Abstract. We conducted a prospective cohort study of 496 adults starting antiretroviral treatment (ART) to determine the impact of neuropsychiatric symptoms and socioeconomic status on adherence and mortality. Almost 60% had good adherence based upon pharmacy records. Poor adherence was associated with being divorced, poorer, food insecure, and less educated. Longer travel time to clinic, concealing one's human immunodeficiency virus (HIV) status, and experiencing side effects predicted poor adherence. Over a third of the patients had cognitive impairment and poorer cognitive function was also associated with poor adherence. During follow-up (mean 275 days), 20% died-usually within 90 days of starting ART. Neuropsychiatric symptoms, advanced HIV, peripheral neuropathy symptoms, food insecurity, and poverty were associated with death. Neuropsychiatric symptoms, advanced HIV, and poverty remained significant independent predictors of death in a multivariate model adjusting for other significant factors. Social, economic, cognitive, and psychiatric problems impact adherence and survival for people receiving ART in rural Zambia.

We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones' spouse (P = 0.047), knowing spouses' HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence.

Background This study evaluates the effects of retinol on intestinal barrier function, growth, total parasites and Giardia spp. infections in children in the Northeast of Brazil. Methods The study was a double-blind, randomized placebo-controlled trial (http://clinicaltrials.gov;Register#NCT00133406) involving 79children reiceved vitamin A 100,000 - 200,000 IU (n = 39) or placebo (n = 40) at enrollment, 4 and 8 months, followed for 36 months. Intestinal barrier function was evaluated using the lactulose:mannitol test. Stool lactoferrin was used as a marker for intestinal inflammation. Results The groups were similar with regard to age, sex, nutritional parameters (z-scores), serum retinol concentrations, proportion of lactoferrin positive stool samples, and intestinal barrier function. The lactulose:mannitol ratio did not change during the same time of follow-up (p>0.05). The proportion of lactoferrin positive samples evaluated at one month did not change between groups (p>0.05). Total intestinal parasitic specifically new infections were significantly lower in the vitamin A treatment compared to control group; these were accounted for entirely by significantly fewer new Giardia infections in the vitamin A treatment group. The cumulative z-scores for weight-for-length or height (WHZ), length or height-for-age z-scores (HAZ), and weight-for-age (WAZ) did not change significantly with vitamin A intervention for 36 months of follow-up. Conclusions These data showed that total parasitic infection and Giardia spp. infections were significantly lower in the vitamin A treatment group when compared to the placebo group, suggesting that vitamin A improves host defenses against Giardia infections.

OBJECTIVE:Apolipoprotein E4 may benefit children during early periods of life when the body is challenged by infection and nutritional decline. We examined whether apolipoprotein E4 affects intestinal barrier function, thereby improving short-term growth and long-term cognitive outcomes in Brazilian shantytown children.METHODS:A total of 213 Brazilian shantytown children with below-median height-for-age z-scores (HAZ) received 200,000 IU of retinol (every four months), zinc (40 mg twice weekly), or both for one year, with half of each group receiving glutamine supplementation for 10 days. Height-for-age z-scores, weight-for-age z-scores, weight-for-height z-scores, and lactulose:mannitol ratios were assessed during the initial four months of treatment. An average of four years (range 1.4-6.6) later, the children underwent cognitive testing to evaluate non-verbal intelligence, coding, verbal fluency, verbal learning, and delayed verbal learning. Apolipoprotein E4 carriage was determined by PCR analysis for 144 children.RESULTS:Thirty-seven children were apolipoprotein E4(+), with an allele frequency of 13.9%. Significant associations were found for vitamin A and glutamine with intestinal barrier function. Apolipoprotein E4(+) children receiving glutamine presented significant positive Pearson correlations between the change in height-for-age z-scores over four months and delayed verbal learning, along with correlated changes over the same period in weight-for-age z-scores and weight-for-height z-scores associated with non-verbal intelligence quotients. There was a significant correlation between vitamin A supplementation of apolipoprotein E4(+) children and improved delta lactulose/mannitol. Apolipoprotein E4(-) children, regardless of intervention, exhibited negative Pearson correlations between the change in lactulose-to-mannitol ratio over four months and verbal learning and non-verbal intelligence.CONCLUSIONS:During development, apolipoprotein E4 may function concomitantly with gut-tropic nutrients to benefit immediate nutritional status, which can translate into better long-term cognitive outcomes.