Antiretroviral therapy and weight gain in naive HIV-1 infected patient: a narrative review.

The prevalence of obesity has increased dramatically in recent decades worldwide. An increase in the prevalence of obesity has also been observed among people living with HIV (PLHIV) in high and low incomes countries. Antiretroviral therapy (ART), by controlling the viral load (VL) and restoring cellular immunity, has improved the health status and life expectancy in PLHIV. However, the risk of developing non-AIDS events (NAEs) remains higher than the general population. Therefore, specific attention is given to managing risk factors associated with NAEs during the follow-up of PLHIV, including obesity. Factors related to weight gain in PLHIV include demographic factors, HIV disease-related factors, and ART-associated factors. In naive PLHIV, weight gain after the initiation of ART is expected. The weight gains observed are generally not severe even if there appear to be risk factors such as the advanced stage of disease (low CD4 cells count and high VL), female sex, black race, and taking integrase strand transfer inhibitors (INSTI) associated or not with tenofovir alafenamide fumarate (TAF). The role of each antiretroviral drug per-se remains to clarify. As INSTI ± TAF has been associated with significant weight gain, further research is needed to identify the individual-level factors predictive of weight gain, the mechanisms of ART-associated weight gain and the clinical relevance of this weight gain. As PLHIV survive longer on effective ART, the prevention and management of NAEs will remain a challenge for healthcare providers.

Debridement, antibiotics, irrigation and retention in prosthetic joint infection : predictive tools of failure.

Debridement, antibiotic, irrigation and retention of the implant (DAIR) is an attractive treatment for periprosthetic joint infection (PJI). The purpose of this study is to determine predictive factors of failure. We reviewed all DAIR procedures for hip PJI performed between 2002-2017 (n=69). Data recorded included all factors correlated with treatment failure. KLIC score, McPherson adapted score were analyzed. Infection eradication for early PJI (< 4 weeks) was achieved in 68% of patients and was correlated with treatment success (p=0.01). KLIC score (p=0.036), McPherson adapted score (p=0.01), CRP (p=0.025) and late PJI (p=0.031) were significantly predictive of failure treatment. We have established an equation in order to predict failure treatment that has to be validated. DAIR is an effective treatment for early PJI. KLIC score and McPherson adapted score are two ways to predict outcome of a DAIR procedure and should help making the decision in PJI treatment.