Depression, one of the most common psychiatric disorders, is two- to three-times more prevalent in people living with HIV (PLHIV) than in the general population in many settings as shown in western ...countries but remains neglected in sub-Saharan Africa (SSA). We aimed to summarize the available evidence on the prevalence of depression and associated factors according to the scales used and the treatment status in PLHIV in SSA. The pooled prevalence estimates of depression ranged between 9% and 32% in PLHIV on antiretroviral treatment (ART) and in untreated or mixed (treated/untreated) ones, with a substantial variability according to the measurement scale used and also for a given scale. Low socio-economic conditions in PLHIV on ART, female sex and immunosuppression in mixed/untreated PLHIV were frequently reported as associated factors but with no consensus. As depression could have deleterious consequences on the PLHIV life, it is critical to encourage its screening and management, integrating these dimensions in HIV care throughout SSA.
Previous studies demonstrate that the metabolic syndrome is associated with distal symmetric polyneuropathy (DSP). We aimed to determine the magnitude of this effect and the precise components ...involved.
We determined the symptomatic DSP prevalence in the Health, Aging, and Body Composition (Health ABC) study (prospective cohort study, with subjects aged 70-79 years at baseline), stratified by glycemic status (glucose tolerance test) and the number of additional metabolic syndrome components (updated National Cholesterol Education Program/Adult Treatment Panel III definition). DSP was defined as neuropathic symptoms (questionnaire) plus at least one of three confirmatory tests (heavy monofilament, peroneal conduction velocity, and vibration threshold). Multivariable logistic and linear regression evaluated the association of metabolic syndrome components with DSP in cross-sectional and longitudinal analyses.
Of 2,382 participants with neuropathy measures (mean age 73.5 ± 2.9 years, 38.2% black, 51.7% women), 21.0% had diabetes, 29.9% prediabetes, 52.8% metabolic syndrome, and 11.1% DSP. Stratified by glycemic status, DSP prevalence increased as the number of metabolic syndrome components increased (P = 0.03). Diabetes (cross-sectional model, odds ratio OR 1.65 95% CI 1.18-2.31) and baseline hemoglobin A1C (longitudinal model, OR 1.42 95% CI 1.15-1.75) were the only metabolic syndrome measures significantly associated with DSP. Waist circumference and HDL were significantly associated with multiple secondary neuropathy outcomes.
Independent of glycemic status, symptomatic DSP is more common in those with additional metabolic syndrome components. However, the issue of which metabolic syndrome components drive this association, in addition to hyperglycemia, remains unclear. Larger waist circumference and low HDL may be associated with DSP, but larger studies with more precise metabolic measures are needed.
OBJECTIVE:--Older adults with type 2 diabetes are more likely to fall, but little is known about risk factors for falls in this population. We determined whether diabetes-related complications or ...treatments are associated with risk of falls in older diabetic adults. RESEARCH DESIGN AND METHODS--In the Health, Aging, and Body Composition cohort of well-functioning older adults, participants reported falls in the previous year at annual visits. Odds ratios (ORs) for more frequent falls among 446 diabetic participants whose mean age was 73.6 years, with an average follow-up of 4.9 years, were estimated with continuation ratio models. RESULTS:--In the first year, 24% reported falling; 22, 26, 31, and 30% fell in subsequent years. In adjusted models, reduced peroneal nerve response amplitude (OR 1.50 -95% CI 1.07-2.12, worst quartile versus others); higher cystatin-C, a marker of reduced renal function (1.38 1.11-1.71, for 1 SD increase); poorer contrast sensitivity (1.41 0.97-2.04, worst quartile versus others); and low A1C in insulin users (4.36 1.32-14.46, A1C <=6 vs. >8%) were associated with risk of falls. In those using oral hypoglycemic medications but not insulin, low A1C was not associated with risk of falls (1.29 0.65-2.54, A1C <=6 vs. >8%). Adjustment for physical performance explained some, but not all, of these associations. CONCLUSIONS:--In older diabetic adults, reducing diabetes-related complications may prevent falls. Achieving lower A1C levels with oral hypoglycemic medications was not associated with more frequent falls, but, among those using insulin, A1C <=6% increased risk of falls.
Objective
To present the current knowledge on physical function, grip strength and frailty in HIV‐infected patients living in sub‐Saharan Africa, where the phenomenon is largely underestimated.
...Methods
A systematic search was conducted on MEDLINE, Scopus and African Index Medicus. We reviewed articles on sub‐Saharan African people living with HIV (PLHIV) >18 years old, published until November 2016.
Results
Of 537 articles, 12 were conducted in six African countries and included in this review. Five articles reported information on functional limitation and one on disability. Two of these five articles reported functional limitation (low gait speed) in PLHIV. Disability was observed in 27% and 3% of PLHIV living in rural and urban places, respectively. Two of three studies reporting grip strength reported lower grip strength (nearly 4 kg) in PLHIV in comparison with uninfected patients. One study reported that PLHIV were more likely to be frail than HIV‐uninfected individuals (19.4% vs. 13.3%), whereas another reported no statistical difference.
Conclusion
Decline in physical function, grip strength and frailty are now part of the burden of PLHIV living in SSA countries, but current data are insufficient to characterise the real public health dimension of these impairments. Further studies are needed to depict this major public health challenge. As this is likely to contribute to a significant burden on the African healthcare systems and human resources in the near future, a holistic care approach should be developed to inform guidelines.
Objectif
Présenter les connaissances actuelles sur la fonction physique, la force de préhension et la fragilité chez les patients infectés par le VIH vivant en Afrique subsaharienne où le phénomène est largement sous‐estimé.
Méthodes
Une recherche systématique a été menée sur Medline, Scopus et African Index Medicus. Nous avons analysé les articles sur les personnes vivant avec le VIH (PVVIH) en Afrique subsaharienne, > 18 ans, publiés jusqu'en novembre 2016.
Résultats
Sur 537 articles, 13 ont été menés dans six pays africains et inclus dans cette analyse. Cinq articles ont rapporté des informations sur la limitation fonctionnelle et une sur le handicap. Deux de ces 5 articles ont rapporté sur la limitation fonctionnelle (faible vitesse de la démarche) chez les PVVIH. Le handicap a été observé dans 27% et 3% des PVVIH vivant en milieu rural et urbain, respectivement. Deux des trois études rapportant sur la force de préhension ont rapporté une force de préhension plus faible (de près de 4 kg) chez les PVVIH par rapport aux patients non infectés. Une étude a rapporté que les PVVIH étaient plus susceptibles d’être fragiles que les personnes non infectées par le VIH (19,4% vs 13,3%), tandis qu'une autre n'a rapporté aucune différence statistique.
Conclusion
Le déclin de la fonction physique, de la force de préhension et la fragilité font maintenant partie du fardeau des PVVIH vivant dans les pays d'Afrique subsaharienne, mais les données actuelles sont insuffisantes pour caractériser l’étendue réelle de ces déficiences en matière de santé publique. Des études supplémentaires sont nécessaires pour illustrer ce défi majeur de santé publique. Dans la mesure où cela est susceptible de contribuer à une charge importante pour les systèmes de santé et les ressources humaines africains dans un avenir proche, une approche de soins holistiques devrait être élaborée pour guider les directives.
Objetivo
Presentar los conocimientos actuales sobre la función física, fuerza de prensión y la fragilidad de pacientes infectados con VIH viviendo en África subsahariana, en donde el fenómeno es subestimado en gran medida.
Métodos
Se realizó una búsqueda sistemática en Medline, Scopus y el African Index Medicus. Revisamos artículos publicados hasta noviembre del 2016 sobre personas viviendo con VIH (PVVIH) en África subsahariana >18 años.
Resultados
De 537 artículos, 13 fueron realizados en seis países Africanos e incluidos en esta revisión. Cinco artículos reportaban información sobre limitaciones funcionales y uno sobre discapacidad. Dos de estos 5 artículos reportaban una limitación funcional (baja velocidad de la marcha) en PVVIH. Se observaba discapacidad en un 27% y 3% de las PVVIH en zonas rurales y urbanas respectivamente. Dos de tres estudios que reportaban fuerza de prensión reportaban una menor fuerza de prensión (cerca 4 kg) en PVVIH en comparación con pacientes no infectados. Un estudio reportaba que las PVVIH tenían mayor probabilidad de ser frágiles que los individuos no infectados con VIH (19.4% vs.13.3%) mientras que otro no reportaba diferencias estadísticas.
Conclusión
Una disminución en la función física, la fuerza de prensión y la fragilidad son ahora parte de la carga de PVVIH en países del África subsahariana, pero los datos disponibles actualmente son insuficientes para caracterizar la dimensión real, a nivel de salud pública, de estas discapacidades. Se requieren más estudios para describir este importante reto de salud pública. Como es posible que contribuya con una carga significativa sobre los sistemas de atención sanitaria Africanos y los recursos humanos en un futuro cercano, deberían desarrollarse programas de atención holística que informen las guías sanitarias.
The current Ebola epidemic massively affected the Macenta district in Forest Guinea. We aimed at investigating its impact on general and HIV care at the only HIV care facility in the district.
...Prospective observational single-facility study.
Routinely collected data on use of general hospital services and HIV care were linked to Ebola surveillance data published by the Guinea Ministry of Health. In addition, we compared retention among HIV-infected patients enrolled into care in the first semesters of 2013 and 2014.
Throughout 2014, service offer was continuous and unaltered at the facility. During the main epidemic period (August-December 2014), compared with the same period of 2013, there were important reductions in attendance at the primary care outpatient clinic (-40%), in HIV tests done (-46%), in new diagnoses of tuberculosis (-53%) and in patients enrolled into HIV care (-47%). There was a smaller reduction in attendance at the HIV follow-up clinic (-11%). Kaplan-Meier estimates of retention were similar among the patients enrolled into care in 2014 and 2013. In a multivariable Cox regression analysis, the year of enrolment was not associated with attrition (hazard ratio 1.02; 95% confidence interval: 0.72-1.43).
The Ebola epidemic resulted in an important decrease in utilization of the facility despite unaltered service offer. Effects on care of HIV-positive patients enrolled prior to the epidemic were limited. HIV care in such circumstances is challenging, but not impossible.
Early recognition of bacterial infections is crucial for their proper management, but is particularly difficult in children with severe acute malnutrition (SAM). The objectives of this study were to ...evaluate the accuracy of C-reactive protein (CRP) and procalcitonin (PCT) for diagnosing bacterial infections and assessing the prognosis of hospitalized children with SAM, and to determine the reliability of CRP and PCT rapid tests suitable for remote settings.
From November 2007 to July 2008, we prospectively recruited 311 children aged 6 to 59 months hospitalized with SAM plus a medical complication in Maradi, Niger. Blood, urine, and stool cultures and chest radiography were performed systematically on admission. CRP and PCT were measured by rapid tests and by reference quantitative methods using frozen serum sent to a reference laboratory.
Median CRP and PCT levels were higher in children with bacteremia or pneumonia than in those with no proven bacterial infection (P < .002). However, both markers performed poorly in identifying invasive bacterial infection, with areas under the curve of 0.64 and 0.67 before and after excluding children with malaria, respectively. At a threshold of 40 mg/L, CRP was the best predictor of death (81% sensitivity, 58% specificity). Rapid test results were consistent with those from reference methods.
CRP and PCT are not sufficiently accurate for diagnosing invasive bacterial infections in this population of hospitalized children with complicated SAM. However, a rapid CRP test could be useful in these settings to identify children most at risk for dying.
Functional decline and physical disability are an important clinical and public health problem in older adults because they are associated with loss of independence, nursing home admission, and ...mortality. Several impairments and comorbidities related to or associated with diabetes are potential disabling conditions that could account for the excess risk of disability. But in most studies, no single condition explains this association. Accelerated loss of muscle strength is a potential mediator in the disabling effect of diabetes. Because some diabetes-related comorbidities are potential modifiable risk factors, preventing and reducing the excess risk of disability associated with diabetes needs further study.
Objective: To examine the association of BMI with functional status and self‐rated health among US adults and how the association differs by age and sex.
Methods and Procedures: All analyses are ...based on the National Health Interview Survey (NHIS), 1997–2005, a yearly, representative study of the US household population. We pooled all survey years and fitted logistic regression for the two sexes and three age strata (ages 18–44, 45–64, and ≥65).
Results: Our study found that although underweight and severe obesity are consistently associated with increased disability and poorer health status, overweight and moderate obesity show associations that vary considerably by age and sex. For men, the adjusted odds ratios (ORs) for disability and poor/fair self‐rated health tended to be lowest among overweight persons, especially for ages ≥45. Among men with moderate obesity, the risk of disability was elevated for ages 18–44 but lower for ages ≥65. For women, the adjusted ORs for disability and poor/fair self‐rated health tended to be lowest among normal‐weight persons, particularly for ages ≤45. Compared to normal‐weight counterparts, overweight women aged ≥65 had a lower risk of disability but a somewhat elevated risk of poor/fair self‐rated health.
Discussion: The results suggest that the association of BMI with functional status and self‐rated health varies significantly across ages and sexes. The variations in the association of BMI with functional status and self‐rated health suggest that a single “ideal body weight category” may not be appropriate for all persons or all health outcomes.
Objectives: To determine the prevalence of and risk factors for hearing loss in a sample of 2,052 older adults (aged 73–84; 46.9% male, 37.3% black) enrolled in the Health, Aging and Body Composition ...(Health ABC) Study.
Design: Cross‐sectional analysis of a longitudinal cohort study.
Setting: Pittsburgh, Pennsylvania, and Memphis, Tennessee, areas.
Participants: Random sample of Medicare beneficiary subjects enrolled in the Health ABC program from 1997 to 1998. They included 2,052 individuals: 660 white men (32.2%), 631 white women (30.8%), 310 black men (15.1%), and 451 black women (22.0%). Participants ranged in age from 73 to 84, with a mean age of 77.5.
Measurements: Hearing sensitivity was measured using pure‐tone threshold testing. Hearing loss was defined based on two averages of hearing thresholds: 500, 1,000, and 2,000 Hz greater than 25‐decibel (dB) hearing level (HL) (hearing loss); and 2,000, 4,000, and 8,000 Hz greater than 40‐dB HL (high‐frequency hearing loss). Potential hearing loss correlates, including demographics, medical history, ototoxic medication use, occupational noise exposure, and lifestyle factors, were collected via questionnaire.
Results: The prevalence of hearing loss was 59.9%; the prevalence of high‐frequency hearing loss was 76.9%. Hearing loss was most common in white men, followed by white women, black men, and black women. Older age, white race, diabetes mellitus, cerebrovascular disease, smoking, poorer cognitive status, occupational noise exposure, and ear surgery were associated with hearing loss after multivariable adjustment. Race‐ and sex‐specific risk factors included higher blood pressure and occupational noise exposure (white men), poorer cognitive status and smoking (black women), and low total hip bone mineral density (black men). Possible protective factors included salicylate use (overall sample, black men) and moderate alcohol intake (black women).
Conclusion: Hearing loss was extremely common in this population. Because many of the identified hearing loss risk factors are modifiable, some of the burden associated with hearing loss in older people should be preventable.
Objective
Verbal fluency decline, observed both in aging and HIV infection, has been related to lower quality of life. This study aimed to evaluate the factors associated with categorical fluency in ...people living with HIV (PLHIV) aged ≥60 years living in West Africa.
Methods
In this longitudinal study, PLHIV aged ≥60 years, on antiretroviral therapy (ART) for ≥6 months were included in three clinics (two in Côte d'Ivoire, one in Senegal) participating in the West Africa International epidemiological Databases to Evaluate AIDS (IeDEA) collaboration. Categorical fluency was evaluated with the Isaacs Set Test at 60 s at baseline and 2 years later. Factors associated with verbal fluency baseline performance and annual rates of changes were evaluated using multivariate linear regression models.
Results
Ninety‐seven PLHIV were included with 41 of them (42%) having a 2‐year follow‐up visit. The median age was 64 (62–67), 45.4% were female, and 89.7% had an undetectable viral load. The median annual change in categorical fluency scores was −0.9 (IQR: −2.7 to 1.8). Low baseline categorical fluency performance and its decline were associated with older age and being a female. Low educational level was associated with low baseline categorical fluency performance but not with its decline. Categorical fluency decline was also associated with marital status and hypertension.
Conclusions
Among older West African PLHIV, usual socio‐demographic variables and hypertension were the main factors associated with low categorical fluency performance and/or its decline. Interventions that focus on supporting cardiometabolic health are highly recommended to prevent cognitive disorders in PLHIV.
PDF
