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  1. Delay of Antiretroviral Therapy Initiation is Common in East African HIV-Infected Individuals in Serodiscordant Partnerships

    PubMed Central

    MUJUGIRA, Andrew; CELUM, Connie; THOMAS, Katherine K.; FARQUHAR, Carey; MUGO, Nelly; KATABIRA, Elly; BUKUSI, Elizabeth A.; TUMWESIGYE, Elioda; BAETEN, Jared M.

    2014-01-01

    Objective WHO guidance recommends antiretroviral therapy (ART) initiation for all persons with a known HIV-uninfected partner, as a strategy to prevent HIV transmission. Uptake of ART among HIV-infected partners in serodiscordant partnerships is not known, which we evaluated in African HIV serodiscordant couples. Design Prospective cohort study. Methods Among HIV-infected persons from Kenya and Uganda who had a known heterosexual HIV-uninfected partner, we assessed ART initiation in those who became ART-eligible under national guidelines during follow-up. Participants received quarterly clinical and semi-annual CD4 monitoring, and active referral for ART upon becoming eligible. Results Of 1958 HIV-infected ART-eligible partners, 58% were women and the median age was 34 years. At the first visit when determined to be ART eligible, the median CD4 count was 273 cells/μL (IQR 221, 330), 77% had WHO stage 1 or 2 HIV disease, and 96% were receiving trimethoprim-sulfamethoxazole prophylaxis. The cumulative probabilities of initiating ART at 6, 12, and 24 months after eligibility were 49.9%, 70.0% and 87.6%, respectively. Younger age (<25 years) (adjusted hazard ratio [AHR] 1.39, p=0.001), higher CD4 count (AHR 1.95, p<0.001 for >350 compared with <200 cells/μL), higher education (AHR 1.25, p<0.001), and lack of income (AHR 1.15, p=0.02) were independent predictors for delay in ART initiation. Conclusions In the context of close CD4 monitoring, ART counseling, and active linkage to HIV care, a substantial proportion of HIV-infected persons with a known HIV-uninfected partner delayed ART initiation. Strategies to motivate ART initiation are needed, particularly for younger persons with higher CD4 counts. PMID:24798765

  2. HIV-Infected African Parents Living in Stockholm, Sweden: Disclosure and Planning for Their Children's Future

    ERIC Educational Resources Information Center

    Asander, Ann-Sofie; Bjorkman, Anders; Belfrage, Erik; Faxelid, Elisabeth

    2009-01-01

    In Sweden, most HIV-infected parents are of African origin. The present study explored the frequency of HIV-infected African parents' disclosure of their status to their children and custody planning for their children's future to identify support needs among these families. Semistructured interviews were conducted with 47 parents (41 families).…

  3. Targeted interventions required against genital ulcers in African countries worst affected by HIV infection.

    PubMed Central

    O'Farrell, N.

    2001-01-01

    It remains unclear why there is such marked variation in the severity of the human immunodeficiency virus (HIV) epidemic between African countries. The prevalence of HIV infection has reached high levels in many parts of southern Africa but in most countries of West Africa the levels are much lower. Although there is good evidence that sexually transmitted infections (STIs) and genital ulcers in particular facilitate heterosexual transmission of HIV, there is little comparative STI data from the African countries worst affected by HIV infection. A MEDLINE search covering the period 1966 to August 2000 using the keywords "sexually transmitted diseases", "genital ulcers" and "Africa" was performed to identify factors that might be relevant to the spread of HIV infection in countries with the highest prevalences of the virus. In the countries worst affected by HIV infection, the proportions of men and women with STI who had genital ulcers lay in the ranges 45-68% and 13-68%, respectively. The proportions were much lower in countries of West Africa than in those of southern Africa. The African countries worst affected by HIV infection should adopt a more specialized approach to STI control than hitherto and specifically target the high incidence of genital ulceration. Locally, technical STI committees should draw up country-specific guidelines taking into account the prevalence of the various causes of genital ulceration. In these countries, national AIDS control programmes and donor agencies should develop a specific focus for decreasing the incidence of genital ulcer disease. PMID:11436480

  4. Bactericidal Immunity to Salmonella in Africans and Mechanisms Causing Its Failure in HIV Infection

    PubMed Central

    Goh, Yun Shan; Necchi, Francesca; O’Shaughnessy, Colette M.; Micoli, Francesca; Gavini, Massimiliano; Young, Stephen P.; Msefula, Chisomo L.; Gondwe, Esther N.; Mandala, Wilson L.; Gordon, Melita A.; Saul, Allan J.; MacLennan, Calman A.

    2016-01-01

    Background Nontyphoidal strains of Salmonella are a leading cause of death among HIV-infected Africans. Antibody-induced complement-mediated killing protects healthy Africans against Salmonella, but increased levels of anti-lipopolysaccharide (LPS) antibodies in some HIV-infected African adults block this killing. The objective was to understand how these high levels of anti-LPS antibodies interfere with the killing of Salmonella. Methodology/Principal Findings Sera and affinity-purified antibodies from African HIV-infected adults that failed to kill invasive S. Typhimurium D23580 were compared to sera from HIV-uninfected and HIV-infected subjects with bactericidal activity. The failure of sera from certain HIV-infected subjects to kill Salmonella was found to be due to an inherent inhibitory effect of anti-LPS antibodies. This inhibition was concentration-dependent and strongly associated with IgA and IgG2 anti-LPS antibodies (p<0.0001 for both). IgG anti-LPS antibodies, from sera of HIV-infected individuals that inhibit killing at high concentration, induced killing when diluted. Conversely, IgG, from sera of HIV-uninfected adults that induce killing, inhibited killing when concentrated. IgM anti-LPS antibodies from all subjects also induced Salmonella killing. Finally, the inhibitory effect of high concentrations of anti-LPS antibodies is seen with IgM as well as IgG and IgA. No correlation was found between affinity or avidity, or complement deposition or consumption, and inhibition of killing. Conclusion/Significance IgG and IgM classes of anti-S. Typhimurium LPS antibodies from HIV-infected and HIV-uninfected individuals are bactericidal, while at very high concentrations, anti-LPS antibodies of all classes inhibit in vitro killing of Salmonella. This could be due to a variety of mechanisms relating to the poor ability of IgA and IgG2 to activate complement, and deposition of complement at sites where it cannot insert in the bacterial membrane. Vaccine trials

  5. Preexposure Prophylaxis for HIV Infection among African Women

    PubMed Central

    Van Damme, Lut; Corneli, Amy; Ahmed, Khatija; Agot, Kawango; Lombaard, Johan; Kapiga, Saidi; Malahleha, Mookho; Owino, Fredrick; Manongi, Rachel; Onyango, Jacob; Temu, Lucky; Monedi, Modie Constance; Mak’Oketch, Paul; Makanda, Mankalimeng; Reblin, Ilse; Makatu, Shumani Elsie; Saylor, Lisa; Kiernan, Haddie; Kirkendale, Stella; Wong, Christina; Grant, Robert; Kashuba, Angela; Nanda, Kavita; Mandala, Justin; Fransen, Katrien; Deese, Jennifer; Crucitti, Tania; Mastro, Timothy D.; Taylor, Douglas

    2013-01-01

    BACKGROUND Preexposure prophylaxis with antiretroviral drugs has been effective in the prevention of human immunodeficiency virus (HIV) infection in some trials but not in others. METHODS In this randomized, double-blind, placebo-controlled trial, we assigned 2120 HIV-negative women in Kenya, South Africa, and Tanzania to receive either a combination of tenofovir disoproxil fumarate and emtricitabine (TDF–FTC) or placebo once daily. The primary objective was to assess the effectiveness of TDF–FTC in preventing HIV acquisition and to evaluate safety. RESULTS HIV infections occurred in 33 women in the TDF–FTC group (incidence rate, 4.7 per 100 person-years) and in 35 in the placebo group (incidence rate, 5.0 per 100 person-years), for an estimated hazard ratio in the TDF-FTC group of 0.94 (95% confidence interval, 0.59 to 1.52; P = 0.81). The proportions of women with nausea, vomiting, or elevated alanine aminotransferase levels were significantly higher in the TDF–FTC group (P = 0.04, P<0.001, and P = 0.03, respectively). Rates of drug discontinuation because of hepatic or renal abnormalities were higher in the TDF–FTC group (4.7%) than in the placebo group (3.0%, P = 0.051). Less than 40% of the HIV-uninfected women in the TDF–FTC group had evidence of recent pill use at visits that were matched to the HIV-infection window for women with seroconversion. The study was stopped early, on April 18, 2011, because of lack of efficacy. CONCLUSIONS Prophylaxis with TDF–FTC did not significantly reduce the rate of HIV infection and was associated with increased rates of side effects, as compared with placebo. Despite substantial counseling efforts, drug adherence appeared to be low. (Supported by the U.S. Agency for International Development and others; FEM-PrEP ClinicalTrials.gov number, NCT00625404.) PMID:22784040

  6. Cancer and HIV infection in referral hospitals from four West African countries.

    PubMed

    Jaquet, Antoine; Odutola, Michael; Ekouevi, Didier K; Tanon, Aristophane; Oga, Emmanuel; Akakpo, Jocelyn; Charurat, Manhattan; Zannou, Marcel D; Eholie, Serge P; Sasco, Annie J; Bissagnene, Emmanuel; Adebamowo, Clement; Dabis, Francois

    2015-12-01

    The consequences of the HIV epidemic on cancer epidemiology are sparsely documented in Africa. We aimed to estimate the association between HIV infection and selected types of cancers among patients hospitalized for cancer in four West African countries. A case-referent study was conducted in referral hospitals of Benin, Côte d'Ivoire, Nigeria and Togo. Each participating clinical ward included all adult patients seeking care with a confirmed diagnosis of cancer. All patients were systematically screened for HIV infection. HIV prevalence of AIDS-defining and some non-AIDS defining cancers (Hodgkin lymphoma, leukemia, liver, lung, skin, pharynx, larynx, oral cavity and anogenital cancers) were compared to a referent group of cancers reported in the literature as not associated with HIV. Odds ratios adjusted on age, gender and lifetime number of sexual partners (aOR) and their 95% confidence intervals (CI) were estimated. Among the 1644 cancer patients enrolled, 184 (11.2%) were identified as HIV-infected. The HIV prevalence in the referent group (n=792) was 4.4% [CI 3.0-5.8]. HIV infection was associated with Kaposi sarcoma (aOR 34.6 [CI: 17.3-69.0]), non-Hodgkin lymphoma (aOR 3.6 [CI 1.9-6.8]), cervical cancer (aOR 4.3 [CI 2.2-8.3]), anogenital cancer (aOR 17.7 [CI 6.9-45.2]) and squamous cell skin carcinoma (aOR 5.2 [CI 2.0-14.4]). A strong association is now reported between HIV infection and Human Papillomavirus (HPV)-related cancers including cervical cancer and anogenital cancer. As these cancers are amenable to prevention strategies, screening of HPV-related cancers among HIV-infected persons is of paramount importance in this African context. PMID:26375806

  7. AFRICAN-AMERICAN AND HISPANIC-AMERICAN ADOLESCENTS, HIV INFECTION, AND PREVENTIVE INTERVENTION

    PubMed Central

    Schinke, Steven P.; Botvin, Gilbert J.; Orlandi, Mario A.; Schilling, Robert F.; Gordon, Adam N.

    2010-01-01

    This paper considers strategies for preventing human immunodeficiency virus (HIV) infection among African-American and Hispanic-American adolescents. We describe culturally sensitive interventions based on social learning theory. The interventions combine elements of cognitive-behavioral skills for problem solving, coping, and interpersonal communication with elements of ethnic pride and HIV facts. The paper discusses the strengths and limitations of skills intervention for AIDS prevention and concludes with directions for research. PMID:2288812

  8. Exploring Decision-Making of HIV-Infected Hispanics and African Americans Participating in Clinical Trials

    PubMed Central

    Rivera-Goba, Migdalia V.; Dominguez, Dinora C.; Stoll, Pamela; Grady, Christine; Ramos, Catalina; Mican, JoAnn M.

    2011-01-01

    Underrepresentation of HIV-infected Hispanics and African Americans in clinical trials seriously limits our understanding of the benefits and risks of treatment in these populations. This qualitative study examined factors that racial/ethnic minority patients consider when making decisions regarding research participation. Thirty-five HIV-infected Hispanic and African American patients enrolled in clinical research protocols at the National Institutes of Health were recruited to participate in focus groups and in-depth interviews. The sample of mostly men (n = 22), had a mean age of 45, nearly equal representation of race/ethnicity, and diagnosed 2 to 22 years ago. Baseline questionnaires included demographics and measures of social support and acculturation. Interviewers had similar racial/ethnic, cultural, and linguistic backgrounds as the participants. Four major themes around participants’ decisions to enroll in clinical trials emerged: Enhancers, Barriers, Beliefs, and Psychosocial Context. Results may help researchers develop strategies to facilitate inclusion of HIV-infected Hispanics and African Americans into clinical trials. PMID:21256054

  9. HLA disease association and protection in HIV infection among African Americans and Caucasians.

    PubMed

    Cruse, J M; Brackin, M N; Lewis, R E; Meeks, W; Nolan, R; Brackin, B

    1991-01-01

    In a previous investigation, we demonstrated an increased progression of overt AIDS in the African American population compared to the Caucasian population as reflected by the significantly lower absolute number of CD4+ lymphocytes detected in the African American population in an earlier study. The present study elucidates some of the possible genetic factors which may contribute to disease association or protection against HIV infection. The HLA phenotypes expressed as A, B, C, DR and DQw antigens were revealed by the Amos-modified typing procedure. NIH scoring was utilized to designate positive cells taking up trypan blue. A test of proportion equivalent to the chi 2 approximation was used to compare the disease population (n = 62; 38 African Americans, 24 Caucasians) to race-matched normal heterosexual local controls (323 African Americans, 412 Caucasians). Significant p values were corrected for the number of HLA antigens tested. HLA markers associated with possible protection from infection for African Americans were Cw4 and DRw6, whereas Caucasians expressed none. Disease association markers present in the African American population were A31, B35, Cw6, Cw7, DR5, DR6, DRw11, DRw12, DQw6 and DQw7, whereas in the Caucasian population A28, Aw66, Aw48, Bw65, Bw70, Cw7, DRw10, DRw12, DQw6 and DQw7 were demonstrated. The highest phenotypic frequency for a disease association marker in the study was for HLA-DR5 (62.9%) in the HIV-infected African American population without Kaposi's sarcoma compared to a frequency of 28.9% for the regional control group (p = 0.0012). We conclude that genetic factors do have a role in HIV infection since only 50-60% of those exposed to the AIDS virus will become infected. PMID:1910527

  10. Effect of SLCO1B1 Polymorphisms on Rifabutin Pharmacokinetics in African HIV-Infected Patients with Tuberculosis

    PubMed Central

    Naiker, Suhashni; Reddy, Tarylee; Egan, Deirdre; Kellerman, Tracy; Wiesner, Lubbe; Owen, Andrew; McIlleron, Helen; Pym, Alexander

    2015-01-01

    Rifabutin, used to treat HIV-infected tuberculosis, shows highly variable drug exposure, complicating dosing. Effects of SLCO1B1 polymorphisms on rifabutin pharmacokinetics were investigated in 35 African HIV-infected tuberculosis patients after multiple doses. Nonlinear mixed-effects modeling found that influential covariates for the pharmacokinetics were weight, sex, and a 30% increased bioavailability among heterozygous carriers of SLCO1B1 rs1104581 (previously associated with low rifampin concentrations). Larger studies are needed to understand the complex interactions of host genetics in HIV-infected tuberculosis patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT00640887.) PMID:26482301

  11. The Cost-effectiveness of Pre-Exposure Prophylaxis for HIV Infection in South African Women

    PubMed Central

    Walensky, Rochelle P.; Park, Ji-Eun; Wood, Robin; Freedberg, Kenneth A.; Scott, Callie A.; Bekker, Linda-Gail; Losina, Elena; Mayer, Kenneth H.; Seage, George R.; Paltiel, A. David

    2012-01-01

    Background. Recent trials report the short-term efficacy of tenofovir-based pre-exposure prophylaxis (PrEP) for prevention of human immunodeficiency virus (HIV) infection. PrEP’s long-term impact on patient outcomes, population-level transmission, and cost-effectiveness remains unknown. Methods. We linked data from recent trials to a computer model of HIV acquisition, screening, and care to project lifetime HIV risk, life expectancy (LE), costs, and cost-effectiveness, using 2 PrEP-related strategies among heterosexual South African women: (1) women receiving no PrEP and (2) women not receiving PrEP (a tenofovir-based vaginal microbicide). We used a South African clinical cohort and published data to estimate population demographic characteristics, age-adjusted incidence of HIV infection, and HIV natural history and treatment parameters. Baseline PrEP efficacy (percentage reduction in HIV transmission) was 39% at a monthly cost of $5 per woman. Alternative parameter values were examined in sensitivity analyses. Results. Among South African women, PrEP reduced mean lifetime HIV risk from 40% to 27% and increased population discounted (undiscounted) LE from 22.51 (41.66) to 23.48 (44.48) years. Lifetime costs of care increased from $7280 to $9890 per woman, resulting in an incremental cost-effectiveness ratio of $2700/year of life saved, and may, under optimistic assumptions, achieve cost savings. Under baseline HIV infection incidence assumptions, PrEP was not cost saving, even assuming an efficacy >60% and a cost <$1. At an HIV infection incidence of 9.1%/year, PrEP achieved cost savings at efficacies ≥50%. Conclusions. PrEP in South African women is very cost-effective by South African standards, conferring excellent value under virtually all plausible data scenarios. Although optimistic assumptions would be required to achieve cost savings, these represent important benchmarks for future PrEP study design. PMID:22474224

  12. What African American Male Adolescents Are Telling Us about HIV Infection among Their Peers: Cultural Approaches for HIV Prevention

    ERIC Educational Resources Information Center

    Voisin, Dexter R.; Bird, Jason D. P.

    2009-01-01

    This study explored the beliefs of African American male adolescents concerning the high rates of HIV infection among their peers and their reasons for those beliefs. In-depth interviews were conducted with a sample of 16 male African Americans, and a thematic analysis of the data was conducted. Half of the participants believed that peers were…

  13. Stroke in HIV-infected African Americans: a retrospective cohort study.

    PubMed

    Thakur, Kiran T; Lyons, Jennifer L; Smith, Bryan R; Shinohara, Russell T; Mateen, Farrah J

    2016-02-01

    The risk of having a first stroke is nearly twice as high among African Americans compared to Caucasians. HIV/AIDS is an independent risk factor for stroke. Our study aimed to report the risk factors and short-term clinical outcomes of African Americans with HIV infection and new-onset stroke admitted at the Johns Hopkins Hospitals (2000-2012). Multivariate linear regression was used to examine the association between potential predictors and odds of an unfavorable outcome, defined as a higher modified Rankin Scale (mRS) score on hospital discharge. African Americans comprised 105/125 (84%) of HIV-infected new-onset stroke inpatients (median age 50 years; 69% men; median CD4 140/mL; ischemic 77%; 39% taking highly active antiretroviral therapy). Vascular risk factors were common: hypertension (67%), cigarette smoking (66%), dyslipidemia (42%), hepatitis C (48%), intravenous drug abuse (32%), and prior myocardial infarction (29%). Prior aspirin and statin use were uncommon (18%, 9%). Unfavorable outcome (mRS score 4-6, n = 22 of 90 available records) was noted in 24% of patients, including seven in-hospital deaths. On multivariate analyses, higher CD4 count on hospital admission was associated with a lower mRS (-0.2 mRS points per 1 unit increase in CD4, 95% CI (-0.3, 0), p = 0.03). Intracerebral hemorrhage was also associated with a lower mRS (1.0 points lower, 95% CI (0.2, 1.8) compared to ischemic stroke, p = 0.01) after adjustment for other potential predictors. This underscores the importance of HIV infection on functional stroke outcomes beyond its recognized influence on stroke risk. PMID:26155903

  14. Structural and Sociocultural Factors Associated with Cervical Cancer Screening Among HIV-Infected African American Women in Alabama

    PubMed Central

    Moneyham, Linda; Kempf, Mirjam-Colette; Chamot, Eric; Scarinci, Isabel

    2015-01-01

    Abstract African American women have disproportionately high prevalence rates of HIV and cervical cancer. HIV-infected women are significantly less likely to obtain recommended cervical cancer screenings than HIV-uninfected women. The purpose of this study was to examine sociocultural and structural factors associated with cervical cancer screening among HIV-infected African American in Alabama. The PEN-3 Model and the Health Belief Model were used as theoretical frameworks. In-depth interviews were conducted with twenty HIV-infected African American women to identify perceptions, enablers, and nurturers, perceived susceptibility, perceived severity, and perceived benefits related to cervical cancer and screening. The most common positive perceptions, enablers, and nurturers that contributed to cervical cancer screening included internal motivation and awareness of the importance of HIV-infected women getting Pap tests due to their weakened immune system. Negative perceptions, enablers, and nurturers included lack of knowledge about cervical cancer and screening, and lack of perceived susceptibility to cervical cancer. The results of this study can be used to guide the development of culturally relevant cervical cancer and screening education interventions aimed at increasing cervical cancer screening adherence among HIV-infected African American women. PMID:25514125

  15. HIV infection among injecting drug users in north-east Malaysia, 1992.

    PubMed

    Singh, S; Crofts, N

    1993-01-01

    Human immunodeficiency virus (HIV) has spread widely among injecting drug users (IDUs) in countries to the north and west of the 'Golden Triangle' region of South-East Asia; it is likely to have spread southwards to Malaysia as well. In order to assess HIV seroprevalence among IDUs in north-east Malaysia and describe risk factors for HIV infection in this population, we performed a cross-sectional seroepidemiological study among 210 IDUs recruited at the detoxification ward of the General Hospital in the capital city of the north-eastern Malaysian state, Kelantan. Subjects were sequential entrants to the detoxification ward, interviewed about HIV risk behaviour, and tested for antibody to HIV and to syphilis. Nearly a third (62/210, 30%) of these IDUs were HIV seropositive. Three-quarters (159/210) had travelled to Thailand in the preceding 5 years, of whom 32% (51/159) were HIV seropositive; this was associated with injecting in Thailand, but not with sexual contact there. Of those who had not left Malaysia in the preceding 5 years, 26% (11/43) were HIV seropositive, a rate not significantly different from those who had travelled. Travel within Malaysia was common (144/210, 69%) among IDUs interviewed, as was unsafe injecting and unsafe sexual behaviour (20% had shared injecting equipment and 21% had had unprotected intercourse) in other states. In every locale, rates of unsafe injecting behaviour were high (55% sharing in last month), even among those who knew they were HIV infected, and rates of condom usage were low (93% of 160 sexually active IDUs had never used a condom). Syphilis was not associated with HIV infection, but with contact with Thai prostitutes.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8218462

  16. Prevalence of common vitamin D receptor gene polymorphisms in HIV-infected and uninfected South Africans

    PubMed Central

    McNamara, Lynne; Takuva, Simbarashe; Chirwa, Tobias; MacPhail, Patrick

    2016-01-01

    Background: Host genetic factors may a play role in susceptibility to infection. Vitamin-D is an immunomodulator that may play a role in HIV infection. Vitamin-D action is mediated by the vitamin-D receptor. We establish prevalence of ApaI, BsmI, FokI and TaqI polymorphisms (VDRPs) amongst a black southern African HIV+ve population and investigate polymorphic differences between HIV+ve and -ve people. Methods: Seventy-nine sex and age-group matched HIV+ve patients of African origin initiating antiretroviral therapy (ART) and 79 HIV-ve participants, also of African origin, were recruited from a public sector HIV testing and treatment clinic and investigated for the 4 polymorphisms. The genotype frequencies were compared, odds ratios and 95% confidence intervals of the association of HIV status and each genotype were calculated. Both dominant, co-dominant, recessive and allele models were tested. Results: We found no evidence of difference in distribution and association between HIV infection and the genotypes of the BsmI, FokI and TaqI VDR polymorphisms. The genotype distributions were consistent with Hardy-Weinberg equilibrium for these genotypes. The ApaI genotype showed differences in distribution by HIV status in the dominant and co-dominant models. However this finding is cautiously stated as the ApaI genotype violated the Hardy-Weinberg equilibrium and frequency of the minor variant was unexpectedly low in this population. Conclusion: We do not show convincing differences in distribution of the VDR genotypes among HIV+ve and HIV-ve black southern African persons. Future studies need to be replicated in larger study populations as understanding polymorphic differences and similarities may offer insights into the different susceptibility and progression of HIV in southern African populations. PMID:27186331

  17. Social factors that make South African women vulnerable to HIV infection.

    PubMed

    Ackermann, Leáne; de, KlerkGerhardtW

    2002-02-01

    The degree to which women are able to control various aspects of their sexual lives is clearly a critical question for health promotion and the prevention of AIDS. It is evident that social factors such as the high rate of rape, the unfavourable economic position of women, and the inability to insist on condom usage make South African women unable to negotiate the timing of sex and the conditions under which it occurs. They are thus rendered powerless to protect themselves against HIV infection. Prevention campaigns often do not take into account the reality of the daily lives of South African women and the difficulties they face gaining control over their own sexual lives. The rampant spread of this disease can only be stemmed if the subordinate position of women is acknowledged and addressed. PMID:11868963

  18. Anti-Retroviral Therapy Increases the Prevalence of Dyslipidemia in South African HIV-Infected Patients

    PubMed Central

    Dave, Joel A.; Levitt, Naomi S.; Ross, Ian L.; Lacerda, Miguel; Maartens, Gary; Blom, Dirk

    2016-01-01

    Purpose Data on the prevalence of dyslipidaemia and associated risk factors in HIV-infected patients from sub-Saharan Africa is sparse. We performed a cross-sectional analysis in a cohort of HIV-infected South African adults. Methods We studied HIV-infected patients who were either antiretroviral therapy (ART)-naive or receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-based or protease inhibitor (PI)-based ART. Evaluation included fasting lipograms, oral glucose tolerance tests and clinical anthropometry. Dyslipidemia was defined using the NCEP ATPIII guidelines. Results The median age of the participants was 34 years (range 19–68 years) and 78% were women. The prevalence of dyslipidemia in 406 ART-naive and 551 participants on ART was 90.0% and 85%, respectively. Low HDL-cholesterol (HDLC) was the most common abnormality [290/406 (71%) ART-naïve and 237/551 (43%) ART- participants]. Participants on ART had higher triglycerides (TG), total cholesterol (TC), LDL-cholesterol (LDLC) and HDLC than the ART-naïve group. Severe dyslipidaemia, (LDLC> 4.9 mmol/L or TG >5.0 mmol/L) was present in <5% of participants. In multivariate analyses there were complex associations between age, gender, type and duration of ART and body composition and LDLC, HDLC and TG, which differed between ART-naïve and ART-participants. Conclusion Participants on ART had higher TG, TC, LDLC and HDLC than those who were ART-naïve but severe lipid abnormalities requiring evaluation and treatment were uncommon. PMID:26986065

  19. Challenges and opportunities for HIV prevention and care: insights from focus groups of HIV-infected African American men.

    PubMed

    Buseh, Aaron G; Stevens, Patricia E; McManus, Patricia; Addison, Reverend Jim; Morgan, Sarah; Millon-Underwood, Sandra

    2006-01-01

    Given the inordinate burden of HIV illness borne by African American men, investigations of HIV prevention and care in this population are urgently needed. In this qualitative study, a sample of 20 HIV-infected African American men participated in two focus groups in which they exchanged experiences and ideas about living with HIV. They shared details about how they were personally impacted by HIV, and together they constructed a perspective on the larger societal context in which the HIV infection rate among African American men continues unabated. The men focused on growing complacency about HIV/AIDS in the United States, underfunding of supports and services, stigmas operative in African American communities, and differential care based on race, gender, and diagnosis. They saw opportunity in personal strategies that help individual men infected with HIV to take a more empowered stance to deal with the disease and improve their health but looked for changes undertaken by African Americans at the community level to make a real difference in the epidemic. Their vision included enhanced support for HIV prevention and care from influential community institutions like Black churches, more open dialogue about drugs and sexual behavior, and capacity-building for families whose members are HIV-infected or at risk for HIV. PMID:16849084

  20. Keep them in school: the importance of education as a protective factor against HIV infection among young South African women

    PubMed Central

    Pettifor, Audrey E; Levandowski, Brooke A; MacPhail, Catherine; Padian, Nancy S; Cohen, Myron S; Rees, Helen V

    2008-01-01

    Objective To identify risk factors for HIV infection among young women aged 15–24 years reporting one lifetime partner in South Africa. Design In 2003, we conducted a nationally representative household survey of sexual behaviour and HIV testing among 11 904 young people aged 15–24 years in South Africa. This analysis focuses on the subset of sexually experienced young women with only one reported lifetime sex partner (n = 1708). Methods Using the proximate determinants framework and the published literature we identified factors associated with HIV in young women. The associations between these factors and HIV infection were explored in multivariable logistic regression models. Results Of the young women, 15% reporting one lifetime partner were HIV positive. In multivariable analyses, young women who had not completed high school were more likely to be infected with HIV compared with those that had completed high school (AOR 3.75; 95% CI 1.34–10.46). Conclusions Young South African women in this population were at high risk of HIV infection despite reporting only having one lifetime partner. Few individual level factors were associated with HIV infection, emphasizing the importance of developing HIV prevention interventions that address structural and partner level risk factors. PMID:18614609

  1. Association of pol Diversity with Antiretroviral Treatment Outcomes among HIV-Infected African Children

    PubMed Central

    Chen, Iris; Khaki, Leila; Lindsey, Jane C.; Fry, Carrie; Cousins, Matthew M.; Siliciano, Robert F.; Violari, Avy; Palumbo, Paul; Eshleman, Susan H.

    2013-01-01

    Background In HIV-infected children, viral diversity tends to increase with age in the absence of antiretroviral treatment (ART). We measured HIV diversity in African children (ages 6–36 months) enrolled in a randomized clinical trial comparing two ART regimens (Cohort I of the P1060 trial). Children in this cohort were exposed to single dose nevirapine (sdNVP) at birth. Methods HIV diversity was measured retrospectively using a high resolution melting (HRM) diversity assay. Samples were obtained from 139 children at the enrollment visit prior to ART initiation. Six regions of the HIV genome were analyzed: two in gag, one in pol, and three in env. A single numeric HRM score that reflects HIV diversity was generated for each region; composite HRM scores were also calculated (mean and median for all six regions). Results In multivariable median regression models using backwards selection that started with demographic and clinical variables, older age was associated with higher HRM scores (higher HIV diversity) in pol (P = 0.005) and with higher mean (P = 0.014) and median (P<0.001) HRM scores. In multivariable models adjusted for age, pre-treatment HIV viral load, pre-treatment CD4%, and randomized treatment regimen, higher HRM scores in pol were associated with shorter time to virologic suppression (P = 0.016) and longer time to study endpoints (virologic failure [VF], VF/death, and VF/off study treatment; P<0.001 for all measures). Conclusions In this cohort of sdNVP-exposed, ART-naïve African children, higher levels of HIV diversity in the HIV pol region prior to ART initiation were associated with better treatment outcomes. PMID:24312277

  2. Gender Expression and Risk of HIV Infection Among Black South African Men Who Have Sex with Men.

    PubMed

    Sandfort, Theodorus G M; Lane, Tim; Dolezal, Curtis; Reddy, Vasu

    2015-12-01

    To explore demographic, behavioral and psychosocial risk factors for HIV infection in South African MSM we recruited 480 MSM (aged 18 and 44 years) using respondent-driven sampling. Data were collected through individual computer-assisted face-to-face interviews. Participants were tested for HIV. RDS-adjusted HIV prevalence is 30.1 % (unadjusted 35.6 %). Few participants had ever engaged in both receptive and insertive anal sex; sex with women was frequently reported. Independent demographic and behavioral correlates of HIV infection include age, education, number of male sexual partners, ever having been forced to have sex, and ever having engaged in transactional sex; engagement in sex with women was a protective factor. Psychosocial risk factors independently associated with HIV infection were feminine identification, internalized homophobia, and hazardous drinking. Our findings confirm what has been found in other studies, but also suggest that the dynamics and context of sexual transmission among MSM in South Africa differ from those among MSM in Western countries. PMID:25869555

  3. Blood Group Antigens C, Lub and P1 May Have a Role in HIV Infection in Africans

    PubMed Central

    Motswaledi, Modisa Sekhamo; Kasvosve, Ishmael; Oguntibeju, Oluwafemi Omoniyi

    2016-01-01

    Background Botswana is among the world’s countries with the highest rates of HIV infection. It is not known whether or not this susceptibility to infection is due to genetic factors in the population. Accumulating evidence, however, points to the role of erythrocytes as potential mediators of infection. We therefore sought to establish the role, if any, of some erythrocyte antigens in HIV infection in a cross-section of the population. Methods 348 (346 HIV-negative and 2 HIV-positive) samples were obtained from the National Blood Transfusion Service as residual samples, while 194 HIV-positive samples were obtained from the Botswana-Harvard HIV Reference Laboratory. Samples were grouped for twenty three antigens. Chi-square or Fischer Exact analyses were used to compare the frequencies of the antigens in the two groups. A stepwise, binary logistic regression was used to study the interaction of the various antigens in the light of HIV-status. Results The Rh antigens C and E were associated with HIV-negative status, while blood group Jka, P1 and Lub were associated with HIV-positive status. A stepwise binary logistic regression analysis yielded group C as the most significant protective blood group while Lub and P1 were associated with significantly higher odds ratio in favor of HIV-infection. The lower-risk-associated group C was significantly lower in Africans compared to published data for Caucasians and might partially explain the difference in susceptibility to HIV-1. Conclusion The most influential antigen C, which also appears to be protective, is significantly lower in Africans than published data for Caucasians or Asians. On the other hand, there appear to be multiple antigens associated with increased risk that may override the protective role of C. A study of the distribution of these antigens in other populations may shed light on their roles in the HIV pandemic. PMID:26900853

  4. Reducing the risk of HIV infection among South African sex workers: socioeconomic and gender barriers.

    PubMed Central

    Karim, Q A; Karim, S S; Soldan, K; Zondi, M

    1995-01-01

    OBJECTIVES. The social context within which women engaged in sex work at a popular truck stop in South Africa are placed at risk of human immunodeficiency virus (HIV) infection and the factors that influence their ability to reduce their risk were assessed. METHODS. Using qualitative and quantitative techniques, an elected sex worker from within the group collected all data. RESULTS. Given the various pressing needs for basic survival, the risk of HIV infection is viewed as one more burden imposed on these women by their lack of social, legal, and economic power. Violence, or the threat thereof, plays an important role in their disempowerment. In the few instances in which sex workers were able to insist on condom use, it resulted in a decrease in earnings, loss of clients, and physical abuse. CONCLUSIONS. Recommendations to reduce the sex workers' risk for HIV infection include negotiation and communication skills to enable them to persuade their clients to use condoms; development of strategies through which they can maximally use their group strength to facilitate unified action; and accessibility of protective methods they can use and control, such as intravaginal microbicides. PMID:7485664

  5. HIV Infection and the Epidemiology of Invasive Pneumococcal Disease (IPD) in South African Adults and Older Children Prior to the Introduction of a Pneumococcal Conjugate Vaccine (PCV)

    PubMed Central

    Meiring, Susan; Cohen, Cheryl; Quan, Vanessa; de Gouveia, Linda; Feldman, Charles; Karstaedt, Alan; Klugman, Keith P.; Madhi, Shabir A.; Rabie, Helene; Sriruttan, Charlotte; von Gottberg, Anne

    2016-01-01

    Introduction Streptococcus pneumoniae is the commonest cause of bacteremic pneumonia among HIV-infected persons. As more countries with high HIV prevalence are implementing infant pneumococcal conjugate vaccine (PCV) programs, we aimed to describe the baseline clinical characteristics of adult invasive pneumococcal disease (IPD) in the pre-PCV era in South Africa in order to interpret potential indirect effects following vaccine use. Methods National, active, laboratory-based surveillance for IPD was conducted in South Africa from 1 January 2003 through 31 December 2008. At 25 enhanced surveillance (ES) hospital sites, clinical data, including HIV serostatus, were collected from IPD patients ≥ 5 years of age. We compared the clinical characteristics of individuals with IPD in those HIV-infected and -uninfected using multivariable analysis. PCV was introduced into the routine South African Expanded Program on Immunization (EPI) in 2009. Results In South Africa, from 2003–2008, 17 604 cases of IPD occurred amongst persons ≥ 5 years of age, with an average incidence of 7 cases per 100 000 person-years. Against a national HIV-prevalence of 18%, 89% (4190/4734) of IPD patients from ES sites were HIV-infected. IPD incidence in HIV-infected individuals is 43 times higher than in HIV-uninfected persons (52 per 100 000 vs. 1.2 per 100 000), with a peak in the HIV-infected elderly population of 237 per 100 000 persons. Most HIV-infected individuals presented with bacteremia (74%, 3 091/4 190). HIV-uninfected individuals were older; and had more chronic conditions (excluding HIV) than HIV-infected persons (39% (210/544) vs. 19% (790/4190), p<0.001). During the pre-PCV immunization era in South Africa, 71% of serotypes amongst HIV-infected persons were covered by PCV13 vs. 73% amongst HIV-uninfected persons, p = 0.4, OR 0.9 (CI 0.7–1.1). Conclusion Seventy to eighty-five percent of adult IPD in the pre-PCV era were vaccine serotypes and 93% of cases had recognized risk

  6. East African Rift Valley, Kenya

    NASA Technical Reports Server (NTRS)

    1990-01-01

    This rare, cloud free view of the East African Rift Valley, Kenya (1.5N, 35.5E) shows a clear view of the Turkwell River Valley, an offshoot of the African REift System. The East African Rift is part of a vast plate fracture which extends from southern Turkey, through the Red Sea, East Africa and into Mozambique. Dark green patches of forests are seen along the rift margin and tea plantations occupy the cooler higher ground.

  7. The Distribution of Obesity Phenotypes in HIV-Infected African Population

    PubMed Central

    Nguyen, Kim Anh; Peer, Nasheeta; de Villiers, Anniza; Mukasa, Barbara; Matsha, Tandi E.; Mills, Edward J.; Kengne, Andre Pascal

    2016-01-01

    The distribution of body size phenotypes in people with human immunodeficiency virus (HIV) infection has yet to be characterized. We assessed the distribution of body size phenotypes overall, and according to antiretroviral therapy (ART), diagnosed duration of the infection and CD4 count in a sample of HIV infected people recruited across primary care facilities in the Western Cape Province, South Africa. Adults aged ≥ 18 years were consecutively recruited using random sampling procedures, and their cardio-metabolic profile were assessed during March 2014 and February 2015. They were classified across body mass index (BMI) categories as normal-weight (BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2), and further classified according to their metabolic status as “metabolically healthy” vs. “metabolically abnormal” if they had less than two vs. two or more of the following abnormalities: high blood glucose, raised blood pressure, raised triglycerides, and low HDL-cholesterol. Their cross-classification gave the following six phenotypes: normal-weight metabolically healthy (NWMH), normal-weight metabolically abnormal (NWMA), overweight metabolically healthy (OvMH), overweight metabolically abnormal (OvMA), obese metabolically healthy (OMH), and obese metabolically abnormal (OMA). Among the 748 participants included (median age 38 years (25th–75th percentiles: 32–44)), 79% were women. The median diagnosed duration of HIV was five years; the median CD4 count was 392 cells/mm3 and most participants were on ART. The overall distribution of body size phenotypes was the following: 31.7% (NWMH), 11.7% (NWMA), 13.4% (OvMH), 9.5% (OvMA), 18.6% (OMH), and 15.1% (OMA). The distribution of metabolic phenotypes across BMI levels did not differ significantly in men vs. women (p = 0.062), in participants below vs. those at or above median diagnosed duration of HIV infection (p = 0.897), in participants below vs. those at or above median

  8. The Distribution of Obesity Phenotypes in HIV-Infected African Population.

    PubMed

    Nguyen, Kim Anh; Peer, Nasheeta; de Villiers, Anniza; Mukasa, Barbara; Matsha, Tandi E; Mills, Edward J; Kengne, Andre Pascal

    2016-01-01

    The distribution of body size phenotypes in people with human immunodeficiency virus (HIV) infection has yet to be characterized. We assessed the distribution of body size phenotypes overall, and according to antiretroviral therapy (ART), diagnosed duration of the infection and CD4 count in a sample of HIV infected people recruited across primary care facilities in the Western Cape Province, South Africa. Adults aged ≥ 18 years were consecutively recruited using random sampling procedures, and their cardio-metabolic profile were assessed during March 2014 and February 2015. They were classified across body mass index (BMI) categories as normal-weight (BMI < 25 kg/m²), overweight (25 ≤ BMI < 30 kg/m²), and obese (BMI ≥ 30 kg/m²), and further classified according to their metabolic status as "metabolically healthy" vs. "metabolically abnormal" if they had less than two vs. two or more of the following abnormalities: high blood glucose, raised blood pressure, raised triglycerides, and low HDL-cholesterol. Their cross-classification gave the following six phenotypes: normal-weight metabolically healthy (NWMH), normal-weight metabolically abnormal (NWMA), overweight metabolically healthy (OvMH), overweight metabolically abnormal (OvMA), obese metabolically healthy (OMH), and obese metabolically abnormal (OMA). Among the 748 participants included (median age 38 years (25th-75th percentiles: 32-44)), 79% were women. The median diagnosed duration of HIV was five years; the median CD4 count was 392 cells/mm³ and most participants were on ART. The overall distribution of body size phenotypes was the following: 31.7% (NWMH), 11.7% (NWMA), 13.4% (OvMH), 9.5% (OvMA), 18.6% (OMH), and 15.1% (OMA). The distribution of metabolic phenotypes across BMI levels did not differ significantly in men vs. women (p = 0.062), in participants below vs. those at or above median diagnosed duration of HIV infection (p = 0.897), in participants below vs. those at or above median CD4

  9. African American community leaders' policy recommendations for reducing racial disparities in HIV infection, treatment, and care: results from a community-based participatory research project in Philadelphia, Pennsylvania.

    PubMed

    Nunn, Amy; Sanders, Julia; Carson, Lee; Thomas, Gladys; Cornwall, Alexandra; Towey, Caitlin; Lee, Hwajin; Tasco, Marian; Shabazz-El, Waheedah; Yolken, Annajane; Smith, Tyrone; Bell, Gary; Feller, Sophie; Smith, Erin; James, George; Shelton Dunston, Brenda; Green, Derek

    2015-01-01

    African Americans account for 45% of new HIV infections in the United States. Little empirical research investigates African American community leaders' normative recommendations for addressing these disparities. Philadelphia's HIV infection rate is 5 times the national average, nearly 70% of new infections are among African Americans, and 2% of African Americans in Philadelphia are living with HIV/AIDS. Using a community-based participatory research approach, we convened focus groups among 52 African American community leaders from diverse backgrounds to solicit normative recommendations for reducing Philadelphia's racial disparities in HIV infection. Leaders recommended that (a) Philadelphia's city government should raise awareness about HIV/AIDS with media campaigns featuring local leaders, (b) local HIV-prevention interventions should address social and structural factors influencing HIV risks rather than focus exclusively on mode of HIV transmission, (c) resources should be distributed to the most heavily affected neighborhoods of Philadelphia, and (d) faith institutions should play a critical role in HIV testing, treatment, and prevention efforts. We developed a policy memo highlighting these normative recommendations for how to enhance local HIV prevention policy. This policy memo led to Philadelphia City Council hearings about HIV/AIDS in October 2010 and subsequently informed local HIV/AIDS prevention policy and development of local HIV prevention interventions. This community-based participatory research case study offers important lessons for effectively engaging community leaders in research to promote HIV/AIDS policy change. PMID:24879446

  10. African American community leaders' policy recommendations for reducing racial disparities in HIV infection, treatment and care: results from a community-based participatory research project in Philadelphia, PA

    PubMed Central

    Nunn, Amy; Sanders, Julia; Carson, Lee; Thomas, Gladys; Cornwall, Alexandra; Towey, Caitlin; Lee, Hwajin; Tasco, Marian; Shabazz-El, Waheedah; Yolken, Annajane; Smith, Tyrone; Bell, Gary; Feller, Sophie; Smith, Erin; James, George; Dunston, Brenda Shelton; Green, Derek

    2015-01-01

    African Americans account for 45% of new HIV infections in the United States. Little empirical research investigates African American community leaders' normative recommendations for addressing these disparities. Philadelphia's HIV infection rate is five times the national average, nearly 70% of new infections are among African Americans, and 2% of African Americans in Philadelphia are living with HIV/AIDS. Using a community-based participatory research (CBPR) approach, we convened focus groups among 52 African American community leaders from diverse backgrounds to solicit normative recommendations for reducing Philadelphia's racial disparities in HIV infection. Leaders recommended: 1) Philadelphia's city government should raise awareness about HIV/AIDS with media campaigns featuring local leaders; 2) Local HIV prevention interventions should address social and structural factors influencing HIV risks rather than focus exclusively on mode of HIV transmission; 3) Resources should be distributed to the most heavily impacted neighborhoods of Philadelphia; and 4) Faith institutions should play a critical role in HIV testing, treatment and prevention efforts. We developed a policy memo highlighting these normative recommendations for how to enhance local HIV prevention policy. This policy memo led to Philadelphia City Council hearings about HIV/AIDS in October 2010 and subsequently informed local HIV/AIDS prevention policy and development of local HIV prevention interventions. This CBPR case study offers important lessons for effectively engaging community leaders in research to promote HIV/AIDS policy change. PMID:24879446

  11. Global oral inequalities in HIV infection.

    PubMed

    Challacombe, S J

    2016-04-01

    Analysis of the prevalence and incidence of HIV infection globally reveal striking variances with regard to continent, country, region and gender. Of the global total of 33 million people infected with HIV, approximately 65% are in sub-Saharan African countries and 15% in South and South-East Asia with the remaining 20% spread over the rest of the world. As a percentage of the population, the Caribbean at 1.1% is second only to sub-Saharan Africa (5.5%). The majority of the world's HIV is in women. Deaths from HIV are twenty-fold greater in Africa than in Europe or the USA. Individual countries in sub-Saharan Africa show huge variances in the HIV+ prevalence with most West African countries having a rate of less than 2% whilst southern African countries including Swaziland and Botswana have rates of around 25%. Environment, education and social habits all contribute to the HIV infection rates. Similar variations between countries are seen in SE Asia with Cambodia and Papua New Guinea having rates three times greater than Pakistan. One of the most striking examples of inequality is in life years added to HIV populations as a result of antiretroviral therapy. UN AIDS figures over 1996-2008 suggest an average of 2.88 added years in the USA and Europe, but only 0.1 in sub-Saharan Africa, a thirty-fold difference largely due to accessibility to ART. ART leads to a reduction in oral lesions but it is estimated that some 10 million HIV+ subjects do not have access to oral care. Thus, inequalities exist both for HIV infection and for the associated oral lesions, mainly related to ART access. HIV infection and oral mucosal lesions both appear to be related to general social determinants of health. Oral HCW must be part of mainstream healthcare teams to address these inequalities. PMID:27109270

  12. PEPFAR Funding and Reduction in HIV Infection Rates in 12 Focus Sub-Saharan African Countries: A Quantitative Analysis

    PubMed Central

    Chin, Roger J.; Sangmanee, Domrongphol; Piergallini, Lisa

    2015-01-01

    Background: HIV and AIDS continue to have a calamitous effect on individuals living on the continent of Africa. U.S. President George W. Bush implemented the President’s Emergency Plan for AIDS Relief (PEPFAR) with the objective of committing approximately $15 billion from 2004 through 2008 to assist with the reduction of the HIV pandemic worldwide. The majority of the PEPFAR policy and funding focused on 12 countries in sub-Saharan Africa: Botswana, Cote d’Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia. The policy question this research paper seeks to analyze is whether the PEPFAR funding (as a % of Gross Domestic Product (GDP)) allocated to the 12 countries in Africa had any effect on the decrease of HIV infection rates of males and females between the ages of 15 and 49. Methods: A fixed-effects panel regression analysis was conducted to determine if this association exists. This study examined the 12 African countries that received PEPFAR funding over the years 2002 to 2010; even though PEPFAR was only active from 2004 through 2008, this research included two years prior and two years after this timeframe in order to better estimate the effect of PEPFAR funding on HIV reduction. Results: The results illustrate that on average, ceteris paribus, for every 1 percentage point increase in PEPFAR funding per GDP a country received, the country’s HIV infection rate decreased by 0.355 percentage points. Conclusions and Global Health Implications: While the empirical findings in this study suggested that the correlation between PEPFAR funding and HIV reduction is statistically significant, the practical significance is perhaps less obvious. Arguably, the reduction rate should be higher given the extent of funding targeted to this project. The conclusion of this research provides suggestions on future research and the policy implications of PEPFAR.

  13. East African Rift

    NASA Technical Reports Server (NTRS)

    2008-01-01

    Places where the earth's crust has formed deep fissures and the plates have begun to move apart develop rift structures in which elongate blocks have subsided relative to the blocks on either side. The East African Rift is a world-famous example of such rifting. It is characterized by 1) topographic deep valleys in the rift zone, 2) sheer escarpments along the faulted walls of the rift zone, 3) a chain of lakes within the rift, most of the lakes highly saline due to evaporation in the hot temperatures characteristic of climates near the equator, 4) voluminous amounts of volcanic rocks that have flowed from faults along the sides of the rift, and 5) volcanic cones where magma flow was most intense. This example in Kenya displays most of these features near Lake Begoria.

    The image was acquired December 18, 2002, covers an area of 40.5 x 32 km, and is located at 0.1 degrees north latitude, 36.1 degrees east longitude.

    The U.S. science team is located at NASA's Jet Propulsion Laboratory, Pasadena, Calif. The Terra mission is part of NASA's Science Mission Directorate.

  14. The effect of partner characteristics on HIV infection among African American men who have sex with men in the Young Men's Survey, Los Angeles, 1999-2000.

    PubMed

    Bingham, Trista A; Harawa, Nina T; Johnson, Denise F; Secura, Gina M; MacKellar, Duncan A; Valleroy, Linda A

    2003-02-01

    Previous studies have documented disparities in HIV prevalence by race among men who have sex with men (MSM), even after adjusting for traditional risk factors. In this analysis of data collected for the 1999-2000 Los Angeles Young Men's Survey, a cross-sectional venue-based survey of MSM aged 23-29, we investigated whether information on male sex-partner characteristics accounts for some of the racial/ethnic differences in HIV prevalence. In this sample of survey participants, we observed that African American MSM reported similar or lower levels of HIV risk behaviors compared with White MSM but much higher HIV prevalence (26% vs. 7.4%, respectively). In an unadjusted logistic regression model, African American participants had 4.4 times higher odds of HIV infection compared with White participants. In a multiple logistic regression model adjusting for participant behaviors, we observed elevation of the relative odds of HIV infection for African Americans compared with Whites (odds ratio [OR] = 6.9, 95% confidence limits [CL] = 2.5, 19). In a fully adjusted model, controlling for the effects of having older partners and more African American partners, we observed a 20% reduction in the relative odds of HIV for African American participants compared with White participants (OR = 5.5, 95% CL = 1.8, 17). Our findings suggest that differences in male partner types, namely older and African American partners, may account for some of the observed racial disparity in HIV infection, especially for African American MSM compared with White MSM in Los Angeles. PMID:12630598

  15. A synthesis of the theory of silencing the self and the social ecological model: understanding gender, race, and depression in African American women living with HIV infection.

    PubMed

    Lanier, Latrona; DeMarco, Rosanna

    2015-03-01

    The challenges that face African American women living with HIV are immense. African American women continue to be disproportionately infected and affected by this chronic and life-threatening infection in a complex context of individual experience, interactions with the environment, formal and informal support systems, and cultural belief systems. This article identifies the Theory of Silencing the Self (STS) and a widely known model, the Social Ecological Model (SEM), as a synthesized explanatory framework in helping nurses understand how to address research questions and clinical care that is congruent with the experience of African American women living with HIV infection. In synthesizing the components of these two frameworks, an explanation of the relationship between disempowerment and depression in this population will be uncovered as a key component to making relationships at the individual, family, and community level better. Helping African American women living with HIV infection to explore and address how choosing to be silent across their life systems will advance healthcare adherence as we currently know it to improved self-management of a chronic, gender-specific, culturally-bound experience of depression. PMID:25614997

  16. The Impact of Taking or Not Taking ARVs on HIV Stigma as Reported by Persons Living with HIV Infection in Five African Countries

    PubMed Central

    Makoae, Lucy N.; Portillo, Carmen J.; Uys, Leana R.; Dlamini, Priscilla S.; Greeff, Minrie; Chirwa, Maureen; Kohi, Thecla W.; Naidoo, Joanne; Mullan, Joseph; Wantland, Dean; Durrheim, Kevin; Holzemer, William L.

    2009-01-01

    Aim This study examined the impact of taking or not taking antiretroviral (ARV) medications on stigma, as reported by people living with HIV infection in five African countries. Design A two group (taking or not taking ARVs) by three (time) repeated measures analysis of variance examined change in reported stigma in a cohort sample of 1,454 persons living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Participants self-reported taking ARV medications and completed a standardized stigma scale validated in the African context. Data were collected at three points in time, from January 2006 to March 2007. Participants taking ARV medications self-reported a mean CD4 count of 273 and those not taking ARV self-reported a mean CD4 count of 418. Results Both groups reported significant decreases in total HIV stigma over time; however, people taking ARVs reported significantly higher stigma at Time 3 compared to those not taking ARVs. Discussion This study documents that this sample of 1,454 HIV infected persons in five countries in Africa reported significantly less HIV stigma over time. In addition, those participants taking ARV medications experienced significantly higher HIV stigma over time compared to those not taking ARVs. This finding contradicts some authors’ opinions that when clients enroll in ARV medication treatment it signifies that they are experiencing less stigma. This work provides caution to health care providers to alert clients new to ARV treatment that they may experience more stigma from their families and communities when they learn they are taking ARV medications. PMID:20024711

  17. Decreased sexual risk behavior in the era of HAART among HIV-infected urban and rural South Africans attending primary care clinics

    PubMed Central

    Venkatesh, Kartik K; de Bruyn, Guy; Lurie, Mark N; Mohapi, Lerato; Pronyk, Paul; Moshabela, Mosa; Marinda, Edmore; Gray, Glenda E; Triche, Elizabeth W; Martinson, Neil A

    2011-01-01

    Objective In light of increasing access to highly active antiretroviral treatment (HAART) in sub-Saharan Africa, we conducted a longitudinal study to assess the impact of HAART on sexual risk behaviors among HIV-infected South Africans in urban and rural primary care clinics. Design Prospective observational cohort study. Methods We conducted a cohort study at rural and urban primary care HIV clinics in South Africa consisting of 1544 men and 4719 women enrolled from 2003–2010, representing 19703 clinic visits. The primary outcomes were being sexually active, unprotected sex, and >1 sex partner and were evaluated at six monthly intervals. Generalized estimated equations assessed the impact of HAART on sexual risk behaviors. Results Among 6263 HIV-infected men and women, over a third (37.2%) initiated HAART during study follow-up. In comparison to pre-HAART follow-up, visits while receiving HAART were associated with a decrease in those reporting being sexually active (AOR: 0.86 [95% CI: 0.78–0.95]). Unprotected sex and having >1 sex partner were reduced at visits following HAART initiation compared to pre-HAART visits (AOR: 0.40 [95% CI: 0.34–0.46] and AOR: 0.20 [95% CI: 0.14–0.29], respectively). Conclusions Sexual risk behavior significantly decreased following HAART initiation among HIV-infected South African men and women in primary care programs. The further expansion of antiretroviral treatment programs could enhance HIV prevention efforts in Africa. PMID:20808202

  18. Potential Clinical and Economic Value of Long-Acting Preexposure Prophylaxis for South African Women at High-Risk for HIV Infection

    PubMed Central

    Walensky, Rochelle P.; Jacobsen, Margo M.; Bekker, Linda-Gail; Parker, Robert A.; Wood, Robin; Resch, Stephen C.; Horstman, N. Kaye; Freedberg, Kenneth A.; Paltiel, A. David

    2016-01-01

    Background. For young South African women at risk for human immunodeficiency virus (HIV) infection, preexposure prophylaxis (PrEP) is one of the few effective prevention options available. Long-acting injectable PrEP, which is in development, may be associated with greater adherence, compared with that for existing standard oral PrEP formulations, but its likely clinical benefits and additional costs are unknown. Methods. Using a computer simulation, we compared the following 3 PrEP strategies: no PrEP, standard PrEP (effectiveness, 62%; cost per patient, $150/year), and long-acting PrEP (effectiveness, 75%; cost per patient, $220/year) in South African women at high risk for HIV infection (incidence of HIV infection, 5%/year). We examined the sensitivity of the strategies to changes in key input parameters among several outcome measures, including deaths averted and program cost over a 5-year period; lifetime HIV infection risk, survival rate, and program cost and cost-effectiveness; and budget impact. Results. Compared with no PrEP, standard PrEP and long-acting PrEP cost $580 and $870 more per woman, respectively, and averted 15 and 16 deaths per 1000 women at high risk for infection, respectively, over 5 years. Measured on a lifetime basis, both standard PrEP and long-acting PrEP were cost saving, compared with no PrEP. Compared with standard PrEP, long-acting PrEP was very cost-effective ($150/life-year saved) except under the most pessimistic assumptions. Over 5 years, long-acting PrEP cost $1.6 billion when provided to 50% of eligible women. Conclusions. Currently available standard PrEP is a cost-saving intervention whose delivery should be expanded and optimized. Long-acting PrEP will likely be a very cost-effective improvement over standard PrEP but may require novel financing mechanisms that bring short-term fiscal planning efforts into closer alignment with longer-term societal objectives. PMID:26681778

  19. Increase of Transmitted Drug Resistance among HIV-Infected Sub-Saharan Africans Residing in Spain in Contrast to the Native Population

    PubMed Central

    Yebra, Gonzalo; de Mulder, Miguel; Pérez-Elías, María Jesús; Pérez-Molina, José Antonio; Galán, Juan Carlos; Llenas-García, Jara; Moreno, Santiago; Holguín, África

    2011-01-01

    Background The prevalence of transmitted HIV drug resistance (TDR) is stabilizing or decreasing in developed countries. However, this trend is not specifically evaluated among immigrants from regions without well-implemented antiretroviral strategies. Methods TDR trends during 1996–2010 were analyzed among naïve HIV-infected patients in Spain, considering their origin and other factors. TDR mutations were defined according to the World Health Organization list. Results Pol sequence was available for 732 HIV-infected patients: 292 native Spanish, 226 sub-Saharan Africans (SSA), 114 Central-South Americans (CSA) and 100 from other regions. Global TDR prevalence was 9.7% (10.6% for Spanish, 8.4% for SSA and 7.9% for CSA). The highest prevalences were found for protease inhibitors (PI) in Spanish (3.1%), for non-nucleoside reverse transcriptase inhibitors (NNRTI) in SSA (6.5%) and for nucleoside reverse transcriptase inhibitors (NRTI) in both Spanish and SSA (6.5%). The global TDR rate decreased from 11.3% in 2004–2006 to 8.4% in 2007–2010. Characteristics related to a decreasing TDR trend in 2007-10 were Spanish and CSA origin, NRTI- and NNRTI-resistance, HIV-1 subtype B, male sex and infection through injection drug use. TDR remained stable for PI-resistance, in patients infected through sexual intercourse and in those carrying non-B variants. However, TDR increased among SSA and females. K103N was the predominant mutation in all groups and periods. Conclusion TDR prevalence tended to decrease among HIV-infected native Spanish and Central-South Americans, but it increased up to 13% in sub-Saharan immigrants in 2007–2010. These results highlight the importance of a specific TDR surveillance among immigrants to prevent future therapeutic failures, especially when administering NNRTIs. PMID:22046345

  20. Sex differences in responses to antiretroviral treatment in South African HIV-infected children on ritonavir-boosted lopinavir- and nevirapine-based treatment

    PubMed Central

    2014-01-01

    Background While studies of HIV-infected adults on antiretroviral treatment (ART) report no sex differences in immune recovery and virologic response but more ART-associated complications in women, sex differences in disease progression and response to ART among children have not been well assessed. The objective of this study was to evaluate for sex differences in response to ART in South African HIV-infected children who were randomized to continue ritonavir-boosted lopinavir (LPV/r)-based ART or switch to nevirapine-based ART. Methods ART outcomes in HIV-infected boys and girls in Johannesburg, South Africa from 2005–2010 were compared. Children initiated ritonavir-boosted lopinavir (LPV/r)-based ART before 24 months of age and were randomized to remain on LPV/r or switch to nevirapine-based ART after achieving viral suppression. Children were followed for 76 weeks post-randomization and then long-term follow up continued for a minimum of 99 weeks and maximum of 245 weeks after randomization. Viral load, CD4 count, lipids, anthropometrics, drug concentrations, and adherence were measured at regular intervals. Outcomes were compared between sexes within treatment strata. Results A total of 323 children (median age 8.8 months, IQR 5.1-13.5), including 168 boys and 155 girls, initiated LPV/r-based ART and 195 children were randomized. No sex differences in risk of virological failure (confirmed viral load >1000 copies/mL) by 156 weeks post-randomization were observed within either treatment group. Girls switched to nevirapine had more robust CD4 count improvement relative to boys in this group through 112 weeks post-randomization. In addition, girls remaining on LPV/r had higher plasma concentrations of ritonavir than boys during post-randomization visits. After a mean of 3.4 years post-randomization, girls remaining on LPV/r also had a higher total cholesterol:HDL ratio and lower mean HDL than boys on LPV/r. Conclusions Sex differences are noted in

  1. Detection of Tuberculosis in HIV-Infected and -Uninfected African Adults Using Whole Blood RNA Expression Signatures: A Case-Control Study

    PubMed Central

    Anderson, Suzanne T.; Bangani, Nonzwakazi; Banwell, Claire M.; Brent, Andrew J.; Crampin, Amelia C.; Dockrell, Hazel M.; Eley, Brian; Heyderman, Robert S.; Hibberd, Martin L.; Kern, Florian; Langford, Paul R.; Ling, Ling; Mendelson, Marc; Ottenhoff, Tom H.; Zgambo, Femia; Wilkinson, Robert J.; Coin, Lachlan J.; Levin, Michael

    2013-01-01

    only culture confirmed TB patients, and the potential that TB may have been misdiagnosed in a small proportion of OD patients despite the extensive clinical investigation used to assign each patient to their diagnostic group. Conclusions In our study, blood transcriptional signatures distinguished TB from other conditions prevalent in HIV-infected and -uninfected African adults. Our DRS, based on these signatures, could be developed as a test for TB suitable for use in HIV endemic countries. Further evaluation of the performance of the signatures and DRS in prospective populations of patients with symptoms consistent with TB will be needed to define their clinical value under operational conditions. Please see later in the article for the Editors' Summary PMID:24167453

  2. Understanding HIV Transmission Risk Behavior Among HIV-Infected South Africans Receiving Antiretroviral Therapy: An Information—Motivation—Behavioral Skills Model Analysis

    PubMed Central

    Kiene, Susan M.; Fisher, William A.; Shuper, Paul A.; Cornman, Deborah H.; Christie, Sarah; MacDonald, Susan; Pillay, Sandy; Mahlase, Gethwana; Fisher, Jeffrey D.

    2014-01-01

    The current study applied the Information—Motivation—Behavioral Skills (IMB) model (J. D. Fisher & Fisher, 1992; W. A. Fisher & Fisher, 1993) to identify factors associated with HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy (ART), a population of considerable significance for curtailing, or maintaining, South Africa’s generalized HIV epidemic. HIV prevention information, HIV prevention motivation, HIV prevention behavioral skills, and HIV transmission risk behavior were assessed in a sample of 1,388 South Africans infected with HIV and receiving ART in 16 clinics in KwaZulu-Natal, South Africa. Results confirmed the assumptions of the IMB model and demonstrated that HIV prevention information and HIV prevention motivation work through HIV prevention behavioral skills to affect HIV transmission risk behavior in this population. Subanalyses confirmed these relationships for HIV transmission risk behavior overall and for HIV transmission risk behavior with partners perceived to be HIV-negative or HIV-status unknown. A consistent pattern of gender differences showed that for men, HIV prevention information and HIV prevention motivation may have direct links with HIV preventive behavior, while for women, the effects of HIV prevention information and HIV prevention motivation work through HIV prevention behavioral skills to affect HIV preventive behavior. These IMB model-based findings suggest directions for HIV prevention interventions with South African men and women living with HIV and on ART as an important component of overall strategies to contain South Africa’s generalized HIV epidemic. PMID:23477576

  3. Culturally Sensitive Approaches to Identification and Treatment of Depression among HIV Infected African American Adults: A Qualitative Study of Primary Care Providers’ Perspectives

    PubMed Central

    Le, Huynh-Nhu; Hipolito, Maria Mananita S; Lambert, Sharon; Terrell-Hamilton, Flora; Rai, Narayan; McLean, Charlee; Kapetanovic, Suad; Nwulia, Evaristus

    2016-01-01

    Background Major depressive disorder (MDD) is highly prevalent among HIV-infected (HIV+) individuals, and is associated with non-adherence to antiretroviral therapy (ART), and accelerated disease progression. MDD is underdiagnosed and undertreated among low-income African Americans, who are disproportionately impacted by the HIV epidemic. To improve detection and treatment of depression among African Americans living with HIV/AIDS, it is important to understand culturally and contextually relevant aspects of MDD and attitudes about mental health treatment. Methods A focus group session was conducted with seven providers and staff at a primary care center that serves a largely African-American community heavily impacted by the HIV epidemic in Washington, DC. Data were analyzed using an inductive approach to distill prominent themes, perspectives, and experiences among participating providers. Results Five themes emerged to characterize the lived experiences of HIV+ African-American patients: (a) Changes in perceptions of HIV over time; (b) HIV is comorbid with mental illness, particularly depression and substance abuse; (c) Stigma is associated with both HIV and depression; (d) Existing mental health services vary and are insufficient and (e) Suggestions for optimal treatment for comorbid HIV and depression. Limitation This study reflects the views of providers from one clinic in this community. Conclusion Substantial economic disadvantage, pervasive childhood adversity, limited education and limited resources jointly put members of this community at risk for acquisition of HIV and for development of depression and addictions. These contextual factors provide an important reminder that any patient-level depression identification or intervention in this community will have to be mindful of such circumstances. PMID:27347445

  4. The East African rift system

    NASA Astrophysics Data System (ADS)

    Chorowicz, Jean

    2005-10-01

    This overview paper considers the East African rift system (EARS) as an intra-continental ridge system, comprising an axial rift. It describes the structural organization in three branches, the overall morphology, lithospheric cross-sections, the morphotectonics, the main tectonic features—with emphasis on the tension fractures—and volcanism in its relationships with the tectonics. The most characteristic features in the EARS are narrow elongate zones of thinned continental lithosphere related to asthenospheric intrusions in the upper mantle. This hidden part of the rift structure is expressed on the surface by thermal uplift of the rift shoulders. The graben valleys and basins are organized over a major failure in the lithospheric mantle, and in the crust comprise a major border fault, linked in depth to a low angle detachment fault, inducing asymmetric roll-over pattern, eventually accompanied by smaller normal faulting and tilted blocks. Considering the kinematics, divergent movements caused the continent to split along lines of preexisting lithospheric weaknesses marked by ancient tectonic patterns that focus the extensional strain. The hypothesis favored here is SE-ward relative divergent drifting of a not yet well individualized Somalian plate, a model in agreement with the existence of NW-striking transform and transfer zones. The East African rift system comprises a unique succession of graben basins linked and segmented by intracontinental transform, transfer and accommodation zones. In an attempt to make a point on the rift system evolution through time and space, it is clear that the role of plume impacts is determinant. The main phenomenon is formation of domes related to plume effect, weakening the lithosphere and, long after, failure inducing focused upper mantle thinning, asthenospheric intrusion and related thermal uplift of shoulders. The plume that had formed first at around 30 Ma was not in the Afar but likely in Lake Tana region (Ethiopia

  5. Sexual Risk Behaviors Among HIV-Infected South African Men and Women with Their Partners in a Primary Care Program: Implications for Couples-Based Prevention

    PubMed Central

    de Bruyn, Guy; Lurie, Mark N.; Modisenyane, Tebogo; Triche, Elizabeth W.; Gray, Glenda E.; Welte, Alex; Martinson, Neil A.

    2011-01-01

    We studied 1163 sexually-active HIV-infected South African men and women in an urban primary care program to understand patterns of sexual behaviors and whether these behaviors differed by partner HIV status. Overall, 40% reported a HIV-positive partner and 60% a HIV-negative or status unknown partner; and 17.5% reported >2 sex acts in the last 2 weeks, 16.4% unprotected sex in the last 6 months, and 3.7% >1 sex partner in the last 6 months. Antiretroviral therapy (ART) was consistently associated with decreased sexual risk behaviors, as well as with reporting a HIV-negative or status unknown partner. The odds of sexual risk behaviors differed by sex; and were generally higher among participants reporting a HIV-positive partner, but continued among those with a HIV-negative or status unknown partner. These data support ART as a means of HIV prevention. Engaging in sexual risk behaviors primarily with HIV-positive partners was not widely practiced in this setting, emphasizing the need for couples-based prevention. PMID:21476005

  6. Abacavir, zidovudine, or stavudine as paediatric tablets for African HIV-infected children (CHAPAS-3): an open-label, parallel-group, randomised controlled trial

    PubMed Central

    Mulenga, Veronica; Musiime, Victor; Kekitiinwa, Adeodata; Cook, Adrian D; Abongomera, George; Kenny, Julia; Chabala, Chisala; Mirembe, Grace; Asiimwe, Alice; Owen-Powell, Ellen; Burger, David; McIlleron, Helen; Klein, Nigel; Chintu, Chifumbe; Thomason, Margaret J; Kityo, Cissy; Walker, A Sarah; Gibb, Diana M

    2016-01-01

    Summary Background WHO 2013 guidelines recommend universal treatment for HIV-infected children younger than 5 years. No paediatric trials have compared nucleoside reverse-transcriptase inhibitors (NRTIs) in first-line antiretroviral therapy (ART) in Africa, where most HIV-infected children live. We aimed to compare stavudine, zidovudine, or abacavir as dual or triple fixed-dose-combination paediatric tablets with lamivudine and nevirapine or efavirenz. Methods In this open-label, parallel-group, randomised trial (CHAPAS-3), we enrolled children from one centre in Zambia and three in Uganda who were previously untreated (ART naive) or on stavudine for more than 2 years with viral load less than 50 copies per mL (ART experienced). Computer-generated randomisation tables were incorporated securely within the database. The primary endpoint was grade 2–4 clinical or grade 3/4 laboratory adverse events. Analysis was intention to treat. This trial is registered with the ISRCTN Registry number, 69078957. Findings Between Nov 8, 2010, and Dec 28, 2011, 480 children were randomised: 156 to stavudine, 159 to zidovudine, and 165 to abacavir. After two were excluded due to randomisation error, 156 children were analysed in the stavudine group, 158 in the zidovudine group, and 164 in the abacavir group, and followed for median 2·3 years (5% lost to follow-up). 365 (76%) were ART naive (median age 2·6 years vs 6·2 years in ART experienced). 917 grade 2–4 clinical or grade 3/4 laboratory adverse events (835 clinical [634 grade 2]; 40 laboratory) occurred in 104 (67%) children on stavudine, 103 (65%) on zidovudine, and 105 (64%), on abacavir (p=0·63; zidovudine vs stavudine: hazard ratio [HR] 0·99 [95% CI 0·75–1·29]; abacavir vs stavudine: HR 0·88 [0·67–1·15]). At 48 weeks, 98 (85%), 81 (80%) and 95 (81%) ART-naive children in the stavudine, zidovudine, and abacavir groups, respectively, had viral load less than 400 copies per mL (p=0·58); most ART

  7. Incidence of serious morbidity in HIV-infected adults on antiretroviral therapy in a West African care centre, 2003-2008

    PubMed Central

    2013-01-01

    Background In resource-limited settings, scaling-up antiretroviral treatment (ART) has required the involvement of decentralized health facilities with limited equipment. We estimated the incidence of serious morbidity among HIV-infected adults receiving ART in one of these HIV routine care center in sub-Saharan Africa. Methods We conducted a prospective study at the Centre Medical de Suivi des Donneurs de Sang (CMSDS), which is affiliated with the National Centre for Blood Transfusion in Abidjan, Côte d’Ivoire. Adult patients infected with HIV-1 or HIV-1/HIV-2 who initiated ART between January 2003 and December 2008 were eligible for the study. Standardized clinical data were collected at each visit. Serious morbidity was defined as a new episode of malaria, WHO stage 3–4 event, ANRS grade 3–4 adverse event, or any event leading to death or to hospitalization. Results 1008 adults, 67% women, with a median age of 35 years, and a median pre-ART CD4 count of 186/mm3 started ART and were followed for a median of 17.3 months. The overall incidences of loss to follow-up, death, and attrition were 6.2/100 person-years (PY) [95% CI 5.1-7.2], 2.3/100 PY [95% CI 1.6-2.9], and 8.1/100 PY [95% CI 7.0-9.4], respectively. The incidence of first serious event was 11.5/100 PY overall, 15.9/100 PY within the first year and 8.3/100 PY thereafter. The most frequently documented specific diagnoses were malaria, tuberculosis, bacterial septicemia and bacterial pneumonia. Conclusion Among HIV-infected adults followed in routine conditions in a West African primary care clinic, we recorded a high incidence of serious morbidity during the first year on ART. Providing care centers with diagnostic tools and standardizing data collection are necessary steps to improve the quality of care in primary care facilities in sub-Saharan Africa. PMID:24373303

  8. A CLUSTER ANALYSIS OF DRUG USE AND SEXUAL HIV RISKS AND THEIR CORRELATES IN A SAMPLE OF AFRICAN-AMERICAN CRACK COCAINE SMOKERS WITH HIV INFECTION

    PubMed Central

    Schönnesson, Lena Nilsson; Atkinson, John; Williams, Mark L.; Bowen, Anne; Ross, Michael W.; Timpson, Sandra C.

    2008-01-01

    The purpose of this cross-sectional study was to classify a sample of HIV seropositive African American crack cocaine smokers into homogenous HIV drug use and sexual risk groups using a two step multivariate cluster analysis. Two hundred and fifty eight crack cocaine smokers participated in the study. Cluster analysis revealed three distinct HIV risk groups. The highest risk group, the largest one, was characterized by frequent, daily crack use, multiple sex partners, trading sex, and inconsistent condom use. The consistent condom use group, the smallest group, was characterized by consistent condom use. The inconsistent condom use group, the second largest group, was distinguished by inconsistent condom use. Comparisons of the three HIV risk groups revealed that the highest risk group had a higher proportion of illegal sources of income, higher proportion of binged crack use, frequent, daily, alcohol use, same gender sex partners, and scored higher on depressive symptoms. Members of the consistent condom use group were more likely to have been HIV diagnosed for a shorter time, to have HIV serodiscordant casual sex partners, higher psychological motivation for condom use, and a lower frequency of vaginal sex. Members of the inconsistent condom use group were more likely to have a main sex partner, to be married, to be on public assistance, to know the HIV serostatus of their casual partner, and less likely to conceal their HIV serostatus. An alarming finding was that a large number of participants inconsistently used condoms with HIV serodiscordant sex partners. Interventions aiming to prevent the secondary spread of HIV infection in African American crack cocaine smokers should take this variability in account and focus on the differences. PMID:18495380

  9. A cluster analysis of drug use and sexual HIV risks and their correlates in a sample of African-American crack cocaine smokers with HIV infection.

    PubMed

    Schönnesson, Lena Nilsson; Atkinson, John; Williams, Mark L; Bowen, Anne; Ross, Michael W; Timpson, Sandra C

    2008-09-01

    The purpose of this cross-sectional study was to classify a sample of HIV-seropositive African-American crack cocaine smokers into homogenous HIV drug use and sexual risk groups using a two step multivariate cluster analysis. Two hundred and fifty-eight crack cocaine smokers participated in the study. Cluster analysis revealed three distinct HIV risk groups. The highest risk group, the largest one, was characterized by frequent, daily crack use, multiple sex partners, trading sex, and inconsistent condom use. The consistent condom use group, the smallest group, was characterized by consistent condom use. The inconsistent condom use group, the second largest group, was distinguished by inconsistent condom use. Comparisons of the three HIV risk groups revealed that the highest risk group had a higher proportion of illegal sources of income, higher proportion of binged crack use, frequent, daily, alcohol use, same gender sex partners, and scored higher on depressive symptoms. Members of the consistent condom use group were more likely to have been HIV diagnosed for a shorter time, to have HIV serodiscordant casual sex partners, higher psychological motivation for condom use, and a lower frequency of vaginal sex. Members of the inconsistent condom use group were more likely to have a main sex partner, to be married, to be on public assistance, to know the HIV serostatus of their casual partner, and less likely to conceal their HIV serostatus. An alarming finding was that a large number of participants inconsistently used condoms with HIV serodiscordant sex partners. Interventions aiming to prevent the secondary spread of HIV infection in African-American crack cocaine smokers should take this variability in account and focus on the differences. PMID:18495380

  10. Incidence and predictors of adverse drug events in an African cohort of HIV-infected adults treated with efavirenz

    PubMed Central

    Abah, Isaac Okoh; Akanbi, Maxwell; Abah, Mercy Enuwa; Finangwai, Amos Istifanus; Dady, Christy W; Falang, Kakjing Dadul; Ebonyi, Augustine Odoh; Okopi, Joseph Anejo; Agbaji, Oche Ochai; Sagay, Altiene Solomon; Okonkwo, Prosper; Idoko, John A; Kanki, Phyllis J

    2015-01-01

    Introduction Adverse drug reactions associated with efavirenz (EFV) therapy are poorly described beyond the first year of treatment. We aimed to describe the incidence and predictors of EFV-related adverse drug reactions (ADRs) in a cohort of adult Nigerian HIV-infected patients on antiretroviral therapy (ART). Methods This retrospective cohort study utilized clinical data of HIV-1 infected adults (aged ≥15 years), commenced on efavirenz containing-regimen between January 2004 and December 2011. The time-dependent occurrence of clinical adverse events as defined by the World Health Organization was analyzed by Cox regression analysis. Results A total of 2920 patients with baseline median (IQR) age of 39 (33-46) years, largely made up of men (78%) were included in the study. During 8834 person-years of follow up, 358 adverse drug events were reported; the incidence rate was 40.3 ADRs per 1000 person-years of treatment. Lipodystrophy and neuropsychiatric disorders were the most common ADRs with incidences of 63 and 30 per 1000 patients respectively. About one-third of the neuropsychiatric adverse events were within 12 months of commencement of ART. The risk of neuropsychiatric ADRs was independently predicted for women [adjusted hazard ratio (aHR) 9.05; 95% CI: 5.18-15.82], those aged <40 years (aHR 2.59; 95% CI: 1.50-4.45), advanced HIV disease (WHO stage 3 or 4) [aHR 2.26; 95% CI: 1.37-3.72], and zidovudine [aHR 2.21; 95% CI: 1.27-3.83] or stavudine [aHR 4.22; 95% CI: 1.99-8.92] containing regimen compared to tenofovir. Conclusion Neuropsychiatric adverse drug events associated with efavirenz-based ART had both early and late onset in our clinical cohort of patients on chronic EFV therapy. Continuous neuropsychiatric assessment for improved detection and management of neuropsychiatric ADRs is recommended in resource-limited settings where the use of efavirenz-based regimens has been scaled up. PMID:26405676

  11. Variations in the heme oxygenase-1 microsatellite polymorphism are associated with plasma CD14 and viral load in HIV-infected African Americans

    PubMed Central

    Seu, Lillian; Burt, Trevor D.; Witte, John S.; Martin, Jeffrey N.; Deeks, Steven G.; McCune, Joseph M.

    2012-01-01

    Heme oxygenase-1 (HO-1) is an anti-inflammatory enzyme that maintains homeostasis during cellular stress. Given previous findings that shorter length variants of a HO-1 promoter-region GTn microsatellite polymorphism are associated with increased HO-1 expression in cell lines, we hypothesized that shorter variants would also be associated with increased levels of HO-1 expression, less inflammation, and lower levels of inflammation-associated viral replication in HIV-infected subjects. Healthy donors (n=20) with shorter GTn repeats had higher HO-1 mRNA transcript in peripheral blood mononuclear cells stimulated with lipopolysaccharide (LPS) (r= −0.38, p=0.05). The presence of fewer GTn repeats in subjects with untreated HIV disease was associated with higher HO-1 mRNA levels in peripheral blood (r= −0.41, p=0.02); similar observations were made in CD14+ monocytes from antiretroviral-treated subjects (r= −0.36, p=0.04). In African-Americans, but not Caucasians, greater GTn repeats were correlated with higher soluble CD14 (sCD14) levels during highly active antiretroviral therapy (HAART) (r= 0.38, p=0.007) as well as higher mean viral load off-therapy (r= 0.24, p=0.04). These data demonstrate that the HO-1 GTn microsatellite polymorphism is associated with higher levels of HO-1 expression and that this pathway may have important effects on the association between inflammation and HIV replication. PMID:22048453

  12. Patient-nominated, community-based HIV treatment supporters: patient perspectives, feasibility, challenges, and factors for success in HIV-infected South African adults.

    PubMed

    Duwell, Monique M; Knowlton, Amy R; Nachega, Jean B; Efron, Anne; Goliath, Rene; Morroni, Chelsea; Maartens, Gary; Chaisson, Richard E

    2013-02-01

    This study aimed to characterize the experience of having a treatment supporter among HIV-infected South African patients enrolled in a randomized controlled trial that compared the efficacy of patient-nominated treatment supporters administering partial directly observed antiretroviral therapy (DOT-ART) versus self-administered ART (Self-ART). Results of the parent study showed no virologic or sustained immunologic differences between groups, but revealed a significant survival benefit among the DOT-ART group. One hypothesis is that this survival benefit may be explained by differences in the training and involvement of the treatment supporters between groups. In the current study, results from a semi-structured exit interview of 172 participants indicate that most participants in both arms maintained a positive, satisfying relationship with a single supporter, typically family member or friend. Most patients (82.6%) perceived supporters as helpful with medication adherence, with no significant difference between groups (p=0.752). Additionally, supporters provided emotional, instrumental, and material support. DOT-ART patients were more likely than Self-ART patients to report that their supporter helped to decrease drug or alcohol use (p=0.03). Patients identified supporter trustworthiness, availability, good communication and reciprocity of support as factors beneficial to a successful relationship. These results suggest: (1) Patient-nominated peers are feasible candidates for ART supporters in this resource-constrained setting; (2) In addition to assistance with medications, treatment supporters have the capacity to promote healthy behaviors and provide other types of support, which may contribute to improved outcomes, particularly with enhanced training; (3) Trustworthiness, availability, good communication, and reciprocity are key factors in a successful patient-supporter relationship. PMID:23373664

  13. HIV infection in the Caribbean.

    PubMed

    Wheeler, V W; Radcliffe, K W

    1994-01-01

    The Caribbean is a multi-ethnic region with many different cultural differences. The majority of the population is of African descent, but there are also other ethnic groups present such as Indians, Chinese, Syrians and Europeans. The Caribbean region is influenced by countries such as the USA, Great Britain, France and Holland. The countries of the Caribbean have a serious problem with HIV infection and AIDS. The epidemiology of HIV infection in this region, is different from most other parts of the world in that the mode of spread does not easily fit into any of the three WHO patterns. This review shows that the infection initially started in the homosexual/bisexual community, but since then, it has moved to the heterosexual population and this form of contact is now the main mode of transmission of the virus. The Governments of the Caribbean countries have realized the extent of the problem and have taken measures to try to control the epidemic. PMID:8031923

  14. Assessing the contributions of East African and West Pacific warming to the 2014 boreal spring East African drought

    USGS Publications Warehouse

    Funk, Christopher C.; Shukla, Shraddhanand; Hoell, Andrew; Livneh, Ben

    2015-01-01

    Anthropogenic warming contributed to the 2014 East African drought by increasing East African and west Pacific temperatures, and increasing the gradient between standardized western and central Pacific SST causing reduced rainfall, evapotranspiration, and soil moisture.

  15. IDEAL Symposium on the East African Lakes

    NASA Astrophysics Data System (ADS)

    Johnson, T. C.; Kelts, K.; Lehman, J. T.; Wuest, A.

    A vast array of interdisciplinary problems presented by the African Great Lakes were highlighted at the International Symposium on the Limnology, Climatology and Paleoclimatology of the East African Lakes, organized by the International Decade for the East African Lakes (IDEAL) February 17-21 in Jinja, Uganda. Approximately 125 scientists attended from North America, Europe, Africa, and New Zealand. Jinja is located on the northern shore of Lake Victoria at the head-waters of the Nile and is the site of the host institution for the symposium, the Uganda Freshwater Fisheries Research Organization (UFFRO). The conveners of the symposium were Tom Johnson of Duke University, George Kitaka of UNESCO-ROSTA, and Eric Odada of the University of Nairobi.

  16. Patient-reported factors associated with reengagement among HIV-infected patients disengaged from care in East Africa

    PubMed Central

    Camlin, Carol S.; Neilands, Torsten B.; Odeny, Thomas A.; Lyamuya, Rita; Nakiwogga-Muwanga, Alice; Diero, Lameck; Bwana, Mwebesa; Braitstein, Paula; Somi, Geoffrey; Kambugu, Andrew; Bukusi, Elizabeth A.; Glidden, David V.; Wools-Kaloustian, Kara K.; Wenger, Megan; Geng, Elvin H.

    2016-01-01

    Objective Engagement in care is key to successful HIV treatment in resource-limited settings; yet little is known about the magnitude and determinants of reengagement among patients out of care. We assessed patient-reported reasons for not returning to clinic, identified latent variables underlying these reasons, and examined their influence on subsequent care reengagement. Design We used data from the East Africa International Epidemiologic Databases to Evaluate AIDS to identify a cohort of patients disengaged from care (>3 months late for last appointment, reporting no HIV care in preceding 3 months) (n = 430) who were interviewed about reasons why they stopped care. Among the 399 patients for whom follow-up data were available, 104 returned to clinic within a median observation time of 273 days (interquartile range: 165–325). Methods We conducted exploratory and confirmatory factor analyses (EFA, CFA) to identify latent variables underlying patient-reported reasons, then used these factors as predictors of time to clinic return in adjusted Cox regression models. Results EFA and CFA findings suggested a six-factor structure that lent coherence to the range of barriers and motivations underlying care disengagement, including poverty, transport costs, and interference with work responsibilities; health system ‘failures,’ including poor treatment by providers; fearing disclosure of HIV status; feeling healthy; and treatment fatigue/seeking spiritual alternatives to medicine. Factors related to poverty and poor treatment predicted higher rate of return to clinic, whereas the treatment fatigue factor was suggestive of a reduced rate of return. Conclusion Certain barriers to reengagement appear easier to overcome than factors such as treatment fatigue. Further research will be needed to identify the easiest, least expensive interventions to reengage patients lost to HIV care systems. Interpersonal interventions may continue to play an important role in addressing

  17. Active Tuberculosis Is Associated with Worse Clinical Outcomes in HIV-Infected African Patients on Antiretroviral Therapy

    PubMed Central

    Siika, Abraham M.; Yiannoutsos, Constantin T.; Wools-Kaloustian, Kara K.; Musick, Beverly S.; Mwangi, Ann W.; Diero, Lameck O.; Kimaiyo, Sylvester N.; Tierney, William M.; Carter, Jane E.

    2013-01-01

    Objective This cohort study utilized data from a large HIV treatment program in western Kenya to describe the impact of active tuberculosis (TB) on clinical outcomes among African patients on antiretroviral therapy (ART). Design We included all patients initiating ART between March 2004 and November 2007. Clinical (signs and symptoms), radiological (chest radiographs) and laboratory (mycobacterial smears, culture and tissue histology) criteria were used to record the diagnosis of TB disease in the program’s electronic medical record system. Methods We assessed the impact of TB disease on mortality, loss to follow-up (LTFU) and incident AIDS-defining events (ADEs) through Cox models and CD4 cell and weight response to ART by non-linear mixed models. Results We studied 21,242 patients initiating ART–5,186 (24%) with TB; 62% female; median age 37 years. There were proportionately more men in the active TB (46%) than in the non-TB (35%) group. Adjusting for baseline HIV-disease severity, TB patients were more likely to die (hazard ratio – HR = 1.32, 95% CI 1.18–1.47) or have incident ADEs (HR = 1.31, 95% CI: 1.19–1.45). They had lower median CD4 cell counts (77 versus 109), weight (52.5 versus 55.0 kg) and higher ADE risk at baseline (CD4-adjusted odds ratio = 1.55, 95% CI: 1.31–1.85). ART adherence was similarly good in both groups. Adjusting for gender and baseline CD4 cell count, TB patients experienced virtually identical rise in CD4 counts after ART initiation as those without. However, the overall CD4 count at one year was lower among patients with TB (251 versus 269 cells/µl). Conclusions Clinically detected TB disease is associated with greater mortality and morbidity despite salutary response to ART. Data suggest that identifying HIV patients co-infected with TB earlier in the HIV-disease trajectory may not fully address TB-related morbidity and mortality. PMID:23301015

  18. Is hardship during migration a determinant of HIV infection? Results from the ANRS PARCOURS study of sub-Saharan African migrants in France

    PubMed Central

    Desgrees-du-Lou, Annabel; Pannetier, Julie; Ravalihasy, Andrainolo; Le Guen, Mireille; Gosselin, Anne; Panjo, Henri; Bajos, Nathalie; Lydie, Nathalie; Lert, France; Dray-Spira, Rosemary

    2016-01-01

    Objectives: In Europe, sub-Saharan African migrants are a key population for HIV infection. We analyse how social hardships during settlement in France shape sexual partnerships and HIV risk. Design: PARCOURS is a life-event survey conducted in 2012–2013 in 74 health-care facilities in the Paris region, among three groups of sub-Saharan migrants: 926 receiving HIV care (296 acquired HIV in France), 779 with chronic hepatitis B, and 763 with neither HIV nor hepatitis B (reference group). Methods: Hardships (lack of residence permit, economic resources and housing) and sexual partnerships were documented for each year since arrival in France. For each sex, reported sexual partnerships were compared by group and their associations with hardships each year analysed with mixed-effects logistic regression models. Results: Hardships were frequent: more than 40% had lived a year or longer without a residence permit, and more than 20% without stable housing. Most of the migrants had nonstable and concurrent partnerships, more frequent among those who acquired HIV in France compared with reference group, as were casual partnerships among men (76.7 vs. 54.2%; P = 0.004) and women (52.4 vs. 30.5%; P = 0.02), concurrent partnerships among men (69.9 vs. 45.8%; P = 0.02), and transactional partnerships among women (8.6 vs. 2.3%; P = 0.006). Hardship increased risky behaviours: in women, lacking a residence permit increased casual and transactional partnerships [resp. odds ratio (OR) = 2.01(1.48–2.72) and OR = 6.27(2.25–17.44)]. Same trends were observed for lacking stable housing [OR = 3.71(2.75–5.00) and OR = 10.58 (4.68–23.93)]. Conclusion: Hardships faced by migrants increase HIV risks. Women, especially during the period without stable housing, appear especially vulnerable. PMID:26558722

  19. Microbiome in HIV infection

    PubMed Central

    Salas, January T.; Chang, Theresa L.

    2014-01-01

    HIV primary infection occurs at mucosa tissues, suggesting an intricate interplay between microbiome and HIV infection. Recent advanced technologies of high-throughput sequencing and bioinformatics allow researchers to explore nonculturable microbes including bacteria, virus and fungi and their association with diseases. HIV/SIV infection is associated with microbiome shifts and immune activation that may affect the outcome of disease progression. Similarly, altered microbiome and inflammation are associated with increased risks of HIV acquisition, suggesting the role of microbiome in HIV transmission. In this review, we will focus on microbiome in HIV infection at various mucosal compartments. Understanding the relationship between microbiome and HIV may offer insights into development of better strategies for HIV prevention and treatment. PMID:25439273

  20. The Offshore East African Rift System

    NASA Astrophysics Data System (ADS)

    Franke, D.; Klimke, J.; Jokat, W.; Stollhofen, H.; Mahanjane, S.

    2014-12-01

    Numerous studies have addressed various aspects of the East African Rift system but surprisingly few on the offshore continuation of the south-eastern branch of the rift into the Mozambique Channel. The most prominent article has been published almost 30 years ago by Mougenot et al. (1986) and is based on vintage seismic data. Several studies investigating earthquakes and plate motions from GPS measurements reveal recent deformation along the offshore branch of the East African Rift system. Slip vectors from earthquakes data in Mozambique's offshore basins show a consistent NE direction. Fault plane solutions reveal ~ E-W extensional failure with focal depth clustering around 19 km and 40 km, respectively. Here, we present new evidence for neotectonic deformation derived from modern seismic reflection data and supported by additional geophysical data. The modern rift system obviously reactivates structures from the disintegration of eastern Gondwana. During the Jurassic/Cretaceous opening of the Somali and Mozambique Basins, Madagascar moved southwards along a major shear zone, to its present position. Since the Miocene, parts of the shear zone became reactivated and structurally overprinted by the East African rift system. The Kerimbas Graben offshore northern Mozambique is the most prominent manifestation of recent extensional deformation. Bathymetry data shows that it deepens northwards, with approximately 700 m downthrown on the eastern shoulder. The graben can be subdivided into four subbasins by crosscutting structural lineaments with a NW-SE trend. Together with the N-S striking graben-bounding faults, this resembles a conjugate fault system. In seismic reflection data normal faulting is distinct not only at the earthquake epicenters. The faults cut through the sedimentary successions and typically reach the seafloor, indicating ongoing recent deformation. Reference: Mougenot, D., Recq, M., Virlogeux, P., and Lepvrier, C., 1986, Seaward extension of the East

  1. Effect of Age at Antiretroviral Therapy Initiation on Catch-Up Growth within the First 24 Months among HIV-Infected Children in the IeDEA West African Pediatric Cohort

    PubMed Central

    Jesson, Julie; Koumakpaï, Sikiratou; Diagne, Ndeye R.; Amorissani-Folquet, Madeleine; Kouéta, Fla; Aka, Addi; Lawson-Evi, Koko; Dicko, Fatoumata; Kouakou, Kouadio; Pety, Touré; Renner, Lorna; Eboua, Tanoh; Coffie, Patrick A.; Desmonde, Sophie; Leroy, Valériane

    2015-01-01

    Background We described malnutrition and the effect of age at antiretroviral therapy (ART) initiation on catch-up growth over 24 months among HIV-infected children enrolled in the IeDEA West African paediatric cohort (pWADA). Methods Malnutrition was defined at ART initiation (baseline) by a Z-score <-2 SD, according to three anthropometric indicators: Weight-for-age (WAZ) for underweight, Height-for-age (HAZ) for stunting, and Weight-for-Height/BMI-for-age (WHZ/BAZ) for wasting. Kaplan-Meier estimates for catch-up growth (Z-score ≥-2 SD) on ART, adjusted for gender, immunodeficiency and malnutrition at ART initiation, ART regimen, time period and country, were compared by age at ART initiation. Cox proportional hazards regression models determined predictors of catch-up growth on ART over 24 months. Results Between 2001 and 2012, 2004 HIV-infected children < 10 years of age were included. At ART initiation, 51% were underweight, 48% were stunted and 33% were wasted. The 24-month adjusted estimates for catch-up growth were 69% (95% confidence interval [CI]: 57;80), 61% (95%CI: 47;70), and 90% (95%CI: 76;95) for WAZ, HAZ, and WHZ/BAZ, respectively. Adjusted catch-up growth was more likely for children <5 years of age at ART initiation compared to children ≥5 years for WAZ, HAZ (P<0.001), and for WHZ/BAZ (P = 0.026). Conclusions Malnutrition among these children is an additional burden that has to be urgently managed. Despite a significant growth improvement after 24 months on ART, especially in children <5 years, a substantial proportion of children still never achieved catch-up growth. Nutritional care should be part of the global healthcare of HIV-infected children in sub-Saharan Africa. PMID:25955835

  2. Comparison of the specificities of IgG, IgG-subclass, IgA and IgM reactivities in African and European HIV-infected individuals with an HIV-1 clade C proteome-based array.

    PubMed

    Gallerano, Daniela; Ndlovu, Portia; Makupe, Ian; Focke-Tejkl, Margarete; Fauland, Kerstin; Wollmann, Eva; Puchhammer-Stöckl, Elisabeth; Keller, Walter; Sibanda, Elopy; Valenta, Rudolf

    2015-01-01

    A comprehensive set of recombinant proteins and peptides of the proteome of HIV-1 clade C was prepared and purified and used to measure IgG, IgG-subclass, IgA and IgM responses in HIV-infected patients from Sub-Saharan Africa, where clade C is predominant. As a comparison group, HIV-infected patients from Europe were tested. African and European patients showed an almost identical antibody reactivity profile in terms of epitope specificity and involvement of IgG, IgG subclass, IgA and IgM responses. A V3-peptide of gp120 was identified as major epitope recognized by IgG1>IgG2 = IgG4>IgG3, IgA>IgM antibodies and a C-terminal peptide represented another major peptide epitope for the four IgG subclasses. By contrast, gp41-derived-peptides were mainly recognized by IgG1 but not by the other IgG subclasses, IgA or IgM. Among the non-surface proteins, protease, reverse transcriptase+RNAseH, integrase, as well as the capsid and matrix proteins were the most frequently and strongly recognized antigens which showed broad IgG subclass and IgA reactivity. Specificities and magnitudes of antibody responses in African patients were stable during disease and antiretroviral treatment, and persisted despite severe T cell loss. Using a comprehensive panel of gp120, gp41 peptides and recombinant non-surface proteins of HIV-1 clade C we found an almost identical antibody recognition profile in African and European patients regarding epitopes and involved IgG-sublass, IgA- and IgM-responses. Immune recognition of gp120 peptides and non-surface proteins involved all four IgG subclasses and was indicative of a mixed Th1/Th2 immune response. The HIV-1 clade C proteome-based test allowed diagnosis and monitoring of antibody responses in the course of HIV-infections and assessment of isotype and subclass responses. PMID:25658330

  3. Comparison of the Specificities of IgG, IgG-Subclass, IgA and IgM Reactivities in African and European HIV-Infected Individuals with an HIV-1 Clade C Proteome-Based Array

    PubMed Central

    Gallerano, Daniela; Ndlovu, Portia; Makupe, Ian; Focke-Tejkl, Margarete; Fauland, Kerstin; Wollmann, Eva; Puchhammer-Stöckl, Elisabeth; Keller, Walter; Sibanda, Elopy; Valenta, Rudolf

    2015-01-01

    A comprehensive set of recombinant proteins and peptides of the proteome of HIV-1 clade C was prepared and purified and used to measure IgG, IgG-subclass, IgA and IgM responses in HIV-infected patients from Sub-Saharan Africa, where clade C is predominant. As a comparison group, HIV-infected patients from Europe were tested. African and European patients showed an almost identical antibody reactivity profile in terms of epitope specificity and involvement of IgG, IgG subclass, IgA and IgM responses. A V3-peptide of gp120 was identified as major epitope recognized by IgG1>IgG2 = IgG4>IgG3, IgA>IgM antibodies and a C-terminal peptide represented another major peptide epitope for the four IgG subclasses. By contrast, gp41-derived-peptides were mainly recognized by IgG1 but not by the other IgG subclasses, IgA or IgM. Among the non-surface proteins, protease, reverse transcriptase+RNAseH, integrase, as well as the capsid and matrix proteins were the most frequently and strongly recognized antigens which showed broad IgG subclass and IgA reactivity. Specificities and magnitudes of antibody responses in African patients were stable during disease and antiretroviral treatment, and persisted despite severe T cell loss. Using a comprehensive panel of gp120, gp41 peptides and recombinant non-surface proteins of HIV-1 clade C we found an almost identical antibody recognition profile in African and European patients regarding epitopes and involved IgG-sublass, IgA- and IgM-responses. Immune recognition of gp120 peptides and non-surface proteins involved all four IgG subclasses and was indicative of a mixed Th1/Th2 immune response. The HIV-1 clade C proteome-based test allowed diagnosis and monitoring of antibody responses in the course of HIV-infections and assessment of isotype and subclass responses. PMID:25658330

  4. [Immunopathogenesis of HIV infection].

    PubMed

    Alcamí, José; Coiras, Mayte

    2011-03-01

    Killing of CD4 lymphocytes and systemic immune suppression are the hallmarks of HIV infection. These milestones are produced by different mechanisms that draw a complex picture of AIDS immunopathogenesis. The role of the GALT system as a preferential target for HIV, chronic activation of the immune system and viral escape mechanisms are recent challenges that have changed our current view on the mechanisms leading to immune destruction and development of AIDS. In this article, the mechanisms of immune suppression, the evolution of immune response throughout the infection and the mechanisms of viral escape are analysed. PMID:21388715

  5. HIV infections in otolaryngology

    PubMed Central

    Rzewnicki, Ireneusz; Olszewska, Ewa; Rogowska-Szadkowska, Dorota

    2012-01-01

    Summary HIV (human immunodeficiency virus) infection may produce no clinical symptoms for 10 years on average. However, after many years of infection most people develop symptoms that indicate progression of the disease. There are no regular characteristic symptoms or early stage, and no logical sequence of AIDS indicator disorders has been observed. People who are not aware of the infection are referred to physicians of various specializations, including otolaryngologists. It is on their knowledge about HIV infections, among other factors, that early diagnosis of the disease depends. Appropriate and quick introduction of anti-retroviral drugs may let a person with HIV live decades longer. PMID:22367140

  6. [Pneumocystosis during HIV infection].

    PubMed

    El Fane, M; Sodqi, M; Oulad Lahsen, A; Chakib, A; Marih, L; Marhoum El Filali, K

    2016-08-01

    Pneumocystosis is an opportunistic disease caused by invasion of unicellular fungus Pneumocystic jirovecii which is responsible for febrile pneumonia among patients with cellular immunodeficiency especially those HIV infected. Despite the decreasing of its incidence due to the introduction of antiretroviral therapy, as well as anti-Pneumocystis prophylaxis among these patients, Pneumocystis pneumonia remains the first AIDS-defining event and a leading cause of mortality among HIV-infected patients. The usual radiological presentation is that of diffuse interstitial pneumonia. The diagnosis is confirmed by the detection of trophozoides and/or cysts P. jirovecii in bronchoalveolar lavage (BAL) samples using several staining techniques. The use of polymerase chain reaction in the BAL samples in conjunction with standard immunofluorescent or colorimetric tests have allowed for more has allowed for more rapid and accurate diagnosis. The standard regimen of treatment is the association of trimethoprim-sulfamethoxazole which has been utilized as an effective treatment with a favourable recovery. Early HIV diagnosis and antiretroviral therapy should reduce the incidence of this dreaded disease. PMID:27349824

  7. HIV infection and lymphoma

    PubMed Central

    Grogg, K L; Miller, R F; Dogan, A

    2007-01-01

    The incidence of lymphoma in patients with HIV infection greatly exceeds that of the general population. The increased risk for lymphoma appears related to multiple factors, including the transforming properties of the retrovirus itself, the immunosuppression and cytokine dysregulation that results from the disease, and, most importantly, opportunistic infections with other lymphotrophic herpes viruses such as Epstein–Barr virus and human herpesvirus 8. Histologically lymphomas fall into three groups: (1) those also occurring in immunocompetent patients; (2) those occurring more specifically in HIV‐positive patients; and (3) those also occurring in patients with other forms of immunosuppression. Aggressive lymphomas account for the vast majority cases. They frequently present with advanced stage, bulky disease with high tumour burden and, typically, involve extranodal sites. Clinical outcome appears to be worse than in similar aggressive lymphomas in the general population. However, following the introduction of highly active antiretroviral therapy, the risk for developing lymphoma in the context of HIV infection has decreased and the clinical outcome has improved. PMID:18042692

  8. [HIV infection and immigration].

    PubMed

    Monge, Susana; Pérez-Molina, José A

    2016-01-01

    Migrants represent around one third of patients newly diagnosed with HIV in Spain and they constitute a population with higher vulnerability to its negative consequences due to the socio-cultural, economical, working, administrative and legal contexts. Migrants are diagnosed later, which worsens their individual prognosis and facilitates the maintenance of the HIV epidemic. In spite of the different barriers they experience to access healthcare in general, and HIV-related services in particular, access to antiretroviral treatment has been similar to that of the autochthonous population. However, benefits of treatment have been not, with women in general and men from Sub-Saharan Africa exhibiting the worse response to treatment. We need to proactively promote earlier diagnosis of HIV infection, the adoption of preventive measures to avoid new infections, and to deliver accessible, adapted and high-quality health-care. PMID:27016136

  9. Prevalence and Correlates of HIV Infection among Street Boys in Kisumu, Kenya

    PubMed Central

    Goldblatt, Ariella; Kwena, Zachary; Lahiff, Maureen; Agot, Kawango; Minnis, Alexandra; Prata, Ndola; Lin, Jessica; Bukusi, Elizabeth A.; Auerswald, Colette L.

    2015-01-01

    Introduction Despite their perceived vulnerability to HIV, East African street youth have been neglected in HIV prevention research. We examined HIV seroprevalence and correlates of HIV infection in a sample of male street youth in Kisumu, Kenya. Methods We enrolled a street-recruited sample of 13–21 year old street youth. Participants completed a survey followed by voluntary HIV counseling and testing. Survey items included demographics, homelessness history, survival activities, sexual behavior and substance use. We examined the relationship between predictor variables, markers of coercion and marginalization and HIV. Results The sample included 296 males. Survival activities included garbage picking (55%), helping market vendors (55%), begging (17%), and working as porters (46%) or domestic workers (4%). Forty-nine percent of participants reported at least weekly use of alcohol and 32% marijuana. Forty-six percent of participants reported lifetime inhalation of glue and 8% fuel. Seventy-nine percent of participants reported lifetime vaginal sex, 6% reported lifetime insertive anal sex and 8% reported lifetime receptive anal sex. Twelve (4.1%; 95% CI: 2.3–7.0) participants tested positive for HIV. Of those, all had been on the street for at least one year and all had engaged in vaginal sex. Occupations placing youth at particular risk of coercion by adults, including helping market vendors (prevalence ratio (PR) = 8.8; 95% CI: 1.2–67.5) and working as domestic workers (PR = 4.6; 95% CI: 1.1–19.0), were associated with HIV infection. Both insertive anal sex (PR = 10.2; 95% CI: 3.6–29.4) and receptive anal sex (PR = 3.9; 95% CI: 1.1–13.4) were associated with HIV infection. Drug use, begging, and garbage picking were not associated with HIV infection. Conclusions Although HIV prevalence in our sample of street youth is comparable to that of similarly-aged male youth in Nyanza Province, our findings highlight behavioral factors associated with HIV

  10. HIV Infection and Adult Vaccination

    MedlinePlus

    ... Resources for Healthcare Professionals HIV Infection and Adult Vaccination Recommend on Facebook Tweet Share Compartir Vaccines are ... percentage is less than 15%. Learn about adult vaccination and other health conditions Asplenia Diabetes Type 1 ...

  11. Incidence of WHO Stage 3 and 4 Events, Tuberculosis, and Mortality in Untreated, HIV-Infected Children Enrolling in Care Before 1 Year of Age: An Iedea (International Epidemiologic Databases To Evaluate AIDS) East Africa Regional Analysis

    PubMed Central

    Ciaranello, Andrea; Lu, Zhigang; Ayaya, Samuel; Losina, Elena; Musick, Beverly; Vreeman, Rachel; Freedberg, Kenneth A.; Abrams, Elaine J.; Dillabaugh, Lisa; Doherty, Katie; Ssali, John; Yiannoutsos, Constantin T.; Wools-Kaloustian, Kara

    2014-01-01

    Background Few studies have reported CD4%- and age-stratified rates of WHO Stage 3 (WHO3) events, WHO Stage 4 (WHO4) events, tuberculosis (TB), and mortality in HIV-infected infants before initiation of antiretroviral therapy (ART). Methods HIV-infected children enrolled before 1 year of age in the International Epidemiologic Databases to Evaluate AIDS (IeDEA) East Africa region (10/01/2002-11/30/2008) were included. We estimated incidence rates of earliest clinical event (WHO3, WHO4, and TB), prior to ART initiation per local guidelines, stratified by current age (< or ≥6 months) and current CD4% (<15%, 15–24%, ≥25%). CD4%-stratified mortality rates were estimated separately for children who did not experience a clinical event (“background” mortality) and for children who experienced an event, including “acute” mortality (≤30 days post-event) and “later” mortality (>30 days post-event). Results Among 847 children (median enrollment age: 4.8 months; median pre-ART follow-up: 10.8 months; 603 (71%) with ≥1 CD4% recorded), event rates were comparable for those aged <6 and ≥6 months. Current CD4% was associated with risk of WHO4 events for children <6 months old, and with all evaluated events for children ≥6 months old (p<0.05). “Background” mortality was 3.7–8.4/100py. “Acute” mortality (≤30 days post-event) was 33.8/100py (after TB) and 41.1/100py (after WHO3 or WHO4). “Later” mortality (>30 days post-event) ranged by CD4% from 4.7–29.1/100py. Conclusions In treatment-naïve, HIV-infected infants, WHO3, WHO4, and TB events were common before and after 6 months of age and led to substantial increases in mortality. Early infant HIV diagnosis and treatment are critically important, regardless of CD4%. PMID:24378935

  12. Pharmacology and immuno-virologic efficacy of once-a-day HAART in African HIV-infected children: ANRS 12103 phase II trial

    PubMed Central

    Nacro, Boubacar; Zoure, Emmanuelle; Hien, Hervé; Tamboura, Hassane; Rouet, François; Ouiminga, Adama; Drabo, Ali; Yameogo, Souleymane; Hien, Alain; Peyriere, Hélène; Mathieu, Olivier; Hirt, Deborah; Treluyer, Jean-Marc; Nicolas, Joëlle; Foulongne, Vincent; Segondy, Michel; van de Perre, Philippe; Diagbouga, Serge

    2011-01-01

    Abstract Objective To assess 12-month survival, pharmacokinetics, immunologic and virologic efficacy, tolerance, compliance and drug resistance in HIV-infected children in Bobo-Dioulasso, Burkina Faso, receiving once-daily highly-active antiretroviral therapy as a combination of didanosine (DDI), lamivudine (3TC) and efavirenz (EFV). Methods In the ANRS 12103 open phase II trial, HIV-infected children were examined at inclusion and monthly thereafter. CD4+ T-lymphocyte (CD4) count, plasma concentration of ribonucleic acid (RNA) of human immunodeficiency virus type 1 (HIV-1) and haematologic and biochemical parameters were measured at baseline and every trimester. HIV-1 resistance testing was performed in case of viral escape. Drug plasma concentrations were determined with high-performance liquid chromatography. Findings From February 2006 to November 2007, 51 children (39% girls) with a mean age of 6.8 years were enrolled and treated for 12 months. At baseline, Z scores for mean weight-for-age and mean height-for-age were −2.01 and −2.12, respectively. Mean CD4% was 9.0. Median plasma HIV-1 RNA viral load was 5.51 log10 copies per millilitre (cp/ml). Two children (3.9%) died and another 11 (22%) suffered 13 severe clinical events. At month 12, mean WAZ had improved by 0.63 (P < 0.001) and mean HAZ by 0.57 (P < 0.001). Mean CD4% had risen to 24 (P < 0.001). Viral load was below 300 RNA cp/ml in 81% of the children; HIV resistance mutations were detected in 11 (21.6%). Conclusion The once-a-day combination of DDI + 3TC + EFV is an alternative first-line treatment for HIV-1-infected children. Dose adjustment should further improve efficacy. PMID:21673861

  13. Immunology of Pediatric HIV Infection

    PubMed Central

    Tobin, Nicole H.; Aldrovandi, Grace M.

    2013-01-01

    Summary Most infants born to human immunodeficiency virus (HIV)-infected women escape HIV infection. Infants evade infection despite an immature immune system and, in the case of breastfeeding, prolonged repetitive, exposure. If infants become infected, the course of their infection and response to treatment differs dramatically depending upon the timing (in utero, intrapartum, or during breastfeeding) and potentially the route of their infection. Perinatally acquired HIV infection occurs during a critical window of immune development. HIV’s perturbation of this dynamic process may account for the striking age-dependent differences in HIV disease progression. HIV infection also profoundly disrupts the maternal immune system upon which infants rely for protection and immune instruction. Therefore, it is not surprising that infants who escape HIV infection still suffer adverse effects. In this review, we highlight the unique aspects of pediatric HIV transmission and pathogenesis with a focus on mechanisms by which HIV infection during immune ontogeny may allow discovery of key elements for protection and control from HIV. PMID:23772619

  14. Estimation of Mortality among HIV-infected people on antiretroviral therapy treatment in east Africa: a sampling based approach in an observational, multisite, cohort study

    PubMed Central

    Geng, Elvin H.; Odeny, Thomas A.; Lyamuya, Rita E.; Nakiwogga-Muwanga, Alice; Diero, Lameck; Bwana, Mwebesa; Muyindike, Winnie; Braitstein, Paula; Somi, Geoffrey R.; Kambugu, Andrew; Bukusi, Elizabeth A.; Wenger, Megan; Wools-Kaloustian, Kara K.; Glidden, David V.; Yiannoutsos, Constantin T.; Martin, Jeffrey

    2015-01-01

    Background Mortality after initiation of antiretroviral treatment (ART) among HIV-infected patients in resource limited settings is a critical measure of the effectiveness and comparative effectiveness of the global public health response. Unknown outcomes due to high loss to follow-up (LTFU) preclude accurate accounting of deaths and limit our understanding of effectiveness. Methods We evaluated in HIV-infected adults on ART in 14 clinics in five settings in Kenya, Uganda and Tanzania using a sampling-based approach in which we intensively traced a random sample of lost patients (> 90 days late for last scheduled visit) and incorporated their vital status outcomes into analyses of the entire clinic population through probability-weighted survival analyses. Findings We followed 34,277 adults on ART from Mbarara and Kampala, Uganda; Eldoret and Kisumu, Kenya; and Morogoro, Tanzania. The median age was 35 years, 34% were men, and median pre-therapy CD4 count was 154 cells/μl. Overall 5,780 (17%) were LTFU, 991 (17%) were randomly selected for tracing and vital status was ascertained in 860 of 991 (87%). Incorporating outcomes among the lost increased estimated 3-year mortality from 3.9% (95% CI: 3.6%-4.2%) to 12.5% (95% CI: 11.8%-13.3%). The sample-corrected, unadjusted 3-year mortality across settings ranged from 7.2% in Mbarara to 23.6% in Morogoro. After adjustment for age, sex, pre-therapy CD4 value, and WHO stage, the sample-corrected hazard ratio comparing the setting with highest vs. lowest mortality was 2.2 (95% CI: 1.5-3.4) and the risk difference for death at 3 years was 11% (95% CI: 5.0%-17.7%). Interpretation A sampling based approach is widely feasible and important for understanding mortality after starting ART. After adjustment for measured biological drivers, mortality differs substantially across settings despite delivery of a similar clinical package of treatment. Implementation research to understand the systems, community, and patient behaviors

  15. Skeletal muscle cellular metabolism in older HIV-infected men.

    PubMed

    Ortmeyer, Heidi K; Ryan, Alice S; Hafer-Macko, Charlene; Oursler, KrisAnn K

    2016-05-01

    Skeletal muscle mitochondrial dysfunction may contribute to low aerobic capacity. We previously reported 40% lower aerobic capacity in HIV-infected men compared to noninfected age-matched men. The objective of this study was to compare skeletal muscle mitochondrial enzyme activities in HIV-infected men on antiretroviral therapy (55 ± 1 years of age, n = 10 African American men) with age-matched controls (55 ± 1 years of age, n = 8 Caucasian men), and determine their relationship with aerobic capacity. Activity assays for mitochondrial function including enzymes involved in fatty acid activation and oxidation, and oxidative phosphorylation, were performed in homogenates prepared from vastus lateralis muscle. Hydrogen peroxide (H2O2), cardiolipin, and oxidized cardiolipin were also measured. β-hydroxy acyl-CoA dehydrogenase (β-HAD) (38%) and citrate synthase (77%) activities were significantly lower, and H2O2 (1.4-fold) and oxidized cardiolipin (1.8-fold) were significantly higher in HIV-infected men. VO2peak (mL/kg FFM/min) was 33% lower in HIV-infected men and was directly related to β-HAD and citrate synthase activity and inversely related to H2O2 and oxidized cardiolipin. Older HIV-infected men have reduced oxidative enzyme activity and increased oxidative stress compared to age-matched controls. Further research is crucial to determine whether an increase in aerobic capacity by exercise training will be sufficient to restore mitochondrial function in older HIV-infected individuals. PMID:27166139

  16. A Census Tract–Level Examination of Social Determinants of Health among Black/African American Men with Diagnosed HIV Infection, 2005–2009—17 US Areas

    PubMed Central

    Gant, Zanetta; Gant, Larry; Song, Ruiguang; Willis, Leigh; Johnson, Anna Satcher

    2014-01-01

    Background HIV disproportionately affects black men in the United States: most diagnoses are for black gay, bisexual, and other men who have sex with men (collectively referred to as MSM). A better understanding of the social conditions in which black men live and work may better explain why HIV incidence and diagnosis rates are higher than expected in this population. Methods Using data from the National HIV Surveillance System and the US Census Bureau's American Community Survey, we examined the relationships of HIV diagnosis rates and 5 census tract–level social determinants of health variables for 21,948 black MSM and non-MSM aged ≥15 years residing in 17 areas in the United States. We examined federal poverty status, marital status, education level, employment status, and vacancy status and computed rate ratios (RRs) and prevalence odds ratios (PORs), using logistic regression with zero-inflated negative binomial modeling. Results Among black MSM, HIV diagnosis rates decreased as poverty increased (RR: 0.54). At the time of HIV diagnosis, black MSM were less likely than black non-MSM to live in census tracts with a higher proportion below the poverty level (POR: 0.81) and with a higher proportion of vacant houses (POR: 0.86). In comparison, housing vacancy was positively associated with HIV diagnosis rates among black non-MSM (RR: 1.65). HIV diagnosis rates were higher for black MSM (RR: 2.75) and non-MSM (RR: 4.90) whose educational level was low. Rates were significantly lower for black MSM (RR: 0.06) and non-MSM (RR: 0.26) as the proportion unemployed and the proportion married increased. Conclusions This exploratory study found differences in the patterns of HIV diagnosis rates for black MSM and non-MSM and provides insight into the transmission of HIV infection in areas that reflect substantial disadvantage in education, housing, employment, and income. PMID:25268831

  17. Preventing HIV Infection in Women

    PubMed Central

    Adimora, Adaora A.; Ramirez, Catalina; Auerbach, Judith D.; Aral, Sevgi O.; Hodder, Sally; Wingood, Gina; El-Sadr, Wafaa; Bukusi, Elizabeth Anne

    2014-01-01

    Although the number of new infections has declined recently, women still constitute almost half of the world's 34 million people with HIV infection, and HIV remains the leading cause of death among women of reproductive age. Prevention research has made considerable progress during the past few years in addressing the biological, behavioral and social factors that influence women's vulnerability to HIV infection. Nevertheless, substantial work still must be done in order to implement scientific advancements and to resolve the many questions that remain. This article highlights some of the recent advances and persistent gaps in HIV prevention research for women and outlines key research and policy priorities. PMID:23764631

  18. Successes and Challenges in East African Conservation Education

    ERIC Educational Resources Information Center

    Johnson-Pynn, Julie S.; Johnson, Laura R.

    2005-01-01

    Environmental education (EE) programs that include service-learning components have great potential to positively impact East African youth, their communities, and their ecology. This exploratory study describes 2 programs in East Africa, The Jane Goodall Institute's Roots & Shoots (R&S) and Wildlife Clubs of Uganda (WCU). The authors studied…

  19. Mucosal Immunology of HIV Infection

    PubMed Central

    Xu, Huanbin; Wang, Xiaolei; Veazey, Ronald S.

    2013-01-01

    Summary Recent advances in the immunology, pathogenesis, and prevention of human immunodeficiency virus (HIV) infection continue to reveal clues to the mechanisms involved in the progressive immunodeficiency attributed to infection but more importantly have shed light on the correlates of immunity to infection and disease progression. HIV selectively infects, eliminates, and/or dysregulates several key cells of the human immune system, thwarting multiple arms of the host immune response, and inflicting severe damage to mucosal barriers, resulting in tissue infiltration of ‘symbiotic’ intestinal bacteria and viruses that essentially become opportunistic infections promoting systemic immune activation. This leads to activation and recruitment or more target cells for perpetuating HIV infection, resulting in persistent, high level viral replication in lymphoid tissues, rapid evolution of resistant strains, and continued evasion of immune responses. However, vaccine studies and studies of spontaneous controllers are finally providing correlates of immunity from protection and disease progression, including virus-specific CD4+ T-cell responses, binding antibodies, innate immune responses, and generation of antibodies with potent antibody-dependent cell-mediated cytotoxicity activity. Emerging correlates of immunity indicate that prevention of HIV infection may be possible through effective vaccine strategies that protect and stimulate key regulatory cells and immune responses in susceptible hosts. Further, immune therapies specifically directed towards boosting specific aspects of the immune system may eventually lead to a cure for HIV-infected patients. PMID:23772612

  20. Troubled Adolescents and HIV Infection.

    ERIC Educational Resources Information Center

    Woodruff, John O., Ed.; And Others

    This report on adolescents, Acquired Immune Deficiency Syndrome (AIDS), and Human Immune Virus (HIV) infection had its beginning in the Knowledge Development Workshop "Issues in the Prevention and Treatment of AIDS Among Adolescents with Serious Emotional Disturbance," held June 9-10, 1988 in the District of Columbia. These papers are included:…

  1. International travel and HIV infection.

    PubMed Central

    von Reyn, C. F.; Mann, J. M.; Chin, J.

    1990-01-01

    Although human immunodeficiency virus (HIV) infection is a worldwide problem, its prevalence and pattern vary from country to country. Accordingly, the risk to international travellers of acquiring HIV infection also varies widely in different parts of the world, and depends principally on their behaviour. The risk of sexual acquisition of HIV infection can be virtually eliminated by avoiding penetrative sexual intercourse with intravenous drug users and persons who have had multiple sexual partners (such as prostitutes) or reduced by the use of condoms. The risk of parenteral exposure to HIV can be reduced by avoiding parenteral drug use and behaviour that is likely to lead to injury (with its attendant risk of requiring blood transfusion) and by seeking medical facilities with adequate capabilities to screen blood donors for HIV and to sterilize instruments. HIV screening of international travellers is an ineffective, costly, and impractical public health strategy for limiting the worldwide spread of HIV infection. Travellers infected with HIV require specialized advice regarding health precautions, prophylactic medications, and immunization. PMID:2194689

  2. HIV Infection Presenting with Dementia.

    PubMed

    Narayanan, K; Gupta, Avneet; Manoj, S; Seshadri, Kp

    2015-08-01

    We present a case of dementia in a young healthy individual. On evaluation he was detected to have HIV infection with low CD4 count and a high viral load. He had no opportunistic infections or any other AIDS defining illnesses. He recovered fully within 3 months of antiretroviral therapy. PMID:27604445

  3. Are WHO/UNAIDS/UNICEF-recommended replacement milks for infants of HIV-infected mothers appropriate in the South African context?

    PubMed Central

    Papathakis, P. C.; Rollins, N. C.

    2004-01-01

    OBJECTIVE: Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/UNAIDS/UNICEF. The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks. METHODS: Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and best available liquid paediatric supplement found in local pharmacies) were compared. Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months. Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers. Time needed to prepare one feed of replacement milk was simulated. FINDINGS: When mixed with water, sugar, and each micronutrient supplement, PM and FM provided <50% of estimated required amounts for vitamins E and C, folic acid, iodine, and selenium and <75% for zinc and pantothenic acid. PM and FM made with UNICEF micronutrient sachets provided 30% adequate intake for niacin. FM prepared with any micronutrient supplement provided no more than 32% vitamin D. All PMs provided more than adequate amounts of vitamin D. Compared with the commercial formula, PM and FM provided 8-60% of vitamins A, E, and C, folic acid, manganese, zinc, and iodine. Preparations of PM and FM provided 11% minimum recommended linoleic acid and 67% minimum recommended alpha-linolenic acid per 450 ml mixture. It took 21-25 minutes to optimally prepare

  4. Spatiotemporal dynamics of HIV infection

    NASA Astrophysics Data System (ADS)

    Strain, Matthew Carl

    Mathematical models of the dynamics of infection with the human immunodeficiency virus (HIV) have contributed to tremendous advances over the past 20 years. This thesis extends this previous work by exploring the importance of spatial heterogeneity in HIV infection both in vitro and in vivo in patients treated with highly-active antiretroviral therapy. Viral infections propagate locally in space, yet HIV infection has been widely regarded as equilibrated over the entire body of an infected patient. This dissertation constructs and explores a cellular automata model of viral spread at the cellular level. Coupling the automata to a blood compartment represented by a differential equation leads to a whole-body model of HIV infection that explicitly includes spatial effects at both the cellular and tissue levels. These models are tested by comparison with experimental data. A central prediction of the spatial model is that, due to competition between Brownian motion and viral lability, HIV infectivity increases with target cell density. This production is verified in a series of in vitro experiments in cell culture. The predicted independence of inhibitory concentrations of antiretoviral agents is verified for nevirapine, but azidothymidine inhibits HIV replication less efficiently in more dense cultures. These in vitro results suggest that systems allowing cell concentrations closer to tissue densities would better reflect virus replication kinetics, although standard measures of relative drug susceptibility may accurately reflect in vivo conditions. The coupled spatial model of in vivo dynamics is compared with novel mathematical analysis of experiments in HIV-infected patients. These analyses indicate that HIV DNA provides a useful marker of the size of long-lived cellular reservoirs of HIV. Levels of HIV DNA in peripheral blood are predictive of the average rate of residual virus production after years of treatment, regardless of whether patients initiate therapy

  5. Middle East and North African Oil.

    ERIC Educational Resources Information Center

    Al-Quazzaz, Ayad

    1981-01-01

    Traces the history of oil and natural gas in the Middle East and relates the importance of the Middle East's current stores of oil to economic development. Information is presented on the relationship of major oil companies and local governments, OPEC, rate of production, and the impact of oil on the societies of the Middle East and North Africa.…

  6. Psychiatry in the East African colonies: a background to confinement.

    PubMed

    Mahone, S

    2006-08-01

    This article is concerned with the discipline of psychiatry in colonial East Africa as it emerged out of the crime and disorder problem to become an intellectually significant 'East African School' of psychiatry. The process of lunacy certification, in particular, provides a snapshot of the medical and political tensions that existed among the medical establishment, the prison system and the colonial courts, all of whom sought to define collective African behaviour. This historical article utilises archaic terminology, such as 'lunatic' or 'lunacy', as these categories were in use at the time. PMID:16943144

  7. East African cheetahs: evidence for two population bottlenecks?

    PubMed Central

    O'Brien, S J; Wildt, D E; Bush, M; Caro, T M; FitzGibbon, C; Aggundey, I; Leakey, R E

    1987-01-01

    A combined population genetic and reproductive analysis was undertaken to compare free-ranging cheetahs from east Africa (Acinonyx jubatus raineyi) with the genetically impoverished and reproductively impaired south African subspecies (Acinonyx jubatus jubatus). Like that of their south African counterparts, the quality of semen specimens from east African cheetahs was poor, with a low concentration of spermatozoa (25.3 X 10(6) per ejaculate) and a high incidence of morphological abnormalities (79%). From an electrophoretic survey of the products of 49 genetic loci in A. jubatus raineyi, two allozyme polymorphisms were detected; one of these, for a nonspecific esterase, shows an allele that is rare (less than 1% incidence) in south African specimens. Estimates of polymorphism (2-4%) and average heterozygosity (0.0004-0.014) affirm the cheetah as the least genetically variable felid species. The genetic distance between south and east African cheetahs was low (0.004), suggesting that the development of genetic uniformity preceded the recent geographic isolation of the subspecies. We propose that at least two population bottlenecks followed by inbreeding produced the modern cheetah species. The first and most extreme was ancient, possibly late Pleistocene (circa 10,000 years ago); the second was more recent (within the last century) and led to the south African populations. PMID:3467370

  8. [HIV infection and human genetics].

    PubMed

    Bobkova, M R

    2009-01-01

    The review summarizes data of recent studies on the impact of human gene polymorphisms on the possibility of HIV infection, as well as the specific features of its pathogenesis, the efficiency of HIV infection treatment and the likelihood of its complication. Main information on the mechanisms responsible for viral penetration into the sensitive cells, for immune response development and involvement of HLA and KIR molecules in this process are briefly outlined. Idea on major cell proteins affecting drug metabolism and excretion and encoding for their genes are generalized. There are many examples that show how different human gene alleles and their combinations affect the nature of the pathogenetic process and the occurrence and degree of adverse reactions. The first example of successfully using the prognostic genetic analysis (HLA-B*5701) registered in 2008 to upgrade the quality of HIV infection treatment is described in detail. Basic requirements for further genetic tests to use the optimal antiretroviral therapy schemes and to reduce its hazardous effects are formulated. PMID:20481056

  9. A preliminary evaluation of the cognitive and motor effects of pediatric HIV infection in Zairian children.

    PubMed

    Boivin, M J; Green, S D; Davies, A G; Giordani, B; Mokili, J K; Cutting, W A

    1995-01-01

    Fourteen asymptomatic HIV-infected Zairian children under 2 years of age displayed social and motor developmental deficits on the Denver Developmental Screening Test when compared with 20 HIV-negative cohorts born to HIV-infected mothers and 16 control children. In a second study, 11 infected children over 2 years of age had sequential motor and visual-spatial memory deficits on the Kaufman Assessment Battery for Children and motor development deficits on the Early Childhood Screening Profiles. HIV infection affects central nervous system structures mediating motor and spatial memory development, even in seemingly asymptomatic children. Furthermore, maternal HIV infection compromises the labor-intensive provision of care in the African milieu and undermines global cognitive development in even uninfected children. PMID:7737068

  10. [Heterosexual transmission of HIV infection

    PubMed

    Coulaud, J P

    1993-02-01

    The AIDS epidemic has spread rapidly in Africa among the urban impoverished where multiple sexual partners and sexually transmitted diseases are common. Over 80% of the 9 million Africans who will develop AIDS before the year 2000 will have been contaminated sexually. Poverty, multiple sexual partners in the framework of prostitution, and drug addiction are responsible for rapid spread of HIV infection in Southeast Asia, the West India, and Brazil. Drug addiction has played a major role in diffusion of HIV into the general population of Europe and the US. Prevalence rates are much higher in sexually transmitted disease centers in France and the US than among blood donors or pregnant women. Sexually transmitted diseases and heterosexual transmission have been studied in Africas since diagnostic tests became available. Several studies, the majority conducted among prostitutes in Nairobi or Kinshasa and their clients, allow establishment of a list of sexually transmitted diseases associated with increased risk of seroconversion. Genital ulcers within the past 6 months presented a relative risk of 2-4 depending on the series. Urethral or cervical gonorrhea has a lower relative risk of 1.2 in most studies. Absence of circumcision was also a risk factor. Studies were subsequently conducted in Europe on factors favoring sexual transmission. 513 heterosexual couples together for a minimum duration of 18 months and an average of 38 months were included in the Multicenter European Study conducted in 10 centers in 9 countries. The "index" subject was male in 400 cases and female in 113. At entry into the study, 73 of 400 males (18.2%) and 10 of 113 females (8.8%) had already infected their partners. Duration of union, frequency of intercourse, mode of transmission of the index subject, and oral contraceptive use had no effect on risk of transmission. Factors increasing risk of infection included the severity of immunosuppression of the index subject, whether judged by

  11. Innovative tephra studies in the East African Rift System

    NASA Astrophysics Data System (ADS)

    WoldeGabriel, Giday; Hart, William K.; Heiken, Grant

    Geosciences investigations form the foundation for paleoanthropological research in the East African Rift System. However, innovative applications of tephra studies for constraining spatial and temporal relations of diverse geological processes, biostratigraphic records, and paleoenvironmental conditions within the East African Rift System were fueled by paleoanthropological investigations into the origin and evolution of hominids and material culture. Tephra is a collective, size-independent term used for any material ejected during an explosive volcanic eruption.The East African Rift System has become a magnet for paleoanthropological research ever since the discovery of the first hominids at Olduvai Gorge, in Tanzania, in the 1950s [Leakey et al., 1961]. Currently, numerous multidisciplinary scientific teams from academic institutions in the United States and Western Europe make annual pilgrimages for a couple of months to conduct paleoanthropological field research in the fossil-rich sedimentary deposits of the East African Rift System in Ethiopia, Kenya, and Tanzania. The field expedition consists of geological, paleontological, archaeological, and paleoenvironmental investigations.

  12. Ecological observations on an East African bat community

    USGS Publications Warehouse

    O'Shea, Thomas J.; Vaughan, Terry A.

    1980-01-01

    The structure and ecology of bat faunas is a subject of interest to mammalogists (Findley, 1976; Wilson, 1973). Syntopic African bat communities, however, have received little study in comparison with neotropical faunas (cf. Fleming et al., 1972; LaVal and Fitch, 1977; McNab, 1971). Verschuren (1957) presented natural history information and species accounts for a localized central African bat fauna. Foraging related characteristics of a Rhodesian community have also been analyzed (Fenton, 1975; Fenton et al., 1977), but not on a seasonal basis. Other reports on African bat faunas are restricted to regional summaries (cf. Koopman, 1975 or Rosevear, 1965) and do not consider ecological aspects of a single localized community. The purpose of our study was to follow species composition, reproduction, and foraging related characteristics of an East African bat fauna over a full annual cycle.

  13. Oral Health Training Programs for Community and Professional Health Care Workers in Nairobi East District Increases Identification of HIV-Infected Patients

    PubMed Central

    Koyio, Lucina N.; van der Sanden, Wil J. M.; Dimba, Elizabeth; Mulder, Jan; Creugers, Nico H. J.; Merkx, Matthias A. W.; van der Ven, Andre; Frencken, Jo E.

    2014-01-01

    Background Better knowledge and skills for diagnosis and management of human immunodeficiency virus (HIV) related oral lesions by primary healthcare workers (PHWs) may increase recognition of HIV-related oral lesions (HROLs) and may improve implementation of HIV testing in Kenya. For this purpose training programs at health facility and community level were evaluated. Design and Methods A pre-post control-test group design in two administrative divisions of Nairobi East District was used. Clinical competencies of PHWs (n = 32 intervention, and n = 27 control) at health facility level were assessed 9 months after training, and after 6 months for community health workers, (CHWs) (n = 411 intervention and n = 404 control) using written questionnaires, clinical data and patient interviews. Effects on referral for HIV testing and actual HIV testing were assessed by comparing laboratory registries pre- and post training. Results PHWs in intervention (n = 27; 84%) and control (n = 15; 60%) divisions, and CHWs in intervention (n = 330; 80%) and control (189; 47%) divisions, completed all questionnaires. Trained PHWs significantly increased their knowledge of HROLs (p<0.02), frequency of oral examinations, diagnosis of HROLs and referral of patients with HROLs for HIV testing. Trained CHWs significantly gained knowledge about HROLs (p<0.02) and referred more patients with HROLs to health facilities. Overall percentage of HIV-positive test results was three-fold for HROLs compared to non-HROLs. Specifically, 70% of patients with oro pharyngeal candidiasis (OPC), the most commonly diagnosed HROL, were confirmed as being HIV-positive. Increase in overall HIV testing rates (1.6% pre-, 1.2% post training) and overall percentage of HIV-positive results (13% pre-, 16% post-intervention) was not significant. Conclusion Training programs significantly increased PHW and CHW knowledge, recognition and management of HROLs but increased neither overall HIV

  14. An investigation of menopausal stage and symptoms on cognition in HIV-infected women

    PubMed Central

    Rubin, Leah H.; Sundermann, Erin E.; Cook, Judith A.; Martin, Eileen M.; Golub, Elizabeth T.; Weber, Kathleen M.; Cohen, Mardge H.; Crystal, Howard; Cederbaum, Julie A.; Anastos, Kathyrn; Young, Mary; Greenblatt, Ruth M.; Maki, Pauline M.

    2014-01-01

    Objective: We evaluated the separate and interactive associations of menopausal stage, menopausal symptoms, and HIV infection on cognition. We hypothesized that HIV-infected, perimenopausal women would show the greatest cognitive difficulties and that menopausal symptoms would be inversely associated with cognition. Methods: This cross-sectional study included 708 HIV-infected and 278 HIV-uninfected, pre-, peri-, or postmenopausal women (64% African-American; median age 44 years) from the Women’s Interagency HIV Study. Participants completed tests of verbal learning and memory, attention/processing speed, and executive function. We administered a menopausal symptom questionnaire that assessed anxiety, vasomotor, and sleep symptoms and obtained measures of depressive symptoms. Results: In multivariable regression analyses controlling for relevant covariates, HIV infection, but not menopausal stage, was associated with worse performance on all cognitive measures (p’s<0.05). Depressive symptoms were associated with lower cognitive performance on measures of verbal learning and memory, attention, and executive function (p’s<0.05); anxiety symptoms were associated with lower performance on measures of verbal learning and memory (p’s<0.05). Vasomotor symptoms were associated with worse attention (p<0.05). HIV and anxiety symptoms interacted to influence verbal learning (p’s<0.05); elevated anxiety was associated with worse verbal learning in HIV-infected women only. Conclusion: Vasomotor, depressive, and anxiety symptoms, but not menopausal stage, were associated with worse cognitive performance in both HIV-infected and uninfected women, although elevated anxiety symptoms were associated with verbal learning deficits more in HIV-infected women. Since cognitive problems can interfere with everyday functioning including treatment adherence, it may be important to screen and treat anxiety in HIV-infected women. PMID:24496085

  15. Sex Differences in Antiretroviral Therapy Initiation in Pediatric HIV Infection.

    PubMed

    Mori, Masahiko; Adland, Emily; Paioni, Paolo; Swordy, Alice; Mori, Luisa; Laker, Leana; Muenchhoff, Maximilian; Matthews, Philippa C; Tudor-Williams, Gareth; Lavandier, Nora; van Zyl, Anriette; Hurst, Jacob; Walker, Bruce D; Ndung'u, Thumbi; Prendergast, Andrew; Goulder, Philip; Jooste, Pieter

    2015-01-01

    The incidence and severity of infections in childhood is typically greater in males. The basis for these observed sex differences is not well understood, and potentially may facilitate novel approaches to reducing disease from a range of conditions. We here investigated sex differences in HIV-infected children in relation to antiretroviral therapy (ART) initiation and post-treatment outcome. In a South African cohort of 2,101 HIV-infected children, we observed that absolute CD4+ count and CD4% were significantly higher in ART-naïve female, compared to age-matched male, HIV-infected children. Absolute CD4 count and CD4% were also significantly higher in HIV-uninfected female versus male neonates. We next showed that significantly more male than female children were initiated on ART (47% female); and children not meeting criteria to start ART by >5 yrs were more frequently female (59%; p<0.001). Among ART-treated children, immune reconstitution of CD4 T-cells was more rapid and more complete in female children, even after adjustment for pre-ART absolute CD4 count or CD4% (p=0.011, p=0.030, respectively). However, while ART was initiated as a result of meeting CD4 criteria less often in females (45%), ART initiation as a result of clinical disease in children whose CD4 counts were above treatment thresholds occurred more often in females (57%, p<0.001). The main sex difference in morbidity observed in children initiating ART above CD4 thresholds, above that of TB disease, was as a result of wasting and stunting observed in females with above-threshold CD4 counts (p=0.002). These findings suggest the possibility that optimal treatment of HIV-infected children might incorporate differential CD4 treatment thresholds for ART initiation according to sex. PMID:26151555

  16. Recommendations for Control of East African Sleeping Sickness in Uganda

    PubMed Central

    Kotlyar, Simon

    2010-01-01

    East African sleeping sickness, caused by Trypanosoma brucei rhodesiense, is prominent in Uganda and poses a serious public health challenge in the region. This publication attempts to provide key components for designing a strategy for a nationwide initiative to provide insecticide-treatment of the animal reservoir to control T. b. rhodesiense. The contents of this article will focus on insecticide-based vector control strategies, monitoring and evaluation framework, and knowledge gaps required for future initiatives. PMID:20300417

  17. Monitoring East African vegetation using AVHRR data

    NASA Technical Reports Server (NTRS)

    Justice, C. O.; Holben, B. N.; Gwynne, M. D.

    1986-01-01

    NOAA Advanced Very High Resolution Radiometer satellite data are applied to regional vegetation monitoring in East Africa. Normalized Difference Vegetation Index (NDVI) data for a one-year period from May 1983 are used to examine the phenology of a range of vegetation types. The integrated NDVI data for the same period are compared with an ecoclimatic zone map of the region and show marked similarities. Particular emphasis is placed on quantifying the phenology of the Acacia Commiphora bushlands. Considerable variation was found in the phenology of the bushlands as determined by the satellite NDVI, and is explained through the high spatial variability in the distribution of rainfall and the resulting green-up of the vegetation. The relationship between rainfall and NDVI is further examined for selected meteorological stations existing within the bushland. A preliminary estimate is made of the length of growing season using an NDVI thresholding technique.

  18. Genetic correlates influencing immunopathogenesis of HIV infection

    PubMed Central

    Sharma, Gaurav; Kaur, Gurvinder; Mehra, Narinder

    2011-01-01

    Variability to HIV infection, its progression as well as responsiveness to antiretroviral therapy (ART) is observed among individuals including viraemia controllers or exposed uninfected, rapid versus slow progressors and ART responders compared to non responders. This differential responsiveness/vulnerability to HIV-1 is governed by multiple host genetic factors that include HLA, cytokines, chemokines, their receptors and others. This review highlights the influence of these genetic factors on HIV/AIDS outcome; however, in India, the information in this area is very limited and most of these genetic studies have been conducted in Caucasian and South African populations. Considering, the population specific differences in the frequencies of protective or susceptibility favouring alleles and their influence on the disease outcome, it is of utmost importance to strengthen ongoing efforts towards defining largely unknown genetic propensity in Indian population, particularly by recruitment of large cohorts of well categorized exposed uninfected individuals, rapid, long term non progressors and elite viraemic controllers. Multi-parametric analysis of these potentially interactive immunogenetic variables in these cohorts may help to define potential targets for diagnostics and therapy in a population specific manner. PMID:22310811

  19. West Indian Ocean variability and East African fish catch.

    PubMed

    Jury, M; McClanahan, T; Maina, J

    2010-08-01

    We describe marine climate variability off the east coast of Africa in the context of fish catch statistics for Tanzania and Kenya. The time series exhibits quasi-decadal cycles over the period 1964-2007. Fish catch is up when sea surface temperature (SST) and atmospheric humidity are below normal in the tropical West Indian Ocean. This pattern relates to an ocean Rossby wave in one phase of its east-west oscillation. Coastal-scale analyses indicate that northward currents and uplift on the shelf edge enhance productivity of East African shelf waters. Some of the changes are regulated by the south equatorial current that swings northward from Madagascar. The weather is drier and a salty layer develops in high catch years. While the large-scale West Indian Ocean has some impact on East African fish catch, coastal dynamics play a more significant role. Climatic changes are reviewed using 200 years of past and projected data. The observed warming trend continues to increase such that predicted SST may reach 30 degrees C by 2100 while SW monsoon winds gradually increase, according to a coupled general circulation model simulation with a gradual doubling of CO(2). PMID:20471674

  20. Does Water Hyacinth on East African Lakes Promote Cholera Outbreaks?

    PubMed Central

    Feikin, Daniel R.; Tabu, Collins W.; Gichuki, John

    2010-01-01

    Cholera outbreaks continue to occur regularly in Africa. Cholera has been associated with proximity to lakes in East Africa, and Vibrio cholerae has been found experimentally to concentrate on the floating aquatic plant, water hyacinth, which is periodically widespread in East African lakes since the late 1980s. From 1994 to 2008, Nyanza Province, which is the Kenyan province bordering Lake Victoria, accounted for a larger proportion of cholera cases than expected by its population size (38.7% of cholera cases versus 15.3% of national population). Yearly water-hyacinth coverage on the Kenyan section of Lake Victoria was positively associated with the number of cholera cases reported in Nyanza Province (r = 0.83; P = 0.0010). Water hyacinth on freshwater lakes might play a role in initiating cholera outbreaks and causing sporadic disease in East Africa. PMID:20682884

  1. HIV infection in females dependent on drugs.

    PubMed

    Wai, B H; Singh, S; Varma, S L

    1996-03-01

    One hundred and seventy-one drug-dependent females in a drug rehabilitation centre were studied to estimate the prevalence of HIV infection among them. Twenty-four (14%) were positive on the Western Blot test. The presence of HIV infection was significantly correlated with syphilis (p < 0.03) and age (p < 0.001); 83% of those who were HIV positive were intravenous drug users. The need for harm reduction programmes to prevent spread of HIV infection among injecting drug users is stressed. PMID:8867206

  2. Solid organ transplantation and HIV infection.

    PubMed

    Polak, Wojciech G; Gładysz, Andrzej

    2003-01-01

    HIV infection has been traditionally considered to be an absolute contraindication for solid organ transplantation. Recent advances in HIV treatment, as highly active antiretroviral therapy (HAART), significantly reduced HIV-related mortality and morbidity. At the same time the number of HIV-infected patients with end-stage organ diseases constantly increased. Current data describing solid organ transplantation in HIV-infected patients demonstrated comparable outcome to that in the HIV-negative population. In light of this, solid organ transplantation should be considered as a treatment option for selected HIV-positive patients with end-stage organ disease. PMID:15171000

  3. East African and Kuunga Orogenies in Tanzania - South Kenya

    NASA Astrophysics Data System (ADS)

    Fritz, H.; Hauzenberger, C. A.; Tenczer, V.

    2012-04-01

    Tanzania and southern Kenya hold a key position for reconstructing Gondwana consolidation because here different orogen belts with different tectonic styles interfere. The older, ca. 650-620 Ma East African Orogeny resulted from the amalgamation of arc terranes in the northern Arabian-Nubian Shield (ANS) and continental collision between East African pieces and parts of the Azania terrane in the south (Collins and Pisarevsky, 2005). The change form arc suturing to continental collision settings is found in southern Kenya where southernmost arcs of the ANS conjoin with thickened continental margin suites of the Eastern Granulite Belt. The younger ca. 570-530 Ma Kuunga orogeny heads from the Damara - Zambesi - Irumide Belts (De Waele et al., 2006) over Tanzania - Mozambique to southern India and clashes with the East African orogen in southern-central Tanzania. Two transitional orogen settings may be defined, (1) that between island arcs and inverted passive continental margin within the East African Orogen and, (2) that between N-S trending East African and W-E trending Kuungan orogenies. The Neoproterozoic island arc suites of SE-Kenya are exposed as a narrow stripe between western Azania and the Eastern Granulite belt. This suture is a steep, NNW stretched belt that aligns roughly with the prominent southern ANS shear zones that converge at the southern tip of the ANS (Athi and Aswa shear zones). Oblique convergence resulted in low-vorticity sinstral shear during early phases of deformation. Syn-magmatic and syn-tectonic textures are compatible with deformation at granulite metamorphic conditions and rocks exhumed quickly during ongoing transcurrent motion. The belt is typified as wrench tectonic belt with horizontal northwards flow of rocks within deeper portions of an island arc. The adjacent Eastern Granulite Nappe experienced westward directed, subhorizontal, low-vorticity, high temperature flow at partly extreme metamorphic conditions (900°C, 1.2 to 1.4 GPa

  4. The Prevalence of Motor Delay among HIV Infected Children Living in Cape Town, South Africa

    ERIC Educational Resources Information Center

    Ferguson, Gillian; Jelsma, Jennifer

    2009-01-01

    Children living with HIV often display delayed motor performance owing to HIV infection of the central nervous system, the effects of opportunistic infections and, indirectly, owing to their social environments. Although these problems have been well documented, the impact of the virus on the development of South African children is less well…

  5. Predictors of HIV infection among women drug users in New York and Miami.

    PubMed

    Tortu, S; McCoy, H V; Beardsley, M; Deren, S; McCoy, C B

    1998-01-01

    In the US, the number of women diagnosed with AIDS continues to increase. In this study, women in New York City (East Harlem) and Miami, two sites with high rates of drug use and HIV infection, were first compared on sociodemographic variables and risk behaviors. Logistic regression analyses were used to identify significant, independent predictors of HIV infection in each city. In comparing women from the two cities, several differences in sociodemographic characteristics and drug use were observed. In both cities, ever exchanging sex for drugs and/or money was predictive of HIV infection; and in East Harlem only, other lifetime risk variables independently predicted HIV infection: drug injection, having a sexually transmitted disease, and not having graduated from high school. Results suggest that intervention efforts with women who exchange sex should be intensified in both cities. Also, further comparisons of women drug users in AIDS epicenter cities are necessary to provide information on similarities and differences in sociodemographic characteristics and individual risk behaviors. More research attention should be focused on examining the social context of HIV risk in order to develop innovative intervention strategies which focus on the link between contextual factors and HIV infection. PMID:9640642

  6. East African climate pulses and early human evolution

    NASA Astrophysics Data System (ADS)

    Maslin, Mark A.; Brierley, Chris M.; Milner, Alice M.; Shultz, Susanne; Trauth, Martin H.; Wilson, Katy E.

    2014-10-01

    Current evidence suggests that all of the major events in hominin evolution have occurred in East Africa. Over the last two decades, there has been intensive work undertaken to understand African palaeoclimate and tectonics in order to put together a coherent picture of how the environment of East Africa has varied in the past. The landscape of East Africa has altered dramatically over the last 10 million years. It has changed from a relatively flat, homogenous region covered with mixed tropical forest, to a varied and heterogeneous environment, with mountains over 4 km high and vegetation ranging from desert to cloud forest. The progressive rifting of East Africa has also generated numerous lake basins, which are highly sensitive to changes in the local precipitation-evaporation regime. There is now evidence that the presence of precession-driven, ephemeral deep-water lakes in East Africa were concurrent with major events in hominin evolution. It seems the unusual geology and climate of East Africa created periods of highly variable local climate, which, it has been suggested could have driven hominin speciation, encephalisation and dispersal out of Africa. One example is the significant hominin speciation and brain expansion event at ˜1.8 Ma that seems to have been coeval with the occurrence of highly variable, extensive, deep-water lakes. This complex, climatically very variable setting inspired first the variability selection hypothesis, which was then the basis for the pulsed climate variability hypothesis. The newer of the two suggests that the long-term drying trend in East Africa was punctuated by episodes of short, alternating periods of extreme humidity and aridity. Both hypotheses, together with other key theories of climate-evolution linkages, are discussed in this paper. Though useful the actual evolution mechanisms, which led to early hominins are still unclear and continue to be debated. However, it is clear that an understanding of East African

  7. HIV Infection Seems to Affect Nervous System

    MedlinePlus

    ... is a clinical fellow in the department of neurology at the University of California, San Francisco (UCSF). " ... early [HIV] infection." Valcour is a professor of neurology at UCSF. "Additionally, the ubiquity of symptoms in ...

  8. HIV Infection Seems to Affect Nervous System

    MedlinePlus

    ... fullstory_159344.html HIV Infection Seems to Affect Nervous System But symptoms tend to subside once antiretroviral drugs ... mild, it is clear that HIV affects the nervous system within days of infection," she said in a ...

  9. Vaccinations for Adults with HIV Infection

    MedlinePlus

    Vaccinations for Adults with HIV Infection The table below shows which vaccinations you should have to protect your health if ... sure you and your healthcare provider keep your vaccinations up to date. Vaccine Do you need it? ...

  10. Trends and variability in East African rainfall and temperature observations

    NASA Astrophysics Data System (ADS)

    Seregina, Larisa; Ermert, Volker; Fink, Andreas H.; Pinto, Joaquim G.

    2014-05-01

    The economy of East Africa is highly dependent on agriculture, leading to a strong vulnerability of local society to fluctuations in seasonal rainfall amounts, including extreme events. Hence, the knowledge about the evolution of seasonal rainfall under future climate conditions is crucial. Rainfall regimes over East Africa are influenced by multiple factors, including two monsoon systems, several convergence zones and the Rift Valley lakes. In addition, local conditions, like topography, modulate the large-scale rainfall pattern. East African rainfall variability is also influenced by various teleconnections like the Indian Ocean Zonal Mode and El Niño Southern Oscillation. Regarding future climate projections, regional and global climate models partly disagree on the increase or decrease of East African rainfall. The specific aim of the present study is the acquirement of historic data from weather stations in East Africa (Kenya, Tanzania, Ruanda and Uganda), the use of gridded satellite (rainfall) products (ARC2 and TRMM), and three-dimensional atmospheric reanalysis (e.g., ERA-Interim) to quantify climate variability in the recent past and to understand its causes. Climate variability and trends, including changes in extreme events, are evaluated using ETCCDI climate change and standardized precipitation indices. These climate indices are determined in order to investigate the variability of temperature and rainfall and their trends with the focus on most recent decades. In the follow-up, statistical and dynamical analyses are conducted to quantify the local impact of pertinent large-scale modes of climate variability (Indian Ocean Zonal Mode, El Niño Southern Oscillation, Sea Surface Temperature of the Indian Ocean).

  11. Mantle support of the East African Rift System

    NASA Astrophysics Data System (ADS)

    Lin, S.; van Keken, P. E.; Brandenburg, J. P.; Furman, T.; Bryce, J.

    2007-12-01

    The African Superplume is a region of slow seismic wave velocities in the lower mantle under southern Africa. The uplift, volcanism and rifting that defines the much of eastern and southern Africa suggest a dynamic link between lower mantle dynamics and near-surface processes affecting the African plate. The dynamic link between the lower mantle and the surface, and the structure and dynamics of the upper mantle below the East African Rift System (EARS) remain unclear. As part of a comprehensive geochemical and numerical investigation of basaltic magmatism in the EARS we have modeled the interaction between putative upper mantle plumes and the rifting continental lithosphere. The modeling provides dynamically tested scenarios that explain the observed episodes of Cenozoic volcanism. Results from recent models that provided an explanation for the present day distribution of volcanism (Lin et al., EPSL, 237, 2005) suggest two plumes below Afar and Tanzania whose uplift is influenced by lithospheric topography. In new 3D modeling we provide improved quantification of the mantle involvement in generating EARS volcanism as constrained by the timing of uplift and regional volcanism. The time scales of episodicity of the volcanism observed at Turkana (related to the Tanzania-Kenya plume) since 45 Ma can be explained by deep- seated time-dependent plume activity. We suggest that this time-dependence is due to thermochemical interactions of dense recycled oceanic crust in the thermally hot regions in the African superplume region (Lin and Van Keken, Nature, 436, 2005).

  12. NEUROCOGNITIVE DEFICITS IN HIV-INFECTED WOMEN AND VICTIMS OF CHILDHOOD TRAUMA

    PubMed Central

    Spies, G; Fennema-Notestine, C; Archibald, SL; Cherner, M; Seedat, S

    2015-01-01

    Objectives The study investigated the behavioral and brain effects of childhood trauma and HIV-infection, both separately and in combination, and assessed potential interactions in women who were dually affected. Methods 83 HIV-positive and 47 matched HIV-negative South African women underwent neuromedical, neuropsychiatric and neurocognitive assessments. Univariate tests of significance assessed if either HIV infection or childhood trauma, or the combination, had a significant effect on neurocognitive performance. Results The majority of women were Black (96%) and had an average age of 30. An analysis of covariance revealed significant HIV effects for the Hopkins Verbal Learning Test (HVLT) learning and delay trials (p < .01) and the Halstead Category test (p < .05). A significant trauma effect was seen on the HVLT delay trial (p < .05). Conclusion The results provide evidence for neurocognitive dysfunction in memory and executive functions in HIV-infected women and memory disturbances in trauma exposed women. PMID:22672200

  13. Identifying HIV-Infected Women’s Psychosocial Stressors: Findings from a Qualitative Study

    PubMed Central

    Brown, Jennifer L.; Vanable, Peter A.; Naughton, Jessie D.; Carey, Michael P.

    2015-01-01

    To inform future psychosocial interventions for HIV-infected women, five focus groups were conducted with 29 HIV-infected women (72% African-American). Sessions were audio-recorded, transcribed, and coded by two raters. HIV-specific stressors included difficulties with serostatus disclosure, HIV medication adherence, and HIV-related discrimination. Stressors not directly linked to HIV were described as more concerning and included mental health or substance use problems, relationship challenges, caretaking for children or grandchildren, and financial difficulties. Participants suggested that interventions provide social support from other HIV-infected women, consistent case management and social work services, and forums to acquire additional information about HIV and treatment options. PMID:26834511

  14. Gender and HIV infection in the context of alcoholism in Kenya.

    PubMed

    Muturi, Nancy

    2015-01-01

    Women in sub-Saharan Africa account for more than half (58%) of people living with the HIV and it is the only continent where HIV prevalence is higher for women than for men. Studies have attributed alcoholism with the high rates of HIV infection due to its impact on sexual behaviour and arousal. African countries with high rates of alcoholism also reportedly have higher rates of HIV infection. This study explores rural communities' perspectives on the risk factors for HIV infection among women who are in alcohol discordant relationships where the man drinks alcohol excessively. Data were gathered through focus group discussions in rural central Kenya where alcoholism has reached epidemic levels. Key findings indicate the perceived severity of alcoholism, the perceived impact of alcoholism on men's reproductive health and the unmet sexual and reproductive needs of women in alcohol discordant relationships. Women engage in risky sexual behaviours in an attempt to meet these needs. Such risky behaviour in addition to alcohol-related sexual violence and low response-efficacy for safer sexual practices make them vulnerable to HIV infection and enhances the spread of HIV within communities. The study concludes that in preventing HIV infection among women in alcohol communities affected by alcohol, it is important to focus on their response efficacy. Intervention programmes that focus on HIV prevention among older married women and that integrate alcohol and HIV prevention are long overdue. PMID:25920984

  15. Lactase persistence alleles reveal partial East African ancestry of southern African Khoe pastoralists.

    PubMed

    Breton, Gwenna; Schlebusch, Carina M; Lombard, Marlize; Sjödin, Per; Soodyall, Himla; Jakobsson, Mattias

    2014-04-14

    The ability to digest milk into adulthood, lactase persistence (LP), as well as specific genetic variants associated with LP, is heterogeneously distributed in global populations. These variants were most likely targets of selection when some populations converted from hunter-gatherer to pastoralist or farming lifestyles. Specific LP polymorphisms are associated with particular geographic regions and populations; however, they have not been extensively studied in southern Africa. We investigate the LP-regulatory region in 267 individuals from 13 southern African populations (including descendants of hunter-gatherers, pastoralists, and agropastoralists), providing the first comprehensive study of the LP-regulatory region in a large group of southern Africans. The "East African" LP single-nucleotide polymorphism (SNP) (14010G>C) was found at high frequency (>20%) in a strict pastoralist Khoe population, the Nama of Namibia, suggesting a connection to East Africa, whereas the "European" LP SNP (13910C>T) was found in populations of mixed ancestry. Using genome-wide data from various African populations, we identify admixture (13%) in the Nama, from an Afro-Asiatic group dating to >1,300 years ago, with the remaining fraction of their genomes being from San hunter-gatherers. We also find evidence of selection around the LCT gene among Khoe-speaking groups, and the substantial frequency of the 14010C variant among the Nama is best explained by adaptation to digesting milk. These genome-local and genome-wide results support a model in which an East African group brought pastoralist practices to southern Africa and admixed with local hunter-gatherers to form the ancestors of Khoe people. PMID:24704072

  16. Neurologic complications of HIV infection.

    PubMed

    Spudich, Serena S; Ances, Beau M

    2012-01-01

    The effects of HIV-1 in the nervous system are a topic of avid interest to investigators and clinicians focused on HIV, judging by the large and discriminating audience at the oral sessions and poster presentations relating to neuroscience at the 19th Conference on Retroviruses and Opportunistic Infections. Major areas of investigation at this year's conference included the use of neuropsychological testing and neuroimaging to assess the state of the central nervous system (CNS) and effects of antiretroviral therapy during HIV infection as well as basic and clinical studies of neuropathogenesis of HIV-associated neurocognitive disorder (HAND). Numerous important suggestions emerged during the meeting. Among them was the proposition that earlier initiation of therapy might benefit the CNS. Another was that the relationship between HIV and normal aging remains unclear and warrants further study. Still another was that ongoing abnormalities may persist despite treatment with antiretroviral therapy-including measurable brain microglial activation, detectable cerebrospinal fluid HIV, and progression of neurologic impairment. PMID:22710906

  17. [HIV infection : Test and treatment].

    PubMed

    Rockstroh, J K; Wasmuth, J-C

    2016-08-01

    In Europe depending on the country 15-80 % of all individuals infected with human immunodeficiency virus (HIV) are either not aware of the diagnosis or are diagnosed later. An early HIV diagnosis could, however, considerably improve the prognosis of individuals infected with HIV and decrease the risk of new infections; therefore, in the presence of indicator diseases, such as sexually transmitted diseases, oral thrush, herpes zoster and lymphoma, the performance of a HIV test is of utmost importance. A newly diagnosed HIV infection represents an indication for starting antiretroviral combination therapy independent of the clinical stage or CD4 cell count. A decline of the viral burden to below the limit of detection and subsequent continuous suppression of viral replication can prevent transition from HIV to acquired immune deficiency syndrome (AIDS) and if started early enough a normal life expectancy can be achieved. Challenges which remain in HIV therapy are the lifelong daily intake of medication and the complex long-term adverse effects. PMID:27368530

  18. Depression in patients with HIV infection.

    PubMed

    Penzak, S R; Reddy, Y S; Grimsley, S R

    2000-02-15

    The epidemiology, clinical features, and drug treatment of depression in HIV-infected patients are discussed. The lifetime prevalence of depression in patients infected with HIV has been estimated at 22-45%. The signs and symptoms of depression are similar in HIV-infected and noninfected patients, but patients with HIV infection may more frequently have sleep and appetite disturbances. Diagnosis should focus on affective or cognitive depression symptoms that reflect mood state alone. Patients with a history of depression, homosexual men, women, and i.v. drug abusers are among HIV-infected individuals who may be at increased risk for depression. Depression may alter the course of HIV infection by impairing immune function or influencing behavior. Depression my contribute to nonadherence to therapy. Antidepressant therapy is effective in most HIV-positive patients with major depression. Tricyclic antidepressants (TCAs) have produced response rates as high as 89%, but their usefulness has been limited by adverse effects. Selective serotonin-reuptake inhibitors and other non-TCAs have also demonstrated efficacy and are generally better tolerated. Psychostimulants have improved mood, cognition, and energy level, and androgens have been used for their anabolic effects. The systemic concentrations of antidepressants may be altered by coadministered drugs that affect their cytochrome P-450 isoenzyme-mediated metabolism; in turn, the metabolism and toxicity of certain antiretrovirals may be affected by antidepressants. Guidelines on the treatment of depression in the general population may be applied to patients with HIV infection. Depressive disorders are prevalent among patients with HIV infection but often respond to a variety of treatments. PMID:10714976

  19. East African coast overlooked. [Oil and gas potential of the east African coast

    SciTech Connect

    Not Available

    1994-09-01

    This paper reviews the petroleum and gas potential of the Tanzania-Mozambique basinal areas. It discusses the locations of the various sedimentary basins in the onshore and near offshore areas, including the central African rift zone. The paper describes the structure, stratigraphy, and petroleum geology of these basins. Finally the paper reviews the exploration history and the outlook for the future of these basins.

  20. Yellow fever, Asia and the East African slave trade.

    PubMed

    Cathey, John T; Marr, John S

    2014-05-01

    Yellow fever is endemic in parts of sub-Saharan Africa and South America, yet its principal vectors--species of mosquito of the genus Aedes--are found throughout tropical and subtropical latitudes. Phylogenetic analyses indicate that yellow fever originated in Africa and that its spread to the New World coincided with the slave trade, but why yellow fever has never appeared in Asia remains a mystery. None of several previously proposed explanations for its absence there is considered satisfactory. We contrast the trans-Atlantic slave trade, and trade across the Sahara and to the Arabian Peninsula and Mesopotamia, with that to Far East and Southeast Asian ports before abolition of the African slave trade, and before the scientific community understood the transmission vector of yellow fever and the viral life cycle, and the need for shipboard mosquito control. We propose that these differences in slave trading had a primary role in the avoidance of yellow fever transmission into Asia in the centuries before the 20(th) century. The relatively small volume of the Black African slave trade between Africa and East and Southeast Asia has heretofore been largely ignored. Although focal epidemics may have occurred, the volume was insufficient to reach the threshold for endemicity. PMID:24743951

  1. Geochemistry of East African Rift basalts: An overview

    NASA Astrophysics Data System (ADS)

    Furman, Tanya

    2007-06-01

    Mafic lavas erupted along the East African Rift System from the Afar triangle in northern Ethiopia to the Rungwe province in southern Tanzania display a wide range of geochemical and isotopic compositions that reflect heterogeneity in both source and process. In areas with the lowest degree of crustal extension (the Western and Southern Kenya Rifts) primitive lavas record the greatest extent of lithospheric melting, manifest in elevated abundances of incompatible elements and highly radiogenic Sr-Nd-Pb isotopic compositions. Where prolonged extension has removed most or all of the mantle lithosphere (the Turkana and Northern Kenya Rifts), a larger role for sub-lithospheric processes is indicated. At intermediate degrees of extension (the Main Ethiopian Rift) both lithospheric and sub-lithospheric contributions are observed, and crustal assimilation occurs in some cases. Despite the wide compositional range of African Rift basalts, a restricted number of source domains contribute to magmatism throughout the area. These individual domains are: (1) the subcontinental mantle lithosphere; (2) a plume source with high-μ Sr-Nd-Pb-He isotopic affinities, present in all areas within and south of the Turkana Depression; and (3) a plume source with isotopic signatures analogous to those observed in some ocean islands, including high 3He/ 4He values, present throughout the Ethiopian Rift and the Afar region. The two plume sources may both be derived from the South African Superplume, which is likely to be a compositionally heterogeneous feature of the lower mantle.

  2. The pace of East African monsoon evolution during the Holocene

    NASA Astrophysics Data System (ADS)

    Weldeab, Syee; Menke, Valerie; Schmiedl, Gerhard

    2014-03-01

    African monsoon precipitation experienced a dramatic change in the course of the Holocene. The pace with which the African monsoon shifted from a strong early to middle to a weak late Holocene is critical for our understanding of climate dynamics, hydroclimate-vegetation interaction, and shifts of prehistoric human settlements, yet it is controversially debated. On the basis of planktonic foraminiferal Ba/Ca time series from the eastern Mediterranean Sea, here we present a proxy record of Nile River runoff that provides a spatially integrated measure of changes in East African monsoon (EAM) precipitation. The runoff record indicates a markedly gradual middle to late Holocene EAM transition that lasted over 3500 years. The timing and pace of runoff change parallels those of insolation and vegetation changes over the Nile basin, indicating orbitally forced variation of insolation as the main EAM forcing and the absence of a nonlinear precipitation-vegetation feedback. A tight correspondence between a threshold level of Nile River runoff and the timing of occupation/abandonment of settlements suggests that along with climate changes in the eastern Sahara, the level of Nile River and intensity of summer floods were likely critical for the habitability of the Nile Valley (Egypt).

  3. Sensitivity of the East African rift lakes to climate variability

    NASA Astrophysics Data System (ADS)

    Olaka, L.; Trauth, M. H.

    2009-04-01

    Lakes in the East African Rift have provided excellent proxies to reconstruct past climate changes in the low latitudes. The lakes occupy volcano-tectonic depressions with highly variable climate and hydrological setting, that present a good opportunity to study the climatic and hydrogeological influences on the lake water budget. Previous studies have used lake floor sediments to establish the sensitivity of the East African rift lakes. This study focuses on geomorphology and climate to offer additional or alternative record of lake history that are key to quantifying sensitivity of these lakes as archives to external and internal climatic forcings. By using the published Holocene lake areas and levels, we analyze twelve lakes on the eastern arm of the East African rift; Ziway, Awassa, Turkana, Suguta, Baringo, Nakuru, Elmenteita, Naivasha, Natron, Manyara and compare with Lake Victoria, that occupies the plateau between the east and the western arms of the rift. Using the SRTM data, Hypsometric (area-altitude) analysis has been used to compare the lake basins between latitude 80 North and 30 South. The mean elevation for the lakes, is between 524 and 2262 meters above sea level, the lakes' hypsometric integrals (HI), a measure of landmass volume above the reference plane, vary from 0.31 to 0.76. The aridity index (Ai), defined as Precipitation/ Evapotranspiration, quantifies the water available to a lake, it encompasses land cover and climatic effects. It is lowest (arid) in the basin between the Ethiopian rift and the Kenyan rift and at the southern termination of the Kenyan Rift in the catchments of lake Turkana, Suguta, Baringo and Manyara with values of 0.55, 0.43, 0.43 and 0.5 respectively. And it is highest (wet) in the catchments of, Ziway, Awassa, Nakuru and Naivasha as 1.33,1.03 and 1.2 respectively, which occupy the highest points of the rift. Lake Victoria has an index of 1.42 the highest of these lakes and receives a high precipitation. We use a

  4. Signatures of positive selection in East African Shorthorn Zebu: a genome-wide SNP analysis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The small East African Shorthorn Zebu is the main indigenous cattle across East Africa. A recent genome wide SNPs analysis has revealed their ancient stable African taurine x Asian zebu admixture. Here, we assess the presence of candidate signature of positive selection in their genome, with the aim...

  5. Examining the Relationship between Urogenital Schistosomiasis and HIV Infection

    PubMed Central

    Mbabazi, Pamela Sabina; Andan, Olivia; Fitzgerald, Daniel W.; Chitsulo, Lester; Engels, Dirk; Downs, Jennifer A.

    2011-01-01

    Background Urogenital schistosomiasis, caused by infection with Schistosoma haematobium, is widespread and causes substantial morbidity on the African continent. The infection has been suggested as an unrecognized risk factor for incident HIV infection. Current guidelines recommend preventive chemotherapy, using praziquantel as a public health tool, to avert morbidity due to schistosomiasis. In individuals of reproductive age, urogenital schistosomiasis remains highly prevalent and, likely, underdiagnosed. This comprehensive literature review was undertaken to examine the evidence for a cause-effect relationship between urogenital schistosomiasis and HIV/AIDS. The review aims to support discussions of urogenital schistosomiasis as a neglected yet urgent public health challenge. Methodology/Principal Findings We conducted a systematic search of the literature including online databases, clinical guidelines, and current medical textbooks. We describe plausible local and systemic mechanisms by which Schistosoma haematobium infection could increase the risk of HIV acquisition in both women and men. We also detail the effects of S. haematobium infection on the progression and transmissibility of HIV in co-infected individuals. We briefly summarize available evidence on the immunomodulatory effects of chronic schistosomiasis and the implications this might have for populations at high risk of both schistosomiasis and HIV. Conclusions/Significance Studies support the hypothesis that urogenital schistosomiasis in women and men constitutes a significant risk factor for HIV acquisition due both to local genital tract and global immunological effects. In those who become HIV-infected, schistosomal co-infection may accelerate HIV disease progression and facilitate viral transmission to sexual partners. Establishing effective prevention strategies using praziquantel, including better definition of treatment age, duration, and frequency of treatment for urogenital

  6. Cardiac involvement in HIV infected people in Yaounde, Cameroon

    PubMed Central

    Nzuobontane, D; Blackett, K; Kuaban, C

    2002-01-01

    Objective: To study the cardiac abnormalities in HIV infected patients in relation to the clinical stage of the disease and the immunological status of the patients. Methods: A total 75 consecutive patients tested for HIV on the basis of clinical suspicion of the disease from July to September 1996 at the University Hospital Centre, Yaounde, Cameroon were recruited. The patients were classified into AIDS, HIV positive non-AIDS, and HIV negative according to clinical findings and outcome of ELISA and western blot testing. Every patient underwent a clinical examination, two dimensional and M-mode echocardiography, and blood lymphocyte typing. Results: Dilated cardiomyopathy occurred in 7/30 (23.33%) AIDS patients, 1/24 (4.17%) HIV positive non-AIDS patient, but in none of the HIV negative patients. Other echocardiographic abnormalities included pericardial separation, effusion, thickening, and mitral valve prolapse. Although these abnormalities were more frequent in HIV infected patients, the differences did not reach levels of statistical significance. Dilated cardiomyopathy occurred in six (31.58%) of the patients with a CD4 cell count ≤100/mm3 and two (6.06%) in those with absolute CD4 counts >100/mm3 (χ2 = 4.02, p = 0.03). Conclusions: Cardiovascular abnormalities are frequent in African HIV infected patients but clinically discrete. Low CD4 cell counts are associated with dilated cardiomyopathy. These abnormalities should be expected with greater frequency in cardiological clinical practice as management of opportunistic infections improves in a situation of continued high disease prevalence in Africa. PMID:12496326

  7. CROI 2016: Neurologic Complications of HIV Infection.

    PubMed

    Spudich, Serena S; Ances, Beau M

    2016-01-01

    The brain remains a major target for HIV infection and a site of potential complications for HIV-infected individuals. Emerging data presented at the 2016 Conference on Retroviruses and Opportunistic Infections suggest that during the early stages of infection, activated CD4+ cells may traffic the virus into the central nervous system (CNS). HIV is detectable in cells and tissues of the CNS in some individuals despite suppressive antiretroviral treatment. A potential source of cerebrospinal fluid HIV escape may be compartmentalized HIV replication within macrophage lineage cells. Virally infected cells can traffic out of the CNS and may have the potential to reseed the systemic compartment. Additional modifiers of HIV-associated neurocognitive disorder (HAND) were identified, including female sex and hepatic dysfunction. Large epidemiologic studies reported an elevated risk of stroke among HIV-infected individuals, related to traditional vascular risk factors, history of recreational drug use, and HIV measures (lower CD4+ cell nadir and higher viral load). Brain imaging may provide a noninvasive means for detecting early changes in the brain associated with HIV infection and may assist in prognosis of HAND. Some potential adjunctive therapies to standard antiretroviral therapy for HIV-infected individuals were considered. PMID:27398860

  8. Seismicity of the Earth 1900-2013 East African Rift

    USGS Publications Warehouse

    Hayes, Gavin P.; Jones, Eric S.; Stadler, Timothy J.; Barnhart, William D.; McNamara, Daniel E.; Benz, Harley M.; Furlong, Kevin P.; Villaseñor, Antonio

    2014-01-01

    Rifting in East Africa is not all coeval; volcanism and faulting have been an ongoing phenomenon on the continent since the Eocene (~45 Ma). The rifting began in northern East Africa, and led to the separation of the Nubia (Africa) and Arabia plates in the Red Sea and Gulf of Aden, and in the Lake Turkana area at the Kenya-Ethiopia border. A Paleogene mantle superplume beneath East Africa caused extension within the Nubia plate, as well as a first order topographic high known as the African superswell which now includes most of the eastern and southern sectors of the Nubia plate. Widespread volcanism erupted onto much of the rising plateau in Ethiopia during the Eocene-Oligocene (45–29 Ma), with chains of volcanoes forming along the rift separating Africa and Arabia. Since the initiation of rifting in northeastern Africa, the system has propagated over 3,000 km to the south and southwest, and it experiences seismicity as a direct result of the extension and active magmatism.

  9. Hypogonadism in the HIV-infected man.

    PubMed

    Rochira, Vincenzo; Guaraldi, Giovanni

    2014-09-01

    Androgen deficiency occurs frequently in men with human immunodeficiency virus (HIV) infection. Antiretroviral treatments had reduced the prevalence of male hypogonadism. The pathogenesis of testosterone (T) deficiency in HIV is multifactorial. Several mechanisms have been proposed; among them, drugs, fat redistribution, and a poor health status could explain the mechanism leading to gonadotropins inhibition and hypogonadotropic hypogonadism. The diagnosis of hypogonadism in HIV-infected men should be made based on clinical symptoms and a specific workup including T measurement. The interpretation of the results of biochemical testing is more difficult in men with HIV due to several confounding factors. T treatment should be offered to HIV-infected men with documented clinical hypogonadism and symptoms, especially if they are losing lean mass. PMID:25169563

  10. [Travel medicine for HIV-infected patients].

    PubMed

    Rossi, M; Furrer, H

    2001-06-01

    Many HIV-infected persons travel from temperate zones to (sub)tropical destinations. HIV-specific immigration issues, medical resources abroad and problems regarding travelling with multiple medications have to be anticipated. When prescribing immunizations and specific chemoprophylaxis, the stage of immunodeficiency as well as drug interactions with antiretrovirals and medicaments against opportunistic infections have to be taken into account. Live vaccines may be contraindicated. Immunocompromised HIV-infected travellers have a higher risk for serious courses of diseases by enteropathogens. Therefore a good information about food hygiene is important and a prescription of an antibiotic to take in case of severe diarrhea may be indicated. A new antiretroviral combination therapy should not be started immediately before travelling to the tropics. The possibility to continue an established HIV treatment during travel has to be evaluated cautiously. With good pre-travel advice the risk of severe health problems is low for most HIV-infected travellers. PMID:11441700

  11. Serum Micronutrient Status of Haart-Naïve, HIV Infected Children in South Western Nigeria: A Case Controlled Study

    PubMed Central

    Anyabolu, H. C.; Adejuyigbe, E. A.; Adeodu, O. O.

    2014-01-01

    Background. Though micronutrients are vital in the pathogenesis of human immunodeficiency virus infection, most studies have been conducted in adults. Knowledge of the status of key micronutrients in HIV infected African children will indicate if supplementation may be beneficial to these children living in this resource-poor region. Objectives. We sought to determine the micronutrient status and associated factors of HAART-naïve HIV infected children and compare them with those of the HIV negative controls. Methods. We enrolled 70 apparently stable HAART naïve HIV infected children. Seventy age and sex matched HIV negative children were equally enrolled as the controls. Their social class, anthropometry, clinical stage, CD4 counts, serum zinc, selenium, and vitamin C were determined. Results. The prevalence of zinc, selenium, and vitamin C deficiency in HIV infected subjects was 77.1%, 71.4%, and 70.0%, respectively, as compared to 44.3%, 18.6%, and 15.7% in HIV negative controls. Among the HIV infected subjects, 58.6% were deficient in the three micronutrients. Micronutrient status was related to the weight, clinical, and immunological stages but not BMI or social class. Conclusion. Deficiency of these key micronutrients is widely prevalent in HAART naïve HIV infected children irrespective of social class. This suggests that supplementation trial studies may be indicated in this population. PMID:25180086

  12. [Is it possible to cure HIV infection?].

    PubMed

    Gutiérrez, Carolina; Madrid, Nadia P; Moreno, Santiago

    2015-09-01

    Antiretroviral therapy has significantly improved the life expectancy in HIV-infected people, but it cannot cure the disease by itself. Several barriers have been identified for the cure of HIV infection, including a reservoir of latently infected cells, persistent viral replication in tissues, and anatomical sanctuaries. The main strategy proposed for the cure of HIV consists on the administration of drugs that, through the reactivation of latent HIV, would eliminate the cell reservoir. Ongoing clinical trials have shown the proof of concept, but the efficacy of these drugs in decreasing the reservoir size has not been proved so far. PMID:26365737

  13. HIV infection and the gastrointestinal immune system

    PubMed Central

    Brenchley, JM; Douek, DC

    2009-01-01

    There has recently been a resurgence of interest in the gastrointestinal pathology observed in patients infected with HIV. The gastrointestinal tract is a major site of HIV replication, which results in massive depletion of lamina propria CD4 T cells during acute infection. Highly active antiretroviral therapy leads to incomplete suppression of viral replication and substantially delayed and only partial restoration of gastrointestinal CD4 T cells. The gastrointestinal pathology associated with HIV infection comprises significant enteropathy with increased levels of inflammation and decreased levels of mucosal repair and regeneration. Assessment of gut mucosal immune system has provided novel directions for therapeutic interventions that modify the consequences of acute HIV infection. PMID:19079157

  14. How can we better identify early HIV infections?

    PubMed Central

    Rosenberg, Nora E.; Pilcher, Christopher D.; Busch, Michael P.; Cohen, Myron S.

    2015-01-01

    Purpose of review Detection of early HIV infections (EHIs), including acute HIV infection (AHI), is important for individual health, prevention of HIV transmission, and measurement of HIV incidence. We describe markers of EHI, diagnostic strategies for detecting these markers, and ways to incorporate these strategies into diagnostic and HIV incidence algorithms. Recent findings For individual diagnosis in the United States and Europe, laboratory-based diagnostic algorithms increasingly incorporate fourth-generation HIV antigen tests, allowing for earlier detection. In some sub-Saharan African settings, symptom-based screening is being explored to identify subsets of persons at high risk for AHI. Point-of-care diagnostics designed for AHI detection are in the pipeline and, if validated, represent an opportunity for real-time AHI diagnosis. At the population level, multiassay algorithms are promising new strategies for estimating HIV incidence on the basis of several assays applied to cross-sectional samples. These algorithms can be developed to optimize performance, in addition to cost and logistical considerations. Summary There are important recent advances in detection of EHIs at the individual and population levels. Applying optimal combinations of tests in diagnostic and HIV incidence algorithms is urgently needed to support the multiple goals derived from enhanced detection and discrimination of EHIs. PMID:25389806

  15. When to consider acute HIV infection in the differential diagnosis.

    PubMed

    Grimes, Richard M; Hardwicke, Robin L; Grimes, Deanna E; DeGarmo, D Sean

    2016-01-16

    Patients presenting with fever, pharyngitis, and lymphadenopathy are likely to have mononucleosis; however, patients with acute HIV infection may present with similar symptoms. Acute HIV infection should be considered as a differential diagnosis if test results for mononucleosis are negative. This article describes when to order HIV testing and discusses the importance of early intervention for acute HIV infection. PMID:26678418

  16. Modeling East African tropical glaciers during the Last Glacial Maximum

    NASA Astrophysics Data System (ADS)

    Doughty, Alice; Kelly, Meredith; Russell, James; Jackson, Margaret; Anderson, Brian; Nakileza, Robert

    2016-04-01

    The timing and magnitude of tropical glacier fluctuations since the last glacial maximum could elucidate how climatic signals transfer between hemispheres. We focus on ancient glaciers of the East African Rwenzori Mountains, Uganda/D.R. Congo, where efforts to map and date the moraines are on-going. We use a coupled mass balance - ice flow model to infer past climate by simulating glacier extents that match the mapped and dated LGM moraines. A range of possible temperature/precipitation change combinations (e.g. -15% precipitation and -7C temperature change) allow simulated glaciers to fit the LGM moraines dated to 20,140±610 and 23,370±470 years old.

  17. Cross-cultural healing in east African ethnography.

    PubMed

    Rekdal, O B

    1999-12-01

    Examples of cross-cultural therapeutic relations have been mentioned frequently in ethnographic accounts from East Africa but have rarely been the object of in-depth description and analysis. Colonialist ideology, structural-functionalist anthropology, and a number of more recent medical anthropological contributions have been biased in ways that have drawn attention away from what is a prominent feature of African traditional medicine: the search for healing in the culturally distant. A focus on the dynamics and ideology of cross-cultural healing may be crucial for an understanding of processes generated by the encounter between biomedicine and African traditional medical systems. As is exemplified by the Iraqw of Tanzania, widespread acceptance and extensive use of biomedical health services may not necessarily mean that people abandon traditional beliefs and practices. Quite the contrary, the attribution of power to the culturally distant implies an openness to the unfamiliar, the alien, and the unknown, which may have facilitated the introduction and acceptance of biomedical health services. PMID:10626276

  18. The relationship between Indian Ocean sea-surface temperature and East African rainfall.

    PubMed

    Black, Emily

    2005-01-15

    Knowledge of the processes that control East African rainfall is essential for the development of seasonal forecasting systems, which may mitigate the effects of flood and drought. This study uses observational data to unravel the relationship between the Indian Ocean Dipole (IOD), the El Nino Southern Oscillation (ENSO) and rainy autumns in East Africa. Analysis of sea-surface temperature data shows that strong East African rainfall is associated with warming in the Pacific and Western Indian Oceans and cooling in the Eastern Indian Ocean. The resemblance of this pattern to that which develops during IOD events implies a link between the IOD and strong East African rainfall. Further investigation suggests that the observed teleconnection between East African rainfall and ENSO is a manifestation of a link between ENSO and the IOD. PMID:15598619

  19. Prevalence and incidence of pulmonary hypertension among HIV-infected people in Africa: a systematic review and meta-analysis

    PubMed Central

    Bigna, Jean Joel R; Nansseu, Jobert Richie N; Um, Lewis N; Noumegni, Steve Raoul N; Simé, Paule Sandra D; Aminde, Leopold Ndemngue; Koulla-Shiro, Sinata; Noubiap, Jean Jacques N

    2016-01-01

    Objective Patients infected with HIV have a direly increased risk of developing pulmonary hypertension (PH), and of dying from the condition. While Africa carries the greatest burden of HIV infection worldwide, there is unclear data summarising the epidemiology of PH among HIV-infected people in this region. Our objective was to determine the prevalence and incidence of PH among HIV-infected people living across Africa. Design A systematic review and meta-analysis. Participants HIV-infected African people residing in Africa. Outcome Prevalence and incidence of PH diagnosed through echocardiography or right heart catheterisation. Data sources Articles published in PubMed/MEDLINE, EMBASE, African Journals Online and African Index Medicus between 1 January 1980 and 30 June 2016, without any language restriction. Results Overall, 121 studies were screened; 3 were included in this review: 1 from Southern Africa (South Africa), 1 from Eastern Africa (Tanzania) and 1 from Central Africa (Cameroon). These studies included HIV-infected adult patients selected based on presentation with cardiovascular symptoms. No study reported PH incidence or PH incidence/prevalence among children and adolescents. The quality assessment yielded moderate risk of bias. Ages of participants ranged between 18 and 78 years, and the proportion of females varied between 52.3% and 68.8%. The prevalence of PH in the pooled sample of 664 patients was 14% (95% CI 6%–23%). Limitations Only 3 studies were found eligible from 3 regions of the African continent. Conclusions The prevalence of PH among HIV-infected people in Africa seems very high. Further studies are urgently warranted to determine the incidence of HIV-induced PH, which must include all subregions of Africa. Trial registration number Review registration number PROSPERO CRD42016033863. PMID:27554104

  20. Children Who Acquire HIV Infection Perinatally Are at Higher Risk of Early Death than Those Acquiring Infection through Breastmilk: A Meta-Analysis

    PubMed Central

    Becquet, Renaud; Marston, Milly; Dabis, François; Moulton, Lawrence H.; Gray, Glenda; Coovadia, Hoosen M.; Essex, Max; Ekouevi, Didier K.; Jackson, Debra; Coutsoudis, Anna; Kilewo, Charles; Leroy, Valériane; Wiktor, Stefan Z.; Nduati, Ruth; Msellati, Philippe; Zaba, Basia; Ghys, Peter D.; Newell, Marie-Louise

    2012-01-01

    Background Assumptions about survival of HIV-infected children in Africa without antiretroviral therapy need to be updated to inform ongoing UNAIDS modelling of paediatric HIV epidemics among children. Improved estimates of infant survival by timing of HIV-infection (perinatally or postnatally) are thus needed. Methodology/Principal Findings A pooled analysis was conducted of individual data of all available intervention cohorts and randomized trials on prevention of HIV mother-to-child transmission in Africa. Studies were right-censored at the time of infant antiretroviral initiation. Overall mortality rate per 1000 child-years of follow-up was calculated by selected maternal and infant characteristics. The Kaplan-Meier method was used to estimate survival curves by child's HIV infection status and timing of HIV infection. Individual data from 12 studies were pooled, with 12,112 children of HIV-infected women. Mortality rates per 1,000 child-years follow-up were 39.3 and 381.6 for HIV-uninfected and infected children respectively. One year after acquisition of HIV infection, an estimated 26% postnatally and 52% perinatally infected children would have died; and 4% uninfected children by age 1 year. Mortality was independently associated with maternal death (adjusted hazard ratio 2.2, 95%CI 1.6–3.0), maternal CD4<350 cells/ml (1.4, 1.1–1.7), postnatal (3.1, 2.1–4.1) or peri-partum HIV-infection (12.4, 10.1–15.3). Conclusions/Results These results update previous work and inform future UNAIDS modelling by providing survival estimates for HIV-infected untreated African children by timing of infection. We highlight the urgent need for the prevention of peri-partum and postnatal transmission and timely assessment of HIV infection in infants to initiate antiretroviral care and support for HIV-infected children. PMID:22383946

  1. [Status of HIV-infections 2005].

    PubMed

    Potthoff, Anja; Brockmeyer, Norbert H

    2005-09-01

    The course of HIV infection has changed dramatically since the beginning of the epidemic. In Germany, 19 antiretrovirally active substances are available. They prevent viral penetration into the cell, inhibit the reverse transcriptase or the protease that are necessary to release infectious viral particles. According to German-Austrian therapy guidelines highly active antiretroviral therapy (HAART) should be started at the onset of HIV-related symptoms and/or when the CD4 cell count is < 350/microl. Patients should be treated in specialized centers because of the complexity of HIV infection and its management. For monitoring, CD4 cell counts and viral load are determined. Potential reasons for therapeutic failure include drug interactions, resistance, or compliance problems. Although HIV infection is often compared to insulin-dependent diabetes mellitus, psychological and social impact on HIV patients is still high. Increasing viral multi-drug resistance, long-term toxicity like lipodystrophy, osteoporosis and cardiovascular disease are only some problems HIV-infected patients are facing in the next years. In Germany, 600-700 patients still die of AIDS every year. PMID:16170674

  2. Contraception for HIV-Infected Adolescents.

    PubMed

    Kourtis, Athena P; Mirza, Ayesha

    2016-09-01

    Access to high-quality reproductive health care is important for adolescents and young adults with HIV infection to prevent unintended pregnancies, sexually transmitted infections, and secondary transmission of HIV to partners and children. As perinatally HIV-infected children mature into adolescence and adulthood and new HIV infections among adolescents and young adults continue to occur in the United States, medical providers taking care of such individuals often face issues related to sexual and reproductive health. Challenges including drug interactions between several hormonal methods and antiretroviral agents make decisions regarding contraceptive options more complex for these adolescents. Dual protection, defined as the use of an effective contraceptive along with condoms, should be central to ongoing discussions with HIV-infected young women and couples wishing to avoid pregnancy. Last, reproductive health discussions need to be integrated with discussions on HIV care, because a reduction in plasma HIV viral load below the level of detection (an "undetectable viral load") is essential for the individual's health as well as for a reduction in HIV transmission to partners and children. PMID:27573084

  3. Public Opinion, Public Policy, and HIV Infection.

    ERIC Educational Resources Information Center

    West, Jane

    1989-01-01

    A four-stage framework for considering the development of public policy in regard to the issue of HIV (Human Immunodeficiency Virus) infection is offered. The phases are denial, irrationality, acceptance, and the development of a rational response. Federal antidiscrimination policies which include persons with HIV infections as disabled are…

  4. Development of a Policy on HIV Infection.

    ERIC Educational Resources Information Center

    Crowell, Barbara D.

    This sample policy, proposed by the Brandywine School District (Delaware), addresses the issue of HIV Infection of employees and/or students. The policy was developed by an AIDS Committee appointed by the superintendent in January 1988, and comprised of members from every area in the school district community. This policy acts as district policy…

  5. The genetics of East African populations: a Nilo-Saharan component in the African genetic landscape

    PubMed Central

    Dobon, Begoña; Hassan, Hisham Y.; Laayouni, Hafid; Luisi, Pierre; Ricaño-Ponce, Isis; Zhernakova, Alexandra; Wijmenga, Cisca; Tahir, Hanan; Comas, David; Netea, Mihai G.; Bertranpetit, Jaume

    2015-01-01

    East Africa is a strategic region to study human genetic diversity due to the presence of ethnically, linguistically, and geographically diverse populations. Here, we provide new insight into the genetic history of populations living in the Sudanese region of East Africa by analysing nine ethnic groups belonging to three African linguistic families: Niger-Kordofanian, Nilo-Saharan and Afro-Asiatic. A total of 500 individuals were genotyped for 200,000 single-nucleotide polymorphisms. Principal component analysis, clustering analysis using ADMIXTURE, FST statistics, and the three-population test were used to investigate the underlying genetic structure and ancestry of the different ethno-linguistic groups. Our analyses revealed a genetic component for Sudanese Nilo-Saharan speaking groups (Darfurians and part of Nuba populations) related to Nilotes of South Sudan, but not to other Sudanese populations or other sub-Saharan populations. Populations inhabiting the North of the region showed close genetic affinities with North Africa, with a component that could be remnant of North Africans before the migrations of Arabs from Arabia. In addition, we found very low genetic distances between populations in genes important for anti-malarial and anti-bacterial host defence, suggesting similar selective pressures on these genes and stressing the importance of considering functional pathways to understand the evolutionary history of populations. PMID:26017457

  6. HIV infection and maternal and child health.

    PubMed

    Ramachandran, P

    1988-01-01

    Collaborative studies to determine the consequences of pregnancy in HIV infected women have been begun in the last 2 years. Both HIV and HIV antibodies pass through the placenta, and 30-50% of infants born to HIV infected mothers are infected in utero. In developed countries it is feasible to screen pregnant women in high risk groups for HIV positivity. In developing countries, where heterosexual transmission is the main route of infection, there are no high risk groups, and it is not feasible to screen all pregnant women. Some data have shown that HIV infection in pregnancy is associated with intrauterine growth retardation, low birth weight, and high infant mortality. There is no evidence that cesarean section reduces infection in neonates, and it should not be performed on HIV infected women. By 1987 almost 1.5% of AIDS cases in the US were in vertically infected infants. In Africa also the main factor in HIV in infancy is vertical transmission. AIDS in infancy follows 1 of 2 distinct patterns: failure to thrive and death from Pneumocystis carinii pneumonia within the 1st year or else apparent health during infancy but death from opportunistic infections by age 3. HIV infection in childhood is uncommon and can usually be traced to blood transfusions or unsterilized needles used for vaccinations. Neurological symptoms often develop early in children. Breast feeding probably does not infect any infants who have not already been infected in utero, and in developing counties breast feeding is still the best assurance of total nutrition. Pooled, unpasteurized milk banks, on the other hand, represent an unnecessary danger, and milk donors should be screened. Since there is no evidence that routine immunization accelerates the course of HIV infection, and since mass screening is not feasible in developing countries, the World Health Organization recommends that routine immunizations be continued. Since the best protection from in utero HIV infection is the use of

  7. Psychiatric Diagnoses among an HIV-Infected Outpatient Clinic Population.

    PubMed

    Shacham, Enbal; Önen, Nur F; Donovan, Michael F; Rosenburg, Neal; Overton, E Turner

    2016-01-01

    As individuals with HIV infection are living longer, the management of psychiatric disorders has increasingly been incorporated into comprehensive care. Individuals were recruited from an outpatient HIV clinic to assess the prevalence and related associations of current psychiatric disorders and biomarkers. Of the 201 participants who completed the interviews, the median age was 43.5 years, and the majority was male and African American. Most were receiving HIV therapy and 78% of those had achieved virologic suppression. Prevalent psychiatric diagnoses included major depressive disorder, generalized anxiety, and agoraphobia. Alcohol and cocaine/crack abuse and dependence were common substance use disorders. Current receipt of HIV therapy was less common among those diagnosed with generalized anxiety disorder. Agoraphobia was the only disorder associated with unsuppressed viral load. Psychiatric and substance use disorders are highly prevalent among an urban HIV clinic population, although we identified few associations between psychiatric diagnoses and HIV diseases status. PMID:25348798

  8. Thymic function in HIV-infection.

    PubMed

    Kolte, Lilian

    2013-04-01

    This thesis is based on seven previously published articles. The work was performed during my employment at The Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, as a scholarship student from 2000-2001 and as a research assistant in the period 2004-2010. HIV-infection is characterized by CD4+ cell depletion. The differences between patients in the degree of CD4+ cell recovery upon treatment with highly active antiretroviral therapy (HAART) may in part be due to differences in the supply of naïve CD4+ cells from the thymus. The thymus atrophies with increasing age for which reason the adult thymus was previously assumed to be without function. The aim of these investigations was to examine the role of the thymus in different aspects of HIV-infection: In adult HIV-infected patients, during HIV-positive pregnancy, and in HIV-exposed uninfected (HIV-EU) children born to HIV-infected mothers. Thymic size and output were determined in 25 adult HIV-infected patients receiving HAART and in 10 controls. Larger thymic size was associated with higher CD4 counts and higher thymic output. Furthermore, patients with abundant thymic tissue seemed to have broader immunological repertoires, compared with patients with minimal thymic tissue. The study supports the mounting evidence of a contribution by the adult thymus to immune reconstitution in HIV-infection. In a follow-up study conducted till 5 years of HAART, the importance of the thymus to the rate of cellular restoration was found to primarily lie within the first two years of HAART. The effect of recombinant human growth hormone (rhGH) was then investigated in a randomized, double-blinded placebo controlled trial in 46 adult HIV-infected patients on HAART. Daily treatment with a low dose of rhGH of 0.7mg for 40 weeks stimulated thymopoiesis as expressed by thymic size, density, and output strongly supporting the assumption that rhGH possesses the potential to stimulate the ageing thymus, holding

  9. A screen-and-treat strategy targeting visceral leishmaniasis in HIV-infected individuals in endemic East African countries: the way forward?

    PubMed

    van Griensven, Johan; Diro, Ermias; Lopez-Velez, Rogelio; Ritmeijer, Koert; Boelaert, Marleen; Zijlstra, Ed E; Hailu, Asrat; Lynen, Lutgarde

    2014-08-01

    In the wake of the HIV epidemic, visceral leishmaniasis (VL), a disseminated protozoan infection caused by the Leishmania donovani complex, has been re-emerging, particularly in North Ethiopia where up to 40% of patients with VL are co-infected with HIV. Management of VL in HIV co-infection is complicated by increased drug toxicity, and high treatment failure and relapse rates with all currently available drugs, despite initiation of antiretroviral treatment. Tackling L. donovani infection before disease onset would thus be a logical approach. A screen-and-treat approach targeting latent or the early stage of infection has successfully been implemented in other HIV-associated opportunistic infections. While conceptually attractive in the context of VL-HIV, the basic understanding and evidence underpinning such an approach is currently lacking. Prospective cohort studies will have to be conducted to quantify the risk of VL in different risk groups and across CD4 cell count levels. This will allow developing clinical prognostic tools, integrating clinical, HIV and Leishmania infection markers. Interventional studies will be needed to evaluate prophylactic or pre-emptive treatment strategies for those at risk, ideally relying on an oral (combination) regimen. Issues like tolerability, emergence of resistance and drug interactions will require due attention. The need for maintenance therapy will have to be assessed. Based on the risk-benefit data, VL risk cut-offs will have to be identified to target treatment to those most likely to benefit. Such a strategy should be complemented with early initiation of antiretroviral treatment and other strategies to prevent HIV and Leishmania infection. PMID:25101627

  10. Biomarkers Reveal Late Neogene Changes in East African Vegetation

    NASA Astrophysics Data System (ADS)

    Ingram, S. J.; Demenocal, P. B.; Eglinton, T. I.

    2004-12-01

    Multiple paleoenvironmental records incorporating diverse proxies and sites are needed to build a complete picture of African environments during the late Neogene period of hominid evolution. Augmenting the picture of progressive aridification of Neogene environments indicated by the progressive enrichment of soil carbonates (Cerling and Hay, 1988; Cerling, 1992; Wynn, 2000), Hominid environment-evolution hypotheses have drawn on evidence for high frequency environmental variability to emphasize the potential importance of climate variability as an evolutionary selection factor (Potts, 1996). Dramatic evidence for Neogene climatic variability is seen in high benthic foraminiferal oxygen isotope records of high latitude climate (Shackleton, 1990, Mix et al., 1995). This `global' signal has also been detected in low latitudes as shown by orbital frequency climate variability in dust records from marine cores around the African continent (deMenocal, 1995). Terrestrial records may provide a more direct record of local habitat change than distal dust deposits, but are unable to resolve with continuity the orbital frequency climatic variability seen in marine records. We therefore turn to molecule-specific carbon isotopic analyses of plant biomarkers in marine sediments to indicate regionally integrative C3-C4 vegetation changes. The validity of this approach has already been demonstrated in marine cores off West Africa (Schefuss et al, 2003). In order to bridge the gap between large scale climatic conditions and local rift valley conditions, we select a marine core in close proximity to hominid sites in the East African rift valley to generate a high resolution, regional integrative record of vegetation change during the Neogene. We take the approach of high resolution (3ka) sampling, capable of resolving precessional variability, in `windows' downcore to provide a measure of the mean and variability of vegetation for timesclices during the last 10Ma. Our results show

  11. Obesity Among HIV-Infected Adults Receiving Medical Care in the United States: Data From the Cross-Sectional Medical Monitoring Project and National Health and Nutrition Examination Survey.

    PubMed

    Thompson-Paul, Angela M; Wei, Stanley C; Mattson, Christine L; Robertson, McKaylee; Hernandez-Romieu, Alfonso C; Bell, Tanvir K; Skarbinski, Jacek

    2015-07-01

    Our objective was to compare obesity prevalence among human immunodeficiency virus (HIV)-infected adults receiving care and the U.S. general population and identify obesity correlates among HIV-infected men and women.Cross-sectional data was collected in 2009 to 2010 from 2 nationally representative surveys: Medical Monitoring Project (MMP) and National Health and Nutrition Examination Survey (NHANES).Weighted prevalence estimates of obesity, defined as body mass index ≥30.0 kg/m, were compared using prevalence ratios (PR, 95% confidence interval [CI]). Correlates of obesity in HIV-infected adults were examined using multivariable logistic regression.Demographic characteristics of the 4006 HIV-infected adults in MMP differed from the 5657 adults from the general U.S. population in NHANES, including more men (73.2% in MMP versus 49.4% in NHANES, respectively), black or African Americans (41.5% versus 11.6%), persons with annual incomes <$20,000 (64.5% versus 21.9%), and homosexuals or bisexuals (50.9% versus 3.9%). HIV-infected men were less likely to be obese (PR 0.5, CI 0.5-0.6) and HIV-infected women were more likely to be obese (PR1.2, CI 1.1-1.3) compared with men and women in the general population, respectively. Among HIV-infected women, younger age was associated with obesity (<40 versus >60 years). Among HIV-infected men, correlates of obesity included black or African American race/ethnicity, annual income >$20,000 and <$50,000, heterosexual orientation, and geometric mean CD4+ T-lymphocyte cell count >200 cells/μL.Obesity is common, affecting 2 in 5 HIV-infected women and 1 in 5 HIV-infected men. Correlates of obesity differ for HIV-infected men and women; therefore, different strategies may be needed for the prevention and treatment. PMID:26166086

  12. Model, Proxy and Isotopic Perspectives on the East African Humid Period

    NASA Technical Reports Server (NTRS)

    Tierney, Jessica E.; Lewis, Sophie C.; Cook, Benjamin I.; LeGrande, Allegra N.; Schmidt, Gavin A.

    2011-01-01

    Both North and East Africa experienced more humid conditions during the early and mid-Holocene epoch (11,000-5000yr BP; 11-5 ka) relative to today. The North African Humid Period has been a major focus of paleoclimatic study, and represents a response of the hydrological cycle to the increase in boreal summer insolation and associated ocean, atmosphere and land surface feedbacks. Meanwhile, the mechanisms that caused the coeval East African Humid Period are poorly understood. Here, we use results from isotopeenabled coupled climate modeling experiments to investigate the cause of the East African Humid Period. The modeling results are interpreted alongside proxy records of both water balance and the isotopic composition of rainfall. Our simulations show that the orbitally-induced increase in dry season precipitation and the subsequent reduction in precipitation seasonality can explain the East African Humid Period, and this scenario agrees well with regional lake level and pollen paleoclimate data. Changes in zonal moisture flux from both the Atlantic and Indian Ocean account for the simulated increase in precipitation from June through November. Isotopic paleoclimate data and simulated changes in moisture source demonstrate that the western East African Rift Valley in particular experienced more humid conditions due to the influx of Atlantic moisture and enhanced convergence along the Congo Air Boundary. Our study demonstrates that zonal changes in moisture advection are an important determinant of climate variability in the East African region.

  13. Programmatic Implications of Acute and Early HIV Infection.

    PubMed

    Suthar, Amitabh B; Granich, Reuben M; Kato, Masaya; Nsanzimana, Sabin; Montaner, Julio S G; Williams, Brian G

    2015-11-01

    Human immunodeficiency virus (HIV) infection includes acute, early, chronic, and late stages. Acute HIV infection lasts approximately 3 weeks and early HIV infection, which includes acute HIV infection, lasts approximately 7 weeks. Many testing and blood screening algorithms detect HIV antibodies about 3 weeks after HIV infection. Incidence estimates are based on results of modeling, cohort studies, surveillance, and/or assays. Viral load is the key modifiable risk factor for HIV transmission and peaks during acute and early HIV infection. Empirical evidence characterizing the impact of acute and early HIV infection on the spread of the HIV epidemic are limited. Time trends of HIV prevalence collected from concentrated and generalized epidemics suggest that acute and early HIV infection may have a limited role in population HIV transmission. Collectively, these data suggest that acute and early HIV infection is relatively short and does not currently require fundamentally different programmatic approaches to manage the HIV/AIDS epidemic in most settings. Research and surveillance will inform which epidemic contexts and phases may require tailored strategies for these stages of HIV infection. PMID:26310309

  14. Ambient noise tomography of the East African Rift in Mozambique

    NASA Astrophysics Data System (ADS)

    Domingues, Ana; Silveira, Graça; Ferreira, Ana M. G.; Chang, Sung-Joon; Custódio, Susana; Fonseca, João F. B. D.

    2016-03-01

    Seismic ambient noise tomography is applied to central and southern Mozambique, located in the tip of the East African Rift (EAR). The deployment of MOZART seismic network, with a total of 30 broad-band stations continuously recording for 26 months, allowed us to carry out the first tomographic study of the crust under this region, which until now remained largely unexplored at this scale. From cross-correlations extracted from coherent noise we obtained Rayleigh wave group velocity dispersion curves for the period range 5-40 s. These dispersion relations were inverted to produce group velocity maps, and 1-D shear wave velocity profiles at selected points. High group velocities are observed at all periods on the eastern edge of the Kaapvaal and Zimbabwe cratons, in agreement with the findings of previous studies. Further east, a pronounced slow anomaly is observed in central and southern Mozambique, where the rifting between southern Africa and Antarctica created a passive margin in the Mesozoic, and further rifting is currently happening as a result of the southward propagation of the EAR. In this study, we also addressed the question concerning the nature of the crust (continental versus oceanic) in the Mozambique Coastal Plains (MCP), still in debate. Our data do not support previous suggestions that the MCP are floored by oceanic crust since a shallow Moho could not be detected, and we discuss an alternative explanation for its ocean-like magnetic signature. Our velocity maps suggest that the crystalline basement of the Zimbabwe craton may extend further east well into Mozambique underneath the sediment cover, contrary to what is usually assumed, while further south the Kaapval craton passes into slow rifted crust at the Lebombo monocline as expected. The sharp passage from fast crust to slow crust on the northern part of the study area coincides with the seismically active NNE-SSW Urema rift, while further south the Mazenga graben adopts an N-S direction

  15. 77 FR 21995 - Trade Facilitation in the East African Community: Recent Developments and Potential Benefits...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-12

    ... COMMISSION Trade Facilitation in the East African Community: Recent Developments and Potential Benefits... African Community (EAC). The report will also describe the potential benefits of trade facilitation in the... literature on the benefits of overall trade facilitation improvements, such as effects on import and...

  16. Hybridization in East African swarm-raiding army ants

    PubMed Central

    2011-01-01

    Background Hybridization can have complex effects on evolutionary dynamics in ants because of the combination of haplodiploid sex-determination and eusociality. While hybrid non-reproductive workers have been found in a range of species, examples of gene-flow via hybrid queens and males are rare. We studied hybridization in East African army ants (Dorylus subgenus Anomma) using morphology, mitochondrial DNA sequences, and nuclear microsatellites. Results While the mitochondrial phylogeny had a strong geographic signal, different species were not recovered as monophyletic. At our main study site at Kakamega Forest, a mitochondrial haplotype was shared between a "Dorylus molestus-like" and a "Dorylus wilverthi-like" form. This pattern is best explained by introgression following hybridization between D. molestus and D. wilverthi. Microsatellite data from workers showed that the two morphological forms correspond to two distinct genetic clusters, with a significant proportion of individuals being classified as hybrids. Conclusions We conclude that hybridization and gene-flow between the two army ant species D. molestus and D. wilverthi has occurred, and that mating between the two forms continues to regularly produce hybrid workers. Hybridization is particularly surprising in army ants because workers have control over which males are allowed to mate with a young virgin queen inside the colony. PMID:21859477

  17. Cage experiments in an East African mangrove forest: a synthesis

    NASA Astrophysics Data System (ADS)

    Schrijvers, J.; Vincx, M.

    1997-12-01

    The impact of epibenthos on endobenthos has frequently been investigated for temperate saltmarsh regions by using cage exclusion experiments. Although the insight into the function of the endobenthos of mangrove forests is crucial for their management, very few cage experiments have so far been carried out in such areas. The present paper summaries the results of such experiments in a typical East African mangrove forest at Gazi Bay about 60 km south of Mombasa, Kenya. Epibenthic animals were excluded for one year in two mangrove zones which differed in forest morphology and intertidal position ( Ceriops tagal and Avicennia marina). Environmental factors and meiobenthic and macrobenthic densities were followed in a randomised block design, and procedural and exclusion effects were statistically detected. In confronting the separate responses of all faunal groups in the two mangrove zones, this synthesis gives a better insight into the tropho-dynamical interactions than the earlier separate reports on the same experiment. The ecosystem of the mangrove zones and the competitive interactions within this system provided an ideal opportunity to discover the existence of two food systems. This confirmed a strong involvement of the majority of the endobenthos in an isolated decompositional pathway in the mangrove sediment. It became clear that this exploitative competition was more important than the epibenthic predation in structuring and regulating the global endobenthic community. This synthesis therefore both demonstrates the decisive role of the endobenthos as regenators of mangrove material, and suggests that endobenthos plays a minor role as prey for the demersal or pelagic carnivores.

  18. Strain distribution in the East African Rift from GPS measurements

    NASA Astrophysics Data System (ADS)

    Stamps, S. D.; Saria, E.; Calais, E.; Delvaux, D.; Ebinger, C.; Combrinck, L.

    2008-12-01

    Rifting of continental lithosphere is a fundamental process that controls the growth and evolution of continents and the birth of ocean basins. Most rifting models assume that stretching results from far-field lithospheric stresses from plate motions, but there is evidence that asthenospheric processes play an active role in rifting, possibly through viscous coupling and/or the added buoyancy and thermal weakening from melt intrusions. The distribution of strain during rifting is a key observable to constrain such models but is however poorly known. The East African Rift (EAR) offers a unique opportunity to quantify strain distribution along and across an active continental rift and to compare a volcanic (Eastern branch) and a non-volcanic (Western branch) segment. In 2006, we established and first surveyed a network of 35 points across Tanzania and installed one continuous station in Dar Es Salaam (TANZ), followed in 2008 by a second occupation campaign. We present a preliminary velocity field for the central part of the EAR, spanning both the Western and Eastern rift branches. We compare our results with a recent kinematic model of the EAR (Stamps et al., GRL, 2008) and discuss its significance for understanding rifting processes.

  19. [Problems of early detection of HIV infection, medical and psychological support of HIV-infected soldiers].

    PubMed

    Uliukin, I M; Bolekhan, V N; Iusupov, V V; Bulan'kov, Iu I; Orlova, E S

    2015-01-01

    The article contains the analysis of materials about HIV infection and the status of work on its early detection among soldiers. Currently, the figures have a tendency to stabilization, but there is an increase in the persantage of HIV-infected persons performing military service under the contract, as well as the actualization sexual way of infection. The insufficient effectiveness of the barrier screening during the laboratory examination of recruits may contribute the increase in the incidence of HIV infection. Have been reviewed the questions medical-diagnostic and medical-psychological support of HIV-infected soldiers. Been analyzed the social consequences of delays in seeking medical help of patients in this group, the opportunities and challenges of their dispensary observation. It was noted that early detection of HIV infection and proper medical and psychological support in the dynamics of pathological process helps to reduce the number of new cases and improve their outcomes and to reduce the period of efficiency recovery of military personnel. PMID:25916037

  20. HIV Infection and Osteoarticular Tuberculosis: Strange Bedfellows

    PubMed Central

    Hodkinson, B.; Osman, N.; Botha-Scheepers, S.

    2016-01-01

    We report the case of a 47-year-old female patient with rheumatoid arthritis and HIV infection presenting with a 3-week history of a painful swollen knee, increased serum inflammatory markers, and a low CD4 lymphocyte count. The diagnosis of TB arthritis was made by synovial fluid culture, GeneXpert/PCR, and confirmed by histopathology of a synovial biopsy. A mini literature review suggests that although HIV infection is associated with extrapulmonary TB, osteoarticular TB is a relatively unusual presentation in an HIV positive patient. The diagnostic utility of the GeneXpert test is explored. We also describe the patient's good response to an intra-articular corticosteroid injection in combination with standard anti-TB therapy. PMID:27366339

  1. Modeling the three stages in HIV infection.

    PubMed

    Hernandez-Vargas, Esteban A; Middleton, Richard H

    2013-03-01

    A typical HIV infection response consists of three stages: an initial acute infection, a long asymptomatic period and a final increase in viral load with simultaneous collapse in healthy CD4+T cell counts. The majority of existing mathematical models give a good representation of either the first two stages or the last stage of the infection. Using macrophages as a long-term active reservoir, a deterministic model is proposed to explain the three stages of the infection including the progression to AIDS. Simulation results illustrate how chronic infected macrophages can explain the progression to AIDS provoking viral explosion. Further simulation studies suggest that the proposed model retains its key properties even under moderately large parameter variations. This model provides important insights on how macrophages might play a crucial role in the long term behavior of HIV infection. PMID:23238280

  2. Cryptococcal Disease in HIV-Infected Children.

    PubMed

    Kao, Carol; Goldman, David L

    2016-09-01

    Cryptococcus neoformans is an encapsulated fungal pathogen that is remarkable for its tendency to cause meningoencephalitis, especially in patients with AIDS. While disease is less common in children than adults, it remains an important cause of morbidity and mortality among HIV-infected children without access to anti-retroviral therapy. This review highlights recent insights into both the biology and treatment of cryptococcosis with a special emphasis on the pediatric literature. PMID:27443557

  3. Ocular Syphilis among HIV-Infected Individuals

    PubMed Central

    Li, Jonathan Z.; Tucker, Joseph D.; Lobo, Ann-Marie; Marra, Christina M.; Davis, Benjamin T.; Papaliodis, George N.; Felsenstein, Donna; Durand, Marlene L.; Yawetz, Sigal; Robbins, Gregory K.

    2010-01-01

    We describe a human immunodeficiency virus (HIV)–infected individual with ocular manifestations of secondary syphilis. Twelve other cases of HIV-associated ocular syphilis are also presented. Six of 12 individuals had normal cerebrospinal fluid study results, and 3 patients required retreatment within 1.5 years. In patients with HIV infection, clinicians should be vigilant for ocular syphilis despite normal cerebrospinal fluid measures and for syphilis reinfection. PMID:20604717

  4. HIV Infection in the Elderly: Arising Challenges

    PubMed Central

    2016-01-01

    Globally there is an increase in the number of people living with HIV at an advanced age (50 years and above). This is mainly due to prolonged survival following the use of highly active antiretroviral therapy. Living with HIV at an advanced age has been shown to be associated with a number of challenges, both clinical and immunological. This minireview aims at discussing the challenges encountered by elderly HIV-infected patients. PMID:27595022

  5. HIV Infection in the Elderly: Arising Challenges.

    PubMed

    Mpondo, Bonaventura C T

    2016-01-01

    Globally there is an increase in the number of people living with HIV at an advanced age (50 years and above). This is mainly due to prolonged survival following the use of highly active antiretroviral therapy. Living with HIV at an advanced age has been shown to be associated with a number of challenges, both clinical and immunological. This minireview aims at discussing the challenges encountered by elderly HIV-infected patients. PMID:27595022

  6. Fosamprenavir calcium plus ritonavir for HIV infection.

    PubMed

    Torres, Harrys A; Arduino, Roberto C

    2007-06-01

    Fosamprenavir is a protease inhibitor (PI) approved for the treatment of HIV-1 infection. Fosamprenavir is a prodrug of amprenavir developed to reduce the pill burden yet maintain the unique resistance pattern and efficacy associated with amprenavir. In a head-to-head, noninferiority trial in antiretroviral treatment-naive HIV-infected patients, the antiviral efficacy and tolerability of ritonavir-boosted fosamprenavir was not inferior to ritonavir-boosted lopinavir, when the PIs were combined with two other nucleoside reverse transcriptase inhibitors. There are fewer studies published about fosamprenavir use in antiretroviral treatment-experienced HIV-infected patients. The high genetic barrier to the development of resistance to fosamprenavir and the low level of cross-resistance between ritonavir-boosted fosamprenavir and other PI regimens are notable. As with amprenavir, gastrointestinal disturbance and rash are the most frequent short-term treatment-limiting events with fosamprenavir. Treatment with ritonavir-boosted fosamprenavir can produce a durable response. To date, fosamprenavir is one of the recommended preferred PI components for the treatment of antiretroviral-naive HIV-infected patients. PMID:17547501

  7. Behavior changes after notification of HIV infection.

    PubMed Central

    Cleary, P D; Van Devanter, N; Rogers, T F; Singer, E; Shipton-Levy, R; Steilen, M; Stuart, A; Avorn, J; Pindyck, J

    1991-01-01

    BACKGROUND. To learn more about how people who did not volunteer for testing react to information about HIV infection, we assessed short-term behavior changes in HIV-positive blood donors. METHODS. Blood donors who were notified at the New York Blood Center that they were HIV positive were asked to participate in a study. A nurse elicited a medical history, performed a limited medical examination, and asked participants to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. Participants were asked to return in 2 weeks to complete another questionnaire. RESULTS. Many fewer men and women reported engaging in unsafe sexual behaviors in the 2 weeks preceding the follow-up visit than had reported such behaviors prior to notification. These changes were greater than those other investigators have reported, but about 40% of the participants still reported unsafe sexual activity at the follow-up interview. CONCLUSIONS. To make nonvolunteer screening programs for HIV infection more effective in reducing the spread of HIV infection, we need to learn more about how to help people change their high-risk behaviors. PMID:1746654

  8. New Regimens to Prevent Tuberculosis in Adults with HIV Infection

    PubMed Central

    Martinson, Neil A.; Barnes, Grace L.; Moulton, Lawrence H.; Msandiwa, Reginah; Hausler, Harry; Ram, Malathi; McIntyre, James A.; Gray, Glenda E.; Chaisson, Richard E.

    2012-01-01

    BACKGROUND Treatment of latent tuberculosis in patients infected with the human immunodeficiency virus (HIV) is efficacious, but few patients around the world receive such treatment. We evaluated three new regimens for latent tuberculosis that may be more potent and durable than standard isoniazid treatment. METHODS We randomly assigned South African adults with HIV infection and a positive tuberculin skin test who were not taking antiretroviral therapy to receive rifapentine (900 mg) plus isoniazid (900 mg) weekly for 12 weeks, rifampin (600 mg) plus isoniazid (900 mg) twice weekly for 12 weeks, isoniazid (300 mg) daily for up to 6 years (continuous isoniazid), or isoniazid (300 mg) daily for 6 months (control group). The primary end point was tuberculosis-free survival. RESULTS The 1148 patients had a median age of 30 years and a median CD4 cell count of 484 per cubic millimeter. Incidence rates of active tuberculosis or death were 3.1 per 100 person-years in the rifapentine–isoniazid group, 2.9 per 100 person-years in the rifampin–isoniazid group, and 2.7 per 100 person-years in the continuous-isoniazid group, as compared with 3.6 per 100 person-years in the control group (P>0.05 for all comparisons). Serious adverse reactions were more common in the continuous-isoniazid group (18.4 per 100 person-years) than in the other treatment groups (8.7 to 15.4 per 100 person-years). Two of 58 isolates of Mycobacterium tuberculosis (3.4%) were found to have multidrug resistance. CONCLUSIONS On the basis of the expected rates of tuberculosis in this population of HIV-infected adults, all secondary prophylactic regimens were effective. Neither a 3-month course of intermittent rifapentine or rifampin with isoniazid nor continuous isoniazid was superior to 6 months of isoniazid. PMID:21732833

  9. The distribution of new HIV infections by mode of exposure in Morocco

    PubMed Central

    Mumtaz, Ghina R; Kouyoumjian, Silva P; Hilmi, Nahla; Zidouh, Ahmed; Rhilani, Houssine El; Alami, Kamal; Bennani, Aziza; Gouws, Eleanor; Ghys, Peter Denis; Abu-Raddad, Laith J

    2013-01-01

    Objectives Building on a wealth of new empirical data, the objective of this study was to estimate the distribution of new HIV infections in Morocco by mode of exposure using the modes of transmission (MoT) mathematical model. Methods The MoT model was implemented within a collaboration with the Morocco Ministry of Health and the Joint United Nations Programme on HIV/AIDS. The model was parameterised through a comprehensive review and synthesis of HIV and risk behaviour data in Morocco, mainly through the Middle East and North Africa HIV/AIDS Synthesis Project. Uncertainty analyses were used to assess the reliability of and uncertainty around our calculated estimates. Results Female sex workers (FSWs), clients of FSWs, men who have sex with men (MSM) and injecting drug users (IDUs) contributed 14%, 24%, 14% and 7% of new HIV infections, respectively. Two-thirds (67%) of new HIV infections occurred among FSWs, clients of FSWs, MSM and IDUs, or among the stable sexual partners of these populations. Casual heterosexual sex contributed 7% of HIV infections. More than half (52%) of HIV incidence is among females, but 71% of these infections are due to an infected spouse. The vast majority of HIV infections among men (89%) are due to high-risk behaviour. A very small HIV incidence is predicted to arise from medical injections or blood transfusions (0.1%). Conclusions The HIV epidemic in Morocco is driven by HIV incidence in high-risk population groups, with commercial heterosexual sex being the largest contributor to incidence. There is a need to focus HIV response more on these populations, mainly through proactive and sustainable HIV surveillance, and the expansion and increased geographical coverage of services such as condom promotion among FSWs, voluntary counselling and testing, harm reduction and treatment. PMID:23413401

  10. Serotonin-Related Gene Polymorphisms and Asymptomatic Neurocognitive Impairment in HIV-Infected Alcohol Abusers

    PubMed Central

    Villalba, Karina; Dévieux, Jessy G.; Rosenberg, Rhonda; Cadet, Jean Lud

    2016-01-01

    HIV-infected individuals continue to experience neurocognitive deterioration despite virologically successful treatments. While the cause remains unclear, evidence suggests that HIV-associated neurocognitive disorders (HAND) may be associated with neurobehavioral dysfunction. Genetic variants have been explored to identify risk markers to determine neuropathogenesis of neurocognitive deterioration. Memory deficits and executive dysfunction are highly prevalent among HIV-infected adults. These conditions can affect their quality of life and HIV risk-taking behaviors. Single nucleotide polymorphisms in the SLC6A4, TPH2, and GALM genes may affect the activity of serotonin and increase the risk of HAND. The present study explored the relationship between SLC6A4, TPH2, and GALM genes and neurocognitive impairment in HIV-infected alcohol abusers. A total of 267 individuals were genotyped for polymorphisms in SLC6A4 5-HTTLPR, TPH2 rs4570625, and GALM rs6741892. To assess neurocognitive functions, the Short Category and the Auditory Verbal Learning Tests were used. TPH2 SNP rs4570625 showed a significant association with executive function in African American males (odds ratio 4.8, 95% CI, 1.5–14.8; P = 0.005). Similarly, GALM SNP rs6741892 showed an increased risk with African American males (odds ratio 2.4, 95% CI, 1.2–4.9; P = 0.02). This study suggests that TPH2 rs4570625 and GALM rs6741892 polymorphisms may be risk factors for HAND. PMID:27069689

  11. Intimate partner violence and HIV infection among women: a systematic review and meta-analysis

    PubMed Central

    Li, Ying; Marshall, Caitlin M; Rees, Hilary C; Nunez, Annabelle; Ezeanolue, Echezona E; Ehiri, John E

    2014-01-01

    Introduction To assess evidence of an association between intimate partner violence (IPV) and HIV infection among women. Methods Medline/PubMed, Embase, Web of Science, EBSCO, Ovid, Cochrane HIV/AIDS Group's Specialized Register and Cochrane Central Register of Controlled Trials were searched up to 20 May 2013 to identify studies that examined the association between IPV and HIV infection in women. We included studies on women aged ≥15 years, in any form of sexually intimate relationship with a male partner. Results Twenty-eight studies [(19 cross-sectional, 5 cohorts and 4 case-control studies) involving 331,468 individuals in 16 countries – the US (eight studies), South Africa (four studies), East Africa (10 studies), India (three studies), Brazil (one study) and multiple low-income countries (two studies)] were included. Results were pooled using RevMan 5.0. To moderate effect estimates, we analyzed all data using the random effects model, irrespective of heterogeneity level. Pooled results of cohort studies indicated that physical IPV [pooled RR (95% CI): 1.22 (1.01, 1.46)] and any type of IPV [pooled RR (95% CI): 1.28 (1.00, 1.64)] were significantly associated with HIV infection among women. Results of cross-sectional studies demonstrated significant associations of physical IPV with HIV infection among women [pooled OR (95% CI): 1.44 (1.10, 1.87)]. Similarly, results of cross-sectional studies indicated that combination of physical and sexual IPV [pooled OR (95% CI): 2.00 (1.24, 3.22) and any type of IPV [pooled OR (95% CI): 1.41 (1.16, 1.73)] were significantly associated with HIV infection among women. Conclusions Available evidence suggests a moderate statistically significant association between IPV and HIV infection among women. To further elucidate the strength of the association between IPV and HIV infection among women, there is a need for high-quality follow-up studies conducted in different geographical regions of the world, and among

  12. Crustal thinning between the Ethiopian and East African Plateaus from modeling Rayleigh wave dispersion

    SciTech Connect

    Benoit, M H; Nyblade, A A; Pasyanos, M E

    2006-01-17

    The East African and Ethiopian Plateaus have long been recognized to be part of a much larger topographic anomaly on the African Plate called the African Superswell. One of the few places within the African Superswell that exhibit elevations of less than 1 km is southeastern Sudan and northern Kenya, an area containing both Mesozoic and Cenozoic rift basins. Crustal structure and uppermost mantle velocities are investigated in this area by modeling Rayleigh wave dispersion. Modeling results indicate an average crustal thickness of 25 {+-} 5 km, some 10-15 km thinner than the crust beneath the adjacent East African and Ethiopian Plateaus. The low elevations can therefore be readily attributed to an isostatic response from crustal thinning. Low Sn velocities of 4.1-4.3 km/s also characterize this region.

  13. Hydrothermal vents in Lake Tanganyika, East African, Rift system

    NASA Astrophysics Data System (ADS)

    Tiercelin, Jean-Jacques; Pflumio, Catherine; Castrec, Maryse; Boulégue, Jacques; Gente, Pascal; Rolet, Joël; Coussement, Christophe; Stetter, Karl O.; Huber, Robert; Buku, Sony; Mifundu, Wafula

    1993-06-01

    Sublacustrine hydrothermal vents with associated massive sulfides were discovered during April 1987 at Pemba and Cape Banza on the Zaire side of the northern basin of Lake Tanganyika, East African Rift system. New investigations by a team of ten scuba divers during the multinational (France, Zaire, Germany, and Burundi) TANGANYDRO expedition (August-October 1991) found hydrothermal vents down to a depth of 46 m along north-trending active faults bounding the Tanganyika rift on the western side. Temperatures from 53 to 103 °C were measured in hydrothermal fluids and sediments. Veins of massive sulfides 1-10 cm thick (pyrite and marcasite banding) were found associated with vents at the Pemba site. At Cape Banza,active vents are characterized by 1-70-cm-high aragonite chimneys, and there are microcrystalline pyrite coatings on the walls of hydrothermal pipes. Hydrothermal fluid end members show distinctive compositions at the two sites. The Pemba end member is a NaHCO3-enriched fluid similar to the NaHCO3 thermal fluids from lakes Magadi and Bogoria in the eastern branch off the rift. The Cape Banza end member is a solution enriched in NaCl. Such brines may have a deep-seated basement origin, as do the Uvinza NaCl brines on the eastern flank of the Tanganyika basin. Geothermometric calculations have yielded temperatures of fluid-rock interaction off 219 and 179 °C in the Pemba and Cape Banza systems, respectively. Abundant white or reddish-brown microbial colonies resembling Beggiatoa mats were found surrounding the active vents. Thermal fluid circulation is permitted by opening of cracks related to 130 °N normal-dextral faults that intersect the north- south major rift trend. The source of heat for such hydrothermal systems may relate to the existence of magmatic bodies under the rift, which is suggested by the isotopic composition of carbon dioxide released at Pemba and Cape Banza.

  14. Seismic anisotropy across the east African plateau from shear wave splitting analysis

    NASA Astrophysics Data System (ADS)

    Bagley, B. C.; Nyblade, A.; Mulibo, G.; Tugume, F.

    2011-12-01

    Previous studies of the east African plateau reveal complicated patterns of seismic anisotropy that are not easily explained by a single mechanism. The pattern is defined by rift-parallel fast directions for stations within or near Cenozoic rift valleys, and near-null results in Precambrian terrains away from the rift. Data from 65 temporary Africa Array stations deployed between 2007 and 2011 are being used to make new shear wave splitting measurements. The stations span the east African plateau and cover both the eastern and western branches of the east African rift system, as well as unrifted Proterozoic and Archean terrains in Uganda, Kenya, Tanzania, and Zambia. Through analysis of shear wave splitting we will better constrain the distribution of seismic anisotropy, and and from it gain new insight into the tectonic evolution of east Africa.

  15. Effect of Cocaine on HIV Infection and Inflammasome Gene Expression Profile in HIV Infected Macrophages

    PubMed Central

    Atluri, Venkata Subba Rao; Pilakka-Kanthikeel, Sudheesh; Garcia, Gabriella; Jayant, Rahul Dev; Sagar, Vidya; Samikkannu, Thangavel; Yndart, Adriana; Nair, Madhavan

    2016-01-01

    We have observed significantly increased HIV infection in HIV infected macrophages in the presence of cocaine that could be due to the downregulation of BST2 restriction factor in these cells. In human inflammasome PCR array, among different involved in inflammasome formation, in HIV infected macrophages in the presence of cocaine, we have observed significant upregulation of NLRP3, AIM2 genes and downstream genes IL-1β and PTGS2. Whereas negative regulatory gene MEFV was upregulated, CD40LG and PYDC1 were significantly downregulated. Among various NOD like receptors, NOD2 was significantly upregulated in both HIV alone and HIV plus cocaine treated cells. In the downstream genes, chemokine (C-C motif) ligand 2 (CCL2), CCL7 and IL-6 were significantly up regulated in HIV plus cocaine treated macrophages. We have also observed significant ROS production (in HIV and/or cocaine treated cells) which is one of the indirect-activators of inflammasomes formation. Further, we have observed early apoptosis in HIV alone and HIV plus cocaine treated macrophages which may be resultant of inflammasome formation and cspase-1 activation. These results indicate that in case of HIV infected macrophages exposed to cocaine, increased ROS production and IL-1β transcription serve as an activators for the formation of NLRP3 and AIM2 mediated inflammasomes that leads to caspase 1 mediated apoptosis. PMID:27321752

  16. Effect of Cocaine on HIV Infection and Inflammasome Gene Expression Profile in HIV Infected Macrophages.

    PubMed

    Atluri, Venkata Subba Rao; Pilakka-Kanthikeel, Sudheesh; Garcia, Gabriella; Jayant, Rahul Dev; Sagar, Vidya; Samikkannu, Thangavel; Yndart, Adriana; Nair, Madhavan

    2016-01-01

    We have observed significantly increased HIV infection in HIV infected macrophages in the presence of cocaine that could be due to the downregulation of BST2 restriction factor in these cells. In human inflammasome PCR array, among different involved in inflammasome formation, in HIV infected macrophages in the presence of cocaine, we have observed significant upregulation of NLRP3, AIM2 genes and downstream genes IL-1β and PTGS2. Whereas negative regulatory gene MEFV was upregulated, CD40LG and PYDC1 were significantly downregulated. Among various NOD like receptors, NOD2 was significantly upregulated in both HIV alone and HIV plus cocaine treated cells. In the downstream genes, chemokine (C-C motif) ligand 2 (CCL2), CCL7 and IL-6 were significantly up regulated in HIV plus cocaine treated macrophages. We have also observed significant ROS production (in HIV and/or cocaine treated cells) which is one of the indirect-activators of inflammasomes formation. Further, we have observed early apoptosis in HIV alone and HIV plus cocaine treated macrophages which may be resultant of inflammasome formation and cspase-1 activation. These results indicate that in case of HIV infected macrophages exposed to cocaine, increased ROS production and IL-1β transcription serve as an activators for the formation of NLRP3 and AIM2 mediated inflammasomes that leads to caspase 1 mediated apoptosis. PMID:27321752

  17. Acute HIV infection - New York City, 2008.

    PubMed

    2009-11-27

    Acute human immunodeficiency virus (HIV) infection (AHI) is a highly infectious phase of disease that lasts approximately 2 months and is characterized by nonspecific clinical symptoms. AHI contributes disproportionately to HIV transmission because it is associated with a high level of viremia, despite negative or indeterminate antibody (Ab) tests. Diagnosis of AHI with individual or pooled nucleic acid amplification tests (p-NAAT) can enable infected persons to adopt behaviors that reduce HIV transmission, facilitate partner referral for counseling and testing, and identify social networks of persons with elevated rates of HIV transmission. The national HIV surveillance case definition does not distinguish AHI from other stages of HIV infection, and the frequency of AHI among reported HIV cases is unknown. In 2008, to increase detection of AHI and demonstrate the feasibility of AHI surveillance, the New York City Department of Health and Mental Hygiene (NYC DOHMH) initiated p-NAAT screening at four sexually transmitted disease (STD) clinics and enhanced citywide HIV surveillance (using a standard case definition) to differentiate AHI among newly reported cases. Seventy cases of AHI (representing 1.9% of all 3,635 HIV diagnoses reported in New York City) were identified: 53 cases from enhanced surveillance and 17 cases from p-NAAT screening (representing 9% of 198 HIV diagnoses at the four clinics). Men who have sex with men (MSM) constituted 81% of AHI cases. Screening STD clinic patients, especially MSM, with p-NAAT can identify additional cases of HIV infection. Surveillance for AHI is feasible and can identify circumstances in which HIV prevention efforts should be intensified. PMID:19940835

  18. [Renal abnormalities in HIV infected patients].

    PubMed

    Pernasetti, María Marta; Chiurchiu, Carlos; Fuente, Jorge de la; Arteaga, Javier de; Douthat, Walter; Bardosy, Cecilia; Zarate, Abel; Massari, Pablo U

    2010-01-01

    Several renal complications may occur during HIV infection, especially in advanced stages related to HIV, to other infectious agents and/or drugs. Little is known about the prevalence of renal diseases that may occur as a complication of or related to HIV infection in asymptomatic patients. This is a single center cross-sectional study of asymptomatic HIV(+) patients referred to a nefrology care service at an Argentine hospital to look for the presence of renal abnormalities. Fifty two consecutive patients were studied between April and November 2008. Patients underwent plasma and urine analysis, ultrasound, and kidney biopsy as needed. Mean age was 39.9 +/- 10.6 years, 88% were male, time from HIV diagnosis 53.2 +/- 41.2 months (2-127); 71% had HIV-disease and 77% were on antiretroviral therapy. Mean plasma HIV-RNA copies number was 7.043 +/- 3.322 and CD4+ cell count: 484 +/- 39. Pathologic findings in urine analysis were present in 30.7% of patients: albuminuria 16.6%, microscopic hematuria 11.5%, hypercalciuria 10.8% and crystalluria 6%. Mean glomerular filtration rate was 102.2 +/- 22.95 ml/min (34-149) and 41% of patients could be classified in stages 1 to 3 of chronic kidney disease. Renal abnormalities prevaled in older patients without relationship with presence of HIV-disease. Two patients were biopsied and the findings included: tubulointerstitial nephritis with presence of crystal deposition in one and IgA nephropathy in the other. No HIV-associated nephropathy was detected. The broad spectrum and the high prevalence of lesions found in this series suggest that asymptomatic HIV-infected patients should routinely undergo renal evaluation. PMID:20529774

  19. Multidecadal variability in East African hydroclimate controlled by the Indian Ocean.

    PubMed

    Tierney, Jessica E; Smerdon, Jason E; Anchukaitis, Kevin J; Seager, Richard

    2013-01-17

    The recent decades-long decline in East African rainfall suggests that multidecadal variability is an important component of the climate of this vulnerable region. Prior work based on analysing the instrumental record implicates both Indian and Pacific ocean sea surface temperatures (SSTs) as possible drivers of East African multidecadal climate variability, but the short length of the instrumental record precludes a full elucidation of the underlying physical mechanisms. Here we show that on timescales beyond the decadal, the Indian Ocean drives East African rainfall variability by altering the local Walker circulation, whereas the influence of the Pacific Ocean is minimal. Our results, based on proxy indicators of relative moisture balance for the past millennium paired with long control simulations from coupled climate models, reveal that moist conditions in coastal East Africa are associated with cool SSTs (and related descending circulation) in the eastern Indian Ocean and ascending circulation over East Africa. The most prominent event identified in the proxy record--a coastal pluvial from 1680 to 1765--occurred when Indo-Pacific warm pool SSTs reached their minimum values of the past millennium. Taken together, the proxy and model evidence suggests that Indian Ocean SSTs are the primary influence on East African rainfall over multidecadal and perhaps longer timescales. PMID:23325220

  20. The stochastic dance of early HIV infection

    NASA Astrophysics Data System (ADS)

    Merrill, Stephen J.

    2005-12-01

    The stochastic nature of early HIV infection is described in a series of models, each of which captures aspects of the dance of HIV during the early stages of infection. It is to this highly variable target that the immune response must respond. The adaptability of the various components of the immune response is an important aspect of the system's operation, as the nature of the pathogens that the response will be required to respond to and the order in which those responses must be made cannot be known beforehand. As HIV infection has direct influence over cells responsible for the immune response, the dance predicts that the immune response will be also in a variable state of readiness and capability for this task of adaptation. The description of the stochastic dance of HIV here will use the tools of stochastic models, and for the most part, simulation. The justification for this approach is that the early stages and the development of HIV diversity require that the model to be able to describe both individual sample path and patient-to-patient variability. In addition, as early viral dynamics are best described using branching processes, the explosive growth of these models both predicts high variability and rapid response of HIV to changes in system parameters.In this paper, a basic viral growth model based on a time dependent continuous-time branching process is used to describe the growth of HIV infected cells in the macrophage and lymphocyte populations. Immigration from the reservoir population is added to the basic model to describe the incubation time distribution. This distribution is deduced directly from the modeling assumptions and the model of viral growth. A system of two branching processes, one in the infected macrophage population and one in the infected lymphocyte population is used to provide a description of the relationship between the development of HIV diversity as it relates to tropism (host cell preference). The role of the immune

  1. Humanized Mouse Models of HIV Infection

    PubMed Central

    Denton, Paul W.; Garcia, J. Victor

    2013-01-01

    Because of the limited tropism of HIV, in vivo modeling of this virus has been almost exclusively limited to other lentiviruses such as SIV that reproduce many important characteristics of HIV infection. However, there are significant genetic and biological differences among lentiviruses and some HIV-specific interventions are not effective against other lentiviruses in non-human hosts. For these reasons much emphasis has recently been placed on developing alternative animal models that support HIV replication and recapitulate key aspects of HIV infection and pathogenesis in humans. Humanized mice, CD34+ hematopoietic progenitor cell transplanted immunodeficient mice and in particular mice also implanted with human thymic/liver tissue (BLT mice) that develop a functional human immune system, have been the focus of a great deal of attention as possible models to study virtually all aspects of HIV biology and pathogenesis. Humanized mice are systemically reconstituted with human lymphoid cells offering rapid, reliable and reproducible experimental systems for HIV research. Peripheral blood of humanized mice can be readily sampled longitudinally to assess reconstitution with human cells and to monitor HIV replication permitting the evaluation of multiple parameters of HIV infection such as viral load levels, CD4+ T cell depletion, immune activation, as well as the effects of therapeutic interventions. Of high relevance to HIV transmission is the extensive characterization and validation of the reconstitution with human lymphoid cells of the female reproductive tract and of the gastrointestinal tract of humanized BLT mice that renders them susceptible to both vaginal and rectal HIV infection. Other important attributes of all types of humanized mice include: 1) their small size and cost that make them broadly accessible; 2) multiple cohorts of humanized mice can be made from multiple human donors and each cohort has identical human cells, permitting control of

  2. The cytokine network in HIV infection.

    PubMed

    Alfano, M; Poli, G

    2002-12-01

    Cytokines are major controller of HIV replication and represent, at the same time, a target for viral-induced immune dysregulation. This mutual relationship has profound implications for both active HIV replication and immune-mediated governance of latency; in addition, cytokines have therapeutic value in the perspective of immune reconstitution. In the current article we will review the most relevant aspects emerged in almost 20 years of research in this area with particular reference to the distinct, but interconnected contribution of the most simple (cell lines) to the most complex (animal) models of HIV infection. PMID:12462389

  3. Risk management information for HIV infection.

    PubMed

    Edwards, A J

    1990-01-01

    This article discusses HIV infection in terms of the risk manager's information needs in the health care environment. The malpractice problem, increasing workman's compensation suits, the greater role of the ombudsman, implementation of the National Practitioner Data Bank, and the Joint Commission on Accreditation of Health Care Organizations' (JCAHO) emphasis on clinical excellence are conditions which have given greater importance to the risk manager's position. Included in this article are hedges to retrieve various components of risk management and a select bibliography from AIDSLINE. PMID:10110456

  4. Hydrothermal vents is Lake Tanganyika, East African Rift system

    SciTech Connect

    Tiercelin, J.J.; Pflumio, C.; Castrec, M.

    1993-06-01

    Sublacustrine hydrothermal vents with associated massive sulfides were discovered during April 1987 at Pemba and Cape Banza on the Zaire side of the northern basin of Lake Tanganyika, East African Rift system. New investigations by a team of ten scuba divers during the multinational (France, Zaire, Germany, and Burundi) TANGANYDRO expedition (August-October 1991) found hydrothermal vents down to a depth of 46 m along north-trending active faults bounding the Tanganyika rift on the western side. Temperatures from 53 to 103 {degrees}C were measured in hydrothermal fluids and sediments. Veins of massive sulfides 1-10 cm thick (pyrite and marcasite banding) were found associated with vents at the Pemba site. At Cape Banza, active vents are characterized by 1-70-cm-high aragonite chimneys, and there are microcrystalline pyrite coatings on the walls of hydrothermal pipes. Hydrothermal fluid end members show distinctive compositions at the two sites. The Pemba end member is a NaHCO{sub 3}-enriched fluid similar to the NaHCO{sub 3} thermal fluids form lakes Magadi and Bogoria in the eastern branch of the rift. The Cape Banza end member is a solution enriched in NaCl. Such brines may have a deep-seated basement origin, as do the Uvinza NaCl brines on the eastern flank of the Tanganyika basin. Geothermometric calculations have yielded temperatures of fluid-rock interaction of 219 and 179 {degrees}C in the Pemba and Cape Banza systems, respectively. Abundant white or reddish-brown microbial colonies resembling Beggiatoa mats were found surrounding the active vents. Thermal fluid circulation is permitted by opening of cracks related to 130{degrees}N normal-dextral faults that intersect the north-south major rift trend. The sources of heat for such hydrothermal systems may relate to the existence of magmatic bodies under the rift, which is suggested by the isotopic composition of carbon dioxide released at Pemba and Cape Banza. 21 refs., 2 figs.

  5. The Presence of Psychiatric Disorders in HIV-Infected Women.

    ERIC Educational Resources Information Center

    Taylor, Elizabeth R.; And Others

    1996-01-01

    Many women of low socioeconomic status who have contracted HIV qualify for individual, dual, and multiple psychiatric diagnoses that predate their knowledge of their HIV infection. Earlier intervention addressing these problems might have prevented the onset of psychiatric disorders as well as high-risk behaviors that lead to HIV infection. (FC)

  6. Primary cutaneous plasmablastic lymphoma revealing clinically unsuspected HIV infection.

    PubMed

    Marques, Silvio Alencar; Abbade, Luciana P Fernandes; Guiotoku, Marcelo Massaki; Marques, Mariangela Esther Alencar

    2016-01-01

    Plasmablastic lymphoma is a rare subtype of diffuse large B-cell lymphoma more frequently diagnosed in immunosuppressed patients, mainly HIV-infected. Primary cutaneous plasmablastic lymphoma is extremely rare, and in this patient it was the first clinical manifestation of unsuspected HIV-infection. PMID:27579749

  7. Microbiome alterations in HIV infection a review.

    PubMed

    Williams, Brett; Landay, Alan; Presti, Rachel M

    2016-05-01

    Recent developments in molecular techniques have allowed researchers to identify previously uncultured organisms, which has propelled a vast expansion of our knowledge regarding our commensal microbiota. Interest in the microbiome specific to HIV grew from earlier findings suggesting that bacterial translocation from the intestines is the cause of persistent immune activation despite effective viral suppression with antiretroviral therapy (ART). Studies of SIV infected primates have demonstrated that Proteobacteria preferentially translocate and that mucosal immunity can be restored with probiotics. Pathogenic SIV infection results in a massive expansion of the virome, whereas non-pathogenic SIV infection does not. Human HIV infected cohorts have been shown to have microbiota distinctive from that of HIV negative controls and efforts to restore the intestinal microbiome via probiotics have often had positive results on host markers. The microbiota of the genital tract may play a significant role in acquisition and transmission of HIV. Modification of commensal microbial communities likely represents an important therapeutic adjunct to treatment of HIV. Here we review the literature regarding human microbiome in HIV infection. PMID:26945815

  8. Use of Machine Learning Techniques for Identification of Robust Teleconnections to East African Rainfall Variability

    NASA Technical Reports Server (NTRS)

    Roberts, J. Brent; Robertson, F. R.; Funk, C.

    2014-01-01

    Hidden Markov models can be used to investigate structure of subseasonal variability. East African short rain variability has connections to large-scale tropical variability. MJO - Intraseasonal variations connected with appearance of "wet" and "dry" states. ENSO/IOZM SST and circulation anomalies are apparent during years of anomalous residence time in the subseasonal "wet" state. Similar results found in previous studies, but we can interpret this with respect to variations of subseasonal wet and dry modes. Reveal underlying connections between MJO/IOZM/ENSO with respect to East African rainfall.

  9. HIV Infection Legal Issues: An Introduction for Developmental Services. Technical Report on Developmental Disabilities and HIV Infection, Number 2.

    ERIC Educational Resources Information Center

    Harvey, David C.; Decker, Curtis L.

    As agencies and programs serving individuals with developmental disabilities are called upon to serve a new population of individuals with human immunodeficiency virus (HIV) infection, they will be forced to confront complex legal questions. This paper discusses the legal frameworks in which individuals with HIV infection are considered eligible…

  10. High osteoporosis risk among East Africans linked to lactase persistence genotype.

    PubMed

    Hilliard, Constance B

    2016-01-01

    This ecological correlation study explores the marked differential in osteoporosis susceptibility between East and West Africans. African tsetse belt populations are lactase non-persistent (lactose intolerant) and possess none of the genetic polymorphisms carried by lactase persistent (lactose tolerant) ethnic populations. What appears paradoxical, however, is the fact that Niger-Kordofanian (NK) West African ethnicities are also at minimal risk of osteoporosis. Although East Africans share a genetic affinity with NK West Africans, they display susceptibility rates of the bone disorder closer to those found in Europe. Similar to Europeans, they also carry alleles conferring the lactase persistence genetic traits. Hip fracture rates of African populations are juxtaposed with a global model to determine whether it is the unique ecology of the tsetse-infested zone or other variables that may be at work. This project uses MINITAB 17 software for regression analyses. The research data are found on AJOL (African Journals Online), PUBMED and JSTOR (Scholarly Journal Archive). Data showing the risk of osteoporosis to be 80 times higher among East Africans with higher levels of lactase persistence than lactase non-persistence West Africans are compared with global statistics. Hip fracture rates in 40 countries exhibit a high Pearson's correlation of r=0.851, with P-value=0.000 in relation to dairy consumption. Lower correlations are seen for hip fracture incidence vis-à-vis lactase persistence, per capita income and animal protein consumption. Ethnic populations who lack lactase persistence single-nucleotide polymorphisms may be at low risk of developing osteoporosis. PMID:27408710

  11. Neurocognitive deficits in HIV-infected women and victims of childhood trauma.

    PubMed

    Spies, G; Fennema-Notestine, C; Archibald, S L; Cherner, M; Seedat, S

    2012-01-01

    The study investigated the behavioral and brain effects of childhood trauma and human immunodeficiency virus (HIV) infection, both separately and in combination, and assessed potential interactions in women who were dually affected. Eighty-three HIV-positive and 47 matched HIV-negative South African women underwent neuromedical, neuropsychiatric, and neurocognitive assessments. Univariate tests of significance assessed if either HIV infection or childhood trauma, or the combination, had a significant effect on neurocognitive performance. The majority of women were Black (96%) and had an average age of 30 years. An analysis of covariance revealed significant HIV effects for the Hopkins Verbal Learning Test (HVLT) learning and delay trials (p < 0.01) and the Halstead Category Test (HCT) (p < 0.05). A significant trauma effect was seen on the HVLT delay trial (p < 0.05). The results provide evidence for neurocognitive dysfunction in memory and executive functions in HIV-infected women and memory disturbances in trauma exposed women. PMID:22672200

  12. Genital tract infections among HIV-infected pregnant women in Malawi, Tanzania and Zambia

    PubMed Central

    Aboud, S; Msamanga, G; Read, J S; Mwatha, A; Chen, Y Q; Potter, D; Valentine, M; Sharma, U; Hoffmann, I; Taha, T E; Goldenberg, R L; Fawzi, W W

    2009-01-01

    Summary The aim of this study was to compare the prevalence and factors associated with genital tract infections among HIV-infected pregnant women from African sites. Participants were recruited from Blantyre and Lilongwe, Malawi; Dar es Salaam, Tanzania; and Lusaka, Zambia. Genital tract infections were assessed at baseline. Of 2627 eligible women enrolled, 2292 were HIV-infected. Of these, 47.8% had bacterial vaginosis (BV), 22.4% had vaginal candidiasis, 18.8% had trichomoniasis, 8.5% had genital warts, 2.6% had chlamydia infection, 2.2% had genital ulcers and 1.7% had gonorrhoea. The main factors associated with genital tract infections included genital warts (adjusted odds ratio [AOR] 1.8, 95% CI 1.2–2.7), genital ulcers (AOR 2.4, 95% CI 1.2–5.1) and abnormal vaginal discharge (AOR 2.5, 95% CI 1.9–3.3) for trichomoniasis. BV was the most common genital tract infection followed by candidiasis and trichomoniasis. Differences in burdens and risk factors call for enhanced interventions for identification of genital tract infections among HIV-infected women. PMID:19050213

  13. Impaired glucose metabolism in HIV-infected pregnant women: a retrospective analysis.

    PubMed

    Moore, Rebecca; Adler, Hugh; Jackson, Valerie; Lawless, Mairead; Byrne, Maria; Eogan, Maeve; Lambert, John S

    2016-06-01

    Metabolic complications, including diabetes mellitus, have been increasingly recognised in HIV-infected individuals since the introduction of antiretroviral therapy, particularly protease inhibitors (PIs). Pregnancy is also a risk factor for impaired glucose metabolism, and previous studies have given conflicting results regarding the contribution of PIs to impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM) in pregnant HIV-infected women. We conducted a retrospective review of all HIV-infected women attending a combined infectious disease and antenatal clinic between 2007 and 2013 who underwent a 100 g oral glucose tolerance test (OGTT) at 24-28 weeks. We grouped the patients based on whether their OGTT result was normal or abnormal, and compared the groups using standard parametric tests (t-test and Fisher's exact test). Of 263 women with HIV who attended the clinic, 142 (53.9%) attended for OGTT and were eligible for inclusion. The mean age was 31 years (SD 5.37), all women were of European or African origin and 33.7% had a body mass index ≥30 kg/m(2) About 93.7% were on PI-based regimens. At delivery, the mean CD4 count was 526 cells/µL, and 13% of patients had a detectable viraemia. The prevalence of IGT was 2.8%, while the prevalence of GDM was 2.1%. Also, 71.4% (n = 5) of women with abnormal glucose metabolism were taking PIs versus 94.8% (n = 128) of normoglycaemic women (p = 0.06). We did not confirm an increased rate of GDM in HIV-infected women in our patient population and found no association between PI use and GDM. PMID:25999164

  14. Dynamics of HIV infection in lymphoid tissue network.

    PubMed

    Nakaoka, Shinji; Iwami, Shingo; Sato, Kei

    2016-03-01

    Human immunodeficiency virus (HIV) is a fast replicating ribonucleic acid virus, which can easily mutate in order to escape the effects of drug administration. Hence, understanding the basic mechanisms underlying HIV persistence in the body is essential in the development of new therapies that could eradicate HIV infection. Lymphoid tissues are the primary sites of HIV infection. Despite the recent progress in real-time monitoring technology, HIV infection dynamics in a whole body is unknown. Mathematical modeling and simulations provide speculations on global behavior of HIV infection in the lymphatic system. We propose a new mathematical model that describes the spread of HIV infection throughout the lymphoid tissue network. In order to represent the volume difference between lymphoid tissues, we propose the proportionality of several kinetic parameters to the lymphoid tissues' volume distribution. Under this assumption, we perform extensive numerical computations in order to simulate the spread of HIV infection in the lymphoid tissue network. Numerical computations simulate single drug treatments of an HIV infection. One of the important biological speculations derived from this study is a drug saturation effect generated by lymphoid network connection. This implies that a portion of reservoir lymphoid tissues to which drug is not sufficiently delivered would inhibit HIV eradication despite of extensive drug injection. PMID:26507442

  15. African American Students in East Baton Rouge Parish: How Have They Fared in Desegregated Schools?

    ERIC Educational Resources Information Center

    Fossey, Richard

    Three generations of children have passed through the Baton Rouge (Louisiana) school system since the "Brown" decision (1954) and one generation since the federal court's 1981 desegregation order. The impact of school desegregation on African American children was studied in the East Baton Rouge School District. For the student body as a whole,…

  16. Characteristics of soils in selected maize growing sites along altitudinal gradients in East African highlands

    PubMed Central

    Njuguna, Elijah; Gathara, Mary; Nadir, Stanley; Mwalusepo, Sizah; Williamson, David; Mathé, Pierre-Etienne; Kimani, Jackson; Landmann, Tobias; Juma, Gerald; Ong’amo, George; Gatebe, Erastus; Ru, Bruno Le; Calatayud, Paul-andré

    2015-01-01

    Maize is the main staple crop in the East African Mountains. Understanding how the edaphic characteristics change along altitudinal gradients is important for maximizing maize production in East African Highlands, which are the key maize production areas in the region. This study evaluated and compared the levels of some macro and micro-elements (Al, Ca, Fe, K, Mg, Mn, Na and P) and other soil parameters (pH, organic carbon content, soil texture [i.e. % Sand, % Clay and % Silt], cation exchange capacity [CEC], electric conductivity [EC], and water holding capacity [HC]). Soil samples were taken from maize plots along three altitudinal gradients in East African highlands (namely Machakos Hills, Taita Hills and Mount Kilimanjaro) characterized by graded changes in climatic conditions. For all transects, pH, Ca, K and Mg decreased with the increase in altitude. In contrast, % Silt, organic carbon content, Al and water holding capacity (HC) increased with increasing altitude. The research provides information on the status of the physical–chemical characteristics of soils along three altitudinal ranges of East African Highlands and includes data available for further research. PMID:26509187

  17. Detection of east/central/south African genotype of chikungunya virus in Myanmar, 2010.

    PubMed

    Tun, Mya Myat Ngwe; Thant, Kyaw Zin; Inoue, Shingo; Nabeshima, Takeshi; Aoki, Kotaro; Kyaw, Aung Kyaw; Myint, Tin; Tar, Thi; Maung, Kay Thwe Thwe; Hayasaka, Daisuke; Morita, Kouichi

    2014-08-01

    In 2010, chikungunya virus of the East Central South African genotype was isolated from 4 children in Myanmyar who had dengue-like symptoms. Phylogenetic analysis of the E1 gene revealed that the isolates were closely related to isolates from China, Thailand, and Malaysia that harbor the A226V mutation in this gene. PMID:25062511

  18. Detection of East/Central/South African Genotype of Chikungunya Virus in Myanmar, 2010

    PubMed Central

    Tun, Mya Myat Ngwe; Thant, Kyaw Zin; Inoue, Shingo; Nabeshima, Takeshi; Aoki, Kotaro; Kyaw, Aung Kyaw; Myint, Tin; Tar, Thi; Maung, Kay Thwe Thwe; Hayasaka, Daisuke

    2014-01-01

    In 2010, chikungunya virus of the East Central South African genotype was isolated from 4 children in Myanmyar who had dengue-like symptoms. Phylogenetic analysis of the E1 gene revealed that the isolates were closely related to isolates from China, Thailand, and Malaysia that harbor the A226V mutation in this gene. PMID:25062511

  19. The Impact of the Geologic History and Paleoclimate on the Diversification of East African Cichlids

    PubMed Central

    Danley, Patrick D.; Husemann, Martin; Ding, Baoqing; DiPietro, Lyndsay M.; Beverly, Emily J.; Peppe, Daniel J.

    2012-01-01

    The cichlid fishes of the East African Great Lakes are the largest extant vertebrate radiation identified to date. These lakes and their surrounding waters support over 2,000 species of cichlid fish, many of which are descended from a single common ancestor within the past 10 Ma. The extraordinary East African cichlid diversity is intricately linked to the highly variable geologic and paleoclimatic history of this region. Greater than 10 Ma, the western arm of the East African rift system began to separate, thereby creating a series of rift basins that would come to contain several water bodies, including the extremely deep Lakes Tanganyika and Malawi. Uplifting associated with this rifting backponded many rivers and created the extremely large, but shallow Lake Victoria. Since their creation, the size, shape, and existence of these lakes have changed dramatically which has, in turn, significantly influenced the evolutionary history of the lakes' cichlids. This paper reviews the geologic history and paleoclimate of the East African Great Lakes and the impact of these forces on the region's endemic cichlid flocks. PMID:22888465

  20. [Prevention and screening of HIV infection ].

    PubMed

    Bourdillon, François

    2014-10-01

    The prevention of the HIV infection remains relevant considering the dynamics of the epidemic and the slackening of the preventive behavior of certain populations. The strategies associate initiatives of universal prevention: information, education, communication, screening; and specific actions in the direction of the most exposed populations. The paradigms of prevention evolved a lot these last years to take into account the preventive efficiency of antiretrovirals. If the condom remains the reference method, it is advisable for the populations the most exposed today to associate all the tools of prevention: behavioral methods, screening and antiretroviral. The possibility given to non-governmental organizations to realize test of fast screening allowed to go to closer of the most exposed populations.The arrival on the market of the autotests must be supervised to touch the people who do not turn to the screening. PMID:25510127

  1. HIV infection surveillance in Mogadishu, Somalia.

    PubMed

    Burans, J P; Fox, E; Omar, M A; Farah, A H; Abbass, S; Yusef, S; Guled, A; Mansour, M; Abu-Elyazeed, R; Woody, J N

    1990-07-01

    A group of 89 prostitutes and 45 patients attending sexually transmitted disease clinics in Mogadishu, Somalia were examined for evidence of HIV infection. Both groups reported more than 1 sexual partner routinely and had sexual contacts with prostitutes. There was a significant amount of sexually transmitted diseases (STDs) in these two groups, with 11.2% and 6.7% respectively being culture positive for N. gonorrhoea. Among the prostitutes, 28.1% were positive for antibodies to T. pallidum while only 4.4% of the STD patients were positive. One isolate of N. gonorrhoea was resistant to penicillin. All study participants were negative for antibodies to HIV suggesting an extremely low prevalence of HIV in high risk behaviour groups in the capital city of Somalia. PMID:2226225

  2. Insulin resistance and diabetes in HIV infection.

    PubMed

    Das, Satyajit

    2011-09-01

    Insulin resistance is an important and under recognized consequence of HIV treatment. Different studies have yielded widely varying estimates of the prevalence of impaired glucose metabolism in people on highly active antiretroviral therapy (HAART). The risk increases further with hepatitis C co infection. Although Protease inhibitors (PIs) are the main drug class implicated in insulin resistance, some studies have shown an association of increased risk of diabetes with cumulative exposure of nucleoside reverse transcriptase inhibitors (NRTIs). The effect of switching to other antiretrovirals has not been fully determined and the long-term consequences of insulin resistance in this population are not known. Treatment of established diabetes mellitus should generally follow existing guidelines. It is therefore reasonable to recommend general measures to increase insulin sensitivity in all patients infected with HIV, such as regular aerobic exercise and weight reduction for overweight persons. The present review article has the information of some recent patents regarding the insulin resistance in HIV infection. PMID:21824074

  3. A mathematical approach to HIV infection dynamics

    NASA Astrophysics Data System (ADS)

    Ida, A.; Oharu, S.; Oharu, Y.

    2007-07-01

    In order to obtain a comprehensive form of mathematical models describing nonlinear phenomena such as HIV infection process and AIDS disease progression, it is efficient to introduce a general class of time-dependent evolution equations in such a way that the associated nonlinear operator is decomposed into the sum of a differential operator and a perturbation which is nonlinear in general and also satisfies no global continuity condition. An attempt is then made to combine the implicit approach (usually adapted for convective diffusion operators) and explicit approach (more suited to treat continuous-type operators representing various physiological interactions), resulting in a semi-implicit product formula. Decomposing the operators in this way and considering their individual properties, it is seen that approximation-solvability of the original model is verified under suitable conditions. Once appropriate terms are formulated to describe treatment by antiretroviral therapy, the time-dependence of the reaction terms appears, and such product formula is useful for generating approximate numerical solutions to the governing equations. With this knowledge, a continuous model for HIV disease progression is formulated and physiological interpretations are provided. The abstract theory is then applied to show existence of unique solutions to the continuous model describing the behavior of the HIV virus in the human body and its reaction to treatment by antiretroviral therapy. The product formula suggests appropriate discrete models describing the dynamics of host pathogen interactions with HIV1 and is applied to perform numerical simulations based on the model of the HIV infection process and disease progression. Finally, the results of our numerical simulations are visualized and it is observed that our results agree with medical and physiological aspects.

  4. Early syphilis affects markers of HIV infection.

    PubMed

    Kotsafti, Ourania; Paparizos, Vassilios; Kourkounti, Sofia; Chatziioannou, Argiro; Nicolaidou, Electra; Kapsimali, Violetta; Antoniou, Christina

    2016-08-01

    The objective of this study was to investigate if early syphilis infection affects markers of HIV infection; CD4 T cells and viral load (VL). A retrospective study was performed on 160 HIV-positive patients (111 receiving antiretroviral therapy [ART] and 49 without ART). Early syphilis diagnosis was made in HIV patients during their follow-up at the HIV/AIDS Unit at a Greek Dermatology and Venereology Unit. The patients' blood tests were available at the time of diagnosis, as well as before and 12 weeks after early syphilis diagnosis. CD4 T cell counts and VL levels were measured. It was found that syphilis infection had a negative impact on the CD4 T cell counts in both groups, with reduced CD4 T cell counts observed in 84.6% (99/111) and 79.5% (39/49) of patients receiving and not receiving ART, respectively. After treatment for syphilis, CD4 T cell counts returned to pre-treatment levels in most patients, especially those receiving ART. There was a slight and transient VL increase. Patients receiving ART had a 27% increase in VL, compared to 71.4% among patients not receiving ART. Although the VL increase was slight (41-14,000 copies/ml) in the group under treatment, 4-5% (5/111) patients did not return to pre-treatment levels. Moreover, viral mutations associated with treatment resistance were identified in these patients. Early syphilis accelerates and complicates the progression of HIV infection. Early diagnosis and treatment of syphilis may prevent infection-associated complications in most instances. Consequently, prevention of syphilis and other sexually transmitted infections is of great importance for patients infected with HIV. PMID:26113517

  5. Acute encephalitis as initial presentation of primary HIV infection.

    PubMed

    Nzwalo, Hipólito; Añón, Rosário Pazos; Àguas, Maria João

    2012-01-01

    Acute encephalitis is a life-threatening condition. A wide variety of infectious agents are implicated and in many patients no cause is found. HIV acute seroconversion illness can rarely present as acute encephalitis. Although most experts agree in starting antiretroviral treatment in severe acute HIV infection, the evidence of the benefits are still lacking. The authors report a case of severe acute encephalitis as a primary presentation of HIV infection in which introduction of highly active antiretroviral treatment resulted in clinical recovery. This case highlights the need to consider HIV infection in the differential diagnosis of treatable viral encephalitis. PMID:22761210

  6. The role of statins in the setting of HIV infection.

    PubMed

    Eckard, Allison Ross; McComsey, Grace A

    2015-09-01

    HIV-infected individuals are at an increased risk of cardiovascular disease (CVD) and other HIV-related co-morbidities. This is due in part to dyslipidemia associated with antiretroviral therapy and increased inflammation and immune activation from chronic HIV infection. Statins not only have potent lipid-lowering properties but are also anti-inflammatory and immunomodulators. Studies suggest that statin therapy in the HIV-infected population may decrease the risk of CVD and other non-AIDS-defining co-morbidities. This review summarizes the recent literature on statin use in the HIV setting. PMID:26126687

  7. Is fluoride-induced hyperthyroidism a cause of psychosis among East African immigrants to Scandinavia?

    PubMed

    Zachariassen, Karl Erik; Flaten, Trond Peder

    2009-05-01

    East African immigrants to Scandinavia are admitted to mental hospitals far more frequently than native Scandinavians. Most of these patients are admitted for psychosis, commonly ascribed to problems adapting to the new culture. However, psychosis is also known to be associated with hyperthyroidism, and the high frequency of psychosis among East Africans in Scandinavia may at least in part be due to hyperthyroidism rather than cultural problems. Large areas in East Africa are notorious for high natural concentrations of fluoride in water and plants. Fluoride inhibits the production of thyroid hormones. To maintain normal thyroxin levels the body increases the capacity for thyroxin production. Goitre is caused by such a compensatory mechanism, and endemic goitre is widespread in many high-fluoride areas, even where dietary access to iodine is adequate. When people from such areas arrive in a low-fluoride area, their elevated capacity to produce thyroid hormones may lead to hyperthyroidism and subsequently to psychosis. PMID:19201548

  8. Late Quaternary behavior of the East African monsoon and the importance of the Congo Air Boundary

    NASA Astrophysics Data System (ADS)

    Tierney, Jessica E.; Russell, James M.; Sinninghe Damsté, Jaap S.; Huang, Yongsong; Verschuren, Dirk

    2011-04-01

    Both Atlantic and Indian Ocean climate dynamics exert influence over tropical African hydroclimate, producing complex patterns of convergence and precipitation. To isolate the Indian Ocean influence on African paleohydrology, we analyzed the deuterium/hydrogen ratio of higher plant leaf waxes ( δD wax) in a 25 000-year sediment record from Lake Challa (3° S, 38° E) in the easternmost area of the African tropics. Whereas both the seismic record of inferred lake level fluctuations and the Branched and Isoprenoidal Tetraether (BIT) index proxy record changes in hydrology within the Challa basin, δD wax, as a proxy for the isotopic composition of precipitation ( δD P) is interpreted as a tracer of large-scale atmospheric circulation that integrates the history of the moisture transported to the Lake Challa area. Specifically, based on modern-day isotope-rainfall relationships, we argue that Lake Challa δD wax reflects the intensity of East African monsoon circulation. The three hydrological proxy records show generally similar trends for the last 25 000 years, but there are important differences between them, primarily during the middle Holocene. We interpret this deviation of δD wax from local hydrological history as a decoupling of East African monsoon intensity - which heavily influences the isotopes of precipitation in East Africa today - from rainfall amount in the Challa basin. In combination, the hydrological proxy data from Lake Challa singularly highlight zonal gradients in tropical African climate that occur over a variety of timescales, suggesting that the Congo Air Boundary plays a fundamental role in controlling hydroclimate in the African tropics.

  9. Polypharmacy in the HIV-infected older adult population

    PubMed Central

    Gleason, Lauren J; Luque, Amneris E; Shah, Krupa

    2013-01-01

    The prevalence of human immunodeficiency virus (HIV) infection among people older than 50 years is increasing. Older HIV-infected patients are particularly at risk for polypharmacy because they often have multiple comorbidities that require pharmacotherapy. Overall, there is not much known with respect to both the impact of aging on medication use in HIV-infected individuals, and the potential for interactions with highly active antiretroviral therapy (HAART) and coadministered medications and its clinical consequences. In this review, we aim to provide an overview of polypharmacy with a focus on its impact on the HIV-infected older adult population and to also provide some clinical considerations in this high-risk population. PMID:23818773

  10. [HIV infection and parenteral virus hepatitis in the Krasnodar territory].

    PubMed

    Larin, F I; Lebedev, V V; Red'ko, A N

    2005-01-01

    The analysis of the morbidity dynamics of HIV infection, hepatitis B and C in the Krasnodar territory for 1996-2003 is presented. The tendency of strengthening direct correlation between age-dependent rates in these groups of diseases has been established. The correlation coefficient (rxy) is at present +0.851 (HIV infection-virus hepatitis B) and +0.892 (HIV infection-virus hepatitis C). The highest levels of primary morbidity are registered in persons aged 20-39 years. The established epidemiological parallels between HIV infection and parenteral hepatitis require the development of the unified strategy of the prophylaxis of these diseases on the federal and regional levels. PMID:16028521

  11. Dendritic cells in progression and pathology of HIV infection

    PubMed Central

    Manches, Olivier; Frleta, Davor; Bhardwaj, Nina

    2014-01-01

    Although the major targets of HIV infection are CD4+ T cells, dendritic cells (DC) represent a crucial subset in HIV infection as they influence viral transmission, target cell infection and antigen presentation of HIV antigens. DC are potent antigen presenting cells that can modulate anti-viral immune responses. Through secretion of inflammatory cytokines and interferons (IFN), DC also alter T cell proliferation and differentiation, participating in the immune dysregulation characteristic of chronic HIV infection. Their wide distribution in close proximity with the mucosal epithelia makes them one of the first cell types to encounter HIV during sexual transmission [1]. We will discuss here the multiple roles that DC play at different stages of HIV infection, emphasizing their relevance to HIV pathology and progression. PMID:24246474

  12. Unreported Male Sex Partners Among Men with Newly Diagnosed HIV Infection - North Carolina, 2011-2013.

    PubMed

    Wu, Hsiu; Hightow-Weidman, Lisa B; Gay, Cynthia L; Zhang, Xinjian; Beagle, Steve; Hall, Laura; Jackson, Tonyka; Marmorino, Jenni; Do, Ann N; Peters, Philip J

    2015-09-25

    Human immunodeficiency virus (HIV) prevention interventions, such as preexposure prophylaxis (PrEP), are often targeted to men who have sex with men (MSM) who self-report high-risk behaviors. Data from a prospective study evaluating methods to detect acute HIV infection among a primarily young (aged <25 years) and black or African American (African American) population from North Carolina were analyzed. In the study, participants were asked about risk behaviors during pretest counseling (at the time of testing) and then during a partner services interview (at HIV diagnosis). Participants whose disclosure of sexual risk behaviors during pretest counseling was different from their disclosure of sexual risk behaviors during their partner services interview were identified, and factors associated with these discordant responses were examined. Among 113 HIV-infected men, 26 (23.0%) did not disclose male sex partners at pretest counseling, but subsequently did disclose this information during their partner services interview. When compared with men who disclosed having male partners at pretest counseling, these 26 MSM who did not disclose male partners during pretest counseling were found to have a similar number of male partners during contact tracing, but were more likely to have a female partner (30.8% versus 6.9%). In addition, the proportions of MSM found to have at least one HIV-infected partner were similar for both groups (MSM who disclosed having male partners during pretest counseling and those who did not). To better customize HIV prevention interventions for MSM, HIV prevention programs might consider using novel strategies to accurately assess risk in this population. PMID:26401589

  13. Evaluation of Olfactory and Gustatory Function of HIV Infected Women

    PubMed Central

    Kuti, Kehinde Mobolanle; Nwaorgu, Onyekwere George; Akinyinka, Olusina Olusegun

    2016-01-01

    Background. Compliance with medication requires good sense of smell and taste. Objective. To evaluate the olfactory and gustatory function of HIV infected women in Ibadan, Nigeria. Methods. A case control study of women comprising 83 HIV infected women and 79 HIV uninfected women. Subjective self-rating of taste and smell function was by visual analogue scale. Olfactory function was measured via olfactory threshold (OT), olfactory discrimination (OD), olfactory identification (OI), and TDI using “Sniffin' sticks” kits and taste function (Total Taste Strips (TTS) score) measurement was by taste strips. Results. The mean age of the HIV infected women was 43.67 years ± 10.72 and control was 41.48 years ± 10.99. There was no significant difference in the self-reported assessment of smell (p = 0.67) and taste (p = 0.84) of HIV infected and uninfected women. Although the mean OT, OD, OI, TDI, and TTS scores of HIV infected and uninfected women were within the normosmic and normogeusic values, the values were significantly higher in the controls (p < 0.05). Hyposmia was in 39.7% of subjects and 12.6% of controls while hypogeusia was in 15.7% of subjects and 1.3% of controls. Conclusions. Hyposmia and hypogeusia are commoner among the HIV infected women than the HIV uninfected women and the risk increases with an increased duration of highly active antiretroviral therapy. PMID:27047688

  14. Women and HIV infection: the makings of a midlife crisis.

    PubMed

    Santoro, Nanette; Fan, Maria; Maslow, BatSheva; Schoenbaum, Ellie

    2009-11-20

    With the advent of highly active antiretroviral agents, women with HIV infection can expect to live longer than ever before. This increased survival has led to concerns about the long-term implications of HIV disease and its treatment. Women with HIV infection appear to lose ovarian function earlier in life than women without HIV infection. They also have evidence of reduced bone mineral density and increased cardiovascular risk. Moreover, many of these increases in risk factors are present even prior to the menopausal transition. All of these risks, present at midlife, augur poorly for future health and describe a substantially increased burden of disease likely to accrue to HIV-infected women as they enter older age groups. Further compounding the adversity faced by the HIV infected, the demographics of women most vulnerable to this disease include adverse social and economic influences, both of which worsen their long-term prognosis. For example, drug use and poverty are related to more severe menopausal symptoms and chronic stress is related to worse psychological and cardiovascular risk. An understanding of how menopause interacts with HIV infection is therefore most important to alert the clinician to perform surveillance for common health problems in postmenopausal women, and to address directly and appropriately symptomatology during the menopausal transition. PMID:19783389

  15. Women and HIV Infection: The Makings of a Midlife Crisis

    PubMed Central

    Santoro, Nanette; Fan, Maria; Maslow, BatSheva; Schoenbaum, Ellie

    2009-01-01

    With the advent of highly active antiretroviral agents, women with HIV infection can expect to live longer than ever before. This increased survival has led to concerns about the long-term implications of HIV disease and its treatment. Women with HIV infection appear to lose ovarian function earlier in life than women without HIV infection. They also have evidence of reduced bone mineral density and increased cardiovascular risk. Moreover, many of these increases in risk factors are present even prior to the menopausal transition. All of these risks, present at mid-life, augur poorly for future health and describe a substantially increased burden of disease likely to accrue to HIV infected women as they enter older age groups. Further compounding the adversity faced by the HIV infected, the demographics of women most vulnerable to this disease include adverse social and economic influences, both of which worsen their long term prognosis. For example, drug use and poverty are related to more severe menopausal symptoms and chronic stress is related to worse psychological and cardiovascular risk. An understanding of how menopause interacts with HIV infection is therefore most important to alert the clinician to perform surveillance for common health problems in postmenopausal women, and to address directly and appropriately symptomatology during the menopausal transition. PMID:19783389

  16. Effects of tobacco smoking on HIV-infected individuals.

    PubMed

    Calvo, Marta; Laguno, Montserrat; Martínez, María; Martínez, Esteban

    2015-01-01

    A longer life expectancy and a high prevalence of tobacco smoking among HIV patients have led to an increasing cumulative exposure to tobacco in this community. Clinical recommendations for smoking cessation in HIV patients are mainly based on the body of evidence from the general population plus few available data from HIV cohort studies. The assumption that the pathophysiology of tobacco-related diseases in HIV-infected patients is similar to that in the general population may be questionable. This article reviews the pathophysiological mechanisms underlying health problems attributable to tobacco in HIV patients, and how these mechanisms may interact with those of HIV infection. Tobacco smoking exerts a greater health impact on HIV-infected patients than on uninfected smokers. Components of tobacco smoke and HIV infection induce complex interrelated pathophysiological changes through different pathways, affecting various organ systems with a cumulative or synergistic effect. This review supports the contention that HIV infection may confer an increased susceptibility to the harmful effects of smoking. Tobacco-related harm in the setting of HIV infection is still underestimated. A better understanding of the pathophysiological interaction between tobacco smoking and HIV will help to promote smoking cessation in this specific population. PMID:25427101

  17. Spatial Distributions of HIV Infection in an Endemic Area of Western Kenya: Guiding Information for Localized HIV Control and Prevention.

    PubMed

    Hoshi, Tomonori; Fuji, Yoshito; Nzou, Samson Muuo; Tanigawa, Chihiro; Kiche, Ibrahim; Mwau, Matilu; Mwangi, Anne Wanjiru; Karama, Mohamed; Hirayama, Kenji; Goto, Kensuke; Kaneko, Satoshi

    2016-01-01

    HIV is still a major health problem in developing countries. Even though high HIV-risk-taking behaviors have been reported in African fishing villages, local distribution patterns of HIV infection in the communities surrounding these villages have not been thoroughly analyzed. The objective of this study was to investigate the geographical distribution patterns of HIV infection in communities surrounding African fishing villages. In 2011, we applied age- and sex-stratified random sampling to collect 1,957 blood samples from 42,617 individuals registered in the Health and Demographic Surveillance System in Mbita, which is located on the shore of Lake Victoria in western Kenya. We used these samples to evaluate existing antibody detection assays for several infectious diseases, including HIV antibody titers. Based on the results of the assays, we evaluated the prevalence of HIV infection according to sex, age, and altitude of participating households. We also used Kulldorff's spatial scan statistic to test for HIV clustering in the study area. The prevalence of HIV at our study site was 25.3%. Compared with the younger age group (15-19 years), adults aged 30-34 years were 6.71 times more likely to be HIV-positive, and the estimated HIV-positive population among women was 1.43 times larger than among men. Kulldorff's spatial scan statistic detected one marginally significant (P = 0.055) HIV-positive and one significant HIV-negative cluster (P = 0.047) in the study area. These results suggest a homogeneous HIV distribution in the communities surrounding fishing villages. In addition to individual behavior, more complex and diverse factors related to the social and cultural environment can contribute to a homogeneous distribution pattern of HIV infection outside of African fishing villages. To reduce rates of transmission in HIV-endemic areas, HIV prevention and control programs optimized for the local environment need to be developed. PMID:26862764

  18. Spatial Distributions of HIV Infection in an Endemic Area of Western Kenya: Guiding Information for Localized HIV Control and Prevention

    PubMed Central

    Hoshi, Tomonori; Fuji, Yoshito; Nzou, Samson Muuo; Tanigawa, Chihiro; Kiche, Ibrahim; Mwau, Matilu; Mwangi, Anne Wanjiru; Karama, Mohamed; Hirayama, Kenji; Goto, Kensuke; Kaneko, Satoshi

    2016-01-01

    HIV is still a major health problem in developing countries. Even though high HIV-risk-taking behaviors have been reported in African fishing villages, local distribution patterns of HIV infection in the communities surrounding these villages have not been thoroughly analyzed. The objective of this study was to investigate the geographical distribution patterns of HIV infection in communities surrounding African fishing villages. In 2011, we applied age- and sex-stratified random sampling to collect 1,957 blood samples from 42,617 individuals registered in the Health and Demographic Surveillance System in Mbita, which is located on the shore of Lake Victoria in western Kenya. We used these samples to evaluate existing antibody detection assays for several infectious diseases, including HIV antibody titers. Based on the results of the assays, we evaluated the prevalence of HIV infection according to sex, age, and altitude of participating households. We also used Kulldorff’s spatial scan statistic to test for HIV clustering in the study area. The prevalence of HIV at our study site was 25.3%. Compared with the younger age group (15–19 years), adults aged 30–34 years were 6.71 times more likely to be HIV-positive, and the estimated HIV-positive population among women was 1.43 times larger than among men. Kulldorff’s spatial scan statistic detected one marginally significant (P = 0.055) HIV-positive and one significant HIV-negative cluster (P = 0.047) in the study area. These results suggest a homogeneous HIV distribution in the communities surrounding fishing villages. In addition to individual behavior, more complex and diverse factors related to the social and cultural environment can contribute to a homogeneous distribution pattern of HIV infection outside of African fishing villages. To reduce rates of transmission in HIV-endemic areas, HIV prevention and control programs optimized for the local environment need to be developed. PMID:26862764

  19. Pan-African granulites of central Dronning Maud Land and Mozambique: A comparison within the East-African-Antarctic orogen

    USGS Publications Warehouse

    Engvik, A.K.; Elevevold, S.; Jacobs, J.; Tveten, E.; de Azevedo, S.; Njange, F.

    2007-01-01

    Granulite-facies metamorphism is extensively reported in Late Neoproterozoic/Early Palaeozoic time during formation of the East-African-Antarctic orogen (EAAO). Metamorphic data acquired from the Pan-African orogen of central Dronning Maud Land (cDML) are compared with data from northern Mozambique. The metamorphic rocks of cDML are characterised by Opx±Grt-bearing gneisses and Sil+Kfs-bearing metapelites which indicate medium-P granulite-facies metamorphism. Peak conditions, which are estimated to 800-900ºC at pressures up to 1.0 GPa, were followed by near-isothermal decompression during late Pan-African extension and exhumation. Granulite-facies lithologies are widespread in northern Mozambique, and Grt+Cpx-bearing assemblages show that high-P granulite-facies conditions with PT reaching 1.55 GPa and 900ºC were reached during the Pan-African orogeny. Garnet is replaced by symplectites of Pl+Opx+Mag indicating isothermal decompression, and the subsequent formation of Pl+amphibole-coronas suggests cooling into amphibolite facies. It is concluded that high-T metamorphism was pervasive in EAAO in Late Neoproterozoic/Early Paleozoic time, strongly overprinting evidences of earlier metamorphic assemblages.

  20. Perceived Discrimination in Clinical Care in a Nationally Representative Sample of HIV-Infected Adults Receiving Health Care

    PubMed Central

    Schuster, Mark A; Collins, Rebecca; Cunningham, William E; Morton, Sally C; Zierler, Sally; Wong, Myra; Tu, Wenli; Kanouse, David E

    2005-01-01

    Background Perceived discrimination in clinical settings could discourage HIV-infected people from seeking health care, adhering to treatment regimens, or returning for follow-up. Objectives This study aims to determine whether HIV-infected people perceive that physicians and other health care providers have discriminated against them. Design, Participants Cross-sectional data (1996 to 1997) from the HIV Cost and Services Utilization Study (HCSUS), which conducted in-person interviews with a nationally representative probability sample of 2,466 HIV-infected adults receiving health care within the contiguous U.S. Measurements Reports of whether health care providers have been uncomfortable with the respondent, treated the respondent as an inferior, preferred to avoid the respondent, or refused the respondent service. Questions also covered the types of providers who engaged in these behaviors. Results Twenty-six percent of HIV-infected adults receiving health care reported experiencing at least 1 of 4 types of perceived discrimination by a health care provider since becoming infected with HIV, including 8% who had been refused service. White respondents (32%) were more likely than others (27%) and Latinos (21%) and nearly twice as likely as African Americans (17%) to report perceived discrimination (P<.001). Respondents whose first positive HIV test was longer ago were also more likely to report discrimination (P<.001). Respondents who reported discrimination attributed it to physicians (54%), nurses and other clinical staff (39%), dentists (32%), hospital staff (31%), and case managers or social workers (8%). Conclusions Many HIV-infected adults believe that their clinicians have discriminated against them. Clinicians should make efforts to address circumstances that lead patients to perceive discrimination, whether real or imagined. PMID:16117747

  1. Persisting high prevalence of pneumococcal carriage among HIV-infected adults receiving antiretroviral therapy in Malawi: a cohort study

    PubMed Central

    Heinsbroek, Ellen; Tafatatha, Terence; Phiri, Amos; Ngwira, Bagrey; Crampin, Amelia C.; Read, Jonathan M.; French, Neil

    2015-01-01

    Objective: HIV-infected adults have high rates of pneumococcal carriage and invasive disease. We investigated the effect of antiretroviral therapy (ART) on pneumococcal carriage in HIV-infected adults prior to infant pneumococcal conjugate vaccine (PCV) rollout. Design: Observational cohort study. Methods: We recruited HIV-infected adults newly attending a rural HIV clinic in northern Malawi between 2008 and 2010. Nasopharyngeal samples were taken at baseline and after 6, 12, 18 and 24 months. We compared pneumococcal carriage by ART status using generalized estimated equation models adjusted for CD4+ cell count, sex, seasonality, and other potential confounders. Results: In total, 336 individuals were included, of which 223 individuals started ART during follow-up. Individuals receiving ART had higher pneumococcal carriage than individuals not receiving ART (25.9 vs. 19.8%, P = 0.03) particularly for serotypes not included in PCV13 (16.1 vs. 9.6% P = 0.003). Following adjustment, increased carriage of non-PCV13 serotypes was still observed for individuals on ART, but results for all serotypes were nonsignificant [all serotypes: adjusted risk ratio (aRR) 1.22 (0.95–1.56); non-PCV13 serotypes: aRR 1.72, 95% CI 1.13–2.62]. Conclusion: Pneumococcal carriage in HIV-infected adults in Malawi remained high despite use of ART, consistent with failure of mucosal immune reconstitution in the upper respiratory tract. There was evidence of increased carriage of non-PCV13 serotypes. HIV-infected adults on ART could remain an important reservoir for pneumococcal diversity post infant pneumococcal vaccine introduction. Control of pneumococcal disease in African HIV remains a priority. PMID:26218599

  2. Treatment of Acute HIV Infection and the Potential Role of Acutely HIV-Infected Persons in Cure Studies.

    PubMed

    Little, Susan J

    Diagnosis of acute HIV infection is important for accurate estimation of HIV incidence, identifying persons who are unaware of their HIV infection, and offering immediate treatment and risk-reduction strategies. The higher viral loads associated with acute HIV infection are associated with an increased risk of transmission. Current treatment recommendations are the same for acute and established infections. Studies of acute HIV infection indicate that initiation of antiretroviral therapy during this period may allow greater recovery of CD4+ T-cell count and function and may result in a smaller latent viral reservoir and a skewing of infection away from central memory CD4+ T cells toward shorter-lived transitional memory CD4+ T cells. This article summarizes a presentation by Susan J. Little, MD, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in Los Angeles, California, in April 2015. PMID:27398768

  3. Seventy years of the East African Medical Journal towards safe motherhood.

    PubMed

    Ojwang, S B

    1993-06-01

    Obstetrical and gynaecological articles related to safe motherhood published in the East African Medical Journal between 1924 and 1989 were reviewed. A total of 133 topics were published. Out of these, 84 (63.2%) were obstetrical and 49 (36.8%) gynaecological. Out of the obstetrical topics, 66 were pregnancy related, 12 were public health and the rest medical topics. A rapid increase in the number of the relevant topics is seen especially after 1970. This is probably due to the increase in the number of of obstetricians training locally in the African region and the international nature of the Journal during the last two decades. PMID:8261963

  4. Feasibility of interactive videodisc technology to teach minority youth about preventing HIV infection.

    PubMed

    Schinke, S P; Orlandi, M A; Schilling, R F; Parms, C

    1992-01-01

    Hispanic and African American adolescents are more likely than white Anglo youth to harbor misconceptions about acquired immunodeficiency syndrome (AIDS) and are also more likely to engage in intravenous drug use and sexual intercourse. This paper describes the development of an AIDS prevention curriculum that uses an interactive videodisc program to teach skills for interventions. Focus group and expert panel studies yielded suggests for intervention vignettes and scenes relevant to Hispanic and African American adolescents. The authors then developed and produced a sample curriculum, specifically designed for Hispanic youth. Content was designed to build knowledge, attitudes, and skills in handling situations where young persons are at risk for human immunodeficiency virus (HIV) infection. The feasibility of the finished pilot product was tested with adolescents and with professionals who serve ethnic and racial minority youth. Adults and Hispanic adolescent viewers rated the videodisc as enjoyable, interesting, and likely to achieve positive effects with the intended target population. Findings suggest that the interactive videodisc is a useful way to interest and help Hispanic adolescents learn ways of reducing their risk of contracting and spreading HIV infection through lifestyle practices. This developmental research in the use of interactive videodisc also provides a basis for further investigation. PMID:1375760

  5. Prevalence and incidence of diabetes in HIV-infected minority patients on protease inhibitors.

    PubMed Central

    Salehian, Behrouz; Bilas, Josephine; Bazargan, Mohsen; Abbasian, Mohammad

    2005-01-01

    In HIV-infected patients, the use of protease inhibitors (PIs) is associated with a constellation of abdominal obesity; buffalo hump; decreased facial and subcutaneous fat; hyperlipidemia and type-2 diabetes mellitus, a so-called HAART-associated dysmetabolic syndrome. The incidence and prevalence of one of its components, the type-2 diabetes mellitus, among minority population is unknown. In August and September 1999, we reviewed 101 charts of HIV-infected patients who visited an inner-city HIV outpatient clinic. The age, gender, ethnicity, BMI, fasting plasma glucose, random serum glucose, triglycerides, CD4 counts, and the type and duration of antiretroviral drugs were recorded. Three years later (2002), the same patient charts were reviewed for evidence of new-onset diabetes. Ten percent of the subjects were identified as diabetic at baseline. The prevalence of diabetes was 12% among those who were taking PIs, compared to 0% among those who were not taking PIs. The incidence of newly diagnosed diabetes during this three-year period was 7.2%. Diabetes occurred only in the group taking PIs. Diabetic subjects were older than their nondiabetic counterparts. All were African Americans. Our study suggests that PIs increase the likelihood of diabetes developing with increasing age in African Americans infected with HIV. PMID:16173323

  6. Histopathological Changes of the Thyroid and Parathyroid Glands in HIV-Infected Patients

    PubMed Central

    Shakir, K. M. Mohamed; Shokrani, Babak; Madduri, Sujay; Mody, Vinod

    2014-01-01

    Objective. To study histopathology of the thyroid and parathyroid glands in HIV-infected African Americans in the United States. Methods. A retrospective review of 102 autopsy cases done by the Department of Pathology at Howard University Hospital from 1980 through 2007 was conducted. The histopathological findings of the thyroid and parathyroid glands were reviewed, both macroscopically and microscopically. A control group of autopsy patients with chronic non-HIV diseases was examined. Results. There were 71 males (70%) and 31 females (30%) with an average age of 38 years (range: 20–71 y). Thirteen patients with abnormal thyroid findings were identified. Interstitial fibrosis was the most common histological finding (4.9%), followed by thyroid hyperplasia (1.9%). Infectious disease affecting the thyroid gland was limited to 2.9% and consisted of mycobacterium tuberculosis, Cryptococcus neoformans, and cytomegalovirus. Kaposi sarcoma of the thyroid gland was present in only one case (0.9%). Parathyroid hyperplasia was the most common histological change noted in the parathyroid glands. Comparing the histological findings of cases and controls, we found a similar involvement of the thyroid, with a greater prevalence of parathyroid hyperplasia in HIV patients. Conclusion. Thyroid and parathyroid abnormalities are uncommon findings in the HIV-infected African American population. PMID:24587936

  7. HIV infection in traditional rural communities.

    PubMed

    Carwein, V L; Sabo, C E; Berry, D E

    1993-03-01

    The challenge to rural nurses to deliver knowledgeable and skilled nursing and health care to individuals with HIV infection and AIDS is indeed tremendous. Isolation of rural communities and health care facilities coupled with limited resources, financial concerns, conservative values of many traditional rural communities, and the tendency to exclude those who do not conform to community norms make it difficult to integrate the individual with HIV disease into the rural health care delivery system fully. Issues of particular concern to the rural nurse include maintenance of client confidentiality, obtaining and maintaining current knowledge and skills necessary to the provision of quality HIV nursing care, management of complex client health care problems, and provision of appropriate support services. Rural nurses must be innovative and creative in developing mechanisms to deal with these concerns. In addition, because rural nurses are well respected by the community and viewed as possessing a great deal of expertise in the delivery of health care, they are well positioned to provide leadership to the community in developing educational and care strategies to more effectively provide HIV care. Indeed, the delivery of high-quality HIV care in rural areas across the United States will likely depend on the expertise and leadership provided by rural nurses. PMID:8451211

  8. Post-treatment control of HIV infection

    DOE PAGESBeta

    Conway, Jessica M.; Perelson, Alan S.

    2015-04-13

    Antiretroviral therapy (ART) for HIV is not a cure. However, recent studies suggest that ART, initiated early during primary infection, may induce post-treatment control (PTC) of HIV infection with HIV RNA maintained at <50 copies per mL. We investigate the hypothesis that ART initiated early during primary infection permits PTC by limiting the size of the latent reservoir, which, if small enough at treatment termination, may allow the adaptive immune response to prevent viral rebound (VR) and control infection. We use a mathematical model of within host HIV dynamics to capture interactions among target cells, productively infected cells, latently infectedmore » cells, virus, and cytotoxic T lymphocytes (CTLs). Analysis of our model reveals a range in CTL response strengths where a patient may show either VR or PTC, depending on the size of the latent reservoir at treatment termination. Below this range, patients will always rebound, whereas above this range, patients are predicted to behave like elite controllers. As a result, using data on latent reservoir sizes in patients treated during primary infection, we also predict population-level VR times for non-controllers consistent with observations.« less

  9. A case of symptomatic primary HIV infection.

    PubMed

    Kobayashi, Satomi; Segawa, Satoko; Kawashima, Makoto; Itoda, Ichiro; Shima, Takako; Imai, Mitsunobu

    2005-02-01

    A 30-year-old homosexual Japanese man had fourteen days of fever, malaise, appetite loss, sore throat, and four days of diarrhea and slightly congested eyes before he developed a skin eruption. He presented with measles-like exanthems on his face, trunk, and extremities. Deep red enanthems were seen on his left buccal mucosa opposite the premolar teeth, and whitish enanthems were seen on the buccal and gingival mucosa. HIV RNA was detected at the high concentration of 5.8 x 10(6) copies /ml in his serum. Cerebrospinal fluid examination revealed aseptic meningitis with 5,488 copies /ml of HIV RNA. Anti-HIV 1 antibodies against Gp160 and p24 tested by Western blot assay showed seroconversion on day 5 of his admission, seven days after he developed the skin eruptions. The fever lasted for three weeks from the initial onset, and the skin eruptions lasted for twelve days. Histopathologically, a mononuclear cell infiltration was seen mainly in the upper dermis surrounding small vessels and sweat ducts, with CD8+ cytotoxic T lymphocytes predominant. Additionally, CD1a+ putative interdigitating dendritic cells had also infiltrated perivascularly, and were surrounded by CD8+ and CD4+ T cells. In situ hybridization study failed to detect HIV products in skin biopsy specimens. Our findings suggested that CD8+ T cells and their interaction with CD1a+ dendritic cells in the skin may be important in inducing skin manifestations in acute HIV infections. PMID:15906546

  10. Nanotechnology and the Treatment of HIV Infection

    PubMed Central

    Parboosing, Raveen; Maguire, Glenn E. M.; Govender, Patrick; Kruger, Hendrik G.

    2012-01-01

    Suboptimal adherence, toxicity, drug resistance and viral reservoirs make the lifelong treatment of HIV infection challenging. The emerging field of nanotechnology may play an important role in addressing these challenges by creating drugs that possess pharmacological advantages arising out of unique phenomena that occur at the “nano” scale. At these dimensions, particles have physicochemical properties that are distinct from those of bulk materials or single molecules or atoms. In this review, basic concepts and terms in nanotechnology are defined, and examples are provided of how nanopharmaceuticals such as nanocrystals, nanocapsules, nanoparticles, solid lipid nanoparticles, nanocarriers, micelles, liposomes and dendrimers have been investigated as potential anti-HIV therapies. Such drugs may, for example, be used to optimize the pharmacological characteristics of known antiretrovirals, deliver anti-HIV nucleic acids into infected cells or achieve targeted delivery of antivirals to the immune system, brain or latent reservoirs. Also, nanopharmaceuticals themselves may possess anti-HIV activity. However several hurdles remain, including toxicity, unwanted biological interactions and the difficulty and cost of large-scale synthesis of nanopharmaceuticals. PMID:22590683

  11. Neurologic diseases in HIV-infected patients.

    PubMed

    Bilgrami, Mohammed; O'Keefe, Paul

    2014-01-01

    Since the introduction of highly active antiretroviral therapy there has been an improvement in the quality of life for people with HIV infection. Despite the progress made, about 70% of HIV patients develop neurologic complications. These originate either in the central or the peripheral nervous system (Sacktor, 2002). These neurologic disorders are divided into primary and secondary disorders. The primary disorders result from the direct effects of the virus and include HIV-associated neurocognitive disorder (HAND), HIV-associated vacuolar myelopathy (VM), and distal symmetric polyneuropathy (DSP). Secondary disorders result from marked immunosuppression and include opportunistic infections and primary central nervous system lymphoma (PCNSL). A differential diagnosis which can be accomplished by detailed history, neurologic examination, and by having a good understanding of the role of HIV in various neurologic disorders will help physicians in approaching these problems. The focus of this chapter is to discuss neuropathogenesis of HIV, the various opportunistic infections, primary CNS lymphoma, neurosyphilis, CNS tuberculosis, HIV-associated peripheral neuropathies, HIV-associated neurocognitive disorder (HAND), and vacuolar myelopathy (VM). It also relies on the treatment recommendations and guidelines for the above mentioned neurologic disorders proposed by the US Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America. PMID:24365422

  12. Mycobacterial Lung Disease Complicating HIV Infection.

    PubMed

    Haas, Michelle K; Daley, Charles L

    2016-04-01

    Mycobacterial infections have caused enormous morbidity and mortality in people living with human immunodeficiency virus (HIV) infection. Of these, the most devastating has been tuberculosis (TB), the leading cause of death among HIV-positive persons globally. TB has killed more people living with HIV than any other infection. Diagnosis of latent TB infection (LTBI) is critical as treatment can prevent emergence of TB disease. Bacteriologic confirmation of TB disease should be sought whenever possible as well as drug susceptibility testing. When detected early, drug susceptible TB is curable. Similar to TB, nontuberculous mycobacteria (NTM) can also produce pulmonary and extrapulmonary infections including disseminated disease that can be fatal. Diagnosis through accurate identification of the pathogenic organism will greatly inform treatment. Depending on the NTM identified, treatment may not be curable. Ultimately, preventive strategies such as initiation of antiretroviral drugs and treatment of LTBI are interventions expected to have significant impacts on control of TB and NTM in the setting of HIV. This chapter will review the impact of pulmonary mycobacterial infections on HIV-positive individuals. PMID:26974300

  13. Post-treatment control of HIV infection

    SciTech Connect

    Conway, Jessica M.; Perelson, Alan S.

    2015-04-13

    Antiretroviral therapy (ART) for HIV is not a cure. However, recent studies suggest that ART, initiated early during primary infection, may induce post-treatment control (PTC) of HIV infection with HIV RNA maintained at <50 copies per mL. We investigate the hypothesis that ART initiated early during primary infection permits PTC by limiting the size of the latent reservoir, which, if small enough at treatment termination, may allow the adaptive immune response to prevent viral rebound (VR) and control infection. We use a mathematical model of within host HIV dynamics to capture interactions among target cells, productively infected cells, latently infected cells, virus, and cytotoxic T lymphocytes (CTLs). Analysis of our model reveals a range in CTL response strengths where a patient may show either VR or PTC, depending on the size of the latent reservoir at treatment termination. Below this range, patients will always rebound, whereas above this range, patients are predicted to behave like elite controllers. As a result, using data on latent reservoir sizes in patients treated during primary infection, we also predict population-level VR times for non-controllers consistent with observations.

  14. Will "Combined Prevention" Eliminate Racial/Ethnic Disparities in HIV Infection among Persons Who Inject Drugs in New York City?

    PubMed

    Des Jarlais, Don; Arasteh, Kamyar; McKnight, Courtney; Feelemyer, Jonathan; Hagan, Holly; Cooper, Hannah; Campbell, Aimee; Tross, Susan; Perlman, David

    2015-01-01

    It has not been determined whether implementation of combined prevention programming for persons who inject drugs reduce racial/ethnic disparities in HIV infection. We examine racial/ethnic disparities in New York City among persons who inject drugs after implementation of the New York City Condom Social Marketing Program in 2007. Quantitative interviews and HIV testing were conducted among persons who inject drugs entering Mount Sinai Beth Israel drug treatment (2007-2014). 703 persons who inject drugs who began injecting after implementation of large-scale syringe exchange were included in the analyses. Factors independently associated with being HIV seropositive were identified and a published model was used to estimate HIV infections due to sexual transmission. Overall HIV prevalence was 4%; Whites 1%, African-Americans 17%, and Hispanics 4%. Adjusted odds ratios were 21.0 (95% CI 5.7, 77.5) for African-Americans to Whites and 4.5 (95% CI 1.3, 16.3) for Hispanics to Whites. There was an overall significant trend towards reduced HIV prevalence over time (adjusted odd ratio = 0.7 per year, 95% confidence interval (0.6-0.8). An estimated 75% or more of the HIV infections were due to sexual transmission. Racial/ethnic disparities among persons who inject drugs were not significantly different from previous disparities. Reducing these persistent disparities may require new interventions (treatment as prevention, pre-exposure prophylaxis) for all racial/ethnic groups. PMID:25965957

  15. Will "Combined Prevention" Eliminate Racial/Ethnic Disparities in HIV Infection among Persons Who Inject Drugs in New York City?

    PubMed Central

    Des Jarlais, Don; Arasteh, Kamyar; McKnight, Courtney; Feelemyer, Jonathan; Hagan, Holly; Cooper, Hannah; Campbell, Aimee; Tross, Susan; Perlman, David

    2015-01-01

    It has not been determined whether implementation of combined prevention programming for persons who inject drugs reduce racial/ethnic disparities in HIV infection. We examine racial/ethnic disparities in New York City among persons who inject drugs after implementation of the New York City Condom Social Marketing Program in 2007. Quantitative interviews and HIV testing were conducted among persons who inject drugs entering Mount Sinai Beth Israel drug treatment (2007–2014). 703 persons who inject drugs who began injecting after implementation of large-scale syringe exchange were included in the analyses. Factors independently associated with being HIV seropositive were identified and a published model was used to estimate HIV infections due to sexual transmission. Overall HIV prevalence was 4%; Whites 1%, African-Americans 17%, and Hispanics 4%. Adjusted odds ratios were 21.0 (95% CI 5.7, 77.5) for African-Americans to Whites and 4.5 (95% CI 1.3, 16.3) for Hispanics to Whites. There was an overall significant trend towards reduced HIV prevalence over time (adjusted odd ratio = 0.7 per year, 95% confidence interval (0.6–0.8). An estimated 75% or more of the HIV infections were due to sexual transmission. Racial/ethnic disparities among persons who inject drugs were not significantly different from previous disparities. Reducing these persistent disparities may require new interventions (treatment as prevention, pre-exposure prophylaxis) for all racial/ethnic groups. PMID:25965957

  16. A new brachypterous scarab species, Orphnus longicornis (Coleoptera: Scarabaeidae: Orphninae), from the East African Rift.

    PubMed

    Frolov, Andrey; Akhmetova, Lilia

    2015-01-01

    The Afrotropical Region is the center of the diversity of the scarab beetle genus Orphnus MacLeay, 1819 (Coleoptera: Scarabaeidae: Orphninae), with 94 species occurring from Sahel in the north to Little Karoo in the south (Paulian, 1948; Petrovitz, 1971; Frolov, 2008). The East African Rift is one of the richest regions of the Afrotropics housing more than 20 species of Orphnus (Paulian, 1948; Frolov, 2013), most of which are endemic to this region. Yet the scarab beetle fauna of the East African Rift, and especially the Eastern Arc Mountains, is still inadequately studied. Examination of the material housed in the Museum of Natural History of Humboldt-Universität, Berlin, Germany (ZMHUB), revealed a series of brachypterous Orphnus beetles belonging to an undescribed species. The new species is described and illustrated below. PMID:26624632

  17. Use of dental care by HIV-infected medical patients.

    PubMed

    Coulter, I D; Marcus, M; Freed, J R; Der-Martirosian, C; Cunningham, W E; Andersen, R M; Maas, W R; Garcia, I; Schneider, D A; Genovese, B; Shapiro, M F; Bozzette, S A

    2000-06-01

    Although increasing attention has been paid to the use of dental care by HIV patients, the existing studies do not use probability samples, and no accurate population estimates of use can be made from this work. The intent of the present study was to establish accurate population estimates of the use of dental services by patients under medical care. The study, part of the HIV Cost and Services Utilization Study (HCSUS), created a representative national probability sample, the first of its kind, of HIV-infected adults in medical care. Both bivariate and logistic regressions were conducted, with use of dental care in the preceding 6 months as the dependent variable and demographic, social, behavioral, and disease characteristics as independent variables. Forty-two percent of the sample had seen a dental health professional in the preceding 6 months. The bivariate logits for use of dental care show that African-Americans, those whose exposure to HIV was caused by hemophilia or blood transfusions, persons with less education, and those who were employed were less likely to use dental care (p < 0.05). Sixty-five percent of those with a usual source of care had used dental care in the preceding 6 months. Use was greatest among those obtaining dental care from an AIDS clinic (74%) and lowest among those without a usual source of dental care (12%). We conclude that, in spite of the high rate of oral disease in persons with HIV, many do not use dental care regularly, and that use varies by patient characteristics and availability of a regular source of dental care. PMID:10890713

  18. Latitudinal Hydrologic Variability Along the East African Rift, Over the Past 200 Kyr

    NASA Astrophysics Data System (ADS)

    Scholz, C. A.

    2014-12-01

    Within the deep sediments of the large lakes of Africa's Great Rift Valley are continuous environmental records of remarkable antiquity and fidelity. Not only do stratigraphic sections from these basins extend back millions of years, many of the intervals represented contain high-resolution material of decadal resolution or better. East African lake basins remain sparsely sampled however, with only a few long and continuous records available. Our ability to image the lakes using seismic reflection methods greatly exceeds our opportunities for coring and drilling however; assessing stratal relationships observed in the geophysical data permits powerful inferences about past hydrologic changes. With intensive hydrocarbon exploration work underway in East Africa, industry well data can also help constrain and ground truth basin histories. Substantial spatio-temporal hydrologic variability is observed in East African basins over the past 200 kyr. Paleohydrological changes in the late Pleistocene and early Holocene are now well constrained in the northern hemisphere East African topics, with widespread aridity and in some cases lake desiccation observed during Heinrich Event 1. A climate recovery followed in the northern hemisphere East African tropics, with the early Holocene African Humid Period a time of positive water balance across most of the rift valley. The paleohydrology of southern hemisphere tropical East Africa is more equivocal, for instance with negligible draw-down of Lake Malawi at HE1. Whereas these late Pleistocene events represent substantial climate reorganizations, severe droughts during the middle-late Pleistocene (150-65 kyr BP) were far more intense, and produced much more severe drawdowns of Lakes Malawi and Tanganyika. Scientific drill cores, kullenberg cores, and extensive seismic reflection data sets from Lakes Malawi and Tanganyika provide indisputable evidence for lowstands of -500m and -600 m respectively. Climate changes that lowered the

  19. Trends and variability of East African rainfall and its relationship to the Mascarene High pressure system

    NASA Astrophysics Data System (ADS)

    Seregina, Larisa; Pinto, Joaquim G.; Fink, Andreas H.; Ermert, Volker

    2016-04-01

    In the recent decades, East Africa needs to deal with strong fluctuations in seasonal rainfall including precipitation extremes. In context of climate change, such extremes can become more frequent in the future. However, regional climate projections are uncertain about the future development of seasonal precipitation in the region. Rainfall regimes over East Africa are influenced by multiple factors, including two monsoon systems, several convergence zones and the Rift Valley lakes. In addition, local conditions, like topography, modulate the large-scale rainfall pattern. East African rainfall variability is also influenced by various teleconnections like the Indian Ocean Zonal Mode and El Niño Southern Oscillation. The study of past climate variability in East Africa requires sufficient observational data coverage in the region. As East Africa does not have a dense observational network of meteorological stations, satellite rainfall observations gain on importance in studies on climate variability in the region. The specific aim of the present study is the analysis of historic data from weather stations in East Africa (Kenya, Tanzania, Ruanda and Uganda), the use of gridded satellite products, and three-dimensional atmospheric reanalysis (e.g., ERA-Interim) to quantify climate variability in the recent past and to understand its causes. Climate variability and trends, including changes in extreme events, are evaluated using ETCCDI climate change and standardized precipitation indices. These climate indices are determined in order to investigate the variability of rainfall and its trends with the focus on recent decades. For seasonal trend analysis, an independent and non-calendaric rainfall onset criterion is introduced. In the follow-up, statistical and dynamical analyses are conducted to quantify the local impact of Mascarene High as a part of the Subtropical High Pressure Ridge on East African seasonal rainfall. Possible connections to pertinent large

  20. Stable isotope geochemistry of East African waters. [Abstract only

    SciTech Connect

    Sayer, M.D.; Cerling, T.E.; Bowman, J.R.

    1983-03-01

    Lakes and Rivers in East Africa have varied stable isotopic compositions. Lakes exhibit enriched delta13-C values (-2 to +5%), while their inflowing rivers show depleted values (-15 to -8%). Hot springs and standing pools of water have intermediate values. Some small lakes are extremely variable in delta18-0 or deltaD (+2 to +8% and +20 to +40%, respectively for Lake Naivasha), whereas larger lakes are relatively constant for long periods of time (+5.6 to 6.1 and +36 to 40, respectively for Lake Turkana). Isotopic values are unrelated to salinity for comparison between lakes. Stable isotopes also reveal the sources of hot spring discharges: the Kapedo hot springs probably originate from Maralel and not from Lake Baringo as local legend has it; the hot springs north of Lake Naivasha are of meteoric origin while those to the south of Lake Naivasha have similar isotopic compositions to Lake Naivasha.

  1. Investigating "mass hysteria" in early postcolonial Uganda: Benjamin H. Kagwa, East african psychiatry, and the Gisu.

    PubMed

    Pringle, Yolana

    2015-01-01

    In the early 1960s, medical officers and administrators began to receive reports of what was being described as "mass madness" and "mass hysteria" in Tanganyika (now Tanzania) and Uganda. Each epidemic reportedly affected between three hundred and six hundred people and, coming in the wake of independence from colonial rule, caused considerable concern. One of the practitioners sent to investigate was Benjamin H. Kagwa, a Ugandan-born psychiatrist whose report represents the first investigation by an African psychiatrist in East Africa. This article uses Kagwa's investigation to explore some of the difficulties facing East Africa's first generation of psychiatrists as they took over responsibility for psychiatry. During this period, psychiatrists worked in an intellectual climate that was both attempting to deal with the legacy of colonial racism, and which placed faith in African psychiatrists to reveal more culturally sensitive insights into African psychopathology. The epidemics were the first major challenge for psychiatrists such as Kagwa precisely because they appeared to confirm what colonial psychiatrists had been warning for years-that westernization would eventually result in mass mental instability. As this article argues, however, Kagwa was never fully able to free himself from the practices and assumptions that had pervaded his discipline under colonial rule. His analysis of the epidemics as a "mental conflict" fit into a much longer tradition of psychiatry in East Africa, and stood starkly against the explanations of the local community. PMID:24191308

  2. Multiplex PCR for the detection of African cassava mosaic virus and East African cassava mosaic Cameroon virus in cassava.

    PubMed

    Alabi, Olufemi J; Kumar, P Lava; Naidu, Rayapati A

    2008-12-01

    A multiplex PCR was developed for simultaneous detection of African cassava mosaic virus (ACMV) and East African cassava mosaic Cameroon virus (EACMCV) in cassava affected with cassava mosaic disease (CMD). One set of three primers consisting of an upstream primer common for both viruses and two down stream virus-specific primers were designed for simultaneous amplification of 368 base pair (bp) and 650 bp DNA fragments specific to the replicase gene of ACMV and EACMCV, respectively. Similarly, a second set of three primers were designed for simultaneous amplification of 540 bp and 655 bp fragments specific to the coat protein gene of EACMCV and ACMV, respectively. Primers that can amplify a 171 bp fragment of the large subunit of ribulose bisphosphate carboxylase oxygenase L were included as an internal control in these assays to determine the reliability of multiplex PCR. A simplified, cost-effective and rapid sample preparation method was adapted in place of the conventional plant DNA extraction procedure for multiplex PCR detection of ACMV and EACMCV. The method was validated using CMD-infected cassava samples obtained from farmers' fields in Nigeria. The multiplex PCR is useful for reliable assessment of the prevalence of CMBs in epidemiological studies and for crop improvement and phytosanitary programs in African countries. PMID:18789974

  3. Obesity Among HIV-Infected Adults Receiving Medical Care in the United States: Data From the Cross-Sectional Medical Monitoring Project and National Health and Nutrition Examination Survey

    PubMed Central

    Thompson-Paul, Angela M.; Wei, Stanley C.; Mattson, Christine L.; Robertson, McKaylee; Hernandez-Romieu, Alfonso C.; Bell, Tanvir K.; Skarbinski, Jacek

    2015-01-01

    Abstract Our objective was to compare obesity prevalence among human immunodeficiency virus (HIV)-infected adults receiving care and the U.S. general population and identify obesity correlates among HIV-infected men and women. Cross-sectional data was collected in 2009 to 2010 from 2 nationally representative surveys: Medical Monitoring Project (MMP) and National Health and Nutrition Examination Survey (NHANES). Weighted prevalence estimates of obesity, defined as body mass index ≥30.0 kg/m2, were compared using prevalence ratios (PR, 95% confidence interval [CI]). Correlates of obesity in HIV-infected adults were examined using multivariable logistic regression. Demographic characteristics of the 4006 HIV-infected adults in MMP differed from the 5657 adults from the general U.S. population in NHANES, including more men (73.2% in MMP versus 49.4% in NHANES, respectively), black or African Americans (41.5% versus 11.6%), persons with annual incomes <$20,000 (64.5% versus 21.9%), and homosexuals or bisexuals (50.9% versus 3.9%). HIV-infected men were less likely to be obese (PR 0.5, CI 0.5–0.6) and HIV-infected women were more likely to be obese (PR1.2, CI 1.1–1.3) compared with men and women in the general population, respectively. Among HIV-infected women, younger age was associated with obesity (<40 versus >60 years). Among HIV-infected men, correlates of obesity included black or African American race/ethnicity, annual income >$20,000 and <$50,000, heterosexual orientation, and geometric mean CD4+ T-lymphocyte cell count >200 cells/μL. Obesity is common, affecting 2 in 5 HIV-infected women and 1 in 5 HIV-infected men. Correlates of obesity differ for HIV-infected men and women; therefore, different strategies may be needed for the prevention and treatment. PMID:26166086

  4. Fine needle aspiration of salivary gland masses in HIV-infected patients.

    PubMed

    Michelow, Pam; Dezube, Bruce J; Pantanowitz, Liron

    2012-08-01

    Salivary gland disease is an important manifestation of HIV-infection. The aim of this study was to evaluate the cytologic findings of salivary gland fine needle aspiration (FNA) in South African human immunodeficiency virus (HIV)-infected patients. A retrospective review was performed on confirmed HIV-positive patients who underwent FNA of various body sites, including salivary glands, over a 5-year period. There were 495 (14.1%) salivary gland FNAs out of a total of 3,501 HIV-positive patients. This included 260 (52.5%) parotid, 226 (45.7%) submandibular, 2 (0.4%) sublingual, and 7 (1.4%) specimens labeled as a salivary gland aspirate, exact site not provided. Patients were of average age 34 years (range 9 months to 63 years) with a female: male ratio of 1:0.6. There were 37 (7.5%) inadequate FNAs and 22 (4.4%) that contained normal gland constituents only. Most diagnoses were benign and comprised 168 (33.9%) reactive lymphadenopathy, 115 (23.2%) benign lymphoepithelial cysts, 62 (12.5%) mycobacterial infections, and 52 (10.5%) abscesses, of which 10 had associated mycobacterial infections. Neoplasms accounted for 31 (6.7%) diagnoses including 11 pleomorphic adenomas, 13 lymphoma, 3 Kaposi sarcoma, 1 squamous cell carcinoma, 1 metastatic carcinoma, and 1 rhabdomyosarcoma. There were four epidermoid inclusion cysts, three non-specific sialadenitis, one mucocele, and one spindle cell lesion not able to be further characterized. FNA is a useful procedure to evaluate salivary gland lesions in an HIV-infected population, allowing prompt management to be undertaken and obviating the need for surgery in many instances, an important consideration in an underfunded public health care system. PMID:22807383

  5. Predictors of Reincarceration and Disease Progression Among Released HIV-Infected Inmates

    PubMed Central

    Giordano, Thomas P.; Harzke, Amy Jo; Spaulding, Anne C.; Wu, Z. Helen; Grady, James J.; Baillargeon, Gwen; Paar, David P.

    2010-01-01

    Abstract We conducted a retrospective cohort study to determine the 3-year reincarceration rate of all HIV-infected inmates (n = 1917) released from the Texas prison system between January 2004 and March 2006. We also analyzed postrelease changes in HIV clinical status in the subgroup of inmates who were subsequently reincarcerated and had either CD4 lymphocyte counts (n = 119) or plasma HIV RNA levels (n = 122) recorded in their electronic medical record at both release and reincarceration. Multivariable analyses were performed to assess predictors of reincarceration and clinical changes in HIV status. Only 20% of all HIV-infected inmates were reincarcerated within 3 years of release. Female inmates (hazard ratio [HR] 0.63; 95% confidence interval [CI], 0.47, 0.84) and inmates taking antiretroviral therapy at the time of release (HR 0.31; 95% CI, 0.25, 0.39) were at decreased risk of reincarceration. African Americans (HR 1.58; 95% CI, 1.22, 2.05), inmates with a major psychiatric disorder (HR 1.82; 95% CI, 1.41, 2.34), and inmates released on parole (HR 2.86; 95% CI, 2.31, 3.55) were at increased risk of reincarceration. A subgroup of reincarcerated inmates had a mean decrease in CD4 cell count of 79.4 lymphocytes per microliter (p < 0.0003) and a mean increase in viral load of 1.5 log10 copies per milliliter (p < 0.0001) in the period between release and reincarceration. Our findings, although substantially limited by selection bias, highlight the importance of developing discharge planning programs to improve linkage to community-based HIV care and reduce recidivism among released HIV-infected inmates. PMID:20565323

  6. HIV Infection and Microbial Diversity in Saliva

    PubMed Central

    Saxena, Deepak; Chen, Zhou; Liu, Gaoxia; Abrams, Willam R.; Phelan, Joan A.; Norman, Robert G.; Fisch, Gene S.; Corby, Patricia M.; Dewhirst, Floyd; Paster, Bruce J.; Kokaras, Alexis S.; Malamud, Daniel

    2014-01-01

    Limited information is available about the effects of HIV and subsequent antiretroviral treatment on host-microbe interactions. This study aimed to determine the salivary microbial composition for 10 HIV-seropositive subjects, before and 6 months after highly active antiretroviral therapy (HAART), compared with that for 10 HIV-seronegative subjects. A conventional culture and two culture-independent analyses were used and consistently demonstrated differences in microbial composition among the three sets of samples. HIV-positive subjects had higher levels of total cultivable microbes, including oral streptococci, lactobacilli, Streptococcus mutans, and Candida, in saliva than did HIV-negative subjects. The total cultivable microbial levels were significantly correlated with CD4+ T cell counts. Denaturing gradient gel electrophoresis (DGGE), which compared the overall microbial profiles, showed distinct fingerprinting profiles for each group. The human oral microbe identification microarray (HOMIM) assay, which compared the 16S rRNA genes, showed clear separation among the three sample groups. Veillonella, Synergistetes, and Streptococcus were present in all 30 saliva samples. Only minor changes or no changes in the prevalence of Neisseria, Haemophilus, Gemella, Leptotrichia, Solobacterium, Parvimonas, and Rothia were observed. Seven genera, Capnocytophaga, Slackia, Porphyromonas, Kingella, Peptostreptococcaceae, Lactobacillus, and Atopobium, were detected only in HIV-negative samples. The prevalences of Fusobacterium, Campylobacter, Prevotella, Capnocytophaga, Selenomonas, Actinomyces, Granulicatella, and Atopobium were increased after HAART. In contrast, the prevalence of Aggregatibacter was significantly decreased after HAART. The findings of this study suggest that HIV infection and HAART can have significant effects on salivary microbial colonization and composition. PMID:24523469

  7. HIV infection and microbial diversity in saliva.

    PubMed

    Li, Yihong; Saxena, Deepak; Chen, Zhou; Liu, Gaoxia; Abrams, Willam R; Phelan, Joan A; Norman, Robert G; Fisch, Gene S; Corby, Patricia M; Dewhirst, Floyd; Paster, Bruce J; Kokaras, Alexis S; Malamud, Daniel

    2014-05-01

    Limited information is available about the effects of HIV and subsequent antiretroviral treatment on host-microbe interactions. This study aimed to determine the salivary microbial composition for 10 HIV-seropositive subjects, before and 6 months after highly active antiretroviral therapy (HAART), compared with that for 10 HIV-seronegative subjects. A conventional culture and two culture-independent analyses were used and consistently demonstrated differences in microbial composition among the three sets of samples. HIV-positive subjects had higher levels of total cultivable microbes, including oral streptococci, lactobacilli, Streptococcus mutans, and Candida, in saliva than did HIV-negative subjects. The total cultivable microbial levels were significantly correlated with CD4+ T cell counts. Denaturing gradient gel electrophoresis (DGGE), which compared the overall microbial profiles, showed distinct fingerprinting profiles for each group. The human oral microbe identification microarray (HOMIM) assay, which compared the 16S rRNA genes, showed clear separation among the three sample groups. Veillonella, Synergistetes, and Streptococcus were present in all 30 saliva samples. Only minor changes or no changes in the prevalence of Neisseria, Haemophilus, Gemella, Leptotrichia, Solobacterium, Parvimonas, and Rothia were observed. Seven genera, Capnocytophaga, Slackia, Porphyromonas, Kingella, Peptostreptococcaceae, Lactobacillus, and Atopobium, were detected only in HIV-negative samples. The prevalences of Fusobacterium, Campylobacter, Prevotella, Capnocytophaga, Selenomonas, Actinomyces, Granulicatella, and Atopobium were increased after HAART. In contrast, the prevalence of Aggregatibacter was significantly decreased after HAART. The findings of this study suggest that HIV infection and HAART can have significant effects on salivary microbial colonization and composition. PMID:24523469

  8. Talaromyces (Penicillium) marneffei infection in non-HIV-infected patients.

    PubMed

    Chan, Jasper F W; Lau, Susanna K P; Yuen, Kwok-Yung; Woo, Patrick C Y

    2016-01-01

    Talaromyces (Penicillium) marneffei is an important pathogenic thermally dimorphic fungus causing systemic mycosis in Southeast Asia. The clinical significance of T. marneffei became evident when the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome epidemic arrived in Southeast Asia in 1988. Subsequently, a decline in the incidence of T. marneffei infection among HIV-infected patients was seen in regions with access to highly active antiretroviral therapy and other control measures for HIV. Since the 1990s, an increasing number of T. marneffei infections have been reported among non-HIV-infected patients with impaired cell-mediated immunity. Their comorbidities included primary adult-onset immunodeficiency due to anti-interferon-gamma autoantibodies and secondary immunosuppressive conditions including other autoimmune diseases, solid organ and hematopoietic stem cell transplantations, T-lymphocyte-depleting immunsuppressive drugs and novel anti-cancer targeted therapies such as anti-CD20 monoclonal antibodies and kinase inhibitors. Moreover, improved immunological diagnostics identified more primary immunodeficiency syndromes associated with T. marneffei infection in children. The higher case-fatality rate of T. marneffei infection in non-HIV-infected than HIV-infected patients might be related to delayed diagnosis due to the lack of clinical suspicion. Correction of the underlying immune defects and early use of antifungals are important treatment strategies. Clinicians should be familiar with the changing epidemiology and clinical management of T. marneffei infection among non-HIV-infected patients. PMID:26956447

  9. Posttraumatic stress disorder in response to HIV infection.

    PubMed

    Kelly, B; Raphael, B; Judd, F; Perdices, M; Kernutt, G; Burnett, P; Dunne, M; Burrows, G

    1998-11-01

    This study investigated the psychological impact of HIV infection through assessment of posttraumatic stress disorder in response to HIV infection. Sixty-one HIV-positive homosexual/bisexual men were assessed for posttraumatic stress disorder in response to HIV infection (PTSD-HIV) using a modified PTSD module of the DIS-III-R. Thirty percent met criteria for a syndrome of posttraumatic stress disorder in response to HIV diagnosis (PTSD-HIV). In over one-third of the PTSD cases, the disorder had an onset greater than 6 months after initial HIV infection diagnosis. PTSD-HIV was associated with other psychiatric diagnoses, particularly the development of first episodes of major depression after HIV infection diagnosis. PTSD-HIV was significantly associated with a pre-HIV history of PTSD from other causes, and other pre-HIV psychiatric disorders and neuroticism scores, indicating a similarity with findings in studies of PTSD from other causes. The findings from this preliminary study suggest that a PTSD response to HIV diagnosis has clinical validity and requires further investigation in this population and other medically ill groups. The results support the inclusion of the diagnosis of life-threatening illness as a traumatic incident that may lead to a posttraumatic stress disorder, which is consistent with the DSM-IV criteria. PMID:9854646

  10. Talaromyces (Penicillium) marneffei infection in non-HIV-infected patients

    PubMed Central

    Chan, Jasper FW; Lau, Susanna KP; Yuen, Kwok-Yung; Woo, Patrick CY

    2016-01-01

    Talaromyces (Penicillium) marneffei is an important pathogenic thermally dimorphic fungus causing systemic mycosis in Southeast Asia. The clinical significance of T. marneffei became evident when the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome epidemic arrived in Southeast Asia in 1988. Subsequently, a decline in the incidence of T. marneffei infection among HIV-infected patients was seen in regions with access to highly active antiretroviral therapy and other control measures for HIV. Since the 1990s, an increasing number of T. marneffei infections have been reported among non-HIV-infected patients with impaired cell-mediated immunity. Their comorbidities included primary adult-onset immunodeficiency due to anti-interferon-gamma autoantibodies and secondary immunosuppressive conditions including other autoimmune diseases, solid organ and hematopoietic stem cell transplantations, T-lymphocyte-depleting immunsuppressive drugs and novel anti-cancer targeted therapies such as anti-CD20 monoclonal antibodies and kinase inhibitors. Moreover, improved immunological diagnostics identified more primary immunodeficiency syndromes associated with T. marneffei infection in children. The higher case-fatality rate of T. marneffei infection in non-HIV-infected than HIV-infected patients might be related to delayed diagnosis due to the lack of clinical suspicion. Correction of the underlying immune defects and early use of antifungals are important treatment strategies. Clinicians should be familiar with the changing epidemiology and clinical management of T. marneffei infection among non-HIV-infected patients. PMID:26956447

  11. Identifying Recent HIV Infections: From Serological Assays to Genomics

    PubMed Central

    Moyo, Sikhulile; Wilkinson, Eduan; Novitsky, Vladimir; Vandormael, Alain; Gaseitsiwe, Simani; Essex, Max; Engelbrecht, Susan; de Oliveira, Tulio

    2015-01-01

    In this paper, we review serological and molecular based methods to identify HIV infection recency. The accurate identification of recent HIV infection continues to be an important research area and has implications for HIV prevention and treatment interventions. Longitudinal cohorts that follow HIV negative individuals over time are the current gold standard approach, but they are logistically challenging, time consuming and an expensive enterprise. Methods that utilize cross-sectional testing and biomarker information have become an affordable alternative to the longitudinal approach. These methods use well-characterized biological makers to differentiate between recent and established HIV infections. However, recent results have identified a number of limitations in serological based assays that are sensitive to the variability in immune responses modulated by HIV subtypes, viral load and antiretroviral therapy. Molecular methods that explore the dynamics between the timing of infection and viral evolution are now emerging as a promising approach. The combination of serological and molecular methods may provide a good solution to identify recent HIV infection in cross-sectional data. As part of this review, we present the advantages and limitations of serological and molecular based methods and their potential complementary role for the identification of HIV infection recency. PMID:26512688

  12. Care of Patients With HIV Infection: Antiretroviral Drug Regimens.

    PubMed

    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    The advent of combination antiretroviral drug regimens has transformed HIV infection from a fatal illness into a manageable chronic condition. All patients with HIV infection should be considered for antiretroviral therapy, regardless of CD4 count or HIV viral load, for individual benefit and to prevent HIV transmission. Antiretroviral drugs affect HIV in several ways: entry inhibitors block HIV entry into CD4 T cells; nucleotide and nucleoside reverse transcriptase inhibitors prevent reverse transcription from RNA to DNA via chain-terminating proteins; nonnucleoside reverse transcriptase inhibitors prevent reverse transcription through enzymatic inhibition; integrase strand transfer inhibitors block integration of viral DNA into cellular DNA; protease inhibitors block maturation and production of the virus. Current guidelines recommend six combination regimens for initial therapy. Five are based on tenofovir and emtricitabine; the other uses abacavir and lamivudine. Five include integrase strand transfer inhibitors. HIV specialists should assist with treating patients with complicated HIV infection, including patients with treatment-resistant HIV infection, coinfection with hepatitis B or C virus, pregnancy, childhood infections, severe opportunistic infections, complex drug interactions, significant drug toxicity, or comorbidities. Family physicians can treat most patients with HIV infection effectively by choosing appropriate treatment regimens, monitoring patients closely, and retaining patients in care. PMID:27092564

  13. Tobacco use and cessation in HIV-infected individuals

    PubMed Central

    Wewers, Mary Ellen; Ferketich, Amy; Diaz, Philip

    2013-01-01

    Synopsis The smoking prevalence estimates among HIV-infected individuals range from 40%-84%; much higher than the overall adult prevalence in the United States. Characteristics that are associated with smokers who are HIV-positive include drug and alcohol abuse, psychiatric comorbidities, and lower education and socioeconomic status. There are important health implications for HIV-infected smokers, including bacterial and Pneumocystis pneumonia, tuberculosis, COPD, lung cancer and coronary artery disease. To date, there have been few tobacco dependence treatment trials conducted among HIV-infected smokers. Most have used nicotine replacement therapy but abstinence rates were low. A recent preliminary study found the use of varenicline to be well tolerated and it may increase abstinence rates with HIV-infected individuals. Recommendations for future research include examining underlying factors that contribute to persistent smoking and barriers to abstinence, identifying ways to increase motivation for quit attempts, increasing the number of multi-centered, two-arm tobacco dependence treatment trials, and using highly efficacious first-line pharmacotherapy in tobacco dependence treatment intervention studies. Addressing the above-mentioned research gaps will help to reduce the tobacco-related disease burden of HIV-infected individuals in the future. PMID:23702169

  14. Identifying Recent HIV Infections: From Serological Assays to Genomics.

    PubMed

    Moyo, Sikhulile; Wilkinson, Eduan; Novitsky, Vladimir; Vandormael, Alain; Gaseitsiwe, Simani; Essex, Max; Engelbrecht, Susan; de Oliveira, Tulio

    2015-10-01

    In this paper, we review serological and molecular based methods to identify HIV infection recency. The accurate identification of recent HIV infection continues to be an important research area and has implications for HIV prevention and treatment interventions. Longitudinal cohorts that follow HIV negative individuals over time are the current gold standard approach, but they are logistically challenging, time consuming and an expensive enterprise. Methods that utilize cross-sectional testing and biomarker information have become an affordable alternative to the longitudinal approach. These methods use well-characterized biological makers to differentiate between recent and established HIV infections. However, recent results have identified a number of limitations in serological based assays that are sensitive to the variability in immune responses modulated by HIV subtypes, viral load and antiretroviral therapy. Molecular methods that explore the dynamics between the timing of infection and viral evolution are now emerging as a promising approach. The combination of serological and molecular methods may provide a good solution to identify recent HIV infection in cross-sectional data. As part of this review, we present the advantages and limitations of serological and molecular based methods and their potential complementary role for the identification of HIV infection recency. PMID:26512688

  15. Suitability of HIV-Infected Subjects for Insurance.

    PubMed

    Singh, Gurmukh; Salkind, Alan R; Kneepkens, Robert F

    2015-01-01

    Objectives .- To ascertain the suitability of HIV-positive individuals for insurance coverage based on international data and practices. Background .- During the first decade of HIV epidemic, diagnosis of HIV-infection carried a poor prognosis. Since the introduction of Highly Active Anti-Retroviral Therapy (HAART or ART), HIV infection is more like other chronic diseases with infected individuals often living 20 or more years after the diagnosis of HIV infection Methods .- Review of peer-reviewed publications was undertaken to assess the risk of death in the HIV-infected population as a whole as well as subsets with favorable outcomes and those with additional comorbidities, such as co-infection with hepatitis viruses and drug use. Results .- Review of literature revealed that in well-educated, non-drug using individuals, negative for hepatitis B and C infection, who had CD 4 counts above 500/cmm, viral loads below 500 particles/mL, and were compliant with treatment, the mortality rate was similar to that of general population. Conclusions .- The risk of death, in at least a subset of HIV-positive subjects, is low enough that insurance providers should consider stratifying HIV-infected individuals according to mortality risk and offering insurance rates comparable to people with other diseases with similar mortality risks. PMID:27584807

  16. Predicting East African spring droughts using Pacific and Indian Ocean sea surface temperature indices

    NASA Astrophysics Data System (ADS)

    Funk, C.; Hoell, A.; Shukla, S.; Bladé, I.; Liebmann, B.; Roberts, J. B.; Robertson, F. R.; Husak, G.

    2014-12-01

    In eastern East Africa (the southern Ethiopia, eastern Kenya and southern Somalia region), poor boreal spring (long wet season) rains in 1999, 2000, 2004, 2007, 2008, 2009, and 2011 contributed to severe food insecurity and high levels of malnutrition. Predicting rainfall deficits in this region on seasonal and decadal time frames can help decision makers implement disaster risk reduction measures while guiding climate-smart adaptation and agricultural development. Building on recent research that links more frequent East African droughts to a stronger Walker circulation, resulting from warming in the Indo-Pacific warm pool and an increased east-to-west sea surface temperature (SST) gradient in the western Pacific, we show that the two dominant modes of East African boreal spring rainfall variability are tied to SST fluctuations in the western central Pacific and central Indian Ocean, respectively. Variations in these two rainfall modes can thus be predicted using two SST indices - the western Pacific gradient (WPG) and central Indian Ocean index (CIO), with our statistical forecasts exhibiting reasonable cross-validated skill (rcv ≈ 0.6). In contrast, the current generation of coupled forecast models show no skill during the long rains. Our SST indices also appear to capture most of the major recent drought events such as 2000, 2009 and 2011. Predictions based on these simple indices can be used to support regional forecasting efforts and land surface data assimilations to help inform early warning and guide climate outlooks.

  17. Monitoring Wetland Changes with Remote Sensing: An East African Example

    PubMed

    Haack

    1996-05-01

    Environmental managers need current, accurate information upon which to base decisions. Viable information, especially in developing countries, is often unavailable. Satellite remote sensing is an appropriate and effective data source for mapping the surface of the earth, including a variety of environmental features. Remote-sensing-derived information is enhanced by being one component within a geographic information system (GIS). These techniques were employed to study an expanding delta in East Africa.The Omo River flows from the Ethiopian Highlands into the northern end of Lake Turkana, creating a large delta extending between Ethiopia and Kenya. This isolated and unique wetland feature has expanded by over 500 sq km in the last 15 years as measured by space-borne remote sensing techniques and corroborated by low-altitude aircraft reconnaissance flights.The growth of the delta appears to be a function of both increased sedimentation and decreased lake levels and river flows. Within the delta there has been a selective decline in wildlife and an increase in human activity, both pastoral and agricultural. The uniqueness of this isolated delta suggests that consideration be given to its possible protection and management. PMID:8661611

  18. Multi-model trends in East African rainfall associated with increased CO2

    NASA Astrophysics Data System (ADS)

    McHugh, Maurice J.

    2005-01-01

    Nineteen coupled ocean-atmosphere general circulation models participating in the Coupled Model Intercomparison Program (CMIP) were used to analyze future rainfall conditions over East Africa under enhanced CO2 conditions. 80 year control runs of these models indicated that four models produced mean annual rainfall distributions closely resembling climatological means and all four models had normalized root mean square errors well within the bounds of observed variability. East African (10°N-20°S, 25°-50°E) rainfall data from transient 80 year experiments which featured CO2 increases of 1% per year were compared with 80 year control simulations. Results indicate enhanced annual and seasonal rainfall rates, and increased extreme wet period frequency. These results indicate that East Africa may face a future in which mosquito-borne diseases such as malaria and Rift Valley fever proliferate resulting from increased CO2.

  19. Gender attitudes and fertility aspirations among young men in five high fertility East African countries.

    PubMed

    Snow, Rachel C; Winter, Rebecca A; Harlow, Siobán D

    2013-03-01

    The relationship between women's attitudes toward gender equality and their fertility aspirations has been researched extensively, but few studies have explored the same associations among men. Using recent Demographic and Health Survey data from five high fertility East African countries, we examine the association between young men's gender attitudes and their ideal family size. Whereas several DHS gender attitude responses were associated with fertility aspirations in select countries, men's greater tolerance of wife beating was consistently associated with higher fertility aspirations across all countries, independent of education, income, or religion. Our findings highlight the overlapping values of male authority within marriage and aspirations for large families among young adult males in East Africa. Total lifetime fertility in East Africa remains among the highest worldwide: thus, governments in the region seeking to reduce fertility may need to explicitly scrutinize and address the reproduction of prevailing masculine values. PMID:23512871

  20. Orogen styles in the East African Orogen: A review of the Neoproterozoic to Cambrian tectonic evolution

    NASA Astrophysics Data System (ADS)

    Fritz, H.; Abdelsalam, M.; Ali, K. A.; Bingen, B.; Collins, A. S.; Fowler, A. R.; Ghebreab, W.; Hauzenberger, C. A.; Johnson, P. R.; Kusky, T. M.; Macey, P.; Muhongo, S.; Stern, R. J.; Viola, G.

    2013-10-01

    The East African Orogen, extending from southern Israel, Sinai and Jordan in the north to Mozambique and Madagascar in the south, is the world´s largest Neoproterozoic to Cambrian orogenic complex. It comprises a collage of individual oceanic domains and continental fragments between the Archean Sahara-Congo-Kalahari Cratons in the west and Neoproterozoic India in the east. Orogen consolidation was achieved during distinct phases of orogeny between ∼850 and 550 Ma. The northern part of the orogen, the Arabian-Nubian Shield, is predominantly juvenile Neoproterozoic crust that formed in and adjacent to the Mozambique Ocean. The ocean closed during a protracted period of island-arc and microcontinent accretion between ∼850 and 620 Ma. To the south of the Arabian Nubian Shield, the Eastern Granulite-Cabo Delgado Nappe Complex of southern Kenya, Tanzania and Mozambique was an extended crust that formed adjacent to theMozambique Ocean and experienced a ∼650-620 Ma granulite-facies metamorphism. Completion of the nappe assembly around 620 Ma is defined as the East African Orogeny and was related to closure of the Mozambique Ocean. Oceans persisted after 620 Ma between East Antarctica, India, southern parts of the Congo-Tanzania-Bangweulu Cratons and the Zimbabwe-Kalahari Craton. They closed during the ∼600-500 Ma Kuungan or Malagasy Orogeny, a tectonothermal event that affected large portions of southern Tanzania, Zambia, Malawi, Mozambique, Madagascar and Antarctica. The East African and Kuungan Orogenies were followed by phases of post-orogenic extension. Early ∼600-550 Ma extension is recorded in the Arabian-Nubian Shield and the Eastern Granulite-Cabo Delgado Nappe Complex. Later ∼550-480 Ma extension affected Mozambique and southern Madagascar. Both extension phases, although diachronous,are interpreted as the result of lithospheric delamination. Along the strike of the East African Orogen, different geodynamic settings resulted in the evolution of

  1. Orogen styles in the East African Orogen: A review of the Neoproterozoic to Cambrian tectonic evolution☆

    PubMed Central

    Fritz, H.; Abdelsalam, M.; Ali, K.A.; Bingen, B.; Collins, A.S.; Fowler, A.R.; Ghebreab, W.; Hauzenberger, C.A.; Johnson, P.R.; Kusky, T.M.; Macey, P.; Muhongo, S.; Stern, R.J.; Viola, G.

    2013-01-01

    The East African Orogen, extending from southern Israel, Sinai and Jordan in the north to Mozambique and Madagascar in the south, is the world́s largest Neoproterozoic to Cambrian orogenic complex. It comprises a collage of individual oceanic domains and continental fragments between the Archean Sahara–Congo–Kalahari Cratons in the west and Neoproterozoic India in the east. Orogen consolidation was achieved during distinct phases of orogeny between ∼850 and 550 Ma. The northern part of the orogen, the Arabian–Nubian Shield, is predominantly juvenile Neoproterozoic crust that formed in and adjacent to the Mozambique Ocean. The ocean closed during a protracted period of island-arc and microcontinent accretion between ∼850 and 620 Ma. To the south of the Arabian Nubian Shield, the Eastern Granulite–Cabo Delgado Nappe Complex of southern Kenya, Tanzania and Mozambique was an extended crust that formed adjacent to theMozambique Ocean and experienced a ∼650–620 Ma granulite-facies metamorphism. Completion of the nappe assembly around 620 Ma is defined as the East African Orogeny and was related to closure of the Mozambique Ocean. Oceans persisted after 620 Ma between East Antarctica, India, southern parts of the Congo–Tanzania–Bangweulu Cratons and the Zimbabwe–Kalahari Craton. They closed during the ∼600–500 Ma Kuungan or Malagasy Orogeny, a tectonothermal event that affected large portions of southern Tanzania, Zambia, Malawi, Mozambique, Madagascar and Antarctica. The East African and Kuungan Orogenies were followed by phases of post-orogenic extension. Early ∼600–550 Ma extension is recorded in the Arabian–Nubian Shield and the Eastern Granulite–Cabo Delgado Nappe Complex. Later ∼550–480 Ma extension affected Mozambique and southern Madagascar. Both extension phases, although diachronous,are interpreted as the result of lithospheric delamination. Along the strike of the East African Orogen, different geodynamic settings

  2. DEWORMING DELUSIONS? MASS DRUG ADMINISTRATION IN EAST AFRICAN SCHOOLS.

    PubMed

    Allen, Tim; Parker, Melissa

    2016-09-01

    Recent debates about deworming school-aged children in East Africa have been described as the 'Worm Wars'. The stakes are high. Deworming has become one of the top priorities in the fight against infectious diseases. Staff at the World Health Organization, the Gates Foundation and the World Bank (among other institutions) have endorsed the approach, and school-based treatments are a key component of large-scale mass drug administration programmes. Drawing on field research in Uganda and Tanzania, and engaging with both biological and social evidence, this article shows that assertions about the effects of school-based deworming are over-optimistic. The results of a much-cited study on deworming Kenyan school children, which has been used to promote the intervention, are flawed, and a systematic review of randomized controlled trials demonstrates that deworming is unlikely to improve overall public health. Also, confusions arise by applying the term deworming to a variety of very different helminth infections and to different treatment regimes, while local-level research in schools reveals that drug coverage usually falls below target levels. In most places where data exist, infection levels remain disappointingly high. Without indefinite free deworming, any declines in endemicity are likely to be reversed. Moreover, there are social problems arising from mass drug administration that have generally been ignored. Notably, there are serious ethical and practical issues arising from the widespread practice of giving tablets to children without actively consulting parents. There is no doubt that curative therapy for children infected with debilitating parasitic infections is appropriate, but overly positive evaluations of indiscriminate deworming are counter-productive. PMID:27428063

  3. Optimizing care for African-American HIV-positive patients.

    PubMed

    Smith, Kimberly Y; Brutus, Andre; Cathcart, Ronald; Gathe, Joseph; Johnson, William; Jordan, Wilbert; Kwakwa, Helena A; Nkwanyou, Joseph; Page, Carlos; Scott, Robert; Vaughn, Anita C; Virgil, Luther A; Williamson, Diana

    2003-10-01

    The African-American community has been disproportionately affected HIV/AIDS, as noted by higher reported rates of HIV infection, higher proportion of AIDS cases, and more deaths caused by complications of AIDS than whites and other ethnic groups. In addition, epidemiologic trends suggest that African Americans with HIV infection are more often diagnosed later in the course of HIV disease than whites. Numerous reasons account for this disparity, including the lack of perception of risk and knowledge about HIV transmission as well as a delays in HIV testing and diagnosis in the African-American community. Understanding the important considerations in the management of HIV infection in the African-American patient may create awareness among health care professionals and broaden the knowledge of HIV-infected patients within the African-American community. PMID:14588093

  4. Care of Patients With HIV Infection: Primary Care.

    PubMed

    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    With the advent of antiretroviral therapy and improved access to care, the average life expectancy of patients with HIV infection receiving optimal treatment approaches that of patients in the general population. AIDS-related opportunistic infections and malignancies are no longer the primary issues; instead, traditional age- and lifestyle-related conditions are a growing concern. Patients with HIV infection are at higher risk of cardiovascular disease, diabetes, hypertension, and some non-AIDS-related cancers than patients in the general population. Family physicians need to be knowledgeable about screening for and managing chronic comorbid conditions as this population ages. Health maintenance, including appropriate vaccinations, prophylaxis against opportunistic infections, and routine screening for sexually transmitted infections, remains an important part of care. As HIV infection becomes a chronic condition, emerging strategies in prevention, including preexposure prophylaxis, fall within the scope of practice of the family physician. PMID:27092565

  5. Early Life Circumstances as Contributors to HIV Infection

    PubMed Central

    Siegel, Karolynn; Lekas, Helen-Maria; Ramjohn, Destiny; Schrimshaw, Eric W.; VanDevanter, Nancy

    2015-01-01

    Adolescents may come from family settings that heighten their vulnerability to early sexual initiation, promiscuity and sexual exploitation. To illuminate how this may occur, we present a set of five representative cases of HIV-infected females from a sample of 26 adolescent and young adult HIV-infected females (ages 16–24) enrolled in a study about the adaptive challenges people their age faced living with the disease. Study participants were recruited from five New York City adolescent HIV clinics that provided comprehensive specialty medical and supportive ancillary social services to adolescents and young adults with HIV. Study participants completed a battery of standardizes measures, using ACASI, and participated in a semi-structured in-depth interview. Using the qualitative interview data, we illustrate how early life and family circumstances including neglectful or dysfunctional parenting (e.g., low parental supervision), sexual abuse, and unstable housing placed these young women on a risk trajectory for HIV infection. PMID:25397349

  6. The clinical implications of HIV infection and aging.

    PubMed

    John, M

    2016-04-01

    The objectives of this study, presented as part of a plenary session at WW7 in Hyderabad, India were to review (i) the epidemiology and current clinical issues of HIV infection with regard to HIV and older populations and (ii) models for increased morbidity and mortality in older HIV-positive individuals with implications for clinical care. HIV infection for those in treatment has become a complex chronic disease in which end-organ injury and resulting morbidity, functional decline, and mortality do not have a single etiology but reflect cumulative loss of organ system reserve from multiple interacting sources leading to functional decline, organ system failure, and death. Emerging guidelines and recommendations suggest a need for increased awareness and treatment of the multifaceted needs of the aging HIV-infected patient. PMID:27109276

  7. Urinary Markers of Tubular Injury in HIV-Infected Patients

    PubMed Central

    Gebreweld, Angesom

    2016-01-01

    Renal disease is a common complication of HIV-infected patients, associated with increased risk of cardiovascular events, progression to AIDS, AIDS-defining illness, and mortality. Early and accurate identification of renal disease is therefore crucial to improve patient outcomes. The use of serum creatinine, along with proteinuria, to detect renal involvement is essentially to screen for markers of glomerular disease and may not be effective in detecting earlier stages of renal injury. Therefore, more sensitive and specific markers are needed in order to early identify HIV-infected patients at risk of renal disease. This review article summarizes some new and important urinary markers of tubular injury in HIV-infected patients and their clinical usefulness in the renal safety follow-up of TDF-treated patients. PMID:27493802

  8. Oral and Airway Microbiota in HIV-Infected Pneumonia Patients

    PubMed Central

    Iwai, Shoko; Fei, Matthew; Huang, Delphine; Fong, Serena; Subramanian, Anuradha; Grieco, Katherine

    2012-01-01

    Despite the increased frequency of recurrent pneumonia in HIV-infected patients and recent studies linking the airway bacterial community (microbiota) to acute and chronic respiratory infection, little is known of the oral and airway microbiota that exist in these individuals and their propensity to harbor pathogens despite antimicrobial treatment for acute pneumonia. This pilot study compared paired samples of the oral and airway microbiota from 15 hospitalized HIV-infected patients receiving antimicrobial treatment for acute pneumonia. Total DNA was extracted, bacterial burden was assessed by quantitative PCR, and amplified 16S rRNA was profiled for microbiome composition using a phylogenetic microarray (16S rRNA PhyloChip). Though the bacterial burden of the airway was significantly lower than that of the oral cavity, microbiota in both niches were comparably diverse. However, oral and airway microbiota exhibited niche specificity. Oral microbiota were characterized by significantly increased relative abundance of multiple species associated with the mouth, including members of the Bacteroides, Firmicutes, and TM7 phyla, while airway microbiota were primarily characterized by a relative expansion of the Proteobacteria. Twenty-two taxa were detected in both niches, including Streptococcus bovis and Chryseobacterium species, pathogens associated with HIV-infected populations. In addition, we compared the airway microbiota of five of these patients to those of five non-HIV-infected pneumonia patients from a previous study. Compared to the control population, HIV-infected patients exhibited relative increased abundance of a large number of phylogenetically distinct taxa, which included several known or suspected pathogenic organisms, suggesting that recurrent pneumonia in HIV-infected populations may be related to the presence of these species. PMID:22760045

  9. The Oral Bacterial Communities of Children with Well-Controlled HIV Infection and without HIV Infection.

    PubMed

    Goldberg, Brittany E; Mongodin, Emmanuel F; Jones, Cheron E; Chung, Michelle; Fraser, Claire M; Tate, Anupama; Zeichner, Steven L

    2015-01-01

    The oral microbial community (microbiota) plays a critical role in human health and disease. Alterations in the oral microbiota may be associated with disorders such as gingivitis, periodontitis, childhood caries, alveolar osteitis, oral candidiasis and endodontic infections. In the immunosuppressed population, the spectrum of potential oral disease is even broader, encompassing candidiasis, necrotizing gingivitis, parotid gland enlargement, Kaposi's sarcoma, oral warts and other diseases. Here, we used 454 pyrosequencing of bacterial 16S rRNA genes to examine the oral microbiome of saliva, mucosal and tooth samples from HIV-positive and negative children. Patient demographics and clinical characteristics were collected from a cross-section of patients undergoing routine dental care. Multiple specimens from different sampling sites in the mouth were collected for each patient. The goal of the study was to observe the potential diversity of the oral microbiota among individual patients, sample locations, HIV status and various dental characteristics. We found that there were significant differences in the microbiome among the enrolled patients, and between sampling locations. The analysis was complicated by uneven enrollment in the patient cohorts, with only five HIV-negative patients enrolled in the study and by the rapid improvement in the health of HIV-infected children between the time the study was conceived and completed. The generally good oral health of the HIV-negative patients limited the number of dental plaque samples that could be collected. We did not identify significant differences between well-controlled HIV-positive patients and HIV-negative controls, suggesting that well-controlled HIV-positive patients essentially harbor similar oral flora compared to patients without HIV. Nor were significant differences in the oral microbiota identified between different teeth or with different dental characteristics. Additional studies are needed to better

  10. The Oral Bacterial Communities of Children with Well-Controlled HIV Infection and without HIV Infection

    PubMed Central

    Goldberg, Brittany E.; Mongodin, Emmanuel F.; Jones, Cheron E.; Chung, Michelle; Fraser, Claire M.; Tate, Anupama; Zeichner, Steven L.

    2015-01-01

    The oral microbial community (microbiota) plays a critical role in human health and disease. Alterations in the oral microbiota may be associated with disorders such as gingivitis, periodontitis, childhood caries, alveolar osteitis, oral candidiasis and endodontic infections. In the immunosuppressed population, the spectrum of potential oral disease is even broader, encompassing candidiasis, necrotizing gingivitis, parotid gland enlargement, Kaposi’s sarcoma, oral warts and other diseases. Here, we used 454 pyrosequencing of bacterial 16S rRNA genes to examine the oral microbiome of saliva, mucosal and tooth samples from HIV-positive and negative children. Patient demographics and clinical characteristics were collected from a cross-section of patients undergoing routine dental care. Multiple specimens from different sampling sites in the mouth were collected for each patient. The goal of the study was to observe the potential diversity of the oral microbiota among individual patients, sample locations, HIV status and various dental characteristics. We found that there were significant differences in the microbiome among the enrolled patients, and between sampling locations. The analysis was complicated by uneven enrollment in the patient cohorts, with only five HIV-negative patients enrolled in the study and by the rapid improvement in the health of HIV-infected children between the time the study was conceived and completed. The generally good oral health of the HIV-negative patients limited the number of dental plaque samples that could be collected. We did not identify significant differences between well-controlled HIV-positive patients and HIV-negative controls, suggesting that well-controlled HIV-positive patients essentially harbor similar oral flora compared to patients without HIV. Nor were significant differences in the oral microbiota identified between different teeth or with different dental characteristics. Additional studies are needed to better

  11. Intestinal Parasitoses in HIV Infected Children in a Nigerian Tertiary Hospital

    PubMed Central

    Oyedeji, Olusola Adetunji; Adejuyigbe, Ebun; Oninla, Samuel Olorunyomi; Akindele, Abiodum Akeem; Adedokun, Samuel Adeyinka

    2015-01-01

    Background Intestinal parasitoses are common amongst people living in developing countries. They may impact negatively on the growth and health of immune competent children. There is paucity of information on the association between HIV and intestinal parasitoses in African children. Objective To identify the intestinal infections responsible for infections in HIV infected children and document characteristics of HIV infected children at a Nigerian teaching hospital. Materials and Methods Consecutive children attending a Paediatric anti-retroviral clinic were studied. Information such as socio-demographics and clinical characteristics elicited from clinical examination were recorded in the proforma. Stool samples of the children were obtained and examined for intestinal parasites. Data was analysed with the SPSS 18 software. Results A total 52 children were studied and their age ranged between 6 months and 14 years, with a mean of 6.5 years ± 3.93. The 52 were made up of 27 boys and 25 girls, giving a male: female ratio of 1.1:1. 10 (19.2%) of the 52 children were infected with cryptosporidium spp, while 1(1.9%) had Ascaris lumbricoides infestation. Anti-helminthics had previously been administered to 86.5% of children studied. Those who previously received anti-helminthics had lower prevalence estimates of cryptosporidium infections. (p<0.01, RR = 0.42, 95%CI = 0.20 – 0.90). Children on co-trimoxazole prophylaxis had lower prevalence estimates of cryptosporidium infections. (P<0.01, RR = 0.35, 95%CI = 0.14 – 0.91). Use of highly active antiretroviral drugs was also associated with lower prevalence estimates of intestinal cryptosporidium. (p=0.04, RR = 0.58, 95%CI = 0.31 – 1.10). Eight of the 10 children infected with cryptosporidium had recurrent abdominal pain in comparison with the six with recurrent abdominal pain amongst the 42 without cryptosporidial infections. (p<0.01, RR=5.6, 95%CI= 2.51 – 12.1). Conclusion Cryptosporidial infection is the most

  12. Transactional sex among young women in rural South Africa: prevalence, mediators and association with HIV infection

    PubMed Central

    Ranganathan, Meghna; Heise, Lori; Pettifor, Audrey; Silverwood, Richard J; Selin, Amanda; MacPhail, Catherine; Delany-Moretlwe, Sinead; Kahn, Kathleen; Gómez-Olivé, F Xavier; Hughes, James P; Piwowar-Manning, Estelle; Laeyendecker, Oliver; Watts, Charlotte

    2016-01-01

    Introduction Young adolescent women in sub-Saharan Africa are three to four times more likely to be HIV-positive than boys or men. One of the relationship dynamics that is likely to be associated with young women's increased vulnerability to HIV is transactional sex. There are a range of HIV-related risk behaviours that may drive this vulnerability. However, to date, limited epidemiological data exist on the role of transactional sex in increasing HIV acquisition, especially among young women in sub-Saharan Africa. Our paper presents data on the prevalence of self-reported engagement in transactional sex and explores whether transactional sex is associated with increased risk of HIV infection among a cohort of young, rural, sexually active South African women. We also explore whether this relationship is mediated through certain HIV-related risk behaviours. Methods We analyzed baseline data from a phase III trial of conditional cash transfers for HIV prevention of 693 sexually active, school-going young women aged 13–20 years in rural South Africa. We examined the association between young women's engagement in transactional sex and HIV infection. Transactional sex is defined as a non-commercial, non-marital sexual relationship whereby sex is exchanged for money and/or gifts. We explored whether this relationship is mediated by certain HIV-related risk behaviours. We used logistic and multinomial regression and report unadjusted and adjusted odds ratios with 95% CI. Results Overall, 14% (n=97) of sexually active young women reported engaging in transactional sex. Engagement in transactional sex was associated with an increased risk of being HIV-positive (aOR: 2.5, CI: 95% 1.19–5.25, p=0.01). The effect size of this association remained nearly unchanged when adjusted for certain other dimensions of HIV risk that might help explain the underlying pathways for this relationship. Conclusions This study provides quantitative support demonstrating that transactional

  13. The 3-dimensional cellular automata for HIV infection

    NASA Astrophysics Data System (ADS)

    Mo, Youbin; Ren, Bin; Yang, Wencao; Shuai, Jianwei

    2014-04-01

    The HIV infection dynamics is discussed in detail with a 3-dimensional cellular automata model in this paper. The model can reproduce the three-phase development, i.e., the acute period, the asymptotic period and the AIDS period, observed in the HIV-infected patients in a clinic. We show that the 3D HIV model performs a better robustness on the model parameters than the 2D cellular automata. Furthermore, we reveal that the occurrence of a perpetual source to successively generate infectious waves to spread to the whole system drives the model from the asymptotic state to the AIDS state.

  14. Brucella canis causing infection in an HIV-infected patient.

    PubMed

    Lucero, Nidia E; Maldonado, Patricia I; Kaufman, Sara; Escobar, Gabriela I; Boeri, Eduardo; Jacob, Néstor R

    2010-06-01

    From the blood culture of an HIV-positive patient with a febrile syndrome (CD4 count 385 cells/microL and viral load nondetectable), Brucella canis was isolated. The patient was presumptively infected from his dogs, which tested positive, and showed good outcome after the therapy with doxycycline-ciprofloxacin, and the HIV infection would seem not to have been influenced by brucellosis. To our knowledge, no other case of B. canis in the setting of HIV infection has been reported in the literature, and the emerging zoonotic potential of the disease in urban areas should be considered. PMID:19725766

  15. Strategies for addressing restorative challenges in HIV-infected children.

    PubMed

    Abdelnur, Juliana Pires; Cerqueira, Daniella Ferraz; Castro, Gloria Fernanda; Maia, Lucianne Cople; de Souza, Ivete Pomarico Ribeiro

    2008-01-01

    The complete caries removal of deep/extensive dentin carious lesions with conventional procedures (high- and low-speed bur) may increase the risk of pulp exposure. In children with systemic diseases, such as HIV-infected children, the dental treatment proposed for the primary dentition with pulp involvement is tooth extraction once endodontic therapies cannot be guaranteed successfully. Therefore, the objective of this study was to describe 3 cases of alternative techniques for caries removal in extensive and/or deep dentin carious lesions in the primary dentition of HIV-infected children: (1) atraumatic restorative treatment (ART); (2) Carisolv; and (3) Papacarie. PMID:18505652

  16. Correlates of Antiretroviral Therapy Adherence among HIV-Infected Older Adults

    PubMed Central

    McCoy, Katryna; Waldrop-Valverde, Drenna; Balderson, Benjamin H.; Mahoney, Christine; Catz, Sheryl

    2016-01-01

    Background Despite the success of antiretroviral therapy (ART), HIV-infected older African Americans experience higher mortality rates compared to their white counterparts. This disparity may be partly attributable to the differences in ART adherence by different racial and gender groups. The purpose of this study was to describe demographic, psychosocial, and HIV disease-related factors that influence ART adherence and to determine whether race and gender impact ART adherence among HIV-infected adults aged 50 years and older. Methods This descriptive study involved a secondary analysis of baseline data from 426 participants in “PRIME,” a telephone-based ART adherence and quality-of-life intervention trial. Logistic regression was used to examine the association between independent variables and ART adherence. Results Higher annual income and increased self-efficacy were associated with being ≥95% ART adherent. Race and gender were not associated with ART adherence. Conclusion These findings indicated that improvements in self-efficacy for taking ART may be an effective strategy to improve adherence regardless of race or gender. PMID:27071744

  17. Intersecting Epidemics Among Pregnant Women: Alcohol Use, Interpersonal Violence, and HIV Infection in South Africa

    PubMed Central

    Russell, Beth S.; Eaton, Lisa A.; Petersen-Williams, Petal

    2013-01-01

    A critical factor for understanding negative health outcomes is acknowledging the synergistic quality that clusters of health problems create. An important step in addressing clusters of health problems involves gaining an awareness of the contextual factors that connect them. This paper considers the intersection of three mutually reinforcing health problems: alcohol use, interpersonal violence (IPV), and HIV infection among pregnant women residing in South Africa. We explore how SAVA (substance abuse, violence and AIDS)- a syndemics related theory- underscores the dire need to intervene in various areas of psycho-social health and general well-being. Based on World Health Organization data, we highlight the remarkably high rates of alcohol use, IPV, and HIV infection among South African women compared to women residing in other countries around the world. We conclude by highlighting the need for improved recognition of the intersection of these epidemics and for improved surveillance of the prevalence of alcohol use among pregnant women. Finally, based on the literature reviewed, we provide recommendations for future interventions. PMID:23233038

  18. Quantitative Evaluation of an Instrument to Identify Chronic Pain in HIV-Infected Individuals.

    PubMed

    Merlin, Jessica S; Westfall, Andrew O; Chamot, Eric; Saag, Michael; Walcott, Melonie; Ritchie, Christine; Kertesz, Stefan

    2015-06-01

    A method to rapidly identify the presence of chronic pain would enhance the care of HIV-infected individuals, but such an instrument has not been assessed in this population to date. We assessed the construct validity of the two-question Brief Chronic Pain Questionnaire (BCPQ) in HIV-infected patients by assessing the association between BCPQ responses and known correlates of chronic pain. Participants in the University of Alabama Center for AIDS Research Network of Integrated Clinical Systems cohort completed the BCPQ, along with the EuroQOL to assess physical function, the PHQ-9 to assess depression, and the PHQ-anxiety module to assess anxiety. Among 100 participants, 25% were female, the mean age was 45 (SD 12), 63% were African American, 27% were publicly insured, the median CD4(+) T cell count was 572 cells/mm(3) (IQR 307-788), and 82% had an undetectable viral load. Participants with chronic pain were more likely to have impaired mobility (43% vs. 12%, p=0.001), difficulty with usual activities (47% vs. 12%, p<0.001), lower overall health state (70 vs. 84, p=0.002), pain today (80% vs. 27%, p<0.001), depression (30% vs. 15%, p=0.10), and anxiety (43% vs. 10%, p<0.001) than those without chronic pain. This study provides preliminary evidence for the BCPQ as a brief questionnaire to identify the presence of chronic pain in HIV care settings. PMID:25693683

  19. Qualitative Investigation of a Brief Chronic Pain Screening Tool in HIV-Infected Patients

    PubMed Central

    Walcott, Melonie M.; Herbey, Ivan; Chamot, Eric; Ritchie, Christine; Saag, Michael S.; Kertesz, Stefan

    2014-01-01

    Abstract Chronic pain in HIV-infected patients is prevalent but understudied. A limitation of HIV/chronic pain research to date is the lack of a widely used chronic pain screening tool. A Brief Chronic Pain Screening tool (BCPS) has been described, but has not yet been tested in a clinical population. This study sought to evaluate how the BCPS is experienced by HIV-infected individuals, and adapt its questions if necessary. We conducted cognitive interviews using cognitive inquiry in participants from the UAB 1917 HIV Clinic Cohort. Data were analyzed using a process of inductive, iterative coding by three investigators. Results: Of 30 participants, most were male, African American, and less than 50 years old. Participants reported that the questions were understandable; however, feedback suggested concerns regarding lack of specificity in regard to the intensity and consistency of pain. An introductory statement aimed at improving clarity resulted in more divergent responses. This research team concluded that the version of the BCPS used in the first 30 interviews was optimum. Its inclusive language allows the respondent to decide what pain merits reporting. This study is the first investigation of the BCPS in a clinical population, and should lead to further quantitative validation studies of this tool. PMID:24621145

  20. Extension and Basin Evolution of the East Kivu Graben, Rwanda, East African Rift: Results of New Multichannel Seismic Reflection Imaging

    NASA Astrophysics Data System (ADS)

    Scholz, C. A.; Zhang, X.; Wood, D.; Mburu, D.

    2012-12-01

    The East Kivu Graben resides within the eastern part of Lake Kivu, the highest Great Lake in the western branch of the East African Rift. The lake is more than 440 m deep in the East Kivu Basin, with a catchment comprised of Precambrian metasedimentary rocks and late-Cenozoic volcanics. Lake Kivu is renowned for its uniquely stratified water column, which is charged with considerable quantities of dissolved CO2 and methane, the former due to magmatic degassing. In February and March 2012 514 km of single- and multi-channel seismic reflection data were acquired in the Rwandan waters of Lake Kivu. The 24-fold multichannel seismic data were acquired aboard a modular research vessel, using a 600 m-long hydrophone streamer and single 40 cubic inch airgun. Extension in the East Kivu basin is largely accommodated along a major N-S striking, east-dipping boundary fault observed along the eastern edge of Iwawa Island, and extending for ~40 km along the length of the basin. Numerous intrabasinal normal faults occur to the east of the boundary fault, commonly displacing the lake floor and controlling the location of modern sublacustrine channels. The deepest sedimentary reflections observed on the new MCS data are 1.2-1.5 km below lake floor, near the center of the basin and boundary fault. Crystalline basement is not observed in these deepest areas however, suggesting the presence of a substantial sedimentary section below the imaged strata. Stratal surfaces dip steeply to the west over large areas of the half-graben basin. An acoustically transparent seismic sequence up to ~25 m thick is observed at the lake floor, which overlies a pronounced erosional unconformity over much of the basin. Some intrabasinal normal faults are draped by and do not penetrate the upper sequences, indicating several generations of fault activity in the basin. The late-Pleistocene exposure surface likely correlates to the previous lake level low stage that persisted prior to volcanic damming by

  1. ILC You Later: Early and Irreparable Loss of Innate Lymphocytes in HIV Infection.

    PubMed

    Mudd, Joseph C; Brenchley, Jason M

    2016-02-16

    Loss of IL-17-producing cells in the gut during HIV infection is linked to GI barrier damage. Kløverpris et al. (2016) find that circulating ILCs are lost early and irreversibly during HIV infection. Early ART administration protects against the ILC loss, and this might be clinically beneficial to HIV-infected individuals. PMID:26885853

  2. Sexual Partner Notification of HIV Infection Among a National United States-Based Sample of HIV-Infected Men

    PubMed Central

    Edelman, E. J.; Gordon, K. S.; Hogben, M.; Crystal, S.; Bryant, K.; Justice, A.C.; Fiellin, D.A.

    2014-01-01

    Limited data exist on whether sexual partner notification practices among HIV-infected men, particularly those who have sex with men (MSM), vary by HIV viral load. We examined factors associated with complete (all partners) vs. incomplete partner notification in 760 HIV-infected individuals across the United States, 49% of whom were MSM. Thirty-four percent reported incomplete partner notification. Incomplete partner notification was more likely among black men, MSM, and those reporting casual partners and non-condom use. Partner notification practices did not vary by HIV viral load except among those with casual partners in whom a detectable viral load was associated with incomplete partner notification. Increased sexual partner notification among HIV-infected men, especially MSM, is needed. PMID:24858394

  3. Can we achieve an AIDS-free generation? Perspectives on the global campaign to eliminate new pediatric HIV infections.

    PubMed

    Abrams, Elaine J; Myer, Landon

    2013-07-01

    Efforts to prevent the mother-to-child transmission (PMTCT) of HIV infection have encountered remarkable successes and considerable challenges around the globe. The reductions in vertical HIV transmission observed in Europe and North America have helped raise the possibility of the virtual elimination of new pediatric HIV infections and in turn an "AIDS-free generation". Yet in many resource-limited settings, preventable new pediatric infections continue to occur daily. Here, we consider what will be required to reach an end to the global pediatric HIV epidemic, and what we can hope for in the context of resurgent international interest. The science of PMTCT has advanced dramatically since the first evidence for the use of antiretroviral (ARV) drugs for PMTCT in 1994. The timing and causes of vertical transmission are now well understood, and this knowledge has led directly to highly efficacious PMTCT interventions based on the use of combination ARV regimens. The application of these interventions around the world has been uneven, however. Several African countries report good access to and uptake of PMTCT services and corresponding low rates of early mother-to-child transmission. However, limited population coverage of PMTCT programs with continued use of suboptimal ARV regimens still hamper prevention efforts in many other countries. Looking forward, reaching ambitious international targets to reduce pediatric HIV infections will require a combination of increased access to efficacious ARV regimens and strengthened health systems for maternal and child health, supported by continued strong political will and international attention. PMID:23764637

  4. Health Needs of HIV-Infected Women in the United States: Insights from The Women Living Positive Survey

    PubMed Central

    Hodder, Sally L.; Feinberg, Judith; Bridge, Dawn Averitt; Abrams, Staats; Storfer, Stephen P.; Aberg, Judith A.

    2011-01-01

    Abstract The objective of this study was to describe attitudes, opinions, and perceived health needs of HIV-infected women in the United States. In this cross-sectional study, women were invited to participate in the Women Living Positive survey, a structured interview instrument with 45 questions. Collected data were deidentified and the margin of error was calculated as four percentage points. Incoming toll-free phone interviews were conducted from December 21, 2006, through March 14, 2007 among subjects recruited from a U.S. national network of AIDS counseling centers. Seven hundred HIV-infected women (43% African American, 28.5% Hispanic, 28.5% Caucasian; median age, 42.5 years) receiving combination antiretroviral therapy for 3 years or more replied to recruitment flyers. Overall, 55% of survey participants had never discussed gender-specific HIV treatment issues with their HIV care providers. Of the 45% who did discuss these issues, almost all (96%) were satisfied. On average, one-third of the women had seen three or more providers since beginning HIV treatment; 43% indicated they had switched providers because of communication issues. Among women who had been or were pregnant at the time of the survey (n=159), more than half (57%) had not had pre-pregnancy discussions with their HIV provider about the most appropriate HIV regimens for women attempting to become pregnant. Significant communication gaps exist between HIV-infected women and their providers when discussing gender-specific treatment issues. These data highlight a need for U.S. health care providers to incorporate discussion of gender-specific issues, including preconception and reproductive counseling, into management strategies for HIV-infected women. PMID:21446785

  5. Drinking Trajectories among HIV-Infected Men Who Have Sex With Men: A Cohort Study of United States Veterans*

    PubMed Central

    Marshall, Brandon D.L.; Operario, Don; Bryant, Kendall J.; Cook, Robert L.; Edelman, E. Jennifer; Gaither, Julie R.; Gordon, Adam J.; Kahler, Christopher W.; Maisto, Stephen A.; McGinnis, Kathleen A.; van den Berg, Jacob J.; Zaller, Nickolas D.; Justice, Amy C.; Fiellin, David A.

    2015-01-01

    Background Although high rates of alcohol consumption and related problems have been observed among HIV-infected men who have sex with men (MSM), little is known about the long-term patterns of and factors associated with hazardous alcohol use in this population. We sought to identify alcohol use trajectories and correlates of hazardous alcohol use among HIV-infected MSM. Methods Sexually active, HIV-infected MSM participating in the Veterans Aging Cohort Study were eligible for inclusion. Participants were recruited from VA infectious disease clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh, and Washington, DC. Data from annual self-reported assessments and group-based trajectory models were used to identify distinct alcohol use trajectories over an eight-year study period (2002–2010). We then used generalized estimate equations (GEE) to examine longitudinal correlates of hazardous alcohol use (defined as an AUDIT-C score ≥4). Results Among 1,065 participants, the mean age was 45.5 (SD=9.2) and 606 (58.2%) were African American. Baseline hazardous alcohol use was reported by 309 (29.3%). Group-based trajectory modeling revealed a distinct group (12.5% of the sample) with consistently hazardous alcohol use, characterized by a mean AUDIT-C score of >5 at every time point. In a GEE-based multivariable model, hazardous alcohol use was associated with earning <$6,000 annually, having an alcohol-related diagnosis, using cannabis, and using cocaine. Conclusions More than 1 in 10 HIV-infected MSM US veterans reported consistent, long-term hazardous alcohol use. Financial insecurity and concurrent substance use were predictors of consistently hazardous alcohol use, and may be modifiable targets for intervention. PMID:25596785

  6. Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy

    PubMed Central

    Yiannoutsos, Constantin Theodore; Johnson, Leigh Francis; Boulle, Andrew; Musick, Beverly Sue; Gsponer, Thomas; Balestre, Eric; Law, Matthew; Shepherd, Bryan E; Egger, Matthias

    2012-01-01

    Objective To provide estimates of mortality among HIV-infected patients starting combination antiretroviral therapy. Methods We report on the death rates from 122 925 adult HIV-infected patients aged 15 years or older from East, Southern and West Africa, Asia Pacific and Latin America. We use two methods to adjust for biases in mortality estimation resulting from loss from follow-up, based on double-sampling methods applied to patient outreach (Kenya) and linkage with vital registries (South Africa), and apply these to mortality estimates in the other three regions. Age, gender and CD4 count at the initiation of therapy were the factors considered as predictors of mortality at 6, 12, 24 and >24 months after the start of treatment. Results Patient mortality was high during the first 6 months after therapy for all patient subgroups and exceeded 40 per 100 patient years among patients who started treatment at low CD4 count. This trend was seen regardless of region, demographic or disease-related risk factor. Mortality was under-reported by up to or exceeding 100% when comparing estimates obtained from passive monitoring of patient vital status. Conclusions Despite advances in antiretroviral treatment coverage many patients start treatment at very low CD4 counts and experience significant mortality during the first 6 months after treatment initiation. Active patient tracing and linkage with vital registries are critical in adjusting estimates of mortality, particularly in low- and middle-income settings. PMID:23172344

  7. Gonadal function and reproductive health in women with HIV infection

    PubMed Central

    Yalamanchi, Swaytha; Dobs, Adrian; Greenblatt, Ruth M.

    2014-01-01

    Synopsis Most HIV infections among women occur early in reproductive life, which highlights the importance of understanding the impact of HIV on reproductive functions, and also the potential implications of reproductive function and aging on the course of HIV disease. HIV infection may influence reproductive biology via multiple mechanisms including: potential directs effects on HIV on the hypothalamic-pituitary-gonadal axes, implications of HIV-related immune dysfunction on reproductive biology, effects of antiretroviral treatments on reproductive functions and the impact of treatment related immune reconstitution on reproductive health. Ovarian function is a crucial component of reproductive biology in women, but standard assessment methods are of limited applicability to women with some chronic diseases, such as HIV. New antiretroviral treatments have the potential to increase the ease of conception planning, and to improve fertility. Drug-drug interactions between antiretroviral medications and hormonal contraceptives are potentially significant and merit careful provider attention. While HIV infection is not a major cause of infertility, high level viremia and low CD4 lymphocyte counts are associated with reduced fertility rates. Conception and pregnancy can now be achieved without transmission of HIV to sexual partner or new born, but complications of pregnancy may be more common in HIV infected women than uninfected women. PMID:25169564

  8. Bone health in children and adolescents with perinatal HIV infection

    PubMed Central

    Puthanakit, Thanyawee; Siberry, George K

    2013-01-01

    The long-term impact on bone health of lifelong HIV infection and prolonged ART in growing and developing children is not yet known. Measures of bone health in youth must be interpreted in the context of expected developmental and physiologic changes in bone mass, size, density and strength that occur from fetal through adult life. Low bone mineral density (BMD) appears to be common in perinatally HIV-infected youth, especially outside of high-income settings, but data are limited and interpretation complicated by the need for better pediatric norms. The potential negative effects of tenofovir on BMD and bone mass accrual are of particular concern as this drug may be used more widely in younger children. Emphasizing good nutrition, calcium and vitamin D sufficiency, weight-bearing exercise and avoidance of alcohol and smoking are effective and available approaches to maintain and improve bone health in all settings. More data are needed to inform therapies and monitoring for HIV-infected youth with proven bone fragility. While very limited data suggest lack of marked increase in fracture risk for youth with perinatal HIV infection, the looming concern for these children is that they may fail to attain their expected peak bone mass in early adulthood which could increase their risk for fractures and osteoporosis later in adulthood. PMID:23782476

  9. Liver involvement in HIV-infected patients with early syphilis.

    PubMed

    Palacios, R; Navarro, F; Narankiewicz, D; Marcos, M; Jiménez-Oñate, F; de la Torre, J; Santos, J

    2013-01-01

    The aim of the paper is to analyse the prevalence of liver involvement and related factors in HIV-infected patients with early syphilis (<2 years). Liver involvement was defined as an elevation above normal ranges of alanine transaminase, aspartate aminotransferase, gamma-glutamyltransferase and/or alkaline phosphatase during early syphilis, or doubling of previous levels in patients with liver enzyme elevation before syphilis. We undertook a multicentre study and of the 147 cases, 86.4% were men who had sex with men, and the diagnoses of syphilis and HIV infection were coincident in 48 (32.7%). Liver involvement was detected in 45 (30.6%) and the only related factor was a rapid plasma reagin (RPR) titre ≥1/64 (odds ratio 3.76; 95% confidence interval 1.3-10.5; P = 0.012). In conclusion, liver involvement occurs in around one-third of HIV-infected patients with early syphilis and is associated with high RPR levels. Syphilis should be included in the differential diagnosis of liver enzyme elevation in HIV-infected patients. PMID:23467288

  10. Ethanol stimulation of HIV infection of oral epithelial cells.

    PubMed

    Zheng, Jun; Yang, Otto O; Xie, Yiming; Campbell, Richard; Chen, Irvin S Y; Pang, Shen

    2004-12-01

    Oral mucosal cells can be infected by exogenous HIV during receptive oral sex or breast-feeding. The risk of oral mucosal infection depends on the infection efficiency of the HIV strains present in the oral cavity, the viral titers, and the defense mechanisms in the oral cavity environment. It is expected that alcohol can weaken the host defense mechanism against HIV infection in the oral cavity. We modified an HIV strain, NL4-3, by inserting the enhanced green fluorescent protein gene and used this virus to infect oral epithelial cells obtained from patients. Various concentrations of ethanol (0%-4%) were added to the infected cells. HIV-infected cells were detected by fluorescent microscopy or fluorescence-activated cell sorting. We found that ethanol significantly increases HIV infection of primary oral epithelial cells (POEs). POEs pretreated with 4% ethanol for less than 10 minutes demonstrated 3- to 6-fold higher susceptibility to infection by the CXCR-4 HIV strain NL4-3. Our studies also demonstrated that HIV infects POEs through a gp120-independent mechanism. We tested an HIV CCR5 strain, JRCSF, and also found its infection efficiency to be stimulated by alcohol. Our results indicate that in cell culture conditions, the ranges of concentrations of alcohol that are commercially available are able to stimulate the infection efficiency of HIV in POEs. PMID:15602121

  11. HIV-infection in the US, Canada, India and Thailand.

    PubMed

    1996-09-30

    A survey conducted in the US, Canada, India, and Thailand found that substantial numbers of health personnel were unaware both of problems associated with the enzyme-linked immunosorbent assay (ELISA) serologic test and of the asymptomatic stage of human immunodeficiency virus (HIV) infection. The proportion of surveyed physicians who had treated an HIV-infected patient ranged from a low of 30% in India to a high of 98% in the US. Mean HIV/acquired immunodeficiency syndrome (AIDS) knowledge scores were 83% in India, 84% in Thailand, 92% in Canada, and 93% in the US. Only 67% of health care providers from India understood the concept of false-negative ELISA test results, and only 78% of Canadian and 76% of US respondents understood the meaning of a false-positive result. Awareness of asymptomatic HIV infection ranged from 32% in India to 74% in Canada. The level of comfort in caring for AIDS patients and AIDS knowledge scores were directly correlated with the amount of previous contact with HIV-infected patients. India and Thailand have been identified by the World Health Organization as the countries likely to experience the sharpest increases in HIV in the years ahead. AIDS prevention efforts in these countries have been hindered by religious and cultural proscriptions against public discussions of sexuality, mistaken idea that AIDS is a foreigners' disease, inadequate funding, and concerns about adverse effects on the tourist industry. PMID:12179204

  12. Alcohol abuse and HIV infection: role of DRD2.

    PubMed

    Agudelo, Marisela; Khatavkar, Pradnya; Yndart, Adriana; Yoo, Changwon; Rosenberg, Rhonda; Devieux, Jessy G; Malow, Robert M; Nair, Madhavan

    2014-01-01

    According to a survey from the HIV Cost and Services Utilization Study (HCSUS), approximately 53% of HIV-infected patients reported drinking alcohol and 8% were classified as heavy drinkers. The role of alcohol as a risk factor for HIV infection has been widely studied and recent research has found a significant association between heavy alcohol consumption and lower levels of CD4 T cells among HIV-infected alcoholics. Although there is evidence on the role of alcohol as a risk factor for HIV transmission and disease progression, there is a need for population studies to determine the genetic mechanisms that affect alcohol's role in HIV disease progression. One of the mechanisms of interest is the dopaminergic system. To date, the effects of dopamine on HIV neuroimmune pathogenesis are not well understood; however, dopaminergic neural degeneration due to HIV is known to occur by viral invasion into the brain via immune cells, and modulation of dopamine in the CNS may be a common mechanism by which different types of substances of abuse impact HIV disease progression. Although previous studies have shown an association of D(2) dopamine receptor (DRD2) polymorphisms with severity of alcohol dependence, the expression of this allele risk on HIV patients with alcohol dependence has not been systematically explored. In the current study, DRD2 Taq1A and C957T SNP genotyping analyses were performed in 165 HIV-infected alcohol abusers and the results were examined with immune status and CD4 counts. PMID:25053368

  13. Confidentiality and Public Policy Regarding Children with HIV Infection.

    ERIC Educational Resources Information Center

    Harvey, David C.

    1994-01-01

    Addresses the relationship between law and policy, examining significant gains in establishing legal precedents for protecting the educational rights of children with Human Immunodeficiency Virus (HIV) infection in confronting HIV-related discrimination. The article looks at legal principles of confidentiality, disclosure, negligence and potential…

  14. Sulforaphane Inhibits HIV Infection of Macrophages through Nrf2

    PubMed Central

    Furuya, Andrea Kinga Marias; Sharifi, Hamayun J.; Jellinger, Robert M.; Cristofano, Paul; Shi, Binshan; de Noronha, Carlos M. C.

    2016-01-01

    Marburg virus, the Kaposi's sarcoma-associated herpesvirus (KSHV) and Dengue virus all activate, and benefit from, expression of the transcription regulator nuclear erythroid 2-related factor 2 (Nrf2). The impact of Nrf2 activation on human immunodeficiency virus (HIV) infection has not been tested. Sulforaphane (SFN), produced in cruciferous vegetables after mechanical damage, mobilizes Nrf2 to potently reprogram cellular gene expression. Here we show for the first time that SFN blocks HIV infection in primary macrophages but not in primary T cells. Similarly SFN blocks infection in PMA-differentiated promonocytic cell lines, but not in other cell lines tested. siRNA-mediated depletion of Nrf2 boosted HIV infectivity in primary macrophages and reduced the anti-viral effects of SFN treatment. This supports a model in which anti-viral activity is mediated through Nrf2 after it is mobilized by SFN. We further found that, like the type I interferon-induced cellular anti-viral proteins SAMHD1 and MX2, SFN treatment blocks infection after entry, but before formation of 2-LTR circles. Interestingly however, neither SAMHD1 nor MX2 were upregulated. This shows for the first time that Nrf2 action can potently block HIV infection and highlights a novel way to trigger this inhibition. PMID:27093399

  15. Parentification and Maternal HIV Infection: Beneficial Role or Pathological Burden?

    ERIC Educational Resources Information Center

    Tompkins, Tanya L.

    2007-01-01

    Parentification, along with parenting and child adjustment, were examined in 23 9-through 16-year-old youth from families affected by maternal HIV infection and 20 same-age peers whose mothers were not infected. Children whose mothers were HIV-positive reported to more often engage in parental role behaviors, relative to children of HIV-negative…

  16. The challenges of success: adolescents with perinatal HIV infection.

    PubMed

    Mofenson, Lynne M; Cotton, Mark F

    2013-01-01

    The great success in the prevention and treatment of pediatric HIV in high resource countries, and now in low resource countries, has changed the face of the HIV epidemic in children from one of near certain mortality to that of a chronic disease. However, these successes pose new challenges as perinatally HIV-infected youth survive into adulthood. Increased survival of HIV-infected children is associated with challenges in maintaining adherence to what is likely life-long therapy, and in selecting successive antiretroviral drug regimens, given the limited availability of pediatric formulations, limitations in pharmacokinetic and safety data of drugs in children, and the development of extensive drug resistance in multi-drug-experienced children. Pediatric HIV care must now focus on morbidity related to long-term HIV infection and its treatment. Survival into adulthood of perinatally HIV-infected youth in high resource countries provides important lessons about how the epidemic will change with increasing access to antiretroviral therapy for children in low resource countries. This series of papers will focus on issues related to management of perinatally infected youth and young adults. PMID:23782484

  17. The challenges of success: adolescents with perinatal HIV infection

    PubMed Central

    Mofenson, Lynne M; Cotton, Mark F

    2013-01-01

    The great success in the prevention and treatment of pediatric HIV in high resource countries, and now in low resource countries, has changed the face of the HIV epidemic in children from one of near certain mortality to that of a chronic disease. However, these successes pose new challenges as perinatally HIV-infected youth survive into adulthood. Increased survival of HIV-infected children is associated with challenges in maintaining adherence to what is likely life-long therapy, and in selecting successive antiretroviral drug regimens, given the limited availability of pediatric formulations, limitations in pharmacokinetic and safety data of drugs in children, and the development of extensive drug resistance in multi-drug-experienced children. Pediatric HIV care must now focus on morbidity related to long-term HIV infection and its treatment. Survival into adulthood of perinatally HIV-infected youth in high resource countries provides important lessons about how the epidemic will change with increasing access to antiretroviral therapy for children in low resource countries. This series of papers will focus on issues related to management of perinatally infected youth and young adults. PMID:23782484

  18. The Experience of Children with Hemophilia and HIV Infection.

    ERIC Educational Resources Information Center

    Hall, Christopher S.

    1994-01-01

    Children with hemophilia and Human Immunodeficiency Virus (HIV) infection are not a transmission risk to other children, and they can help enact best practices for school attendance by other such children. The article examines the National Hemophilia Foundation's work to promote appropriate inclusion of students with hemophilia and HIV in all…

  19. [HIV infection, gonorrhea and syphilis from Thailand to Norway].

    PubMed

    Aavitsland, P; Nilsen, O

    1999-10-30

    Thailand, a popular tourist destination for Norwegians, is experiencing an increasing epidemic of HIV infection. We used the Norwegian surveillance system for communicable diseases to assess the connections between the Norwegian and Thai epidemics. Before 1999, 1,869 cases of HIV-infection had been reported in Norway. From 1993 to 1998, 1,334 cases of gonorrhoea and 62 cases of syphilis were reported. We studied cases with a Thai patient or source partner and cases acquired in Thailand. 56 (3%) of HIV-infection cases, 64 (5%) of gonorrhoea cases and two (3%) of syphilis cases were connected to Thailand. All the Norwegians who acquired HIV in Thailand were males, with a median age of 39. Eight of them were diagnosed in 1998 as compared to 16 during the previous ten-year period. 21 Thai women and seven males were diagnosed with HIV infection in Norway, eight in 1998 and 20 in the previous ten-year period. The Norwegian HIV epidemic is influenced by the Thai epidemic. Norwegian men are infected in Thailand during holidays. Thai women come with their Norwegian partner to Norway and later discover their HIV status. We recommend raising the awareness of the Thai epidemic among Norwegian tourists. Immigrants to Norway from highly endemic countries should be offered HIV counselling and testing. PMID:10592752

  20. Geriatric Syndromes in Older HIV-Infected Adults

    PubMed Central

    Greene, Meredith; Covinsky, Kenneth E.; Valcour, Victor; Miao, Yinghui; Madamba, Joy; Lampiris, Harry; Cenzer, Irena Stijacic; Martin, Jeffrey; Deeks, Steven G.

    2015-01-01

    Background Geriatric syndromes such as falls, frailty, and functional impairment are multifactorial conditions used to identify vulnerable older adults. Limited data exists on these conditions in older HIV-infected adults and no studies have comprehensively examined these conditions. Methods Geriatric syndromes including falls, urinary incontinence, functional impairment, frailty, sensory impairment, depression and cognitive impairment were measured in a cross-sectional study of HIV-infected adults age 50 and older who had an undetectable viral load on antiretroviral therapy (ART). We examined both HIV and non-HIV related predictors of geriatric syndromes including sociodemographics, number of co-morbidities and non-antiretroviral medications, and HIV specific variables in multivariate analyses. Results We studied 155 participants with a median age of 57 (IQR 54-62); (94%) were men. Pre-frailty (56%), difficulty with instrumental activities of daily living (46%), and cognitive impairment (47%) were the most frequent geriatric syndromes. Lower CD4 nadir (IRR 1.16, 95% CI 1.06-1.26), non-white race (IRR 1.38, 95% CI 1.10-1.74), and increasing number of comorbidities (IRR 1.09, 95%CI 1.03-1.15) were associated with increased risk of having more geriatric syndromes. Conclusions Geriatric syndromes are common in older HIV infected adults. Treatment of comorbidities and early initiation of ART may help to prevent development of these age related complications. Clinical care of older HIV-infected adults should consider incorporation of geriatric principles. PMID:26009828

  1. Pediatric HIV Infection: A Neuropsychological and Educational Challenge.

    ERIC Educational Resources Information Center

    Armstrong, F. Daniel; And Others

    1993-01-01

    This article reviews the effects of human immunodeficiency virus (HIV) on the central nervous system and the educational implications of increasing numbers of students with perinatal HIV infection and pediatric acquired immunodeficiency syndrome (AIDS). Studies on the relationship between HIV and child development are urged. (Author/DB)

  2. Sulforaphane Inhibits HIV Infection of Macrophages through Nrf2.

    PubMed

    Furuya, Andrea Kinga Marias; Sharifi, Hamayun J; Jellinger, Robert M; Cristofano, Paul; Shi, Binshan; de Noronha, Carlos M C

    2016-04-01

    Marburg virus, the Kaposi's sarcoma-associated herpesvirus (KSHV) and Dengue virus all activate, and benefit from, expression of the transcription regulator nuclear erythroid 2-related factor 2 (Nrf2). The impact of Nrf2 activation on human immunodeficiency virus (HIV) infection has not been tested. Sulforaphane (SFN), produced in cruciferous vegetables after mechanical damage, mobilizes Nrf2 to potently reprogram cellular gene expression. Here we show for the first time that SFN blocks HIV infection in primary macrophages but not in primary T cells. Similarly SFN blocks infection in PMA-differentiated promonocytic cell lines, but not in other cell lines tested. siRNA-mediated depletion of Nrf2 boosted HIV infectivity in primary macrophages and reduced the anti-viral effects of SFN treatment. This supports a model in which anti-viral activity is mediated through Nrf2 after it is mobilized by SFN. We further found that, like the type I interferon-induced cellular anti-viral proteins SAMHD1 and MX2, SFN treatment blocks infection after entry, but before formation of 2-LTR circles. Interestingly however, neither SAMHD1 nor MX2 were upregulated. This shows for the first time that Nrf2 action can potently block HIV infection and highlights a novel way to trigger this inhibition. PMID:27093399

  3. Evidence of dysregulation of dendritic cells in primary HIV infection

    PubMed Central

    Sabado, Rachel Lubong; O'Brien, Meagan; Subedi, Abhignya; Qin, Li; Hu, Nan; Taylor, Elizabeth; Dibben, Oliver; Stacey, Andrea; Fellay, Jacques; Shianna, Kevin V.; Siegal, Frederick; Shodell, Michael; Shah, Kokila; Larsson, Marie; Lifson, Jeffrey; Nadas, Arthur; Marmor, Michael; Hutt, Richard; Margolis, David; Garmon, Donald; Markowitz, Martin; Valentine, Fred; Borrow, Persephone

    2010-01-01

    Myeloid and plasmacytoid dendritic cells (DCs) are important mediators of both innate and adaptive immunity against pathogens such as HIV. During the course of HIV infection, blood DC numbers fall substantially. In the present study, we sought to determine how early in HIV infection the reduction occurs and whether the remaining DC subsets maintain functional capacity. We find that both myeloid DC and plasmacytoid DC levels decline very early during acute HIV in-fection. Despite the initial reduction in numbers, those DCs that remain in circulation retain their function and are able to stimulate allogeneic T-cell responses, and up-regulate maturation markers plus produce cytokines/chemokines in response to stimulation with TLR7/8 agonists. Notably, DCs from HIV-infected subjects produced significantly higher levels of cytokines/chemokines in response to stimulation with TLR7/8 agonists than DCs from uninfected controls. Further examination of gene expression profiles indicated in vivo activation, either directly or indirectly, of DCs during HIV infection. Taken together, our data demonstrate that despite the reduction in circulating DC numbers, those that remain in the blood display hyperfunctionality and implicates a possible role for DCs in promoting chronic immune activation. PMID:20693428

  4. Adherence to Tobacco Dependence Treatment Among HIV-Infected Smokers.

    PubMed

    Browning, Kristine K; Wewers, Mary Ellen; Ferketich, Amy K; Diaz, Philip; Koletar, Susan L; Reynolds, Nancy R

    2016-03-01

    High prevalence of tobacco use and low success in quitting remain significant problems for reducing disease burden among HIV-infected persons. This study's purpose was to examine participant responsiveness and tobacco dependence treatment adherence and their influences on tobacco abstinence among HIV-infected patients. This non-randomized study included HIV-infected smokers 18 years of age or older, who smoked at least 5 cigarettes per day, and had an interest in quitting smoking in the next 30 days. HIV-infected smokers (n = 247) received a 12-week tobacco dependence treatment intervention that included pharmacotherapy and telephone counseling. Younger age and non-White race were associated with lower adherence to pharmacotherapy. Younger age, non-White race, and increased monthly binge drinking were associated with lower adherence to telephone counseling. High participant responsiveness was associated with adherence to pharmacotherapy, counseling, and abstinence. Development and testing of interventions to improve adherence to evidence-based tobacco dependence treatment is warranted. PMID:25855045

  5. The challenges of modelling antibody repertoire dynamics in HIV infection

    SciTech Connect

    Luo, Shishi; Perelson, Alan S.

    2015-07-20

    Antibody affinity maturation by somatic hypermutation of B-cell immunoglobulin variable region genes has been studied for decades in various model systems using well-defined antigens. While much is known about the molecular details of the process, our understanding of the selective forces that generate affinity maturation are less well developed, particularly in the case of a co-evolving pathogen such as HIV. Despite this gap in understanding, high-throughput antibody sequence data are increasingly being collected to investigate the evolutionary trajectories of antibody lineages in HIV-infected individuals. Here, we review what is known in controlled experimental systems about the mechanisms underlying antibody selection and compare this to the observed temporal patterns of antibody evolution in HIV infection. In addition, we describe how our current understanding of antibody selection mechanisms leaves questions about antibody dynamics in HIV infection unanswered. Without a mechanistic understanding of antibody selection in the context of a co-evolving viral population, modelling and analysis of antibody sequences in HIV-infected individuals will be limited in their interpretation and predictive ability.

  6. The challenges of modelling antibody repertoire dynamics in HIV infection

    DOE PAGESBeta

    Luo, Shishi; Perelson, Alan S.

    2015-07-20

    Antibody affinity maturation by somatic hypermutation of B-cell immunoglobulin variable region genes has been studied for decades in various model systems using well-defined antigens. While much is known about the molecular details of the process, our understanding of the selective forces that generate affinity maturation are less well developed, particularly in the case of a co-evolving pathogen such as HIV. Despite this gap in understanding, high-throughput antibody sequence data are increasingly being collected to investigate the evolutionary trajectories of antibody lineages in HIV-infected individuals. Here, we review what is known in controlled experimental systems about the mechanisms underlying antibody selectionmore » and compare this to the observed temporal patterns of antibody evolution in HIV infection. In addition, we describe how our current understanding of antibody selection mechanisms leaves questions about antibody dynamics in HIV infection unanswered. Without a mechanistic understanding of antibody selection in the context of a co-evolving viral population, modelling and analysis of antibody sequences in HIV-infected individuals will be limited in their interpretation and predictive ability.« less

  7. East African pigs have a complex Indian, Far Eastern and Western ancestry.

    PubMed

    Noce, A; Amills, M; Manunza, A; Muwanika, V; Muhangi, D; Aliro, T; Mayega, J; Ademun, R; Sànchez, A; Egbhalsaied, S; Mercadé, A; Masembe, C

    2015-08-01

    In this study, we have characterized the mitochondrial diversity of 81 swine from Uganda. Median-joining network analysis of D-loop sequences from these individuals and others characterized in previous studies allowed us to determine that Ugandan pigs cluster with populations from the West (Europe/North Africa), Far East and India. In addition, partial sequencing of the Y-chromosome UTY locus in 18 Ugandan domestic pigs revealed the segregation of a single HY1 lineage that has a cosmopolitan distribution. A Western and Far Eastern ancestry for East African pigs had been already reported, but this is the first study demonstrating an additional contribution from the Indian porcine gene pool. This result is consistent with the high frequency of zebuine alleles in cattle from East Africa. The geographic coordinates of East Africa, at the crossroads of many trading routes that, through the ages, linked Europe, Africa and Asia, might explain the rich and complex genetic heritage of livestock native to this area. PMID:26011180

  8. Psychological and social problems in HIV infection: interviews with general practitioners in London.

    PubMed

    King, M B

    1989-09-16

    A random sample of 270 general practitioners in London was interviewed to assess current practice and opinions about managing psychological and social problems related to HIV infection. Physicians caring for patients with HIV infection were asked about numbers of patients in their pratice with HIV or AIDS; consultation with third parties such as sexual partners or family; reports to employers and other third parties; terminal care; contact with HIV clinics; testing for HIV infection without consent; and the impact of patients with HIV infection on their practice. All physicians were asked about patients concerned with HIV infection; awareness of other health resources for patients with HIV infection; terminal care; "safer sex" education; confidentiality; interest in AIDS; intravenous drug users as patients; managing homosexual patients; and ethical considerations. King discusses the findings and draws conclusions about primary care of HIV-infected patients in London. PMID:2508884

  9. STD Clinic Patients' Awareness of Non-AIDS Complications of HIV Infection

    PubMed Central

    Castro, José Guillermo; Granovsky, Inna; Jones, Deborah; Weiss, Stephen M.

    2016-01-01

    Participants were recruited from a sexually transmitted disease (STD) clinic in Florida and were assessed regarding the knowledge and awareness of non-AIDS conditions associated with HIV infection. Questionnaires were administered before and after a brief information session on non-AIDS conditions associated with HIV infection. Participants included men (n = 46) and women (n = 51). Prior to the information session, at baseline, only 34% of the participants were worried about HIV infection. Most participants (82%) agreed that HIV could be treated with antiretroviral therapy (ART), while only 38% were aware that HIV-associated conditions cannot be easily treated with ART. After the information session, almost all participants reported they were concerned regarding the risk of HIV infection. High-risk patients may have limited knowledge about the consequences of HIV infection beyond the traditional AIDS-associated conditions. Increased awareness of these less known consequences of HIV infection may decrease the potential for complacency regarding acquiring HIV infection. PMID:25331221

  10. Differences between the course of the drug addict's HIV infection and that of other HIV-infected patients.

    PubMed

    Gölz, J

    1993-11-01

    Drug addicts have, in general, a less complicated course of HIV infection than homosexual HIV patients. They show fewer opportunistic infections and tumors. But this advantage is lost by unnecessary complications due to their psychic disorders. Their non-compliance and concealment of signs of disease lead to worse outcomes of infections, which could be well-treated or prevented. PMID:8300042

  11. Muslim women's reflections on the acceptability of vaginal microbicidal products to prevent HIV infection.

    PubMed

    Hoel, Nina; Shaikh, Sadiyya; Kagee, Ashraf

    2011-04-01

    This paper examines South African Muslim women's opinions of the acceptability of microbicidal products to prevent HIV infection if these were to become available in the future. In the context of the HIV pandemic, prophylactic methods such as male circumcision, vaccines and microbicidal preparations are increasingly thought of as ways to reduce the incidence of infection. We examine the extent to which participants' religious beliefs and the implications of religious norms and ideals might influence decision-making concerning hypothetical acceptability to use a microbicide. We conducted qualitative interviews with 29 Muslim women residing in South Africa, a country with one of the highest HIV prevalence rates in the world. Four themes emerged from the data, namely, (1) participants' questioning of the need for microbicides; (2) reasons they gave in favour of microbicide use; (3) the juxtaposition of microbicide use and religious ethics; and (4) the role of religious authorities in decision-making regarding microbicide use. The juxtaposition of microbicide use and religious ethics was further informed by three sub-themes, namely, the life-promoting nature of both Islam and microbicide use, the possibility that microbicide use could encourage sexual risk-taking among male partners, and that the use of these products contradicted womens' notions of ethical agency and ideals about marriage. These themes and sub-themes are analysed in the context of gender relations among South African Muslims. The study findings are significant in light of recent data showing the effectiveness of a microbicidal preparation in reducing the risk of HIV infection in South Africa. We also show that the acceptability of microbicidal products is to a certain extent linked to a variety of religious persuasions and ideals. When microbicides become available in the future, proponents of their use will need to consider religious reasoning of potential users, including that of Muslim women. PMID

  12. Post-collisional magmatism in the central East African Orogen: The Maevarano Suite of north Madagascar

    USGS Publications Warehouse

    Goodenough, K.M.; Thomas, Ronald J.; De Waele, B.; Key, R.M.; Schofield, D.I.; Bauer, W.; Tucker, R.D.; Rafahatelo, J.-M.; Rabarimanana, M.; Ralison, A.V.; Randriamananjara, T.

    2010-01-01

    Late tectonic, post-collisional granite suites are a feature of many parts of the Late Neoproterozoic to Cambrian East African Orogen (EAO), where they are generally attributed to late extensional collapse of the orogen, accompanied by high heat flow and asthenospheric uprise. The Maevarano Suite comprises voluminous plutons which were emplaced in some of the tectonostratigraphic terranes of northern Madagascar, in the central part of the EAO, following collision and assembly during a major orogeny at ca. 550 Ma. The suite comprises three main magmatic phases: a minor early phase of foliated gabbros, quartz diorites, and granodiorites; a main phase of large batholiths of porphyritic granitoids and charnockites; and a late phase of small-scale plutons and sheets of monzonite, syenite, leucogranite and microgranite. The main phase intrusions tend to be massive, but with variably foliated margins. New U-Pb SHRIMP zircon data show that the whole suite was emplaced between ca. 537 and 522 Ma. Geochemically, all the rocks of the suite are enriched in the LILE, especially K, and the LREE, but are relatively depleted in Nb, Ta and the HREE. These characteristics are typical of post-collisional granitoids in the EAO and many other orogenic belts. It is proposed that the Maevarano Suite magmas were derived by melting of sub-continental lithospheric mantle that had been enriched in the LILE during earlier subduction events. The melting occurred during lithospheric delamination, which was associated with extensional collapse of the East African Orogen. ?? 2009 Natural Environment Research Council.

  13. Storm-time characteristics of the equatorial ionization anomaly in the East African sector

    NASA Astrophysics Data System (ADS)

    Kassa, T.; Damtie, B.; Bires, A.; Yizengaw, E.; Cilliers, P.

    2015-07-01

    The equatorial ionization anomaly (EIA), inferred from the electron density profile, was used to study the ionospheric effect of 11 March 2011, 06 April 2011, 09 March 2012 and 01 October 2012 geomagnetic storms in the East African sector. The electron density profile was reconstructed from slant total electron content (sTEC) measurements using statistical linear inversion method. The sTEC measurements were recorded by a chain of ten ground-based GPS receivers deployed in the East African region in the latitude range of 6° S-20° N GeoLat (15.29° S-10.62° N geomagnetic latitude). The analysis of the effect of the storms on the EIA has demonstrated that the effect could be positive or negative. The sudden positive effects of the EIA, in terms of increasing the peak and widening the width, during storm events of 06 April 2011, 09 March 2012 and 01 October 2012 were observed dominantly due to prompt penetration electric fields to the magnetic equator, which were caused by a southward turning of the interplanetary magnetic field (Bz). The prolonged effects after the onset of the storm were attributed to disturbance dynamo electric field due to the storm-time neutral wind circulation. The depletion on the electron density profile during 11 March 2011 storm was due to a decrease in [O] to [N2 ] ratio in the thermosphere composition.

  14. Determinants of Smoking and Quitting in HIV-Infected Individuals

    PubMed Central

    Regan, Susan; Meigs, James B.; Grinspoon, Steven K.; Triant, Virginia A.

    2016-01-01

    Background Cigarette smoking is widespread among HIV-infected patients, who confront increased risk of smoking-related co-morbidities. The effects of HIV infection and HIV-related variables on smoking and smoking cessation are incompletely understood. We investigated the correlates of smoking and quitting in an HIV-infected cohort using a validated natural language processor to determine smoking status. Method We developed and validated an algorithm using natural language processing (NLP) to ascertain smoking status from electronic health record data. The algorithm was applied to records for a cohort of 3487 HIV-infected from a large health care system in Boston, USA, and 9446 uninfected control patients matched 3:1 on age, gender, race and clinical encounters. NLP was used to identify and classify smoking-related portions of free-text notes. These classifications were combined into patient-year smoking status and used to classify patients as ever versus never smokers and current smokers versus non-smokers. Generalized linear models were used to assess associations of HIV with 3 outcomes, ever smoking, current smoking, and current smoking in analyses limited to ever smokers (persistent smoking), while adjusting for demographics, cardiovascular risk factors, and psychiatric illness. Analyses were repeated within the HIV cohort, with the addition of CD4 cell count and HIV viral load to assess associations of these HIV-related factors with the smoking outcomes. Results Using the natural language processing algorithm to assign annual smoking status yielded sensitivity of 92.4, specificity of 86.2, and AUC of 0.89 (95% confidence interval [CI] 0.88–0.91). Ever and current smoking were more common in HIV-infected patients than controls (54% vs. 44% and 42% vs. 30%, respectively, both P<0.001). In multivariate models HIV was independently associated with ever smoking (adjusted rate ratio [ARR] 1.18, 95% CI 1.13–1.24, P <0.001), current smoking (ARR 1.33, 95% CI 1.25

  15. [Molecular epidemiology of HIV-infection in drug addicts of Southern Ural].

    PubMed

    Kazennova, E V; Bobkova, M R; Zemerov, V B; Shantseva, N A; Fedotova, T A; Kiva, L D; Fedotova, T T; Kapizov, A S; Bagautdinov, A T; Gerasimov, V E; Seliutina, L I; Kostian, I R; Raspopin, V I; Pokrovskiĭ, V V; Bobkov, A F

    2004-01-01

    The analysis of HIV-1 variants circulating among drug addicts in 16 settlements of the Sverdlov, Chelyabinsk and Orenburg regions (72, 90 and 42 patients respectively) was carried out. As shown by the serological analysis, the spread of HIV-1 variant IDU-A among the drug addicts in this area continued in this area and could be detected in 99.5% of the samples (203 out of 204 samples). These data were confirmed by the results of the analysis of 35 samples by the Heteroduplex Mobility Assay for genes env and gag. The analysis of nucleotide sequences of gene env revealed that HIV-1 variants in the Southern Urals, where the greatest outbreak of HIV infection in Russia had been registered, were genetically related to viruses of subtype A, detected earlier in this group of risk in other regions of Russia, as well as in Ukraine, Belarus and other East European countries. PMID:15188556

  16. Accuracy of Clinical Suspicion and Pathologic Diagnosis of Kaposi Sarcoma in East Africa

    PubMed Central

    Woodruff, Carina Martin; Forrestel, Amy; Wenger, Megan; McCalmont, Timothy; LeBoit, Philip; Maurer, Toby; Laker-Oketta, Miriam; Muyindike, Winnie; Bwana, Mwebesa; Buziba, Nathan; Busakhala, Naftali; Wools-Kaloustian, Kara; Martin, Jeffrey

    2016-01-01

    Background: HIV-associated Kaposi sarcoma (KS) is one of the most common malignancies in sub-Saharan Africa. The diagnosis is often based on clinical suspicion, without histopathologic confirmation. When biopsies are performed, the accuracy of interpretation by local pathologists is poorly understood. We assessed the accuracy of clinical suspicion and pathologic diagnosis of KS in 2 East African countries. Methods: At 2 large HIV care sites in Uganda and Kenya, we evaluated consecutive biopsies performed from October 2008 to January 2013 on HIV-infected adults with clinically suspected KS. Biopsies were interpreted by both local African pathologists and a group of US-based dermatopathologists from a high volume medical center. For the purpose of this analysis, the US-based dermatopathologist interpretation was used as the gold standard. Positive predictive value was used to characterize accuracy of local African clinical suspicion of KS, and concordance, sensitivity, and specificity were used to characterize accuracy of local pathologic diagnosis. Results: Among 1106 biopsies, the positive predictive value of clinical suspicion of KS was 77% (95% confidence interval: 74% to 79%). When KS was not histopathologically diagnosed, clinically banal conditions were found in 35%, medically significant disorders which required different therapy in 59% and life-threatening diseases in 6%. Concordance between African pathologists and US-based dermatopathologists was 69% (95% confidence interval: 66% to 72%). Sensitivity and specificity of African pathologic diagnoses were 68% and 89%, respectively. Conclusions: Among East African HIV-infected patients, we found suboptimal positive predictive value of clinical suspicion of KS and specific, but not sensitive, histopathologic interpretation. The findings call for abandonment of isolated clinical diagnosis of KS in the region and augmentation of local dermatopathologic services. PMID:26452066

  17. Potential Health Impacts of Heavy Metals on HIV-Infected Population in USA

    PubMed Central

    Xu, Xiaohui; Hu, Hui; Dailey, Amy B.; Kearney, Greg; Talbott, Evelyn O.; Cook, Robert L.

    2013-01-01

    Purpose Noninfectious comorbidities such as cardiovascular diseases have become increasingly prevalent and occur earlier in life in persons with HIV infection. Despite the emerging body of literature linking environmental exposures to chronic disease outcomes in the general population, the impacts of environmental exposures have received little attention in HIV-infected population. The aim of this study is to investigate whether individuals living with HIV have elevated prevalence of heavy metals compared to non-HIV infected individuals in United States. Methods We used the National Health and Nutrition Examination Survey (NHANES) 2003-2010 to compare exposures to heavy metals including cadmium, lead, and total mercury in HIV infected and non-HIV infected subjects. Results In this cross-sectional study, we found that HIV-infected individuals had higher concentrations of all heavy metals than the non-HIV infected group. In a multivariate linear regression model, HIV status was significantly associated with increased blood cadmium (p=0.03) after adjusting for age, sex, race, education, poverty income ratio, and smoking. However, HIV status was not statistically associated with lead or mercury levels after adjusting for the same covariates. Conclusions Our findings suggest that HIV-infected patients might be significantly more exposed to cadmium compared to non-HIV infected individuals which could contribute to higher prevalence of chronic diseases among HIV-infected subjects. Further research is warranted to identify sources of exposure and to understand more about specific health outcomes. PMID:24023932

  18. Early virological failure and the development of antiretroviral drug resistance mutations in HIV-infected Ugandan children

    PubMed Central

    Ruel, Theodore D.; Kamya, Moses R.; Li, Pelin; Pasutti, William; Charlebois, Edwin D.; Liegler, Teri; Dorsey, Grant; Rosenthal, Philip J.; Havlir, Diane V.; Wong, Joseph K.; Achan, Jane

    2011-01-01

    Background Without virologic testing, HIV-infected African children starting antiretroviral (ARV)-therapy are at risk for undetected virological failure and the development of ARV-resistance. We sought to determine the prevalence of early virologic failure (EVF), to characterize the evolution of ARV-resistance mutations, and to predict the impact on second-line therapy. Methods The prevalence of EVF (HIV-RNA >400 copies/mL on sequential visits after 6 months of therapy) was identified among 120 HIV-infected Ugandan children starting ARV-therapy. ARV-mutations were identified by population sequencing of HIV-1 pol in sequential archived specimens. Composite discrete genotypic susceptibility scores (dGSS) were determined for second-line ARV-regimens. Results EVF occurred in 16 (13%) children and persisted throughout a median (IQR) 938 (760-1066) days of follow-up. M184V and non-nucleoside-reverse-transcriptase-inhibitor-associated mutations emerged within 6 months of EVF; thymidine-analog-mutations arose after 12 months. Worse dGSS scores correlated with increasing duration of failure (Spearman R = −0.47, p=0.001). Only 1 child met World Health Organization CD4 criteria for ARV-failure at the time of EVF or during the follow-up period. Conclusions A significant portion of HIV-infected African children experience EVF that would be undetected using CD4/clinical monitoring and resulted in the accumulation of ARV-mutations that could compromise second line therapy options. PMID:21099693

  19. Progress toward curing HIV infections with hematopoietic stem cell transplantation.

    PubMed

    Smiley, Stephen T; Singh, Anjali; Read, Sarah W; Sharma, Opendra K; Finzi, Diana; Lane, Clifford; Rice, Jeffrey S

    2015-01-15

    Combination antiretroviral therapy can suppress human immunodeficiency virus (HIV) infection but cannot completely eradicate the virus. A major obstacle in the quest for a cure is the difficulty in targeting and measuring latently infected cells. To date, a single person seems to have been cured of HIV. Hematopoietic stem cell transplantation (HSCT) preceded this cancer patient's long-term sustained HIV remission, but researchers have been unable to replicate this cure, and the mechanisms that led to HIV remission remain to be established. In February 2014, the National Institute of Allergy and Infectious Diseases sponsored a workshop that provided a venue for in-depth discussion of whether HSCT could be exploited to cure HIV in cancer patients requiring such procedures. Participants also discussed how HSCT might be applied to a broader community of HIV-infected persons in whom the risks of HSCT currently outweigh the likelihood and benefits of HIV cure. PMID:25273081

  20. Cytokines and T-Cell Homeostasis in HIV Infection.

    PubMed

    Freeman, Michael L; Shive, Carey L; Nguyen, Thao P; Younes, Souheil-Antoine; Panigrahi, Soumya; Lederman, Michael M

    2016-10-01

    Untreated human immunodeficiency virus (HIV) infection is characterized by progressive CD4(+) T-cell depletion and CD8(+) T-cell expansion, and CD4(+) T-cell depletion is linked directly to the risk for opportunistic infections and infection-associated mortality. With suppression of HIV replication by antiretroviral therapy, circulating CD4(+) Tcell numbers typically improve while CD8(+) T-cell expansion persists, and both CD4(+) T-cell cytopenia and CD8(+) T-cell expansion are associated with morbidity and mortality. In this brief review, we report on the role that selected homeostatic and inflammatory cytokines may play both in the failure of CD4(+) T-cell restoration and the CD8(+) T-cell expansion that characterize HIV infection. PMID:27625431

  1. Dynamics of HIV infection on 2D cellular automata

    NASA Astrophysics Data System (ADS)

    Benyoussef, A.; HafidAllah, N. El; ElKenz, A.; Ez-Zahraouy, H.; Loulidi, M.

    2003-05-01

    We use a cellular automata approach to describe the interactions of the immune system with the human immunodeficiency virus (HIV). We study the evolution of HIV infection, particularly in the clinical latency period. The results we have obtained show the existence of four different behaviours in the plane of death rate of virus-death rate of infected T cell. These regions meet at a critical point, where the virus density and the infected T cell density remain invariant during the evolution of disease. We have introduced two kinds of treatments, the protease inhibitors and the RT inhibitors, in order to study their effects on the evolution of HIV infection. These treatments are powerful in decreasing the density of the virus in the blood and the delay of the AIDS onset.

  2. Psychosocial impact of the lipodystrophy syndrome in HIV infection.

    PubMed

    Collins, E; Wagner, C; Walmsley, S

    2000-09-01

    Lipodystrophy is a poorly understood condition associated with antiretroviral therapy in HIV infection. The symptoms may include some combination of central fat accumulation, peripheral fat depletion, and metabolic disturbance. A qualitative survey of 33 HIV-infected heterosexual women and gay men with lipodystrophy assessed psychosocial impact and effect on quality of life. Dominant themes included erosion of self-image and self-esteem, problems in social and sexual relations, threats to locus of control, forced HIV disclosure, and demoralization and depression. Another theme was clinicians' minimization of the importance of lipodystrophy. Further research is required to fully understand the psychosocial impact of lipodystrophy and to develop strategies that help individuals cope. PMID:11019453

  3. Care of Patients With HIV Infection: Medical Complications and Comorbidities.

    PubMed

    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    Care of patients with HIV infection starts with diagnosis as soon as possible, preferably at or near the time of acute infection. Opportunistic infections, malignancies, and other conditions develop progressively over time, particularly in untreated patients. The AIDS-defining opportunistic infections most common in the United States include Pneumocystis jirovecii pneumonia, Candida esophagitis, toxoplasmic encephalitis, tuberculosis, disseminated Mycobacterium avium complex, cryptococcal meningitis, and cytomegalovirus retinitis. Specific prophylaxis regimens exist for several opportunistic infections, and effective antiretroviral therapy reduces the risk of most others. Other AIDS-defining conditions include wasting syndrome and HIV encephalopathy. AIDS-defining malignancies include Kaposi sarcoma, systemic non-Hodgkin lymphoma, primary central nervous system lymphoma, and invasive cervical cancer. Although not an AIDS-defining condition, anal cancer is common in patients with HIV infection. Other HIV-related conditions include thrombocytopenia, recurrent bacterial respiratory infections, HIV-associated nephropathy, and HIV-associated neurocognitive disorder. PMID:27092563

  4. Continued risky behavior in HIV-infected youth.

    PubMed Central

    Diamond, C; Buskin, S

    2000-01-01

    OBJECTIVES: The purpose of this study was to describe and compare risky behaviors in HIV-infected youths and adults. METHODS: Records of HIV-infected outpatients were reviewed for the period January 1990 to February 1998. Youths (younger than 22 years at HIV diagnosis and younger than 25 years at study entry, n = 139) were compared with adults (22 years or older at HIV diagnosis or 25 years or older at study entry, n = 2880). Risky behaviors occurring after HIV diagnosis included unsafe sex and needle sharing. RESULTS: Female and male youths were more than twice as likely as adults to engage in risky behavior (adjusted odds ratios of 2.6 and 2.3, respectively). CONCLUSIONS: Both youths and adults continue to engage in risky behaviors after HIV diagnosis. Prospective studies are needed, along with targeted public health campaigns, for youths with HIV and for those at risk of infection. PMID:10630148

  5. Clinical Care of the HIV-Infected Drug User

    PubMed Central

    Bruce, R. Douglas; Altice, Frederick L.

    2007-01-01

    HIV/AIDS and chemical dependency, both of which are complicated by and intertwined with mental illness, are complex, overlapping spheres that adversely influence each other and the overall clinical outcomes of the affected individual [1]. Each disorder individually impacts tens of millions of people, with explosive epidemics described worldwide. Drug users have increased age matched morbidity and mortality for a number of medical and psychiatric conditions. HIV/AIDS, with its immunosuppressed states and direct virologic effects, exacerbate morbidity and mortality further among HIV-infected drug users. This article addresses the adverse consequences of HIV/AIDS, drug injection, the secondary comorbidities of both, and the impact of immunosuppression on presentation of disease as well as approaches to managing the HIV-infected drug user. PMID:17502234

  6. Mortality and Risk Stratification of HIV Infected Individuals.

    PubMed

    Heltemes, Bradley R

    2015-01-01

    For the first decade and a half after the Human Immunodeficiency Virus (HIV) was first identified, the prognosis for most people infected with HIV was quite poor. Life insurance companies responded accordingly and insurance laboratories developed new means to test for the infection. However, it is now clear that people with HIV infection are living longer and that the majority of deaths occurring among those on treatment are now no longer due to AIDS-defining illnesses. This review examines the results of selected studies which analyzed mortality outcomes in those with HIV infection, the many factors which influence those outcomes, and the limitations in the data and in their applicability to an insurance population. PMID:27584921

  7. Penicillium keratitis in a HIV-infected patient.

    PubMed

    Anutarapongpan, Orapin; Thanathanee, Onsiri; Suwan-Apichon, Olan

    2016-01-01

    A 36-year-old HIV-positive man presented with symptoms of redness, blurred vision and foreign body sensation in his right eye for 3 months. The slit lamp examination revealed deep stromal infiltration with a feathery margin in an otherwise minimal anterior chamber reaction. A corneal scraping was negative. Confocal microscopy demonstrated an abnormal large hyper-reflective oval shape in the corneal stroma. Corneal infiltration did not show improvement after topical, intrastromal and intracameral antifungal treatment. Therapeutic penetrating keratoplasty was performed to eradicate the infection. Corneal button culture and histopathological results confirmed the diagnosis of Penicillium marneffei keratitis. No recurrent infection occurred after corneal transplantation. This appears to be the first report of P. marneffei keratitis in an HIV-infected patient. Although it is an uncommon condition, it should be one of the differential diagnoses in an HIV-infected patient presenting with keratitis. PMID:27535731

  8. Early Clinical Signs and Symptoms of HIV Infection

    PubMed Central

    Miedzinski, Lil J.

    1992-01-01

    Early clinical signs and symptoms of human immunodeficiency virus infection are protean and can reflect the effects of the virus or represent early manifestations of an illness associated with the acquired immunodeficiency syndrome. Knowledge of a patient's potential risk for HIV infection and of the natural history of the illness allow early signs and symptoms to be recognized. Early intervention can delay progression to AIDS. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6 PMID:21221397

  9. HIV infection is associated with attenuated frontostriatal intrinsic connectivity

    PubMed Central

    Ipser, Jonathan C.; Brown, Gregory G.; Bischoff-Grethe, Amanda; Connolly, Colm G.; Ellis, Ronald J.; Heaton, Robert K.; Grant, Igor

    2015-01-01

    Objective HIV-associated cognitive impairments are prevalent, and are consistent with injury to both frontal cortical and subcortical regions of the brain. The current study aimed to assess the impact of HIV infection on functional connections within the frontostriatal network, circuitry hypothesized to be highly vulnerable to HIV infection. Method Fifteen HIV-positive and 15 demographically matched control participants underwent 6 minutes of resting-state functional magnetic resonance imaging (RS-fMRI). Multivariate group comparisons of age-adjusted estimates of connectivity within the frontostriatal network were derived from BOLD data for dorsolateral prefrontal cortex (DLPFC), dorsal caudate and mediodorsal thalamic regions of interest. Whole-brain comparisons of group differences in frontostriatal connectivity were conducted, as were pairwise tests of connectivity associations with measures of global cognitive functioning and clinical and immunological characteristics (nadir and current CD4 count, duration of HIV infection, plasma HIV RNA). Results HIV – associated reductions in connectivity were observed between the DLPFC and the dorsal caudate, particularly in younger participants (< 50 years, N = 9). Seropositive participants also demonstrated reductions in dorsal caudate connectivity to frontal and parietal brain regions previously demonstrated to be functionally connected to the DLPFC. Cognitive impairment, but none of the assessed clinical/immunological variables, was associated with reduced frontostriatal connectivity. Conclusions In conclusion, our data indicate that a diagnosis of HIV is associated with attenuated intrinsic frontostriatal connectivity. Intrinsic connectivity of this network may therefore serve as a marker of the deleterious effects of HIV infection on the brain, possibly via HIV-associated dopaminergic abnormalities. These findings warrant independent replication in larger studies. PMID:25824201

  10. Atraumatic splenic rupture secondary to chronic HIV infection.

    PubMed

    Martin, Thomas C S; Martin, Natasha K; Naresh, Kikkeri N; Nelson, Mark

    2013-12-01

    As patients infected with HIV live longer due to effective anti-retroviral therapy, new disease manifestations are becoming apparent. We describe the case of a 59-year-old patient who presented to our unit with atraumatic splenic rupture secondary to chronic HIV infection. Given the high mortality associated with atraumatic splenic rupture, we believe it should be included in the differential diagnosis of HIV-positive patients presenting with acute abdominal pain. PMID:23970617

  11. Methicillin-resistant Staphylococcus aureus in HIV-infected patients

    PubMed Central

    Hidron, Alicia I; Kempker, Russell; Moanna, Abeer; Rimland, David

    2010-01-01

    Concordant with the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the community setting, colonization and infections with this pathogen have become a prevalent problem among the human immunodeficiency virus (HIV)-positive population. A variety of different host- and, possibly, pathogen-related factors may play a role in explaining the increased prevalence and incidence observed. In this article, we review pathophysiology, epidemiology, clinical manifestations, and treatment of MRSA in the HIV-infected population. PMID:21694896

  12. Selective Serotonin Reuptake Inhibitor Suppression of HIV Infectivity and Replication

    PubMed Central

    Benton, Tami; Lynch, Kevin; Dubé, Benoit; Gettes, David R.; Tustin, Nancy B.; Lai, Jian Ping; Metzger, David S.; Blume, Joshua; Douglas, Steven D.; Evans, Dwight L.

    2010-01-01

    Objective To test the hypothesis that the selective serotonin reuptake inhibitor (SSRI) citalopram would down regulate HIV infectivity and that the greatest effects would be seen in people with depression. Depression is a risk factor for morbidity and mortality in HIV/AIDS. Serotonin (5-HT) neurotransmission has been implicated in the pathobiology of depression, and pharmacologic therapies for depression target this system. The 5-HT transporter and 5-HT receptors are widely distributed throughout the central nervous and immune systems. Depression has been associated with suppression of natural killer cells (NK) cells and CD8+ lymphocytes, key regulators of HIV infection. Methods Ex-vivo models for acute and chronic HIV infection were used to study the effects of citalopram on HIV viral infection and replication, in 48 depressed and non-depressed women. For both the acute and chronic infection models, HIV reverse transcriptase (RT) activity was measured in the citalopram treatment condition and the control condition. Results The SSRI significantly downregulated the RT response in both the acute and chronic infection models. Specifically, citalopram significantly decreased the acute HIV infectivity of macrophages. Citalopram also significantly decreased HIV viral replication in the latently infected T-cell line and in the latently infected macrophage cell line. There was no difference in down-regulation by depression status. Conclusions These studies suggest that an SSRI enhances NK/CD8 non-cytolytic HIV suppression in HIV/AIDS and decreases HIV viral infectivity of macrophages, ex vivo, suggesting the need for in vivo studies to determine a potential role for agents targeting serotonin in the host defense against HIV. PMID:20947783

  13. HIV Infection--Guangdong Province, China, 1997-2007.

    PubMed

    2009-04-24

    In 2007, an estimated 700,000 persons in China were living with human immunodeficiency virus (HIV) infection. An estimated 50,000 new HIV infections and 20,000 deaths related to acquired immunodeficiency syndrome (AIDS) occurred in 2007, and an estimated 71% of persons with HIV infection were unaware of their HIV status. In 2007, 40.6% of those living with HIV had been infected through heterosexual transmission and 38.1% through injection-drug use. Guangdong Province in southeastern China is the country's most populous province, with an estimated 75.6 million permanent residents and 16.5 million migrants; the province has undergone rapid economic development. Since 1986, a case-based surveillance system (CBSS) in China has collected data on persons infected with HIV, including demographic characteristics and transmission categories. To assess recent trends in HIV infection in the province, the Guangdong Center for Disease Control, with technical assistance from CDC, analyzed CBSS data for the period 1997--2007. The results of that analysis indicated that the number of HIV cases increased from 102 in 1997 to 4,593 in 2007, although this increase resulted, in part, from expanded testing and surveillance. Among males classified by HIV transmission category, 82.1% of newly diagnosed infections were attributed to injection-drug use. Among females classified by HIV transmission category, 53.7% engaged in high-risk heterosexual conduct. Despite substantial methodologic limitations, these results can be useful to Guangdong public health agencies in targeting and evaluating HIV prevention, care, and treatment programs. PMID:19390507

  14. Smart nanoparticles as targeting platforms for HIV infections

    NASA Astrophysics Data System (ADS)

    Adhikary, Rishi Rajat; More, Prachi; Banerjee, Rinti

    2015-04-01

    While Human Immunodeficiency Virus (HIV) infections are reducing in incidence with the advent of Highly Active Anti-retroviral Therapy (HAART), there remain a number of challenges including the existence of reservoirs, drug resistance and anatomical barriers to antiretroviral therapy. To overcome these, smart nanoparticles with stimuli responsive release are proposed for delivery of anti-retroviral agents. The paper highlights the strategic similarities between the design of smart antiretroviral nanocarriers and those optimized for cancer chemotherapy. This includes the development of nanoparticles capable of passive and active targeting as well as those that are responsive to various internal and external triggers. For antiretroviral therapy, the relevant triggers for stimuli responsive release of drugs include semen, enzymes, endosomal escape, temperature and magnetic field. Deriving from the experience of cancer chemotherapy, additional potential triggers are light and ultrasound which remain hitherto unexplored in HIV therapy. In addition, the roles of nanomicrobicides (nanogels) and virus mimetic nanoparticles are discussed from the point of view of prevention of HIV transmission. The challenges associated with translation of smart nanoparticles for HIV infections to realize the Millennium Development Goal of combating HIV infections are discussed.

  15. The Diagnosis of HIV Infection in Infants and Children.

    PubMed

    Abdollahi, Alireza; Saffar, Hana

    2016-01-01

    It is estimated that the number of HIV infected children globally has increased from 1.6 million in 2001 to 3.3 million in 2012. The number of children below 15 years of age living with HIV has increased worldwide. Published data from recent studies confirmed dramatic survival benefit for infants started anti-retroviral therapy (ART) as early as possible after diagnosis of HI. Early confirmation of HIV diagnosis is required in order to identify infants who need immediate ART. WHO has designed recommendations to improve programs for both early diagnoses of HIV infection and considering ART whenever indicated? It is strongly recommended that HIV virologocal assays for diagnosis of HIV have sensitivity of at least 95% and ideally greater than 98% and specificity of 98% or more under standardized and validated conditions. Timing of virological testing is also important. Infants infected at or around delivery may take short time to have detectable virus. Therefore, sensitivity of virological tests is lower at birth. In utero HIV infection, HIV DNA or RNA can be detected within 48 h of birth and in infants with peripartum acquisition it needs one to two weeks. Finally it is emphasized that all laboratories performing HIV tests should follow available services provided by WHO or CDC for quality assurance programs. Both clinicians and staffs providing laboratory services need regular communications, well-defined SOPs and nationally validated algorithms for optimal use of laboratory tests. Every country should use assays that have been validated by national reference laboratory. PMID:27499768

  16. Correction options for lipoatrophy in HIV-infected patients.

    PubMed

    Engelhard, Peter

    2006-03-01

    Lipoatrophy (LA) is a form of lipodystrophy, characterized by volume depletion caused by fat loss in the limbs, buttocks, and face. Facial volume loss is the most obvious outward sign of LA because it alters the facial contours in the cheeks, temples, and orbits. Lipodystrophy and LA are most commonly seen in patients with HIV on highly active antiretroviral therapy (HAART), which was introduced in the mid-1990s for the management of HIV, and is currently considered the mainstay therapy for HIV-infected patients. However, the etiology of LA is likely multifactorial as underlying patient conditions, including duration and severity of HIV and increasing age, have also been found to contribute to its occurrence. The volume loss of LA can be very dramatic with some patients exhibiting no signs of facial fat. As a result, many HIV-infected patients with associated LA suffer from psychological and lifestyle effects, which can lead to noncompliance with HAART. Thus, increases in facial volume and improvement in morphology is anticipated to reduce anxiety caused by LA in HIV-infected patients, and improve quality of life. This review discusses the benefits and limitations of several treatment options available to correct the volume depletion associated with LA, including antiretroviral switching, permanent surgical implants and injectables, poly-L-lactic acid, collagen, and hyaluronic acid derivatives. PMID:16548712

  17. The Diagnosis of HIV Infection in Infants and Children

    PubMed Central

    Abdollahi, Alireza; Saffar, Hana

    2016-01-01

    It is estimated that the number of HIV infected children globally has increased from 1.6 million in 2001 to 3.3 million in 2012. The number of children below 15 years of age living with HIV has increased worldwide. Published data from recent studies confirmed dramatic survival benefit for infants started anti-retroviral therapy (ART) as early as possible after diagnosis of HI. Early confirmation of HIV diagnosis is required in order to identify infants who need immediate ART. WHO has designed recommendations to improve programs for both early diagnoses of HIV infection and considering ART whenever indicated? It is strongly recommended that HIV virologocal assays for diagnosis of HIV have sensitivity of at least 95% and ideally greater than 98% and specificity of 98% or more under standardized and validated conditions. Timing of virological testing is also important. Infants infected at or around delivery may take short time to have detectable virus. Therefore, sensitivity of virological tests is lower at birth. In utero HIV infection, HIV DNA or RNA can be detected within 48 h of birth and in infants with peripartum acquisition it needs one to two weeks. Finally it is emphasized that all laboratories performing HIV tests should follow available services provided by WHO or CDC for quality assurance programs. Both clinicians and staffs providing laboratory services need regular communications, well-defined SOPs and nationally validated algorithms for optimal use of laboratory tests. Every country should use assays that have been validated by national reference laboratory.

  18. Modeling dynamics of HIV infected cells using stochastic cellular automaton

    NASA Astrophysics Data System (ADS)

    Precharattana, Monamorn; Triampo, Wannapong

    2014-08-01

    Ever since HIV was first diagnosed in human, a great number of scientific works have been undertaken to explore the biological mechanisms involved in the infection and progression of the disease. Several cellular automata (CA) models have been introduced to gain insights into the dynamics of the disease progression but none of them has taken into account effects of certain immune cells such as the dendritic cells (DCs) and the CD8+ T lymphocytes (CD8+ T cells). In this work, we present a CA model, which incorporates effects of the HIV specific immune response focusing on the cell-mediated immunities, and investigate the interaction between the host immune response and the HIV infected cells in the lymph nodes. The aim of our work is to propose a model more realistic than the one in Precharattana et al. (2010) [10], by incorporating roles of the DCs, the CD4+ T cells, and the CD8+ T cells into the model so that it would reproduce the HIV infection dynamics during the primary phase of HIV infection.

  19. Reproductive decision-making among HIV-Infected women.

    PubMed Central

    Bedimo-Rung, Ariane Lisann; Clark, A. Rebecca; Dumestre, Jeanne; Rice, Janet; Kissinger, Patricia

    2005-01-01

    OBJECTIVE: To describe factors related to reproductive decision-making among HIV-infected women. MATERIALS AND METHODS: A sample of HIV-infected women (N=104) who received care at an HIV clinic in the southern United States were interviewed about their reproductive decision-making. Women who became pregnant subsequent to HIV diagnosis were compared to women who did not become pregnant, and women who underwent a sterilization procedure subsequent to HIV diagnosis were compared to women who did not get sterilized. RESULTS: Compared to women who did not get pregnant after receiving an HIV diagnosis, women who became pregnant were more likely to be young, single, diagnosed earlier in the epidemic and to have more recently used a noninjecting drug. Among women who did not get pregnant, 63% reported their diagnosis greatly affected that decision. Having a partner who wants more children was not associated with pregnancy. Compared to women who did not get sterilized after learning their HIV status, women who did get sterilized tended to be Baptist and already had a prior live birth. Neither a woman's desire nor her partner's desire for more children was associated with sterilization. CONCLUSIONS: HIV is an important influence on HIV-infected women's reproductive choices, regardless of the decision being made. Reproductive counseling by HIV care providers needs to be sensitive to all the issues faced by these women. PMID:16353661

  20. Educational software for simulating risk of HIV infection

    NASA Astrophysics Data System (ADS)

    Rothberg, Madeleine A.; Sandberg, Sonja; Awerbuch, Tamara E.

    1994-03-01

    The AIDS epidemic is still growing rapidly and the disease is thought to be uniformly fatal. With no vaccine or cure in sight, education during high school years is a critical component in the prevention of AIDS. We propose the use of computer software with which high school students can explore via simulation their own risk of acquiring an HIV infection given certain sexual behaviors. This particular software is intended to help students understand the three factors that determine their risk of HIV infection (number of sexual acts, probability that their partners are infected, and riskiness of the specific sexual activities they choose). Users can explicitly calculate their own chances of becoming infected based on decisions they make. Use of the program is expected to personalize the risk of HIV infection and thus increase users' concern and awareness. Behavioral change may not result from increased knowledge alone. Therefore the effectiveness of this program in changing attitudes toward risky sexual behaviors would be enhanced when the simulation is embedded in an appropriate curriculum. A description of the program and an example of its use are presented.

  1. HIV infection and stroke: current perspectives and future directions

    PubMed Central

    Benjamin, Laura A; Bryer, Alan; Emsley, Hedley CA; Khoo, Saye; Solomon, Tom; Connor, Myles D

    2012-01-01

    Summary HIV infection can result in stroke via several mechanisms, including opportunistic infection, vasculopathy, cardioembolism, and coagulopathy. However, the occurrence of stroke and HIV infection might often be coincidental. HIV-associated vasculopathy describes various cerebrovascular changes, including stenosis and aneurysm formation, vasculitis, and accelerated atherosclerosis, and might be caused directly or indirectly by HIV infection, although the mechanisms are controversial. HIV and associated infections contribute to chronic inflammation. Combination antiretroviral therapies (cART) are clearly beneficial, but can be atherogenic and could increase stroke risk. cART can prolong life, increasing the size of the ageing population at risk of stroke. Stroke management and prevention should include identification and treatment of the specific cause of stroke and stroke risk factors, and judicious adjustment of the cART regimen. Epidemiological, clinical, biological, and autopsy studies of risk, the pathogenesis of HIV-associated vasculopathy (particularly of arterial endothelial damage), the long-term effects of cART, and ideal stroke treatment in patients with HIV are needed, as are antiretrovirals that are without vascular risk. PMID:22995692

  2. HIV-infected mothers' experiences during their infants' HIV testing.

    PubMed

    Shannon, Maureen T

    2015-04-01

    Both survival with HIV and rates of perinatal HIV infection have significantly declined during the past decade, due to antiretroviral therapies that interrupt HIV transmission to the fetus and newborn. Although HIV is no longer routinely fatal to mothers or transmitted to fetuses, and the testing of newborns for HIV has been improved, evidence about HIV-infected mothers' experiences during the months of their infants' HIV testing predates these improvements. This qualitative study on 16 mothers was an analysis of interviews conducted several weeks after testing was completed and all infants had been determined to be uninfected. Mothers reported that their experiences evolved during the months of testing. Initial reactions included maternal trauma and guilt associated with infant testing. They then reported learning to cope with the roller coaster ride of repeated testing with the help of information from clinicians. By the end of the testing period, ambiguity began to resolve as they engaged in tentative maternal-infant attachment and expressed desire for a sense of normalcy. Need for support and fear of stigma persisted throughout. These findings expand current knowledge about this experience and suggest clinical strategies to guide HIV-infected women during this stressful period. PMID:25739368

  3. Unresolved antiretroviral treatment management issues in HIV-infected children.

    PubMed

    Heidari, Shirin; Mofenson, Lynne M; Hobbs, Charlotte V; Cotton, Mark F; Marlink, Richard; Katabira, Elly

    2012-02-01

    Antiretroviral therapy in children has expanded dramatically in low-income and middle-income countries. The World Health Organization revised its pediatric HIV guidelines to recommend initiation of antiretroviral therapy in all HIV-infected children younger than 2 years, regardless of CD4 count or clinical stage. The number of children starting life-long antiretroviral therapy should therefore expand dramatically over time. The early initiation of antiretroviral therapy has indisputable benefits for children, but there is a paucity of definitive information on the potential adverse effects. In this review, a comprehensive literature search was conducted to provide an overview of our knowledge about the complications of treating pediatric HIV. Antiretroviral therapy in children, as in adults, is associated with enhanced survival, reduction in opportunistic infections, improved growth and neurocognitive function, and better quality of life. Despite antiretroviral therapy, HIV-infected children may continue to lag behind their uninfected peers in growth and development. In addition, epidemic concurrent conditions, such as tuberculosis, malaria, and malnutrition, can combine with HIV to yield more rapid disease progression and poor treatment outcomes. Additional studies are required to evaluate the long-term effects of antiretroviral therapy in HIV-infected infants, children, and adolescents, particularly in resource-limited countries where concomitant infections and conditions may enhance the risk of adverse effects. There is an urgent need to evaluate drug-drug interactions in children to determine optimal treatment regimens for both HIV and coinfections. PMID:22138766

  4. Coping With Stress Strategies in HIV-infected Iranian Patients.

    PubMed

    Mahmoudi, Maryam; Dehdari, Tahereh; Shojaeezadeh, Davoud; Abbasian, Ladan

    2015-01-01

    Stress has significant adverse impacts on health outcomes of HIV-infected patients. Our study explored coping with stress strategies by HIV-infected Iranian patients. A qualitative content analysis study was conducted at the Consultation Clinic of HIV at the Imam Khomeini Hospital in Tehran, Iran in 2012. Twenty-six semi-structured in-depth interviews were done. Participants were asked about coping strategies for stress. After the first interview, continuous analysis of data was started and continued up to data saturation. Results showed that participants used two categories of strategies (emotion-based coping and problem-based coping) to cope with stress. Emotion-based coping had two sub-themes: adaptive and maladaptive. The problem-based coping category had three sub-themes: participation in education sessions, adherence to medication, and efforts to maintain a healthy lifestyle. Explanations of different strategies available to HIV-infected patients to cope with stress may help develop tailored interventions to improve the psychological conditions of people living with HIV. PMID:25769759

  5. Gastrointestinal symptoms in ambulatory HIV-infected patients.

    PubMed

    May, G R; Gill, M J; Church, D L; Sutherland, L R

    1993-08-01

    Gastrointestinal symptoms are commonly seen in patients with established AIDS. We examined the charts of 258 HIV-infected patients attending our HIV outpatient clinic to determine: (1) the frequency of gastrointestinal symptoms in unselected HIV-infected patients and (2) if there are any predictors of the development of symptoms in initially asymptomatic patients. We found the overall frequency of gastrointestinal symptoms at initial presentation in our ambulatory, predominantly homosexual population of HIV-infected patients was 35% (95% CI 30-40%) with 19% having anorexia, 15% weight loss, 14% diarrhea, and 5% dysphagia. There was no association between the presence of symptoms and stool parasites, which were found in 51% of patients. In 165 patients who were initially asymptomatic, 72% subsequently developed symptoms over 36 months of actuarial follow-up. Patients with initial T4 counts < 500 were more likely to develop symptoms. Patients with a greater degree of immunosuppression as indicated by a lower T4 count, are more likely to develop gastrointestinal symptoms. PMID:8102092

  6. Care of Patients With HIV Infection: Diagnosis and Monitoring.

    PubMed

    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    Appropriate screening for HIV infection is the cornerstone of HIV-related care. There have been several recent changes in testing technology and screening recommendations. The US Preventive Services Task Force recommends universal HIV screening at least once for adolescents and adults ages 15 to 65 years, and additional screening for patients at higher risk, although evidence is insufficient to determine optimum rescreening intervals. All pregnant women should be screened for HIV infection in the first trimester, and pregnant women at high risk should be screened again in the third trimester. The Centers for Disease Control and Prevention recommends use of an algorithm using fourth-generation tests for screening; this decreases the window period between infection and detection to as few as 14 days, thereby reducing the number of false-negative results. Home HIV testing kits, which require follow-up confirmatory testing, also are available. Clinicians should be aware of HIV-specific laws in their states, including those criminalizing HIV exposure and transmission. Thorough medical and laboratory evaluations are essential at initiation of care for patients with HIV infection, along with appropriate follow-up monitoring, as recommended in various guidelines. PMID:27092562

  7. Apoptosis and HIV infection: about molecules and genes.

    PubMed

    Cossarizza, Andrea

    2008-01-01

    During the evolution, the immune system has developed several strategies to fight viral infections. Apoptosis, autophagy and necrosis are different types of cell death that play a main role in the interactions between infective agents and the host, since they are often important defence mechanisms that have to avoid the spreading of the infection. In turn, viruses have evolved numerous ways to evade the host immune system by influencing the behaviour and functionality of several components. HIV infects and kills CD4+ T helper lymphocytes, preferentially those that are antigen-specific, but also encodes proteins with apoptotic capacities, including gp120, gp160, Tat, Nef, Vpr, Vpu, Vif and, last but not least, the viral protease. This latter protein can kill infected and uninfected lymphocytes through the action of several host molecules, mainly members of the tumor necrosis factor family, or via the mitochondrial apoptotic pathway. The proinflammatory state that is characteristic of both the acute and chronic phase of HIV infection facilitates cell death, and is an additional cause of immune damage. Potent antiretroviral drugs that are largely use in therapy can reduce apoptosis by different mechanisms, that not only include the diminished production of the virus by infected cells and the subsequent reduction of inflammation, but also a direct action on the viral protease. The role of the host genetic background is finally crucial in understanding the process of cell death in HIV infection. PMID:18220834

  8. Migration, Marital Change, and HIV Infection in Malawi

    PubMed Central

    Anglewicz, Philip

    2013-01-01

    Research on the relationship between migration and HIV infection in sub-Saharan Africa often suggests that migrants are at higher risk of HIV infection because they are more likely to engage in risk behavior than non-migrants, and tend to move to areas with a relatively higher HIV prevalence. While migration may be a risk factor for HIV infection, I instead focus on the possibility that the HIV positive are more likely to migrate. Using a longitudinal dataset of permanent rural residents and migrants from Malawi, I find that migrants originating from rural areas are indeed more likely than non-migrants to be HIV positive and to have engaged in HIV risk behavior. The increased HIV risk among migrants may be due to the selection of HIV positive individuals into migration; I find that HIV positive individuals are more likely migrate than those who are HIV negative. The explanation for this phenomenon appears to be marital instability, which occurs more frequently among HIV positive individuals and leads to migration after marital change. PMID:22109083

  9. Evaluation of the capability of RegCM4.0 in simulating East African climate

    NASA Astrophysics Data System (ADS)

    Ogwang, Bob Alex; Chen, Haishan; Li, Xing; Gao, Chujie

    2016-04-01

    The International Centre for Theoretical Physics (ICTP) regional climate model RegCM4.0 is used in this study to examine its ability to reproduce the climate of East Africa (EA) in regard to the annual cycle and June-to-August (JJA) seasonal climatology. Two domain sizes [large domain (LD) and small domain (SD)] and two cumulus convection schemes [Grell convection scheme with Fritsch-Chappell closure assumption (GRE scheme) and MIT scheme (EMA scheme)] are used. Simulations were done for the period 1989-2008 at a resolution of 50 km. The experiments were performed with the initial and lateral boundary conditions obtained from ERA-Interim-gridded reanalysis data at a 1.5° resolution. The variables investigated are precipitation, temperature, humidity, diurnal temperature range, and 850-hPa winds. Results show that the model realistically reproduces the East African climate, with a few discrepancies due to the different cumulus convection schemes and the domain sizes used. Grell with Fritsch-Chappell (Grell-FC) scheme captures well the observed climate in regard to the annual cycle and June-to-August seasonal climatology, with a tendency to underestimate rainfall over the JJA rainfall maximum region (RMR). This scheme performs better in LD than in SD. EMA scheme similarly captures well the observed climatology. It tends to overestimate rainfall over RMR. It however performs better in SD than in LD. The ensemble mean of simulations with GRE and EMA schemes (ENSM) tends to offer an improved representation of the observed climate, with a few discrepancies owing to the individual schemes used. In general, therefore, considering the performance of the model in both domains, the East African climate based on this study is better simulated by the Grell-FC scheme over LD. The observed biases in this study signify that the ability of the model in simulating climate over East Africa is still a significant challenge. Thus, future work must focus on improving the performance of

  10. Half-precessional climate forcing of Indian Ocean monsoon dynamics on the East African equator

    NASA Astrophysics Data System (ADS)

    Verschuren, D.; Sinninghe Damste, J. S.; Moernaut, J.; Kristen, I.; Fagot, M.; Blaauw, M.; Haug, G. H.; Project Members, C.

    2008-12-01

    The EuroCLIMATE project CHALLACEA produced a detailed multi-proxy reconstruction of the climate history of equatorial East Africa, based on the sediment record of Lake Challa, a 4.2 km2, 92-m deep crater lake on the lower East slope of Mt. Kilimanjaro (Kenya/Tanzania). Relatively stable sedimentation dynamics over the past 25,000 years resulted in a unique combination of high temporal resolution, excellent radiometric (210Pb, 14C) age control, and confidence that recording parameters of the climatic proxy signals extracted from the sediment have remained constant through time. The equatorial (3 deg. S) location of our study site in East Africa, where seasonal migration of convective activity spans the widest latitude range worldwide, produced unique information on how varying rainfall contributions from the northeasterly and southeasterly Indian Ocean monsoons shaped regional climate history. The Challa proxy records for temperature (TEX86) and moisture balance (reflection-seismic stratigraphy and the BIT index of soil bacterial input) uniquely weave together tropical climate variability at orbital and shorter time scales. The temporal pattern of reconstructed moisture balance bears the clear signature of half- precessional insolation forcing of Indian Ocean monsoon dynamics, modified by northern-latitude influence on moisture-balance variation at millennial and century time scales. During peak glacial time (but not immediately before) and the Younger Dryas, NH ice sheet influences overrode local insolation influence on monsoon intensity. After the NH ice sheets had melted and a relatively stable interglacial temperature regime developed, precession-driven summer insolation became the dominant determinant of regional moisture balance, with anti-phased patterns of Holocene hydrological change in the northern and southern (sub)tropics, and a uniquely hybrid pattern on the East African equator. In the last 2-3000 years a series of multi-century droughts with links to

  11. Molar proportions of volatile fatty acids in the gastrointestinal tract of East African wild ruminants.

    PubMed

    Clemens, E T; Maloiy, G M; Sutton, J D

    1983-01-01

    The molar proportions of seven individual VFA's were determined at select sites along the gastrointestinal tract of sixteen species of East African wild ruminants. The resulting data were statistically analyzed for species effect, and for effects due to major feeding groups (browsers, grazers, fresh grass grazers, etc.) and for body weight groups (5-750 kg animals). Present data suggest that body weight, rather than diet, is the more influential factor in reticulo-rumen fermentation rate, and in the molar proportion of fatty acids present. The molar proportions of VFA's observed in the mid and hindgut of these wild ruminants appeared more responsive to diet and body weight of the animal than did foregut VFA values. PMID:6139202

  12. Predicting East African spring droughts using Pacific and Indian Ocean sea surface temperature indices

    USGS Publications Warehouse

    Funk, Christopher C.; Hoell, Andrew; Shukla, Shraddhanand; Blade, Ileana; Liebmann, Brant; Roberts, Jason B.; Robertson, Franklin R.

    2014-01-01

    In southern Ethiopia, Eastern Kenya, and southern Somalia poor boreal spring rains in 1999, 2000, 2004, 2007, 2008, 2009 and 2011 contributed to severe food insecurity and high levels of malnutrition. Predicting rainfall deficits in this region on seasonal and decadal time frames can help decision makers support disaster risk reduction while guiding climate-smart adaptation and agricultural development. Building on recent research that links more frequent droughts to a stronger Walker Circulation, warming in the Indo-Pacific warm pool, and an increased western Pacific sea surface temperature (SST) gradient, we explore the dominant modes of East African rainfall variability, links between these modes and sea surface temperatures, and a simple index-based monitoring-prediction system suitable for drought early warning.

  13. Testing the stages model in the adaptive radiation of cichlid fishes in East African Lake Tanganyika

    PubMed Central

    Muschick, Moritz; Nosil, Patrik; Roesti, Marius; Dittmann, Marie Theres; Harmon, Luke; Salzburger, Walter

    2014-01-01

    Adaptive radiation (AR) is a key process in the origin of organismal diversity. However, the evolution of trait disparity in connection with ecological specialization is still poorly understood. Available models for vertebrate ARs predict that diversification occurs in the form of temporal stages driven by different selective forces. Here, we investigate the AR of cichlid fishes in East African Lake Tanganyika and use macroevolutionary model fitting to evaluate whether diversification happened in temporal stages. Six trait complexes, for which we also provide evidence of their adaptiveness, are analysed with comparative methods: body shape, pharyngeal jaw shape, gill raker traits, gut length, brain weight and body coloration. Overall, we do not find strong evidence for the ‘stages model’ of AR. However, our results suggest that trophic traits diversify earlier than traits implicated in macrohabitat adaptation and that sexual communication traits (i.e. coloration) diversify late in the radiation. PMID:25274371

  14. Testing the stages model in the adaptive radiation of cichlid fishes in East African Lake Tanganyika.

    PubMed

    Muschick, Moritz; Nosil, Patrik; Roesti, Marius; Dittmann, Marie Theres; Harmon, Luke; Salzburger, Walter

    2014-11-22

    Adaptive radiation (AR) is a key process in the origin of organismal diversity. However, the evolution of trait disparity in connection with ecological specialization is still poorly understood. Available models for vertebrate ARs predict that diversification occurs in the form of temporal stages driven by different selective forces. Here, we investigate the AR of cichlid fishes in East African Lake Tanganyika and use macroevolutionary model fitting to evaluate whether diversification happened in temporal stages. Six trait complexes, for which we also provide evidence of their adaptiveness, are analysed with comparative methods: body shape, pharyngeal jaw shape, gill raker traits, gut length, brain weight and body coloration. Overall, we do not find strong evidence for the 'stages model' of AR. However, our results suggest that trophic traits diversify earlier than traits implicated in macrohabitat adaptation and that sexual communication traits (i.e. coloration) diversify late in the radiation. PMID:25274371

  15. Two Plumes Beneath the East African Rift System: a Geochemical Investigation into Possible Interactions in Ethiopia

    NASA Astrophysics Data System (ADS)

    Nelson, W. R.; Furman, T.; van Keken, P. E.; Lin, S.

    2007-12-01

    East African Rift System magmatism began over 40 my ago and has continued through the present. Numerical models have determined two plumes are necessary to create the spatial and temporal distribution of volcanism. Geochemical data support the presence of two chemically distinct plumes initially located beneath the Afar Depression (NE Ethiopia) and the Turkana Depression (SW Ethiopia/N Kenya). The timing and eruptive of the Afar and Kenya plumes are also distinct. While there is growing evidence to support the existence of two dynamically and chemically distinct plumes beneath the East African Rift System, the interactions between them remain unclear. Our study focuses on the geochemistry of mafic shield lavas from three locations on the eastern flank of the Ethiopian plateau. These lavas are spatially located between the surface manifestation of the Afar and Kenya plumes. The majority of the lava is alkaline and has experienced varying degrees of olivine and pyroxene fractionation. The northernmost lavas (9°10'N) are transitional and display the most fractionation. Primitive mantle melts were generated at depths near the fertile mantle garnet-spinel transition zone and deeper (80-100km) and are free of metasomatic influence. Minor HREE depletions also support derivation of melts from a garnet-bearing source. Lavas with lithospheric influence are generated from shallower depths and show minor amphibole influence. Overall, geochemical data show the lavas in this study closely resemble those from various episodes of Kenya plume magmatism with modifications attributed to lithospheric contamination. This interpretation is consistent with current numerical models suggesting episodic northward movement of Kenya plume magmas along the lithosphere-asthenosphere boundary. The data imply that the Kenya plume has a much larger spatial influence and therefore a larger geodynamic influence in the EARS than previously recognized.

  16. TEC ingestion into NeQuick 2 to model the East African equatorial ionosphere

    NASA Astrophysics Data System (ADS)

    Nigussie, M.; Radicella, S. M.; Damtie, B.; Nava, B.; Yizengaw, E.; Ciraolo, L.

    2012-10-01

    NeQuick 2 ionospheric empirical model depends on global ionospheric coefficients that are estimated from unevenly distributed ionosonde measurements. In regions, like Africa, where very few observational data were available until recently, the model estimated the ionospheric peak parameters by interpolation. When one wants to employ the model to specify the ionosphere where very few data have been used for model development, the performances of the model need careful validation. This study investigates the performances of NeQuick 2 in the East African region by assisting the model with measurements from a single Global Positioning System (GPS) receiver, which has been deployed recently. This can be done by first calculating an effective ionization level that drives NeQuick 2 to compute slant total electron content (sTEC) which fits, in the least square sense, with the measurements taken from a single GPS receiver. We then quantify the performances of NeQuick 2 in reproducing the measured TEC by running the model at four other locations, where GPS stations are available, using the same effective ionization level that we calculated from a single GPS station as a driver of the model. Finally, the performances of the model before and after data ingestion have been investigated by comparing the model results with the experimental sTEC and vertical TEC (vTEC) obtained from the four test stations. Three months data during low solar activity conditions have been used for this study. We have shown that the capability of NeQuick 2, in describing the East African region of the ionosphere, can be improved substantially by data ingestion. We found that the model after ingestion reproduces the experimental TEC better as far as about 620 km away from the reference station than that before adaptation. The statistical comparisons of the performances of the model in reproducing sTEC before and after ingestion are also discussed in this study.

  17. OBESITY AND DYSLIPIDEMIA IN BEHAVIORALLY HIV-INFECTED YOUNG WOMEN: ADOLESCENT TRIALS NETWORK (ATN) STUDY 021

    PubMed Central

    Mulligan, Kathleen; Harris, D. Robert; Monte, Dina; Stoszek, Sonia; Emmanuel, Patricia; Hardin, Dana S.; Kapogiannis, Bill G.; Worrell, Carol; Meyer, William A.; Sleasman, John; Wilson, Craig M.

    2009-01-01

    Background The goal of this study was to determine the nature and prevalence of abnormalities in lipids, glucose metabolism, and body composition in behaviorally HIV-infected young women and their relationship to different classes of antiretroviral therapy (ART) regimens. Methods We conducted a cross-sectional multicenter study in behaviorally infected women ages 12-24 years (HIVpos; N=173) and seronegative controls (HIVneg; N=61). HIVpos women were categorized as ART-naïve (N=85), on a non-nucleoside reverse transcriptase inhibitor-containing regimen (NNRTI; N=33), on a protease inhibitor-containing regimen (PI; N=36), or on a non-NNRTI/non-PI containing regimen (N=19). Measurements included fasting lipids; glucose and insulin before and 2 hours after an oral glucose challenge; high-sensitivity C-reactive protein (hsCRP); anthropometry; fat distribution (dual energy X-ray absorptiometry); and ART and medical histories. Race-adjusted results were compared across groups and within HIVpos groups. Results The median age was 20 (range 14-24) years. 77% of HIVpos were African American, 35% smoked cigarettes, and 32% reported exercising regularly. More than 40% had a BMI ≥25 kg/m2. Triglycerides; total, HDL, and non-HDL cholesterol; and hsCRP differed significantly among groups, with higher levels most common among those on ART. Indices of glucose metabolism did not differ among groups. In general, cholesterol, hsCRP, and indices of glucose metabolism worsened as BMI increased. Conclusions Obesity, dyslipidemia, and inflammation were prominent in HIV-infected adolescent women and, coupled with other risk factors, may accelerate the lifetime risk of cardiovascular disease and other adverse events. These results underscore the need for a multifaceted approach to addressing risk reduction in this population. PMID:19947855

  18. Blood vitamins and trace elements in Northern-East African cheetahs (Acinonyx jubatus soemmeringii) in captivity in the Middle East.

    PubMed

    Beckmann, Katie M; O'Donovan, Declan; McKeown, Sean; Wernery, Ulli; Basu, Puja; Bailey, Tom A

    2013-09-01

    There are few published data regarding the endangered Northern-East African cheetah (Acinonyx jubatus soemmeringii), held in captivity in the Middle East and Europe. Studies have demonstrated a high incidence of disease in captive cheetahs, in which vitamin and trace element imbalances have often been implicated. Blood vitamin and trace element reference values in cheetahs merit further investigation. In this study, blood samples were opportunistically collected from apparently healthy A. j. soemmeringii from two collections (A and B) with successful breeding programs in the United Arab Emirates. The cheetahs were fed whole prey of mixed species (and, in Collection B, goat muscle and bone as well) dusted with vitamin and mineral supplements. Mean serum vitamin and trace element values (for cheetahs > 4 mo in age) were as follows: vitamin A (retinol), 2.20 microM/L (n = 27); vitamin B1, 0.0818 microM/L (n = 45); vitamin C, 28.6 microM/L (n=10); vitamin E (alpha-tocopherol), 35.6 microM/L (n = 27); copper (Cu), 12.53 microM/L (n = 27); selenium (Se), 3.10 microM/L (n = 27); and zinc (Zn), 10.87 microM/L (n = 27). Mean values of vitamin A, vitamin E, Cu, and Zn fell within ranges of published cheetah mean values, and mean Se was lower than range values for cheetahs presented in one previous study; blood vitamin B1 and vitamin C values of cheetahs have not previously been published. The values were taken to indicate that the cheetahs' nutritional status was adequate with regard to those nutrients analyzed. Serum vitamin E was particularly high in cheetahs fed fresh whole prey, and on this basis vitamin E supplementation of fresh whole prey appeared to have been unnecessary. There were differences (P < 0.05) between collections in serum vitamin B1, vitamin E, Cu, and 10 other hematologic and biochemical parameters. Nine hematologic and blood biochemical parameters differed among age categories. PMID:24063089

  19. Hearing Loss in HIV-Infected Children in Lilongwe, Malawi

    PubMed Central

    Hrapcak, Susan; Kuper, Hannah; Bartlett, Peter; Devendra, Akash; Makawa, Atupele; Kim, Maria; Kazembe, Peter; Ahmed, Saeed

    2016-01-01

    Introduction With improved access to antiretroviral therapy (ART), HIV infection is becoming a chronic illness. Preliminary data suggest that HIV-infected children have a higher risk of disabilities, including hearing impairment, although data are sparse. This study aimed to estimate the prevalence and types of hearing loss in HIV-infected children in Lilongwe, Malawi. Methods This was a cross-sectional survey of 380 HIV-infected children aged 4–14 years attending ART clinic in Lilongwe between December 2013-March 2014. Data was collected through pediatric quality of life and sociodemographic questionnaires, electronic medical record review, and detailed audiologic testing. Hearing loss was defined as >20 decibels hearing level (dBHL) in either ear. Predictors of hearing loss were explored by regression analysis generating age- and sex-adjusted odds ratios. Children with significant hearing loss were fitted with hearing aids. Results Of 380 patients, 24% had hearing loss: 82% conductive, 14% sensorineural, and 4% mixed. Twenty-one patients (23% of those with hearing loss) were referred for hearing aid fitting. There was a higher prevalence of hearing loss in children with history of frequent ear infections (OR 7.4, 4.2–13.0) and ear drainage (OR 6.4, 3.6–11.6). Hearing loss was linked to history of WHO Stage 3 (OR 2.4, 1.2–4.5) or Stage 4 (OR 6.4, 2.7–15.2) and history of malnutrition (OR 2.1, 1.3–3.5), but not to duration of ART or CD4. Only 40% of caregivers accurately perceived their child’s hearing loss. Children with hearing impairment were less likely to attend school and had poorer emotional (p = 0.02) and school functioning (p = 0.04). Conclusions There is an urgent need for improved screening tools, identification and treatment of hearing problems in HIV-infected children, as hearing loss was common in this group and affected school functioning and quality of life. Clear strategies were identified for prevention and treatment, since most

  20. Premature aging and immune senescence in HIV-infected children

    PubMed Central

    Gianesin, Ketty; Noguera-Julian, Antoni; Zanchetta, Marisa; Del Bianco, Paola; Petrara, Maria Raffaella; Freguja, Riccardo; Rampon, Osvalda; Fortuny, Clàudia; Camós, Mireia; Mozzo, Elena; Giaquinto, Carlo; De Rossi, Anita

    2016-01-01

    Objective: Several pieces of evidence indicate that HIV-infected adults undergo premature aging. The effect of HIV and antiretroviral therapy (ART) exposure on the aging process of HIV-infected children may be more deleterious since their immune system coevolves from birth with HIV. Design: Seventy-one HIV-infected (HIV+), 65 HIV-exposed-uninfected (HEU), and 56 HIV-unexposed-uninfected (HUU) children, all aged 0–5 years, were studied for biological aging and immune senescence. Methods: Telomere length and T-cell receptor rearrangement excision circle levels were quantified in peripheral blood cells by real-time PCR. CD4+ and CD8+ cells were analysed for differentiation, senescence, and activation/exhaustion markers by flow cytometry. Results: Telomere lengths were significantly shorter in HIV+ than in HEU and HUU children (overall, P < 0.001 adjusted for age); HIV+ ART-naive (42%) children had shorter telomere length compared with children on ART (P = 0.003 adjusted for age). T-cell receptor rearrangement excision circle levels and CD8+ recent thymic emigrant cells (CD45RA+CD31+) were significantly lower in the HIV+ than in control groups (overall, P = 0.025 and P = 0.005, respectively). Percentages of senescent (CD28−CD57+), activated (CD38+HLA-DR+), and exhausted (PD1+) CD8+ cells were significantly higher in HIV+ than in HEU and HUU children (P = 0.004, P < 0.001, and P < 0.001, respectively). Within the CD4+ cell subset, the percentage of senescent cells did not differ between HIV+ and controls, but programmed cell death receptor-1 expression was upregulated in the former. Conclusions: HIV-infected children exhibit premature biological aging with accelerated immune senescence, which particularly affects the CD8+ cell subset. HIV infection per se seems to influence the aging process, rather than exposure to ART for prophylaxis or treatment. PMID:26990630

  1. Helium isotopes at Rungwe Volcanic Province, Tanzania, and the origin of East African Plateaux

    NASA Astrophysics Data System (ADS)

    Hilton, D. R.; Halldórsson, S. A.; Barry, P. H.; Fischer, T. P.; de Moor, J. M.; Ramirez, C. J.; Mangasini, F.; Scarsi, P.

    2011-11-01

    We report helium isotope ratios (3He/4He) of lavas and tephra of the Rungwe Volcanic Province (RVP) in southern Tanzania. Values as high as 15RA (RA = air 3He/4He) far exceed typical upper mantle values, and are the first observation of plume-like ratios south of the Turkana Depression which separates the topographic highs of the Ethiopia and Kenya domes. The African Superplume - a tilted low-velocity seismic anomaly extending to the core-mantle boundary beneath southern Africa - is the likely source of these high 3He/4He ratios. High 3He/4He ratios at RVP together with similarly-high values along the Main Ethiopian Rift and in Afar provide compelling evidence that the African Superplume is a feature that extends through the 670-km seismic discontinuity and provides dynamic support - either as a single plume or via multiple upwellings - for the two main topographic features of the East Africa Rift System as well as heat and mass to drive continuing rift-related magmatism.

  2. Persistence and Change in Disparities in HIV Infection Among Injection Drug Users in New York City After Large-Scale Syringe Exchange Programs

    PubMed Central

    Arasteh, Kamyar; Hagan, Holly; McKnight, Courtney; Perlman, David C.; Friedman, Samuel R.

    2009-01-01

    Objectives. We examined racial/ethnic disparities in HIV infection among injection drug users (IDUs) before and after implementation of large-scale syringe exchange programs in New York City. Methods. Participants were recruited from IDUs entering the Beth Israel drug detoxification program in New York City. Participants (n = 1203) recruited from 1990 through 1994, prior to large-scale syringe exchange programs (pre-exchange), were compared with 1109 participants who began injecting in 1995 or later and were interviewed in 1995 through 2008 (post-exchange). Results. There were large differences in HIV prevalence among pre-exchange vs post-exchange participants (African Americans, 57% vs 15%; Hispanics, 53% vs 5%; Whites, 27% vs 3%). Pre- and post-exchange relative disparities of HIV prevalence were similar for African Americans vs Whites (adjusted odds ratio [AOR] = 3.46, 95% confidence interval [CI] = 2.41, 4.96 and AOR = 4.02, 95% CI = 1.67, 9.69, respectively) and Hispanics vs Whites (AOR = 1.76, 95% CI = 1.49, 2.09 and AOR = 1.49, 95% CI = 1.02, 2.17). Racial/ethnic group differences in risk behavior did not explain differences in HIV prevalence. Conclusions. New interventions are needed to address continuing disparities in HIV infection among IDUs, but self-reported risk behaviors by themselves may not be adequate outcome measures for evaluating interventions to reduce racial/ethnic disparities in HIV infection. PMID:19797757

  3. African 2, a Clonal Complex of Mycobacterium bovis Epidemiologically Important in East Africa▿ †

    PubMed Central

    Berg, Stefan; Garcia-Pelayo, M. Carmen; Müller, Borna; Hailu, Elena; Asiimwe, Benon; Kremer, Kristin; Dale, James; Boniotti, M. Beatrice; Rodriguez, Sabrina; Hilty, Markus; Rigouts, Leen; Firdessa, Rebuma; Machado, Adelina; Mucavele, Custodia; Ngandolo, Bongo Nare Richard; Bruchfeld, Judith; Boschiroli, Laura; Müller, Annélle; Sahraoui, Naima; Pacciarini, Maria; Cadmus, Simeon; Joloba, Moses; van Soolingen, Dick; Michel, Anita L.; Djønne, Berit; Aranaz, Alicia; Zinsstag, Jakob; van Helden, Paul; Portaels, Françoise; Kazwala, Rudovick; Källenius, Gunilla; Hewinson, R. Glyn; Aseffa, Abraham; Gordon, Stephen V.; Smith, Noel H.

    2011-01-01

    We have identified a clonal complex of Mycobacterium bovis isolated at high frequency from cattle in Uganda, Burundi, Tanzania, and Ethiopia. We have named this related group of M. bovis strains the African 2 (Af2) clonal complex of M. bovis. Af2 strains are defined by a specific chromosomal deletion (RDAf2) and can be identified by the absence of spacers 3 to 7 in their spoligotype patterns. Deletion analysis of M. bovis isolates from Algeria, Mali, Chad, Nigeria, Cameroon, South Africa, and Mozambique did not identify any strains of the Af2 clonal complex, suggesting that this clonal complex of M. bovis is localized in East Africa. The specific spoligotype pattern of the Af2 clonal complex was rarely identified among isolates from outside Africa, and the few isolates that were found and tested were intact at the RDAf2 locus. We conclude that the Af2 clonal complex is localized to cattle in East Africa. We found that strains of the Af2 clonal complex of M. bovis have, in general, four or more copies of the insertion sequence IS6110, in contrast to the majority of M. bovis strains isolated from cattle, which are thought to carry only one or a few copies. PMID:21097608

  4. A live weight-heart girth relationship for accurate dosing of east African shorthorn zebu cattle.

    PubMed

    Lesosky, Maia; Dumas, Sarah; Conradie, Ilana; Handel, Ian Graham; Jennings, Amy; Thumbi, Samuel; Toye, Phillip; Bronsvoort, Barend Mark de Clare

    2013-01-01

    The accurate estimation of livestock weights is important for many aspects of livestock management including nutrition, production and appropriate dosing of pharmaceuticals. Subtherapeutic dosing has been shown to accelerate pathogen resistance which can have subsequent widespread impacts. There are a number of published models for the prediction of live weight from morphometric measurements of cattle, but many of these models use measurements difficult to gather and include complicated age, size and gender stratification. In this paper, we use data from the Infectious Diseases of East Africa calf cohort study and additional data collected at local markets in western Kenya to develop a simple model based on heart girth circumference to predict live weight of east African shorthorn zebu (SHZ) cattle. SHZ cattle are widespread throughout eastern and southern Africa and are economically important multipurpose animals. We demonstrate model accuracy by splitting the data into training and validation subsets and comparing fitted and predicted values. The final model is weight(0.262) = 0.95 + 0.022 × girth which has an R (2) value of 0.98 and 95 % prediction intervals that fall within the ± 20 % body weight error band regarded as acceptable when dosing livestock. This model provides a highly reliable and accurate method for predicting weights of SHZ cattle using a single heart girth measurement which can be easily obtained with a tape measure in the field setting. PMID:22923040

  5. Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2)

    ClinicalTrials.gov

    2016-04-13

    Acquired Immunodeficiency Syndrome; Lung Diseases; Cardiovascular Diseases; Heart Diseases; Heart Failure; HIV Infections; Cytomegalovirus Infections; Pneumocystis Carinii Infections; Ebstein-Barr Virus Infections

  6. Motivation, Management, and Mastery: A Theory of Resilience in the Context of HIV Infection

    PubMed Central

    De Santis, Joseph P.; Florom-Smith, Aubrey; Vermeesch, Amber; Barroso, Susana; DeLeon, Diego A.

    2013-01-01

    BACKGROUND Clients with HIV infection have been conceptualized as a resilient population. Although a few researchers have documented resilience among clients with HIV infection, a theory of resilience in the context of HIV infection has not been developed. The purpose of this study was to describe the process by which resilience occurs for clients in the context of HIV infection. METHOD Grounded theory methodology was used to sample and analyze data from 15 qualitative interviews with adults with HIV infection. Data were collected until saturation was reached. RESULTS A theory, motivation, management, and mastery, a description of the process by which resilience occurs in the context of HIV infection, emerged from the data. CONCLUSION Many clients living with HIV infection are resilient, despite the physical, psychological, and social challenges of this chronic illness. Nursing interventions to promote resilience among clients with HIV infection should be directed toward identification of client motivation factors and disease management strategies that may influence health outcomes of people living with HIV infection. PMID:23392433

  7. HPTN 068: A Randomized Control Trial of a Conditional Cash Transfer to Reduce HIV Infection in Young Women in South Africa-Study Design and Baseline Results.

    PubMed

    Pettifor, Audrey; MacPhail, Catherine; Selin, Amanda; Gómez-Olivé, F Xavier; Rosenberg, Molly; Wagner, Ryan G; Mabuza, Wonderful; Hughes, James P; Suchindran, Chirayath; Piwowar-Manning, Estelle; Wang, Jing; Twine, Rhian; Daniel, Tamu; Andrew, Philip; Laeyendecker, Oliver; Agyei, Yaw; Tollman, Stephen; Kahn, Kathleen

    2016-09-01

    Young women in South Africa are at high risk for HIV infection. Cash transfers offer promise to reduce HIV risk. We present the design and baseline results from HPTN 068, a phase III, individually randomized trial to assess the effect of a conditional cash transfer on HIV acquisition among South African young women. A total of 2533 young women were randomized to receive a monthly cash transfer conditional on school attendance or to a control group. A number of individual-, partner-, household- and school-level factors were associated with HIV and HSV-2 infection. After adjusting for age, all levels were associated with an increased odds of HIV infection with partner-level factors conveying the strongest association (aOR 3.05 95 % CI 1.84-5.06). Interventions like cash transfers that address structural factors such as schooling and poverty have the potential to reduce HIV risk in young women in South Africa. PMID:26891839

  8. Sismotectonics in the western branch of the East African Rift System

    NASA Astrophysics Data System (ADS)

    Delvaux, Damien; Kervyn, François; Mulumba, Jean-Luc; Kipata, Louis; Sebagenzi, Stanislas; Mavonga, Georges; Macheyeki, Athanas; Temu, Elly Bryan

    2013-04-01

    The western branch of the East African rift system is known of its particular seismic activity with larger magnitude (up to Ms 7.3) and more frequent destructive earthquakes than in the eastern branch. As a contribution to the IGCP 601 project Seismotectonic Map of Africa, we compiled the known active faults, thermal springs and historical seismicity in Central Africa. Using the rich archives of the Royal Museum for Central Africa, publications and own field observations, we present a compilation of available data relative to the current seismotectonic activity along the western branch of the East African rift system, in DRC, Rwanda, Burundi and Tanzania. Neotectonic activity related to the western rift branch is in general well expressed and relatively well studied in the eastern flank of this rift branch, in Uganda, Rwanda, Burundi and Tanzania. In contrast, the western flank of this rift branch, largely exposed in the DRC, has attracted less attention. However, data collected during the colonial times show significant sismotectonic activity in East DRC, not only in the western flank of the western rift branch, but extending far westwards up to the margin of the Congo basin. In particular, our predecessors paid a special attention to the mapping and description of thermal springs, noticing that they are often controlled by active faults. In addition, the operators of the relatively dense network of meteorological stations installed in the DRC, Rwanda and Burundi also recorded were with variable level of completeness and detail the earthquakes that they could felt. This provides a rich database that is used to complete the existing knowledge on historical seismicity. An important effort has still to be paid to identify and map potentially active fault due to poor field accessibility, tropical climate weathering and vegetation coverage. The main problem in the compilation of active fault data is that very few of them have been investigated by paleoseismic trenching

  9. Comparison of simulated and reconstructed variations in East African hydroclimate over the last millennium

    NASA Astrophysics Data System (ADS)

    Klein, François; Goosse, Hugues; Graham, Nicholas E.; Verschuren, Dirk

    2016-07-01

    The multi-decadal to centennial hydroclimate changes in East Africa over the last millennium are studied by comparing the results of forced transient simulations by six general circulation models (GCMs) with published hydroclimate reconstructions from four lakes: Challa and Naivasha in equatorial East Africa, and Masoko and Malawi in southeastern inter-tropical Africa. All GCMs simulate fairly well the unimodal seasonal cycle of precipitation in the Masoko-Malawi region, while the bimodal seasonal cycle characterizing the Challa-Naivasha region is generally less well captured by most models. Model results and lake-based hydroclimate reconstructions display very different temporal patterns over the last millennium. Additionally, there is no common signal among the model time series, at least until 1850. This suggests that simulated hydroclimate fluctuations are mostly driven by internal variability rather than by common external forcing. After 1850, half of the models simulate a relatively clear response to forcing, but this response is different between the models. Overall, the link between precipitation and tropical sea surface temperatures (SSTs) over the pre-industrial portion of the last millennium is stronger and more robust for the Challa-Naivasha region than for the Masoko-Malawi region. At the inter-annual timescale, last-millennium Challa-Naivasha precipitation is positively (negatively) correlated with western (eastern) Indian Ocean SST, while the influence of the Pacific Ocean appears weak and unclear. Although most often not significant, the same pattern of correlations between East African rainfall and the Indian Ocean SST is still visible when using the last-millennium time series smoothed to highlight centennial variability, but only in fixed-forcing simulations. This means that, at the centennial timescale, the effect of (natural) climate forcing can mask the imprint of internal climate variability in large-scale teleconnections.

  10. Exploring Pacific Climate Variability and Its Impacts on East African Water Resources and Food Security

    NASA Astrophysics Data System (ADS)

    Funk, C. C.; Hoerling, M. P.; Hoell, A.; Liebmann, B.; Verdin, J. P.; Eilerts, G.

    2014-12-01

    In 8 out the past 15 boreal springs (1999, 2000, 2004, 2008, 2009, 2011, 2012, and 2013), substantial parts of eastern East Africa experienced very low boreal spring rains. These rainfall deficits have triggered widespread food insecurity, and even contributed to the outbreak of famine conditions in Somalia in 2011. At both seasonal and decadal time scales, new science supported by the USAID Famine Early Warning Systems Network seeks to understand the mechanisms producing these droughts. We present research suggesting that the ultimate and proximate causes of these increases in aridity are i) stronger equatorial Pacific SST gradients and ii) associated increases in the strength of the Indo-Pacific Walker circulation. Using observations and new modeling ensembles, we explore the relative contributions of Pacific Decadal Variability (PDV) and global warming under warm and cold east Pacific Ocean states. This question is addressed in two ways: by using atmospheric GCMs forced with full and ENSO-only SSTs, and ii) by decomposing coupled ocean-atmosphere climate simulations into PDV and non-PDV components. These analyses allow us to explore the Walker circulation's sensitivity to climate change under various PDV states, and inform a tentative bracketing of 2030 climate conditions. We conclude by discussing links to East African development. Regions of high rainfall sensitivity are delineated and intersected with recent changes in population and land cover/land use. The interaction of elevation and climate is shown to create climatically secure regions that are likely to remain viable even under drier and warmer conditions; such regions may be logical targets for agricultural intensification. Conversely, arid low elevation regions are likely to experience substantial temperature impacts. Continued expansion into these areas may effectively create more 'drought' even if rainfall increases.

  11. The physical and psychological effects of HIV infection and its treatment on perinatally HIV-infected children

    PubMed Central

    Vreeman, Rachel C; Scanlon, Michael L; McHenry, Megan S; Nyandiko, Winstone M

    2015-01-01

    Introduction As highly active antiretroviral therapy (HAART) transforms human immunodeficiency virus (HIV) into a manageable chronic disease, new challenges are emerging in treating children born with HIV, including a number of risks to their physical and psychological health due to HIV infection and its lifelong treatment. Methods We conducted a literature review to evaluate the evidence on the physical and psychological effects of perinatal HIV (PHIV+) infection and its treatment in the era of HAART, including major chronic comorbidities. Results and discussion Perinatally infected children face concerning levels of treatment failure and drug resistance, which may hamper their long-term treatment and result in more significant comorbidities. Physical complications from PHIV+ infection and treatment potentially affect all major organ systems. Although treatment with antiretroviral (ARV) therapy has reduced incidence of severe neurocognitive diseases like HIV encephalopathy, perinatally infected children may experience less severe neurocognitive complications related to HIV disease and ARV neurotoxicity. Major metabolic complications include dyslipidaemia and insulin resistance, complications that are associated with both HIV infection and several ARV agents and may significantly affect cardiovascular disease risk with age. Bone abnormalities, particularly amongst children treated with tenofovir, are a concern for perinatally infected children who may be at higher risk for bone fractures and osteoporosis. In many studies, rates of anaemia are significantly higher for HIV-infected children. Renal failure is a significant complication and cause of death amongst perinatally infected children, while new data on sexual and reproductive health suggest that sexually transmitted infections and birth complications may be additional concerns for perinatally infected children in adolescence. Finally, perinatally infected children may face psychological challenges, including

  12. Sexual risk of HIV infection among expatriates posted in AIDS endemic areas.

    PubMed

    de Graaf, R; van Zessen, G; Houweling, H; Ligthelm, R J; van den Akker, R

    1997-07-15

    A survey conducted among 864 Dutch expatriates returning home from assignment in AIDS-endemic areas in sub-Saharan Africa, Latin America, and South and South East Asia revealed a low rate of HIV infection, despite widespread high-risk sexual practices. During an average stay out of the country of 26 months in 1991-96, 41% of the 634 male respondents reported sex with casual or steady local partners and 11% with casual or steady expatriate partners. Among the 230 female expatriates, these rates were 31% and 24%, respectively. 58% of men with casual local partners paid for sex at least once. Among men, consistent condom use was practiced in 69% of encounters with casual local partners and 63% of the time with casual expatriate partners. Among women, these rates were 64% and 48%, respectively. The prevalence of consistent condom use with casual local partners in this study was three times greater than that identified in a study conducted among Dutch expatriates in 1987-89. Condom use with regular local or expatriate partners was substantially lower (16.1-27.8%), however. Inconsistent condom use with casual partners was significantly associated, among men, with being abroad for a longer period of time, failure to bring condoms with them from the Netherlands, posting in an Asian country, and a relatively low estimated HIV prevalence in the local population. Among women, these risk factors were failure to take condoms to their destination and lack of intention at departure to have sex abroad. Only one case of HIV infection was detected in the 847 respondents who underwent serologic testing. Since expatriates function as a bridge between areas with high and low HIV prevalence, educational campaigns that prepare departing workers for differences between the sexual culture at home and abroad and encourage them to take a supply of condoms are recommended. PMID:9233466

  13. Autoantibodies against peripheral blood cells appear early in HIV infection and their prevalence increases with disease progression.

    PubMed Central

    Klaassen, R J; Mulder, J W; Vlekke, A B; Eeftinck Schattenkerk, J K; Weigel, H M; Lange, J M; von dem Borne, A E

    1990-01-01

    The presence of platelet- and neutrophil-bound immunoglobulin (PBIg and NBIg) in thrombocytopenic or neutropenic HIV-infected individuals has led to the concept that in HIV infection thrombocytopenia and neutropenia are mediated by autoimmunity. However, PBIg and NBIg were also demonstrated in non-cytopenic HIV-infected individuals. We determined the prevalence of autoantibodies against neutrophils and platelets by immunofluorescence in randomly chosen persons in different stages of asymptomatic and symptomatic HIV infection. Platelet and neutrophil autoantibodies already appeared in the asymptomatic stage and their prevalence further increased in the symptomatic stages. No correlation was found between the presence of either platelet or neutrophil antibodies and the occurrence of circulating immune complexes in the blood or the serum immunoglobulin level. There was no significant difference in neutrophil counts in HIV-infected persons with or without neutrophil autoantibodies. In addition, no significant difference in neutrophil count was found between HIV-infected and non-HIV-infected persons. HIV-infected individuals with platelet autoantibodies tended to have a lower platelet count than HIV-infected individuals without these antibodies. However, the platelet count in HIV-infected individuals without platelet antibodies was significantly lower than in the non-HIV infected persons. Thus, autoantibodies against platelets and neutrophils occur early in HIV infection and their prevalence is correlated with disease progression. Their presence is associated with cytopenia only in a limited number of persons. Non-immune mechanisms also mediate thrombocytopenia in HIV infection. PMID:1974174

  14. Short Communication: Tenofovir Diphosphate in Dried Blood Spots As an Objective Measure of Adherence in HIV-Infected Women

    PubMed Central

    Castillo-Mancilla, Jose R.; Searls, Kristina; Caraway, Patricia; Zheng, Jia-Hua; Gardner, Edward M.; Predhomme, Julie; Bushman, Lane R.; Meditz, Amie L.

    2015-01-01

    Abstract Simple and reproducible tools to assess antiretroviral adherence are needed. A level of tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) <1,250 fmol/punch is predicted to identify imperfect adherence. Herein we evaluated TFV-DP in DBS as a measure of adherence among HIV-infected women. DBS and peripheral blood mononuclear cells (PBMCs) were collected twice (∼1 week apart) in 35 well-controlled HIV-infected women [median age 42 years, 14 African American/black (AA)] receiving daily coformulated tenofovir/emtricitabine and either atazanavir/ritonavir (n=20) or raltegravir (n=16). TFV-DP in DBS and PBMCs was quantified by LC-MS/MS. Six-month adherence was measured as average days between monthly pharmacy refills. Data were loge transformed for analysis and presented as median (range); the correlation between continuous variables was analyzed using the Pearson correlation coefficient. The average TFV-DP between the two visits (aTFV-DP) in DBS and PBMCs was 1,874 (706–3,776) fmol/punch and 125 (1–278) fmol/106 cells, respectively. AA women had lower levels of aTFV-DP in DBS compared to whites (1,660 vs. 1,970 fmol/punch; p=0.04), with a viremic patient having the lowest drug levels (706 fmol/punch). Days between pharmacy refills were 34 (30–54) vs. 30 (26–40) in women with TFV-DP in DBS <1,250 vs. ≥1,250 fmol/punch (p=0.006). TFV-DP in DBS was negatively correlated with an increasing number of days between refills (r=−0.56, p=0.002). TFV-DP DBS was a reliable and objective measure of adherence in HIV-infected women based on a strong inverse relationship with pharmacy refill adherence. PMID:25328112

  15. Short communication: Tenofovir diphosphate in dried blood spots as an objective measure of adherence in HIV-infected women.

    PubMed

    Castillo-Mancilla, Jose R; Searls, Kristina; Caraway, Patricia; Zheng, Jia-Hua; Gardner, Edward M; Predhomme, Julie; Bushman, Lane R; Anderson, Peter L; Meditz, Amie L

    2015-04-01

    Simple and reproducible tools to assess antiretroviral adherence are needed. A level of tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) <1,250 fmol/punch is predicted to identify imperfect adherence. Herein we evaluated TFV-DP in DBS as a measure of adherence among HIV-infected women. DBS and peripheral blood mononuclear cells (PBMCs) were collected twice (∼1 week apart) in 35 well-controlled HIV-infected women [median age 42 years, 14 African American/black (AA)] receiving daily coformulated tenofovir/emtricitabine and either atazanavir/ritonavir (n=20) or raltegravir (n=16). TFV-DP in DBS and PBMCs was quantified by LC-MS/MS. Six-month adherence was measured as average days between monthly pharmacy refills. Data were loge transformed for analysis and presented as median (range); the correlation between continuous variables was analyzed using the Pearson correlation coefficient. The average TFV-DP between the two visits (aTFV-DP) in DBS and PBMCs was 1,874 (706-3,776) fmol/punch and 125 (1-278) fmol/10(6) cells, respectively. AA women had lower levels of aTFV-DP in DBS compared to whites (1,660 vs. 1,970 fmol/punch; p=0.04), with a viremic patient having the lowest drug levels (706 fmol/punch). Days between pharmacy refills were 34 (30-54) vs. 30 (26-40) in women with TFV-DP in DBS <1,250 vs. ≥1,250 fmol/punch (p=0.006). TFV-DP in DBS was negatively correlated with an increasing number of days between refills (r=-0.56, p=0.002). TFV-DP DBS was a reliable and objective measure of adherence in HIV-infected women based on a strong inverse relationship with pharmacy refill adherence. PMID:25328112

  16. Oral Glucose Tolerance Testing identifies HIV+ infected women with Diabetes Mellitus (DM) not captured by standard DM definition

    PubMed Central

    Tian, Fang; Anastos, Kathryn; Cohen, Mardge H; Tien, Phyllis C

    2016-01-01

    Objective HIV-infected (HIV+) individuals may have differential risk of diabetes mellitus (DM) compared to the general population, and the optimal diagnostic algorithm for DM in HIV+ persons remains unclear. We aimed to assess the utility of oral glucose tolerance testing (OGTT) for DM diagnosis in a cohort of women with or at risk for HIV infection. Methods Using American Diabetic Association DM definitions, DM prevalence and incidence were assessed among women enrolled in the Women’s Interagency HIV Study. DM was defined by 2-hour OGTT ≥ 200 mg/dL (DM_OGTT) or a clinical definition (DM_C) that included any of the following: (i) anti-diabetic medication use or self-reported DM confirmed by either fasting glucose (FG) ≥126 mg/dL or HbA1c ≥ 6.5%, (ii) FG ≥ 126 mg/dL confirmed by a second FG ≥ 126 mg/dL or HbA1c 6.5%, or (iii) HbA1c 6.5% confirmed by FG ≥ 126 mg/dL cohort. Results Overall, 390 women (285 HIV+, median age 43 years; 105 HIV−, median age 37 years) were enrolled between 2003-2006. Over half of all women were African American. Using DM_C, DM prevalence rates were 5.6% and 2.8% among HIV+ and HIV− women, respectively. Among HIV+ women, adding DM_OGTT to DM_C increased DM prevalence from 5.6% to 7.4%, a 31% increase in the number of diabetes cases diagnosed (p=0.02). In HIV− women, no additional cases were diagnosed by DM-OGTT. Conclusion In HIV+ women, OGTT identified DM cases that were not identified by a standardized clinical definition. Further investigation is needed to determine whether OGTT should be considered as an adjunctive tool for DM diagnosis in the setting of HIV infection. PMID:27066296

  17. Continuous ambulatory peritoneal dialysis and survival of HIV infected patients with end-stage renal disease.

    PubMed

    Kimmel, P L; Umana, W O; Simmens, S J; Watson, J; Bosch, J P

    1993-08-01

    As the number of human immunodeficiency virus (HIV) infected patients has increased in the U.S., the number of infected patients treated for end-stage renal disease (ESRD) has stabilized at about 1 to 2% of the hemodialyzed population. Little has been written regarding the role of continuous ambulatory peritoneal dialysis (CAPD) in the treatment of HIV infected patients with ESRD. To evaluate the effectiveness of CAPD as a long term therapy for HIV infected patients with ESRD, we reviewed our ESRD program's experience. We entered 392 patients from its inception in February 1984 until April 1992. Thirty-one, or 7.9% of our population were HIV infected. Twenty, or 64.5% had stage IV infection. Patients were entered into our chronic hemodialysis (HD) or CAPD program according to standard clinical criteria. Eight HIV infected patients elected to start CAPD, while 23 patients were treated exclusively with HD. The proportion of stage IV infected patients was similar in both treatment modality groups. HIV infected ESRD patients were younger than non-HIV infected patients (37.5 +/- 9.7 vs. 49.8 +/- 15.7 years, respectively, P < 0.0001) at the start of treatment. We used Cox regression techniques to analyze survival data. Mean survival time for our entire non-HIV infected ESRD population (N = 361) was 44.0 +/- 33.9 months. Mean survival time for HIV infected patients with ESRD was 15.5 +/- 9.9 months. Median survival for HIV infected ESRD patients was 13 months compared to 38 months for the non-infected population. As expected, mean survival time in HIV infected ESRD patients was significantly diminished compared to non-infected ESRD patients (P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8377381

  18. [Pneumocystosis in non-HIV-infected immunocompromised patients].

    PubMed

    Fillâtre, P; Revest, M; Belaz, S; Robert-Gangneux, F; Zahar, J-R; Roblot, F; Tattevin, P

    2016-05-01

    Pneumocystis jiroveci (formerly P. carinii) is an opportunistic fungus responsible for pneumonia in immunocompromised patients. Pneumocystosis in non-HIV-infected patients differs from AIDS-associated pneumocystosis in mostly two aspects: diagnosis is more difficult, and prognosis is worse. Hence, efforts should be made to target immunocompromised patients at higher risk of pneumocystosis, so that they are prescribed long-term, low-dose, trimethoprime-sulfamethoxazole, highly effective for pneumocystosis prophylaxis. Patients at highest risk include those with medium and small vessels vasculitis, lymphoproliferative B disorders (chronic or acute lymphocytic leukaemia, non-Hodgkin lymphoma), and solid cancer on long-term corticosteroids. Conversely, widespread use of prophylaxis in all patients carrier of inflammatory diseases on long-term corticosteroids is not warranted. The management of pneumocystosis in non-AIDS immunocompromised patients follows the rules established for AIDS patients. The diagnosis relies on the detection of P. jiroveci cyst on respiratory samples, while PCR does not reliably discriminate infection from colonization, in 2015. High-doses trimethoprim-sulfamethoxazole is, by far, the treatment of choice. The benefit of adjuvant corticosteroid therapy for hypoxic patients, well documented in AIDS patients, has a much lower level of evidence in non-HIV-infected patients, most of them being already on corticosteroid by the time of pneumocystosis diagnosis anyway. However, based on its striking impact on morbi-mortality in AIDS patients, adjuvant corticosteroid is recommended in hypoxic, non-HIV-infected patients with pneumocystosis by many experts and scientific societies. PMID:26644039

  19. Analysis of Michigan Medicaid costs to treat HIV infection.

    PubMed

    Solomon, D J; Hogan, A J; Bouknight, R R; Solomon, C T

    1989-01-01

    To obtain better understanding of the nature and cost of health care related to human immunodeficiency virus (HIV) infection, medical payment records were analyzed for 204 men, women, and children older than 60 months who had indications of HIV infection. The records were those of Michigan Medicaid, the General Assistance Medical Program, and the Resident County Hospitalization Program, with service dates on or after January 1, 1984, and which were processed by November 30, 1987. Patient payment records were coded according to whether the patient's condition was considered to be pre-HIV, HIV unrelated, possibly HIV related, or HIV related. Average monthly payments were found to be $150 for pre-HIV patient payment records, $114 for those HIV unrelated, $57 for those possibly related, and $1,213 for those related to HIV infection. HIV-related monthly payments rose from about $1,500 per month in the period 3 months prior to the patient's death to more than $8,000 in the last month of life. Men were found to have twice as many claims as women, and men's claims cost about three times as much. A higher percentage of women than men (91 percent versus 37 percent) received pre-HIV paid services, indicating a higher percentage of women were at least initially receiving Medicaid for reasons other than an HIV-related disability. Diagnostic categories that accounted for the bulk of the HIV-related health care utilization included infectious and parasitic diseases, acquired immunodeficiency syndrome, diseases of the respiratory system, and non-HIV-specific immunity disorders. Inpatient hospitalization accounted for more than 75 percent of the payments, followed by physician costs (11 percent), pharmacy costs (5 percent), and outpatient costs (3 percent). A total of 45, or about 22 percent of the recipients, received zidovudine (AZT) prescriptions at an average monthly cost of $404. PMID:2508170

  20. Benign monoclonal expansion of CD8+ lymphocytes in HIV infection

    PubMed Central

    Smith, P.; Cavenagh, J.; Milne, T.; Howe, D.; Wilkes, S.; Sinnott, P.; Forster, G.; Helbert, M.

    2000-01-01

    Background—A transient expansion of the CD8+ T cell pool normally occurs in the early phase of HIV infection. Persistent expansion of this pool is observed in two related settings: diffuse infiltrative lymphocytosis syndrome (DILS) and HIV associated CD8+ lymphocytosis syndrome. Aim—To investigate a group of HIV infected patients with CD8+ lymphocytosis syndrome with particular emphasis on whether monoclonality was present. Methods—A group of 18 patients with HIV-1 infection and persistent circulating CD8+ lymphocytosis was compared with 21 HIV positive controls. Serum samples were tested for antinuclear antibodies, antibodies to extractable nuclear antigens, immunoglobulin levels, paraproteins, human T lymphotropic virus type 1 (HTLV-1), Epstein-Barr virus, and cytomegalovirus serology. Lymphocyte phenotyping and HLA-DR typing was performed, and T cell receptor (TCR) gene rearrangement studies used to identify monoclonal populations of T cells. CD4+ and CD8+ subsets of peripheral blood lymphocytes were purified to determine whether CD8+ populations inhibited HIV replication in autologous CD4+ cells. Results—A subgroup of patients with HIV-1 infection was found to have expanded populations of CD8+ T cell large granular lymphocytes persisting for 6 to 30 months. The consensus immunophenotype was CD4- CD8+ DRhigh CD11a+ CD11c+ CD16- CD28± CD56- CD57+, consistent with typical T cell large granular lymphocytes expressing cellular activation markers. Despite the finding of monoclonal TCR gene usage in five of 18 patients, there is evidence that the CD8+ expansions are reactive populations capable of mediating non-cytotoxic inhibition of HIV replication. Conclusions—A subgroup of HIV positive patients has CD8+ lymphocytosis, but despite the frequent occurrence of monoclonal TCR gene usage there is evidence that this represents an immune response to viral infection rather than a malignant disorder. Key Words: HIV infection • CD8+ lymphocytosis • clonality

  1. Differential Gene Expression in HIV-Infected Individuals Following ART

    PubMed Central

    Massanella, Marta; Singhania, Akul; Beliakova-Bethell, Nadejda; Pier, Rose; Lada, Steven; White, Cory H.; Pérez-Santiago, Josué; Blanco, Julià; Richman, Douglas D.; Little, Susan J.; Woelk, Christopher H.

    2013-01-01

    Previous studies of the effect of ART on gene expression in HIV-infected individuals have identified small numbers of modulated genes. Since these studies were underpowered or cross-sectional in design, a paired analysis of peripheral blood mononuclear cells (PBMCs), isolated before and after ART, from a robust number of HIV-infected patients (N=32) was performed. Gene expression was assayed by microarray and 4,157 differentially expressed genes (DEGs) were identified following ART using multivariate permutation tests. Pathways and Gene Ontology (GO) terms over-represented for DEGs reflected the transition from a period of active virus replication before ART to one of viral suppression (e.g., repression of JAK-STAT signaling) and possible prolonged drug exposure (e.g. oxidative phosphorylation pathway) following ART. CMYC was the DEG whose product made the greatest number of interactions at the protein level in protein interaction networks (PINs), which has implications for the increased incidence of Hodgkin’s lymphoma (HL) in HIV-infected patients. The differential expression of multiple genes was confirmed by RT-qPCR including well-known drug metabolism genes (e.g., ALOX12 and CYP2S1). Targets not confirmed by RT-qPCR (i.e., GSTM2 and RPL5) were significantly confirmed by droplet digital (ddPCR), which may represent a superior method when confirming DEGs with low fold changes. In conclusion, a paired design revealed that the number of genes modulated following ART was an order of magnitude higher than previously recognized. PMID:23933117

  2. Altered Functional Response to Risky Choice in HIV Infection

    PubMed Central

    Connolly, Colm G.; Bischoff-Grethe, Amanda; Jordan, Stephan J.; Woods, Steven Paul; Ellis, Ronald J.; Paulus, Martin P.; Grant, Igor

    2014-01-01

    Background Risky decision-making is commonly observed in persons at risk for and infected with HIV and is associated with executive dysfunction. Yet it is currently unknown whether HIV alters brain processing of risk-taking decision-making. Methods This study examined the neural substrate of a risky decision-making task in 21 HIV seropositive (HIV+) and 19 seronegative (HIV-) comparison participants. Functional magnetic resonance imaging was conducted while participants performed the risky-gains task, which involves choosing among safe (20 cents) and risky (40/80 cent win or loss) choices. Linear mixed effects analyses examining group and decision type were conducted. Robust regressions were performed to examine the relationship between nadir CD4 count and Kalichman sexual compulsivity and brain activation in the HIV+ group. The overlap between the task effects and robust regressions was explored. Results Although there were no serostatus effects in behavioral performance on the risky-gains task, HIV+ individuals exhibited greater activation for risky choices in the basal ganglia, i.e. the caudate nucleus, but also in the anterior cingulate, dorsolateral prefrontal cortex, and insula relative to the HIV- group. The HIV+ group also demonstrated reduced functional responses to safe choices in the anterior cingulate and dorsolateral prefrontal cortex relative to the HIV- group. HIV+ individuals with higher nadir CD4 count and greater sexual compulsivity displayed lower differential responses to safe versus risky choices in many of these regions. Conclusions This study demonstrated fronto-striatal loop dysfunction associated with HIV infection during risky decision-making. Combined with similar between-group task behavior, this suggests an adaptive functional response in regions critical to reward and behavioral control in the HIV+ group. HIV-infected individuals with higher CD4 nadirs demonstrated activation patterns more similar to seronegative individuals. This

  3. Amyloid and tau cerebrospinal fluid biomarkers in HIV infection

    PubMed Central

    2009-01-01

    Background Because of the emerging intersections of HIV infection and Alzheimer's disease, we examined cerebrospinal fluid (CSF) biomarkers related of amyloid and tau metabolism in HIV-infected patients. Methods In this cross-sectional study we measured soluble amyloid precursor proteins alpha and beta (sAPPα and sAPPβ), amyloid beta fragment 1-42 (Aβ1-42), and total and hyperphosphorylated tau (t-tau and p-tau) in CSF of 86 HIV-infected (HIV+) subjects, including 21 with AIDS dementia complex (ADC), 25 with central nervous system (CNS) opportunistic infections and 40 without neurological symptoms and signs. We also measured these CSF biomarkers in 64 uninfected (HIV-) subjects, including 21 with Alzheimer's disease, and both younger and older controls without neurological disease. Results CSF sAPPα and sAPPβ concentrations were highly correlated and reduced in patients with ADC and opportunistic infections compared to the other groups. The opportunistic infection group but not the ADC patients had lower CSF Aβ1-42 in comparison to the other HIV+ subjects. CSF t-tau levels were high in some ADC patients, but did not differ significantly from the HIV+ neuroasymptomatic group, while CSF p-tau was not increased in any of the HIV+ groups. Together, CSF amyloid and tau markers segregated the ADC patients from both HIV+ and HIV- neuroasymptomatics and from Alzheimer's disease patients, but not from those with opportunistic infections. Conclusions Parallel reductions of CSF sAPPα and sAPPβ in ADC and CNS opportunistic infections suggest an effect of CNS immune activation or inflammation on neuronal amyloid synthesis or processing. Elevation of CSF t-tau in some ADC and CNS infection patients without concomitant increase in p-tau indicates neural injury without preferential accumulation of hyperphosphorylated tau as found in Alzheimer's disease. These biomarker changes define pathogenetic pathways to brain injury in ADC that differ from those of Alzheimer's disease

  4. Differential gene expression in HIV-infected individuals following ART.

    PubMed

    Massanella, Marta; Singhania, Akul; Beliakova-Bethell, Nadejda; Pier, Rose; Lada, Steven M; White, Cory H; Pérez-Santiago, Josué; Blanco, Julià; Richman, Douglas D; Little, Susan J; Woelk, Christopher H

    2013-11-01

    Previous studies of the effect of ART on gene expression in HIV-infected individuals have identified small numbers of modulated genes. Since these studies were underpowered or cross-sectional in design, a paired analysis of peripheral blood mononuclear cells (PBMCs), isolated before and after ART, from a robust number of HIV-infected patients (N=32) was performed. Gene expression was assayed by microarray and 4157 differentially expressed genes (DEGs) were identified following ART using multivariate permutation tests. Pathways and gene ontology (GO) terms over-represented for DEGs reflected the transition from a period of active virus replication before ART to one of viral suppression (e.g., repression of JAK-STAT signaling) and possible prolonged drug exposure (e.g., oxidative phosphorylation pathway) following ART. CMYC was the DEG whose product made the greatest number of interactions at the protein level in protein interaction networks (PINs), which has implications for the increased incidence of Hodgkin's lymphoma (HL) in HIV-infected patients. The differential expression of multiple genes was confirmed by RT-qPCR including well-known drug metabolism genes (e.g., ALOX12 and CYP2S1). Targets not confirmed by RT-qPCR (i.e., GSTM2 and RPL5) were significantly confirmed by droplet digital (ddPCR), which may represent a superior method when confirming DEGs with low fold changes. In conclusion, a paired design revealed that the number of genes modulated following ART was an order of magnitude higher than previously recognized. PMID:23933117

  5. Cerebral white matter integrity during primary HIV infection

    PubMed Central

    Wright, Patrick W.; Vaida, Florin F.; Fernández, Ricardo J.; Rutlin, Jerrel; Price, Richard W.; Lee, Evelyn; Peterson, Julia; Fuchs, Dietmar; Shimony, Joshua S.; Robertson, Kevin R.; Walter, Rudolph; Meyerhoff, Dieter J.; Spudich, Serena; Ances, Beau M.

    2016-01-01

    Objective Inflammation and infection within the central nervous system is initiated during primary HIV infection (PHI), but the association of these processes with the integrity of brain white matter during PHI is unknown. Design We used diffusion tensor imaging (DTI) in this prospective cross-sectional neuroimaging study to determine the extent of white matter involvement in early HIV infection. Methods Antiretroviral-naive PHI (defined as <1 year after infection, n = 62), chronic HIV infection (CHI, n = 16), and HIV-uninfected (n = 19) participants had DTI, laboratory, and neuropsychometric performance assessments. DTI metrics were examined using region of interest and whole brain voxelwise analyses. Linear mixed-effects models assessed correlations between DTI measures and laboratory and neuropsychometric performance values. Results PHI participants were assessed at a median 4.1 months after estimated infection, and had median CD4+ cell count of 573 cells/µl, and HIV-1 RNA viral load of 4.5 log10 copies/ml in plasma and 2.6 log10 copies/ml in cerebrospinal fluid (CSF). DTI metrics in PHI individuals were similar to HIV— participants and correlated with disruptions in the blood-brain barrier (indicated by CSF/plasma albumin ratio and CSF protein). CHI participants had significant loss of white matter integrity that correlated with biomarkers of infection and inflammation (blood viral load, CD4+ T-cell count, and neopterin, and CSF white blood cell). Within the PHI group, DTI metrics inversely correlated with increasing days since infection. Conclusion In individuals assessed during PHI, group DTI measures suggested relative preservation of white matter microstructural integrity, but were associated with disruption of the blood-brain barrier and estimated duration of infection. PMID:25513818

  6. Interaction between Endogenous Bacterial Flora and Latent HIV Infection

    PubMed Central

    Victoriano, Ann Florence B.; Imai, Kenichi

    2013-01-01

    Human commensal bacteria do not normally cause any diseases. However, in certain pathological conditions, they exhibit a number of curious behaviors. In HIV infection, these bacteria exhibit bidirectional relationships: whereas they cause opportunistic infections based on immunological deterioration, they also augment HIV replication, in particular, viral replication from latently infected cells, which is attributable to the effect of butyric acid produced by certain anaerobic bacteria by modifying the state of chromatin. Here, we review recent evidence supporting the contributory role of such endogenous microbes in disrupting HIV latency and its potential link to the clinical progression of AIDS. PMID:23616411

  7. Sexually transmitted infections among HIV-infected women in Thailand

    PubMed Central

    2013-01-01

    Background Data on sexually transmitted infections (STI) prevalence among HIV-infected women in Thailand are limited. We studied, among HIV-infected women, prevalence of STI symptoms and signs; prevalence and correlates of having any STI; prevalence and correlates of Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (GC) among women without CT and/or GC symptoms or signs; and number of women without CT and/or GC symptoms or signs needed to screen (NNS) to detect one woman with CT and/or GC overall, among pregnant women, and among women ≤25 years. Methods During October 2004–September 2006, HIV-infected women at 3 obstetrics and gynecology clinics were asked about sexual behaviors and STI symptoms, physically examined, and screened for chlamydia, gonorrhea, trichomoniasis, and syphilis. Multivariate logistic regression was used to identify correlates of infections. NNS was calculated using standard methods. Results Among 1,124 women, 526 (47.0%) had STI symptoms or signs, 469 (41.7%) had CT and/or GC symptoms or signs, and 133 (11.8%) had an STI. Correlates of having an STI included pregnancy and having STI signs. Among 469 women and 655 women with vs. without CT and/or GC symptoms or signs, respectively, 43 (9.2%) vs. 31 (4.7%), 2 (0.4%) vs. 9 (1.4%), and 45 (9.6%) vs. 38 (5.8%) had CT, GC, or “CT or GC”, respectively; correlates included receiving care at university hospitals and having sex with a casual partner within 3 months. NNS for women overall and women ≤25 years old were 18 (95% CI, 13-25) and 11 (95% CI, 6-23), respectively; and for pregnant and non-pregnant women, 8 (95% CI, 4-24) and 19 (95% CI, 14-27), respectively. Conclusions STI prevalence among HIV-infected women, including CT and GC among those without symptoms or signs, was substantial. Screening for CT and GC, particularly for pregnant women, should be considered. PMID:23601556

  8. Seasonal patterns of mixed species groups in large East African mammals.

    PubMed

    Kiffner, Christian; Kioko, John; Leweri, Cecilia; Krause, Stefan

    2014-01-01

    Mixed mammal species groups are common in East African savannah ecosystems. Yet, it is largely unknown if co-occurrences of large mammals result from random processes or social preferences and if interspecific associations are consistent across ecosystems and seasons. Because species may exchange important information and services, understanding patterns and drivers of heterospecific interactions is crucial for advancing animal and community ecology. We recorded 5403 single and multi-species clusters in the Serengeti-Ngorongoro and Tarangire-Manyara ecosystems during dry and wet seasons and used social network analyses to detect patterns of species associations. We found statistically significant associations between multiple species and association patterns differed spatially and seasonally. Consistently, wildebeest and zebras preferred being associated with other species, whereas carnivores, African elephants, Maasai giraffes and Kirk's dik-diks avoided being in mixed groups. During the dry season, we found that the betweenness (a measure of importance in the flow of information or disease) of species did not differ from a random expectation based on species abundance. In contrast, in the wet season, we found that these patterns were not simply explained by variations in abundances, suggesting that heterospecific associations were actively formed. These seasonal differences in observed patterns suggest that interspecific associations may be driven by resource overlap when resources are limited and by resource partitioning or anti-predator advantages when resources are abundant. We discuss potential mechanisms that could drive seasonal variation in the cost-benefit tradeoffs that underpin the formation of mixed-species groups. PMID:25470495

  9. Mapping the East African Ionosphere Using Ground-based GPS TEC Measurements

    NASA Astrophysics Data System (ADS)

    Mengist, Chalachew Kindie; Kim, Yong Ha; Yeshita, Baylie Damtie; Workayehu, Abyiot Bires

    2016-03-01

    The East African ionosphere (3°S-18°N, 32°E-50°E) was mapped using Total Electron Content (TEC) measurements from ground-based GPS receivers situated at Asmara, Mekelle, Bahir Dar, Robe, Arbaminch, and Nairobi. Assuming a thin shell ionosphere at 350 km altitude, we project the Ionospheric Pierce Point (IPP) of a slant TEC measurement with an elevation angle of >10° to its corresponding location on the map. We then infer the estimated values at any point of interest from the vertical TEC values at the projected locations by means of interpolation. The total number of projected IPPs is in the range of 24-66 at any one time. Since the distribution of the projected IPPs is irregularly spaced, we have used an inverse distance weighted interpolation method to obtain a spatial grid resolution of 1°×1° latitude and longitude, respectively. The TEC maps were generated for the year 2008, with a 2 hr temporal resolution. We note that TEC varies diurnally, with a peak in the late afternoon (at 1700 LT), due to the equatorial ionospheric anomaly. We have observed higher TEC values at low latitudes in both hemispheres compared to the magnetic equatorial region, capturing the ionospheric distribution of the equatorial anomaly. We have also confirmed the equatorial seasonal variation in the ionosphere, characterized by minimum TEC values during the solstices and maximum values during the equinoxes. We evaluate the reliability of the map, demonstrating a mean error (difference between the measured and interpolated values) range of 0.04-0.2 TECU (Total Electron Content Unit). As more measured TEC values become available in this region, the TEC map will be more reliable, thereby allowing us to study in detail the equatorial ionosphere of the African sector, where ionospheric measurements are currently very few.

  10. Anomalous deep earthquakes beneath the East African Rift: evidence for rift induced delamination of the lithosphere?

    NASA Astrophysics Data System (ADS)

    Lindenfeld, Michael; Rümpker, Georg; Schmeling, Harro; Wallner, Herbert

    2010-05-01

    The over 5000 m high Rwenzori Mountains are situated within the western branch of the East African Rift System, at the border between Uganda and the Democratic Republic of Congo. They represent a basement block within the rift valley whose origin and relation to the evolution of the EARS are highly puzzling. During 2006/2007 a network of 27 seismological stations was operated in this area to investigate crustal and upper mantle structure in conjunction with local seismicity. The data analysis revealed unexpectedly high microseismic activity. On average more than 800 events per month could be located with magnitudes ranging from 0.5 to 5.1. Hypocentral depths go as deep as 30 km with a pronounced concentration of activity at a depth of about 15 km. This presentation focuses on a cluster of seven earthquakes that were located at anomalous depths between 53 and 60 km. According to our present knowledge these are the deepest events so far observed within the EARS and the African Plate. Their origin might be connected to magmatic intrusions. However, the existence of earthquakes at this depth is enigmatic, especially within a rifting regime were one expects hot and weak material close to the surface, which is not capable of seismogenic deformation. We think that these events are closely related to the evolution of the Rwenzoris. A recent hypothesis to explain the extreme uplift of the Rwenzori Mountains is rift induced delamination (RID) of mantle lithosphere that is captured between two approaching rift segments. By numerical modelling we show that the RID-process is also able to bring material that is cold and brittle enough to release seismic energy into greater depth. Therefore the RID-mechanism gives a consistent explanation for the detected deep events as well as for the uplift of a mountain block in a rift setting.

  11. Seasonal Patterns of Mixed Species Groups in Large East African Mammals

    PubMed Central

    Kiffner, Christian; Kioko, John; Leweri, Cecilia; Krause, Stefan

    2014-01-01

    Mixed mammal species groups are common in East African savannah ecosystems. Yet, it is largely unknown if co-occurrences of large mammals result from random processes or social preferences and if interspecific associations are consistent across ecosystems and seasons. Because species may exchange important information and services, understanding patterns and drivers of heterospecific interactions is crucial for advancing animal and community ecology. We recorded 5403 single and multi-species clusters in the Serengeti-Ngorongoro and Tarangire-Manyara ecosystems during dry and wet seasons and used social network analyses to detect patterns of species associations. We found statistically significant associations between multiple species and association patterns differed spatially and seasonally. Consistently, wildebeest and zebras preferred being associated with other species, whereas carnivores, African elephants, Maasai giraffes and Kirk's dik-diks avoided being in mixed groups. During the dry season, we found that the betweenness (a measure of importance in the flow of information or disease) of species did not differ from a random expectation based on species abundance. In contrast, in the wet season, we found that these patterns were not simply explained by variations in abundances, suggesting that heterospecific associations were actively formed. These seasonal differences in observed patterns suggest that interspecific associations may be driven by resource overlap when resources are limited and by resource partitioning or anti-predator advantages when resources are abundant. We discuss potential mechanisms that could drive seasonal variation in the cost-benefit tradeoffs that underpin the formation of mixed-species groups. PMID:25470495

  12. Spatial patterns of sea surface temperature influences on East African precipitation as revealed by empirical orthogonal teleconnections

    NASA Astrophysics Data System (ADS)

    Appelhans, Tim; Nauss, Thomas

    2016-02-01

    East Africa is characterized by a rather dry annual precipitation climatology with two distinct rainy seasons. In order to investigate sea surface temperature driven precipitation anomalies for the region we use the algorithm of empirical orthogonal teleconnection analysis as a data mining tool. We investigate the entire East African domain as well as 5 smaller sub-regions mainly located in areas of mountainous terrain. In searching for influential sea surface temperature patterns we do not focus any particular season or oceanic region. Furthermore, we investigate different time lags from zero to twelve months. The strongest influence is identified for the immediate (i.e. non-lagged) influences of the Indian Ocean in close vicinity to the East African coast. None of the most important modes are located in the tropical Pacific Ocean, though the region is sometimes coupled with the Indian Ocean basin. Furthermore, we identify a region in the southern Indian Ocean around the Kerguelen Plateau which has not yet been reported in the literature with regard to precipitation modulation in East Africa. Finally, it is observed that not all regions in East Africa are equally influenced by the identified patterns.

  13. Molecular genetic analyses of historical lake sediments from the East African Rift Valley

    NASA Astrophysics Data System (ADS)

    Epp, L. S.; Stoof, K.; Trauth, M. H.; Tiedemann, R.

    2009-04-01

    Ancient DNA research, especially that of environmental samples, has to date focussed mainly on samples obtained from colder regions, owing to better DNA preservation. We explored the potential of using ancient DNA from sediments and sediment cores of shallow lakes in Kenya. These lakes, located in the eastern branch of the East African Rift Valley, are in close proximity, yet display strikingly different hydrological and geological features. Present day lakes range in alkalinity from pH 11 (Lake Elmenteita) to pH 8 (Lake Naivasha), and in depth from less than one meter to 15 meters. Historically they have undergone a number of drastic changes in lake level and environmental conditions, both on geological timescales and during the last centuries. Within this setting we employed molecular genetic methods to study DNA from recent and historic lake sediments, focussing on rotifers and diatoms. We analyzed population and species succession in the alkaline-saline crater lake Sonachi since the beginning of the 19th century, as well as distributions in recent and historic sediments of other lakes of the East African Rift System. To specifically detect diatoms, we developed a protocol using taxon-specific polymerase chain reactions and separation of products by denaturing high performance liquid chromatography (DHPLC). Employing this protocol we retrieved "ancient" DNA from a number of taxonomically diverse organisms, but found diatoms only in sediments younger than approximately 90 years. Using higly specific reactions for rotifers of the genus Brachionus, we tracked species and population succession in Lake Sonachi during the last 200 years. Populations were dominated by a single mitochondrial haplotype for a period of 150 years, and two putatively intraspecific turnovers in dominance occurred. They were both correlated to major environmental changes documented by profound visible changes in sediment composition of the core: the deposition of a volcanic ash and a

  14. Shaded Relief with Height as Color, Virunga and Nyiragongo Volcanoes and the East African Rift

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Volcanic, tectonic, erosional and sedimentary landforms are all evident in this comparison of two elevation models of a region along the East African Rift at Lake Kivu. The area shown covers parts of Congo, Rwanda and Uganda.

    These two images show exactly the same area. The image on the left was created using the best global topographic data set previously available, the U.S. Geological Survey's GTOPO30. In contrast, the much more detailed image on the right was generated with data from the Shuttle Radar Topography Mission, which collected enough measurements to map 80 percent of Earth's landmass at this level of precision. Elevation is color coded, progressing from green at the lower elevations through yellow to brown at the higher elevations. A false sun in the northwest (upper left) creates topographic shading.

    Lake Kivu is shown as black in the Shuttle Radar Topography Mission version (southwest corner). It lies within the East African Rift, an elongated tectonic pull-apart depression in Earth's crust. The rift extends to the northeast as a smooth lava- and sediment-filled trough. Two volcanic complexes are seen in the rift. The one closer to the lake is the Nyiragongo volcano, which erupted in January 2002, sending lava toward the lake shore and through the city of Goma. East of the rift, even more volcanoes are seen. These are the Virunga volcano chain, which is the home of the endangered mountain gorillas. Note that the terrain surrounding the volcanoes is much smoother than the eroding mountains that cover most of this view, such that topography alone is a good indicator of the extent of the lava flows. But this clear only at the higher spatial resolution of the shuttle mission's data set.

    For some parts of the globe, Shuttle Radar Topography Mission measurements are 30 times more precise than previously available topographical information, according to NASA scientists. Mission data will be a welcome resource for national and local governments

  15. A Rare Case of Brucella canis in an HIV-Infected Patient

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Presentation: A 46-year-old HIV-infected woman was admitted with a three-day history of high fever, diffuse arthralgias, malaise, and loose stools. History: The patient had been diagnosed with HIV infection for 16 years with no previous AIDS-defining diagnoses or other complications. A self-impos...

  16. AIDS Prevention Guide. The Facts about HIV Infection and AIDS. Putting the Facts to Use.

    ERIC Educational Resources Information Center

    Centers for Disease Control and Prevention (DHHS/PHS), Atlanta, GA.

    Many teenagers engage in behaviors that increase their risk of becoming infected with HIV. This document is a compilation of information about AIDS and HIV Infection, and provides suggestions for parents and other adults in discussing AIDS/HIV with young people. Basic facts are outlined, including what AIDS is and how HIV infection causes AIDS;…

  17. VITAMINS C AND E IN ADOLESCENTS AND YOUNG ADULTS WITH HIV INFECTION

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Background: Oxidative stress during HIV infection may impair immune function, cause rapid disease progression, and increase requirements for dietary antioxidants such as vitamins C and E. Objective: The study had 2 principal objectives. The first was to ascertain whether HIV infection and immune act...

  18. 42 CFR Appendix A to Part 130 - Definition of HIV Infection or HIV

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Definition of HIV Infection or HIV A Appendix A to... PAYMENTS RICKY RAY HEMOPHILIA RELIEF FUND PROGRAM Pt. 130, App. A Appendix A to Part 130—Definition of HIV Infection or HIV ER31MY00.000 ER31MY00.001...

  19. 42 CFR Appendix A to Part 130 - Definition of HIV Infection or HIV

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Definition of HIV Infection or HIV A Appendix A to... PAYMENTS RICKY RAY HEMOPHILIA RELIEF FUND PROGRAM Pt. 130, App. A Appendix A to Part 130—Definition of HIV Infection or HIV ER31MY00.000 ER31MY00.001...

  20. HIV Infection among People Who Inject Drugs: The Challenge of Racial/Ethnic Disparities

    ERIC Educational Resources Information Center

    Des Jarlais, Don C.; McCarty, Dennis; Vega, William A.; Bramson, Heidi

    2013-01-01

    Racial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among Hispanics and non-Hispanic Blacks. A meta-analysis of international research concluded that…

  1. HIV infection presenting proliferation of CD8+ T lymphocyte and hemophagocytic lymphohistiocytosis.

    PubMed

    Usman, Mohammad; Thapa, Sudeep D; Hadid, Hiba; Yessayan, Lenar T

    2016-04-01

    Hemophagocytic lymphohistiocytosis is a rare hyperinflammatory disorder characterised by CD8+ T lymphocyte activation and hypercytokinemia. Autoimmune disorders including hemophagocytic lymphohistiocytosis have been described in HIV patients; however, it is a rare initial presentation of HIV infection. We present an unusual case of HIV infection presenting with hemophagocytic lymphohistiocytosis. PMID:25941054

  2. Risk for HIV Infection among Adolescents in the Border City of Tijuana, Mexico

    ERIC Educational Resources Information Center

    Martinez-Donate, Ana P.; Blumberg, Elaine J.; Hovell, Melbourne F.; Sipan, Carol L.; Zellner, Jennifer A.; Hughes, Suzanne

    2004-01-01

    Previous studies have suggested high rates of HIV infection and other sexually transmitted infections in theU.S.-Mexico border region. However, no information is available on the risk for HIV infection among Mexican adolescents living in this geographic area. This study examines the prevalence of HIV risk practices and psychosocial correlates…

  3. 42 CFR Appendix A to Part 130 - Definition of HIV Infection or HIV

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Definition of HIV Infection or HIV A Appendix A to... PAYMENTS RICKY RAY HEMOPHILIA RELIEF FUND PROGRAM Pt. 130, App. A Appendix A to Part 130—Definition of HIV Infection or HIV ER31MY00.000 ER31MY00.001...

  4. 42 CFR Appendix A to Part 130 - Definition of HIV Infection or HIV

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Definition of HIV Infection or HIV A Appendix A to... PAYMENTS RICKY RAY HEMOPHILIA RELIEF FUND PROGRAM Pt. 130, App. A Appendix A to Part 130—Definition of HIV Infection or HIV ER31MY00.000 ER31MY00.001...

  5. 42 CFR Appendix A to Part 130 - Definition of HIV Infection or HIV

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Definition of HIV Infection or HIV A Appendix A to... PAYMENTS RICKY RAY HEMOPHILIA RELIEF FUND PROGRAM Pt. 130, App. A Appendix A to Part 130—Definition of HIV Infection or HIV ER31MY00.000 ER31MY00.001...

  6. Value of CXCL13 in diagnosing asymptomatic neurosyphilis in HIV-infected patients.

    PubMed

    Hu, RongXin; Lu, Chun; Lu, Sihan; Hu, Yunxin; Ma, Han; Lai, Wei; Zhu, Guoxing; Feng, Peiying; Lu, Rongbiao; Li, Ying

    2016-02-01

    Diagnosing asymptomatic neurosyphilis (ANS) in HIV-infected patients is difficult. A recent report suggested that CXCL13 is a promising diagnostic marker for neurosyphilis in HIV-positive patients. However, whether CXCL13 can be a diagnostic marker for ANS in HIV-infected patients remains unknown. The purpose of our study was to determine the role of CXCL13 in diagnosing ANS in HIV-infected patients. This study comprised two study and three control groups. Two study groups included 12 HIV-infected patients with ANS and 25 patients with syphilis and HIV co-infection (without ANS). Three control groups included 9 patients with ANS without HIV infection, 25 HIV-infected patients without syphilis and 10 healthy volunteers. Concentrations of CSF CXCL13 were measured before and after neurosyphilis therapy. Our results showed that CSF CXCL13 concentrations were significantly increased in all of the HIV-infected patients with ANS, the 25 HIV patients with syphilis and the 9 ANS patients without HIV, but not in the patients of the other two control groups. CSF CXCL13 concentrations declined in the two study groups of patients following neurosyphilis therapy. Therefore, CSF CXCL13 concentrations could improve the diagnosis of ANS in HIV-infected patients. PMID:25769888

  7. Towards an understanding and application of environmental flow requirements for human welfare in East African Rivers

    NASA Astrophysics Data System (ADS)

    McClain, Michael

    2013-04-01

    In semi-arid regions of Africa, rivers are of vital importance to humans for the many direct ecosystem services they provide and, in some cases, for their potential to irrigate and power larger-scale development. More than in most regions of the world, Africans still rely individually on rivers for domestic water, nutrition, and other materials contributing to their daily welfare. This has led to a uniquely African adaptation of the environmental flow concept to incorporate the basic water needs of people as well as ecosystems. The combined flow is referred to as the 'Reserve'. East Africa has seen comparatively little development of its water resources to-date, but ambitious initiatives are underway to increase water use in new large-scale irrigation schemes and hydropower projects. Consequently, a number of comprehensive environmental flow assessments and ecohydrological research activities have recently been carried out in the region. This presentation briefly reviews the initiatives underway across the region but focuses mainly on combined research and flow-setting efforts in the transboundary Mara River Basin of Kenya and Tanzania, home to more than 800,000 people and the region's most popular conservation areas, Masai-Mara National Reserve and Serengeti National Park. Since 2006 a team of scientists, in cooperation with water authorities and the World Wide Fund for Nature (WWF), has investigated the hydrology, hydraulics, biology, and human uses of the Mara River in order to make initial environmental flow (reserve) recommendations. The flow regime of the still largely unregulated Mara River, based on analyses or 20+ years of data from three gauging stations, is highly variable and perennial flow in the middle reaches is dependent on inflows from two tributaries draining the heavily deforested Mau Escarpment, one of Kenya's five water towers. Downstream flows are also seasonally influenced by inflows from ephemeral tributaries that drain degraded grazing

  8. Discovery of sublacustrine hydrothermal activity and associated massive sulfides and hydrocarbons in the north Tanganyika trough, East African Rift

    NASA Astrophysics Data System (ADS)

    Tiercelin, Jean-Jacques; Thouin, Catherine; Kalala, Tchibangu; Mondeguer, André

    1989-11-01

    Massive sulfides and carbonate mineral deposits associated with sublacustrine thermal springs were recently discovered along the Zaire side of the north Tanganyika trough, western branch of the East African Rift. This hydrothermal activity, investigated by scuba diving at a maximum depth of 20 m, is located at the intersection of major north-south normal faults and northwest-southeast faults belonging to the Tanganyika-Rukwa-Malawi (TRM) strike-slip fault zone. The preliminary results presented here come from analyses of sulfide deposits, hydrothermal fluids, and associated hydrocarbons that result from geothermal activity in this part of the East African Rift filled by a thick pile of sediment, the north Tanganyika trough.

  9. Half-precessional dynamics of monsoon rainfall near the East African Equator.

    PubMed

    Verschuren, Dirk; Sinninghe Damsté, Jaap S; Moernaut, Jasper; Kristen, Iris; Blaauw, Maarten; Fagot, Maureen; Haug, Gerald H

    2009-12-01

    External climate forcings-such as long-term changes in solar insolation-generate different climate responses in tropical and high latitude regions. Documenting the spatial and temporal variability of past climates is therefore critical for understanding how such forcings are translated into regional climate variability. In contrast to the data-rich middle and high latitudes, high-quality climate-proxy records from equatorial regions are relatively few, especially from regions experiencing the bimodal seasonal rainfall distribution associated with twice-annual passage of the Intertropical Convergence Zone. Here we present a continuous and well-resolved climate-proxy record of hydrological variability during the past 25,000 years from equatorial East Africa. Our results, based on complementary evidence from seismic-reflection stratigraphy and organic biomarker molecules in the sediment record of Lake Challa near Mount Kilimanjaro, reveal that monsoon rainfall in this region varied at half-precessional ( approximately 11,500-year) intervals in phase with orbitally controlled insolation forcing. The southeasterly and northeasterly monsoons that advect moisture from the western Indian Ocean were strengthened in alternation when the inter-hemispheric insolation gradient was at a maximum; dry conditions prevailed when neither monsoon was intensified and modest local March or September insolation weakened the rain season that followed. On sub-millennial timescales, the temporal pattern of hydrological change on the East African Equator bears clear high-northern-latitude signatures, but on the orbital timescale it mainly responded to low-latitude insolation forcing. Predominance of low-latitude climate processes in this monsoon region can be attributed to the low-latitude position of its continental regions of surface air flow convergence, and its relative isolation from the Atlantic Ocean, where prominent meridional overturning circulation more tightly couples low

  10. Late Miocene to Pliocene carbon isotope record of differential diet change among East African herbivores.

    PubMed

    Uno, Kevin T; Cerling, Thure E; Harris, John M; Kunimatsu, Yutaka; Leakey, Meave G; Nakatsukasa, Masato; Nakaya, Hideo

    2011-04-19

    Stable isotope and molecular data suggest that C(4) grasses first appeared globally in the Oligocene. In East Africa, stable isotope data from pedogenic carbonate and fossil tooth enamel suggest a first appearance between 15-10 Ma and subsequent expansion during the Plio-Pleistocene. The fossil enamel record has the potential to provide detailed information about the rates of dietary adaptation to this new resource among different herbivore lineages. We present carbon isotope data from 452 fossil teeth that record differential rates of diet change from C(3) to mixed C(3)/C(4) or C(4) diets among East African herbivore families at seven different time periods during the Late Miocene to the Pliocene (9.9-3.2 Ma). Significant amounts of C(4) grasses were present in equid diets beginning at 9.9 Ma and in rhinocerotid diets by 9.6 Ma, although there is no isotopic evidence for expansive C(4) grasslands in this part of the Late Miocene. Bovids and hippopotamids followed suit with individuals that had C(4)-dominated (>65%) diets by 7.4 Ma. Suids adopted C(4)-dominated diets between 6.5 and 4.2 Ma. Gomphotheriids and elephantids had mostly C(3)-dominated diets through 9.3 Ma, but became dedicated C(4) grazers by 6.5 Ma. Deinotheriids and giraffids maintained a predominantly C(3) diet throughout the record. The sequence of differential diet change among herbivore lineages provides ecological insight into a key period of hominid evolution and valuable information for future studies that focus on morphological changes associated with diet change. PMID:21464327

  11. Late Miocene to Pliocene carbon isotope record of differential diet change among East African herbivores

    PubMed Central

    Uno, Kevin T.; Cerling, Thure E.; Harris, John M.; Kunimatsu, Yutaka; Leakey, Meave G.; Nakatsukasa, Masato; Nakaya, Hideo

    2011-01-01

    Stable isotope and molecular data suggest that C4 grasses first appeared globally in the Oligocene. In East Africa, stable isotope data from pedogenic carbonate and fossil tooth enamel suggest a first appearance between 15–10 Ma and subsequent expansion during the Plio-Pleistocene. The fossil enamel record has the potential to provide detailed information about the rates of dietary adaptation to this new resource among different herbivore lineages. We present carbon isotope data from 452 fossil teeth that record differential rates of diet change from C3 to mixed C3/C4 or C4 diets among East African herbivore families at seven different time periods during the Late Miocene to the Pliocene (9.9–3.2 Ma). Significant amounts of C4 grasses were present in equid diets beginning at 9.9 Ma and in rhinocerotid diets by 9.6 Ma, although there is no isotopic evidence for expansive C4 grasslands in this part of the Late Miocene. Bovids and hippopotamids followed suit with individuals that had C4-dominated (>65%) diets by 7.4 Ma. Suids adopted C4-dominated diets between 6.5 and 4.2 Ma. Gomphotheriids and elephantids had mostly C3-dominated diets through 9.3 Ma, but became dedicated C4 grazers by 6.5 Ma. Deinotheriids and giraffids maintained a predominantly C3 diet throughout the record. The sequence of differential diet change among herbivore lineages provides ecological insight into a key period of hominid evolution and valuable information for future studies that focus on morphological changes associated with diet change. PMID:21464327

  12. Malaria in East African highlands during the past 30 years: impact of environmental changes

    PubMed Central

    Himeidan, Yousif E.; Kweka, Eliningaya J.

    2012-01-01

    East African highlands are one of the most populated regions in Africa. The population densities in the highlands ranged between 158 persons/km2 in Ethiopia and 410 persons/km2 in Rwanda. According to the United Nations Population Fund, the region has the world's highest population growth rate. These factors are likely behind the high rates of poverty among the populations. As there were no employment opportunities other than agricultural, this demographic pressure of poor populations have included in an extensive unprecedented land use and land cover changes such as modification of bushland, woodland, and grassland on hillsides to farmland and transformation of papyrus swamps in valley bottoms to dairy pastures and cropland and changing of fallows on hillsides from short or seasonal to longer or perennial. Areas harvested for food crops were therefore increased by more than 100% in most of the highlands. The lost of forest areas, mainly due to subsistence agriculture, between 1990 and 2010 ranged between 8000 ha in Rwanda and 2,838,000 ha in Ethiopia. These unmitigated environmental changes in the highlands led to rise temperature and optimizing the spread and survival of malaria vectors and development of malaria parasites. Malaria in highlands was initially governed by low ambient temperature, trend of malaria transmission was therefore increased and several epidemics were observed in late 1980s and early 2000s. Although, malaria is decreasing through intensified interventions since mid 2000s onwards, these environmental changes might expose population in the highlands of east Africa to an increase risk of malaria and its epidemic particularly if the current interventions are not sustained. PMID:22934065

  13. Pharmacogenetics of plasma efavirenz exposure in HIV-infected adults and children in South Africa

    PubMed Central

    Sinxadi, Phumla Z; Leger, Paul D; McIlleron, Helen M; Smith, Peter J; Dave, Joel A; Levitt, Naomi S; Maartens, Gary; Haas, David W

    2015-01-01

    Aims Genetic factors, notably CYP2B6 516G→T [rs3745274] and 983T→C [rs28399499], explain much of the interindividual variability in efavirenz pharmacokinetics, but data from Africa are limited. We characterized relationships between genetic polymorphisms and plasma efavirenz concentrations in HIV-infected Black South African adults and children. Methods Steady-state mid-dosing interval efavirenz concentrations were measured. We genotyped 241 polymorphisms in genes potentially relevant to efavirenz metabolism and transport, including ABCB1, CYP2A6, CYP2B6, CYP3A4, CYP3A5, NR1I2 and NR1I3. Results Among 113 participants (59 adults and 54 children), minor allele frequencies for CYP2B6 516G→T, 983T→C, and 15582C→T [rs4803419] were 0.36, 0.07, and 0.09, respectively. Based on composite CYP2B6 15582/516/983 genotype, there were 33 extensive metabolizer, 62 intermediate metabolizer and 18 slow metabolizer genotypes. Median (IQR) mid-dose efavirenz concentrations were 1.44 (1.21–1.93) µg ml–1, 2.08 (1.68–2.94) µg ml–1 and 7.26 (4.82–8.34) µg ml–1 for extensive, intermediate and slow metabolizers, respectively. In univariate analyses, a model that included composite genotype best predicted efavirenz concentrations (β = 0.28, 95% CI 0.21, 0.35, P = 2.4 × 10–11). Among individual CYP2B6 polymorphisms, 516G→T best predicted efavirenz concentrations (β = 0.22, 95% CI 0.13, 0.30, P = 1.27 × 10−6). There was also associations with 983T→C (β = 0.27, 95% CI 0.10, 0.44, P = 0.002) and 15582C→T (β = 0.11, 95% CI 0.01, 0.22, P = 0.04). Associations were consistent in adults and children. No other polymorphisms were independently associated with efavirenz concentrations. Conclusions Composite CYP2B6 genotype based on CYP2B6 516G→T, 983T→C, and 15582C→T best described efavirenz exposure in HIV-infected Black South African adults and children. PMID:25611810

  14. The Chew Bahir Project, southern Ethiopia: Reconstructing East African palaeoenvironments in the source region of modern man

    NASA Astrophysics Data System (ADS)

    Foerster, V. E.; Chew Bahir Science Team

    2011-12-01

    Chew Bahir is a tectonically bounded basin in the southern part of the Main Ethiopian Rift and in close proximity to the Omo valley, which contains some of the oldest known early modern human sites. As East African palaeoenvironments are highly variable and marked by extreme fluctuations in moisture availability, this in turn bears far reaching implications for the life, evolution and most notably for the expansion of Homo sapiens beyond the limits of the African continent. This study is a prerequisite for the ICDP- Hominin Sites And Paleolakes Drilling Project and part of the CRC-806 "Our way to Europe". The Chew Bahir Project will provide fundamental data to reconstruct late Quaternary East African environments including the timing, amplitude, synchronicity and abruptness of dry-wet-dry cycles and focuses on the interaction between those rapid climate shifts and their influence on the biosphere. This poster presents results from six cores (9-18m depth) from a NW-SE transect across the Chew Bahir basin that have recorded the climatic history of the past 45 ka and therewith can potentially elucidate those highly variable East African palaeoenvironments with emphasis on the last of the wet periods, the African Humid Period (AHP). Based on a series of multi-proxy analyses, comprising geochemical, physical and biological indicators as well as AMS 14C dates, it becomes obvious that the Chew Bahir responds decidedly sensitive towards even minor climatic fluctuations on millennial to even centennial timescales. Therefore, the Chew Bahir represents a unique site to reveal the impact of timing and mechanisms of local, regional and global climate events on the key region for humankind.

  15. Seroprevalence of CMV, HSV-2 and HBV among HIV-Infected Malawian Children: A Cross-sectional Survey

    PubMed Central

    Chris Buck, W.; Kazembe, Peter N.; Phiri, Sam; Andrianarimanana, Diavolana; Weigel, Ralf

    2016-01-01

    Background: Little is known about viral co-infections in African human immunodeficiency virus (HIV)-infected children. We examined the prevalence of seromarkers for cytomegalovirus (CMV), herpes simplex virus type 2 (HSV-2) and hepatitis B virus (HBV) infections among HIV-infected, antiretroviral treatment (ART)-naïve children in Lilongwe, Malawi. Methods: Ninety-one serum samples were tested for IgG and IgM antibodies to CMV, and IgG antibodies to HSV-2 and hepatitis B surface antigen (HBsAg). Baseline demographic, clinical and laboratory data were abstracted from electronic records. Results: CMV IgG was the most common positive result in all age groups (in 73% of children <1 year, and 100% in all other groups). Three patients were CMV IgM positive (3.3%), suggesting acute infection. HSV-2 IgG was positive in four patients (4.4%), and HBsAg in two (2.2%). Conclusions: CMV infection occurred early in life, and few children had specific signs of CMV infection at the time of ART initiation. Unrecognized HBV infection represents opportunities for testing and treatment of HIV/HBV co-infected children. PMID:26884443

  16. Intimate partner sexual and physical violence among women in Togo, West Africa: Prevalence, associated factors, and the specific role of HIV infection

    PubMed Central

    Burgos-Soto, Juan; Orne-Gliemann, Joanna; Encrenaz, Gaëlle; Patassi, Akouda; Woronowski, Aurore; Kariyiare, Benjamin; Lawson-Evi, Annette K.; Leroy, Valériane; Dabis, François; Ekouevi, Didier K.

    2014-01-01

    conclusions The prevalence rates of both lifetime physical and sexual violence were very high among HIV-uninfected women and even higher among HIV-infected women recruited in health facilities in this West African country. Screening for intimate partner violence should be systematic in health-care settings, and specifically within HIV care services. At a time of increased investments in couple-oriented HIV prevention interventions, further longitudinal research to better understanding of HIV-serodiscordant couple dynamics in terms of intimate partner violence is needed. PMID:24866864

  17. Bystander CD4+ T lymphocytes survive in HIV-infected human lymphoid tissue

    NASA Technical Reports Server (NTRS)

    Grivel, Jean-Charles; Biancotto, Angelique; Ito, Yoshinori; Lima, Rosangela G.; Margolis, Leonid B.

    2003-01-01

    HIV infection is associated with depletion of CD4(+) T cells. The mechanisms of this phenomenon remain to be understood. In particular, it remains controversial whether and to what extent uninfected ("bystander") CD4(+) T cells die in HIV-infected individuals. We address this question using a system of human lymphoid tissue ex vivo. Tissue blocks were inoculated with HIV-1. After productive infection was established, they were treated with the reverse transcriptase inhibitor nevirapine to protect from infection those CD4(+) T cells that had not yet been infected. These CD4(+) T cells residing in HIV-infected tissue are by definition bystanders. Our results demonstrate that after nevirapine application the number of bystander CD4(+) T cells is conserved. Thus, in the context of HIV-infected human lymphoid tissue, productive HIV infection kills infected cells but is not sufficient to cause the death of a significant number of uninfected CD4(+) T cells.

  18. Human Papillomavirus Vaccination in HIV-infected Women: Need for Increased Coverage

    PubMed Central

    Kojic, Erna Milunka; Rana, Aadia I.; Cu-Uvin, Susan

    2016-01-01

    HIV-infected women carry a significant burden on HPV infection and associated diseases. As HIV-infected individuals are living longer, the prevalence of HPV infection is rising and HPV-associated cytologic abnormalities remain high despite successful treatments of HIV infection. Several HPV vaccines are currently available and recommended for adolescents and adults up to age 26. The vaccine is safe, immunogenic and effective in preventing diseases due to HPV types included in the vaccines, particularly among persons without prior HPV exposure. This review summarizes available data on the use of the HPV vaccines among HIV infected women. The immunogenicity and safety of the vaccine is highlighted and in particular, barriers to vaccination among HIV infected women are discussed. PMID:26599305

  19. Use of Machine Learning Techniques for Iidentification of Robust Teleconnections to East African Rainfall Variability in Observations and Models

    NASA Technical Reports Server (NTRS)

    Roberts, J. Brent; Robertson, Franklin R.; Funk, Chris

    2014-01-01

    Providing advance warning of East African rainfall variations is a particular focus of several groups including those participating in the Famine Early Warming Systems Network. Both seasonal and long-term model projections of climate variability are being used to examine the societal impacts of hydrometeorological variability on seasonal to interannual and longer time scales. The NASA / USAID SERVIR project, which leverages satellite and modeling-based resources for environmental decision making in developing nations, is focusing on the evaluation of both seasonal and climate model projections to develop downscaled scenarios for using in impact modeling. The utility of these projections is reliant on the ability of current models to capture the embedded relationships between East African rainfall and evolving forcing within the coupled ocean-atmosphere-land climate system. Previous studies have posited relationships between variations in El Niño, the Walker circulation, Pacific decadal variability (PDV), and anthropogenic forcing. This study applies machine learning methods (e.g. clustering, probabilistic graphical model, nonlinear PCA) to observational datasets in an attempt to expose the importance of local and remote forcing mechanisms of East African rainfall variability. The ability of the NASA Goddard Earth Observing System (GEOS5) coupled model to capture the associated relationships will be evaluated using Coupled Model Intercomparison Project Phase 5 (CMIP5) simulations.

  20. Sedimentary budgets of the Tanzania coastal basin and implications for uplift history of the East African rift system

    NASA Astrophysics Data System (ADS)

    Said, Aymen; Moder, Christoph; Clark, Stuart; Abdelmalak, Mohamed Mansour

    2015-11-01

    Data from 23 wells were used to quantify the sedimentary budgets in the Tanzania coastal basin in order to unravel the uplift chronology of the sourcing area located in the East African Rift System. We quantified the siliciclastic sedimentary volumes preserved in the Tanzania coastal basin corrected for compaction and in situ (e.g., carbonates) production. We found that the drainage areas, which supplied sediments to this basin, were eroded in four episodes: (1) during the middle Jurassic, (2) during the Campanian-Palaeocene, (3) during the middle Eocene and (4) during the Miocene. Three of these high erosion and sedimentation periods are more likely related to uplift events in the East African Rift System and earlier rift shoulders and plume uplifts. Indeed, rapid cooling in the rift system and high denudation rates in the sediment source area are coeval with these recorded pulses. However, the middle Eocene pulse was synchronous with a fall in the sea level, a climatic change and slow cooling of the rift flanks and thus seems more likely due to climatic and eustatic variations. We show that the rift shoulders of the East African rift system have inherited their present relief from at least three epeirogenic uplift pulses of middle Jurassic, Campanian-Palaeocene, and Miocene ages.

  1. Giant seismites and megablock uplift in the East African Rift: evidence for Late Pleistocene large magnitude earthquakes.

    PubMed

    Hilbert-Wolf, Hannah Louise; Roberts, Eric M

    2015-01-01

    In lieu of comprehensive instrumental seismic monitoring, short historical records, and limited fault trench investigations for many seismically active areas, the sedimentary record provides important archives of seismicity in the form of preserved horizons of soft-sediment deformation features, termed seismites. Here we report on extensive seismites in the Late Quaternary-Recent (≤ ~ 28,000 years BP) alluvial and lacustrine strata of the Rukwa Rift Basin, a segment of the Western Branch of the East African Rift System. We document examples of the most highly deformed sediments in shallow, subsurface strata close to the regional capital of Mbeya, Tanzania. This includes a remarkable, clastic 'megablock complex' that preserves remobilized sediment below vertically displaced blocks of intact strata (megablocks), some in excess of 20 m-wide. Documentation of these seismites expands the database of seismogenic sedimentary structures, and attests to large magnitude, Late Pleistocene-Recent earthquakes along the Western Branch of the East African Rift System. Understanding how seismicity deforms near-surface sediments is critical for predicting and preparing for modern seismic hazards, especially along the East African Rift and other tectonically active, developing regions. PMID:26042601

  2. Investigating “mass hysteria” in early postcolonial Uganda: Benjamin H. Kagwa, East African psychiatry, and the Gisu

    PubMed Central

    Pringle, Yolana

    2016-01-01

    In the early 1960s, medical officers and administrators began to receive reports of what was being described as “mass madness” and “mass hysteria” in Tanganyika (now Tanzania) and Uganda. Each epidemic reportedly affected between 300 and 600 people and, coming in the wake of independence from colonial rule, caused considerable concern. One of the practitioners sent to investigate was Benjamin H. Kagwa, a Ugandan-born psychiatrist whose report represents the first investigation by an African psychiatrist in East Africa. This article uses Kagwa’s investigation to explore some of the difficulties facing East Africa’s first generation of psychiatrists as they took over responsibility for psychiatry. During this period, psychiatrists worked in an intellectual climate that was both attempting to deal with the legacy of colonial racism, and which placed faith in African psychiatrists to reveal more culturally sensitive insights into African psychopathology. The epidemics were the first major challenge for psychiatrists such as Kagwa precisely because they appeared to confirm what colonial psychiatrists had been warning for years—that westernization would eventually result in mass mental instability. As this article argues, however, Kagwa was never fully able to free himself from the practices and assumptions that had pervaded his discipline under colonial rule. His analysis of the epidemics as a “mental conflict” fit into a much longer tradition of psychiatry in East Africa, and stood starkly against the explanations of the local community. PMID:24191308

  3. Giant Seismites and Megablock Uplift in the East African Rift: Evidence for Late Pleistocene Large Magnitude Earthquakes

    PubMed Central

    Hilbert-Wolf, Hannah Louise; Roberts, Eric M.

    2015-01-01

    In lieu of comprehensive instrumental seismic monitoring, short historical records, and limited fault trench investigations for many seismically active areas, the sedimentary record provides important archives of seismicity in the form of preserved horizons of soft-sediment deformation features, termed seismites. Here we report on extensive seismites in the Late Quaternary-Recent (≤ ~ 28,000 years BP) alluvial and lacustrine strata of the Rukwa Rift Basin, a segment of the Western Branch of the East African Rift System. We document examples of the most highly deformed sediments in shallow, subsurface strata close to the regional capital of Mbeya, Tanzania. This includes a remarkable, clastic ‘megablock complex’ that preserves remobilized sediment below vertically displaced blocks of intact strata (megablocks), some in excess of 20 m-wide. Documentation of these seismites expands the database of seismogenic sedimentary structures, and attests to large magnitude, Late Pleistocene-Recent earthquakes along the Western Branch of the East African Rift System. Understanding how seismicity deforms near-surface sediments is critical for predicting and preparing for modern seismic hazards, especially along the East African Rift and other tectonically active, developing regions. PMID:26042601

  4. Impact of CD4+ Lymphocytes and HIV Infection on Anti-Müllerian Hormone Levels in a Large Cohort of HIV-infected and -uninfected Women

    PubMed Central

    Scherzer, Rebecca; Bacchetti, Peter; Messerlian, Geralyn; Goderre, Johanna; Maki, Pauline M.; Seifer, David B.; Anastos, Kathryn; Karim, Roksana; Greenblatt, Ruth M.

    2014-01-01

    Problem Effects of HIV infection on ovarian function and aging are unclear. Method of Study Anti-Müllerian Hormone (AMH) levels were analyzed in 2621 HIV-infected and 941 uninfected participants using left-censored longitudinal models. Results Age-adjusted AMH levels were 16% lower in women with undetectable viremia and 26% lower in detectable viremia, relative to uninfected women. Current CD4 count associated with higher AMH in both HIV-infected and HIV-uninfected women. After controlling for current and nadir CD4, AMH was ~15% higher in HIV-infected relative to uninfected women, regardless of HIV viremia. Gravidity, amenorrhea, and nadir total lymphocyte counts associated with higher AMH; hormonal contraceptive use and past weight loss associated with lower AMH. Conclusions CD4+ lymphocyte counts were associated with AMH in both HIV-infected and uninfected women. After adjustment for CD4 counts and age, HIV infection was associated with higher AMH. CD4 T cells and cellular activation may influence ovarian granulosa cell function. PMID:25339186

  5. Hodgkin lymphoma in the elderly, pregnant, and HIV-infected.

    PubMed

    Bachanova, Veronika; Connors, Joseph M

    2016-07-01

    Hodgkin lymphoma (HL) presenting in patients with co-incidental advanced age, pregnancy, or human immunodeficiency virus (HIV) infection is uniquely challenging to manage. In this article we integrate recent evidence and clinical expertise to present recommendations for diagnosis and therapeutic management. Older patients with HL need to be carefully evaluated for comorbidies after which judicious choice of chemotherapy should minimize functional compromise. A pregnant patient with concurrent HL should be staged with minimal use of imaging requiring ionizing radiation and treated in an individualized manner optimally combining the strategies of treatment deferral when appropriate, use of single-agent vinblastine for symptomatic disease and reservation of multi-agent chemotherapy for the small minority of patients with aggressive clinical presentation. Treatment of HL coincident with HIV infection requires a combination of highly active anti-retroviral agents (HAART), standard multi-agent chemotherapy with meticulous attention to drug-drug interactions, and vigorous supportive care to ensure the best chance of cure. PMID:27496312

  6. Antiretroviral treatment of HIV infection: Swedish recommendations 2007.

    PubMed

    Josephson, Filip; Albert, Jan; Flamholc, Leo; Gisslén, Magnus; Karlström, Olof; Lindgren, Susanne-Rosa; Navér, Lars; Sandström, Eric; Svedhem-Johansson, Veronica; Svennerholm, Bo; Sönnerborg, Anders

    2007-01-01

    On 3 previous occasions, in 2002, 2003 and 2005, the Swedish Medical Products Agency (Läkemedelsverket) and the Swedish Reference Group for Antiviral Therapy (RAV) have jointly published recommendations for the treatment of HIV infection. An expert group, under the guidance of RAV, has now revised the text again. Since the publication of the previous treatment recommendations, 1 new drug for the treatment of HIV has been approved - the protease inhibitor (PI) darunavir (Prezista). Furthermore, 3 new drugs have become available: the integrase inhibitor raltegravir (MK-0518), the CCR5-inhibitor maraviroc (Celsentri), both of which have novel mechanisms of action, and the non-nucleoside reverse transcriptase inhibitor (NNRTI) etravirine (TMC-125). The new guidelines differ from the previous ones in several respects. The most important of these are that abacavir is now preferred to tenofovir and zidovudine, as a first line drug in treatment-naïve patients, and that initiation of antiretroviral treatment is now recommended before the CD4 cell count falls below 250/microl, rather than 200/microl. Furthermore, recommendations on the treatment of HIV infection in children have been added to the document. As in the case of the previous publication, recommendations are evidence-graded in accordance with the Oxford Centre for Evidence Based Medicine, 2001 (see http://www.cebm.net/levels_of_evidence.asp#levels). PMID:17577810

  7. Simulation of HIV infection in artificial immune systems

    NASA Astrophysics Data System (ADS)

    Sieburg, Hans B.; McCutchan, J. Allen; Clay, Oliver K.; Cabalerro, Lisa; Ostlund, James J.

    1990-09-01

    Infection by the human immunodeficiency virus (HIV) causes a multi-faceted disease process which ultimately leads to severe degenerative conditions in the immune and nervous systems. The complexity of the virus/host-system interaction has brought into sharp focus the need for alternative efforts by which to overcome the limitations of available animal models. This article reports on the dynamics of HIV infection in an artificial immune system (AIS), a novel in silico tool for bio-medical research. Using a method of graphical programming, the HIV/AIS interactions are described at the cellular level and then transferred into the setting of an asynchronous cellular automaton simulation. A specific problem in HIV pathogenesis is addressed: To determine the extent by which the physiological connectivity of a normal B-cell, T-cell, macrophage immune system supports persistence of infection and disease progression to AIDS. Several observations are discussed which will be presented in four categories: (a) the major known manifestations of HIV infection and AIDS; (b) the predictability of latency and sudden progression to disease; (c) the predictability of HIV-dependent alterations of cytokine secretion patterns, and (d) secondary infections, which are found to be a critical element in establishing and maintaining a progressive disease dynamics. The effects of exogenously applied cytokine Interleukin 2 are considered. All results are summarized in a phase-graph model of the global HIV/AIS dynamical system.

  8. Partner Violence and Health among HIV-Infected Jail Detainees

    PubMed Central

    Meyer, Jaimie P.; Wickersham, Jeffrey A.; Fu, Jeannia J.; Brown, Shan-Estelle; Sullivan, Tami P.; Springer, Sandra A.; Altice, Frederick L.

    2013-01-01

    Purpose Little is known about the association of intimate partner violence (IPV) with specific HIV treatment outcomes, especially among criminal justice (CJ) populations who are disproportionately affected by IPV, HIV, mental and substance use disorders (SUDs) and are at high risk of poor post-release continuity of care. Design/Methodology/Approach Mixed methods were used to describe the prevalence, severity, and correlates of lifetime IPV exposure among HIV-infected jail detainees enrolled in a novel jail-release demonstration project in Connecticut. Additionally, the effect of IPV on HIV treatment outcomes and longitudinal healthcare utilization was examined. Findings Structured baseline surveys defined 49% of 84 participants as having significant IPV-exposure, which was associated with female gender, longer duration since HIV diagnosis, suicidal ideation, having higher alcohol use severity, having experienced other forms of childhood and adulthood abuse, and homo/bisexual orientation. IPV was not directly correlated with HIV healthcare utilization or treatment outcomes. In-depth qualitative interviews with 20 surveyed participants, however, confirmed that IPV was associated with disengagement from HIV care especially in the context of overlapping vulnerabilities, including transitioning from CJ to community settings, having untreated mental disorders, and actively using drugs or alcohol at the time of incarceration. Value Post-release interventions for HIV-infected CJ populations should minimally integrate HIV secondary prevention with violence reduction and treatment for SUDs. PMID:24376468

  9. Depressive symptoms in blood donors notified of HIV infection.

    PubMed Central

    Cleary, P D; Van Devanter, N; Rogers, T F; Singer, E; Shipton-Levy, R; Steilen, M; Stuart, A; Avorn, J; Pindyck, J

    1993-01-01

    OBJECTIVES. Understanding more about the psychological state of persons notified of human immunodeficiency virus (HIV) infection is critical for designing notification and counseling programs that will have the most positive effect. METHODS. The subjects were blood donors who had been notified of HIV infection by the New York Blood Center. A nurse elicited a medical history, performed a limited medical examination, and asked the subjects to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. The subjects completed another questionnaire approximately 2 weeks later. RESULTS. The average depressive symptom scores for both men and women were substantially higher than scores typically found in representative population samples. More than a quarter of the men and more than a third of the women reported seeking psychological or psychiatric services in the first few weeks following notification. CONCLUSIONS. Anticipating and meeting individuals' psychological needs may be necessary if HIV screening programs are to address effectively the needs of persons infected with HIV. PMID:8460730

  10. Dental care access and use among HIV-infected women.

    PubMed Central

    Shiboski, C H; Palacio, H; Neuhaus, J M; Greenblatt, R M

    1999-01-01

    OBJECTIVES: This study sought to identify predictors of dental care use in HIV-infected women. METHODS: In a cross-sectional survey of HIV-infected women enrolled in the northern California site of the Women's Interagency HIV Study, dental care use and unmet need were assessed in relation to selected variables. RESULTS: Among 213 respondents, who were predominantly Black and younger than 45 years, 43% had not seen a dentist and 53% (among dentate women) reported no dental cleaning in more than a year (although 67% had dental insurance coverage, mainly state Medicaid). Nine percent were edentulous. Among nonusers of dental care, 78% reported that they wanted care but failed to get it. Barriers included fear of and discomfort with dentists, not getting around to making an appointment, and not knowing which dentist to visit. Multivariate analysis showed that lack of past-year dental care was associated mainly with unemployment, a perception of poor oral health, and edentulism. CONCLUSIONS: HIV-positive women appear to be underusing dental care services. Fear and lack of information regarding available resources, in addition to unemployment and perception of poor oral health, may be important barriers. PMID:10358671

  11. Counselling challenges in haemophilia and HIV infection/AIDS.

    PubMed

    Pittadaki, J

    1996-01-01

    The advent of AIDS has had such a deep-reaching effect on the international haemophilia community that one can make a reasonable distinction between a pre-AIDS and a post-AIDS era in haemophilia management. In the context of counselling, however, talking about a 'before' and an 'after' in haemophilia does not (and, in our opinion, should not) necessarily imply a separation of the past from the present. Dealing with the psycho-social implications of haemophilia and HIV infection does not mean focusing exclusively on HIV-generated problems at the expense of haemophilia-related issues. Since the HIV crisis, counselling has posed the multiple challenge of: (a) assessing and alleviating the more immediate emotional effects of HIV infection; (b) paying due attention to the underlying influence of haemophilia on reaction, defence and coping; (c) formulating a flexible approach that is based on close cooperation with the medical staff and effective interpersonal communication with the counsellees.* In practice, the flexibility and effectiveness of the counselling model are promoted by means of: (a) ongoing counselling, (b) multiple counselling sites (i.e. the Haemophilia Centre and other appropriate locations), (c) interdisciplinary team-work, (d) respect for individual/ ethnic values, (e) maintenance of exo-empathy (i.e. neutrality), and (f) transfer of coping skills. The above framework can help maximize the effectiveness of counselling sessions through a personalized rapport of mutual trust and confidence between the counselling team and the counsellees. PMID:27213898

  12. Robustness of a cellular automata model for the HIV infection

    NASA Astrophysics Data System (ADS)

    Figueirêdo, P. H.; Coutinho, S.; Zorzenon dos Santos, R. M.

    2008-11-01

    An investigation was conducted to study the robustness of the results obtained from the cellular automata model which describes the spread of the HIV infection within lymphoid tissues [R.M. Zorzenon dos Santos, S. Coutinho, Phys. Rev. Lett. 87 (2001) 168102]. The analysis focused on the dynamic behavior of the model when defined in lattices with different symmetries and dimensionalities. The results illustrated that the three-phase dynamics of the planar models suffered minor changes in relation to lattice symmetry variations and, while differences were observed regarding dimensionality changes, qualitative behavior was preserved. A further investigation was conducted into primary infection and sensitiveness of the latency period to variations of the model’s stochastic parameters over wide ranging values. The variables characterizing primary infection and the latency period exhibited power-law behavior when the stochastic parameters varied over a few orders of magnitude. The power-law exponents were approximately the same when lattice symmetry varied, but there was a significant variation when dimensionality changed from two to three. The dynamics of the three-dimensional model was also shown to be insensitive to variations of the deterministic parameters related to cell resistance to the infection, and the necessary time lag to mount the specific immune response to HIV variants. The robustness of the model demonstrated in this work reinforce that its basic hypothesis are consistent with the three-stage dynamic of the HIV infection observed in patients.

  13. Viral lesions of the mouth in HIV-infected patients.

    PubMed

    Itin, P H; Lautenschlager, S

    1997-01-01

    Viral lesions of the mouth in patients with HIV infection are common and these diseases any be a marker for HIV and disease progression. We review the spectrum of oral viral manifestations and discuss treatment modalities. The most common Epstein-Barr virus (EBV)-induced disorder in HIV-infected patients is oral hairy leukoplakia. EBV-related oral B-cell and T-cell lymphoma in AIDS patients has been described repeatedly. Herpes virus type 1 and rarely type 2 may lead to painful and resistant oral ulcers, and systemic treatment with acyclovir, valaciclovir or famciclovir is indicated. In acyclovir-resistant cases foscarnet is the treatment of choice. In recent years it has been documented that Kaposi's sarcoma, which often affects oral mucosa, is probably induced by herpesvirus type 8. Cytomegalovirus was found in 53% of cases with herpesviridae-induced mucosal ulcers as the only ulcerogenic viral agent in AIDS patients. In severe cytomegalovirus infection treatment with ganciclovir is helpful. Viral warts induced by different HPV may occur in the mouth. Several physical treatment modalities are possible in the oral mucosa. In AIDS patients mollusca contagiosa may occur as large and atypical lesions in the face and lips and rarely in the oral cavity. Cryotherapy is a bloodless treatment in such patients. PMID:9031782

  14. Epidemiology of Meningitis in an HIV-Infected Ugandan Cohort

    PubMed Central

    Rajasingham, Radha; Rhein, Joshua; Klammer, Kate; Musubire, Abdu; Nabeta, Henry; Akampurira, Andrew; Mossel, Eric C.; Williams, Darlisha A.; Boxrud, Dave J.; Crabtree, Mary B.; Miller, Barry R.; Rolfes, Melissa A.; Tengsupakul, Supatida; Andama, Alfred O.; Meya, David B.; Boulware, David R.

    2015-01-01

    There is limited understanding of the epidemiology of meningitis among human immunodeficiency virus (HIV)-infected populations in sub-Saharan Africa. We conducted a prospective cohort study of HIV-infected adults with suspected meningitis in Uganda, to comprehensively evaluate the etiologies of meningitis. Intensive cerebrospiral fluid (CSF) testing was performed to evaluate for bacterial, viral, fungal, and mycobacterial etiologies, including neurosyphilis,16s ribosomal DNA (rDNA) polymerase chain reaction (PCR) for bacteria, Plex-ID broad viral assay, quantitative-PCR for HSV-1/2, cytomegalovirus (CMV), Epstein–Barr virus (EBV), and Toxoplasma gondii; reverse transcription-PCR (RT-PCR) for Enteroviruses and arboviruses, and Xpert MTB/RIF assay. Cryptococcal meningitis accounted for 60% (188 of 314) of all causes of meningitis. Of 117 samples sent for viral PCR, 36% were EBV positive. Among cryptococcal antigen negative patients, the yield of Xpert MTB/RIF assay was 22% (8 of 36). After exclusion of cryptococcosis and bacterial meningitis, 61% (43 of 71) with an abnormal CSF profile had no definitive diagnosis. Exploration of new TB diagnostics and diagnostic algorithms for evaluation of meningitis in resource-limited settings remains needed, and implementation of cryptococcal diagnostics is critical. PMID:25385864

  15. Is Prospective Memory a Dissociable Cognitive Function in HIV infection?

    PubMed Central

    Gupta, Saurabh; Woods, Steven Paul; Weber, Erica; Dawson, Matthew S.; Grant, Igor

    2010-01-01

    An emerging literature indicates that HIV infection is associated with deficits in prospective memory (ProM), or the ability to execute a future intention. This literature offers evidence of neurobiological dissociability of ProM from other cognitive abilities and its incremental ecological validity as a predictor of poorer everyday functioning outcomes (e.g., medication non-adherence). The present study evaluated the hypothesis that ProM represents a unique cognitive construct in HIV disease. A confirmatory 4-factor structural equation model was tested on data derived from 162 participants with HIV. The model posited that measures of ProM comprise a unique factor, apart from standard clinical tests of retrospective memory, executive functions, and motor skills. The fit of the model was evaluated using the Bollen-Stine bootstrap method and indicated a 4-factor model with measures of ProM loading on a unique factor fit the data well, and better than a model with a single common factor hypothesized to drive cognitive performance. The results of this study lend further evidence to the dissociability of ProM in HIV infection, are consistent with prior studies in healthy adults, and contribute to a growing literature on the construct validity of ProM in HIV disease. PMID:20425662

  16. HIV Infection Upregulates Caveolin 1 Expression To Restrict Virus Production▿

    PubMed Central

    Lin, Shanshan; Wang, Xiao Mei; Nadeau, Peter E.; Mergia, Ayalew

    2010-01-01

    Caveolin 1 (Cav-1) is a major protein of a specific membrane lipid raft known as caveolae. Cav-1 interacts with the gp41 of the human immunodeficiency virus (HIV) envelope, but the role of Cav-1 in HIV replication and pathogenesis is not known. In this report, we demonstrate that HIV infection in primary human monocyte-derived macrophages (MDMs), THP-1 macrophages, and U87-CD4 cells results in a dramatic upregulation of Cav-1 expression mediated by HIV Tat. The activity of p53 is essential for Tat-induced Cav-1 expression, as our findings show enhanced phosphorylation of serine residues at amino acid positions 15 and 46 in the presence of Tat with a resulting Cav-1 upregulation. Furthermore, inhibition of p38 mitogen-activated protein kinase (MAPK) blocked phosphorylation of p53 in the presence of Tat. Infection studies of Cav-1-overexpressing cells reveal a significant reduction of HIV production. Taken together, these results suggest that HIV infection enhances the expression of Cav-1, which subsequently causes virus reduction, suggesting that Cav-1 may contribute to persistent infection in macrophages. PMID:20610713

  17. Dyslipidaemia associated with antiretroviral therapy in HIV-infected patients.

    PubMed

    Calza, Leonardo; Manfredi, Roberto; Chiodo, Francesco

    2004-01-01

    Highly active antiretroviral therapy (HAART) has had a significant impact on the natural history of human immunodeficiency virus (HIV) infection, leading to a remarkable decrease in its morbidity and mortality, but is frequently associated with clinical and metabolic complications. Fat redistribution or lipodystrophy, hypertriglyceridaemia, hypercholesterolaemia, insulin resistance and diabetes mellitus have been extensively reported in subjects treated with protease inhibitor (PI)-based antiretroviral regimens. In particular, dyslipidaemia occurs in up to 70-80% of HIV-infected individuals receiving HAART and can be associated with all the available PIs, although hypertriglyceridaemia appears to be more frequent in patients treated with ritonavir, ritonavir-saquinavir, or ritonavir-lopinavir. The potential long-term consequences of HAART-associated hyperlipidaemia are not completely understood, but an increased risk of premature coronary artery disease has been reported in young HIV-positive persons receiving PIs. Dietary changes, regular aerobic exercise and switching to a PI-sparing regimen may act favourably on dyslipidaemia. Lipid-lowering therapy is often required with statins or fibrates. The choice of hypolipidaemic drugs should take into account potential pharmacological interactions with antiretroviral agents. PMID:14645323

  18. The episode of genetic drift defining the migration of humans out of Africa is derived from a large east African population size.

    PubMed

    Elhassan, Nuha; Gebremeskel, Eyoab Iyasu; Elnour, Mohamed Ali; Isabirye, Dan; Okello, John; Hussien, Ayman; Kwiatksowski, Dominic; Hirbo, Jibril; Tishkoff, Sara; Ibrahim, Muntaser E

    2014-01-01

    Human genetic variation particularly in Africa is still poorly understood. This is despite a consensus on the large African effective population size compared to populations from other continents. Based on sequencing of the mitochondrial Cytochrome C Oxidase subunit II (MT-CO2), and genome wide microsatellite data we observe evidence suggesting the effective size (Ne) of humans to be larger than the current estimates, with a foci of increased genetic diversity in east Africa, and a population size of east Africans being at least 2-6 fold larger than other populations. Both phylogenetic and network analysis indicate that east Africans possess more ancestral lineages in comparison to various continental populations placing them at the root of the human evolutionary tree. Our results also affirm east Africa as the likely spot from which migration towards Asia has taken place. The study reflects the spectacular level of sequence variation within east Africans in comparison to the global sample, and appeals for further studies that may contribute towards filling the existing gaps in the database. The implication of these data to current genomic research, as well as the need to carry out defined studies of human genetic variation that includes more African populations; particularly east Africans is paramount. PMID:24845801

  19. Plasma progesterone and blood metabolite profiles in post-partum small east African zebu cows.

    PubMed

    Tegegne, A; Entwistle, K W; Mukasa-Mugerwa, E

    1993-05-01

    Plasma progesterone profiles were used to monitor post-partum reproductive activity in 12 Small East African zebu (Bos indicus) cows allocated to either supplementary or no supplementary feeding (control) with continuous or restricted (twice daily) suckling regimes. Intact bulls were used for breeding. Blood samples were collected 3 times a week for 33 weeks to determine plasma progesterone levels. Weekly blood samples were also used to determine blood metabolite concentrations. Plasma progesterone levels remained below 1 ng/ml in all cows until week 12 post-partum. Only 5 cows showed ovarian activity over the 33 week period. Cows that cycled expressed irregular and short-lived progesterone rises (> 1 ng/ml) lasting 8 to 12 days prior to establishment of normal patterns of progesterone secretion where progesterone levels ranged from 8 to 10 ng/ml in cows with normal cycles. Plasma total protein, albumin, globulin, blood urea nitrogen and glucose levels varied over time without consistent trends, and were not influenced by either supplementary feeding of suckling regimes, nor differed between cyclic and acyclic cows. It was concluded that extended post-partum anoestrus, conception failure and early embryonic mortality were responsible for lowered reproductive efficiency in zebu cows. Blood metabolite concentrations were not good indicators of nutritional status and were not related to post-partum ovarian activity. PMID:8236477

  20. Niche divergence promotes rapid diversification of East African sky island white-eyes (Aves: Zosteropidae)

    PubMed Central

    Cox, Siobhan C; Prys-Jones, Robert P; Habel, Jan C; Amakobe, Bernard A; Day, Julia J

    2014-01-01

    The Eastern Afromontane biodiversity hotspot composed of highly fragmented forested highlands (sky islands) harbours exceptional diversity and endemicity, particularly within birds. To explain their elevated diversity within this region, models founded on niche conservatism have been offered, although detailed phylogeographic studies are limited to a few avian lineages. Here, we focus on the recent songbird genus Zosterops, represented by montane and lowland members, to test the roles of niche conservatism versus niche divergence in the diversification and colonization of East Africa's sky islands. The species-rich white-eyes are a typically homogeneous family with an exceptional colonizing ability, but in contrast to their diversity on oceanic islands, continental diversity is considered depauperate and has been largely neglected. Molecular phylogenetic analysis of ∼140 taxa reveals extensive polyphyly among different montane populations of Z. poliogastrus. These larger endemic birds are shown to be more closely related to taxa with divergent habitat types, altitudinal distributions and dispersal abilities than they are to populations of restricted endemics that occur in neighbouring montane forest fragments. This repeated transition between lowland and highland habitats over time demonstrate that diversification of the focal group is explained by niche divergence. Our results also highlight an underestimation of diversity compared to morphological studies that has implications for their taxonomy and conservation. Molecular dating suggests that the spatially extensive African radiation arose exceptionally rapidly (1–2.5 Ma) during the fluctuating Plio-Pleistocene climate, which may have provided the primary driver for lineage diversification. PMID:24954273

  1. Immune-Related Functions of the Hivep Gene Family in East African Cichlid Fishes

    PubMed Central

    Diepeveen, Eveline T.; Roth, Olivia; Salzburger, Walter

    2013-01-01

    Immune-related genes are often characterized by adaptive protein evolution. Selection on immune genes can be particularly strong when hosts encounter novel parasites, for instance, after the colonization of a new habitat or upon the exploitation of vacant ecological niches in an adaptive radiation. We examined a set of new candidate immune genes in East African cichlid fishes. More specifically, we studied the signatures of selection in five paralogs of the human immunodeficiency virus type I enhancer-binding protein (Hivep) gene family, tested their involvement in the immune defense, and related our results to explosive speciation and adaptive radiation events in cichlids. We found signatures of long-term positive selection in four Hivep paralogs and lineage-specific positive selection in Hivep3b in two radiating cichlid lineages. Exposure of the cichlid Astatotilapia burtoni to a vaccination with Vibrio anguillarum bacteria resulted in a positive correlation between immune response parameters and expression levels of three Hivep loci. This work provides the first evidence for a role of Hivep paralogs in teleost immune defense and links the signatures of positive selection to host–pathogen interactions within an adaptive radiation. PMID:24142922

  2. Predicting East African spring droughts using Pacific and Indian Ocean sea surface temperature indices

    NASA Astrophysics Data System (ADS)

    Funk, C.; Hoell, A.; Shukla, S.; Bladé, I.; Liebmann, B.; Roberts, J. B.; Robertson, F. R.; Husak, G.

    2014-03-01

    In southern Ethiopia, Eastern Kenya, and southern Somalia, poor boreal spring rains in 1999, 2000, 2004, 2007, 2008, 2009, and 2011 contributed to severe food insecurity and high levels of malnutrition. Predicting rainfall deficits in this region on seasonal and decadal time frames can help decision makers implement disaster risk reduction measures while guiding climate-smart adaptation and agricultural development. Building on recent research that links more frequent droughts in that region to a stronger Walker Circulation, warming in the Indo-Pacific warm pool, and an increased western Pacific sea surface temperature (SST) gradient, we show that the two dominant modes of East African boreal spring rainfall variability are tied, respectively, to western-central Pacific and central Indian Ocean SST. Variations in these rainfall modes can be predicted using two previously defined SST indices - the West Pacific Gradient (WPG) and Central Indian Ocean index (CIO), with the WPG and CIO being used, respectively, to predict the first and second rainfall modes. These simple indices can be used in concert with more sophisticated coupled modeling systems and land surface data assimilations to help inform early warning and guide climate outlooks.

  3. Drivers of Intensity and Prevalence of Flea Parasitism on Small Mammals in East African Savanna Ecosystems.

    PubMed

    Young, Hillary S; Dirzo, Rodolfo; McCauley, Douglas J; Agwanda, Bernard; Cattaneo, Lia; Dittmar, Katharina; Eckerlin, Ralph P; Fleischer, Robert C; Helgen, Lauren E; Hintz, Ashley; Montinieri, John; Zhao, Serena; Helgen, Kristofer M

    2015-06-01

    The relative importance of environmental factors and host factors in explaining variation in prevalence and intensity of flea parasitism in small mammal communities is poorly established. We examined these relationships in an East African savanna landscape, considering multiple host levels: across individuals within a local population, across populations within species, and across species within a landscape. We sampled fleas from 2,672 small mammals of 27 species. This included a total of 8,283 fleas, with 5 genera and 12 species identified. Across individual hosts within a site, both rodent body mass and season affected total intensity of flea infestation, although the explanatory power of these factors was generally modest (<10%). Across host populations in the landscape, we found consistently positive effects of host density and negative effects of vegetation cover on the intensity of flea infestation. Other factors explored (host diversity, annual rainfall, anthropogenic disturbance, and soil properties) tended to have lower and less consistent explanatory power. Across host species in the landscape, we found that host body mass was strongly positively correlated with both prevalence and intensity of flea parasitism, while average robustness of a host species to disturbance was not correlated with flea parasitism. Cumulatively, these results provide insight into the intricate roles of both host and environmental factors in explaining complex patterns of flea parasitism across landscape mosaics. PMID:25634599

  4. A robust phylogeny among major lineages of the East African cichlids.

    PubMed

    Takahashi, Tetsumi; Sota, Teiji

    2016-07-01

    The huge monophyletic group of the East African cichlid radiations (EAR) consists of thousands of species belonging to 12-14 tribes; the number of tribes differs among studies. Many studies have inferred phylogenies of EAR tribes using various genetic markers. However, these phylogenies partly contradict one another and can have weak statistic support. In this study, we conducted maximum-likelihood (ML) phylogenetic analyses using restriction site-associated DNA (RAD) sequences and propose a new robust phylogenetic hypothesis among Lake Tanganyika cichlid fishes, which cover most EAR tribes. Data matrices can vary in size and contents depending on the strategies used to process RAD sequences. Therefore, we prepared 23 data matrices with various processing strategies. The ML phylogenies inferred from 15 large matrices (2.0×10(6) to 1.1×10(7) base pairs) resolved every tribe as a monophyletic group with 100% bootstrap support and shared the same topology regarding relationships among the tribes. Most nodes among the tribes were supported by 100% bootstrap values, and the bootstrap support for the other node varied among the 15 ML trees from 70% to 100%. These robust ML trees differ partly in topology from those in earlier studies, and these phylogenetic relationships have important implications for the tribal classification of EAR. PMID:27068840

  5. The offshore East African Rift System: Structural framework at the toe of a juvenile rift

    NASA Astrophysics Data System (ADS)

    Franke, Dieter; Jokat, Wilfried; Ladage, Stefan; Stollhofen, Harald; Klimke, Jennifer; Lutz, Ruediger; Mahanjane, Estevão. Stefane; Ehrhardt, Axel; Schreckenberger, Bernd

    2015-10-01

    The Cenozoic East African Rift System (EARS) extends from the Red Sea to Mozambique. Here we use seismic reflection and bathymetric data to investigate the tectonic evolution of the offshore branch of the EARS. The data indicate multiple and time transgressive neotectonic deformations along ~800 km of the continental margin of northern Mozambique. We observe a transition from a mature rift basin in the north to a juvenile fault zone in the south. The respective timing of deformation is derived from detailed seismic stratigraphy. In the north, a ~30 km wide and more than 150 km long, N-S striking symmetric graben initiated as half-graben in the late Miocene. Extension accelerated in the Pliocene, causing a continuous conjugate border fault and symmetric rift graben. Coevally, the rift started to propagate southward, which resulted in a present-day ~30 km wide half-graben, approximately 200 km farther south. Since the Pleistocene, the rift has continued to propagate another ~300 km, where the incipient rift is reflected by subrecent small-scale normal faulting. Estimates of the overall brittle extension of the matured rift range between 5 and 12 km, with an along-strike southward decrease of the extension rate. The offshore portion of the EARS evolves magma poor, similar to the onshore western branch. The structural evolution of the offshore EARS is suggested to be related to and controlled by differing inherited lithospheric fabrics. Preexisting fabrics may not only guide and focus extension but also control rift architecture.

  6. Increased Hot Flash Severity and Related Interference in Perimenopausal HIV-infected Women

    PubMed Central

    Looby, Sara E.; Shifren, Jan; Corless, Inge; Rope, Alison; Pedersen, Maria C.; Joffe, Hadine; Grinspoon, Steven

    2013-01-01

    Objective As women with HIV are living longer, more are entering the perimenopause. Prior studies suggest that HIV-infected women are more likely to have hot flashes than non-HIV-infected women. However, little is known regarding the severity and degree of interference that hot flashes have on daily function, mood, and quality of life in this population. Methods Perimenopausal HIV-infected and non-HIV-infected women matched by age, race, and menstrual patterns completed the Menopause Rating Scale (MRS) to assess hot flash severity and the Hot Flash Related Daily Interference Scale (HFRDIS). MRS and HFRDIS scores and subscores were compared between groups. Results 33 HIV-infected and 33 non-HIV-infected women similar in age (47 (45,48) median (interquartile range) vs. 47 (46,49) yrs; race (64% vs. 52% non-white; P=0.32), and menstrual patterns (# periods in past year; 5 (4,9) vs. 6 (4,10); P=0.53) were studied. Perimenopausal HIV-infected women reported greater hot flash severity (HIV; 2 (1,3) vs. non-HIV: 1 (0,3); P=0.03), and hot flash-related interference (HFRDIS total score; 37 (10,60) vs. 6 (0,20); P=0.001). Conclusions Perimenopausal HIV-infected women experience greater hot flash severity and related interference compared to non-HIV-infected perimenopausal women. Increased distress secondary to hot flashes may reduce quality of life and negatively impact important health-promoting behaviors including adherence to antiretroviral therapy in HIV-infected women. PMID:23820600

  7. What the volcanism of the East African Rift tells us on its evolution and dynamics: a reappraisal

    NASA Astrophysics Data System (ADS)

    Michon, Laurent

    2015-04-01

    The East African Rift (EAR) is one of the most studied tectonic structures on Earth. Classically, it is described as extending from Afar in the North to the Malawi rift in the South, along the eastern and western branches, respectively. A widely accepted consensus also exists on two main points: 1- the rift initiated first with plume emplacement below the northern part of the eastern branch and 2- extension and volcanism subsequently migrated southward along the western branch (e.g., Ebinger, 1989). However, an increasing amount of new geochronological data on the volcanic activity in the southern part of the East African Rift tends to weaken these interpretations and imposes a reassessment of the rift dynamics. The volcanic activity being one of the main characteristics of this rift, I use it here to determine the lateral extension of the rift system and to assess the rift activity through times. First, the volcanism unambiguously indicates that the rift is not limited to the African continent but can be traced in the Mozambique Channel and in Madagascar where it is closely related to active tectonics (graben and transfer faults) initiated since at least the Miocene. Moreover, the synthesis of more than 800 published geochronological data of volcanic products distributed over the overal East African Rift allows the distinction of two parts. The first part, the Northern EAR, corresponds to the sole eastern branch, which is characterized by volcanic plateaus resulting from huge magma flux during three main periods (32-28, 18-12, 6-0 Ma). Provinces of the second part, the Southern EAR (the western branch, the Mozambique Channel and Madagascar), share rift-related scattered volcanic centres characterized by coeval periods of activity since the Oligocene (28-24, 20-16 and 12-0 Ma). This synthesis highlights the lack of southward migration of the volcanism during the evolution of the East African Rift and instead reveals the almost synchronous development of the

  8. HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response

    PubMed Central

    Abdool Karim, Salim S.; Churchyard, Gavin J.; Abdool Karim, Quarraisha; Lawn, Stephen D.

    2009-01-01

    One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0·7% of the world’s population, had 17% of the global burden of HIV infection, and one of the world’s worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government’s response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches. PMID:19709731

  9. Disclosure of maternal HIV-infection in South Africa: description and relationship to child functioning.

    PubMed

    Palin, Frances L; Armistead, Lisa; Clayton, Alana; Ketchen, Bethany; Lindner, Gretchen; Kokot-Louw, Penny; Pauw, Analie

    2009-12-01

    South Africa has one of the highest HIV-infection rates in the world, yet few studies have examined disclosure of maternal HIV status and its influence on children. This study provides descriptive information about HIV disclosure among South African mothers and explores whether family context variables interact with maternal HIV disclosure to affect children's functioning. A total of 103 mothers, who self-identified as living with HIV and who were the primary caregivers of a child between the ages of 11 and 16, were interviewed. A total of 44% of mothers had disclosed, and those who had most typically perceived children's reactions to disclosure to be sadness and worry. Widows and married mothers were more likely than single mothers to disclose their HIV status. Disclosure to children significantly predicted externalizing, but not internalizing, behaviors. Family variables had direct but not interactive effects on child functioning. This study highlights the complexity of disclosure-related decisions and the importance of addressing the family context. PMID:18770026

  10. Sexual risk-reduction strategies among HIV-infected men receiving ART in Kibera, Nairobi.

    PubMed

    Ragnarsson, Anders; Thorson, Anna; Dover, Paul; Carter, Jane; Ilako, Festus; Indalo, Dorcas; Ekstrom, Anna Mia

    2011-03-01

    This paper explores motivational factors and barriers to sexual behaviour change among men receiving antiretroviral treatment (ART). Twenty in-depth interviews were undertaken with male patients enrolled at the African Medical and Research Foundation clinic in Africa's largest urban informal settlement, Kibera in Nairobi, Kenya. All participants experienced prolonged and severe illness prior to the initiation of ART. Fear of symptom relapse was the main trigger for sexual behaviour change. Partner reduction was reported as a first option for behaviour change since this decision could be made by the individual. Condom use was perceived as more difficult as it had to be negotiated with female partners. Cultural norms regarding expectations for reproduction and marriage were not supportive of sexual risk-reduction strategies. Thus, local sociocultural contexts of HIV-infected people must be incorporated into the contextual adaptation and design of ART programmes and services as they have an over-riding influence on sexual behaviour and programme effectiveness. Also, HIV-prevention interventions need to address both personal, micro- and macro-level factors of behaviour to encourage individuals to take on sexual risk-reduction strategies. In order to achieve the anticipated preventive effect of ART, these issues are important for the donor community and policy-makers, who are the major providers of ART programme support within weak health systems in sub-Saharan Africa. PMID:21347894

  11. Fecal bacterial microbiome diversity in chronic HIV-infected patients in China.

    PubMed

    Sun, Yang; Ma, Yingfei; Lin, Ping; Tang, Yi-Wei; Yang, Liying; Shen, Yinzhong; Zhang, Renfan; Liu, Li; Cheng, Jun; Shao, Jiashen; Qi, Tangkai; Tang, Yan; Cai, Rentian; Guan, Liqian; Luo, Bin; Sun, Meiyan; Li, Ben; Pei, Zhiheng; Lu, Hongzhou

    2016-01-01

    The purpose of this study was to identify fecal bacterial microbiome changes in patients with chronic human immunodeficiency virus (HIV) infection in China. Bacterial 16S rRNA genes were amplified, sequenced (454 pyrosequencing), and clustered into operational taxonomic units using the QIIME software. Relative abundance at the phylum and genus levels were calculated. Alpha diversity was determined by Chao 1 and observed-species indices, and beta diversity was determined by double principal component analysis using the estimated phylogeny-based unweighted Unifrac distance matrices. Fecal samples of the patients with chronic HIV-infection tended to be enriched with bacteria of the phyla Firmicutes (47.20% ± 0.43 relative abundance) and Proteobacteria (37.21% ± 0.36) compared with those of the non-HIV infected controls (17.95% ± 0.06 and 3.81% ± 0.02, respectively). Members of the genus Bilophila were exclusively detected in samples of the non-HIV infected controls. Bacteroides and arabacteroides were more abundant in the chronic HIV-infected patients. Our study indicated that chronic HIV-infected patients in China have a fecal bacterial microbiome composition that is largely different from that found in non-HIV infected controls, and further study is needed to evaluate whether microbiome changes play a role in disease complications in the distal gut, including opportunistic infections. PMID:27048741

  12. Fecal bacterial microbiome diversity in chronic HIV-infected patients in China

    PubMed Central

    Sun, Yang; Ma, Yingfei; Lin, Ping; Tang, Yi-Wei; Yang, Liying; Shen, Yinzhong; Zhang, Renfan; Liu, Li; Cheng, Jun; Shao, Jiashen; Qi, Tangkai; Tang, Yan; Cai, Rentian; Guan, Liqian; Luo, Bin; Sun, Meiyan; Li, Ben; Pei, Zhiheng; Lu, Hongzhou

    2016-01-01

    The purpose of this study was to identify fecal bacterial microbiome changes in patients with chronic human immunodeficiency virus (HIV) infection in China. Bacterial 16S rRNA genes were amplified, sequenced (454 pyrosequencing), and clustered into operational taxonomic units using the QIIME software. Relative abundance at the phylum and genus levels were calculated. Alpha diversity was determined by Chao 1 and observed-species indices, and beta diversity was determined by double principal component analysis using the estimated phylogeny-based unweighted Unifrac distance matrices. Fecal samples of the patients with chronic HIV-infection tended to be enriched with bacteria of the phyla Firmicutes (47.20%±0.43 relative abundance) and Proteobacteria (37.21%±0.36) compared with those of the non-HIV infected controls (17.95%±0.06 and 3.81%±0.02, respectively). Members of the genus Bilophila were exclusively detected in samples of the non-HIV infected controls. Bacteroides and arabacteroides were more abundant in the chronic HIV-infected patients. Our study indicated that chronic HIV-infected patients in China have a fecal bacterial microbiome composition that is largely different from that found in non-HIV infected controls, and further study is needed to evaluate whether microbiome changes play a role in disease complications in the distal gut, including opportunistic infections. PMID:27048741

  13. Seismicity Patterns and Magmatic Processes in the Rwenzori Region, East-African Rift

    NASA Astrophysics Data System (ADS)

    Lindenfeld, M.; Rumpker, G.; Schmeling, H.; Wallner, H.

    2010-12-01

    The 5000m high Rwenzori Mountains are situated within the western branch of the East African Rift System (EARS), at the border between Uganda and the Democratic Republic of Congo. They represent a basement block located within the rift valley whose origin and relation to the evolution of the EARS are highly puzzling. During a recent seismological campaign we located more than 800 earthquakes per month with magnitudes ranging from 0.5 to 5.1. Vertical sections across the northern parts of the Rwenzoris show, that west of the mountains (towards the rift valley) the focal depths range from 10 to 20 km, whereas the hypocentres go as deep as 30 km on the eastern side. This is in good agreement with Moho-depths derived from receiver functions and implies that all of these events are located within the crust. However, about 30 km east of the northern mountain ridge we located a cluster of 7 events that exhibit an anomalous depth of about 60 km. We can confidently locate these earthquakes within the mantle lithosphere beneath the rift. The existence of earthquakes at this depth is enigmatic, especially within a rifting regime were one expects hot and weak material relatively close to the surface. We think that these events are possibly related to the evolution of the Rwenzori Mountains. A recent hypothesis to explain the extreme uplift of the Rwenzori Mountains is rift induced delamination (RID) of mantle lithosphere. Here we show that the RID-process is indeed capable of explaining the seismic energy release in the mantle. However, in view of the specific hypocentral location of the event cluster, magmatic impregnation processes associated with dyke propagation into the mantle lithosphere may be a more realistic cause for seismic radiation at the observed depth. Crustal earthquakes northeast of the Rwenzori area are relocated with a double-difference algorithm to improve the spatial resolution of seismicity pattern. Several event clusters in the vicinity of the Fort

  14. The species flocks of East African cichlid fishes: recent advances in molecular phylogenetics and population genetics

    NASA Astrophysics Data System (ADS)

    Salzburger, Walter; Meyer, Axel

    With more than 3,000 species, the fish family Cichlidae is one of the most species-rich families of vertebrates. Cichlids occur in southern and central America, Africa, Madagascar, and India. The hotspot of their biodiversity is East Africa, where they form adaptive radiations composed of hundreds of endemic species in several lakes of various sizes and ages. The unparalleled species richness of East African cichlids has been something of a conundrum for evolutionary biologists and ecologists, since it has been in doubt whether these hundreds of species arose by allopatric speciation or whether it is necessary to invoke somewhat less traditional models of speciation, such as micro-allopatric, peripatric, or even sympatric speciation or evolution through sexual selection mediated by female choice. Ernst Mayr's analyses of these evolutionary uniquely diverse species assemblages have contributed to a more direct approach to this problem and have led to a deeper understanding of the patterns and processes that caused the formation of these huge groups of species. We review here recent molecular data on population differentiation and phylogenetics, which have helped to unravel, to some extent, the patterns and processes that led to the formation and ecological maintenance of cichlid species flocks. It is becoming apparent that sexually selected traits do play an important role in speciation in micro-allopatric or even sympatric settings. Species richness seems to be roughly correlated with the surface area, but not the age, of the lakes. We observe that the oldest lineages of a species flock of cichlids are often less species-rich and live in the open water or deepwater habitats. While the species flocks of the Lake Malawai and the Lake Victoria areas were shown to be monophyletic, the cichlid assemblage of Lake Tanganyika seems to consist of several independent species flocks. Cichlids emerge as an evolutionary model system in which many fundamental questions in

  15. Istopically Defined Source Reservoirs of Primitive Magmas in the East African Rift.

    NASA Astrophysics Data System (ADS)

    Rooney, T. O.; Furman, T.; Hanan, B.

    2005-12-01

    Extension within the East African Rift is a function of the interaction between plume-driven uplift and far-field stresses associated with plate tectonic processes. Geochemical and isotopic investigation of primitive basalts from the Main Ethiopian Rift (MER) reveals systematic spatial variations in the contributions from distinct and identifiable source reservoirs that, in turn help identify the mechanisms by which along-axis rifting has progressed. The Sr-Nd-Pb isotopic characteristics of MER basalts can be described by a three-component mixing model involving the long-lived Afar plume, a depleted mantle component similar to the source region for Gulf of Aden MORB from east of 48° E and a reservoir that is likely lithospheric (sub-continental mantle lithosphere, magmatic underplate or lower crust). Quaternary basalts in the central MER exhibit a systematic decrease in plume influence southward from 9.5° N to 8° N, i.e., away from the modern surface expression of the Afar plume in Djibouti and Erta 'Ale. The composition of the Afar plume component is comparable to the "C" mantle reservoir. This southward decrease in plume influence is coupled with an increase in the influence of the lithospheric and depleted mantle components. Linear arrays observed within Pb-Pb isotopic space at each eruptive center require distinctive ratio of lithospheric + depleted mantle components mixing with variable amounts of the "C"-like plume component. This isotopic evidence suggests the depleted mantle and lithosphere mixed prior to the generation of the recent magmas. To the south, the Sr-Nd-Pb isotopic compositions of Turkana (Kenya) rift basalts record a mix of a similar "C"-like plume component and a fourth HIMU-like source component. Low 3He/4He values observed in the HIMU-dominated lavas from Turkana contrast with the higher ratios found in basalts associated with the "C"-like Afar plume. Further analysis of "C"-HIMU lavas at Turkana is required to fully constrain the He

  16. Bladder Cancer in HIV-infected Adults: An Emerging Issue? Case-Reports and Systematic Review

    PubMed Central

    Chawki, Sylvain; Ploussard, Guillaume; Montlahuc, Claire; Verine, Jérome; Mongiat-Artus, Pierre; Desgrandchamps, François; Molina, Jean-Michel

    2015-01-01

    Objectives Non-AIDS-related malignancies now represent a frequent cause of death among HIV-infected patients. Albeit bladder cancer is one of the most common malignancies worldwide, it has been rarely reported among HIV-infected patients. We wished to assess the prevalence and characteristics of bladder cancer in HIV-infected patients. Methods We conducted a single center retrospective study from 1998 to 2013 in a university hospital in Paris. Cases of bladder cancer among HIV-infected patients were identified using the electronic records of the hospital database and of the HIV-infected cohort. Patient characteristics and outcomes were retrieved from patients charts. A systematic review of published cases of bladder cancers in patients with HIV-infection was also performed. Results During the study period we identified 15 HIV-infected patients (0.2% of the cohort) with a bladder cancer. Patients were mostly men (73%) and smokers (67%), with a median age of 56 years at cancer diagnosis. Bladder cancer was diagnosed a median of 14 years after HIV-infection. Most patients were on ART (86%) with median current and nadir CD4 cell counts of 506 and 195 cells/mm3, respectively. Haematuria (73%) was the most frequent presenting symptom and HPV-associated lesions were seen in 6/10 (60%) patients. Histopathology showed transitional cell carcinoma in 80% and a high proportion of tumors with muscle invasion (47%) and high histologic grade (73%). One-year survival rate was 74.6%. The systematic review identified 13 additional cases of urothelial bladder cancers which shared similar features. Conclusions Bladder cancers in HIV-infected patients remain rare but may occur in relatively young patients with a low nadir CD4 cell count, have aggressive pathological features and can be fatal. PMID:26642314

  17. Earthquakes along the East African Rift System: A multiscale, system-wide perspective

    NASA Astrophysics Data System (ADS)

    Yang, Zhaohui; Chen, Wang-Ping

    2010-12-01

    On the basis of a comprehensive data set of precisely determined depths of 121 large to moderate-sized earthquakes along and near the entire East African Rift System (EARS), there are three distinct patterns in focal depths which seem to correlate with progressive stages in the development of the largest active rift in the world. First, away from both ends of the western, younger branch of the EARS, very large (Mw ≥ 7) earthquakes occurred in the top 15 km of the crust where surficial expressions of rifting are yet to appear. Curiously, there are unusually deep aftershocks reaching down to 35 ± 3 km. Second, under well-developed but amagmatic rift segments, focal depths show a bimodal distribution, with peaks centered near depths of about 15 ± 5 km and 35 ± 5 km. This pattern is present both under the main axis of the EARS, where rift zone have lengths approaching 1000 km, and beneath rift units 10 times shorter in length. Underside reflections off the Moho indicate that at least part of the second peak in seismicity is due to mantle earthquakes down to 44 ± 4 km, attesting to high differential stress in the mantle lithosphere which is capable of accumulating seismogenic, elastic strain (the "jelly sandwich" rheology). Third, beneath magmatic segments of well-developed rifts, seismicity is largely confined to the upper 15 km of the crust as observed previously, akin to the pattern along mid-ocean ridges where plastic flow due to high temperature inhibits accumulation of shear stress deep in the lithosphere.

  18. Organization of sensory cortex in the East African hedgehog (Atelerix albiventris).

    PubMed

    Catania, K C; Collins, C E; Kaas, J H

    2000-05-29

    We investigated the organization of neocortex in the East African hedgehog (Atelerix albiventris) with microelectrode recordings from sensory areas that were later correlated with cytochrome oxidase patterns in sections of flattened cortex. The location of corticospinal projecting neurons was also examined and related to sensory areas by making small injections of wheat germ agglutinin-horseradish peroxidase into the spinal cord. Our goals were to determine how hedgehog cortex is organized, how much sensory areas overlap, and to compare results with recent findings in other insectivores. Evidence was found for three separate topographically organized somatosensory areas, two visual areas, and a caudolateral auditory area. A medial somatosensory area corresponded to S1, the primary somatosensory area, whereas two lateral areas partially encircled auditory cortex and corresponded to the parietal ventral area (PV) and the secondary somatosensory area (S2). Primary visual cortex (V1) was delineated by a caudomedial cytochrome oxidase dark oval, and a more lateral visual area between V1 and somatosensory cortex corresponded to V2, or area 18. Two patches of corticospinal projecting cells were found primarily overlapping S1 and S2. Some bimodal auditory and somatosensory responses were found in parts of PV and S2, but for the most part, areas had relatively sharp histochemically apparent and physiologically defined borders. The present results indicate that the caudal neocortex of hedgehogs has only a few sensory areas, corresponding to those commonly found in several other small-brained mammals. Hedgehog cortical organization differs significantly in somatotopy, number, and position of fields from that of closely related shrews and moles. Thus, clear specializations occur, even within the order Insectivora. PMID:10813786

  19. Mixed-host aggregations and helminth parasite sharing in an East African wildlife-livestock system.

    PubMed

    VanderWaal, Kimberly; Omondi, George Paul; Obanda, Vincent

    2014-09-15

    Parasitic infections transmitted between livestock and wildlife pose a significant risk to wildlife conservation efforts and constrain livestock productivity in tropical regions of the world. Gastrointestinal helminths are among the most ubiquitous parasites, and many parasites within this taxon can readily infect a wide range of host species. Factors shaping bidirectional transmission of parasites in wildlife-livestock systems are understudied. In this study, we investigate the prevalence and diversity of helminth infections in an East African community of wild and domestic ungulates. We also identify pairs of host species between which transmission may be possible based on shared parasite taxa, and explore the role of multi-host aggregations in shaping patterns of parasite sharing. Helminth taxa detected included Trichostrongylus, Trichuris, Paramphistomum, Skrjabinema, Strongyloides, Strongylus spp., and other strongyle-type nematodes. We found that nearly 50% of individuals harbored at least one species of helminth, but certain species, such as zebra and impala, exhibited higher prevalence than others. High canopy feeders, like giraffe, had lower prevalence than hosts feeding at medium and low foraging heights. For helminths, patterns of parasite sharing likely emerge from shared space use, which is mediated in part by mixed-species aggregations. The frequency with which host species associated together in mixed-species aggregations was positively correlated with the number of parasite taxa shared. We suggest that variation among species in their tendency to form mixed-species aggregations creates heterogeneity in transmission opportunities, and consequently, parasite sharing across ungulate species. These results enhance our understanding of the role of spatiotemporal relationships among host species in shaping parasite communities in mixed wildlife-livestock grazing systems. PMID:25086496

  20. Ambient Noise Tomography of the East African Rift System in Mozambique

    NASA Astrophysics Data System (ADS)

    Domingues, A.; Chamussa, J.; Silveira, G. M.; Custodio, S.; Lebedev, S.; Chang, S.; Ferreira, A. M.; Fonseca, J. F.

    2013-12-01

    A wide range of studies has shown that the cross-correlation of ambient noise can provide an estimate of the Greens functions between pairs of stations. Project MOZART (funded by FCT, Lisbon, PI J. Fonseca) deployed 30 broadband (120s) seismic stations from the SEIS-UK Pool in Central Mozambique and NE South Africa, with the purpose of studying the East African Rift System (EARS) in Mozambique. We applied the Ambient Noise Tomography (ANT) method to broadband seismic data recorded from March 2011 until July 2012. Cross-correlations were computed between all pairs of stations, and from these we obtained Rayleigh wave group velocity dispersion curves for all interstation paths, in the period range from 3 to 50 seconds. We tested various approaches for pre-processing the ambient noise data regarding time-domain and spectral normalisation, as well as the use of phase cross-correlations. Moreover, we examined the robustness of our dispersion maps by splitting our dataset into various sub-sets of Green's functions with similar paths and by quantifying the differences between the dispersion maps obtained from the various sub-sets of data. We find that while the geographical distribution of the group velocity anomalies is well constrained, the amplitudes of the anomalies are slightly less robust. We performed a three-dimensional inversion to obtain the S-wave velocity of the crust and upper mantle. In addition, our preliminary results show a good correlation between the Rayleigh wave group velocity and the geology of Mozambique. In order to extend the investigation to longer periods and, thus, to be able to look into the lithosphere-asthenosphere depth range in the upper mantle, we apply a recent implementation of the surface-wave two-station method (teleseismic interferometry) and augment our dataset with Rayleigh wave phase velocities curves in broad period ranges.

  1. Capacity Building and Financing Oral Health in the African and Middle East Region.

    PubMed

    Mumghamba, E G; Joury, E; Fatusi, O; Ober-Oluoch, J; Onigbanjo, R J; Honkala, S

    2015-07-01

    Many low- and middle-income countries do not yet have policies to implement effective oral health programs. A reason is lack of human and financial resources. Gaps between resource needs and available health funding are widening. By building capacity, countries aim to improve oral health through actions by oral health care personnel and oral health care organizations and their communities. Capacity building involves achieving measurable and sustainable results in training, research, and provision of care. Actions include advancement of knowledge, attitudes and skills, expansion of support, and development of cohesiveness and partnerships. The aim of this critical review is to review existing knowledge and identify gaps and variations between and within different income levels in relation to the capacity building and financing oral health in the African and Middle East region (AMER). A second aim is to formulate research priorities and outline a research agenda for capacity building and financing to improve oral health and reduce oral health inequalities in the AMER. The article focuses on capacity building for oral health and oral health financing in the AMER of the IADR. In many communities in the AMER, there are clear and widening gaps between the dental needs and the existing capacity to meet these needs in terms of financial and human resources. Concerted efforts are required to improve access to oral health care through appropriate financing mechanisms, innovative health insurance schemes, and donor support and move toward universal oral health care coverage to reduce social inequality in the region. It is necessary to build capacity and incentivize the workforce to render evidence-based services as well as accessing funds to conduct research on equity and social determinants of oral health while promoting community engagement and a multidisciplinary approach. PMID:26101338

  2. At the tip of a propagating rift - The offshore East African Rift

    NASA Astrophysics Data System (ADS)

    Franke, Dieter; Jokat, Wilfried; Ladage, Stefan; Stollhofen, Harald; Klimke, Jennifer; Lutz, Ruediger; Mahanjane, Stefane; Ehrhardt, Axel; Schreckenberger, Bernd

    2016-04-01

    Numerous studies have addressed various aspects of the East African Rift system (EARS) but surprisingly few the offshore continuation of the south-eastern branch of the rift into the Mozambique Channel. Here, we present new evidence for neotectonic deformation derived from modern seismic reflection data and supported by additional geophysical data. The Kerimbas Graben offshore northern Mozambique is the most prominent manifestation of sub-recent extensional deformation. The seismic reflection data reveals that recent normal faulting often utilizes preexisting, deeply buried half-graben structures which likely are related to the formation of the Somali Basin. The ~30 km wide and ~150 km long symmetric graben is in a stage where the linkage of scattered normal faults already did happen, resulting in increased displacement and accommodation of most of the extension across the basin. However, deep earthquakes below the rift indicate a strong and still preserved lithospheric mantle. Extension is becoming diffuse where an onshore suture, subdividing the northern from the southern metamorphic basement onshore Mozambique, is closest to the offshore rift. It appears likely that this suture is the origin for the variation in rifting style, indicating that mantle fabric resulting from a Cambrian collision has been preserved as mechanical anisotropy of the lithospheric mantle. Further south the rift focuses in an about 30 km wide half-graben. An important finding is that the entire offshore branch of the EARS lacks significant volcanism. Along the offshore EARS there are only negligible indications for recent volcanism in the reflection seismic data such as sills and dikes. Apparently the "Comoros mantle plume" (French and Romanowicz, 2015) has a very minor influence on the progressive extensional deformation along the northern Mozambique continental margin, leading eventually to breakup sometimes in the future. Combining structural with earthquake data reveals that the magma

  3. Trading or coercion? Variation in male mating strategies between two communities of East African chimpanzees

    PubMed Central

    Kaburu, Stefano S. K.; Newton-Fisher, Nicholas E.

    2015-01-01

    Across taxa, males employ a variety of mating strategies, including sexual coercion and the provision, or trading, of resources. Biological market theory (BMT) predicts that trading of commodities for mating opportunities should exist only when males cannot monopolize access to females and/or obtain mating by force, in situations where power differentials between males are low; both coercion and trading have been reported for chimpanzees (Pan troglodytes). Here, we investigate whether the choice of strategy depends on the variation in male power differentials, using data from two wild communities of East African chimpanzees (Pan troglodytes schweinfurthii): the structurally despotic Sonso community (Budongo, Uganda) and the structurally egalitarian M-group (Mahale, Tanzania). We found evidence of sexual coercion by male Sonso chimpanzees, and of trading—of grooming for mating—by M-group males; females traded sex for neither meat nor protection from male aggression. Our results suggest that the despotism–egalitarian axis influences strategy choice: male chimpanzees appear to pursue sexual coercion when power differentials are large and trading when power differentials are small and coercion consequently ineffective. Our findings demonstrate that trading and coercive strategies are not restricted to particular chimpanzee subspecies; instead, their occurrence is consistent with BMT predictions. Our study raises interesting, and as yet unanswered, questions regarding female chimpanzees’ willingness to trade sex for grooming, if doing so represents a compromise to their fundamentally promiscuous mating strategy. It highlights the importance of within-species cross-group comparisons and the need for further study of the relationship between mating strategy and dominance steepness. PMID:26279605

  4. Oral Health Inequalities between Rural and Urban Populations of the African and Middle East Region.

    PubMed

    Ogunbodede, E O; Kida, I A; Madjapa, H S; Amedari, M; Ehizele, A; Mutave, R; Sodipo, B; Temilola, S; Okoye, L

    2015-07-01

    Although there have been major improvements in oral health, with remarkable advances in the prevention and management of oral diseases, globally, inequalities persist between urban and rural communities. These inequalities exist in the distribution of oral health services, accessibility, utilization, treatment outcomes, oral health knowledge and practices, health insurance coverage, oral health-related quality of life, and prevalence of oral diseases, among others. People living in rural areas are likely to be poorer, be less health literate, have more caries, have fewer teeth, have no health insurance coverage, and have less money to spend on dental care than persons living in urban areas. Rural areas are often associated with lower education levels, which in turn have been found to be related to lower levels of health literacy and poor use of health care services. These factors have an impact on oral health care, service delivery, and research. Hence, unmet dental care remains one of the most urgent health care needs in these communities. We highlight some of the conceptual issues relating to urban-rural inequalities in oral health, especially in the African and Middle East Region (AMER). Actions to reduce oral health inequalities and ameliorate rural-urban disparity are necessary both within the health sector and the wider policy environment. Recommended actions include population-specific oral health promotion programs, measures aimed at increasing access to oral health services in rural areas, integration of oral health into existing primary health care services, and support for research aimed at informing policy on the social determinants of health. Concerted efforts must be made by all stakeholders (governments, health care workforce, organizations, and communities) to reduce disparities and improve oral health outcomes in underserved populations. PMID:26101336

  5. Varying styles of magmatic strain accommodation across the East African Rift

    NASA Astrophysics Data System (ADS)

    Muirhead, James D.; Kattenhorn, Simon A.; Le Corvec, Nicolas

    2015-09-01

    Observations of active dike intrusions provide present day snapshots of the magmatic contribution to continental rifting. However, unravelling the contributions of upper crustal dikes over the timescale of continental rift evolution is a significant challenge. To address this issue, we analyzed the morphologies and alignments of >1500 volcanic cones to infer the distribution and trends of upper crustal dikes in various rift basins across the East African Rift (EAR). Cone lineament data reveal along-axis variations in the distribution and geometries of dike intrusions as a result of changing tectonomagmatic conditions. In younger (<10 Ma) basins of the North Tanzanian Divergence, dikes are largely restricted to zones of rift-oblique faulting between major rift segments, referred to here as transfer zones. Cone lineament trends are highly variable, resulting from the interplay between (1) the regional stress field, (2) local magma-induced stress fields, and (3) stress rotations related to mechanical interactions between rift segments. We find similar cone lineament trends in transfer zones in the western branch of the EAR, such as the Virunga Province, Democratic Republic of the Congo. The distributions and orientations of upper crustal dikes in the eastern branch of the EAR vary during continental rift evolution. In early-stage rifts (<10 Ma), upper crustal dikes play a limited role in accommodating extension, as they are confined to areas in and around transfer zones. In evolved rift basins (>10 Ma) in Ethiopia and the Kenya Rift, rift-parallel dikes accommodate upper crustal extension along the full length of the basin.

  6. Estimation of Earthquake Source Properties Along the East African Rift Using Full Waveforms

    NASA Astrophysics Data System (ADS)

    Baker, B.; Roecker, S. W.

    2015-12-01

    Recently, the Continental Rifting in Africa: Fluids-Tectonic Interaction (CRAFTI) experiment was conducted in northern Tanzania and southern Kenya as a means to better evaluate the effect of tectonic and magmatic strain along the east African rift. Towards this goal S. Roecker has computed a 3D structural model by joint inversion of gravity, local seismic body wave, and surface wave data. The joint inversion in turn produces a quality estimate of the compressional, shear, and density structure in the region. In the process of tomography of local body wave data it was observed that there exist some anomalously deep seismic events. To better quantify these events we look towards waveform modeling in this new and laterally heterogeneous structural model. It is thought that better quantification of later arriving direct and scattered phases will provide better resolved estimates of the event locations and lower the trade-off between source time and depth uncertainty inherent in travel time inversions. Since our main objective is testing the validity of seismic depths in the travel time inversion we will favor a grid search based approach around the current hypocenters using a method similar Zhao, 2006. To expedite processing, we make use of seismic reciprocity and save the strain wave fields produced by impulsive sources at receiver locations in the vicinity of the initial hypocenters. We then perform a moment tensor inversion at each location around the hypocenter, estimate the corresponding source time function, compute the resulting synthetics, and finally calculate a cumulative waveform misfit objective function for all stations. It is thought this procedure should well sample the objective function in the neighborhood of the initial hypocenters and thereby provide an avenue for resolution analysis of the event depths.

  7. Adaptive divergence between lake and stream populations of an East African cichlid fish.

    PubMed

    Theis, Anya; Ronco, Fabrizia; Indermaur, Adrian; Salzburger, Walter; Egger, Bernd

    2014-11-01

    Divergent natural selection acting in different habitats may build up barriers to gene flow and initiate speciation. This speciation continuum can range from weak or no divergence to strong genetic differentiation between populations. Here, we focus on the early phases of adaptive divergence in the East African cichlid fish Astatotilapia burtoni, which occurs in both Lake Tanganyika (LT) and inflowing rivers. We first assessed the population structure and morphological differences in A. burtoni from southern LT. We then focused on four lake-stream systems and quantified body shape, ecologically relevant traits (gill raker and lower pharyngeal jaw) as well as stomach contents. Our study revealed the presence of several divergent lake-stream populations that rest at different stages of the speciation continuum, but show the same morphological and ecological trajectories along the lake-stream gradient. Lake fish have higher bodies, a more superior mouth position, longer gill rakers and more slender pharyngeal jaws, and they show a plant/algae and zooplankton-biased diet, whereas stream fish feed more on snails, insects and plant seeds. A test for reproductive isolation between closely related lake and stream populations did not detect population-assortative mating. Analyses of F1 offspring reared under common garden conditions indicate that the detected differences in body shape and gill raker length do not constitute pure plastic responses to different environmental conditions, but also have a genetic basis. Taken together, the A. burtoni lake-stream system constitutes a new model to study the factors that enhance and constrain progress towards speciation in cichlid fishes. PMID:25256664

  8. Evolution of the East African rift: Drip magmatism, lithospheric thinning and mafic volcanism

    NASA Astrophysics Data System (ADS)

    Furman, Tanya; Nelson, Wendy R.; Elkins-Tanton, Linda T.

    2016-07-01

    The origin of the Ethiopian-Yemeni Oligocene flood basalt province is widely interpreted as representing mafic volcanism associated with the Afar mantle plume head, with minor contributions from the lithospheric mantle. We reinterpret the geochemical compositions of primitive Oligocene basalts and picrites as requiring a far more significant contribution from the metasomatized subcontinental lithospheric mantle than has been recognized previously. This region displays the fingerprints of mantle plume and lithospheric drip magmatism as predicted from numerical models. Metasomatized mantle lithosphere is not dynamically stable, and heating above the upwelling Afar plume caused metasomatized lithosphere with a significant pyroxenite component to drip into the asthenosphere and melt. This process generated the HT2 lavas observed today in restricted portions of Ethiopia and Yemen now separated by the Red Sea, suggesting a fundamental link between drip magmatism and the onset of rifting. Coeval HT1 and LT lavas, in contrast, were not generated by drip melting but instead originated from shallower, dominantly anhydrous peridotite. Looking more broadly across the East African Rift System in time and space, geochemical data support small volume volcanic events in Turkana (N. Kenya), Chyulu Hills (S. Kenya) and the Virunga province (Western Rift) to be derived ultimately from drip melting. The removal of the gravitationally unstable, metasomatized portion of the subcontinental lithospheric mantle via dripping is correlated in each case with periods of rapid uplift. The combined influence of thermo-mechanically thinned lithosphere and the Afar plume together thus controlled the locus of continental rift initiation between Africa and Arabia and provide dynamic support for the Ethiopian plateau.

  9. [Pathogenesis of lipodystrophy and metabolic syndromes associated with HIV infection].

    PubMed

    Muñoz-Sanz, Agustín; Rodríguez-Vidigal, Francisco F; Domingo, Pere

    2006-09-30

    Lipodystrophy, and the metabolic alterations (dislipemia, insulin-resistance) associated with human immunodeficiency virus (HIV) infection, is a multifactorial syndrome due to the interaction of host related factors (cellular immune status, diet, gene mutations), viral factors (cytokine synthesis, polyunsaturated fatty acid or PUFA depletion), and pharmacological effects (mitochondrial DNA-polymerase inhibition, lipolysis inhibition, adiponectin synthesis reduction). HIV probably modifies the adipocyte differentiation and the lipid metabolism. This retroviral effect is mediated by proinflammatory cytokines (tumor necrosis factor) and the participation of other factors (drugs, diet), all in the context of a particular host genetic setting. The adipocyte (and several cellular receptors, fatty acids, membrane proteins, and cytokines) plays a central role in the pathogenesis of HIV-associated lipodystrophy. PMID:17040633

  10. [Position of dolutegravir in the treatment of HIV infection].

    PubMed

    Martínez, Esteban; Gatell, José M

    2015-03-01

    Initial treatment with dolutegravir offers higher efficacy than treatment with efavirenz, darunavir/ritonavir and even with raltegravir in patients with a high viral load. Like ritonavir-boosted protease inhibitors, dolutegravir will probably have a high genetic barrier to resistance and prior genetic testing will not be required in integrase inhibitor-naïve patients. The drug is well tolerated and associated with few treatment discontinuations. It can be administered once daily and the tablet size is small. A fixed-dose combination tablet containing dolutegravir, abacavir and lamivudine will soon be available. Dolutegravir has few interactions with commonly-used drugs. It does not require pharmacological boosting and has no food or time of day restrictions. Because of these characteristics, dolutegravir has a unique profile and is the ideal drug for most HIV-infected patients. PMID:25858610

  11. Immunologic Biomarkers, Morbidity, and Mortality in Treated HIV Infection.

    PubMed

    Hunt, Peter W; Lee, Sulggi A; Siedner, Mark J

    2016-10-01

    Despite marked improvements in the modern treatment era, human immunodeficiency virus (HIV)-infected individuals, particularly those who initiated antiretroviral therapy (ART) at advanced disease stages, continue to have increased age-related morbidity and mortality, compared with the general population. Immune activation and inflammation persist despite suppressive ART and predict many of these morbidities. The goal of this review is to examine the evidence suggesting a link between the persistent inflammatory state and morbidity and mortality in this setting, to describe the impact of early ART initiation on these factors, and to highlight important unanswered questions for the field. We also advance a hypothesis to explain why some morbidities-and their root inflammatory drivers-may be prevented more than others by early ART initiation. PMID:27625430

  12. The posterior reversible encephalopathy syndrome in HIV infection

    PubMed Central

    Nightingale, Sam; Wood, Chris; Ainsworth, Jonathan

    2012-01-01

    Posterior reversible encephalopathy syndrome (PRES) is often associated with hypertension, however recent advances in the understanding of this condition have shown that endothelial dysfunction is responsible for much of the pathogenesis and the condition can occur in the absence of hypertension. This case describes a 32-year-old lady with untreated HIV infection who developed PRES at a normal blood pressure and without opportunistic infection or other conditions known to precipitate PRES. HIV, particularly when untreated, is associated with endothelial dysfunction and this may have been sufficient to cause PRES in this patient. To our knowledge this is the first case to describe PRES in HIV without uncontrolled hypertension, sepsis or other precipitating cause. PMID:22736775

  13. Recurrent pneumococcal meningitis in a splenectomised HIV-infected patient

    PubMed Central