroviral drugs (ARVs). In this study, we investigated the anti-HIV effect of a chemodietary agent, Cucurbitacin-D (Cur-D), in HIV-infected macrophages using an in-vitro blood-brain barrier (BBB) model. Since tobacco smoking is prevalent in the HIV population, and it exacerbates HIV replication, we also tested the effect of Cur-D against cigarette smoke condensate (CSC)-induced HIV replication. Our results showed that Cur-D treatment reduces the viral load in a dose-dependent (0-1 µM) manner without causing significant toxicity at <1 µM concentration. Further, a daily dose of Cur-D (0.1 µM) not only reduced p24 in control conditions, but also reduced CSC (10 µg/mL)-induced p24 in U1 cells. Similarly, Cur-D (single dose of 0.4 µM) significantly reduced the CSC (single dose of 40 µg/mL)-induced HIV replication across the BBB model. In addition, treatment with Cur-D reduced the level of pro-inflammatory cytokine IL-1ß. Therefore, Cur-D, as an adjuvant therapy, may be used not only to suppress HIV in the brain, but also to reduce the CNS toxicity of currently existing ARVs.

Marginal structural models for repeated measures where intercept and slope are correlated: An application exploring the benefit of nutritional supplements on weight gain in HIV-infected children initiating antiretroviral therapy.

BACKGROUND: The impact of nutritional supplements on weight gain in HIV-infected children on antiretroviral treatment (ART) remains uncertain. Starting supplements depends upon current weight-for-age or other acute malnutrition indicators, producing time-dependent confounding. However, weight-for-age at ART initiation may affect subsequent weight gain, independent of supplement use. Implications for marginal structural models (MSMs) with inverse probability of treatment weights (IPTW) are unclear. METHODS: In the ARROW trial, non-randomised supplement use and weight-for-age were recorded monthly from ART initiation. The effect of supplements on weight-for-age over the first year was estimated using generalised estimating equation MSMs with IPTW, both with and without interaction terms between baseline weight-for-age and time. Separately, data were simulated assuming no supplement effect, with use depending on current weight-for-age, and weight-for-age trajectory depending on baseline weight-for-age to investigate potential bias associated with different MSM specifications. RESULTS: In simulations, despite correctly specifying IPTW, omitting an interaction in the MSM between baseline weight-for-age and time produced increasingly biased estimates as associations between baseline weight-for-age and subsequent weight trajectory increased. Estimates were unbiased when the interaction between baseline weight-for-age and time was included, even if the data were simulated with no such interaction. In ARROW, without an interaction the estimated effect was +0.09 (95%CI +0.02,+0.16) greater weight-for-age gain per month's supplement use; this reduced to +0.03 (-0.04,+0.10) including the interaction. DISCUSSION: This study highlights a specific situation in which MSM model misspecification can occur and impact the resulting estimate. Since an interaction in the MSM (outcome) model does not bias the estimate of effect if the interaction does not exist, it may be advisable to include such a term when fitting MSMs for repeated measures.

Serum Trimethylamine-N-oxide Concentrations in People Living with HIV and the Effect of Probiotic Supplementation.

BACKGROUND: The incidence of cardiovascular disorders in people living with HIV (PLWH) is higher than that in non-infected individuals. Traditional and specific risk factors have been described but the role of the gut microbiota-dependent choline metabolite, trimethylamine-N-oxide (TMAO) is still unclear. METHODS: A cross-sectional analysis and a longitudinal analysis (with high-dose probiotic supplementation) were performed to measure serum TMAO concentrations through UHPLC-MS/MS. Stable outpatients living with HIV on highly active antiretroviral treatment with no major cardiovascular disease were enrolled. Non-parametric tests (bivariate and paired tests) and a multivariate linear regression analysis were used. RESULTS: A total of 175 participants were enrolled in the study. Median serum TMAO concentrations were 165 (103-273) ng/mL. An association with age, serum creatinine, number of antiretrovirals, multimorbidity and polypharmacy was observed; at linear logistic regression analysis, multimorbidity was the only independent predictor of TMAO concentrations. Carotid intima media thickness (IMT) was 0.85 (0.71-1.21) mm, with a trend towards higher TMAO concentrations observed in patients with IMT >0.9 mm (P=0.087). In the 25 participants who received probiotic supplementation, TMAO levels did not significantly change after 24 weeks (Wilcoxon paired P=0.220). CONCLUSION: Serum TMAO levels in PLWH were associated with multimorbidity, higher cardiovascular risk and subclinical atherosclerosis and were not affected by 6 months of high-dose probiotic supplementation.

Efecto de la terapia con probióticos/prebióticos sobre la reconstitución del tejido linfoide asociado a la mucosa gastrointestinal durante la infección por el virus de la inmunodeficiencia humana-1 / Effects of prebiotics and probiotics on gastrointestinal tract lymphoid tissue in hiv infected patients

HIV infection induces alterations in almost all immune cell populations, mainly in CD4+ T cells, leading to the development of opportunistic infections. The gut-associated lymphoid tissue (GALT) constitutes the most important site for viral replication, because the main target cells, memory T-cells, reside in this tissue. It is currently known that alterations in GALT are critical during the course of the infection, as HIV-1 induces loss of tissue integrity and promotes translocation of microbial products from the intestinal lumen to the systemic circulation, leading to a persistent immune activation state and immune exhaustion. Although antiretroviral treatment decreases viral load and substantially improves the prognosis of the infection, the alterations in GALT remains, having a great impact on the ability to establish effective immune responses. This emphasizes the importance of developing new therapeutic alternatives that may promote structural and functional integrity of this tissue. In this regard, therapy with probiotics/prebiotics has beneficial effects in GALT, mainly in syndromes characterized by intestinal dysbiosis, including the HIV-1 infection. In these patients, the consumption of probiotics/prebiotics decreased microbial products in plasma and CD4+ T cell activation, increased CD4+ T cell frequency, in particular Th17, and improved the intestinal flora. In this review, the most important findings on the potential impact of the probiotics/prebiotics therapy are discussed.

Effect of Chocolate and Yerba Mate Phenolic Compounds on Inflammatory and Oxidative Biomarkers in HIV/AIDS Individuals.

Flavonoids in cocoa and yerba mate have a beneficial role on inflammation and oxidative disorders. Their effect on HIV individuals has not been studied yet, despite the high cardiovascular risk of this population. This study investigated the role of cocoa and yerba mate consumption on oxidative and inflammatory biomarkers in HIV+ individuals. A cross-over, placebo-controlled, double-blind, randomized clinical trial was conducted in 92 individuals on antiretroviral therapy for at least six months and at viral suppression. Participants were randomized to receive either 65 g of chocolate or chocolate-placebo or 3 g of yerba mate or mate-placebo for 15 days each, alternating by a washout period of 15 days. At baseline, and at the end of each intervention regimen, data regarding anthropometry, inflammatory, oxidative and immunological parameters were collected. High-sensitivity C-reactive protein, fibrinogen, lipid profile, white blood cell profile and thiobarbituric acid reactive substances were assessed. There was a difference between mean concentrations of HDL-c (ANOVA; p ≤ 0.05) among the different regimens: dark chocolate, chocolate-placebo, yerba mate and mate-placebo. When a paired Student t-test was used for comparisons between mean HDL-c at baseline and after each regimen, the mean concentration of HDL-c was higher after supplementation with dark chocolate (p = 0.008).

Omega 3 Fatty Acids Supplementation and Oxidative Stress in HIV-Seropositive Patients. A Clinical Trial.

HIV-seropositive patients show high incidence of coronary heart disease and oxidative stress has been described as relevant key in atherosclerosis development. The aim of this study was to assess the effect of omega 3 fatty acids on different markers of oxidative stress in HIV-seropositive patients. We performed a randomized parallel controlled clinical trial in The Instituto Mexicano del Seguro Social, a public health hospital. 70 HIV-seropositive patients aged 20 to 55 on clinical score A1, A2, B1 or B2 receiving highly active antiretroviral therapy (HAART) were studied. They were randomly assigned to receive omega 3 fatty acids 2.4 g (Zonelabs, Marblehead MA) or placebo for 6 months. At baseline and at the end of the study, anthropometric measurements, lipid profile, glucose and stress oxidative levels [nitric oxide catabolites, lipoperoxides (malondialdehyde plus 4-hydroxialkenals), and glutathione] were evaluated. Principal HAART therapy was EFV/TDF/FTC (55%) and AZT/3TC/EFV (15%) without difference between groups. Treatment with omega 3 fatty acids as compared with placebo decreased triglycerides (-0.32 vs. 0.54 mmol/L; p = 0.04), but oxidative stress markers were not different between groups.

Effect of Extra Virgin Olive Oil on Biomarkers of Inflammation in HIV-Infected Patients: A Randomized, Crossover, Controlled Clinical Trial.

BACKGROUND: Premature atherosclerosis in HIV-infected patients is associated with chronic infection by itself and adverse effects of antiretroviral treatment (ART). Extra virgin olive oil (EVOO) has a beneficial effect on the cardiovascular system because of its anti-inflammatory properties. The objective of this study was to determine whether the consumption of EVOO improves inflammation and atherosclerosis biomarkers in HIV-infected patients receiving ART. MATERIAL AND METHODS: This randomized, crossover, controlled trial included 39 HIV-positive male participants who consumed 50 mL of EVOO or refined olive oil (ROO) daily. Four participants dropped out of the study. Leukocyte count, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hsCRP), interleukin-6, fibrinogen, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, malondialdehyde, glutathione-peroxidase, superoxide dismutase, oxidized LDL and von Willebrand factor were determined before the first and after each of the 2 intervention periods. Intervention and washout periods lasted for 20 and 14 days, respectively. RESULTS: In participants with >90% compliance (N=30), hsCRP concentrations were lower after EVOO intervention (geometric mean [GM], 1.70 mg/L; 95% confidence interval [CI], 1.15-2.52) compared to ROO administration (GM, 2.92 mg/L; 95% CI, 1.95-4.37) (p=0.035). In participants using lopinavir/ritonavir, ESR and hsCRP concentrations decreased 62% and 151%, respectively, after EVOO administration. In the whole study population (N=35) we found no difference in analyzed biomarkers after EVOO administration. CONCLUSIONS: Our exploratory study suggests that EVOO consumption could lower hsCRP in patients on ART.

Effect of increasing glutathione with cysteine and glycine supplementation on mitochondrial fuel oxidation, insulin sensitivity, and body composition in older HIV-infected patients.

BACKGROUND: HIV-infected patients are reported to have impaired oxidation of fatty acids despite increased availability, suggesting a mitochondrial defect. We investigated whether diminished levels of a key mitochondrial antioxidant, glutathione (GSH), was contributing to defective fatty acid oxidation in older HIV-infected patients, and if so, the metabolic mechanisms contributing to GSH deficiency in these patients. METHODS: In an open-label design, 8 older GSH-deficient HIV-infected males were studied before and after 14 days of oral supplementation with the GSH precursors cysteine and glycine. A combination of stable-isotope tracers, calorimetry, hyperinsulinemic-euglycemic clamp, and dynamometry were used to measure GSH synthesis, fasted and insulin-stimulated (fed) mitochondrial fuel oxidation, insulin sensitivity, body composition, anthropometry, forearm-muscle strength, and lipid profiles. RESULTS: Impaired synthesis contributed to GSH deficiency in the patients and was restored with cysteine plus glycine supplementation. GSH improvement was accompanied by marked improvements in fasted and fed mitochondrial fuel oxidation. Associated benefits included improvements in insulin sensitivity, body composition, anthropometry, muscle strength, and dyslipidemia. CONCLUSIONS: This work identifies 2 novel findings in older HIV-infected patients: 1) diminished synthesis due to decreased availability of cysteine and glycine contributes to GSH deficiency and can be rapidly corrected by dietary supplementation of these precursors and 2) correction of GSH deficiency is associated with improvement of mitochondrial fat and carbohydrate oxidation in both fasted and fed states and with improvements in insulin sensitivity, body composition, and muscle strength. The role of GSH on ameliorating metabolic complications in older HIV-infected patients warrants further investigation.

Manejo nutricional en un paciente con VIH e insuficiencia respiratoria aguda tipo I / Nutritional management in a patient with HIV and acute respiratory failure tipe I

Paciente de sexo masculino, de 31 años de edad. HIV (+) desde hace 1 año. Se encontraba recibiendo TARGA; acude al HNDAC por presentar disnea, tos persistente, secreciones mucopurulentas amarillo-verdosas, náuseas. Ingresó por cuadro de Insuficiencia Respiratoria Aguda (IRA tipo 1) al servicio de Unidad de Cuidados Intensivos del Hospital Nacional Daniel Alcides Carrión en Julio de 2013. Al momento de la Intervención Nutricional se le venía haciendo manejo ventilatorio y control hemodinámico. Sala: Unidad de Cuidados Intensivos. Edad: 31 años. Sexo: Masculino, Fecha de ingreso al hospital: 17/07/2013, Fecha de ingreso a servicio: 18/07/2013, Diagnóstico médico: IRA Tipo I en VM, por NAC, Hemoptisis inactiva, VIH (+) en TARGAy alcalosis respiratoria.

Male patient, 31 years of age. He is HIV (+) for 1 year. Patient is receiving Highly Active Antiretroviral Treatmen (HAART). Pacient arrives to Daniel Alcides Carrión Hospital in Callao because of symtoms such as breathlessness, persistent cough, yellow-green mucopurulent secretions, nausea. Patient is admitted to Intensive Care Unit with Respiratory failure in July 2013. At the moment of the Nutritional Intervention, patient was receiving ventilatory managament and hemodinamic con Room: Intensive Care Unit. Age: 31 years. Gender: Male. Hospital admission date: 17/07/2013. Service entry date: 1 8/07/201 3. Medical diagnosis: IRA VM Type 1, by NAC, Hemoptysis inactive HIV (+) on HAART and respiratory alkalosis.

Budget impact analysis of HIV testing in the VA healthcare system.

OBJECTIVES: The long-term cost effectiveness of routine HIV testing is favorable relative to other medical interventions. Facility-specific costs of expanded HIV testing and care for newly identified patients, however, are less well defined. To aid in resource allocation decisions, we developed a spreadsheet-based budget-impact tool populated with estimates of facility-specific HIV testing and care costs incurred with an expanded testing program. METHODS: We modeled intervention effects on quarterly costs of antiretroviral therapy (ART), outpatient resource utilization, and staff expenditures in the Department of Veterans Affairs over a 2-year period of increasing HIV testing rates. We used HIV prevalence estimates, screening rates, counseling, positive tests, Veterans Affairs treatment, and published sources as inputs. We evaluated a single-facility cohort of 20,000 patients and at baseline assumed a serodiagnostic rate of 0.45%. RESULTS: Expanding testing from 2% to 15% annually identified 21 additional HIV-positive patients over 2 years at a cost of approximately $290,000, more than 60% of which was due to providing ART to newly diagnosed patients. While quarterly testing costs decreased longitudinally as fewer persons required testing, quarterly ART costs increased from $10,000 to more than $60,000 over 2 years as more infected patients were identified and started on ART. In sensitivity analyses, serodiagnostic and annual HIV testing rates had the greatest cost impact. CONCLUSIONS: Expanded HIV testing costs are greatest during initial implementation and predominantly due to ART for new patients. Cost determinations of expanded HIV testing provide an important tool for managers charged with allocating resources within integrated systems providing both HIV testing and care.

The impact of integrating food supplementation, nutritional education and HAART (Highly Active Antiretroviral Therapy) on the nutritional status of patients living with HIV/AIDS in Mozambique: results from the DREAM Programme.

DREAM (Drug Resources Enhancement against AIDS and Malnutrition) is a multiregional health program active in Mozambique since 2002 and provides free of charge an integrating package of care consisting of peer to peer nutritional and health education, food supplementation, voluntary counseling and testing, immunological, virological, clinical assessment and HAART (Highly Active AntiRetroviral Treatment). The main goals of this paper are to describe the state of health and nutrition and the adequacy of the diet of a sample of HIV/AIDS patients in Mozambique on HAART and not. A single-arm retrospective cohort study was conducted. 106 HIV/AIDS adult patients (84 in HAART), all receiving food supplementation and peer-to-peer nutritional education, were randomly recruited in Mozambique in two public health centres where DREAM is running. The programme is characterized by: provision of HAART, clinical and laboratory monitoring, peer to peer health and nutritional education and food supplementation. We measured BMI, haemoglobin, viral load, CD4 count at baseline (T0) and after at least 1 year (T1). Dietary intake was estimated using 24h food recall and dietary diversity was assessed by using the Dietary Diversity Score (DDS) at T1. Overall, the patients'diet appeared to be quite balanced in nutrients. In the cohort not in HAART the mean BMI values showed an increases but not significant (initial value: 21.9 ± 2.9; final value: 22.5 ± 3.3 ) and the mean haemoglobin values (g/dl) showed a significant increases (initial value: 10.5+ 2.1; final value: 11.5 ± 1.7 p< 0.024) . In the cohort in HAART, both the mean of BMI value (initial value: 20.7 ± 3.9; final value: 21.9 ± 3.3 p< 0.001) and of haemoglobin (initial value: 9.9 ± 2.2; final value: 10.8 ± 1.7 p< 0.001) showed a higher significant increase. The increase in BMI was statistically associated with the DDS in HAART patients. In conclusion nutritional status improvement was observed in both cohorts. The improvement in BMI was significant and substantially higher in HAART patients because of the impact of HAART on nutritional status of AIDS patients. Subjects on HAART and with a DDS > 5, showed a substantial BMI gain. This association showed an additional expression of the synergic effect of integrating food supplementation, nutritional education and HAART on the nutritional status of African AIDS patients and also highlights the complementary role of an adequate and diversified diet in persons living with HIV/AIDS in resources limited settings.

Efficacy of Tat-conjugated ritonavir-loaded nanoparticles in reducing HIV-1 replication in monocyte-derived macrophages and cytocompatibility with macrophages and human neurons.

Human immunodeficiency virus (HIV)-1 targets mononuclear phagocytes (MP), which disseminate infection to organs such as brain, spleen and lymph. Thus MP, which include microglia, tissue macrophages and infiltrating monocyte-derived macrophages (MDM), are important target of anti-HIV-1 drug therapy. Most of the currently used antiretroviral drugs are effective in reducing viral loadin the periphery but cannot effectively eradicate infection from tissue reservoirs such as brain MP. HIV-1 infection of the central nervous system can lead to a wide variety of HIV-1-associated neurocognitive disorders. In this study, we demonstrate that ritonavir-loaded nanoparticles (RNPs) are effective in inhibiting HIV-1 infection of MDM. Reduced infection is observed in multiple read-out systems including reduction of cytopathic effects, HIV-1 p24 protein secretion and production of progeny virions. Furthermore, the RNPs retained antiretroviral efficacy after being removed from MDM cultures. As HIV-1-infected cells in the brain are likely to survive for a long period of time, both acute and chronic infection paradigms were evaluated. Tat-peptide-conjugated RNPs (Tat-RNP) were effective in both short-term and long-term HIV-1-infected MDM. Importantly, we confirm that delivery of RNPs, both with and without Tat-peptide conjugation, is toxic neither to MDM nor to neural cells, which may be bystander targets of the nanoformulations. In conclusion, Tat-NPs could be a safe and effective way of delivering anti-HIV-1 drugs for controlling viral replication occurring within brain MP.

Nutrición e infección por VIH/SIDA en niños / Nutrition and HIV/AIDS in children

La infección por VIH está asociada con un elevado riesgo de malnutrición. Los mecanismos por los cuales un paciente con SIDA pierde peso, pueden llegar a ser disminución de ingreso alimentario por falta de apetito; pérdida de las capacidades cognoscitiva, visual, auditiva, olfatoria ó por pérdida del estado de consciencia; aversión a los alimentos por cambio de sabores; dificultad ó dolor al deglutir, por enfermedades del esófago; náuseas ó vómito por gastritis medicamentosa ó por efectos adversos de los medicamentos; pérdidas alimentarías anormales ó mayor consumo de energía y nutrimentos causado por la enfermedad ó sus complicaciones, sin olvidar factores económicos y el social. Diversos factores aquejan una ingesta anormal en el paciente con VIH/SIDA. El síndrome de malabsorción intestinal, aparece en el 31% de los niños infectados. Las infecciones oportunistas pueden ocasionar fiebre, provocando un estado hipermetabólico, con incremento de las necesidades energéticas del organismo así como las pérdidas de nitrógeno por orina. Los factores psicosociales también contribuyen de manera importante al crecimiento subóptimo de niños infectados con VIH.

The mechanisms by which an AIDS patient loses weight, may become reduced food intake due to lack of appetite, loss of cognitive skills, visual, auditory, olfactory or loss of the state of consciousness, aversion to food for change flavors, difficulty or pain on swallowing, esophageal diseases, gastritis, nausea or vomiting from medications or adverse drugs effects, los sor abnormal eating more energy and nutrients caused by the disease or its complications, not to mention economic factors and social. Several factors facing an abnormal intake in patients with HIV/AIDS. Intestinal malabsorption síndrome, occurs in 31% of infected children. Opporunistic infecions can cause fever, causing a hypermetabolic state with increased energy needs and body nitrogen losses in urine. Psychosocial factors also contribute significantly to suboptimal growth of children infected with HIV.

Consumo alimentar e dislipidemia decorrente da terapia antirretroviral combinada para infecção pelo HIV: uma revisão sistemática / Dietary intake and dyslipidemia arising from combination antiretroviral therapy for HIV infection: a systematic review

Revisar e sintetizar as evidências científicas disponíveis sobre a relação entre o consumo alimentar e dislipidemia em pacientes infectados pelo HIV em terapia antirretroviral combinada de alta atividade (TARV). Desenvolveu-se uma revisão sistemática de literatura. Foram pesquisados estudos originais e duas categorias de exposição dietética foram revisadas: consumo de energia e nutriente ou consumo de uma dieta teste. Foi feita síntese narrativa dos estudos selecionados. Os achados foram sintetizados segundo a categoria de desfecho metabólico (efeito sobre colesterol total e LDL-c, efeito sobre HDL-c e efeito sobre triglicérides). Vinte estudos originais foram incluídos na revisão, sendo 13 ensaios clínicos e 7 estudos epidemiológicos observacionais. A suplementação com ácido graxo ω-3 resultou em significativa redução nos níveis séricos de triglicérides. Observou-se evidência insuficiente acerca da efetividade de intervenções dietéticas na prevenção e controle das dislipidemias em pacientes infectados pelo HIV em uso de TARV.

To review and synthesize the available scientific evidence on the relationship between dietary intake and dyslipidemias in HIV-infected patients in combination antiretroviral therapy (ART). A systematic review of literature was carried out. Original and published studies were investigated and two categories of dietary exposure were considered: energy and nutrient intake, and consumption of a test diet. A narrative review of included studies was conducted. The findings were summarized according to category of metabolic outcomes (effect on total cholesterol and LDL-c, effect on HDL-c and effect on triglycerides). Twenty original studies were included in this review, being 13 clinical trials and 7 observational studies. ω-3 fatty acid supplementation led to a significant decrease in triglycerides. There was very little evidence on the effectiveness of dietary interventions for the prevention and control of dyslipidemias in HIV-infected patients receiving ART.

Position of the American Dietetic Association: oral health and nutrition.

It is the position of the American Dietetic Association that nutrition is an integral component of oral health. The American Dietetic Association supports the integration of oral health with nutrition services, education, and research. Collaboration between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between nutrition and the integrity of the oral cavity in health and disease. Oral health and nutrition have a synergistic bidirectional relationship. Oral infectious diseases, as well as acute, chronic, and terminal systemic diseases with oral manifestations, impact the functional ability to eat as well as diet and nutrition status. Likewise, nutrition and diet may affect the development and integrity of the oral cavity as well as the progression of oral diseases. As we advance in our discoveries of the links between oral and nutrition health, practitioners of both disciplines must learn to provide screening, baseline education, and referral to each other as part of comprehensive client/patient care. Dietetics practice requires registered dietitians to provide medical nutrition therapy that incorporates a person's total health needs, including oral health. Inclusion of both didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in both dental and dietetic education programs. Collaborative endeavors between dietetics and dentistry in research, education, and delineation of health provider practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.

Correlação clínico-terapêutica e aspectos moleculares da infecção pelo HIV em pacientes pediátricos: em busca de melhor qualidade de vida / Physician-therapeutical correlation and molecular aspects of the infection for the HIV in pediatric patients: in search of the better quality of life

Introdução: o controle da infecção pelo HIV em pacientes pediátricos tem alcançado um amplo espectro que vai desde a abordagem da família naadesão ao tratamento anti-retroviral até a análise dos aspectos moleculares da infecção neste grupo, a fim de que ocorra a promoção de uma melhor qualidade de vida e uma maior sobrevida destes. Objetivo: descrever os aspectos clínico-terapêuticos de pacientes pediátricos infectados pelo HIV e descrever sua correlação com os aspectos moleculares da infecção, nutricionais e psicológicos. De modo a enfatizar a importância de se avaliar estas crianças sobre a ótica da qualidade de vida. Métodos: foi realizado um levantamento bibliográfico que teve como base publicações de organismos nacionais e internacionais (Medline e Lilacs), periódicos científicos e livros técnicos. Resultados: as particularidades no curso da infecção pelo HIV em pacientes pediátricos vão desde as manifestações clínicas que os diferem dos adultos, a necesaidsde do apoio familiar na adesão ao tratamento proposto pelo médico até a superação de possíveis efeitos adversos da terapia anti-retroviral, como a intolerância e a toxicidade. Por outro lado diantedo quadro patológico impõem-se desafios, como amparar estas crianças que podem desenvolver desordens psicológicas, conceder uma dieta que contribua em uma melhor ação no tratamento, assim como a necesaidsde de se estudar as possíveis mutações que implicam em resistência viral a fim de que ocorra o desenvolvimento de novas drogas. Conclusão: o curso clínico-terapêutico deve ser a base no conhecimento dos diversos aspectos da infecção pelo HIV em pacientes pediátricos concedendo ao profissional de saúde o apoio fundamental na escolha dos meios de fornecer uma melhor qualidade de vida a estes pacientes e uma maior tranqüilidade durante o acompanhamento clínico a seus responsáveis.

Introduction: the control of the HIV infection in pediatrics patients has reached a larger specter that goes since the boarding of the family in theadhesion to the anti-retroviral treatment until the analysis of the molecular aspects of the infection in this group topromove better quality of life and agreater follow-up. Objective: report the clinical-therapeutical aspects of pediatrics patients infecty by the HIV and describe its psychological correlation with the molecular aspects of the infection, nutricionais. In order to emphasize the importance of evaluating these children on the optics of the quality of life. Methods: it was carried through a bibliographical survey that had as base publications of national and international organisms (- Medline and Lilacs), periodic scientific and books technician. Results: the particularitities in the course of the infection for the HIV in pediatrics patients go since the clinical manifestations that differ them from the adults, the necessity of the familiar support in the adhesion to the treatment considered for the doctor until the overcoming of possible adverse effect of the anti-retroviral therapy as the intolerance and the toxicological effects. On the other hand ahead of the pathological picture one imposes challenges as to support these children who can develop psychological clutters, to grant a diet that contribute in one better action in the treatment, as well as the necessity of if studying the possible mutations that imply in viral resistance so that the development of new drugs occurs. Conclusion: the clinical-therapeutical course must be the base in the knowledge of the diverse aspects of the infection for the HIV in pediatrics patients granting to the health professional the basic support in the choice of the ways to supply to one better quality of life to these patients and a bigger tranquillity during the clinical accompaniment its responsible ones.

Lipid-lowering and anti-inflammatory effects of tetradecylthioacetic acid in HIV-infected patients on highly active antiretroviral therapy.

BACKGROUND: Highly active antiretroviral therapy (HAART) often leads to a dramatic improvement in clinical, viral and immunologic parameters in HIV-infected individuals. However, the emergence of long-term side-effects of HAART and in particular dylipidaemia is increasingly reported. Based on the potential lipid-lowering and immunomodulatory properties of tetradecylthioacetic acid (TTA) we examined whether TTA in combination with dietary intervention could modify lipid levels in peripheral blood in HIV-infected patients on HAART. MATERIALS AND METHODS: Ten HIV-infected patients on protease inhibitor-based HAART with hyperlipidaemia followed a cholesterol-lowering diet throughout the study period (8 weeks). During the last 4 weeks of the study all patients received TTA (1 g qd) in addition to the cholesterol-lowering diet. RESULTS: Our main and novel findings were: (i) TTA in combination with dietary intervention reduces total cholesterol, LDL cholesterol, triglycerides and LDL/HDL cholesterol in these patients, and a particularly suppressing effect was observed during the TTA phase regarding total cholesterol. (ii) During the TTA phase, the cholesterol-lowering effect was accompanied by a significant reduction in plasma levels of tumour necrosis factor alpha. (iii) Our studies in peripheral blood mononuclear cells from these patients and in the liver from wild-type mice receiving TTA suggest that the hypolipidaemic effects of TTA may involve up-regulation of scavenger and LDL-receptor expression. CONCLUSIONS: Although few patients were studied, the present pilot study suggests that TTA combined with dietary intervention could be an interesting therapeutic approach in HIV-infected patients on HAART, potentially resulting in both hypolipidaemic and anti-inflammatory effects.