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  1. HIV infection in the South African construction industry.

    PubMed

    Bowen, Paul; Govender, Rajen; Edwards, Peter; Lake, Antony

    2017-09-20

    South Africa has one of the highest HIV prevalences in the world, and compared with other sectors of the national economy, the construction industry is disproportionately adversely affected. Using data collected nationally from more than 57,000 construction workers, HIV infection among South African construction workers was estimated, together with an assessment of the association between worker HIV serostatus and worker characteristics of gender, age, nature of employment, occupation, and HIV testing history. The HIV infection of construction workers was estimated to be lower than that found in a smaller 2008 sample. All worker characteristics are significantly associated with HIV serostatus. In terms of most at-risk categories: females are more at risk of HIV infection than males; workers in the 30-49 year old age group are more at risk than other age groups; workers employed on a less permanent basis are more at risk; as are workers not having recently tested for HIV. Among occupations in the construction industry, general workers, artisans, and operator/drivers are those most at risk. Besides yielding more up-to-date estimated infection statistics, this research also identifies vulnerable sub-groups as valuable pointers for more targeted workplace interventions by construction firms.

  2. High levels of viral suppression among East African HIV-infected women and men in serodiscordant partnerships initiating antiretroviral therapy with high CD4 counts and during pregnancy.

    PubMed

    Mujugira, Andrew; Baeten, Jared; Kidoguchi, Lara; Haberer, Jessica; Celum, Connie; Donnell, Deborah; Ngure, Kenneth; Bukusi, Elizabeth; Mugo, Nelly; Asiimwe, Stephen; Odoyo, Josephine; Tindimwebwa, Edna; Bulya, Nulu; Katabira, Elly; Heffron, Renee

    2017-09-13

    People who are asymptomatic and feel healthy, including pregnant women, may be less motivated to initiate ART or achieve high adherence. We assessed whether ART initiation, and viral suppression 6, 12 and 24-months after ART initiation, were lower in HIV-infected members of serodiscordant couples who initiated during pregnancy or with higher CD4 counts. We used data from the Partners Demonstration Project, an open-label study of the delivery of integrated PrEP and ART (at any CD4 count) for HIV prevention among high-risk HIV serodiscordant couples in Kenya and Uganda. Differences in viral suppression (HIV RNA <400 copies/ml) among people initiating ART at different CD4 count levels (≤350, 351-500, and >500 cells/mm3) and during pregnancy were estimated using Poisson regression. Of 865 HIV-infected participants retained after becoming eligible for ART during study follow-up, 95% initiated ART. Viral suppression 24-months after ART initiation was high overall (97%), and comparable among those initiating ART at CD4 counts >500, 351-500 and ≤350 cells/mm3 (96% vs 97% vs 97%; relative risk [RR] 0.98; 95% CI: 0.93-1.03 for CD4 >500 vs <350 and RR 0.99; 95% CI: (0.93-1.06) for CD4 351-500 vs ≤350). Viral suppression was as likely among women initiating ART primarily to prevent perinatal transmission as ART initiation for other reasons (p=0.9 at 6 months and p=0.5 at 12 months). Nearly all HIV-infected partners initiating ART were virally suppressed by 24 months, irrespective of CD4 count or pregnancy status. These findings suggest that people initiating ART at high CD4 counts or due to pregnancy can adhere to ART as well as those starting treatment with symptomatic HIV disease or low CD4 counts.

  3. 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).…

  4. 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).…

  5. 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

  6. Preexposure prophylaxis for HIV infection among African women.

    PubMed

    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

    2012-08-02

    Preexposure prophylaxis with antiretroviral drugs has been effective in the prevention of human immunodeficiency virus (HIV) infection in some trials but not in others. 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. 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. 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.).

  7. 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

  8. 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.

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

    PubMed Central

    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

    2015-01-01

    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, leukaemia, 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 1,644 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

  10. Alternative antiretroviral monitoring strategies for HIV-infected patients in east Africa: opportunities to save more lives?

    PubMed Central

    2011-01-01

    Background Updated World Health Organization guidelines have amplified debate about how resource constraints should impact monitoring strategies for HIV-infected persons on combination antiretroviral therapy (cART). We estimated the incremental benefit and cost effectiveness of alternative monitoring strategies for east Africans with known HIV infection. Methods Using a validated HIV computer simulation based on resource-limited data (USAID and AMPATH) and circumstances (east Africa), we compared alternative monitoring strategies for HIV-infected persons newly started on cART. We evaluated clinical, immunologic and virologic monitoring strategies, including combinations and conditional logic (e.g., only perform virologic testing if immunologic testing is positive). We calculated incremental cost-effectiveness ratios (ICER) in units of cost per quality-adjusted life year (QALY), using a societal perspective and a lifetime horizon. Costs were measured in 2008 US dollars, and costs and benefits were discounted at 3%. We compared the ICER of monitoring strategies with those of other resource-constrained decisions, in particular earlier cART initiation (at CD4 counts of 350 cells/mm3 rather than 200 cells/mm3). Results Monitoring strategies employing routine CD4 testing without virologic testing never maximized health benefits, regardless of budget or societal willingness to pay for additional health benefits. Monitoring strategies employing virologic testing conditional upon particular CD4 results delivered the most benefit at willingness-to-pay levels similar to the cost of earlier cART initiation (approximately $2600/QALY). Monitoring strategies employing routine virologic testing alone only maximized health benefits at willingness-to-pay levels (> $4400/QALY) that greatly exceeded the ICER of earlier cART initiation. Conclusions CD4 testing alone never maximized health benefits regardless of resource limitations. Programmes routinely performing virologic testing but

  11. 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

  12. Attention deficit hyperactivity and oppositional defiance disorder in HIV-infected South African children.

    PubMed

    Zeegers, I; Rabie, H; Swanevelder, S; Edson, C; Cotton, M; van Toorn, R

    2010-04-01

    To determine the prevalence of attention deficit-hyperactivity disorder (ADHD) and oppositional defiance disorder (ODD) in HIV-infected South African children. Swanson, Nolan and Pelham (SNAP-IV) questionnaires were used to determine ADHD and ODD severity and a draw-a-person (DAP) test was used to screen for developmental disorders. Associations between behavioural subtypes, psychological functioning, demographic and health variables were investigated. The SNAP-IV caregiver questionnaires showed a 26% prevalence of ADHD inattentive type; 38% hyperactive type and 24% combined type. The prevalence of ODD was 12% on parent questionnaires and 9.5% on teacher's questionnaires. Parents/caregiver-only SNAP-IV questionnaires indicate a high prevalence of significant ADHD (all subtypes) and ODD in HIV-infected children. No significant differences were found between the severity of HIV disease and the presence of a behavioural disorder. The SNAP IV questionnaires and DAP test may prove valuable screening tools in HIV children with behavioural problems.

  13. Foster care history and HIV infection among drug-using African American female sex workers.

    PubMed

    Surratt, Hilary L; Kurtz, Steven P

    2012-05-01

    Foster care has been associated with increased HIV risk behaviors among youth, yet long-term association with HIV infection has not been examined. This study explored the associations between foster placement, victimization, mental health, onset of sex work and HIV infection among highly vulnerable female sex workers. 562 drug-involved African American women were enrolled into an intervention study to increase health services utilization and reduce HIV risk. Seventeen percent reported a history of foster placement. Foster history was associated with significantly lower educational attainment, higher victimization, and more severe mental health problems. Women with foster histories reported significantly earlier entry into paid sex work, with some 62% active in the sex trade before age 18. Multivariate analyses found that foster care was independently associated with HIV seropositivity, and that early sex work partially mediated this association. The potential long-term health vulnerabilities associated with foster placement are understudied and warrant additional research.

  14. Optimal waist circumference threshold for diagnosing metabolic syndrome in African people living with HIV infection

    PubMed Central

    Peer, Nasheeta; de Villiers, Anniza; Mukasa, Barbara; Matsha, Tandi E.; Mills, Edward J.; Kengne, Andre P.

    2017-01-01

    Background The applicability of the internationally advocated cut-off points of waist circumference (WC) derived from Caucasians to diagnose metabolic syndrome (MS) in HIV-infected Africans is unknown. This study aimed to determine the optimal WC cutoffs for MS diagnosis in HIV-infected people receiving care at public healthcare facilities in the Western Cape Province in South Africa. Methods Data from 748 randomly selected participants (591 women), with a median age of 38 years, were analysed. The Youden’s index and the top-left-point approaches were used to determine the optimal cutoffs of WC for predicting ≥2 non-adipose MS components. Results The two approaches generated the same WC cut-off point in women, 92 cm (sensitivity 64%, specificity 64%) but different cut-off points in men: 87 cm (sensitivity 48%, specificity 85%) based on the Younden’s index and 83 cm (sensitivity 59%, specificity 74%) by the top-left-point method. The advocated thresholds of 94 cm in men had low sensitivity (30%) but high specificity (92%) whereas 80 cm in women showed low specificity (32%) but high sensitivity (85%) for diagnosing MS in this sample. Most African-specific cut-off points performed well, with 90 cm providing acceptable performance in both men (sensitivity 43%, specificity 88%) and women (sensitivity 66%, specificity 59%). Conclusions This study underlines the sub-optimal performance of internationally recommended WC thresholds for MS diagnosis in HIV-infected Africans, and supports the need to revisit the guidelines on WC criterion in African population across the board. A single threshold of 90 cm for both genders would be a practical suggestion. PMID:28886047

  15. Relationship between Alcohol Use/Abuse, HIV Infection and Neuropsychological Performance in African American Men

    PubMed Central

    Durvasula, Ramani S.; Myers, Hector f.; Mason, Karen; Hinkin, Charles

    2010-01-01

    This study examines the impact of alcohol use and HIV infection on neuropsychological performance in a sample of 497 community-resident African American men. HIV serostatus and alcohol use (during the past 12 months) exerted an interactive effect on psychomotor speed, reaction time, and motor speed, and in general, HIV infected heavy drinkers evidenced significantly poorer performance than other HIV positive subjects. Main effects for HIV serostatus were noted for reaction time, with seronegative men performing better than seropositives. This study examines a sample of men who continue to show increases in HIV infection, however, sample specific issues such as comorbid substance use, past histories of head injury, and lack of data on alcohol abuse and dependence require caution in definitively attributing the findings solely to alcohol and HIV. However, these findings suggest that relatively recent heavy alcohol use may represent a potential risk factor for more rapid or pronounced cognitive decline in HIV positive individuals, and that these patterns may be even more pronounced in persons with comorbid substance use. PMID:16618627

  16. 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

  17. Appetite testing in HIV-infected African adults recovering from malnutrition and given antiretroviral therapy.

    PubMed

    Rehman, Andrea M; Woodd, Susannah; Chisenga, Molly; Siame, Joshua; Sampson, Gemma; PrayGod, George; Koethe, John R; Kelly, Paul; Filteau, Suzanne

    2015-03-01

    The Nutritional Support for Africans Starting Antiretroviral Therapy (NUSTART) trial was designed to determine whether nutritional support for malnourished HIV-infected adults starting antiretroviral therapy (ART) can improve early survival. Appetite is related to health outcomes in this population, but the optimal appetite metric for field use is uncertain. We evaluated two measures of appetite with the goal of improving understanding and treatment of malnutrition in HIV-infected adults. Longitudinal cohort study embedded in a clinical trial of vitamin and mineral-fortified, v. unfortified, lipid-based nutritional supplements. HIV clinics in Mwanza, Tanzania and Lusaka, Zambia. Malnourished (BMI<18.5 kg/m2) HIV-infected adults starting ART. Appetite measurements, by short questionnaire and by weight of maize porridge consumed in a standardized test, were compared across time and correlated with changes in weight. Appetite questionnaire scores, from polychoric correlation, and porridge test results were normally distributed for Tanzanians (n 187) but clustered and unreliable for Zambians (n 297). Among Tanzanian patients, the appetite score increased rapidly from referral for ART, plateaued at the start of ART and then increased slowly during the 12-week follow-up. Change in appetite questionnaire score, but not porridge test, correlated with weight change in the corresponding two-week intervals (P=0.002) or over the whole study (P=0.05) but a point estimate of hunger did not predict weight change (P=0.4). In Tanzania change in appetite score correlated with weight change, but single point measurements did not. Appetite increases several weeks after the start of ART, which may be an appropriate time for nutritional interventions for malnourished HIV-infected adults.

  18. 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…

  19. 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…

  20. Genetic predictors of cervical dysplasia in African American HIV-infected women: ACTG DACS 268.

    PubMed

    Cespedes, Michelle S; Kerns, Sarah L; Holzman, Robert S; McLaren, Paul J; Ostrer, Harry; Aberg, Judith A

    2013-01-01

    To examine genome-wide associations in HIV-infected women with a history of cervical dysplasia compared with HIV-infected women with no history of abnormal Papanicolaou (Pap) tests. Case-control study using data from women analyzed for the HIV Controllers Study and enrolled in HIV treatment-naïve studies in the AIDS Clinical Trials Group (ACTG). Genotyping utilized Illumina HumanHap 650 Y or 1MDuo platforms. After quality control and principal component analysis, ~610,000 significant single nucleotide polymorphisms (SNPs) were tested for association. Threshold for significance was P < 5 × 10(-8) for genome-wide associations. No significant genomic association was observed between women with low-grade dysplasia and controls. The genome-wide association study (GWAS) analysis between women with high-grade dysplasia or invasive cervical cancer and normal controls identified significant SNPs. In the analyses limited to African American women, 11 SNPs were significantly associated with the development of high-grade dysplasia or cancer after correcting for multiple comparisons. The model using significant SNPs alone had improved accuracy in predicting high-grade dysplasia in African American women compared to the use of clinical data (area under the receiver operating characteristic curve for genetic and clinical model = 0.9 and 0.747, respectively). These preliminary data serve as proof of concept that there may be a genetic predisposition to developing high-grade cervical dysplasia in African American HIV-infected women. Given the small sample size, the results need to be validated in a separate cohort.

  1. 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)

  2. Structural and sociocultural factors associated with cervical cancer screening among HIV-infected African American women in Alabama.

    PubMed

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

    2015-01-01

    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.

  3. Skills-Based, Interactive Computer Interventions to Prevent HIV Infection Among African-American and Hispanic Adolescents

    PubMed Central

    Schinke, Steven P.; Orlandi, Mario A.

    2010-01-01

    The spread of the acquired immunodeficiency virus (AIDS) virus, human immunodeficiency virus (HIV) infection, is increasingly evident. Despite the attention that HIV infection has received, few effective prevention strategies have been developed. The present paper reviews the epidemiology of AIDS among African-American and Hispanic adolescents. From epidemiological data, the authors argue for preventive approaches to reduce the risks of HIV transmission among African-American and Hispanic adolescents. Emphasizing culturally sensitive prevention strategies, the authors describe an intervention for these adolescents that combines skills-based and interactive computer approaches. PMID:20589223

  4. Skills-Based, Interactive Computer Interventions to Prevent HIV Infection Among African-American and Hispanic Adolescents.

    PubMed

    Schinke, Steven P; Orlandi, Mario A

    1990-01-01

    The spread of the acquired immunodeficiency virus (AIDS) virus, human immunodeficiency virus (HIV) infection, is increasingly evident. Despite the attention that HIV infection has received, few effective prevention strategies have been developed. The present paper reviews the epidemiology of AIDS among African-American and Hispanic adolescents. From epidemiological data, the authors argue for preventive approaches to reduce the risks of HIV transmission among African-American and Hispanic adolescents. Emphasizing culturally sensitive prevention strategies, the authors describe an intervention for these adolescents that combines skills-based and interactive computer approaches.

  5. 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

  6. Mortality among blacks or African Americans with HIV infection--United States, 2008-2012.

    PubMed

    Siddiqi, Azfar-e-Alam; Hu, Xiaohong; Hall, H Irene

    2015-02-06

    A primary goal of the National HIV/AIDS Strategy is to reduce HIV-related health disparities, including HIV-related mortality in communities at high risk for human immunodeficiency virus (HIV) infection. As a group, persons who self-identify as blacks or African Americans (referred to as blacks in this report), have been affected by HIV more than any other racial/ethnic population. Forty-seven percent of persons who received an HIV diagnosis in the United States in 2012 and 43% of all persons living with diagnosed HIV infection in 2011 were black. Blacks also experienced a low 3-year survival rate among persons with HIV infection diagnosed during 2003-2008. CDC and its partners have been pursuing a high-impact prevention approach and supporting projects focusing on minorities to improve diagnosis, linkage to care, and retention in care, and to reduce disparities in HIV-related health outcomes. To measure trends in disparities in mortality among blacks, CDC analyzed data from the National HIV Surveillance System. The results of that analysis indicated that among blacks aged ≥13 years the death rate per 1,000 persons living with diagnosed HIV decreased from 28.4 in 2008 to 20.5 in 2012. Despite this improvement, in 2012 the death rate per 1,000 persons living with HIV among blacks was 13% higher than the rate for whites and 47% higher than the rate for Hispanics or Latinos. These data demonstrate the need for implementation of interventions and public health strategies to further reduce disparities in deaths.

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

    PubMed

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

    2015-10-19

    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.). Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  8. [Study of new HIV infection between 2000 and 2007 in the north and east of France].

    PubMed

    Henard, S; Letranchant, L; Borel, A; Ajana, F; Rey, D; Hustache-Mathieu, L; Chavanet, P; May, T; Rabaud, C

    2010-09-01

    In France, since 2003, all new HIV infection must be reported. Data collected with the declaration system is not exhaustive and only concerns epidemiological data. The authors' aim was to study the epidemiologic evolution of new HIV cases between January 1, 2000 and December 31, 2007 in North and East of France, to compare them with national and local data, to complete them, and to identify local specificities. A retrospective observational study was made, with a standardized questionnaire completed by any volunteer HIV care center in the North and the East of France. Three thousand and thirty questionnaires were analyzed. The main trends over these eight years were similar to those observed in the rest of France: a decreasing number of women and patients of foreign origin, a decreasing number of patients with a late diagnosis, an increasing number of primary infections, and a higher CD4 count on initiation of antiretroviral treatment. However, local specificities appeared, such as: increasing proportion of men having sex with men and a less important proportion of co-infected patients with hepatitis B and/or C than on the national level. The therapeutic regimen is adequate according to expert recommendations, with, however, a marked "center effect" concerning prescription habits. Such a local epidemiological study, even if it confirms observed trends in the rest of France, allows detailing them and suggesting prevention measures more specifically adapted to local settings. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  9. Factors associated with pulmonary impairment in HIV-infected South African adults.

    PubMed

    Gupte, Akshay N; Wong, Michelle L; Msandiwa, Reginah; Barnes, Grace L; Golub, Jonathan; Chaisson, Richard E; Hoffmann, Christopher J; Martinson, Neil A

    2017-01-01

    HIV-infected individuals have increased risk of developing obstructive lung disease (OLD). Studies from developed countries report high viral load, low CD4 counts, and anti-retroviral therapy (ART) to be associated with OLD; but these findings may not be generalizable to populations in resource-limited settings. We conducted a prospective cohort study of lung function in 730 HIV-infected black South African adults. Pre-bronchodilator spirometry was performed at enrollment and repeated annually for three years. Logistic regression models were used to identify factors associated with OLD, defined as FEV1/FVC<0.70, at enrollment. Excess annual declines in FEV1 and FVC were modelled as the product-term of follow-up time and exposures using random effects regression. Median (IQR) age at enrollment was 36 (32-41) years, 85% were female and 30% ever-smoked with a median (IQR) exposure of 3 (1-6) pack-years. Median (IQR) CD4 count and viral load at enrollment were 372 (261-518) cells/mm3 and 2655 (91-13,548) copies/mL respectively. Overall, 25% were receiving ART at enrollment, 16% of whom reported at least 6 months of ART receipt. OLD was found in 35 (5%) at enrollment. Increasing age (aOR = 2.08 per 10-years [95%CI 1.22-3.57], p = 0.007), current smoking (aOR = 3.55 [95%CI 1.20-10.53], p = 0.02), and CRP (aOR = 1.01 per unit-increase [95%CI 1.00-1.03], p = 0.04) were significantly associated with OLD at enrollment; while increasing CD4 count (aOR = 1.02 per-100 cells/mm3 [95%CI 0.85-1.22], p = 0.82), viral load (aOR = 0.67 per log-increase [95%CI 0.43-1.10], p = 0.12) and receipt of ART (aOR = 0.57 [95%CI 0.18-1.75], p = 0.32) were not. The median (IQR) follow-up time was 18 (12-24) months. Participants with a history of tuberculosis (TB) had a 35 mL (95%CI 2-68, p = 0.03) and 57 mL (95%CI 19-96, p = 0.003) per year excess loss of FEV1 and FVC respectively. Prevalent OLD was associated with older age, current smoking and higher CRP levels, but not CD4 counts and ART, in

  10. The Duffy-null state is associated with a survival advantage in leukopenic HIV-infected persons of African ancestry

    PubMed Central

    Kulkarni, Hemant; Marconi, Vincent C.; He, Weijing; Landrum, Michael L.; Okulicz, Jason F.; Delmar, Judith; Kazandjian, Dickran; Castiblanco, John; Ahuja, Seema S.; Wright, Edwina J.; Weiss, Robin A.; Clark, Robert A.; Dolan, Matthew J.

    2009-01-01

    Persons of African ancestry, on average, have lower white blood cell (WBC) counts than those of European descent (ethnic leukopenia), but whether this impacts negatively on HIV-1 disease course remains unknown. Here, in a large natural history cohort of HIV-infected subjects, we show that, although leukopenia (< 4000 WBC/mm3 during infection) was associated with an accelerated HIV disease course, this effect was more prominent in leukopenic subjects of European than African ancestry. The African-specific −46C/C genotype of Duffy Antigen Receptor for Chemokines (DARC) confers the malaria-resisting, Duffy-null phenotype, and we found that the recently described association of this genotype with ethnic leukopenia extends to HIV-infected African Americans (AAs). The association of Duffy-null status with HIV disease course differed according to WBC but not CD4+ T-cell counts, such that leukopenic but not nonleukopenic HIV+ AAs with DARC −46C/C had a survival advantage compared with all Duffy-positive subjects. This survival advantage became increasingly pronounced in those with progressively lower WBC counts. These data highlight that the interaction between DARC genotype and the cellular milieu defined by WBC counts may influence HIV disease course, and this may provide a partial explanation of why ethnic leukopenia remains benign in HIV-infected AAs, despite immunodeficiency. PMID:19620399

  11. Recruitment approaches to identifying newly diagnosed HIV infection among African American men who have sex with men.

    PubMed

    Ellen, J M; McCree, D H; Muvva, R; Chung, S-E; Miazad, R M; Arrington-Sanders, R; Jones, K; Burnett, P; Fichtenberg, C

    2013-05-01

    To determine effectiveness of alternate venue testing (AVT), social network strategy (SNS) and provider referral (PR) for identifying previously undiagnosed HIV-infected 18-64-year-old African American men who have sex with men (AA MSM) by a health department. For AVT, staff used a mobile clinic to conduct HIV testing. For PR, staff solicited contact information from HIV-infected AA MSM, located contacts and offered HIV testing. For SNS, HIV-positive AA MSM recruited network associates for HIV testing. Two hundred and eighteen self-identified AA MSM were tested through AVT (25.2% HIV positivity) of whom 20 were newly identified HIV-positive. Fourteen HIV-positive men participated in SNS; 22 AA MSM contacts were recruited through SNS, eight (36.4%) were HIV positive and none were new positives. Two HIV-infected men participated in the PR strategy, yielding two AA MSM sex partners (one previously positive). The results suggest the need for health departments to consider using several complimentary strategies for identifying previously undiagnosed HIV infections in AA MSM in urban environments such as Baltimore.

  12. Saving our children: strategies to empower African-American adolescents to reduce their risk for HIV infection.

    PubMed

    Jemmott, L S

    2000-01-01

    Adolescence is normally a healthy period of life. For some young people it is a period of experimentation with risky behavior. For others, it marks the development of habitual risk behaviors that persist into adulthood. Of special concern is adolescent involvement with sexual behaviors that increase the risk of infection with HIV and other sexually transmitted diseases (STDs). Nurses who work with adolescents are seeing an increase in STDs, including HIV infection occurring disproportionately among African-American adolescents. Although the use of condoms can reduce the risk of these sexually transmitted diseases, most sexually active adolescents do not consistently use condoms. This paper will discuss the scope of the problem of STDs, especially HIV infection among African-American adolescents. It will describe the Theory of Planned Behavior as a framework for designing interventions to reduce the sexual transmission of HIV and other STDs. Finally, it will provide strategies for nurses to intervene by empowering African-American adolescents to reduce their risk for sexually transmitted HIV infection.

  13. Transmission of Tuberculosis in a South African Community With a High Prevalence of HIV Infection

    PubMed Central

    Middelkoop, Keren; Mathema, Barun; Myer, Landon; Shashkina, Elena; Whitelaw, Andrew; Kaplan, Gilla; Kreiswirth, Barry; Wood, Robin; Bekker, Linda-Gail

    2015-01-01

    Background. In settings of high tuberculosis transmission, little is known of the interaction between human immunodeficiency virus (HIV) positive and HIV-negative tuberculosis disease and of the impact of antiretroviral treatment (ART) programs on tuberculosis transmission dynamics. Methods. Mycobacterium tuberculosis isolates were collected from patients with tuberculosis who resided in a South African township with a high burden of tuberculosis and HIV infection. Demographic and clinical data were extracted from clinic records. Isolates underwent IS6110-based restriction fragment length polymorphism analysis. Patients with unique (nonclustered) M. tuberculosis genotypes and cluster index cases (ie, the first tuberculosis case in a cluster) were defined as having tuberculosis due to reactivation of latent M. tuberculosis infection. Secondary cases in clusters were defined as having tuberculosis due to recent M. tuberculosis infection. Results. Overall, 311 M. tuberculosis genotypes were identified among 718 isolates from 710 patients; 224 (31%) isolates were unique strains, and 478 (67%) occurred in 87 clusters. Cluster index cases were significantly more likely than other tuberculosis cases to be HIV negative. HIV-positive patients were more likely to be secondary cases (P = .001), including patients receiving ART (P = .004). Only 8% of cases of adult-adult transmission of tuberculosis occurred on shared residential plots. Conclusions. Recent infection accounted for the majority of tuberculosis cases, particularly among HIV-positive patients, including patients receiving ART. HIV-negative patients may be disproportionally responsible for ongoing transmission. PMID:25053739

  14. Duration of hospitalization and appetite of HIV-infected South African children.

    PubMed

    Mda, Siyazi; van Raaij, Joop M A; MacIntyre, Una E; de Villiers, François P R; Kok, Frans J

    2011-04-01

    Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and nutritional status of HIV-infected children with that of uninfected children. A cross-sectional study was performed on children (2-24 months) admitted with diarrhoea or pneumonia to the university hospital. Children were tested for HIV, and the duration of hospitalization was noted for 189 children. Follow-up for blood analysis (n=154) and appetite measurement (n=48) was performed 4-8 weeks after discharge. Appetite was measured as ad libitum intake of a commercial infant cereal using highly standardized procedures. Hospitalization (in days) was significantly longer in HIV-infected children; among children admitted with diarrhoea (5.9 ± 1.9 vs. 3.8 ± 1.5) (mean ± standard deviation) and with pneumonia (9.0 ± 2.5 vs. 5.9 ± 1.9). Serum zinc, iron and transferrin concentrations, and haemoglobin levels were significantly lower in HIV-infected children compared with uninfected children. Appetites [amounts eaten (g) per kg body weight] of HIV-infected children were significantly poorer than those of HIV-uninfected children (18.6 ± 5.8 vs. 25.2 ± 7.4). The eating rates (g min(-1) ) of HIV-infected children were also slower (17.6 ± 6.2 vs. 10.1 ± 3.7) Mean Z-scores for length-for-age were significantly lower among HIV-infected children compared with HIV-uninfected children. Weight-for-length Z-scores were not significantly different. In summary, HIV-infected children had a 55% longer duration of hospitalization and a 21% lower appetite.

  15. HIV Infection, Stressful Life Events, and Intimate Relationship Power: The Moderating Role of Community Resources for Black South African Women

    PubMed Central

    Ketchen, Bethany; Armistead, Lisa; Cook, Sarah L.

    2009-01-01

    Background Black women in South Africa are vulnerable with limited power in intimate relationships. This study explored whether stressful life events and/or HIV infection were associated with relationship power and whether the impact was moderated by community resources. Method 104 women living with HIV (WLWH) and 152 women not living with HIV (WNLWH) participated in individual interviews. Results Undesirable life changes were negatively associated with relationship control. HIV infection and women's knowledge of community resources were associated with mutual decision-making, while frequency of family use of community resources was negatively related to female dominated decisions. WLWH perceived their male partners as less dominant when they perceived their community resources to be more helpful. Conclusions Power in intimate relationships may enhance the quality and length of life for black South African women living with HIV. Knowledge of and perceived helpfulness of community resources are avenues for promoting relationship power. PMID:19533510

  16. Vitamin D deficiency in HIV-infected postmenopausal Hispanic and African-American women.

    PubMed

    Stein, E M; Yin, M T; McMahon, D J; Shu, A; Zhang, C A; Ferris, D C; Colon, I; Dobkin, J F; Hammer, S M; Shane, E

    2011-02-01

    We evaluated vitamin D status in HIV+ and HIV- postmenopausal African-American (AA) and Hispanic women. Most women (74-78%) had insufficient 25-hydroxyvitamin D (25OHD) levels, regardless of HIV status. 25OHD was lower in AA women and women lacking supplement use, providing support for screening and supplementation. Among HIV+ women, 25OHD was associated with current CD4 but not type of antiretroviral therapy. To evaluate vitamin D status and factors associated with vitamin D deficiency and insufficiency in HIV-infected (HIV+) postmenopausal minority women. In this cross-sectional study, 89 HIV+ and 95 HIV- postmenopausal women (33% AA and 67% Hispanic) underwent assessment of 25OHD, 1,25-dihydroxyvitamin D, parathyroid hormone, markers of bone turnover and bone mineral density by dual energy X-ray absorptiometry. The prevalence of low 25OHD did not differ by HIV status; the majority of both HIV+ and HIV- women (74-78%) had insufficient levels (<30 ng/ml). Regardless of HIV status, 25OHD was significantly lower in AA subjects, and higher in subjects who used both calcium and multivitamins. In HIV+ women on antiretroviral therapy (ART), 25OHD was directly associated with current CD4 count (r=0.32; p<0.01) independent of age, ethnicity, BMI, or history of AIDS-defining illness. No association was observed between 1,25(OH)(2)D and CD4 count or between serum 25OHD, 1,25(OH)(2)D or PTH and type of ART. In postmenopausal minority women, vitamin D deficiency was highly prevalent and associated with AA race and lack of supplement use, as well as lower current CD4 cell count. These results provide support for screening and repletion of vitamin D in HIV+ patients.

  17. Vitamin D deficiency in HIV-infected postmenopausal Hispanic and African-American women

    PubMed Central

    Stein, E. M.; McMahon, D. J.; Shu, A.; Zhang, C. A.; Ferris, D. C.; Colon, I.; Dobkin, J. F.; Hammer, S. M.; Shane, E.

    2011-01-01

    Summary We evaluated vitamin D status in HIV+ and HIV− postmenopausal African-American (AA) and Hispanic women. Most women (74–78%) had insufficient 25-hydroxyvitamin D (25OHD) levels, regardless of HIV status. 25OHD was lower in AA women and women lacking supplement use, providing support for screening and supplementation. Among HIV+ women, 25OHD was associated with current CD4 but not type of antiretroviral therapy. Introduction To evaluate vitamin D status and factors associated with vitamin D deficiency and insufficiency in HIV-infected (HIV+) postmenopausal minority women. Methods In this cross-sectional study, 89 HIV+ and 95 HIV− postmenopausal women (33% AA and 67% Hispanic) underwent assessment of 25OHD, 1,25-dihydroxyvitamin D, parathyroid hormone, markers of bone turnover and bone mineral density by dual energy X-ray absorptiometry. Results The prevalence of low 25OHD did not differ by HIV status; the majority of both HIV+ and HIV− women (74–78%) had insufficient levels (<30 ng/ml). Regardless of HIV status, 25OHD was significantly lower in AA subjects, and higher in subjects who used both calcium and multi-vitamins. In HIV+ women on antiretroviral therapy (ART), 25OHD was directly associated with current CD4 count (r= 0.32; p<0.01) independent of age, ethnicity, BMI, or history of AIDS-defining illness. No association was observed between 1,25(OH)2D and CD4 count or between serum 25OHD, 1,25(OH)2D or PTH and type of ART. Conclusions In postmenopausal minority women, vitamin D deficiency was highly prevalent and associated with AA race and lack of supplement use, as well as lower current CD4 cell count. These results provide support for screening and repletion of vitamin D in HIV+ patients. PMID:20585939

  18. Factors associated with high cardiovascular risk in a primarily African American, urban HIV-infected population

    PubMed Central

    Bagchi, Shashwatee; Burrowes, Shana AB; Fantry, Lori E; Hossain, Mian B; Tollera, Gemechis H; Kottilil, Shyamasundaran; Pauza, C David; Miller, Michael; Baumgarten, Mona; Redfield, Robert R

    2017-01-01

    Objective: To determine factors associated with increased risk of developing cardiovascular disease in a high-risk patient population. Design: Cross-sectional analysis of a retrospective cohort study. Methods: One-hundred patients at an inner city HIV clinic in 2008 were reviewed. The atherosclerotic vascular disease risk score was calculated using the Pooled Cohort Equation. Chi-square test was performed to identify associations of potential risk factors with elevated atherosclerotic vascular disease risk. Results: Eighty-one participants were included in the final analysis. In total, 95.1% were African American, and 38.3% were women. The median atherosclerotic vascular disease risk score was 8.8% and 8.1% in 2008 and 2012, respectively. The medical co-morbidities associated with increased atherosclerotic vascular disease risk were hepatitis C infection (X2 = 3.93; p value = 0.048), elevated triglycerides levels (X2 = 4.0; p value = 0.046), and low albumin (X2 = 4.65; p value = 0.031). There were a higher number of women with known atherosclerotic vascular disease despite lower median atherosclerotic vascular disease risk score compared to men. Conclusion: An elevated risk of developing cardiovascular disease persists in high-risk demographic groups of the HIV epidemic even in the current HIV era. There is an unexplained gender disparity and some non-traditional risk factors not accounted for in the Pooled Cohort Equation may be contributing to the excess cardiovascular disease risk observed among HIV-infected patients. PMID:28839941

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

    PubMed Central

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

    2015-01-01

    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

  20. HIV Infection Is Associated with Decreased Dietary Diversity in South African Children1,2

    PubMed Central

    Mpontshane, Nontobeko; Broeck, Jan Van den; Chhagan, Meera; Luabeya, Kany Kany Angelique; Johnson, Ayesha; Bennish, Michael L.

    2008-01-01

    Little is known about dietary diversity of children residing in areas of high HIV prevalence. This study examined dietary diversity in 381 children ages 6−24 mo in rural South Africa. Twenty-eight (7.3%) children and 170 mothers (44.6%) were HIV infected. Home visits were conducted weekly and a detailed history of dietary intake obtained. A dietary diversity score was computed based on the weekly consumption of 8 food classes. Low dietary diversity was defined as falling within the lowest quartile of the diversity scale. There were 22,772 child weeks of observation: 1369 for HIV-infected children, 8876 for HIV-uninfected children born to HIV-infected mothers, and 12,527 for HIV-uninfected children born to HIV-uninfected mothers. Low dietary diversity was more common in HIV-infected children [crude odds ratio (OR), 2.59; 95% CI, 1.52 to 4.41) compared with children born to HIV-uninfected mothers. In a multiple logistic regression analysis adjusting for socioeconomic and health status, HIV-infected children had lower dietary diversity (conditional OR, 1.76; 95% CI, 1.06 to 2.94) than HIV-uninfected children. HIV-infected children consumed less in 6 of 8 food classes compared with HIV-uninfected children, with the 2 exceptions being breast milk and formula milk. In rural South Africa, HIV-infected children's diets are significantly less diverse than those of HIV-uninfected children. This may be a factor contributing to increased morbidity and poorer survival in these children. PMID:18716173

  1. Socioeconomic status as a risk factor for HIV infection in women in East, Central and Southern Africa: a systematic review.

    PubMed

    Wojcicki, Janet Maia

    2005-01-01

    This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women's access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female's SES and fourteen also included a measurement of partner's SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income sub-Saharan Africans

  2. The nutritional status of asymptomatic HIV-infected Africans: directions for dietary intervention?

    PubMed

    Vorster, Hester H; Kruger, Annamarie; Margetts, Barrie M; Venter, Christina S; Kruger, H Salomé; Veldman, Frederick J; Macintyre, Una E

    2004-12-01

    To compare the relationships between food (nutrient) intakes and biochemical markers of nutritional status of asymptomatic HIV-infected with HIV-uninfected subjects, to gain more information on the appropriate diet for HIV-infected persons at an early stage of infection. Cross-sectional population-based survey. North West Province, South Africa. Two hundred and sixteen asymptomatic HIV-infected and 1550 HIV-uninfected men and women volunteers aged 15 years and older, recruited as 'apparently healthy' subjects from 37 randomly selected sites. Food and nutrient intakes, measured with a validated food-frequency questionnaire, and nutritional status indicated by anthropometric and biochemical variables, measured by a standardised methodology. The prevalence of HIV infection in the study population was 11.9%. The anthropometric indices and nutrient intakes of HIV-infected and uninfected subjects did not differ significantly, indicating that these 216 HIV-infected subjects were at an early stage of infection. Of the biochemical nutritional status variables, high-density lipoprotein cholesterol and total cholesterol, haemoglobin, albumin and triglycerides were significantly lower in infected subjects. They also had higher globulin and liver enzyme levels than uninfected subjects. In infected subjects, serum albumin correlated significantly with serum lipids, serum vitamin A, serum vitamin E, serum iron, total iron-binding capacity and haemoglobin. The significant positive correlations of the liver enzymes with serum lipids, albumin, vitamin A and iron, observed in HIV-uninfected subjects, disappeared in the infected subjects. Polyunsaturated fat intake showed significant positive correlations with the increased liver enzymes in infected subjects. A principal components analysis indicated that, in infected subjects, increased liver enzymes correlated with higher consumption of maize meal and lower consumption of meat and vegetables. This survey indicated that asymptomatic

  3. 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.

  4. 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.

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

    PubMed

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

    2016-01-01

    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. 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. 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. 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.

  6. Vitamin D deficiency is associated with coronary artery calcification in cardiovascularly asymptomatic African Americans with HIV infection.

    PubMed

    Lai, Shenghan; Fishman, Elliot K; Gerstenblith, Gary; Brinker, Jeffrey; Tai, Hong; Chen, Shaoguang; Li, Ji; Tong, Wenjing; Detrick, Barbara; Lai, Hong

    2013-01-01

    Patients with HIV infection are at increased risk for coronary artery disease (CAD), and growing evidence suggests a possible link between vitamin D deficiency and clinical/subclinical CAD. However, the relationship between vitamin D deficiency and coronary artery calcification (CAC), a sensitive marker for subclinical CAD, in those with HIV infection is not well investigated. CAC was quantified using a Siemens Cardiac 64 scanner, and vitamin D levels and the presence of traditional and novel risk factors for CAD were obtained in 846 HIV-infected African American (AA) participants aged 25 years or older in Baltimore, MD, USA without symptoms or clinical evidence of CAD. The prevalence of vitamin D deficiency (25-hydroxy vitamin D <10 ng/mL) was 18.7%. CAC was present in 238 (28.1%) of the 846 participants. Logistic regression analysis revealed that the following factors were independently associated with CAC: age (adjusted odds ratio [OR]: 1.11; 95% confidence interval [CI]: 1.08-1.14); male sex (adjusted OR: 1.71; 95% CI: 1.18-2.49); family history of CAD (adjusted OR: 1.53; 95% CI: 1.05-2.23); total cholesterol (adjusted OR: 1.006; 95% CI: 1.002-1.010); high-density lipoprotein cholesterol (adjusted OR: 0.989; 95% CI: 0.979-0.999); years of cocaine use (adjusted OR: 1.02; 95% CI: 1.001-1.04); duration of exposure to protease inhibitors (adjusted OR: 1.004; 95% CI: 1.001-1.007); and vitamin D deficiency (adjusted OR: 1.98; 95% CI: 1.31-3.00). Both vitamin D deficiency and CAC are prevalent in AAs with HIV infection. In order to reduce the risk for CAD in HIV-infected AAs, vitamin D levels should be closely monitored. These data also suggest that clinical trials should be conducted to examine whether vitamin D supplementations reduce the risk of CAD in this AA population.

  7. East African ROAD

    NASA Astrophysics Data System (ADS)

    Tekle, Kelali

    2016-10-01

    In the developing world astronomy had been treated as the science of elites. As a result of this overwhelming perception, astronomy compared with other applied sciences has got less attention and its role in development has been insignificant. However, the IAU General Assembly decision in 2009 opened new opportunity for countries and professionals to deeply look into Astronomy and its role in development. Then, the subsequent establishment of regional offices in the developing world is helping countries to integrate astronomy with other earth and space based sciences so as to progressively promote its scientific and development importance. Gradually nations have come to know that space is the frontier of tomorrow and the urgency of preeminence on space frontier starts at primary school and ascends to tertiary education. For this to happen, member nations in east African region have placed STEM education at the center of their education system. For instance, Ethiopian has changed University enrollment strategy to be in favor of science and engineering subjects, i.e. every year seventy percent of new University entrants join science and engineering fields while thirty percent social science and humanities. Such bold actions truly promote astronomy to be conceived as gateway to science and technology. To promote the concept of astronomy for development the East African regional office has actually aligned it activities to be in line with the focus areas identified by the IAU strategy (2010 to 2020).

  8. Control beliefs and health locus of control in Ugandan, German and migrated sub-Saharan African HIV infected individuals.

    PubMed

    Milz, Ruth U; Husstedt, Ingo-W; Reichelt, Doris; Evers, Stefan

    2016-04-01

    Little is known about the influence of control beliefs on antiretroviral drug adherence in patients who migrated from sub-Saharan Africa to Europe. The aim of this study was to explore the differences in health locus of control and control beliefs between HIV infected patients from sub-Saharan Africa with and without a lifetime experience of migration. A sample of 62 HIV infected consecutive patients referred to the HIV clinics at the University Hospital of Münster (Germany) and at the Rubaga Hospital Kampala (Uganda) were enrolled into this study. We compared three groups of patients: sub-Saharan African migrants, German patients, and local Ugandan patients. We used the German health and illness related control beliefs questionnaire (KKG), the Competence and control beliefs questionnaire (FKK), and the Powe Fatalism Inventory-HIV/AIDS-Version (PFI-HIV/AIDS-Version) and translated these scales into English and Luganda. In addition, the patients' sociodemographic, acculturation, clinical, and immunological data were registered. Significant results were shown in HIV related external locus of control between migrated sub-Saharan African and local Ugandan patients compared to German patients. General control beliefs showed no significant differences. In the PFI-HIV-Version, there was a significant difference between migrated sub-Saharan African and Ugandan patients compared to German patients. Our data suggest that the experience of migration does not influence the locus of control. Compared to German HIV patients, African patients in general showed a significantly higher external health locus of control which might have implications for drug adherence. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. 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

    2016-06-02

    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

  10. 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

  11. 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

  12. 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.

  13. Multiplex Urinary Antigen Detection for 13 Streptococcus pneumoniae Serotypes Improves Diagnosis of Pneumococcal Pneumonia in South African HIV-Infected Adults.

    PubMed

    Albrich, Werner C; Pride, Michael W; Madhi, Shabir A; Callahan, Jan; Adrian, Peter V; French, Roger; van Niekerk, Nadia; Sebastian, Shite; Souza, Victor; Telles, Jean-Noel; Paranhos-Baccalà, Glaucia; Jansen, Kathrin U; Klugman, Keith P

    2017-01-01

    A serotype-specific urinary antigen detection (UAD) assay for 13 serotypes included in the pneumococcal conjugate vaccine (PCV13) was recently reported as a useful diagnostic tool for pneumococcal pneumonia. We aimed to assess the diagnostic accuracy of the UAD in HIV-infected South African adults. Urine specimens from a well-defined cohort of HIV-infected South African adults with pneumonia were evaluated retrospectively in the UAD assay. Pneumonia was considered pneumococcal if either sputum Gram stain, sputum culture, blood culture, or the immunochromatographic (ICT) BinaxNow S. pneumoniae test (composite diagnostic) was positive. Among 235 enrolled pneumonia patients, the UAD assay was more frequently positive (104 [44.3%]) than the composite diagnostic (71 [30.2%]; P < 0.001) and increased the pneumococcal etiology from 30.2% by an additional 22.6% to 52.8%. The UAD assay detected more pneumococcal etiologies (45.0%) than the serotype-independent ICT (23.4%, P < 0.001). UAD identified 6/7 patients with PCV13 serotype bacteremia without misclassification of bacteremia episodes due to non-PCV13 serotypes. UAD was positive for 5.1% of asymptomatic HIV-infected persons, with higher rates among those with nasopharyngeal carriage. Concordance between serotypes identified by UAD and by Quellung reaction and PCR serotyping was 70/86 (81.4%). UAD identified the dominant serotype in multiple serotype carriage. This study confirms the utility of the UAD assay for HIV-infected adults comparing favorably with other diagnostic tests. A highly valent UAD may become a new standard for detection of pneumococcal pneumonia in adults. Prior to PCV introduction, at least 53% of pneumonia cases were due to pneumococci in HIV-infected South African adults. Copyright © 2016 American Society for Microbiology.

  14. Nevirapine pharmacokinetics and risk of rash and hepatitis among HIV-infected sub-Saharan African women.

    PubMed

    Dong, Betty J; Zheng, Yu; Hughes, Michael D; Frymoyer, Adam; Verotta, Davide; Lizak, Patricia; Sawe, Frederick; Currier, Judith S; Lockman, Shahin; Aweeka, Francesca T

    2012-04-24

    To estimate nevirapine (NVP) pharmacokinetics and examine its association with rash and/or hepatotoxicity in women starting antiretroviral treatment in the AIDS Clinical Trials Group A5208/OCTANE study in Africa. In HIV-infected, nonpregnant women with screening CD4 cell count less than 200 cells/μl randomized to NVP (twice daily, after 14-day once-daily lead-in period) and tenofovir/emtricitabine, single NVP blood samples were collected 14 and 28 days following randomization. Rash and hepatotoxicity that occurred during therapy, or within 7 days after the last dose of NVP, were defined as toxicity. NVP pharmacokinetics were modeled by population pharmacokinetic analysis. Individual Bayesian pharmacokinetic estimates were used to calculate clearance, 24-h area under the curve, and predicted plasma concentrations. Median week 4 NVP clearance was 2 l/h. Among the 359 women, 194 (54%) developed a rash of any grade; 82 (23%) had grade 2+ and nine (3%) had grade 3+ rash. Median clearance was 1.7 l/h for participants exhibiting 3+ rash versus 2 l/h in women without 3+ rash (P = 0.046). The odds of developing 3+ rash was 50% higher for every 20% decrease in clearance (P = 0.046). NVP discontinuation due to rash/liver toxicity was significantly more common among women with pretreatment CD4 cell count more than 250 cells/μl (P = 0.003). In this study, HIV-infected African women starting a NVP-based antiretroviral regimen had a lower NVP clearance compared to previous reports. Severe rash, but not hepatotoxicity, was associated with higher NVP exposure. Albeit observed in a small number of women, baseline CD4 cell count at least 250 cells/μl was significantly associated with NVP toxicity.

  15. Nevirapine (NVP) Pharmacokinetics (PK) and Risk of Rash and Hepatitis among HIV-Infected Sub-Saharan African Women

    PubMed Central

    DONG, Betty J.; ZHENG, Yu; HUGHES, Michael D.; FRYMOYER, Adam; VEROTTA, Davide; LIZAK, Patty; SAWE, Frederick; CURRIER, Judith S.; LOCKMAN, Shahin; AWEEKA, Francesca T.

    2012-01-01

    Objectives To estimate nevirapine pharmacokinetics and examine its association with rash and/or hepatotoxicity in women starting antiretroviral treatment in the ACTG A5208/OCTANE study in Africa. Design In HIV-infected, non-pregnant women with screening CD4<200 cells/mm3 randomized to nevirapine (twice daily, after 14-day once-daily lead-in period) plus tenofovir/emtricitabine, single nevirapine blood samples were collected 14 and 28 days following randomization. Rash and hepatotoxicity that occurred during therapy, or within 7 days after the last dose of nevirapine, were defined as toxicity. Methods Nevirapine pharmacokinetics were modeled by population pharmacokinetic analysis. Individual Bayesian pharmacokinetic estimates were used to calculate clearance, 24-hour area under the curve, and predicted plasma concentrations. Results Median week 4 nevirapine clearance was 2.0 L/hr. Among the 359 women, 194 (54%) developed a rash of any grade; 82 (23%) had grade 2+ and 9 (3%) had grade 3+ rash. Median clearance was 1.7L/hr for subjects exhibiting 3+ rash versus 2.0 L/hr in women without 3+ rash (p=0.046). The odds of developing 3+ rash was 50% higher for every 20% decrease in clearance (p=0.046). Nevirapine discontinuation due to rash/liver toxicity was significantly more common among women with pretreatment CD4 count > 250 cells/mm3 (p=0.003). Conclusions In this study, HIV-infected African women starting a nevirapine-based antiretroviral regimen had a lower nevirapine clearance compared to previous reports. Severe rash, but not hepatotoxicity, was associated with higher NVP exposure. Albeit observed in a small number of women, baseline CD4≥250 cells/mm3 was significantly associated with NVP toxicity. PMID:22301417

  16. [Use of spirulina supplement for nutritional management of HIV-infected patients: study in Bangui, Central African Republic].

    PubMed

    Yamani, E; Kaba-Mebri, J; Mouala, C; Gresenguet, G; Rey, J L

    2009-02-01

    Treatment of HIV-infected persons including nutritional management is a major concern in Africa and in particular in the Central African Republic (CAR). This six-month randomized prospective longitudinal study was carried out at the Friends of Africa Center that was a facility for comprehensive management of persons infected and affected by HIV in Banqui, CAR. The purpose of the study was to assess the impact of spirulina supplement on clinical and laboratory findings in HIV-infected patients who were not indications for ARV treatment. A total of 160 patients were randomly assigned to two groups. Patients in group 1 (n=79) received 10 grams of spirulina per day on a regular basis while patients in group 2 (n = 81) received a placebo. In addition patients in both groups received dietary products supplied by the World Food Program (WFP). Follow-up of the 160 patients at three and six months showed that 16 patients had been lost from follow-up and 16 had died, with no difference in distribution between the two groups. A significant improvement in the main follow-up criteria, i.e., weight, arm girth, number of infectious episodes, CD4 count, and protidemia, was observed in both groups. No difference was found between the two groups except with regard to protidemia and creatinemia that were higher in the group receiving spirulina supplement. From a clinical standpoint results were less clear-cut since the Karnofsky score was better in the group receiving spirulina than in the group receiving the placebo at 3 months but not at 6 months and fewer patients presented pneumonia at six months. Further study over a longer period will be needed to determine if spirulina is useful and to evaluate if higher doses can have beneficial nutritional and immunitary effects without adverse effects, in particular renal problems.

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

    PubMed

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

    2015-01-01

    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. 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. 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. 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.

  18. Tobacco use and its determinants in HIV-infected patients on antiretroviral therapy in West African countries

    PubMed Central

    Jaquet, Antoine; Ekouevi, Didier-Koumavi; Aboubakrine, Maiga; Bashi, Jules; Messou, Eugène; Maiga, Moussa; Traore, Hamar-Alassane; Zannou, Marcel; Guehi, Calixte; Ba-Gomis, Franck-Olivier; Minga, Albert; Allou, Gérard; Eholie, Serge-Paul; Dabis, Francois; Bissagnene, Emmanuel; Sasco, Annie-Jeanne

    2009-01-01

    INTRODUCTION Tobacco smoking is common in HIV-infected patients from industrialized countries. In West Africa, few data exist concerning tobacco consumption. METHODS A cross-sectional survey was conducted within the International epidemiological Database to Evaluate AIDS (IeDEA) network in West Africa. Health workers administered to patients receiving antiretroviral treatment a questionnaire assessing tobacco and cannabis consumption. Regular smokers were defined as present smokers who smoked >1 cigarette per day for ≥1 year. RESULTS Overall, 2920 patients were enrolled in three countries. The prevalence of ever smokers and present smokers were 46.2% (95% CI 42.8–49.5) and 15.6% (95% CI 13.2–18.0) in men and 3.7% (95% CI 2.9–4.5) and 0.6% (95% CI 0.3–0.9) in women, respectively. Regular smoking was associated being from Côte d’Ivoire or Mali compared to Benin (OR 4.6; 95% CI 2.9–7.3 and 7.7; 95% CI 4.4–13.6), a severely impaired immunological status at HAART initiation (OR 1.5; 95% CI 1.1–2.2) and a history of tuberculosis (OR 1.8; 95% CI 1.1–3.0). CONCLUSION Marked differences of smoking prevalence exist between these West African countries. This survey approach also provides evidences concerning the association between cigarette smoking and tuberculosis in HIV-infected patients, a major public health issue in this part of the world. PMID:19861019

  19. Factors Associated with Negative Direct Sputum Examination in Asian and African HIV-Infected Patients with Tuberculosis (ANRS 1260)

    PubMed Central

    Chartier, Loïc; Leng, Chanthy; Sire, Jean-Marie; Le Minor, Odile; Saman, Manil; Bercion, Raymond; Rahalison, Lila; Fontanet, Arnaud; Germany, Yves; L'Her, Pierre; Mayaud, Charles; Vray, Muriel

    2011-01-01

    Objective To identify factors associated with negative direct sputum examination among African and Cambodian patients co-infected by Mycobacterium tuberculosis and HIV. Design Prospective multicenter study (ANRS1260) conducted in Cambodia, Senegal and Central African Republic. Methods Univariate and multivariate analyses (logistic regression) were used to identify clinical and radiological features associated with negative direct sputum examination in HIV-infected patients with positive M. tuberculosis culture on Lowenstein-Jensen medium. Results Between September 2002 and December 2005, 175 co-infected patients were hospitalized with at least one respiratory symptom and pulmonary radiographic anomaly. Acid-fast bacillus (AFB) examination was positive in sputum samples from 110 subjects (63%) and negative in 65 patients (37%). Most patients were at an advanced stage of HIV disease (92% at stage III or IV of the WHO classification) with a median CD4 cell count of 36/mm3. In this context, we found that sputum AFB negativity was more frequent in co-infected subjects with associated respiratory tract infections (OR = 2.8 [95%CI:1.1–7.0]), dyspnea (OR = 2.5 [95%CI:1.1–5.6]), and localized interstitial opacities (OR = 3.1 [95%CI:1.3–7.6]), but was less frequent with CD4≤50/mm3 (OR = 0.4 [95%CI:0.2–0.90), adenopathies (OR = 0.4 [95%CI:0.2–0.93]) and cavitation (OR = 0.1 [95%CI:0.03–0.6]). Conclusions One novel finding of this study is the association between concomitant respiratory tract infection and negative sputum AFB, particularly in Cambodia. This finding suggests that repeating AFB testing in AFB-negative patients should be conducted when broad spectrum antibiotic treatment does not lead to complete recovery from respiratory symptoms. In HIV-infected patients with a CD4 cell count below 50/mm3 without an identified cause of pneumonia, systematic AFB direct sputum examination is justified because of atypical clinical features

  20. Factors associated with negative direct sputum examination in Asian and African HIV-infected patients with tuberculosis (ANRS 1260).

    PubMed

    Chartier, Loïc; Leng, Chanthy; Sire, Jean-Marie; Le Minor, Odile; Saman, Manil; Bercion, Raymond; Rahalison, Lila; Fontanet, Arnaud; Germany, Yves; L'her, Pierre; Mayaud, Charles; Vray, Muriel

    2011-01-01

    To identify factors associated with negative direct sputum examination among African and Cambodian patients co-infected by Mycobacterium tuberculosis and HIV. Prospective multicenter study (ANRS1260) conducted in Cambodia, Senegal and Central African Republic. Univariate and multivariate analyses (logistic regression) were used to identify clinical and radiological features associated with negative direct sputum examination in HIV-infected patients with positive M. tuberculosis culture on Lowenstein-Jensen medium. Between September 2002 and December 2005, 175 co-infected patients were hospitalized with at least one respiratory symptom and pulmonary radiographic anomaly. Acid-fast bacillus (AFB) examination was positive in sputum samples from 110 subjects (63%) and negative in 65 patients (37%). Most patients were at an advanced stage of HIV disease (92% at stage III or IV of the WHO classification) with a median CD4 cell count of 36/mm³. In this context, we found that sputum AFB negativity was more frequent in co-infected subjects with associated respiratory tract infections (OR = 2.8 [95%CI:1.1-7.0]), dyspnea (OR = 2.5 [95%CI:1.1-5.6]), and localized interstitial opacities (OR = 3.1 [95%CI:1.3-7.6]), but was less frequent with CD4 ≤ 50/mm³ (OR = 0.4 [95%CI:0.2-0.90), adenopathies (OR = 0.4 [95%CI:0.2-0.93]) and cavitation (OR = 0.1 [95%CI:0.03-0.6]). One novel finding of this study is the association between concomitant respiratory tract infection and negative sputum AFB, particularly in Cambodia. This finding suggests that repeating AFB testing in AFB-negative patients should be conducted when broad spectrum antibiotic treatment does not lead to complete recovery from respiratory symptoms. In HIV-infected patients with a CD4 cell count below 50/mm3 without an identified cause of pneumonia, systematic AFB direct sputum examination is justified because of atypical clinical features (without cavitation) and high pulmonary mycobacterial

  1. Effect of Pregnancy on Response to Antiretroviral Therapy in HIV-Infected African Women.

    PubMed

    Kourtis, Athena P; Wiener, Jeffrey; King, Caroline C; Heffron, Renee; Mugo, Nelly R; Nanda, Kavita; Pyra, Maria; Donnell, Deborah; Celum, Connie; Lingappa, Jairam R; Baeten, Jared M

    2017-01-01

    While most recent evidence does not support a role for pregnancy in accelerating HIV disease progression, very little information is available on the effects of incident pregnancy in response to antiretroviral therapy (ART). Hormonal, immune, and behavioral changes during pregnancy may influence response to ART. We sought to explore the effects of incident pregnancy (after ART initiation) on virologic, immunologic, and clinical response to ART. Data were collected from HIV-infected women participating in 3 prospective studies (Partners in Prevention Herpes simplex virus/HIV Transmission Study, Couples Observational Study, and Partners Preexposure Prophylaxis Study) from 7 countries in Africa from 2004 to 2012. Women were included in this analysis if they were ≤45 years of age, were started on ART during the study and were not pregnant at ART initiation. Pregnancy was treated as a time-dependent exposure variable covering the duration of pregnancy, including all pregnancies occurring after ART initiation. Virologic failure was defined as a viral load (VL) greater than 400 copies per milliliter ≥6 months after ART initiation and viral suppression was defined as VL ≤400 copies per milliliter. Multivariable Cox proportional hazards models were used to assess the association between pregnancy and time to viral suppression, virologic failure, World Health Organization clinical stage III/IV, and death. Linear mixed-effects models were used to assess the association between pregnancy and CD4 count and VL. All analyses were adjusted for confounders, including pre-ART CD4 count and plasma VL. A total of 1041 women were followed, contributing 1196.1 person-years of follow-up. Median CD4 count before ART initiation was 276 cells per cubic millimeter (interquartile range, 209-375); median pre-ART VL was 17,511 copies per milliliter (interquartile range, 2480-69,286). One hundred ten women became pregnant after ART initiation. Pregnancy was not associated with time to

  2. Effect of Pregnancy on Response to Antiretroviral Therapy in HIV-Infected African Women

    PubMed Central

    Wiener, Jeffrey; King, Caroline C.; Heffron, Renee; Mugo, Nelly R.; Nanda, Kavita; Pyra, Maria; Donnell, Deborah; Celum, Connie; Lingappa, Jairam R.; Baeten, Jared M.

    2017-01-01

    Background: While most recent evidence does not support a role for pregnancy in accelerating HIV disease progression, very little information is available on the effects of incident pregnancy in response to antiretroviral therapy (ART). Hormonal, immune, and behavioral changes during pregnancy may influence response to ART. We sought to explore the effects of incident pregnancy (after ART initiation) on virologic, immunologic, and clinical response to ART. Methods: Data were collected from HIV-infected women participating in 3 prospective studies (Partners in Prevention Herpes simplex virus/HIV Transmission Study, Couples Observational Study, and Partners Preexposure Prophylaxis Study) from 7 countries in Africa from 2004 to 2012. Women were included in this analysis if they were ≤45 years of age, were started on ART during the study and were not pregnant at ART initiation. Pregnancy was treated as a time-dependent exposure variable covering the duration of pregnancy, including all pregnancies occurring after ART initiation. Virologic failure was defined as a viral load (VL) greater than 400 copies per milliliter ≥6 months after ART initiation and viral suppression was defined as VL ≤400 copies per milliliter. Multivariable Cox proportional hazards models were used to assess the association between pregnancy and time to viral suppression, virologic failure, World Health Organization clinical stage III/IV, and death. Linear mixed-effects models were used to assess the association between pregnancy and CD4+ count and VL. All analyses were adjusted for confounders, including pre-ART CD4+ count and plasma VL. Results: A total of 1041 women were followed, contributing 1196.1 person-years of follow-up. Median CD4+ count before ART initiation was 276 cells per cubic millimeter (interquartile range, 209–375); median pre-ART VL was 17,511 copies per milliliter (interquartile range, 2480–69,286). One hundred ten women became pregnant after ART initiation. Pregnancy

  3. Pubertal development in HIV-infected African children on first-line antiretroviral therapy

    PubMed Central

    Szubert, Alexander J.; Musiime, Victor; Bwakura-Dangarembizi, Mutsawashe; Nahirya-Ntege, Patricia; Kekitiinwa, Adeodata; Gibb, Diana M.; Nathoo, Kusum; Prendergast, Andrew J.; Walker, A. Sarah

    2015-01-01

    Objectives: To estimate age at attaining Tanner stages in Ugandan/Zimbabwean HIV-infected children initiating antiretroviral therapy (ART) in older childhood and investigate predictors of delayed puberty, particularly age at ART initiation. Design: Observational analysis within a randomized trial. Methods: Tanner staging was assessed every 24 weeks from 10 years of age, menarche every 12 weeks and height every 4–6 weeks. Age at attaining different Tanner stages was estimated using normal interval regression, considering predictors using multivariable regression. Growth was estimated using multilevel models with child-specific intercepts and trajectories. Results: Median age at ART initiation was 9.4 years (inter-quartile range 7.8, 11.3) (n = 582). At the first assessment, the majority (80.2%) were in Tanner stage 1; median follow-up with staging was 2.8 years. There was a strong delaying effect of older age at ART initiation on age at attaining all Tanner stages (P < 0.05) and menarche (P = 0.02); in boys the delaying effect generally weakened with older age. There were additional significant delays associated with greater impairments in pre-ART height-for-age Z-score (P < 0.05) in both sexes and pre-ART BMI-for-age in girls (P < 0.05). There was no evidence that pre-ART immuno-suppression independently delayed puberty or menarche. However, older children/adolescents had significant growth spurts in intermediate Tanner stages, and were still significantly increasing their height when in Tanner stage 5 (P < 0.01). Conclusion: Delaying ART initiation until older childhood substantially delays pubertal development and menarche, independently of immuno-suppression. This highlights that factors other than CD4+, such as pubertal development, need consideration when making decisions about timing of ART initiation in older children. PMID:25710288

  4. Avascular osteonecrosis of the femoral head in three West African HIV-infected adults with heterozygous sickle cell disease.

    PubMed

    Eholié, Serge P; Ouiminga, Mariama; Ehui, Eboi; Nzunetu, Gustave; Ouattara, Songda I; Konan, Alexis V; Anglaret, Xavier; Bissagnéné, Emmanuel

    2009-01-01

    Three men (aged 33, 44 and 45 years, CD4(+) T-cell nadir 86 cells/mm(3), 99 cells/mm(3) and 12 cells/mm(3), respectively) were admitted to the Department of Infectious Diseases (Treichville Hospital, Abidjan, Côte d'Ivoire) for hip pain and impaired mobility. Their last available CD4(+) T-cell counts were 243 cells/mm(3), 245 cells/mm(3) and 8 cells/mm(3), respectively. They had all received antiretroviral therapy for >4 years, including lopinavir/ritonavir for >8 months. The other risk factors were hypertriglyceridaemia (n=3), smoking addiction (n=2), alcohol consumption (n=2) and lipodystrophy (n=1). All three patients had heterozygous haemoglobin AS sickle cell disease (percentage of haemoglobin S 41%, 45% and 50%, respectively). The diagnosis of avascular osteonecrosis of the femoral head (unilateral n=2 and bilateral n=1) was documented by CT scan. Only one patient underwent surgical arthroplasty. In resource-limited settings, avascular osteonecrosis is uneasy to diagnose and unlikely to be appropriately treated. Physicians should be aware of its symptoms and risk factors, including HIV infection and antiretroviral therapy. Future studies should explore whether these risk factors might include haemoglobin AS sickle cell disease, a common trait in the West African general population.

  5. Stages of HIV Infection

    MedlinePlus

    ... Infection Subscribe Translate Text Size Print Stages of HIV Infection How Does HIV Progress in Your Body? Without treatment, HIV advances ... are the three stages of HIV infection: Acute HIV Infection Stage Within 2-4 weeks after HIV ...

  6. Bordetella pertussis Infection in South African HIV-Infected and HIV-Uninfected Mother–Infant Dyads: A Longitudinal Cohort Study

    PubMed Central

    Nunes, Marta C.; Downs, Sarah; Jones, Stephanie; van Niekerk, Nadia; Cutland, Clare L.; Madhi, Shabir A.

    2016-01-01

    Background. There is a paucity of data regarding the burden of Bordetella pertussis in African women and young infants, and particularly the impact of maternal human immunodeficiency virus (HIV) infection thereon. We performed a retrospective analysis of respiratory illness samples from longitudinal cohorts of HIV-uninfected and HIV-infected women and their infants to evaluate the burden of pertussis illness in a black-African community. Methods. The women were followed up for respiratory illness from midpregnancy and together with their infants until 24 weeks postpartum. Respiratory samples obtained at the time of illness visits were tested for B. pertussis by polymerase chain reaction (PCR). Results. The study included 194 HIV-infected and 1060 HIV-uninfected women, and 188 and 1028 infant offspring, respectively. There were 7 PCR-confirmed pertussis cases in the HIV-exposed infants and 30 in HIV-unexposed infants (7.4 vs 5.5 episodes per 1000 infant-months; P = .47), at a mean age of 70.9 days. All infant pertussis cases had a history of cough (mean duration, 6.3 days). Six of 17 (35.3%) pertussis-confirmed cases in infants <2 months of age were admitted to hospital within 21 days of B. pertussis detection, whereas none of the 20 cases ≥2 months of age required hospitalization. Ten PCR-positive pertussis-associated illnesses were detected in HIV-infected women compared with 32 in the HIV-uninfected women (6.8 vs 3.9 episodes per 1000 person-months; P = .12). Conclusions. Bordetella pertussis identification was common among young infants with respiratory illness, most of whom were too young to be fully protected through direct vaccination. Vaccination of pregnant women might be a valuable strategy in a setting such us ours to prevent B. pertussis–associated illness in women and their young infants. PMID:27838670

  7. Cognitive-Behavioral Intervention to Reduce African American Adolescents' Risk for HIV Infection.

    ERIC Educational Resources Information Center

    St. Lawrence, Janet S.; And Others

    1995-01-01

    Randomly assigned 246 African American adolescents either to an educational program or to an 8-week intervention that combined education with behavior skills training. Results indicate that, compared with the education program, youth in behavioral skills training lowered their infection risk to a greater degree, maintained risk reduction changes…

  8. Prevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan African countries: a systematic review.

    PubMed

    Spiegel, Paul B; Bennedsen, Anne Rygaard; Claass, Johanna; Bruns, Laurie; Patterson, Njogu; Yiweza, Dieudonne; Schilperoord, Marian

    2007-06-30

    Violence and rape are believed to fuel the HIV epidemic in countries affected by conflict. We compared HIV prevalence in populations directly affected by conflict with that in those not directly affected and in refugees versus the nearest surrounding host communities in sub-Saharan African countries. Seven countries affected by conflict (Democratic Republic of Congo, southern Sudan, Rwanda, Uganda, Sierra Leone, Somalia, and Burundi) were chosen since HIV prevalence surveys within the past 5 years had been done and data, including original antenatal-care sentinel surveillance data, were available. We did a systematic and comprehensive literature search using Medline and Embase. Only articles and reports that contained original data for prevalence of HIV infection were included. All survey reports were independently evaluated by two epidemiologists to assess internationally accepted guidelines for HIV sentinel surveillance and population-based surveys. Whenever possible, data from the nearest antenatal care and host country sentinel site of the neighbouring countries were presented. 95% CIs were provided when available. Of the 295 articles that met our search criteria, 88 had original prevalence data and 65 had data from the seven selected countries. Data from these countries did not show an increase in prevalence of HIV infection during periods of conflict, irrespective of prevalence when conflict began. Prevalence in urban areas affected by conflict decreased in Burundi, Rwanda, and Uganda at similar rates to urban areas unaffected by conflict in their respective countries. Prevalence in conflict-affected rural areas remained low and fairly stable in these countries. Of the 12 sets of refugee camps, nine had a lower prevalence of HIV infection, two a similar prevalence, and one a higher prevalence than their respective host communities. Despite wide-scale rape in many countries, there are no data to show that rape increased prevalence of HIV infection at the

  9. 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.

  10. The quality of life of HIV-infected South African university students: Experiences with the WHOQOL-HIV-Bref.

    PubMed

    Cronje, Johan Herman; Williams, Margaret; Steenkamp, Liana; Venter, Danie; Elkonin, Diane

    2017-05-01

    HIV and AIDS has serious repercussions on psychological, social and physical well-being, and the assessment of Quality of Life (QoL) of people living with HIV and AIDS is essential to gauge how these challenges are met. The WHOQoL-HIV Bref forms part of a suite of instruments developed by the World Health Organisation. The purpose of this paper is to describe the quality of life of a sample of HIV-infected students at a South African university, as well as explain the internal consistency between questions within each of the QoL domains. A descriptive, cross-sectional study design using a quantitative approach was applied. A non-probability, purposive sampling approach was utilized and students enrolled in the antiretroviral therapy or wellness programme were invited to voluntarily participate in this study. The WHOQOL-HIV Bref was self-administered after explanation of the questions by a registered, trained health care professional. A total of 63 students returned completed questionnaires that were included in the analysis. Acceptable to good reliability scores were established for the following domains: Level of Independence; Social Relations; Environment and Spiritual or Personal Beliefs. Assessing QoL in the sample, the lowest score was for "Spirituality" and the highest "Social Relations". The "Physical" and "Psychological" domain scores for females were significantly lower than the score for males. There was no significant difference between any of the domain scores among participants with CD4 cell counts above or below 350 cells/mm(3). In general the performance of this sample is encouraging and it is recommended that the measure be utilized for QoL screening, and further research. The WHOQOL-HIV Bref for students does not contain an academic wellness component which should be added considering the significant effects of HIV on neuropsychological functioning. Also further investigation into the reasons for poor scores obtained in physical and psychological

  11. Correlates of HIV Infection Among African American Women from 20 Cities in the United States

    PubMed Central

    Miles, Isa; Le, Binh; Paz-Bailey, Gabriela

    2016-01-01

    Little research has been conducted to investigate multiple levels of HIV risk—individual risk factors, sex partner characteristics, and socioeconomic factors—among African American women, who, in 2010, comprised 64 % of the estimated 9,500 new infections in women. Respondent-driven sampling was used to recruit and interview women in 20 cities with high AIDS prevalence in the United States through the National HIV Behavioral Surveillance System. We assessed individual risk factors, sex partner characteristics, and socioeconomic characteristics associated with being HIV-positive but unaware of the infection among African American women. Among 3,868 women with no previous diagnosis of HIV, 68 % had high school education or more and 84 % lived at or below the poverty line. In multivariable analysis, women who were 35 years or older, homeless, received Medicaid, whose last sex partner ever used crack cocaine or was an exchange sex partner were more likely to be HIV-positive-unaware. Developing and implementing strategies that address socioeconomic factors, such as homelessness and living in poverty, as well as individual risk factors, can help to maximize the effectiveness of the public health response to the HIV epidemic. PMID:24077972

  12. Plasma Efavirenz Exposure, Sex, and Age Predict Virological Response in HIV-Infected African Children

    PubMed Central

    Bienczak, Andrzej; Denti, Paolo; Cook, Adrian; Wiesner, Lubbe; Mulenga, Veronica; Kityo, Cissy; Kekitiinwa, Addy; Gibb, Diana M.; Burger, David; Walker, A. Sarah

    2016-01-01

    Background: Owing to insufficient evidence in children, target plasma concentrations of efavirenz are based on studies in adults. Our analysis aimed to evaluate the pediatric therapeutic thresholds and characterize the determinants of virological suppression in African children. Methods: We analyzed data from 128 African children (aged 1.7–13.5 years) treated with efavirenz, lamivudine, and one among abacavir, stavudine, or zidovudine, and followed up to 36 months. Individual pharmacokinetic (PK) measures [plasma concentration 12 hours after dose (C12h), plasma concentration 24 hours after dose (C24h), and area under the curve (AUC0-24)] were estimated using population PK modeling. Cox multiple failure regression and multivariable fractional polynomials were used to investigate the risks of unsuppressed viral load associated with efavirenz exposure and other factors among 106 initially treatment-naive children, and likelihood profiling was used to identify the most predictive PK thresholds. Results: The risk of viral load >100 copies per milliliter decreased by 42% for every 2-fold increase in efavirenz mid-dose concentration [95% confidence interval (CI): 23% to 57%; P < 0.001]. The most predictive PK thresholds for increased risk of unsuppressed viral load were C12h 1.12 mg/L [hazard ratio (HR): 6.14; 95% CI: 2.64 to 14.27], C24h 0.65 mg/L (HR: 6.57; 95% CI: 2.86 to 15.10), and AUC0-24 28 mg·h/L (HR: 5.77; 95% CI: 2.28 to 14.58). Children older than 8 years had a more than 10-fold increased risk of virological nonsuppression (P = 0.005); among children younger than 8 years, boys had a 5.31 times higher risk than girls (P = 0.007). Central nervous system adverse events were infrequently reported. Conclusions: Our analysis suggests that the minimum target C24h and AUC0-24 could be lowered in children. Our findings should be confirmed in a prospective pediatric trial. PMID:27116047

  13. Plasma Efavirenz Exposure, Sex, and Age Predict Virological Response in HIV-Infected African Children.

    PubMed

    Bienczak, Andrzej; Denti, Paolo; Cook, Adrian; Wiesner, Lubbe; Mulenga, Veronica; Kityo, Cissy; Kekitiinwa, Addy; Gibb, Diana M; Burger, David; Walker, A Sarah; McIlleron, Helen

    2016-10-01

    Owing to insufficient evidence in children, target plasma concentrations of efavirenz are based on studies in adults. Our analysis aimed to evaluate the pediatric therapeutic thresholds and characterize the determinants of virological suppression in African children. We analyzed data from 128 African children (aged 1.7-13.5 years) treated with efavirenz, lamivudine, and one among abacavir, stavudine, or zidovudine, and followed up to 36 months. Individual pharmacokinetic (PK) measures [plasma concentration 12 hours after dose (C12h), plasma concentration 24 hours after dose (C24h), and area under the curve (AUC0-24)] were estimated using population PK modeling. Cox multiple failure regression and multivariable fractional polynomials were used to investigate the risks of unsuppressed viral load associated with efavirenz exposure and other factors among 106 initially treatment-naive children, and likelihood profiling was used to identify the most predictive PK thresholds. The risk of viral load >100 copies per milliliter decreased by 42% for every 2-fold increase in efavirenz mid-dose concentration [95% confidence interval (CI): 23% to 57%; P < 0.001]. The most predictive PK thresholds for increased risk of unsuppressed viral load were C12h 1.12 mg/L [hazard ratio (HR): 6.14; 95% CI: 2.64 to 14.27], C24h 0.65 mg/L (HR: 6.57; 95% CI: 2.86 to 15.10), and AUC0-24 28 mg·h/L (HR: 5.77; 95% CI: 2.28 to 14.58). Children older than 8 years had a more than 10-fold increased risk of virological nonsuppression (P = 0.005); among children younger than 8 years, boys had a 5.31 times higher risk than girls (P = 0.007). Central nervous system adverse events were infrequently reported. Our analysis suggests that the minimum target C24h and AUC0-24 could be lowered in children. Our findings should be confirmed in a prospective pediatric trial.

  14. 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

  15. Genome-wide association study of nevirapine hypersensitivity in a sub-Saharan African HIV-infected population.

    PubMed

    Carr, Daniel F; Bourgeois, Stephane; Chaponda, Mas; Takeshita, Louise Y; Morris, Andrew P; Castro, Elena M Cornejo; Alfirevic, Ana; Jones, Andrew R; Rigden, Daniel J; Haldenby, Sam; Khoo, Saye; Lalloo, David G; Heyderman, Robert S; Dandara, Collet; Kampira, Elizabeth; van Oosterhout, Joep J; Ssali, Francis; Munderi, Paula; Novelli, Giuseppe; Borgiani, Paola; Nelson, Matthew R; Holden, Arthur; Deloukas, Panos; Pirmohamed, Munir

    2017-04-01

    The antiretroviral nevirapine is associated with hypersensitivity reactions in 6%-10% of patients, including hepatotoxicity, maculopapular exanthema, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). To undertake a genome-wide association study (GWAS) to identify genetic predisposing factors for the different clinical phenotypes associated with nevirapine hypersensitivity. A GWAS was undertaken in a discovery cohort of 151 nevirapine-hypersensitive and 182 tolerant, HIV-infected Malawian adults. Replication of signals was determined in a cohort of 116 cases and 68 controls obtained from Malawi, Uganda and Mozambique. Interaction with ERAP genes was determined in patients positive for HLA-C*04:01 . In silico docking studies were also performed for HLA-C*04:01 . Fifteen SNPs demonstrated nominal significance ( P  <   1 × 10 -5 ) with one or more of the hypersensitivity phenotypes. The most promising signal was seen in SJS/TEN, where rs5010528 ( HLA-C locus) approached genome-wide significance ( P  <   8.5 × 10 -8 ) and was below HLA -wide significance ( P  <   2.5 × 10 -4 ) in the meta-analysis of discovery and replication cohorts [OR 4.84 (95% CI 2.71-8.61)]. rs5010528 is a strong proxy for HLA-C*04:01 carriage: in silico docking showed that two residues (33 and 123) in the B pocket were the most likely nevirapine interactors. There was no interaction between HLA-C*04:01 and ERAP1 , but there is a potential protective effect with ERAP2 [ P  =   0.019, OR 0.43 (95% CI 0.21-0.87)]. HLA-C*04:01 predisposes to nevirapine-induced SJS/TEN in sub-Saharan Africans, but not to other hypersensitivity phenotypes. This is likely to be mediated via binding to the B pocket of the HLA-C peptide. Whether this risk is modulated by ERAP2 variants requires further study.

  16. Cryotherapy reduces progression of cervical intraepithelial neoplasia grade 1 in South African HIV-infected women: a randomized, controlled trial.

    PubMed

    Firnhaber, Cynthia; Swarts, Avril; Goeieman, Bridgette; Rakhombe, Ntombi; Mulongo, Masangu; Williamson, Anna-Lise; Michelow, Pam; Ramotshela, Sibongile; Faesen, Mark; Levin, Simon; Wilkin, Timothy

    2017-09-07

    HIV-infected women are at increased risk of cervical cancer, especially in resource-limited countries. Cervical cancer prevention strategies focus treating cervical high-grade squamous intraepithelial lesions (HSIL). The management of low-grade squamous intraepithelial lesions (LSIL) in HIV-infected women is unknown. HIV treatment clinic in Johannesburg, South Africa METHODS:: We randomized HIV-infected women with histologic cervical LSIL to cervical cryotherapy vs. no treatment (standard of care). Cervical high-risk human papillomavirus testing (hrHPV) was performed at baseline. All women underwent cervical cytology and colposcopic biopsies 12 months after enrollment. The primary endpoint was HSIL on histology at Month 12. Chi-square was used to compare arms. 220 HIV-infected women were randomized to cryotherapy (n=112) or no treatment (n=108). Median age was 38 years, 94% were receiving antiretroviral therapy, median CD4 499 cells/mm3, 59% were hrHPV positive. Cryotherapy reduced progression to HSIL: 2/99 (2%) in the cryotherapy arm and 15/103 (15%) in the no treatment arm developed HSIL, 86% reduction (95%, CI, 41%-97%, p=.002). Among 17 HSIL endpoints, 16 were hrHPV+ at baseline. When restricting the analysis to hrHPV+ women, HSIL occurred in 2/61 (3%) in the cryotherapy arm vs. 14/54 (26%) in the no treatment arm, 87% reduction (95% CI, 47%-97%, P=.0004). Participants in the cryotherapy arm experienced greater regression to normal histology and improved cytologic outcomes. Treatment of cervical LSIL with cryotherapy, decreased progression to HSIL among HIV-infected women especially if hrHPV positive. These results support treatment of LSIL in HPV test-and-treat approaches for cervical cancer prevention in resource-constrained settings.

  17. 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

  18. Asymptomatic HIV infection

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/000682.htm Asymptomatic HIV infection To use the sharing features on this page, please enable JavaScript. Asymptomatic HIV infection is a phase of HIV/AIDS during which ...

  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. Improved appetite after multi-micronutrient supplementation for six months in HIV-infected South African children.

    PubMed

    Mda, Siyazi; van Raaij, Joop M A; Macintyre, Una E; de Villiers, François P R; Kok, Frans J

    2010-02-01

    The aim of the study was to assess the effect of multi-micronutrient supplementation on the appetite of HIV-infected children. HIV-infected children (6-24 months) who had previously been hospitalized were enrolled into a double-blind randomized trial, and given daily multi-micronutrient supplements or placebos for six months. Appetite tests were performed at enrollment and after three and six months. Appetite was measured as ad libitum intake of a commercial cereal test food served after an overnight fast according to standardized procedures. Body weights and total amount of test food eaten were measured. In total, 99 children completed the study (50 on supplements and 49 on placebos). Amounts eaten per kilogram body weight in the supplement group at enrollment and after six months were 36.7+/-17.7 g/kg (mean+/-SD) and 41.3+/-15.0 g/kg respectively, while the amounts in the placebo group were 47.1+/-14.9 g/kg and 45.7+/-13.1g/kg respectively. The change in amount eaten per kilogram body weight over six months was significantly higher in the supplement group (4.7+/-14.7 g/kg) than in the placebo group (-1.4+/-15.1g/kg). Multi-micronutrient supplementation for six months seems to significantly improve the appetite of HIV-infected children.

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

    PubMed

    Shiau, Stephanie; Kuhn, Louise; Strehlau, Renate; Martens, Leigh; McIlleron, Helen; Meredith, Sandra; Wiesner, Lubbe; Coovadia, Ashraf; Abrams, Elaine J; Arpadi, Stephen M

    2014-02-12

    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. 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. 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. Sex differences are noted in treated HIV-infected children even at a young age, and

  3. Early Diagnosis of HIV Infection in Infants - One Caribbean and Six Sub-Saharan African Countries, 2011-2015.

    PubMed

    Diallo, Karidia; Kim, Andrea A; Lecher, Shirley; Ellenberger, Dennis; Beard, R Suzanne; Dale, Helen; Hurlston, Mackenzie; Rivadeneira, Molly; Fonjungo, Peter N; Broyles, Laura N; Zhang, Guoqing; Sleeman, Katrina; Nguyen, Shon; Jadczak, Steve; Abiola, Nadine; Ewetola, Raimi; Muwonga, Jérémie; Fwamba, Franck; Mwangi, Christina; Naluguza, Mary; Kiyaga, Charles; Ssewanyana, Isaac; Varough, Deyde; Wysler, Domercant; Lowrance, David; Louis, Frantz Jean; Desinor, Olbeg; Buteau, Josiane; Kesner, Francois; Rouzier, Vanessa; Segaren, Nat; Lewis, Tessa; Sarr, Abdoulaye; Chipungu, Geoffrey; Gupta, Sundeep; Singer, Daniel; Mwenda, Reuben; Kapoteza, Hilary; Chipeta, Zawadi; Knight, Nancy; Carmona, Sergio; MacLeod, William; Sherman, Gayle; Pillay, Yogan; Ndongmo, Clement B; Mugisa, Bridget; Mwila, Annie; McAuley, James; Chipimo, Peter J; Kaonga, Wezi; Nsofwa, Dailess; Nsama, Davy; Mwamba, Fales Zulu; Moyo, Crispin; Phiri, Clement; Borget, Marie-Yolande; Ya-Kouadio, Leonard; Kouame, Abo; Adje-Toure, Christiane A; Nkengasong, John

    2016-11-25

    Pediatric human immunodeficiency virus (HIV) infection remains an important public health issue in resource-limited settings. In 2015, 1.4 million children aged <15 years were estimated to be living with HIV (including 170,000 infants born in 2015), with the vast majority living in sub-Saharan Africa (1). In 2014, 150,000 children died from HIV-related causes worldwide (2). Access to timely HIV diagnosis and treatment for HIV-infected infants reduces HIV-associated mortality, which is approximately 50% by age 2 years without treatment (3). Since 2011, the annual number of HIV-infected children has declined by 50%. Despite this gain, in 2014, only 42% of HIV-exposed infants received a diagnostic test for HIV (2), and in 2015, only 51% of children living with HIV received antiretroviral therapy (1). Access to services for early infant diagnosis of HIV (which includes access to testing for HIV-exposed infants and clinical diagnosis of HIV-infected infants) is critical for reducing HIV-associated mortality in children aged <15 years. Using data collected from seven countries supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), progress in the provision of HIV testing services for early infant diagnosis was assessed. During 2011-2015, the total number of HIV diagnostic tests performed among HIV-exposed infants within 6 weeks after birth (tests for early infant diagnosis of HIV), as recommended by the World Health Organization (WHO) increased in all seven countries (Cote d'Ivoire, the Democratic Republic of the Congo, Haiti, Malawi, South Africa, Uganda, and Zambia); however, in 2015, the rate of testing for early infant diagnosis among HIV-exposed infants was <50% in five countries. HIV positivity among those tested declined in all seven countries, with three countries (Cote d'Ivoire, the Democratic Republic of the Congo, and Uganda) reporting >50% decline. The most common challenges for access to testing for early infant diagnosis included

  4. Understanding HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy: an information--motivation--behavioral skills model analysis.

    PubMed

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

    2013-08-01

    The current study applied the Information-Motivation-Behavioral Skills (IMB) model (Fisher & Fisher, 1992; Fisher & Fisher, 1993) to identify factors associated with human immunodeficiency virus (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. Findings 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, whereas for women, the effect of HIV prevention motivation works 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. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  5. Dual method use for protection of pregnancy and disease prevention among HIV-infected women in South East Nigeria.

    PubMed

    Lawani, Lucky O; Onyebuchi, Azubuike K; Iyoke, Chukwuemeka A

    2014-03-07

    sub-Saharan Africa continue to bear the greatest burden of HIV/AIDS epidemic due to its large population, high fertility rate and unmet contraceptive need, most especially with poor uptake of dual methods (use of condom and another effective family planning method) which protects against STIs/HIV and unplanned pregnancy. The aim of this study was to assess the awareness, pattern and practice of dual methods by HIV infected women, and factors influencing its use in southeast Nigeria. This was a cross sectional descriptive study of 658 HIV positive women attending the PMTCT/postnatal/family planning clinics in three health facilities in southeast Nigeria. An interviewer administered semi-structured questionnaire was used to abstract needed information. The data were analyzed with Epi-info™ version 7.0 (Centers for Disease Control and Prevention, Atlanta, GA, USA), Odd ratio was determined and the test of statistical significance was with Fisher exact test at 95% CI. The mean age of the participants was 29 ± 4.3 years. All the respondents were aware of their HIV status, 62.4% did not know their partners status; 23.1% were sero-concordant, while 14.5% were sero-discordant. Most (67.9%) of the respondents lack awareness on dual methods with only 179/658 (27.2%) practicing it. The commonest (141/179; 78.9%) dual method used was a combination of condom and injectable hormonal contraceptives. Lack of awareness (222/479; 46.3%) and non disclosure (133/479; 27.8%) were the main reasons for non use of dual method in the present study. STI's was higher amongst non users with odd ratio of 1.74 (1.26-2.41), p-value < 0.0004. Unplanned pregnancy was higher in non users with odd ratio of 3.89 (2.52-6.00), p-value < 0.0000 at 95% CI. The awareness and uptake of dual methods amongst HIV infected women in southeast Nigeria is still low and thus associated with a higher risk of STIs and unplanned pregnancy. It is expected that increased awareness, uptake and consistent

  6. Effect of antiretroviral therapy on the memory and activation profiles of B cells in HIV-infected African women

    PubMed Central

    Tanko, Ramla F.; Soares, Andreia P.; Müller, Tracey L.; Garrett, Nigel J.; Samsunder, Natasha; Abdool Karim, Quarraisha; Abdool Karim, Salim S.

    2016-01-01

    HIV infection induces a wide range of effects in B cells, including skewed memory cell differentiation, compromised B cell function and hypergammaglobulinaemia. However, data on the extent to which these B cell abnormalities can be reversed by antiretroviral therapy (ART) are limited. To investigate the effect of ART on B cells, the activation (CD86) and differentiation (IgD, CD27 and CD38) profiles of B cells were measured longitudinally in 19 HIV-infected individuals before (median, 2 months) and after ART initiation (median, 12 months) and compared to 19 age-matched HIV-uninfected individuals, using flow cytometry. Twelve months of ART restored the typical distribution of B cell subsets, increasing the proportion of naive B cells (CD27-IgD+CD38-) and concomitantly decreasing the immature transitional (CD27-IgD+CD38+), unswitched memory (CD27+IgD+CD38-), switched memory (CD27+IgD-CD38- or CD27-IgD-CD38-) and plasmablast (CD27+IgD-CD38high) subsets. However, B cell activation was only partially normalized post-ART, with the frequency of activated B cells (CD86+CD40+) reduced compared to pre-ART levels (p=0.0001), but remaining significantly higher compared to HIV-uninfected individuals (p=0.0001). Interestingly, unlike for T cell activation profiles, the extent of B cell activation prior to ART did not correlate with HIV plasma viral load, but positively associated with plasma sCD14 levels (p=0.01, r=0.58). Overall, ART partially normalizes the skewed B cell profiles induced by HIV, with some activation persisting. Understanding the effect of HIV on B cell dysfunction and restoration following ART may provide important insights into mechanisms of HIV pathogenesis. PMID:28039305

  7. Forced Sexual Experiences as Risk Factor for Self-Reported HIV Infection among Southern African Lesbian and Bisexual Women

    PubMed Central

    Sandfort, Theo G. M.; Baumann, Linda R. M.; Matebeni, Zethu; Reddy, Vasu; Southey-Swartz, Ian

    2013-01-01

    Even though women who have sex with women are usually understood to be at no or very low risk for HIV infection, we explored whether lesbian and bisexual women in a geographical area with high HIV prevalence (Southern Africa) get tested for HIV and whether, among those women who get tested, there are women who live with HIV/AIDS. The study was conducted in collaboration with community-based organizations in Botswana, Namibia, South Africa and Zimbabwe. Data were collected via written surveys of women who in the preceding year had had sex with a woman (18 years and older; N = 591). Most participating women identified as lesbian and black. Almost half of the women (47.2%) reported ever having had consensual heterosexual sex. Engagement in transactional sex (lifetime) was reported by 18.6% of all women. Forced sex by men or women was reported by 31.1% of all women. A large proportion of the women reported to ever have been tested for HIV (78.3%); number of lifetime female and male partners was independently associated with having been tested; women who had engaged in transactional sex with women only or with women and men were less likely to have been tested. Self-reported HIV prevalence among tested women who knew their serostatus was 9.6%. Besides age, the sole independent predictor of a positive serostatus was having experienced forced sex by men, by women, or by both men and women. Study findings indicate that despite the image of invulnerability, HIV/AIDS is a reality for lesbian and bisexual women in Southern Africa. Surprisingly, it is not sex with men per se, but rather forced sex that is the important risk factor for self-reported HIV infection among the participating women. HIV/AIDS policy should also address the needs of lesbian, bisexual and other women who have sex with women. PMID:23326452

  8. Incidence and risk factors of HCV and HIV infections in a cohort of intravenous drug users in the North and East of France.

    PubMed

    Lucidarme, D; Bruandet, A; Ilef, D; Harbonnier, J; Jacob, C; Decoster, A; Delamare, C; Cyran, C; Van Hoenacker, A F; Frémaux, D; Josse, P; Emmanuelli, J; Le Strat, Y; Desenclos, J C; Filoche, B

    2004-08-01

    In order to evaluate the incidence and risk factors of infection by hepatitis C virus (HCV) among injecting drug users (IDUs), we conducted a prospective cohort study of HCV- and human immunodeficiency virus (HIV)-negative IDUs in the North and East of France. A total of 231 HCV and HIV IDUs who had injected drugs at least once in their lifetime were followed up every 3 months over a 12-month period. Serum anti-HCV and anti-HIV were tested at inclusion in the study and at the end of the follow-up. Data on injecting practices were collected at inclusion and at each visit. Of the 231 participants included, 165 (71.4%) underwent a final HCV and HIV serum test. The incidence was nil for HIV infection and 9/100 person-years (95% CI 4.6-13.4) for HCV infection. In a multivariable analysis, we found that syringe and cotton sharing were the only independent predictive factors of HCV seroconversion.

  9. 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.

  10. Persons living with HIV infection on antiretroviral therapy also consulting traditional healers: a study in three African countries.

    PubMed

    Wanyama, Jane N; Tsui, Sharon; Kwok, Cynthia; Wanyenze, Rhoda K; Denison, Julie A; Koole, Olivier; van Praag, Eric; Castelnuovo, Barbara; Wabwire-Mangen, Fred; Kwesigabo, Gideon P; Colebunders, Robert

    2017-01-01

    Traditional healers provide healthcare to a substantial proportion of people living with HIV infection (PLHIV) in high HIV burden countries in sub-Saharan Africa. However, the impact on the health of retained patients visiting traditional healers is unknown. In 2011, a study to asses adherence to anti-retroviral therapy (ART) performed in 18 purposefully selected HIV treatment centers in Tanzania, Zambia and Uganda showed that 'consulting a traditional healer/herbalist because of HIV' was an independent risk factor for incomplete ART adherence. To identify characteristics of PLHIV on ART who were also consulting traditional healers, we conducted a secondary analysis of the data from this study. It was found that 260 (5.8%) of the 4451 patients enrolled in the study had consulted a traditional healer during the last three months because of HIV. In multivariable analysis, patients with fewer HIV symptoms, those who had been on ART for >5.3 years and those from Tanzania were more likely to have consulted a traditional healer. However, at the time of the study, there was a famous healer in Manyara district, Loliondo village of Tanzania who claimed his herbal remedy was able to cure all chronic diseases including HIV. HIV treatment programs should be aware that patients with fewer HIV symptoms, those who have been on ART for five or more years, and patients attending ART centers near famous traditional healers are likely to consult traditional healers. Such patients may need more support or counseling about the risks of both stopping ART and poor adherence. Considering the realities of inadequate human resources for health and the burden of disease caused by HIV in sub-Saharan Africa, facilitating a collaboration between allopathic and traditional health practitioners is recommended.

  11. Effect of Antiretroviral Therapy on the Memory and Activation Profiles of B Cells in HIV-Infected African Women.

    PubMed

    Tanko, Ramla F; Soares, Andreia P; Müller, Tracey L; Garrett, Nigel J; Samsunder, Natasha; Abdool Karim, Quarraisha; Abdool Karim, Salim S; Riou, Catherine; Burgers, Wendy A

    2017-02-01

    Human immunodeficiency virus infection induces a wide range of effects in B cells, including skewed memory cell differentiation, compromised B cell function, and hypergammaglobulinemia. However, data on the extent to which these B cell abnormalities can be reversed by antiretroviral therapy (ART) are limited. To investigate the effect of ART on B cells, the activation (CD86) and differentiation (IgD, CD27, and CD38) profiles of B cells were measured longitudinally in 19 HIV-infected individuals before (median, 2 mo) and after ART initiation (median, 12 mo) and compared with 19 age-matched HIV-uninfected individuals using flow cytometry. Twelve months of ART restored the typical distribution of B cell subsets, increasing the proportion of naive B cells (CD27(-)IgD(+)CD38(-)) and concomitantly decreasing the immature transitional (CD27(-)IgD(+)CD38(+)), unswitched memory (CD27(+)IgD(+)CD38(-)), switched memory (CD27(+)IgD(-)CD38(-) or CD27(-)IgD(-)CD38(-)), and plasmablast (CD27(+)IgD(-)CD38(high)) subsets. However, B cell activation was only partially normalized post-ART, with the frequency of activated B cells (CD86(+)CD40(+)) reduced compared with pre-ART levels (p = 0.0001), but remaining significantly higher compared with HIV-uninfected individuals (p = 0.0001). Interestingly, unlike for T cell activation profiles, the extent of B cell activation prior to ART did not correlate with HIV plasma viral load, but positively associated with plasma sCD14 levels (p = 0.01, r = 0.58). Overall, ART partially normalizes the skewed B cell profiles induced by HIV, with some activation persisting. Understanding the effects of HIV on B cell dysfunction and restoration following ART may provide important insights into the mechanisms of HIV pathogenesis.

  12. Psychogenic "HIV infection".

    PubMed

    Sno, H N; Storosum, J G; Wortel, C H

    1991-01-01

    The case of a man who falsely represented himself as being HIV positive is reported. In less than one year he was admitted twice with symptoms suggestive of HIV infection. The diagnoses malingering and factitious disorder were consecutively made. Early recognition of Factitious Disorder is essential to prevent patients from harmful diagnostic procedures or surgical treatments. Psychiatric treatment is best focused on management and care rather than cure. Psychogenic "HIV infection" might become more common than acknowledged up to now. Physicians should consider the occurrence of psychogenic "HIV infection," part of the symptomatology may be psychogenically determined, or indeed frankly simulated.

  13. 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.

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

    PubMed

    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

    2016-02-01

    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. 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. 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-experienced children maintained suppression (p=1·00). All

  15. 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

  16. 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

  17. Travelers' Health: HIV Infection

    MedlinePlus

    ... Share Compartir Chapter 3 - Histoplasmosis Chapter 3 - Influenza HIV Infection Philip J. Peters, John T. Brooks INFECTIOUS ... at 888-448-4911 ( www.nccc.ucsf.edu ). HIV TESTING REQUIREMENTS FOR US TRAVELERS ENTERING FOREIGN COUNTRIES ...

  18. Thinking about HIV infection.

    PubMed

    Simpkins, Evelyn P; Siberry, George K; Hutton, Nancy

    2009-09-01

    Mother-to-child transmission of HIV can occur during pregnancy, labor, delivery, and breastfeeding. Evidence-based interventions (routine screening of pregnant women, initiation of antiretroviral drugs for mother's treatment or prevention of MTCT, and avoiding breastfeeding) have reduced transmission rates in the United States from 25% to 30% to less than 2%. Triple-drug combination antiretroviral therapy effectively controls HIV infection and improves survival and quality of life for HIV-infected children and adolescents. Initial regimens use combinations of two NRTIs together with an NNRTI or a ritonavir-boosted PI. These regimens have been shown to increase CD4 counts and achieve virologic suppression. Prevention of serious and opportunistic infections reduces morbidity and mortality in children and adolescents who have HIV infection. Recommendations for immunizations and chemoprophylaxis vary with the patient's CD4 count. Condoms made from latex, polyurethane, or other synthetic materials have been shown to decrease the transmission of STIs, including HIV infection.

  19. 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.

  20. Knowledge, attitudes and practices of South African healthcare workers regarding the prevention and treatment of influenza among HIV-infected individuals

    PubMed Central

    Gaga, Sisanda; Clark, David; Muller, Madeleine; Kuwane, Bulenani; Cohen, Cheryl; Walaza, Sibongile; Tempia, Stefano; Ramatoboe, Puleng; Furumele, Tsakani; Widdowson, Marc-Alain; McMorrow, Meredith L.; Cohen, Adam L.

    2017-01-01

    Background The South African Department of Health (DOH) publishes annual guidelines identifying priority groups, including immunosuppressed individuals and healthcare workers (HCW), for influenza vaccination and treatment. How these guidelines have impacted HCW and their patients, particularly those infected with HIV, remains unknown. Methods We aimed to describe the knowledge, attitudes and practices regarding influenza and the vaccine among South African HCW. Surveys were distributed by two local non-governmental organizations in public health clinics and hospitals in 21 districts/municipalities (5 of 9 provinces). Results There were 1164 respondents; median age 41 years; 978/1126 (87%) female; 801/1122 (71%) nurses. One-third (34%) of HCW reported getting influenza vaccine 2013/2014 and most (94%) recommended influenza vaccine to patients infected with HIV. Ability to get vaccine free of charge (aOR 1.69; 95% CI 1.21–2.37) and having received influenza government training (aOR 1.50; 95% CI 1.04–2.15) were significantly associated with self-reported vaccination in 2013/2014. Self-reported 2013/2014 vaccination (aOR 3.76; 95% CI 1.28–11.03) and availability of influenza vaccine during the healthcare visit (aOR 2.56; 95% CI 1.18–5.57) were significantly associated with recommending influenza vaccine to patients infected with HIV/AIDS. Conclusion Only one-third of participants were vaccinated in 2013–2014 but those who were vaccinated were more likely to recommend vaccination to their patients. Free and close access to influenza vaccine were associated with a higher likelihood of getting vaccinated in 2013/2014. HCW who reported getting the influenza vaccine themselves, had vaccine to offer during the patient consult and were familiar with DOH guidelines/trainings were more likely to recommend vaccine to HIV-infected patients. PMID:28301593

  1. Prevalence, incidence and predictors of peripheral neuropathy in African adults with HIV infection within the DART trial.

    PubMed

    Kiwuwa-Muyingo, Sylvia; Kikaire, Bernard; Mambule, Ivan; Musana, Helen; Musoro, Godfrey; Gilks, Charles F; Levin, Jonathan B; Walker, Anne Sarah

    2014-11-13

    We investigated the prevalence, incidence and predictors of new peripheral neuropathy episodes in previously untreated, symptomatic HIV-infected Ugandan/Zimbabwean adults initiating zidovudine-based antiretroviral therapy (ART). An open-label, multicentre, randomized trial. Peripheral neuropathy was self-reported at 12-weekly clinic visits. Cox regression models (excluding participants reporting preexisting peripheral neuropathy at ART initiation), considered sex; pre-ART WHO stage, age and CD4(+) cell count; CD4(+) cell count versus no CD4(+) cell count monitoring; and time-updated CD4(+) cell count, weight and use of stavudine, isoniazid and didanosine. Four hundred and twenty-one out of 3316(13%) patients reported preexisting peripheral neuropathy at ART initiation. Median (interquartile range, IQR) follow-up in 2895 participants without preexisting peripheral neuropathy was 4.9 (4.7-5.4) years. Three hundred and fifty-four (12%) took stavudine as first-line substitution and 518 (18%) took isoniazid during follow-up. Two hundred and ninety (11%) participants developed a new peripheral neuropathy episode, an incidence of 2.12 per 100 person-years. Eighteen (0.1%) had a grade 3/4 episode. Independent predictors of peripheral neuropathy were current stavudine use [adjusted hazard ratio (a)HR 4.16 (95% confidence interval, 95% CI 3.06-5.66], current isoniazid use [aHR 1.59 (95% CI 1.02-2.47)] and current didanosine use [aHR 1.60 (95% CI 1.19-2.14)]. Higher risks were independently associated with higher pre-ART weight [aHR (per+5 kg) 1.07 (95% CI 1.01-1.13)] and older age aHR (per 10 years older) 1.29 (95% CI 1.12-1.49), but there was no significant effect of sex (P = 0.13), pre-ART CD4(+) cell count (P = 0.91) or CD4(+) cell count monitoring (P = 0.73). Current stavudine, didanosine or isoniazid use continue to increase peripheral neuropathy risks, as does older age and weight at ART initiation; however, we found no evidence of increased risk in women

  2. Pediatric HIV Infection.

    PubMed

    Espanol, Teresa; Caragol, Isabel; Soler, Pere; Hernandez, Manuel

    2004-12-01

    HIV infection by maternal transmission is increasing in the world due to the increase in infected women who are not receiving appropriate antiretroviral therapy. Prognosis of HIV infection in children is poor because the newborn has an immature immune system. Early diagnosis and therapy are needed to avoid the development of AIDS. New therapies are becoming available but prevention of infection, through maternal therapy during pregnancy, is the most effective measure in avoiding this infection through this transmission route.

  3. Antiretroviral therapy enrollment characteristics and outcomes among HIV-infected adolescents and young adults compared with older adults--seven African countries, 2004-2013.

    PubMed

    Auld, Andrew F; Agolory, Simon G; Shiraishi, Ray W; Wabwire-Mangen, Fred; Kwesigabo, Gideon; Mulenga, Modest; Hachizovu, Sebastian; Asadu, Emeka; Tuho, Moise Zanga; Ettiegne-Traore, Virginie; Mbofana, Francisco; Okello, Velephi; Azih, Charles; Denison, Julie A; Tsui, Sharon; Koole, Olivier; Kamiru, Harrison; Nuwagaba-Biribonwoha, Harriet; Alfredo, Charity; Jobarteh, Kebba; Odafe, Solomon; Onotu, Dennis; Ekra, Kunomboa A; Kouakou, Joseph S; Ehrenkranz, Peter; Bicego, George; Torpey, Kwasi; Mukadi, Ya Diul; van Praag, Eric; Menten, Joris; Mastro, Timothy; Dukes Hamilton, Carol; Swaminathan, Mahesh; Dokubo, E Kainne; Baughman, Andrew L; Spira, Thomas; Colebunders, Robert; Bangsberg, David; Marlink, Richard; Zee, Aaron; Kaplan, Jonathan; Ellerbrock, Tedd V

    2014-11-28

    Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to declines of about 30% in the global annual number of human immunodeficiency (HIV)-related deaths and declines in global HIV incidence, estimated annual HIV-related deaths among adolescents have increased by about 50% and estimated adolescent HIV incidence has been relatively stable. In 2012, an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15-24 years. Difficulty enrolling adolescents and young adults in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this age group, but data are limited. To evaluate age-related ART retention challenges, data from retrospective cohort studies conducted in seven African countries among 16,421 patients, aged ≥15 years at enrollment, who initiated ART during 2004-2012 were analyzed. ART enrollment and outcome data were compared among three groups defined by age at enrollment: adolescents and young adults (aged 15-24 years), middle-aged adults (aged 25-49 years), and older adults (aged ≥50 years). Enrollees aged 15-24 years were predominantly female (81%-92%), commonly pregnant (3%-32% of females), unmarried (54%-73%), and, in four countries with employment data, unemployed (53%-86%). In comparison, older adults were more likely to be male (p<0.001), employed (p<0.001), and married, (p<0.05 in five countries). Compared with older adults, adolescents and young adults had higher LTFU rates in all seven countries, reaching statistical significance in three countries in crude and multivariable analyses. Evidence-based interventions to reduce LTFU for adolescent and young adult ART enrollees could help reduce mortality and HIV incidence in this age group.

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

    PubMed

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

    2016-02-20

    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. 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). 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. 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)]. Hardships faced by migrants increase HIV risks. Women, especially during the period without stable housing, appear especially vulnerable.

  5. Patient-Nominated, Community-Based HIV Treatment Supporters: Patient Perspectives, Feasibility, Challenges, and Factors for Success in HIV-Infected South African Adults

    PubMed Central

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

    2013-01-01

    Abstract 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

  6. 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.

  7. 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

  8. Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age

    PubMed Central

    Ciaranello, Andrea L.; Doherty, Kathleen; Penazzato, Martina; Lindsey, Jane C.; Harrison, Linda; Kelly, Kathleen; Walensky, Rochelle P.; Essajee, Shaffiq; Losina, Elena; Muhe, Lulu; Wools-Kaloustian, Kara; Ayaya, Samuel; Weinstein, Milton C.; Palumbo, Paul; Freedberg, Kenneth A.

    2015-01-01

    Background: The International Maternal, Pediatric, and Adolescent Clinical Trials P1060 trial demonstrated superior outcomes for HIV-infected children less than 3 years old initiating antiretroviral therapy (ART) with lopinavir/ritonavir compared to nevirapine, but lopinavir/ritonavir is four-fold costlier. Design/methods: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Pediatric model, with published and P1060 data, to project outcomes under three strategies: no ART; first-line nevirapine (with second-line lopinavir/ritonavir); and first-line lopinavir/ritonavir (second-line nevirapine). The base-case examined South African children initiating ART at age 12 months; sensitivity analyses varied all key model parameters. Outcomes included life expectancy, lifetime costs, and incremental cost-effectiveness ratios [ICERs; dollars/year of life saved ($/YLS)]. We considered interventions with ICERs less than 1× per-capita gross domestic product (South Africa: $7500)/YLS as ‘very cost-effective,’ interventions with ICERs below 3× gross domestic product/YLS as ‘cost-effective,’ and interventions leading to longer life expectancy and lower lifetime costs as ‘cost-saving’. Results: Projected life expectancy was 2.8 years with no ART. Both ART regimens markedly improved life expectancy and were very cost-effective, compared to no ART. First-line lopinavir/ritonavir led to longer life expectancy (28.8 years) and lower lifetime costs ($41 350/person, from lower second-line costs) than first-line nevirapine (27.6 years, $44 030). First-line lopinavir/ritonavir remained cost-saving or very cost-effective compared to first-line nevirapine unless: liquid lopinavir/ritonavir led to two-fold higher virologic failure rates or 15-fold greater costs than in the base-case, or second-line ART following first-line lopinavir/ritonavir was very ineffective. Conclusions: On the basis of P1060 data, first-line lopinavir/ritonavir leads to longer life

  9. 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

  10. 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

  11. 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

    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

    2015-07-01

    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 International epidemiologic Databases to Evaluate Aids West African paediatric cohort. Malnutrition was defined at ART initiation (baseline) by a Z score <-2 standard deviations, according to 3 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 standard deviations) 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. 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 with children ≥5 years for WAZ, HAZ (P < 0.001) and WHZ/BAZ (P = 0.026). 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.

  12. Prevalence of Anal Human Papillomavirus (HPV) and Performance of Cepheid Xpert and Hybrid Capture 2 (hc2) HPV Assays in South African HIV-Infected Women.

    PubMed

    Mbulawa, Zizipho Z A; Wilkin, Timothy; Goeieman, Bridgette J; Jong, Eefje; Michelow, Pamela; Swarts, Avril; Smith, Jennifer S; Kegorilwe, Patricia; Firnhaber, Cynthia S; Williamson, Anna-Lise

    2017-08-01

    This study investigated anal high-risk HPV (HR-HPV) prevalence in HIV-infected women using the Cepheid Xpert HPV assay and compares its performance with that of Hybrid Capture-2 (hc2). A total of 199 HIV-infected women were recruited from Helen Joseph Hospital, Johannesburg. Stored ThinPrep anal swabs that had previously been tested using hc2 were tested for HPV using Xpert. The HR-HPV prevalence by Xpert was 40.8% and similar to hc2 (41.8%) with overall agreement of 86.7%; Cohen's kappa 0.73 (95% CI 0.63-0.82). High grade squamous intraepithelial lesions (HSIL) was associated with increasing number of multiple HPV infection (P < .001). Xpert and hc2 were similarly sensitive (77.4% and 77.4%, respectively) and specific (66.1% and 64.8% respectively) for HSIL detection. HPV16 (OR: 14.0, 95% CI: 3.9-48.0, P < .0001), HPV39/68/56/66 (OR: 4.1, 95% CI: 1.4-12, P = .01) and HPV51/59 (OR: 2.8, 95% CI: 1.1-7.6, P = .04) were independently associated with anal HSIL. Xpert HPV typing is a promising anal screening test in HIV-infected women that performs similarly to hc2.

  13. Orthophosphate turnover in East African lakes.

    PubMed

    Peters, Robert Henry; MacIntyre, Sally

    1976-12-01

    Turnover rates of (32)P-PO4 and concentrations of orthophosphate as soluble reactive phosphorus (SRP) were measured in five East African waters. Rapid incorporation of (32)P-PO4 by the seston and orthophosphate concentrations below the limit of detectibility were found in Lakes Elmenteita, Naivasha, and Naivasha Crater Lake. Turnover was slow and orthophosphate concentration high in both Lake Nakuru and the Crescent Island Crater basin of Lake Naivasha. Further experiments in Lake Nakuru indicated that colloidal binding of orthophosphate was limited and that particles retained by an 8.0 μ filter incorporated 66% as much tracer as particles retained by a 0.1 μ filter. These experiments strengthen our conclusion that a large quantity of orthophosphate is available for algal use in Lake Nakuru.

  14. 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

  15. 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

  16. Literature Review and Case Histories of Histoplasma capsulatum var. duboisii Infections in HIV-infected Patients

    PubMed Central

    Loulergue, Pierre; Bastides, Frédéric; Baudouin, Véronique; Chandenier, Jacques; Mariani-Kurkdjian, Patricia; Dupont, Bertrand; Viard, Jean-Paul; Dromer, Françoise

    2007-01-01

    African histoplasmosis caused by Histoplasma capsulatum var. duboisii is an invasive fungal infection endemic in central and west Africa. Most of its ecology and pathogenesis remain unknown. H. capsulatum var. capsulatum is an AIDS-defining opportunistic infection in HIV-infected patients who are living in or have traveled to histoplasmosis-endemic areas. In contrast, reports concerning African histoplasmosis during HIV infection are rare, although both pathogens coexist in those regions. We report 3 cases of imported African histoplasmosis diagnosed in France in HIV-infected patients and a literature review on similar cases. PMID:18217546

  17. Tryptophan depletion in context of the inflammatory and general nutritional status of a low-income South African HIV-infected population.

    PubMed

    Bipath, Priyesh; Levay, Peter F; Viljoen, Margaretha

    2016-02-17

    The essential amino acid tryptophan cannot be synthesised in the body and must be acquired through dietary intake. Oxidation of tryptophan, due to immune induction of the enzyme indoleamine 2,3-dioxygenase (IDO), is considered to be the main cause of tryptophan depletion in HIV infection and AIDS. We examined plasma tryptophan levels in a low-income sub-Saharan HIV-infected population and compared it to that of developed countries. Tryptophan levels were further examined in context of the general nutritional and inflammatory status. This cross-sectional study included 105 HIV-positive patients recruited from the Kalafong Hospital in Pretoria, South Africa, and 60 HIV-negative controls. Patient tryptophan levels were in general markedly lower than those reported for developed countries. In contrast to reports from developed countries that showed tryptophan levels on average to be 18.8 % lower than their control values, tryptophan levels in our study were 44.1 % lower than our controls (24.4 ± 4.1 vs. 43.6 ± 11.9 μmol/l; p < 0.001). Tryptophan levels correlated with both CD4 counts (r = 0.341; p = 0.004) and with pro-inflammatory activity as indicated by neopterin levels (r = -0.399; p = 0.0001). Nutritional indicators such as albumin and haemoglobin correlated positively with tryptophan and negatively with the pro-inflammatory indicators neopterin, interleukin 6 and C-reactive protein. The most probable causes of the lower tryptophan levels seen in our population are food insecurity and higher levels of inflammatory activity. We contend that inflammation-induced tryptophan depletion forms part of a much wider effect of pro-inflammatory activity on the nutritional profile of HIV-infected patients.

  18. HIV infection in children.

    PubMed

    Canosa, C A

    1991-01-01

    Various studies have reported rates of human immunodeficiency virus (HIV) transmission from mother to child of 13-40%. Vertical transmission occurs in utero, during delivery, or, in a small number of cases, through breast milk. Whether mothers at various stages of HIV infection experience different rates of transmission remains unknown. Maternal antibodies cross the placenta and are present from birth up to 18 months of age. The offspring of HIV-positive mothers tend to be low birthweight, under 37 weeks' gestation, and at high risk of perinatal mortality. It is likely, however, that this profile is indicative of the low socioeconomic status of most women with HIV rather than a result of infection. Also emerging is a psychosocial profile of the HIV child. These children are isolated, neglected, battered, frequently abandoned, and exhibit various degrees of mental retardation. Also common are delayed psychomotor development, loss of developmental milestones, limited attention span, poor language development, and abnormal reflexes. These features result from the interaction of low socioeconomic status, a lack of psychosocial stimulation, nutritional deficiencies, and central nervous system infections. Since HIV-infected children tend to be the offspring of drug addicts, bisexuals, and prostitutes, they are not awarded the same compassion as children afflicted with other terminal illnesses. Moreover, these children are generally neglected by groups formed to provide support to AIDS patients. Thus, it is up to the general public, the mass media, and the health care system to advocate for the needs of these neglected children.

  19. East African runners: their genetics, lifestyle and athletic prowess.

    PubMed

    Onywera, Vincent O

    2009-01-01

    East African runners have dominated distance running events for over 5 decades. Some explanations have been advanced to explain why such a small population has dominated distance running events over time. Suggested reasons include, among others, a genetic predisposition, diet, living at high altitude as well as sociocultural background. This chapter gives possible insight into the past, present and hopefully future success of East African runners; it mainly explores the foundations of running excellence, talent identification, diet and injury management methods used by East African runners. The chapter also explores means and ways by which East African runners can sustain their running excellence by using their past experiences, to perfect the present and predict the future. 2009 S. Karger AG, Basel

  20. The East African Mantle: Warm but not Hot

    NASA Astrophysics Data System (ADS)

    Rooney, T. O.; Herzberg, C. T.; Bastow, I. D.

    2011-12-01

    East Africa is underlain by one of the most conspicuous features of global tomographic models: the African Super-plume. Magmatism during the African-Arabian flood basalt event and ongoing development of the East African rift have long been linked to the super-plume, with high temperatures usually cited as evidence for its existence. However, our work shows that seismic wave-speeds in the East African mantle are too low to be accounted for by only thermal effects. Other factors such as composition must also play a role. To address these issues we present mantle potential temperature estimates (TP) and preliminary high-precision compositional data from olivine crystals for East African lavas with the goal of constraining the thermo-chemical conditions of the East African upper mantle. Our estimates of mantle TP show that the East African mantle has remained warmer than ambient mantle conditions over the past 40 Myr, peaking during the Oligocene African-Arabian flood basalt episode (1520°C). These TP values, while clearly elevated, fall toward the lower end of the global temperature range of large igneous provinces, and are inconsistent with a solely thermal origin for the profound mantle seismic velocity anomalies beneath East Africa. Evidence of compositional heterogeneity in the East African upper mantle is preserved in the Fe, Mn, Ca, and Ni content of olivine crystals in lavas. We have found that Fe/Mn (42-95) within this preliminary dataset extend to the most extreme values yet recorded in the global LIP and oceanic island database, plotting well-outside fields accepted for olivine derived from peridotite-sourced melt. These data are strong evidence of a significant role for non-peridotite lithologies such as pyroxenite in the East African upper mantle. Such pyroxenites may reside in the metasomatized lithospheric mantle, or be derived from the reaction of recycled oceanic slabs upwelling in the African Superplume. Such recycled materials likely contain

  1. East African discourses on khat and sex.

    PubMed

    Beckerleg, Susan

    2010-12-01

    The study aims to review and analyse the varied East African discourses on the effects of khat use on libido, fertility, transmission of HIV, prostitution and rape. The data were gathered between 2004 and 2009 in Kenya and Uganda. Between 2004 and 2005 across Kenya and Uganda a broad survey approach was adopted, involving identification of and travel to production areas, interviews with producers and consumers in rural and urban settings. In addition, a survey of 300 Ugandan consumers was carried out in late 2004. Between 2007 and 2009, an in-depth study of khat production, trade and consumption was conducted in Uganda. This study also employed a mixture of methods, including key informant interviews participant-observation and a questionnaire survey administered to 210 khat consumers. Khat is associated, by consumers and its detractors alike, with changes in libido and sexual performance. Although there is no evidence to support their claims, detractors of khat use argue that khat causes sexual violence, causes women to enter sex work, and that chewing causes the spread of sexually transmitted diseases, including the HIV virus. In East Africa the discourse on khat and sex has led to consumption of the substances being associated by many people with uncontrolled sexual behaviour. There is no evidence that khat use fuels promiscuity, commercial sex, sexually transmitted diseases or rape. The current discourse on khat and sex touches on all these topics. Local religious and political leaders invoke khat use as a cause of what they argue is a breakdown of morals and social order. In Kenya and Uganda it is women khat consumers who are seen as sexually uncontrolled. In Uganda, the argument is extended even to men: with male khat chewers labelled as prone to commit rape. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  2. A qualitative study exploring the social and environmental context of recently acquired HIV infection among men who have sex with men in South-East England.

    PubMed

    Gourlay, Annabelle; Fox, Julie; Gafos, Mitzy; Fidler, Sarah; Nwokolo, Nneka; Clarke, Amanda; Gilson, Richard; Orkin, Chloe; Collins, Simon; Porter, Kholoud; Hart, Graham

    2017-08-28

    A key UK public health priority is to reduce HIV incidence among gay and other men who have sex with men (MSM). This study aimed to explore the social and environmental context in which new HIV infections occurred among MSM in London and Brighton in 2015. A qualitative descriptive study, comprising in-depth interviews, was carried out as a substudy to the UK Register of HIV Seroconverters cohort: an observational cohort of individuals whose date of HIV seroconversion was well estimated. An inductive thematic analysis was conducted in NVivo, guided by a socio-ecological framework. Participants were recruited from six HIV clinics in London and Brighton. Fieldwork was conducted between January and April 2015. All MSM eligible for the UK Register Seroconverter cohort (an HIV-positive antibody test result within 12 months of their last documented HIV-negative test or other laboratory evidence of HIV seroconversion) diagnosed within the past 12 months and aged ≥18 were eligible for the qualitative substudy. 21 MSM participated, aged 22-61 years and predominantly white. A complex interplay of factors, operating at different levels, influenced risk behaviours and HIV acquisition. Participants saw risk as multi-factorial, but the relative importance of factors varied for each person. Individual psycho-social factors, including personal history, recent life stressors and mental health, enhanced vulnerability towards higher risk situations, while features of the social environment, such as chemsex and social media, and prevalent community beliefs regarding treatment and HIV normalisation, encouraged risk taking. Recently acquired HIV infection among MSM reflects a complex web of factors operating at different levels. These findings point to the need for multi-level interventions to reduce the risk of HIV acquisition among high-risk MSM in the UK and similar settings. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All

  3. 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

  4. Autoimmune diseases and HIV infection

    PubMed Central

    Virot, Emilie; Duclos, Antoine; Adelaide, Leopold; Miailhes, Patrick; Hot, Arnaud; Ferry, Tristan; Seve, Pascal

    2017-01-01

    Abstract To describe the clinical manifestations, treatments, prognosis, and prevalence of autoimmune diseases (ADs) in human immunodeficiency virus (HIV)-infected patients. All HIV-infected patients managed in the Infectious Diseases Department of the Lyon University Hospitals, France, between January 2003 and December 2013 and presenting an AD were retrospectively included. Thirty-six ADs were found among 5186 HIV-infected patients which represents a prevalence of 0.69% including immune thrombocytopenic purpura (n = 15), inflammatory myositis (IM) (n = 4), sarcoidosis (n = 4), Guillain–Barré syndrome (GBS) (n = 4), myasthenia gravis (n = 2), Graves’ disease (n = 2), and 1 case of each following conditions: systemic lupus erythematosus, rheumatoid arthritis, autoimmune hepatitis, Hashimoto thyroiditis and autoimmune hemolytic anemia. One patient presented 2 ADs. Thirty patients were known to be HIV-infected when they developed an AD. The AD preceded HIV infection in 2 patients. GBS and HIV infection were diagnosed simultaneously in 3 cases. At AD diagnosis, CD4 T lymphocytes count were higher than 350/mm3 in 63% of patients, between 200 and 350/mm3 in 19% and less than 200/mm3 in 19%. Twenty patients benefited from immunosuppressant treatments, with a good tolerance. ADs during HIV infection are uncommon in this large French cohort. Immune thrombocytopenic purpura, sarcoidosis, IM, and GBS appear to be more frequent than in the general population. Immunosuppressant treatments seem to be effective and well tolerated. PMID:28121924

  5. 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

  6. [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.

  7. [Cryptococcosis during HIV infection].

    PubMed

    El Fane, M; Badaoui, L; Ouladlahsen, A; Sodqi, M; Marih, L; Chakib, A; Marhoum El Filali, K

    2015-12-01

    Cryptococcosis is a cosmopolitan fungal serious condition due to an encapsulated yeast Cryptococcus neoformans. This is the systemic fungal infection the most common in HIV infection. This yeast is present in the environment and its main entrance in the body is the respiratory tract. Its gravity is linked to its tropism for the central nervous system. It generally affects subjects with severe deficit of cellular immunity and in particular, patients living with HIV. The diagnosis of neuromeningeal cryptococcosis is based on the detection of encapsulated yeasts at microscopic examination of cerebrospinal fluid, the detection of capsular polysaccharide antigen in serum or cerebrospinal fluid, but especially on the culture. A staging is always essential. The prognosis is severe. The control of intracranial hypertension is a major element of prognosis. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. 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…

  9. 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…

  10. The role of SNPs in the α-chain of the IL-7R gene in CD4+ T-cell recovery in HIV-infected African patients receiving suppressive cART.

    PubMed

    Rajasuriar, R; Booth, D R; Gouillou, M; Spelman, T; James, I; Solomon, A; Chua, K; Stewart, G; Deeks, S; Bangsberg, D R; Muzoora, C; Cameron, P U; Hunt, P; Martin, J; Lewin, S R

    2012-01-01

    We previously found an association between faster CD4+ T-cell recovery in HIV-infected patients receiving combination antiretroviral therapy (cART) and interleukin-7 receptor-α (IL-7Rα) haplotype-2 in a predominantly Caucasian cohort. This study aims to determine whether this association was also significant in Africans. Patients were recruited from the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort (n=352). We used survival analysis and linear mixed modelling (LMM) to determine factors associated with CD4 T-cell recovery. Eight IL-7Rα single-nucleotide polymorphisms (SNPs) were genotyped in both Africans and Caucasians (n=57). Soluble (s)IL-7Rα levels were measured by ELISA. In UARTO, IL-7Rα haplotype-2 was associated with slower CD4 T-cell recovery following cART by using survival analysis (P=0.020) and no association was found with LMM (P=0.958). The tagging-SNP for IL-7Rα haplotype-2 (rs6897932) was associated with decreased sIL-7Rα (P<0.001). The haplotypes for the IL-7Rα were significantly different in Africans and Caucasians. Using IL-7Rα genotypes we found slower CD4 T-cell recovery in UARTO patients was still associated with rs6897932 (P=0.009) and rs3194051 was associated with faster CD4 T-cell recovery (P=0.006). Unlike Caucasians, we did not demonstrate a significant association between IL-7Rα haplotype 2 and faster CD4 T-cell recovery in Africans. The IL-7Rα SNPs associated with CD4 T-cell recovery following cART differ in African and Caucasian cohorts.

  11. Assessment of the agreement between the Framingham and DAD risk equations for estimating cardiovascular risk in adult Africans living with HIV infection: a cross-sectional study.

    PubMed

    Noumegni, Steve Raoul; Ama, Vicky Jocelyne Moor; Assah, Felix K; Bigna, Jean Joel; Nansseu, Jobert Richie; Kameni, Jenny Arielle M; Katte, Jean-Claude; Dehayem, Mesmin Y; Kengne, Andre Pascal; Sobngwi, Eugene

    2017-01-01

    The Absolute cardiovascular disease (CVD) risk evaluation using multivariable CVD risk models is increasingly advocated in people with HIV, in whom existing models remain largely untested. We assessed the agreement between the general population derived Framingham CVD risk equation and the HIV-specific Data collection on Adverse effects of anti-HIV Drugs (DAD) CVD risk equation in HIV-infected adult Cameroonians. This cross-sectional study involved 452 HIV infected adults recruited at the HIV day-care unit of the Yaoundé Central Hospital, Cameroon. The 5-year projected CVD risk was estimated for each participant using the DAD and Framingham CVD risk equations. Agreement between estimates from these equations was assessed using the spearman correlation and Cohen's kappa coefficient. The mean age of participants (80% females) was 44.4 ± 9.8 years. Most participants (88.5%) were on antiretroviral treatment with 93.3% of them receiving first-line regimen. The most frequent cardiovascular risk factors were abdominal obesity (43.1%) and dyslipidemia (33.8%). The median estimated 5-year CVD risk was 0.6% (25th-75th percentiles: 0.3-1.3) using the DAD equation and 0.7% (0.2-2.0) with the Framingham equation. The Spearman correlation between the two estimates was 0.93 (p < 0.001). The kappa statistic was 0.61 (95% confident interval: 0.54-0.67) for the agreement between the two equations in classifying participants across risk categories defined as low, moderate, high and very high. Most participants had a low-to-moderate estimated CVD risk, with acceptable level of agreement between the general and HIV-specific equations in ranking CVD risk.

  12. 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 ...

  13. Immunology of pediatric HIV infection.

    PubMed

    Tobin, Nicole H; Aldrovandi, Grace M

    2013-07-01

    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. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. 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

  15. 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.…

  16. 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.…

  17. Fulminant amebic colitis in an HIV-infected homosexual man.

    PubMed

    Ishioka, Haruhiko; Umezawa, Masami; Hatakeyama, Shuji

    2011-01-01

    We present a case of fulminant amebic colitis in a human immunodeficiency virus (HIV)-infected homosexual man. The patient developed colonic perforation over a short time despite empirical therapy with metronidazole, and underwent right hemicolectomy. Amebic colitis was pathologically diagnosed by identifying invasive trophozoites of Entamoeba in a surgical specimen. Amebic colitis is one of the important differential diagnoses of acute abdomen in HIV-infected patients and/or homosexual men, especially in East Asia. Although fulminant amebic colitis is a rare manifestation of amebiasis, early diagnosis and treatment are thought to be important to improve the outcome of this highly fatal complication.

  18. [HIV infection in immigrants].

    PubMed

    López-Vélez, Rogelio; Navarro Beltrá, Miriam; Hernando Jerez, Asunción; del Amo Valero, Julia

    2008-05-01

    Immigration to Spain has greatly increased since 1995. Currently, more than 4 million foreigners are resident in the country. The immigration process increases vulnerability. The most common route of HIV infection in the immigrant population and ethnic minorities is heterosexual transmission. The number of people living with HIV worldwide (39.5 million people in 2006) and the number of those dying from AIDS continues to increase. In 2006, there were an estimated 30,000 people living with HIV/AIDS in Spain. The number of cases of AIDS in immigrants has risen in the last few years. AIDS in immigrants from any country, and especially in those from sub-Saharan Africa, is associated with a greater frequency of tuberculosis disease. Knowledge of opportunistic pathogens with tropical distribution is required for a correct differential diagnosis. Throughout the European Union, the number of AIDS cases has progressively decreased since the introduction of highly effective anti- HIV treatment, but this decrease has been significantly lower in immigrants. The difference may be due to lower access to health systems caused by administrative, legal, cultural and linguistic barriers.

  19. Assessment of conventional oil resources of the East African Rift Province, East Africa, 2016

    USGS Publications Warehouse

    Brownfield, Michael E.; Schenk, Christopher J.; Klett, Timothy R.; Mercier, Tracey J.; Gaswirth, Stephanie B.; Marra, Kristen R.; Finn, Thomas M.; Le, Phuong A.; Leathers-Miller, Heidi M.

    2017-03-27

    Using a geology-based assessment methodology, the U.S. Geological Survey estimated undiscovered, technically recoverable mean conventional resources of 13.4 billion barrels of oil and 4.6 trillion cubic feet of gas in the East African Rift Province of east Africa.

  20. 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

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

    PubMed

    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.

  2. Science challenging HIV infection.

    PubMed

    Rao, R R; Lakshi, V

    1993-04-01

    The first accepted report of a novel human, slow virus disease belonging to "lentivirus" known as acquired immunodeficiency syndrome can be traced to reports of June 1981. HIV-1 and HIV-2 were later found over the period 1984-86 to be unequivocally associated with AIDS. They are two serologically distinct viruses belonging to the same family with the unique properties of integration and latency in the host cell genome and the presence of reverse transcriptase. Typical of all retroviruses, the HIV genome comprises three genes governing the synthesis of all core proteins, replication protein encoding, and envelope proteins. HIV uses the CD4 antigen on T-helper cells, and about 40% of blood monocytes and tissue macrophages as a cell surface receptor. HIV may, however, also infect cells which contain no CD4. Macrophages serve as the main reservoir of HIV and may carry the virus to different organs. Very recently a rare type of white blood cell called the dendritic cell has been found to allow for direct infection by HIV during sexual intercourse. These cells are prominently present in the anal and vaginal mucosa. The authors discuss facts and figures on the HIV epidemic, the Indian scenario, classification of the clinical spectrum, the enzyme immunoassay HIV testing format, Western blot, immunofluorescence antibody, HIV culture, flow cytometry, radio immuno precipitation assay, and the detection of HIV DNA. Significant advances have been made over the last ten years in understanding the pathogenesis of HIV infection and accurately diagnosing infected individuals, with recombinant technology, polymerase chain reaction, and the construction of synthetic hybrid virus rapidly becoming part of routine diagnostics. More sensitive, specific, and rapid techniques are, however, needed for the early diagnosis and management of AIDS cases. The need for more ideal antibody incorporating both regulatory and structural proteins of the virion, preferably manufactured using

  3. HIV infection and AIDS.

    PubMed

    Lloyd, A

    1996-09-01

    Many of the clinical features of HIV/AIDS can be ascribed to the profound immune deficiency which develops in infected patients. The destruction of the immune system by the virus results in opportunistic infection, as well as an increased risk of autoimmune disease and malignancy. In addition, disease manifestations related to the virus itself may occur. For example, during the primary illness which occurs within weeks after first exposure to HIV, clinical symptoms occur in at least 50% of cases, typically as a mononucleosis syndrome. HIV-related complications are rarely encountered in patients with preserved immunity (i.e. CD4 T-cell counts greater than 500 cells/mm3). Recurrent mucocutaneous herpes simplex (HSV), herpes zoster (VZV), oral candidiasis and oral hairy leukoplakia occur with increasing frequency as the CD4 count drops below this level. Immune thrombocytopenia (ITP) occurs in association with HIV and often presents early in the clinical course. The risk of developing opportunistic infections and malignancies typical of AIDS increases progressively as CD4 counts fall below 200 cells/mm3. The clinical manifestations of infections associated with AIDS tend to fall into well-recognized patterns of presentation, including pneumonia, dysphagia/odynophagia, diarrhoea, neurological symptoms, fever, wasting, anaemia and visual loss. The commonest pathogens include Candida albicans, Pneumocystis carinii, Mycobacterium tuberculosis, Toxoplasma gondii, Cryptococcus neoformans, Mycobacterium avium intracellulare and cytomegalovirus. Malignant disease in patients with HIV infection also occurs in a characteristic pattern. Only two tumours are prevalent: Kaposi's sarcoma, a multifocal tumour of vascular endothelium which typically involves skin and mucosal surfaces; and non-Hodgkin's lymphoma, which is typically high grade in phenotype, often arising within the central nervous system. The principles of therapy include reduction of HIV replication by antiretroviral

  4. HIV infection in the elderly

    PubMed Central

    Nguyen, Nancy; Holodniy, Mark

    2008-01-01

    In the US, an estimated 1 million people are infected with HIV, although one-third of this population are unaware of their diagnosis. While HIV infection is commonly thought to affect younger adults, there are an increasing number of patients over 50 years of age living with the condition. UNAIDS and WHO estimate that of the 40 million people living with HIV/AIDS in the world, approximately 2.8 million are 50 years and older. With the introduction of highly active antiretroviral therapy (HAART) in the mid-1990s, survival following HIV diagnosis has risen dramatically and HIV infection has evolved from an acute disease process to being managed as a chronic medical condition. As treated HIV-infected patients live longer and the number of new HIV diagnoses in older patients rise, clinicians need to be aware of these trends and become familiar with the management of HIV infection in the older patient. This article is intended for the general clinician, including geriatricians, and will review epidemiologic data and HIV treatment as well as provide a discussion on medical management issues affecting the older HIV-infected patient. PMID:18982916

  5. Sexual learning among East African adolescents in the context of generalized HIV epidemics: A systematic qualitative meta-synthesis

    PubMed Central

    McNealy, Kim R.; Al-Khattab, Halima; Carter-Harris, Lisa; Oruche, Ukamaka Marian; Naanyu, Violet; Draucker, Claire Burke

    2017-01-01

    Background AIDS-related illness is the leading cause of mortality for adolescents in sub-Saharan Africa. Together, Kenya, Tanzania, and Uganda account for 21% of HIV-infected adolescents in sub-Saharan Africa. The United Nations framework for addressing the epidemic among adolescents calls for comprehensive sexual and reproductive health education. These HIV prevention efforts could be informed by a synthesis of existing research about the formal and informal sexual education of adolescents in countries experiencing generalized epidemics. The purpose of this study was to describe the process of sexual learning among East African adolescents living in the context of generalized HIV epidemics. Methods Qualitative metasynthesis, a systematic procedure for integrating the results of multiple qualitative studies addressing a similar phenomenon, was used. Thirty-two research reports met study inclusion criteria. The reports were assessed in a four-step analytic process: appraisal, classification of findings, synthesis of findings, and construction of a framework depicting the process of sexual learning in this population. Results The framework includes three phases of sexual learning: 1) being primed for sex, 2) making sense of sex, and 3) having sexual experiences. Adolescents were primed for sex through gender norms, cultural practices, and economic structures as well as through conversations and formal instruction. They made sense of sex by acquiring information about sexual intercourse, reproduction and pregnancy, sexually transmitted infections, and relationships and by developing a variety of beliefs and attitudes about these topics. Some adolescents described having sexual experiences that met wants or needs, but many experienced sex that was coerced or violent. Whether sex was wanted, coerced, or violent, adolescents experienced worry about sexually transmitted infections or premarital pregnancy. Conclusions The three phases of sexual learning interact to shape

  6. Sexual learning among East African adolescents in the context of generalized HIV epidemics: A systematic qualitative meta-synthesis.

    PubMed

    Knopf, Amelia S; McNealy, Kim R; Al-Khattab, Halima; Carter-Harris, Lisa; Oruche, Ukamaka Marian; Naanyu, Violet; Draucker, Claire Burke

    2017-01-01

    AIDS-related illness is the leading cause of mortality for adolescents in sub-Saharan Africa. Together, Kenya, Tanzania, and Uganda account for 21% of HIV-infected adolescents in sub-Saharan Africa. The United Nations framework for addressing the epidemic among adolescents calls for comprehensive sexual and reproductive health education. These HIV prevention efforts could be informed by a synthesis of existing research about the formal and informal sexual education of adolescents in countries experiencing generalized epidemics. The purpose of this study was to describe the process of sexual learning among East African adolescents living in the context of generalized HIV epidemics. Qualitative metasynthesis, a systematic procedure for integrating the results of multiple qualitative studies addressing a similar phenomenon, was used. Thirty-two research reports met study inclusion criteria. The reports were assessed in a four-step analytic process: appraisal, classification of findings, synthesis of findings, and construction of a framework depicting the process of sexual learning in this population. The framework includes three phases of sexual learning: 1) being primed for sex, 2) making sense of sex, and 3) having sexual experiences. Adolescents were primed for sex through gender norms, cultural practices, and economic structures as well as through conversations and formal instruction. They made sense of sex by acquiring information about sexual intercourse, reproduction and pregnancy, sexually transmitted infections, and relationships and by developing a variety of beliefs and attitudes about these topics. Some adolescents described having sexual experiences that met wants or needs, but many experienced sex that was coerced or violent. Whether sex was wanted, coerced, or violent, adolescents experienced worry about sexually transmitted infections or premarital pregnancy. The three phases of sexual learning interact to shape adolescents' sexual lives and their risk

  7. Adult-onset Still's disease presenting as fever of unknown origin in a patient with HIV infection.

    PubMed

    DelVecchio, Sally; Skidmore, Peter

    2008-02-15

    A 43-year-old African American man with known human immunodeficiency virus (HIV) infection was found to have adult-onset Still's disease manifesting as fever of unknown origin. In the era of highly active antiretroviral therapy, HIV-infected patients are preserving their immune status and, thus, must be evaluated in a manner similar to that for the general population.

  8. Bone disease and HIV infection.

    PubMed

    Amorosa, Valerianna; Tebas, Pablo

    2006-01-01

    The high prevalence of bone demineralization among human immunodeficiency virus (HIV)-infected patients in the current therapeutic era has been described in multiple studies, sounding the alarm that we may expect an epidemic of fragility fractures in the future. However, despite noting high overall prevalences of osteopenia and osteoporosis, recent longitudinal studies that we review here have generally not observed accelerated bone loss during antiretroviral therapy beyond the initial period after treatment initiation. We discuss the continued progress toward understanding the mechanisms of HIV-associated bone loss, particularly the effects of HIV infection, antiretroviral therapy, and host immune factors on bone turnover. We summarize results of clinical trials published in the past year that studied the safety and efficacy of treatment of bone loss in HIV-infected patients and provide provisional opinions about who should be considered for bone disease screening and treatment.

  9. [Microbiological diagnosis of HIV infection].

    PubMed

    López-Bernaldo de Quirós, Juan Carlos; Delgado, Rafael; García, Federico; Eiros, José M; Ortiz de Lejarazu, Raúl

    2007-12-01

    Currently, there are around 150,000 HIV-infected patients in Spain. This number, together with the fact that this disease is now a chronic condition since the introduction of antiretroviral therapy, has generated an increasing demand on the clinical microbiology laboratories in our hospitals. This increase has occurred not only in the diagnosis and treatment of opportunistic diseases, but also in tests related to the diagnosis and therapeutic management of HIV infection. To meet this demand, the Sociedad de Enfermedades Infecciosas y Microbiología Clinica (Spanish Society of Infectious Diseases and Clinical Microbiology) has updated its standard Procedure for the microbiological diagnosis of HIV infection. The main advances related to serological diagnosis, plasma viral load, and detection of resistance to antiretroviral drugs are reviewed in this version of the Procedure.

  10. 15 Month follow up of African children following vaginal cleansing with benzalkonium chloride of their HIV infected mothers during late pregnancy and delivery

    PubMed Central

    Mandelbrot, L; Msellati, P; Meda, N; Leroy, V; Likikouet, R; Van de Perre, P; Dequae-Merchadoux, L; Sylla-Koko, F; Ouangre, A; Ouassa, T; Ramon, R; Gautier-Charpenti..., L; Cartoux, M; Dosso, M; Dabis, F; Welffens-Ekra, C

    2002-01-01

    Objectives: To study mother to child HIV-1 transmission (MTCT) and infant mortality following benzalkonium chloride (BC) disinfection. Methods: A randomised, double blind phase II placebo controlled trial. Women testing positive for HIV-1 infection in prenatal care units in Abidjan, Côte d'Ivoire, and Bobo-Dioulasso, Burkina Faso, from November 1996 to April 1997 were eligible, with their informed consent. Women self administered daily a vaginal suppository of 1% BC (53) or matched placebo (54) from 36 weeks of pregnancy, plus a single dose during labour. The neonate was bathed with 1% BC solution or placebo within 30 minutes after birth. MTCT rate was assessed based on repeated polymerase chain reaction (PCR) and serology results. For the present analysis, children were followed up to 15 months. Results: A total of 107 women were enrolled. Of 103 eligible liveborn children, 23 were HIV infected, 75 uninfected, and five of indeterminate status. MTCT transmission rate was 24.2% overall (95% confidence interval (CI): 14.3% to 30.4%). On an intent to treat basis, the transmission rate did not differ between the two groups (23.5%, CI 13.8 to 38.5, in the BC group and 24.8%, CI 15.0 to 39.6, in the placebo group at 15 months). Similarly, there was no difference in mortality at 15 months (22.9%, CI 13.7 to 36.9, in the BC group and 16.5%, CI 9.0 to 29.4, in the placebo group). Conclusion: This analysis failed to suggest any benefit of BC disinfection on mother to child HIV transmission or perinatal and infant mortality. PMID:12181464

  11. 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

  12. Pregnancy among HIV-infected refugees in Rhode Island.

    PubMed

    Blood, Erica; Beckwith, Curt; Bazerman, Lauri; Cu-Uvin, Susan; Mitty, Jennifer

    2009-02-01

    In 1999, immigration laws lifted previous barriers, allowing more HIV-infected refugees entrance to the US. Many of these refugees are women of reproductive age. At our center in Providence, RI, a significant number of HIV-infected refugees have become pregnant since resettling in the US. We describe the pregnancies seen among these predominantly West African HIV-infected refugees. A retrospective chart review was conducted on all HIV-infected female refugees who established care from 2000-2006. Descriptive statistics were used to describe the population at this site. We found that between 2000 and 2006, 28 HIV-infected female refugees established care. Liberia was the country of origin of 79% (22) of the women. There were 20 pregnancies among 14 women between 2000-2006. The median time from resettlement in the US to first pregnancy was 16 (<1-69) months. The median age at time of first pregnancy was 29 years (19-39). At time of pregnancy, the median CD4 count was 506 cells/mL and the median plasma viral load (PVL) was 3.36 log10 copies/ml. There were nine deliveries, one current pregnancy and one loss to follow-up. Other pregnancy outcomes included five terminations and three spontaneous abortions. All women received antiretroviral therapy during their pregnancy. At the time of delivery the median PVL was <1.88 log. There was one HIV transmission from mother to child. Two women became pregnant while on efavirenz, which was subsequently discontinued. One of the women delivered a normal term infant; the other relocated and transferred her care. Among this cohort of HIV-infected refugees, there is a high rate of pregnancy, highlighting the need for timely initiation of medical care, including comprehensive preconception counseling, upon resettlement in the US. It is important to gain a better understanding of this unique and growing population in order to provide the best possible care for these women.

  13. 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

  14. 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.

  15. Maintaining Academic Integrity among East African University Students

    ERIC Educational Resources Information Center

    Mwamwenda, T. S.

    2012-01-01

    The purpose of this research was to examine the extent to which academic integrity is maintained in the academic programmes of three East African university students selected from one of the universities in each one of the three countries. For confidentiality and identification purposes, the universities were labeled A, B and C. The level of…

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

    PubMed

    Papathakis, P C; Rollins, N C

    2004-03-01

    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. 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. 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 120 ml of replacement feed from

  17. 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

  18. 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:…

  19. 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.

  20. 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

  1. African-American Adolescents' Knowledge, Health-Related Attitudes, Sexual Behavior, and Contraceptive Decisions: Implications for the Prevention of Adolescent HIV Infection.

    ERIC Educational Resources Information Center

    St. Lawrence, Janet S.

    1993-01-01

    African-American adolescents (n=195) completed measures on Acquired Immune Deficiency Syndrome (AIDS) knowledge, condoms, health locus of control, vulnerability to human immunodeficiency virus, peer sexual norms, sexual behavior, and contraceptive preferences. Girls were more knowledgeable about AIDS, reported fewer sexual partners, held more…

  2. Drivers of future changes in East African precipitation

    NASA Astrophysics Data System (ADS)

    Souverijns, N.; Thiery, W.; Demuzere, M.; Van Lipzig, N. P. M.

    2016-11-01

    Precipitation amounts over East Africa have been declining over the last decades. These changes and future climate change over the region are highly debated. This study analyzes drivers of future precipitation changes over East Africa by applying a classification of circulation patterns on 15 historical and future members of the COordinated Regional climate Downscaling EXperiment. Typical circulation types (CTs) are obtained. Under a high emission scenario, changes in the frequency of occurrence of these CTs attribute for 23% of the total change in precipitation over East Africa by the end of the century. The remaining part (77%) is not related to East African synoptics, e.g. changes in moisture content, local/mesoscale feedbacks, and changes in moisture influx. These other effects comprise increases in precipitation close to the equator and the Somali region, while decreases are found over northwestern Ethiopia, the Sudan region and the lake areas.

  3. Genetic diversity of lactase persistence in East African populations.

    PubMed

    Hassan, Hisham Y; van Erp, Anke; Jaeger, Martin; Tahir, Hanan; Oosting, Marije; Joosten, Leo A B; Netea, Mihai G

    2016-01-04

    The expression of lactase which digests lactose from milk in humans is generally lost after weaning, but selected mutations influencing the promoter of the lactase gene have spread into the human populations. This is considered a classical example of gene-culture co-evolution, and several studies suggested that the lactase gene has been under strong directional evolutionary selective pressure in the past 5000 to 10,000 years. In the present study we investigated the distribution of three gene variants leading to lactase persistence in 12 different East African populations as well as one European population. Our results show that with the exception of Copts and Nilotic populations who are fully lactose non-persistent, the majority of populations of East Africa show at least partly lactose persistence, with both ethnic and socio-economic aspects playing an important role in the distribution of genetic variants. In this study, the variants C/G-13907 and T/G-13915, which are the major variants among the nomadic Arabs in the Arabia and Beja of East Africa, showed remarkable frequencies in Sudanese populations, especially those of pastoralists, in line with the historical links and bidirectional migration of nomadic populations between Arabia and East Africa. The C/T-13910 variant, generally associated with European populations is uniquely present among the Fulani. These data indicate that a combination of socio-economic, ethnic and evolutionary factors converged to shape the genetic structure of lactase persistence in East African populations.

  4. The dopamine-related polymorphisms BDNF, COMT, DRD2, DRD3, and DRD4 are not linked with changes in CSF dopamine levels and frequency of HIV infection.

    PubMed

    Horn, Anne; Scheller, C; du Plessis, S; Burger, R; Arendt, G; Joska, J; Sopper, S; Maschke, C M; Obermann, M; Husstedt, I W; Hain, J; Riederer, P; Koutsilieri, E

    2017-04-01

    We showed previously that higher levels in CSF dopamine in HIV patients are associated with the presence of the dopamine transporter (DAT) 10/10-repeat allele which was also detected more frequently in HIV-infected individuals compared to uninfected subjects. In the current study, we investigated further whether other genetic dopamine (DA)-related polymorphisms may be related with changes in CSF DA levels and frequency of HIV infection in HIV-infected subjects. Specifically, we studied genetic polymorphisms of brain-derived neurotrophic factor, catechol-O-methyltransferase, and dopamine receptors DRD2, DRD3, and DRD4 genetic polymorphisms in uninfected and HIV-infected people in two different ethnical groups, a German cohort (Caucasian, 72 individuals with HIV infection and 22 individuals without HIV infection) and a South African cohort (Xhosan, 54 individuals with HIV infection and 19 individuals without HIV infection). We correlated the polymorphisms with CSF DA levels, HIV dementia score, CD4(+) T cell counts, and HIV viral load. None of the investigated DA-related polymorphisms was associated with altered CSF DA levels, CD4(+) T cell count, viral load, and HIV dementia score. The respective allele frequencies were equally distributed between HIV-infected patients and controls. Our findings do not show any influence of the studied genetic polymorphisms on CSF DA levels and HIV infection. This is in contrast to what we found previously for the DAT 3'UTR VNTR and highlights the specific role of the DAT VNTR in HIV infection and disease.

  5. 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.

  6. Cold urticaria and HIV infection.

    PubMed

    Lin, R Y; Schwartz, R A

    1993-10-01

    Three patients, all seropositive for HIV antibody, complained of swelling and pruritus on the head and limbs when exposed to the cold. All three had received zidovudine for significant CD4 cell depletion, but had no AIDS-defining illnesses. An ice-cube test was positive on each individual. There was no evidence of cold agglutinins, cryoglobulins, syphilis, or other concurrent diseases in any of the patients. This association may represent yet another allergic manifestation in HIV infection.

  7. HIV infection of the penis

    PubMed Central

    Anderson, Deborah; Politch, Joseph A.; Pudney, Jeffrey

    2010-01-01

    The penile foreskin, shaft, glans/corona, meatus and urethral introitus are all potential sites of HIV-1 acquisition in men. Circumcision decreases HIV infection in heterosexual men by 50–60%, indicating that the foreskin plays an important role, but that other sites are also involved. HIV target cells have been described throughout the male genital epithelium, but appear to be more accessible in the inner foreskin and urethral introitus, both of which are mucosal (wet) epithelia and infectable with HIV in vitro. Sexually transmitted co-infections can increase the risk of HIV infection at these and other sites by eroding the protective epithelial layer and by attracting and activating HIV target cells in the mucosal epithelium. The moist subpreputial cavity hosts a unique microbiome that may also play a role in HIV infection. Both innate and adaptive immune defense mechanisms are operative in the lower male genital region. The penile urethral mucosa contains accumulations of IgA+ plasma cells and T lymphocytes, and may provide a responsive target for future mucosal vaccines to prevent HIV sexual transmission. PMID:21214659

  8. Pharmacotherapy of Pediatric HIV Infection

    PubMed Central

    Rakhmanina, Natella; Phelps, Ryan

    2012-01-01

    SYNOPSIS With the ongoing epidemic of human immune deficiency virus (HIV) infections in the pediatric age group, the delivery of safe and effective antiretroviral therapy to children and adolescents is crucial to save the lives of millions of children worldwide. Antiretroviral drugs have been demonstrated to significantly decrease HIV-associated morbidity and mortality, assure normal growth and development, and improve survival and quality of life in children and adolescents. The immunologic response to HIV infection is closely related to the child’s development and creates age specific parameters for the evaluation of therapeutic response to antiretroviral therapy in pediatric HIV disease. In addition to the changes in immunological response to HIV infection, the development and maturation of organ systems involved in drug absorption, distribution, metabolism, and elimination determines significant changes in the pharmacokinetics of antiretroviral drugs throughout the childhood. Multiple factors including age-specific adherence barriers, changes in social and economical surroundings, and psychological and sexual maturation affect the choices and outcomes of the treatment of pediatric HIV disease. In this chapter we will review the evolution of antiretroviral treatment from early infancy through adolescence. PMID:23036246

  9. 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).

  10. Does water hyacinth on East African lakes promote cholera outbreaks?

    PubMed

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

    2010-08-01

    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.

  11. 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

  12. 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

  13. Vitamin D in HIV-Infected Patients

    PubMed Central

    JE, Lake; JS, Adams

    2013-01-01

    Observational studies have noted very high rates of low 25(OH)D (vitamin D) levels in both the general and HIV-infected populations. In HIV-infected patients, low 25(OH)D levels are likely a combination of both traditional risk factors and HIV- and antiretroviral therapy-specific contributors. Because of this unique risk profile, HIV-infected persons may be at greater risk for low 25(OH)D levels and frank deficiency and/or may respond to standard repletion regimens differently than HIV-uninfected patients. Currently, the optimal repletion and maintenance dosing regimens for HIV-infected patients remain unknown, as do potential benefits of supplementation that may be unique to the HIV-infected population. This paper reviews data published on HIV infection and vitamin D health in adults over the last year. PMID:21647555

  14. Dental management of HIV-infected individuals.

    PubMed

    Aldous, J A

    1990-11-01

    In 1981, a group of male homosexuals was found to have an immunological defect resulting in opportunistic infections. The pattern of symptoms became known as acquired immune deficiency syndrome (AIDS). Much time and expense have been invested to study the human immunodeficiency virus (HIV), prevent its spread, and find a cure for HIV infection. Fear of HIV infection has resulted in implementation of stricter infection control practices. Intervention by the Occupational Safety and Health Administration (OSHA) and Environmental Protection Agency (EPA) has mandated procedures for infection control and waste disposal. Ethical questions and social problems have surfaced concerning the treatment of HIV-infected patients. Despite reports on infection control, literature concerning management of HIV-infected dental patients is limited. Misinformation has prevented the application of reliable information about the care of HIV-infected individuals. An accurate general knowledge of HIV infection is essential for optimal care of these patients.

  15. Views and experiences of healthcare professionals towards the use of African traditional, complementary and alternative medicines among patients with HIV infection: the case of eThekwini health district, South Africa.

    PubMed

    Nlooto, Manimbulu

    2015-06-06

    Many patients with human immunodeficiency virus infection use traditional, complementary, and alternative medicines and other practices to combat the disease, with some also using prescribed antiretroviral therapy provided by the public health sector. This study aimed to establish the awareness of public sector biomedical health care providers on the use of traditional, complementary and alternative medicines by HIV-infected patients who also used highly active antiretroviral therapy, and to determine whether this was based on patients seen or cases being reported to them. Potential risks of interactions between the prescribed antiretroviral and non-prescribed medication therapies may pose safety and effectiveness issues in patients using both types of treatment. A descriptive cross-sectional study, using a researcher administered semi-structured questionnaire, was conducted from June to August 2013 at ten public sector antiretroviral clinics in five regional, three specialised and two district hospitals in eThekwini Health District, South Africa. Questionnaires were administered through face-to face interview to 120 eligible participants consisting of doctors, nurses, pharmacists and post-basic pharmacist assistants in HIV clinical practice. The results are presented as percent or proportion with standard error (SE), or as frequency. Ninety-four respondents completed the questionnaire, yielding a response rate of 78.3 %. Almost half (48/94) were aware of patients using African traditional herbal medicines, over-the-counter supplements, unnamed complementary Ayurveda medicines and acupuncture. Twenty-three of the 94 respondents (24.4 %) said they had consulted patients who were using both antiretroviral therapy and certain types of non-prescribed medication in the previous three months. Awareness among healthcare providers on patient use of traditional, complementary and alternative medicines was relatively high. Few respondents had seen patients who used mostly

  16. Cholesterol Is Associated with the Presence of a Lipid Core in Carotid Plaque of Asymptomatic, Young-to-Middle-Aged African Americans with and without HIV Infection and Cocaine Use Residing in Inner-City Baltimore, Md., USA

    PubMed Central

    Du, Jiefu; Wasserman, Bruce A.; Tong, Weijing; Chen, Shaoguang; Lai, Shenghan; Malhotra, Saurabh; Lai, Hong

    2012-01-01

    HIV positive. Among the factors investigated, including age, sex, blood pressure, cigarette smoking, C-reactive protein, fasting glucose, triglycerides, serum total cholesterol, coronary calcium, cocaine use, and HIV infection, only total cholesterol was significantly associated with the presence of a lipid core. Conclusions This study revealed an unexpectedly high rate of the presence of lipid core in carotid plaque and highlights the importance of cholesterol lowering to prevent cerebrovascular disease in this population. Further population-based studies are warranted to confirm these results. PMID:22327293

  17. Cholesterol is associated with the presence of a lipid core in carotid plaque of asymptomatic, young-to-middle-aged African Americans with and without HIV infection and cocaine use residing in inner-city Baltimore, Md., USA.

    PubMed

    Du, Jiefu; Wasserman, Bruce A; Tong, Weijing; Chen, Shaoguang; Lai, Shenghan; Malhotra, Saurabh; Lai, Hong

    2012-01-01

    factors investigated, including age, sex, blood pressure, cigarette smoking, C-reactive protein, fasting glucose, triglycerides, serum total cholesterol, coronary calcium, cocaine use, and HIV infection, only total cholesterol was significantly associated with the presence of a lipid core. This study revealed an unexpectedly high rate of the presence of lipid core in carotid plaque and highlights the importance of cholesterol lowering to prevent cerebrovascular disease in this population. Further population-based studies are warranted to confirm these results. Copyright © 2012 S. Karger AG, Basel.

  18. 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

  19. 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

  20. Vaccination in HIV-Infected Adults

    PubMed Central

    Wallace, Mark R.

    2014-01-01

    Abstract Vaccines are critical components for protecting HIV-infected adults from an increasing number of preventable diseases. However, missed opportunities for vaccination among HIV-infected persons persist, likely due to concerns regarding the safety and efficacy of vaccines, as well as the changing nature of vaccine guidelines. In addition, the optimal timing of vaccination among HIV-infected adults in regards to HIV stage and receipt of antiretroviral therapy remain important questions. This article provides a review of the current recommendations regarding vaccines among HIV-infected adults and a comprehensive summary of the evidence-based literature of the benefits and risks of vaccines among this vulnerable population. PMID:25029589

  1. 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).

  2. Mitochondrial DNA Haplogroups and Neurocognitive Impairment During HIV Infection

    PubMed Central

    Hulgan, Todd; Samuels, David C.; Bush, William; Ellis, Ronald J.; Letendre, Scott L.; Heaton, Robert K.; Franklin, Donald R.; Straub, Peter; Murdock, Deborah G.; Clifford, David B.; Collier, Ann C.; Gelman, Benjamin B.; Marra, Christina M.; McArthur, Justin C.; McCutchan, J. Allen; Morgello, Susan; Simpson, David M.; Grant, Igor; Kallianpur, Asha R.

    2015-01-01

    Background. Neurocognitive impairment (NCI) remains an important complication in persons infected with human immunodeficiency virus (HIV). Ancestry-related mitochondrial DNA (mtDNA) haplogroups have been associated with outcomes of HIV infection and combination antiretroviral therapy (CART), and with neurodegenerative diseases. We hypothesize that mtDNA haplogroups are associated with NCI in HIV-infected adults and performed a genetic association study in the CNS HIV Antiretroviral Therapy Effects Research (CHARTER) cohort. Methods. CHARTER is an observational study of ambulatory HIV-infected adults. Haplogroups were assigned using mtDNA sequence, and principal components were derived from ancestry-informative nuclear DNA variants. Outcomes were cross-sectional global deficit score (GDS) as a continuous measure, GDS impairment (GDS ≥ 0.50), and HIV-associated neurocognitive disorder (HAND) using international criteria. Multivariable models were adjusted for comorbidity status (incidental vs contributing), current CART, plasma HIV RNA, reading ability, and CD4 cell nadir. Results. Haplogroups were available from 1027 persons; median age 43 years, median CD4 nadir 178 cells/mm3, 72% on CART, and 46% with HAND. The 102 (9.9%) persons of genetically determined admixed Hispanic ancestry had more impairment by GDS or HAND than persons of European or African ancestry (P < .001 for all). In multivariate models including persons of admixed Hispanic ancestry, those with haplogroup B had lower GDS (β = −0.34; P = .008) and less GDS impairment (odds ratio = 0.16; 95% confidence interval, .04, .63; P = .009) than other haplogroups. There were no significant haplogroup associations among persons of European or African ancestry. Conclusions. In these mostly CART-treated persons, mtDNA haplogroup B was associated with less NCI among persons of genetically determined Hispanic ancestry. mtDNA variation may represent an ancestry-specific factor influencing NCI in HIV-infected

  3. Ocular manifestations of HIV infection.

    PubMed Central

    Jabs, D A

    1995-01-01

    OBJECTIVE: To evaluate the frequency of ocular complications and the clinical outcomes of these complications in patients with various stages of HIV infection. METHODS: Retrospective review of all HIV-infected patients seen in an AIDS ophthalmology clinic from November 1983 through December 31, 1992. RESULTS: Eleven-hundred sixty-three patients were seen for ophthalmologic evaluation. Of these, 781 had the acquired immune deficiency syndrome (AIDS), 226 had symptomatic HIV infection (AIDs-related complex [ARC]), and 156 had asymptomatic HIV infection. Non-infectious HIV retinopathy was the most common ocular complication, affecting 50% of the patients with AIDS, 34% of the patients with ARC, and 3% of the patients with asymptomatic HIV infection. Cytomegalovirus (CMV) retinitis was the most common opportunistic ocular infection, affecting 37% of the patients with AIDS. Other opportunistic ocular infections, including ocular toxoplasmosis, varicella zoster virus retinitis, and Pneumocystis choroidopathy were all much less common, each occurring in < or = 1% of the patients with AIDS. Treatment of CMV retinitis with either foscarnet or ganciclovir was successful in initially controlling the retinitis. However, relapse represented a significant problem and required frequent re-inductions. As a consequence of the retinal damage associated with relapse, loss of visual acuity occurred. The median time to a visual acuity of 20/200 or worse for all eyes with CMV retinitis was 13.4 months, and the median time to a visual acuity of 20/200 or worse in the better eye was 21.1 months. At last follow-up, 75% of the patients had a final visual acuity of 20/40 or better in at least one eye. Retinal detachments were a frequent ophthalmologic complication of CMV retinitis with a cumulative probability of a retinal detachment in at least one eye of 57% at 12 months after the diagnosis of CMV retinitis. Herpes zoster ophthalmicus developed in 3% of the overall series and was seen in

  4. Emerging landscape degradation trends in the East African Horn

    NASA Astrophysics Data System (ADS)

    Pricope, N. G.; Michaelsen, J.; Husak, G. J.; Funk, C. C.; Lopez-Carr, D.

    2012-12-01

    Increasing climate variability along with declining trends in rainfall represent major risk factors affecting food security in many regions of the world. We identify Africa-wide regions where significant rainfall decreases from 1979-2011 are coupled with significant human population density increases. The rangelands of the East African Horn remain one of the world's most food insecure regions with significantly increasing human populations predominantly dependent on pastoralist and agro-pastoralist livelihoods. Widespread vegetation degradation is occurring, adversely impacting fragile ecosystems and human livelihoods. Using MODIS land cover and normalized difference vegetation index (NDVI) data collected since 2000, we observe significant changes in vegetation patterns and productivity over the last decade across the East African Horn and demonstrate that these two products can be used concurrently at large spatial scales to monitor vegetation dynamics at decadal time scales. Results demonstrate that a near doubling of the population in pastoral regions is linked with hotspots of degradation in vegetation condition. The most significant land cover change and browning trends are observed in areas experiencing drying precipitation trends in addition to increasing population pressures. These findings have serious implications for current and future regional food security monitoring and forecasting and for mitigation and adaptation strategies in a region where population is expected to continue increasing against a backdrop of drying climate trends.Fig.1(a)Change in standardized precipitation index in Africa between 1979-2010 (b)Change in population density at continental scale using the GRUMPv1 1990 and 2000 and AfriPop 2010 population density datasets Fig.2 Land cover change trajectories based on 2001-2009 MOD12Q1 Land Cover product for the East African Horn overlaid over aggregated FEWS Net Livelihoods Zones.

  5. Prevalence of malnutrition among HIV-infected children in Central and West-African HIV-care programmes supported by the Growing Up Programme in 2011: a cross-sectional study.

    PubMed

    Jesson, Julie; Masson, David; Adonon, Arsène; Tran, Caroline; Habarugira, Capitoline; Zio, Réjane; Nicimpaye, Léoncie; Desmonde, Sophie; Serurakuba, Goreth; Kwayep, Rosine; Sare, Edith; Konate, Tiefing; Nimaga, Abdoulaye; Saina, Philemon; Kpade, Akossiwa; Bassuka, Andrée; Gougouyor, Gustave; Leroy, Valériane

    2015-05-26

    The burden of malnutrition among HIV-infected children is not well described in sub-Saharan Africa, even though it is an important problem to take into account to guarantee appropriate healthcare for these children. We assessed the prevalence of malnutrition and its associated factors among HIV-infected children in HIV care programmes in Central and West-Africa. A cross-sectional study was conducted from September to December 2011 among the active files of HIV-infected children aged 2-19 years old, enrolled in HIV-care programmes supported by the Sidaction Growing Up Programme in Benin, Burundi, Cameroon, Côte d'Ivoire, Mali, Chad and Togo. Socio-demographics characteristics, anthropometric, clinical data, and nutritional support were collected. Anthropometric indicators, expressed in Z-scores, were used to define malnutrition: Height-for-age (HAZ), Weight-for-Height (WHZ) for children < 5 years and BMI-for-age (BAZ) for children ≥5 years. Three types of malnutrition were defined: acute malnutrition (WHZ/BAZ < -2 SD and HAZ ≥ -2 SD), chronic malnutrition (HAZ < -2 SD and WHZ/BAZ ≥ -2 SD) and mixed malnutrition (WHZ/BAZ < -2 SD and HAZ < -2 SD). A multinomial logistic regression model explored associated factors with each type of malnutrition. Overall, 1350 HIV-infected children were included; their median age was 10 years (interquartile range [IQR]: 7-13 years), 49 % were girls. 80 % were on antiretroviral treatment (ART), for a median time of 36 months. The prevalence of malnutrition was 42 % (95 % confidence interval [95% CI]: 40-44 %) with acute, chronic and mixed malnutrition at 9 % (95% CI: 6-12 %), 26 % (95% CI: 23-28 %), and 7 % (95% CI: 5-10 %), respectively. Among those malnourished, more than half of children didn't receive any nutritional support at the time of the survey. Acute malnutrition was associated with male gender, severe immunodeficiency, and the absence of ART; chronic malnutrition with male gender and age (<5

  6. 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.

  7. [Stroke in HIV-infected patients].

    PubMed

    Lino, Ireneia; Sousa, António; Correia, José

    2007-01-01

    The spectrum of human immunodeficiency virus infection (HIV) is changing. New drug treatments have reduced morbidity and mortality of this disease, therefore it is necessary to start treating the HIV infection as a chronical disease. The association of the stroke with the HIV infection was inicially thought to be a result of other opportunistic infeccions and tumors. However, the vascular disease associated with HIV infection has been a subject of research and debate. New evidence shows that the vascular diseases could be a threat for the pacients doing highly active antirretroviral therapy (HAART). In this paper, we review the association between the HIV infection and stroke. Furthermore, we have done an analysis of the risk for the stroke on pacients with HIV infection considering the changes of the infection spectrum by the introduction of HAART.

  8. Morphine Enhances HIV Infection of Neonatal Macrophages

    PubMed Central

    Li, Yuan; Merrill, Jeffrey D.; Mooney, Kathy; Song, Li; Wang, Xu; Guo, Chang-Jiang; Savani, Rashmin C.; Metzger, David S.; Douglas, Steven D.; Ho, Wen-Zhe

    2014-01-01

    Perinatal transmission of HIV accounts for almost all new HIV infections in children. There is an increased risk of perinatal transmission of HIV with maternal illicit substance abuse. Little is known about neonatal immune system alteration and subsequent susceptibility to HIV infection after morphine exposure. We investigated the effects of morphine on HIV infection of neonatal monocyte-derived macrophages (MDM). Morphine significantly enhanced HIV infection of neonatal MDM. Morphine-induced HIV replication in neonatal MDM was completely suppressed by naltrexone, the opioid receptor antagonist. Morphine significantly up-regulated CCR5 receptor expression and inhibited the endogenous production of macrophage inflammatory protein-1β in neonatal MDM. Thus, morphine, most likely through alteration of β-chemokines and CCR5 receptor expression, enhances the susceptibility of neonatal MDM to HIV infection, and may have a cofactor role in perinatal HIV transmission and infection. PMID:12736382

  9. Screening for Cervical Cancer and Sexually Transmitted Diseases Among HIV-Infected Women

    PubMed Central

    Frazier, Emma L.; Sutton, Madeline Y.; Tie, Yunfeng; McNaghten, A.D.; Blair, Janet M.; Skarbinski, Jacek

    2017-01-01

    Background Women living with HIV infection are at higher risk for cervical cancer, an AIDS-defining diagnosis. We examined the prevalence of cervical cancer and sexually transmitted disease (STD) screening among human immunodeficiency virus (HIV)-infected women and factors associated with the receipt of Papanicolaou (Pap) tests. Methods We did a cross-sectional analysis of weighted data from a sample of HIV-infected adults receiving outpatient medical care. We used matched interview (report of Pap test) and medical record data (STD screenings) from HIV-infected women. We performed logistic regression to compute adjusted prevalence ratios and 95% confidence intervals for the association between demographic, behavioral, and clinical factors and receipt of Pap tests among HIV-infected women. Results Data were available for 2,270 women, who represent 112,894 HIV-infected women; 62% were African American, 17% were Hispanic/Latina, and 18% were white. Most (78%) reported having a Pap test in the past year. Among sexually active women (n= 1234), 20% reported sex without condoms, 27% were screened for gonorrhea, and 29% were screened for chlamydia. Being screened for STDs was less likely among women who did not have a Pap test in the past year (adjusted prevalence ratios 0.82, 95% confidence interval 0.77–0.87). Women who were ≥50 years of age and reported income above federal poverty level, no sexual activity, depression, no HIV care from an obstetrician/gynecologist, and no documented STD tests, were less likely to report a Pap test (p < 0.05). Conclusions Screening for cervical cancer and STDs among HIV-infected women is suboptimal. Clinical visits for Pap tests are an important opportunity for HIV-infected sexually active women to also receive STD screenings and counseling regarding condoms. PMID:26447835

  10. Review of cytomegalovirus coinfection in HIV-infected individuals in Africa.

    PubMed

    Grønborg, Helene Ladefoged; Jespersen, Sanne; Hønge, Bo Langhoff; Jensen-Fangel, Søren; Wejse, Christian

    2017-01-01

    Cytomegalovirus (CMV) infection among HIV-infected individuals may cause end-organ disease, which is an AIDS-defining condition. Evidence from high-income countries suggests that CMV may alter the outcome of HIV infection, other than causing end-organ diseases. We reviewed literature on HIV and CMV coinfection in Africa. Systematic review of published studies on HIV and CMV coinfection in Africa using the PubMed database. High CMV seroprevalence was found throughout Africa, exceeding 90% in most populations. Retinitis, pneumonia, and colitis were the most commonly reported CMV manifestations in HIV-infected individuals. Among patients with pulmonary symptoms, the prevalence of CMV pneumonitis varied from 20% to over 60%, whereas CMV was found in 0% to 14% of patients with gastrointestinal manifestations. Cytomegalovirus retinitis was found in 0% to 2.6% of examined HIV-infected individuals. The diagnostics of CMV end-organ diseases were found complex and difficult to interpret in African settings. Cytomegalovirus viremia was correlated with significantly lower CD4 cell count and increase in activated and apoptosis vulnerable T-lymphocytes. Also, CMV coinfection was found to be associated with increased transmission and progression of HIV infection. Moreover, detectable CMV DNA was an independent predictor of HIV transmission and mortality among HIV-infected individuals. Cytomegalovirus is highly prevalent in Africa and a common cause of disease manifestations in HIV-infected individuals among all age groups. Cytomegalovirus coinfection in HIV-infected individuals in Africa is associated with increased transmission and mortality of HIV, but it is a neglected area of research. Copyright © 2016 John Wiley & Sons, Ltd.

  11. Screening for Cervical Cancer and Sexually Transmitted Diseases Among HIV-Infected Women.

    PubMed

    Frazier, Emma L; Sutton, Madeline Y; Tie, Yunfeng; McNaghten, A D; Blair, Janet M; Skarbinski, Jacek

    2016-02-01

    Women living with HIV infection are at higher risk for cervical cancer, an AIDS-defining diagnosis. We examined the prevalence of cervical cancer and sexually transmitted disease (STD) screening among human immunodeficiency virus (HIV)-infected women and factors associated with the receipt of Papanicolaou (Pap) tests. We did a cross-sectional analysis of weighted data from a sample of HIV-infected adults receiving outpatient medical care. We used matched interview (report of Pap test) and medical record data (STD screenings) from HIV-infected women. We performed logistic regression to compute adjusted prevalence ratios and 95% confidence intervals for the association between demographic, behavioral, and clinical factors and receipt of Pap tests among HIV-infected women. Data were available for 2,270 women, who represent 112,894 HIV-infected women; 62% were African American, 17% were Hispanic/Latina, and 18% were white. Most (78%) reported having a Pap test in the past year. Among sexually active women (n = 1234), 20% reported sex without condoms, 27% were screened for gonorrhea, and 29% were screened for chlamydia. Being screened for STDs was less likely among women who did not have a Pap test in the past year (adjusted prevalence ratios 0.82, 95% confidence interval 0.77-0.87). Women who were ≥50 years of age and reported income above federal poverty level, no sexual activity, depression, no HIV care from an obstetrician/gynecologist, and no documented STD tests, were less likely to report a Pap test (p < 0.05). Screening for cervical cancer and STDs among HIV-infected women is suboptimal. Clinical visits for Pap tests are an important opportunity for HIV-infected sexually active women to also receive STD screenings and counseling regarding condoms.

  12. The innovative and collective capacity of low-income East African women in the era of HIV/AIDS: contesting western notions of African Women.

    PubMed

    Mkandawire-Valhmu, Lucy; Kako, Peninnah; Kibicho, Jennifer; Stevens, Patricia E

    2013-01-01

    Historically, African women have been viewed through a colonizing and Eurocentric lens emphasizing poverty, oppression, and suffering. A postcolonial, feminist approach to our two qualitative studies with human immunodeficiency virus (HIV)-infected women in Malawi and Kenya led us to depart from this discourse, highlighting women's capacity. Through this article, not only is a forum created for African women's voices to be heard as subaltern knowledge leading to transformational change, but also health care providers are made aware, through women's words, of how they might capitalize on grassroots women's movements, particularly in resource-poor communities, to implement effective HIV prevention and treatment strategies.

  13. 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.

  14. Structure of some East African Glossina fuscipes fuscipes populations

    PubMed Central

    Krafsur, E. S.; Marquez, J. G.; Ouma, J. O.

    2008-01-01

    Glossina fuscipes fuscipes Newstead 1910 (Diptera: Glossinidae) is the primary vector of human sleeping sickness in Kenya and Uganda. This is the first report on its population structure. A total of 688 nucleotides of mitochondrial ribosomal 16S2 and cytochrome oxidase I genes were sequenced. Twenty-one variants were scored in 79 flies from three geographically diverse natural populations. Four haplotypes were shared among populations, eight were private and nine were singletons. The mean haplotype and nucleotide diversities were 0.84 and 0.009, respectively. All populations were genetically differentiated and were at demographic equilibrium. In addition, a longstanding laboratory culture originating from the Central African Republic (CAR-lab) in 1986 (or before) was examined. Haplotype and nucleotide diversities in this culture were 0.95 and 0.012, respectively. None of its 27 haplotypes were shared with the East African populations. A first approximation of relative effective population sizes was Uganda > CAR-lab > Kenya. It was concluded that the structure of G. f. fuscipes populations in East Africa is localized. PMID:18816270

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

    USDA-ARS?s Scientific Manuscript database

    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...

  16. 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

  17. 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; 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.

  18. Energy expenditure in HIV infection.

    PubMed

    Kosmiski, Lisa

    2011-12-01

    Energy intake recommendations for adults should be based preferably on direct measurements of total daily energy expenditure (TDEE) in corresponding populations who are maintaining healthy body weight and satisfactory physical activity levels. During adolescence, pregnancy, and lactation, energy requirements should be based on TDEE plus the additional energy required to advance these physiologic states. With illness, energy expenditure and energy intake change, but nutritional intervention is not necessarily beneficial. This article reviews data on energy expenditure in HIV infection with a focus on adults, adolescents aged ≥14 y, and pregnant and lactating women. Resting energy expenditure (REE) in adults with untreated asymptomatic HIV is ~ 10% higher than in healthy control subjects. In asymptomatic adults receiving antiretroviral therapy, REE may be similarly increased. HIV wasting and secondary infections are also associated with increased REE. In contrast, TDEE is typically normal in asymptomatic HIV and decreased in HIV wasting and secondary infection. No direct measurements of REE or TDEE are available in adolescents or in pregnant or lactating women with HIV. On the basis of current data, energy intake may need to increase by ~ 10% in adults with asymptomatic HIV to maintain body weight. In adolescents and in pregnant and lactating women with asymptomatic HIV, energy requirements should approximate recommendations for their uninfected counterparts until further data are available. In the resource-rich world, the energy expenditure changes associated with HIV are unlikely to contribute to significant weight loss. More data are needed on energy expenditure in HIV-infected populations from developing nations, where concurrent malnutrition and coinfections are common.

  19. Pharmacotherapy of pediatric and adolescent HIV infection

    PubMed Central

    Schuval, Susan J

    2009-01-01

    Significant advances have been made in the treatment of human immunodeficiency virus (HIV) infection over the past two decades. Improved therapy has prolonged survival and improved clinical outcome for HIV-infected children and adults. Sixteen antiretroviral (ART) medications have been approved for use in pediatric HIV infection. The Department of Health and Human Services (DHHS) has issued “Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection”, which provide detailed information on currently recommended antiretroviral therapies (ART). However, consultation with an HIV specialist is recommended as the current therapy of pediatric HIV therapy is complex and rapidly evolving. PMID:19707256

  20. 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.

  1. 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…

  2. 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…

  3. East African weathering dynamics controlled by vegetation-climate feedbacks

    USGS Publications Warehouse

    Ivory, Sarah J.; McGlue, Michael M.; Ellis, Geoffrey S.; Boehlke, Adam; Lézine, Anne-Marie; Vincens, Annie; Cohen, Andrew S.

    2017-01-01

    Tropical weathering has important linkages to global biogeochemistry and landscape evolution in the East African rift. We disentangle the influences of climate and terrestrial vegetation on chemical weathering intensity and erosion at Lake Malawi using a long sediment record. Fossil pollen, microcharcoal, particle size, and mineralogy data affirm that the detrital clays accumulating in deep water within the lake are controlled by feedbacks between climate and hinterland forest composition. Particle-size patterns are also best explained by vegetation, through feedbacks with lake levels, wildfires, and erosion. We develop a new source-to-sink framework that links lacustrine sedimentation to hinterland vegetation in tropical rifts. Our analysis suggests that climate-vegetation interactions and their coupling to weathering/erosion could threaten future food security and has implications for accurately predicting petroleum play elements in continental rift basins.

  4. Cognitive Deficits in HIV Infected Children

    PubMed Central

    Ravindran, O. S.; Rani, Mrudula P.; Priya, G.

    2014-01-01

    Background and Objectives: Children infected with HIV are at risk for significant neurological and neuropsychological problems. This study is aimed at identifying cognitive deficits in HIV-infected children and to compare them with equal number of normal controls. Materials and Methods: Twenty children with HIV infection who are currently on antiretroviral therapy were recruited. They were assessed for their intelligence using Malin's Intelligence Scale for Indian Children and also evaluated for their cognitive abilities with a comprehensive neuropsychological battery. They were matched with equal number of normal controls. Results: HIV-infected children have shown substantial impairments in the domains of attention, language, verbal learning and memory, visuomotor functions, fine motor performance, and executive functions. Conclusion: HIV-infected children have average intelligence, but they performed poorly on several neuropsychological measures. PMID:25035547

  5. 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? ...

  6. Hantavirus Strains in East Africa Related to Western African Hantaviruses.

    PubMed

    Těšíková, Jana; Bryjová, Anna; Bryja, Josef; Lavrenchenko, Leonid A; Goüy de Bellocq, Joëlle

    2017-04-01

    Hantaviruses are RNA viruses primarily carried by rodents, soricomorphs, and bats. The data about the distribution and genetic diversity of these viruses are often limited, especially in most regions of sub-Saharan Africa. Moreover, the majority of representatives were identified in western African localities, while only three hantaviruses have been reported in East Africa to date. In this study, a total of 1866 small mammals captured between 2009 and 2014 in various countries of Eastern Africa (Ethiopia, Zambia, Mozambique, Kenya, and Tanzania) were molecularly screened for the presence of hantaviruses. Hantavirus RNA was detected in dried blood samples of the Cape pipistrelle bat (Neoromicia capensis) captured in Ethiopia and the African wood mouse (Hylomyscus endorobae) from Kenya. Phylogenetic analysis of partial genomic segments revealed that the Ethiopian sample represents a sister lineage of the Mouyassué virus (reported previously from the congeneric bat in Côte d'Ivoire), and the Kenyan sample is a sister lineage of the Sangassou virus (described from the same mouse genus in Guinea).

  7. Indian Ocean Dipole drives malaria resurgence in East African highlands.

    PubMed

    Hashizume, Masahiro; Chaves, Luis Fernando; Minakawa, Noboru

    2012-01-01

    Malaria resurgence in African highlands in the 1990s has raised questions about the underlying drivers of the increase in disease incidence including the role of El-Niño-Southern Oscillation (ENSO). However, climatic anomalies other than the ENSO are clearly associated with malaria outbreaks in the highlands. Here we show that the Indian Ocean Dipole (IOD), a coupled ocean-atmosphere interaction in the Indian Ocean, affected highland malaria re-emergence. Using cross-wavelet coherence analysis, we found four-year long coherent cycles between the malaria time series and the dipole mode index (DMI) in the 1990s in three highland localities. Conversely, we found a less pronounced coherence between malaria and DMI in lowland localities. The highland/lowland contrast can be explained by the effects of mesoscale systems generated by Lake Victoria on its climate basin. Our results support the need to consider IOD as a driving force in the resurgence of malaria in the East African highlands.

  8. 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.

  9. 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

  10. 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

  11. 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.

  12. 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

  13. Cardiovascular manifestations of HIV infection in children.

    PubMed

    Idris, Nikmah S; Grobbee, Diederick E; Burgner, David; Cheung, Michael M H; Kurniati, Nia; Sastroasmoro, Sudigdo; Uiterwaal, Cuno S P M

    2015-11-01

    HIV infection in children is now considered as a chronic condition, in which various non-infectious complications may occur, including those affecting the developing cardiovascular system. As children are expected to survive well into adulthood, understanding childhood as well as potential future cardiovascular complications is of major importance. We reviewed published literature on childhood cardiac manifestations and longer term effects of pediatric HIV infection on the cardiovascular system. Evidence gaps that should be prioritized in research are highlighted. Through poorly understood mechanisms, HIV infection may cause various cardiac complications already manifesting in childhood, such as structural and functional myocardial derangements, pulmonary hypertension, pericardial effusion and possibly endocarditis. Evidence indicates that HIV infection in children also has unfavorable effects on the vasculature and cardiovascular biomarkers, such as increased intima-media thickness and decreased flow-mediated dilation, a marker of endothelial function. However, studies are small and predominantly include antiretroviral therapy-treated children, so that it is difficult to differentiate between effects of HIV infection per se and antiretroviral therapy treatment, reported in adults to have cardiovascular side effects. HIV infection in children may greatly impact the cardiovascular system, including effects on the heart, which tend to manifest early in childhood, and on the vasculature. The underlying mechanisms, essential for targeted prevention, are poorly understood. Current evidence largely stems from research in adults. However, as modes of infection, immune maturity, growth and development, and treatment are markedly different in children, specific pediatric research, accounting for the complex interplay of normal growth and development, HIV infection and treatment, is clearly warranted. © The European Society of Cardiology 2014 Reprints and permissions

  14. Shaded Relief with Height as Color, Virunga and Nyiragongo Volcanoes and the East African Rift Valley

    NASA Image and Video Library

    2002-07-11

    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.

  15. 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

  16. CCR5 and HIV infection.

    PubMed

    Blanpain, Cédric; Libert, Frédérick; Vassart, Gilbert; Parmentier, Marc

    2002-01-01

    Chemokines and chemokine receptors play a crucial role in the trafficking of leukocyte populations across the body, and are involved in the development of a large variety of human diseases. CCR5 is the main coreceptor used by macrophage (M)-tropic strains of human immunodeficiency virus type 1 (HIV-1) and HIV-2, which are responsible for viral transmission. CCR5 therefore plays an essential role in HIV pathogenesis. A number of inflammatory CC-chemokines, including MIP-1 alpha, MIP-1 beta, RANTES, MCP-2, and HCC-1[9-74] act as CCR5 agonists, while MCP-3 is a natural antagonist of the receptor. CCR5 is mainly expressed in memory T-cells, macrophages, and immature dendritic cells, and is upregulated by proinflammatory cytokines. It is coupled to the Gi class of heterotrimeric G-proteins, and inhibits cAMP production, stimulates Ca2+ release, and activates PI3-kinase and MAP kinases, as well as other tyrosine kinase cascades. A mutant allele of CCR5, CCR5 delta 32 is frequent in populations of European origin, and encodes a nonfunctional truncated protein that is not transported to the cell surface. Homozygotes for the delta 32 allele exhibit a strong, although incomplete, resistance to HIV infection, whereas heterozygotes display delayed progression to acquired immunodeficiency syndrome (AIDS). Many other alleles, affecting the primary structure of CCR5 or its promoter have been described, some of which lead to nonfunctional receptors or otherwise influence AIDS progression. CCR5 is considered as a drug target in the field of HIV, but also in a growing number of inflammatory diseases. Modified chemokines, monoclonal antibodies and small chemical antagonists, as well as a number of gene therapy approaches have been developed in this frame.

  17. Geographic mapping of HIV infection among civilian applicants for United States military service.

    PubMed

    Bautista, Christian T; Sateren, Warren B; Sanchez, José L; Singer, Darrell E; Scott, Paul

    2008-09-01

    We assessed the geographic distribution of HIV infection among civilian applicants for US military service. High smoothed HIV prevalences were observed among white applicants in California, Texas, Florida, New York, and New Jersey, and among African-American applicants in New York, New Jersey, Connecticut, Massachusetts, Washington DC, North and South Carolina, Florida, and California. Three HIV spatial clusters were found among whites: New York/New Jersey, southern California, and in south and central Texas. Among African-Americans, three HIV spatial clusters were found: New York/New Jersey, Washington DC/Virginia, and south and central California. The South accounted for a significant proportion of HIV-infected African-American applicants.

  18. [Osteonecrosis in HIV-infected patients].

    PubMed

    Bottaro, Edgardo G; Figueroa, Raúl H; Scapellato, Pablo G; Vidal, Gabriela I; Rodriguez Brieschke, Maria T; Da Representaçao, Silvia; Seoane, Maria B; Laurido, Marcelo F; Caiafa, Diego; Lopardo, Gustavo; Herrera, Fabian; Cassetti, Isabel

    2004-01-01

    Osteonecrosis, also known as avascular necrosis, is chiefly characterized by death of bone caused by vascular compromise. The true incidence of osteonecrosis in HIV-infected patients is not well known and the pathogenesis remains undefined. Hypothetical risk factors peculiar to HIV-infected individuals that might play a role in the pathogenesis of osteonecrosis include the introduction of protease inhibitors and resulting hyperlipidemia, the presence of anticardiolipin antibodies in serum leading to a hypercoagulable state, immune recovery and vasculitis. Hereby we present a series of 13 HIV-infected patients with osteonecrosis. The most common symptom upon presentation was arthralgia. The majority of the patients had received steroids, 9 had developed hyperlipidemia after the introduction of HAART, 8 were smokers and 4 patients were alcoholics. In 2 patients, seric anticardiolipin antibodies were detected. Twelve patients had AIDS and were on HAART (11 were on protease inhibitors). We believe that osteonecrosis should be included as differential diagnosis of every HIV-infected patient who complains of pain of weight bearing joints. Likewise, it seems prudent to rule out HIV infection in subjects with osteonecrosis.

  19. Innate Sensing of HIV-Infected Cells

    PubMed Central

    Lepelley, Alice; Louis, Stéphanie; Sourisseau, Marion; Law, Helen K. W.; Pothlichet, Julien; Schilte, Clémentine; Chaperot, Laurence; Plumas, Joël; Randall, Richard E.; Si-Tahar, Mustapha; Mammano, Fabrizio; Albert, Matthew L.; Schwartz, Olivier

    2011-01-01

    Cell-free HIV-1 virions are poor stimulators of type I interferon (IFN) production. We examined here how HIV-infected cells are recognized by plasmacytoid dendritic cells (pDCs) and by other cells. We show that infected lymphocytes are more potent inducers of IFN than virions. There are target cell-type differences in the recognition of infected lymphocytes. In primary pDCs and pDC-like cells, recognition occurs in large part through TLR7, as demonstrated by the use of inhibitors and by TLR7 silencing. Donor cells expressing replication-defective viruses, carrying mutated reverse transcriptase, integrase or nucleocapsid proteins induced IFN production by target cells as potently as wild-type virus. In contrast, Env-deleted or fusion defective HIV-1 mutants were less efficient, suggesting that in addition to TLR7, cytoplasmic cellular sensors may also mediate sensing of infected cells. Furthermore, in a model of TLR7-negative cells, we demonstrate that the IRF3 pathway, through a process requiring access of incoming viral material to the cytoplasm, allows sensing of HIV-infected lymphocytes. Therefore, detection of HIV-infected lymphocytes occurs through both endosomal and cytoplasmic pathways. Characterization of the mechanisms of innate recognition of HIV-infected cells allows a better understanding of the pathogenic and exacerbated immunologic events associated with HIV infection. PMID:21379343

  20. [HIV infection--a sexually transmitted disease].

    PubMed

    Stapiński, A

    1989-01-01

    In the light of literature reports and own experiences and observations the most important epidemiological aspects of HIV infection acquired through sexual contacts are discussed, including the likelihood of infection during heterosexual or homosexual intercourse, factors increasing the infection risk in homosexuals intercourse and the more or less safe forms of sexual intercourse. The combination of HIV infections with infections with other sexually transmitted diseases is discussed on the basis of own observations which showed that HIV infection was acquired much more frequently by homosexuals treated in outpatient clinics for venereological diseases (19.7%) as compared to other homosexual groups (2.7%), and the risk was even lower in heterosexuals treated in these clinics for sexually transmitted diseases (0.2%). Over half the patients infected with HIV had or had had syphilis. HIV infection was sought for in Warsaw prostitutes, and 0.6% of them were found to be infected, two-thirds of the infected ones were drug addicted prostitutes. The importance of the sexual route of infection in drug addicts and transmission of this infection to the heterosexual population are considered. The principles of prophylaxis, the directions of health education, and the importance of screening for HIV infection prevention are considered. Attention is called to the harmful effects of all types of restriction of the infected people which lead to trials of infection concealment.

  1. Methamphetamine Enhances HIV Infection of Macrophages

    PubMed Central

    Liang, Hao; Wang, Xu; Chen, Hui; Song, Li; Ye, Li; Wang, Shi-Hong; Wang, Yan-Jian; Zhou, Lin; Ho, Wen-Zhe

    2008-01-01

    Epidemiological studies have demonstrated that the use of methamphetamine (meth), a sympathomimetic stimulant, is particularly common among patients infected with HIV. However, there is a lack of direct evidence that meth promotes HIV infection of target cells. This study examined whether meth is able to enhance HIV infection of macrophages, the primary target site for the virus. Meth treatment resulted in a significant and dose-dependent increase of HIV reverse transcriptase activity in human blood monocyte-derived macrophages. Dopamine D1 receptor antagonists (SCH23390 and SKF83566) blocked this meth-mediated increase in the HIV infectivity of macrophages. Investigation of the underlying mechanisms of meth action showed that meth up-regulated the expression of the HIV entry co-receptor CCR5 on macrophages. Additionally, meth inhibited the expression of endogenous interferon-α and signal transducer and activator of transcription-1 in macrophages. These findings provide direct in vitro evidence to support the possibility that meth may function as a cofactor in the immunopathogenesis of HIV infection and may lead to the future development of innate immunity-based intervention for meth users with HIV infection. PMID:18458095

  2. 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.

  3. Model, proxy and isotopic perspectives on the East African Humid Period

    NASA Astrophysics Data System (ADS)

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

    2011-07-01

    Both North and East Africa experienced more humid conditions during the early and mid-Holocene epoch (11,000-5000 yr 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 isotope-enabled 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.

  4. 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.

  5. 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

  6. Tectonic Evolution of Mozambique Ridge in East African continental margin

    NASA Astrophysics Data System (ADS)

    Tang, Yong

    2017-04-01

    Tectonic Evolution of Mozambique Ridge in East African continental margin Yong Tang He Li ES.Mahanjane Second Institute of Oceanography,SOA,Hangzhou The East Africa passive continental margin is a depression area, with widely distributed sedimentary wedges from southern Mozambique to northern Somali (>6500km in length, and about 6km in thickness). It was resulted from the separation of East Gondwana, and was developed by three stages: (1) rifting in Early-Middle Jurassic; (2) spreading from Late Jurassic to Early Cretaceous; (3) drifting since the Cretaceous period. Tectonic evolution of the Mozambique continental margin is distinguished by two main settings separated by a fossil transform, the Davie Fracture Zone; (i) rifting and transform setting in the northern margin related to opening of the Somali and Rovuma basins, and (ii) rifting and volcanism setting during the opening of the Mozambique basin in the southern margin. 2D reflection seismic investigation of the crustal structure in the Zambezi Delta Depression, provided key piece of evidence for two rifting phases between Africa and Antarctica. The magma-rich Rift I phase evolved from rift-rift-rift style with remarkable emplacement of dyke swarms (between 182 and 170 Ma). Related onshore outcrops are extensively studied, the Karoo volcanics in Mozambique, Zimbabwe and South Africa, all part of the Karoo "triple-junction". These igneous bodies flow and thicken eastwards and are now covered by up to 5 km of Cretaceous and Tertiary sediments and recorded by seismic and oil exploration wells. Geophysical and geological data recorded during oceanographic cruises provide very controversial results regarding the nature of the Mozambique Ridge. Two conflicting opinions remains open, since the early expeditions to the Indian Ocean, postulating that its character is either magmatic (oceanic) or continental origin. We have carried out an China-Mozambique Joint Cruise(CMJC) on southern Mozambique Basin on 1st June to

  7. 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.

  8. 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

  9. Present-day kinematics of the East African Rift

    NASA Astrophysics Data System (ADS)

    Saria, E.; Calais, E.; Stamps, D. S.; Delvaux, D.; Hartnady, C. J. H.

    2014-04-01

    The East African Rift (EAR) is a type locale for investigating the processes that drive continental rifting and breakup. The current kinematics of this ~5000 km long divergent plate boundary between the Nubia and Somalia plates is starting to be unraveled thanks to a recent augmentation of space geodetic data in Africa. Here we use a new data set combining episodic GPS measurements with continuous measurements on the Nubian, Somalian, and Antarctic plates, together with earthquake slip vector directions and geologic indicators along the Southwest Indian Ridge to update the present-day kinematics of the EAR. We use geological and seismological data to determine the main rift faults and solve for rigid block rotations while accounting for elastic strain accumulation on locked active faults. We find that the data are best fit with a model that includes three microplates embedded within the EAR, between Nubia and Somalia (Victoria, Rovuma, and Lwandle), consistent with previous findings but with slower extension rates. We find that earthquake slip vectors provide information that is consistent with the GPS velocities and helps to significantly reduce uncertainties of plate angular velocity estimates. We also find that 3.16 Myr MORVEL average spreading rates along the Southwest Indian Ridge are systematically faster than prediction from GPS data alone. This likely indicates that outward displacement along the SWIR is larger than the default value used in the MORVEL plate motion model.

  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.

  11. Innate immunity in resistance to HIV infection.

    PubMed

    Biasin, Mara; Clerici, Mario; Piacentini, Luca

    2010-11-01

    Resistance to human immunodeficiency virus (HIV) infection in subjects who do not seroconvert despite multiple exposures to the virus and to the progression to AIDS in HIV‐infected individuals depends on multiple factors involving both the innate and the adaptive immune system. The contribution of natural immunity in preventing HIV infection has so far received little attention, but many recently published articles suggest a key role for Toll‐like receptors, natural killer cells, interleukin‐22, acute‐phase amyloid A protein, and APOBEC3G in conferring resistance to HIV infection. The study of these factors will shed light on HIV pathogenesis and contribute to the development of new therapeutic approaches to this elusive disease.

  12. Antiretroviral Drugs Used in the Treatment of HIV Infection

    MedlinePlus

    ... Treatment Antiretroviral drugs used in the treatment of HIV infection Share Tweet Linkedin Pin it More sharing ... Email Print Drugs Used in the Treatment of HIV Infection Click on drug brand name for additional ...

  13. [Hepatitis A seroprevalence in HIV-infected patients].

    PubMed

    Rey, D; Frick-Michot, E; Partisani, M; Hess-Kempf, G; Cheneau, C; Priester, M; Bernard-Henry, C; de Mautort, E; Wendling, M J; Meyer, P; Lang, J M

    2005-01-01

    The authors had for aim to prospectively study the hepatitis A seroprevalence of an HIV-infected population, followed-up in an outpatient clinic (CISIH Strasbourg). Blood tests were performed on all patients from September 2003 to March 2004 to screen for hepatitis A (total antibodies with Elisa). The overall seroprevalence was 219/514 (56.6%), similar in male and female patients. It increased with age, especially in European patients (P = 0.003). The seroprevalence was lower in European subjects: 46.3% (while it reached 100% in sub-Saharan Africans), the prevalence was similar whatever the HIV risk group (46% in homosexual as well as in heterosexual patients, 44% in intravenous drug users). Hepatitis B or C co-infection did not increase the seroprevalence of hepatitis A. The hepatitis A seroprevalence was similar in various CD4 T cell count categories. Our results stress the utility of hepatitis A serology in HIV-infected patients (more than 50% of European patients are non immune), and the importance of assessing hepatitis A vaccination.

  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. Cancer Prevention in HIV-Infected Populations

    PubMed Central

    Goncalves, Priscila H.; Montezuma-Rusca, Jairo M.; Yarchoan, Robert; Uldrick, Thomas S.

    2016-01-01

    People living with human immunodeficiency virus (HIV) are living longer since the advent of effective combined antiretroviral therapy (cART). While cART substantially decreases the risk of developing some cancers, HIV-infected individuals remain at high risk for Kaposi sarcoma, lymphoma and several solid tumors. Currently HIV-infected patients represent an aging group, and malignancies have become a leading cause of morbidity and mortality. Tailored cancer-prevention strategies are needed for this population. In this review we describe the etiologic agents and pathogenesis of common malignancies in the setting of HIV, as well as current evidence for cancer prevention strategies and screening programs. PMID:26970136

  16. Cutaneous histoplasmosis disclosing an HIV-infection*

    PubMed Central

    Marques, Silvio Alencar; Silvares, Maria Regina Cavariani; de Camargo, Rosangela Maria Pires; Marques, Mariangela Esther Alencar

    2013-01-01

    Histoplasmosis is a systemic mycosis endemic in extensive areas of the Americas. The authors report on an urban adult male patient with uncommon oral-cutaneous lesions proven to be histoplasmosis. Additional investigation revealed unnoticed HIV infection with CD4+ cell count of 7/mm3. The treatment was performed with amphotericin B, a 2065 mg total dose followed by itraconazole 200mg/daily plus antiretroviral therapy with apparent cure. Histoplasmosis is an AIDS-defining opportunistic disease process; therefore, its clinical diagnosis must drive full laboratory investigation looking for unnoted HIV-infection. PMID:23793220

  17. Type 1 Diabetes Among East African Immigrant and Nonimmigrant Black Youth in the U.S.

    PubMed

    O'Connor, M Rebecca; Dobra, Adrian; Voss, Joachim; Pihoker, Catherine; Doorenbos, Ardith

    2015-01-01

    Type 1 diabetes has not previously been described in East African immigrant youth in the United States. The purpose of this study was to compare East African immigrant and nonimmigrant Black youth with type 1 diabetes. Among other clinical and demographic differences, estimated prevalence of type 1 diabetes was nearly four times higher among East African youth in King County, Washington (6.20/1000, 95% confidence interval (CI) [4.49, 7.91] vs. 1.56/1000, 95% CI [1.03, 2.09]) compared to nonimmigrant Black youth. These observations are lost within the Black/African American race classification and additional work is needed to confirm and further explore these findings.

  18. 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.

  19. 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.

  20. Renal pathology and HIV infection in Thailand.

    PubMed

    Praditpornsilpa, K; Napathorn, S; Yenrudi, S; Wankrairot, P; Tungsaga, K; Sitprija, V

    1999-02-01

    The existence of a human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) as a distinct disease entity characterized by glomerulosclerosis is well established in North America and Western Europe. Although the large number of HIV-infected cases overwhelm the Asian countries, no cases of HIVAN are documented in the literature. We studied 26 cases of HIV-infected Thai patients with proteinuria greater than 1.5 g/d of protein during 1995 and 1996. None of the patients were treated with antiretroviral drugs at the time of renal biopsy. Intravenous drug addiction and sexual transmission were risk factors in 11 and 15 patients, respectively. Pathological examinations were performed by light microscopic and immunoperoxidase study. Mesangial proliferative glomerulonephritis was found in 17 cases, immunoglobulin A (IgA) nephropathy in 2 cases, and diffuse proliferative glomerulonephritis and interstitial nephritis secondary to cryptococcal infection in 2 cases each. One case each had membranous glomerulopathy, membranoproliferative glomerulonephritis, and granulomatous interstitial nephritis secondary to tuberculosis. The renal pathological findings of HIVAN with the unique features described in previous literature were not evident in these patients. Although the data in this study are limited to 26 HIV-infected Thai patients, we believe that HIVAN is uncommon in the Asian HIV-infected population.

  1. Kaleidoscope of autoimmune diseases in HIV infection.

    PubMed

    Roszkiewicz, Justyna; Smolewska, Elzbieta

    2016-11-01

    Within the last 30 years, the human immunodeficiency virus (HIV) infection has changed its status from inevitably fatal to chronic disorder with limited impact on life span. However, this breakthrough was mainly the effect of introduction of the aggressive antiviral treatment, which has led to the clinically significant increase in CD4+ cell count, resulting in fewer cases of the acquired immunodeficiency syndrome (AIDS) and improved management of opportunistic infections occurring in the course of the disease. The occurrence of a particular autoimmune disease depends on degree of immunosuppression of the HIV-positive patient. In 2002, four stages of autoimmunity were proposed in patients infected by HIV, based on the absolute CD4+ cell count, feature of AIDS as well as on the presence of autoimmune diseases. Spectrum of autoimmune diseases associated with HIV infection seems to be unexpectedly wide, involving several organs, such as lungs (sarcoidosis), thyroid gland (Graves' disease), liver (autoimmune hepatitis), connective tissue (systemic lupus erythematosus, rheumatoid arthritis, polyarteritis nodosa and other types of vasculitis, antiphospholipid syndrome) or hematopoietic system (autoimmune cytopenias). This paper contains the state of art on possible coincidences between HIV infection and a differential types of autoimmune diseases, including the potential mechanisms of this phenomenon. As the clinical manifestations of autoimmunization often mimic those inscribed in the course of HIV infection, health care providers should be aware of this rare but potentially deadly association and actively seek for its symptoms in their patients.

  2. The Dilemmas of Childhood HIV Infection.

    ERIC Educational Resources Information Center

    Rudigier, Anne F.; And Others

    1990-01-01

    Increase in number of children infected with human immunodeficiency virus (HIV), and consequential developmental disabilities of these children are discussed. Families caring for HIV-infected children express four recurrent themes: psychological stress, grief and mourning, guilt and self-blame, and isolation and fear of discrimination. Flexible…

  3. Heroin dependence and HIV infection in Malaysia.

    PubMed

    Chawarski, Marek C; Mazlan, Mahmud; Schottenfeld, Richard S

    2006-04-01

    Malaysia is experiencing severe problems with heroin dependence and HIV infection. This, study evaluated drug use and other HIV risk behaviors and their association with HIV and other infectious diseases in heroin-dependent subjects enrolled in a clinical trial of drug abuse treatment in Muar, Malaysia. Baseline assessment of treatment-seeking subjects (n=177) included the Addiction Severity Index; AIDS Risk Inventory; serological tests for HIV, hepatitis B, and hepatitis C; and chest X-ray. All of the subjects were male; 67.8% were Malays, 28.8% Chinese, and 2.3%. Indian. Subjects had a mean (SD) age of 37.2 (9.1) years and 14.4 (8.5) years of using heroin; 76.3% reported lifetime injection drug use (IDU), and 41.5% reported current IDU; 30 of 156 (19.2%) tested HIV positive, 143 of 159 (89.9%) tested hepatitis C positive, and 25 of 159 (15.7%) had radiological evidence of pulmonary tuberbulosis. Malay subjects had a significantly higher prevalence of current IDU, needle sharing (p<0.01), and HIV infection (p<0.05) compared with Chinese subjects. Lifetime IDU, needle sharing, lack of consistent condom use, and Malay ethnicity were significantly associated with HIV infection. The high prevalence of HIV infection among heroin-dependent individuals, in Malaysia supports the important of interventions to reduce the major risk factors for HIV, including IDU, needle sharing, and unprotected sex.

  4. Pediatric HIV Infection and Developmental Disabilities.

    ERIC Educational Resources Information Center

    Seidel, John F.

    This paper presents an overview of the developmental disabilities associated with pediatric Human Immunodeficiency Virus (HIV) infection, and examines efficacious practices for assessment and intervention programming. The focus population is early childhood into school age. The paper describes the complex array of challenges presented by these…

  5. Cognitive function in early HIV infection.

    PubMed

    Prakash, Aanchal; Hou, Jue; Liu, Lei; Gao, Yi; Kettering, Casey; Ragin, Ann B

    2017-04-01

    This study aimed to examine cognitive function in acute/early HIV infection over the subsequent 2 years. Fifty-six HIV+ subjects and 21 seronegative participants of the Chicago Early HIV Infection Study were evaluated using a comprehensive neuropsychological assessment at study enrollment and at 2-year follow-up. Cognitive performance measures were compared in the groups using t tests and mixed-effect models. Patterns of relationship with clinical measures were determined between cognitive function and clinical status markers using Spearman's correlations. At the initial timepoint, the HIV group demonstrated significantly weaker performance on measures of verbal memory, visual memory, psychomotor speed, motor speed, and executive function. A similar pattern was found when cognitive function was examined at follow-up and across both timepoints. The HIV subjects had generally weaker performance on psychomotor speed, executive function, motor speed, visual memory, and verbal memory. The rate of decline in cognitive function across the 2-year follow-up period did not differ between groups. Correlations between clinical status markers and cognitive function at both timepoints showed weaker performance associated with increased disease burden. Neurocognitive difficulty in chronic HIV infection may have very early onset and reflect consequences of initial brain viral invasion and neuroinflammation during the intense, uncontrolled viremia of acute HIV infection. Further characterization of the changes occurring in initial stages of infection and the risk and protective factors for cognitive function could inform new strategies for neuroprotection.

  6. 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…

  7. Liver transplantation in HIV-infected recipients.

    PubMed

    Roland, Michelle E; Stock, Peter G

    2006-08-01

    Although human immunodeficiency virus (HIV)-infected patients are living longer and dying less often from complications related to acquired immunodeficiency syndrome (AIDS), they are experiencing significant morbidity and mortality related to end-stage liver disease. Advances in the management of HIV disease have made it difficult to continue denying transplantation to this population based upon futility arguments alone. Patient and graft survival rates in HIV-infected study subjects appear similar to those in large transplant databases. There are no reports suggesting significant HIV disease progression. There are substantial interactions between immunosuppressants and antiretroviral drugs that require careful monitoring and dose adjustment. The evaluation and management of HIV-infected transplant candidates and recipients require excellent communication among a multidisciplinary team and the primary HIV care provider. It is critical that HIV clinicians and hepatologists are aware that liver transplantation is an option for HIV-infected patients at many transplant centers as delays in referral result in unnecessary mortality during the pretransplantation evaluation process.

  8. 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

  9. Children who acquire HIV infection perinatally are at higher risk of early death than those acquiring infection through breastmilk: a meta-analysis.

    PubMed

    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

    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. 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). 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.

  10. Estimated Perinatal HIV Infection Among Infants Born in the United States, 2002-2013.

    PubMed

    Taylor, Allan W; Nesheim, Steven R; Zhang, Xinjian; Song, Ruiguang; FitzHarris, Lauren F; Lampe, Margaret A; Weidle, Paul J; Sweeney, Patricia

    2017-05-01

    Perinatal transmission of human immunodeficiency virus (HIV) can be reduced through services including antiretroviral treatment and prophylaxis. Data on the national incidence of perinatal HIV transmission and missed prevention opportunities are needed to monitor progress toward elimination of mother-to-child HIV transmission. To estimate the number of perinatal HIV cases among infants born in the United States. Data were obtained from the National HIV Surveillance System on infants with HIV born in the United States (including the District of Columbia) and their mothers between 2002 and 2013 (reported through December 31, 2015). Estimates were adjusted for delay in diagnosis and reporting by weighting each reported case based on a model incorporating time from birth to diagnosis and report. Analysis was performed from April 1 to August 15, 2016. Maternal HIV infection and antiretroviral medication, including maternal receipt prenatally or during labor/delivery and infant receipt postnatally. Diagnosis of perinatally acquired HIV infection in infants born in the United States. Infant and maternal characteristics, including receipt of perinatal HIV testing, treatment, and prophylaxis. The estimated annual number of perinatally infected infants born in the United States decreased from 216 (95% CI, 206-230) in 2002 to 69 (95% CI, 60-83) in 2013. Among perinatally HIV-infected children born in 2002-2013, 836 (63.0%) of the mothers identified as black or African American and 243 (18.3%) as Hispanic or Latino. A total of 236 (37.5%) of the mothers had HIV infection diagnosed before pregnancy in 2002-2005 compared with 120 (51.5%) in 2010-2013; the proportion of mother-infant pairs receiving all 3 recommended arms of antiretroviral prophylaxis or treatment (prenatal, intrapartum, and postnatal) was 22.4% in 2002-2005 and 31.8% in 2010-2013, with approximately 179 (28.4%) (2002-2005) and 94 (40.3%) (2010-2013) receiving antiretroviral prophylaxis or treatment during

  11. The metabolic syndrome and HIV infection.

    PubMed

    Li Vecchi, Valentina; Maggi, Paolo; Rizzo, Manfredi; Montalto, Giuseppe

    2014-01-01

    The metabolic syndrome (MetS), a cluster of risk factors for cardiovascular disease and type 2 diabetes, has become an important public health problem. Considerable differences in the prevalence of the MetS in human immunodeficiency virus (HIV)-infected subjects have been reported, as a consequence of several limitations regarding the diagnostic critera for MetS. New evidence suggests that the use of optimal waist cut-off points specific for the various ethnic populations could represent a step forward in overcoming these limitations. Also the use of specific cut-off points for measuring upper trunk fat as an adjunctive criterion of MetS in HIV patients with lipodystrophy could represent an interesting new research topic. Although metabolic disorders have been associated indirectly with highly active antiretroviral therapy (HAART), directly with HIV infection per se or with host conditions, current circumstances could change the framework of MetS in the HIV setting: For example, the aging HIV population and newer, less metabolically toxic antiretroviral drugs. Lipotoxicity and adipokines have been focused as key issues for explaining MetS in HIV patients. Several studies have investigated the pathophysiology of MetS and cardiovascular complications in HIV infection. Evidence shows that both HIV infection per se and HIV-related chronic immune activation despite antiretroviral therapy are critical factors linking MetS and cardiovascular complications. Current epidemiological and pathogenetic data on MetS in HIV infection, prevention strategies and therapeutic options for all MetS components are reviewed in the light of the recent Adult Treatment Panel IV recommendations and the new antiretroviral drugs.

  12. 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.

  13. Factors influencing intent to get pregnant in HIV-infected women living in the southern USA.

    PubMed

    Sowell, R L; Murdaugh, C L; Addy, C L; Moneyham, L; Tavokoli, A

    2002-04-01

    This descriptive study sought to identify factors that influence HIV-infected women's intent to get pregnant. Interviews were conducted with a convenience sample of n = 322 HIV-infected women at risk for pregnancy. Participants were predominantly African-American (84.4%), single (57.9%), and ranged in age from 17 to 48 years. Forty per cent (n = 128) of the women had been pregnant since becoming HIV-positive. Potential factors influencing intent to get pregnant that were examined included demographic characteristics, HIV-related factors and personal beliefs and attitudes. In simple logistic regression models, younger age, increased motivation for child bearing, decreased perceived threat of HIV, decreased HIV symptomatology, higher traditional gender role orientation, and greater avoidance coping were all associated with greater intent to get pregnant. Following a model selection procedure, motivation for child bearing (OR = 16.05, 95% CI 7.95, 30.41) and traditional sex roles (OR = 4.49, 95% CI 1.44, 13.55) were significantly associated with greater intent to get pregnant. Traditional gender role orientation and motivation for childbearing are significant factors in predicting intent to get pregnant among HIV-infected women. These factors, as well as other non HIV-related factors, need to be routinely assessed by health care providers in developing plans of care for HIV-infected women.

  14. Early Sexual Debut and HIV Infection among Men Who Have Sex with Men in Shenzhen, China

    PubMed Central

    Xu, Ruiwei; Dai, Wenjie; Zhao, Guanglu; Tu, Dan; Yang, Lin; Wang, Feng; Cai, Yumao; Lan, Lina; Tan, Hongzhuan; Liu, Aizhong; Kaminga, Atipatsa C.

    2016-01-01

    Studies investigating the association between early sexual debut and human immunodeficiency virus (HIV) infection have mainly focused on Africans or females but rarely on men who have sex with men (MSM) in China. This study, therefore, mainly aimed at exploring the association between early sexual debut and HIV infection among MSM in Shenzhen, China. A total of 533 MSM were enrolled in this study using a convenience sampling method. Information about sociodemographic characteristics and risky sexual behaviors was collected. It was found that the prevalence of HIV infection was 24.2% among this study population and 66.4% of the MSM reported having had vaginal sexual intercourse with females. The mean ages at first vaginal sexual intercourse, first anal sexual intercourse, and first sexual intercourse were 21.38, 22.43, and 19.87 years, respectively. Multivariable logistic regression analyses showed that the MSM who experienced early anal sexual debut were more likely to be infected with HIV than those who did not. The results indicate that HIV infection is quite prevalent among MSM in Shenzhen. Early and efficient intervention strategies should be taken, and the MSM experiencing early anal sexual debut should be given special attention. PMID:28004003

  15. Identification of Germinal Center B Cells in Blood from HIV-infected Drug-naive Individuals in Central Africa

    PubMed Central

    Béniguel, Lydie; Bégaud, Evelyne; Cognasse, Fabrice; Gabrié, Philippe; Mbolidi, Christophe D.; Sabido, Odile; Marovich, Mary A.; deFontaine, Christiane; Frésard, Anne; Lucht, Frédéric; Genin, Christian; Garraud, Olivier

    2004-01-01

    To better understand the pathophysiology of B cell populations—the precursors of antibody secreting cells—during chronic human immunodeficiency virus (HIV) infection, we examined the phenotype of circulating B cells in newly diagnosed Africans. We found that all African individuals displayed low levels of naive B cells and of memory-type CD27+ B cells, and high levels of differentiated B cells. On the other hand, HIV-infected African patients had a population of germinal center B cells (i.e. CD20+, sIgM-, sIgD+, CD77+, CD138±), which are generally restricted to lymph nodes and do not circulate unless the lymph node architecture is altered. The first observations could be linked to the tropical environment whereas the presence of germinal center B cells may be attributable to chronic exposure to HIV as it is not observed in HIV-negative African controls and HAART treated HIV-infected Europeans. It may impact the management of HIV infection in countries with limited access to HIV drugs and urges consideration for implementation of therapeutic vaccines. PMID:15154608

  16. Tomography of the East African Rift System in Mozambique

    NASA Astrophysics Data System (ADS)

    Domingues, A.; Silveira, G. M.; Custodio, S.; Chamussa, J.; Lebedev, S.; Chang, S. J.; Ferreira, A. M. G.; Fonseca, J. F. B. D.

    2014-12-01

    Unlike the majority of the East African Rift, the Mozambique region has not been deeply studied, not only due to political instabilities but also because of the difficult access to its most interior regions. An earthquake with M7 occurred in Machaze in 2006, which triggered the investigation of this particular region. The MOZART project (funded by FCT, Lisbon) installed a temporary seismic network, with a total of 30 broadband stations from the SEIS-UK pool, from April 2011 to July 2013. Preliminary locations of the seismicity were estimated with the data recorded from April 2011 to July 2012. A total of 307 earthquakes were located, with ML magnitudes ranging from 0.9 to 3.9. We observe a linear northeast-southwest distribution of the seismicity that seems associated to the Inhaminga fault. The seismicity has an extension of ~300km reaching the Machaze earthquake area. The northeast sector of the seismicity shows a good correlation with the topography, tracing the Urema rift valley. In order to obtain an initial velocity model of the region, the ambient noise method is used. This method is applied to the entire data set available and two additional stations of the AfricaARRAY project. Ambient noise surface wave tomography is possible by computing cross-correlations between all pairs of stations and measuring the group velocities for all interstation paths. With this approach we obtain Rayleigh wave group velocity dispersion curves in the period range from 3 to 50 seconds. Group velocity maps are calculated for several periods and allowing a geological and tectonic interpretation. In order to extend the investigation to longer wave periods and thus probe both the crust and upper mantle, we apply a recent implementation of the surface-wave two-station method (teleseismic interferometry - Meier el al 2004) to augment our dataset with Rayleigh wave phase velocities curves in a broad period range. Using this method we expect to be able to explore the lithosphere

  17. 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.

  18. 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.

  19. Mitochondrial phylogeny and phylogeography of East African squeaker catfishes (Siluriformes: Synodontis)

    PubMed Central

    Koblmüller, Stephan; Sturmbauer, Christian; Verheyen, Erik; Meyer, Axel; Salzburger, Walter

    2006-01-01

    Background Squeaker catfishes (Pisces, Mochokidae, Synodontis) are widely distributed throughout Africa and inhabit a biogeographic range similar to that of the exceptionally diverse cichlid fishes, including the three East African Great Lakes and their surrounding rivers. Since squeaker catfishes also prefer the same types of habitats as many of the cichlid species, we hypothesized that the East African Synodontis species provide an excellent model group for comparative evolutionary and phylogeographic analyses. Results Our analyses reveal the existence of six major lineages of Synodontis in East Africa that diversified about 20 MYA from a Central and/or West African ancestor. The six lineages show a clear geographic patterning. Two lineages are endemic to Lake Tanganyika (plus one non-endemic representative), and these are the only two Synodontis lineages that diversified further into a small array of species. One of these species is the cuckoo catfish (S. multipunctatus), a unique brood parasite of mouthbrooding haplochromine cichlids, which seems to have evolved in parallel with the radiation of its cichlid host lineage, the Tropheini. We also detect an accelerated rate of molecular evolution in S. multipunctatus, which might be the consequence of co-evolutionary dynamics. Conclusion We conclude that the ancestral lineage of today's East African squeaker catfish fauna has colonized the area before the Great Lakes have formed. This ancestor diversified rapidly into at least six lineages that inhabit lakes and rivers in East Africa. Lake Tanganyika is the only lake harboring a small species flock of squeaker catfishes. PMID:16784525

  20. Mitochondrial phylogeny and phylogeography of East African squeaker catfishes (Siluriformes: Synodontis).

    PubMed

    Koblmüller, Stephan; Sturmbauer, Christian; Verheyen, Erik; Meyer, Axel; Salzburger, Walter

    2006-06-19

    Squeaker catfishes (Pisces, Mochokidae, Synodontis) are widely distributed throughout Africa and inhabit a biogeographic range similar to that of the exceptionally diverse cichlid fishes, including the three East African Great Lakes and their surrounding rivers. Since squeaker catfishes also prefer the same types of habitats as many of the cichlid species, we hypothesized that the East African Synodontis species provide an excellent model group for comparative evolutionary and phylogeographic analyses. Our analyses reveal the existence of six major lineages of Synodontis in East Africa that diversified about 20 MYA from a Central and/or West African ancestor. The six lineages show a clear geographic patterning. Two lineages are endemic to Lake Tanganyika (plus one non-endemic representative), and these are the only two Synodontis lineages that diversified further into a small array of species. One of these species is the cuckoo catfish (S. multipunctatus), a unique brood parasite of mouthbrooding haplochromine cichlids, which seems to have evolved in parallel with the radiation of its cichlid host lineage, the Tropheini. We also detect an accelerated rate of molecular evolution in S. multipunctatus, which might be the consequence of co-evolutionary dynamics. We conclude that the ancestral lineage of today's East African squeaker catfish fauna has colonized the area before the Great Lakes have formed. This ancestor diversified rapidly into at least six lineages that inhabit lakes and rivers in East Africa. Lake Tanganyika is the only lake harboring a small species flock of squeaker catfishes.

  1. Group Counseling with Traumatized East African Refugee Women in the United States: Using the "Kaffa" Ceremony Intervention

    ERIC Educational Resources Information Center

    Loewy, Michael I.; Williams, DiAnna Toliver; Keleta, Aster

    2002-01-01

    The Kaffa ceremony is a unique, culturally appropriate, group counseling intervention for female East African refugees. A counseling group is described in which the Kaffa ceremony was instrumental in helping to bridge the gap between Western counseling and East African culture, providing a context for the group members to resolve long-held trauma.…

  2. Group Counseling with Traumatized East African Refugee Women in the United States: Using the "Kaffa" Ceremony Intervention

    ERIC Educational Resources Information Center

    Loewy, Michael I.; Williams, DiAnna Toliver; Keleta, Aster

    2002-01-01

    The Kaffa ceremony is a unique, culturally appropriate, group counseling intervention for female East African refugees. A counseling group is described in which the Kaffa ceremony was instrumental in helping to bridge the gap between Western counseling and East African culture, providing a context for the group members to resolve long-held trauma.…

  3. Autochthonous Transmission of East/Central/South African Genotype Chikungunya Virus, Brazil.

    PubMed

    Cunha, Marcela S; Cruz, Nádia V G; Schnellrath, Laila C; Medaglia, Maria Luiza Gomes; Casotto, Michele E; Albano, Rodolpho M; Costa, Luciana J; Damaso, Clarissa R

    2017-10-01

    We isolated East/Central/South African genotype chikungunya virus during the 2016 epidemic in Rio de Janeiro, Brazil. Genome sequencing revealed unique mutations in the nonstructural protein 4 (NSP4-A481D) and envelope protein 1 (E1-K211T). Moreover, all Brazil East/Central/South isolates shared the exclusive mutations E1-M407L and E2-A103T.

  4. 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.

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

    PubMed Central

    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

  6. Bloodstream infections in HIV-infected patients

    PubMed Central

    Taramasso, Lucia; Tatarelli, Paola; Di Biagio, Antonio

    2016-01-01

    ABSTRACT In the combined antiretroviral therapy era, HIV-infected patients remain a vulnerable population for the onset of bloodstream infections (BSI). Worldwide, nontyphoid salmonellae, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus and coagulase negative staphylococci are the most important pathogens. Intravenous catheter associated infection, skin-soft tissue infection and endocarditis are associated with Gram-positive bacteremia. Among the Gram-negative, nontyphoidal Salmonella have been previously correlated to sepsis. Other causes of BSI in HIV-infected patients are mycobacteria and fungi. Mycobacteria constitute a major cause of BSI in limited resource countries. Fungal BSI are not frequent and among them Cryptococcus neoformans is the most common life-threatening infection. The degree of immunosuppression remains the key prognostic factor leading to the development of BSI. PMID:26950194

  7. [Endocrine abnormalities in HIV-infected patients].

    PubMed

    Krysiak, Robert; Kedzia, Agnieszka; Krupej-Kedzierska, Joanna; Okopień, Bogusław

    2013-01-01

    HIV infection is associated with a number of adverse consequences, including endocrine disorders. The endocrine changes associated with HIV infection have been studied in depth and, as the results of so far carried out studies suggest, their aetiology is usually multifactoral. Their pathogenesis includes direct infection of endocrine glands by HIV or opportunistic organisms, infiltration by neoplasms and adverse effects of drugs. Endocrine problems that most frequently affect this group of patients include: hypogonadism, adrenal insufficiency, thyroid disorders, impaired growth hormone release, lipodystrophy and bone loss. They may develop in both the early as well as late stages of the infection, ranging from subclinical disturbances to overt endocrine symptoms. The purpose of this paper is to review the aetiology, clinical manifestations, diagnosis and treatment of HIV-associated endocrine disturbances with a special emphasis on the most recent literature.

  8. Sleep disturbance in early HIV infection.

    PubMed

    Darko, D F; Mitler, M M; White, J L

    1995-10-01

    Immune proteins may have a role in HIV-related sleep disturbance. Observations of two notable sleep changes, increase in slow wave sleep and the need for too much sleep, during early stage HIV infection prompted researchers to investigate the neurological changes occurring with sleep structure alterations. When psychiatric, psychological, medical, and pharmacological variables are excluded, researchers begin to examine the effect of HIV infection on the brain itself. While reasons for sleep structure distortion remain unknown, new data suggests that irregular levels of peptides may be involved. Upcoming clinical trials will evaluate medications for efficacy in treating HIV-related sleep disturbance. This could lead to therapies that restore sleep and improve quality of life.

  9. Bloodstream infections in HIV-infected patients.

    PubMed

    Taramasso, Lucia; Tatarelli, Paola; Di Biagio, Antonio

    2016-04-02

    In the combined antiretroviral therapy era, HIV-infected patients remain a vulnerable population for the onset of bloodstream infections (BSI). Worldwide, nontyphoid salmonellae, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus and coagulase negative staphylococci are the most important pathogens. Intravenous catheter associated infection, skin-soft tissue infection and endocarditis are associated with Gram-positive bacteremia. Among the Gram-negative, nontyphoidal Salmonella have been previously correlated to sepsis. Other causes of BSI in HIV-infected patients are mycobacteria and fungi. Mycobacteria constitute a major cause of BSI in limited resource countries. Fungal BSI are not frequent and among them Cryptococcus neoformans is the most common life-threatening infection. The degree of immunosuppression remains the key prognostic factor leading to the development of BSI.

  10. Diagnosis of Acute HIV Infection in Connecticut

    PubMed Central

    DUBROW, ROBERT; SIKKEMA, KATHLEEN J.; MAYER, KENNETH H.; BRUCE, R. DOUGLAS; JULIAN, PAMELA; RODRIGUEZ, IRMA; BECKWITH, CURT; ROOME, AARON; DUNNE, DANA; BOEVING, ALEXANDRA; KIDDER, THOMAS J.; JENKINS, HEIDI; DOBSON, MICHAEL; BECKER, JOSEPH; MERSON, MICHAEL H.

    2011-01-01

    Acute HIV infection (AHI) is the earliest stage of HIV disease, when plasma HIV viremia, but not HIV antibodies, can be detected. Acute HIV infection often presents as a nonspecific viral syndrome. However, its diagnosis, which enables linkage to early medical care and limits further HIV transmission, is seldom made. We describe the experience of Yale's Center for Interdisciplinary Research on AIDS with AHI diagnosis in Connecticut, as a participating center in the National Institute of Mental Health Multisite AHI Study. We sought to identify AHI cases by clinical referrals and by screening for AHI at two substance abuse care facilities and an STD clinic: We identified one case by referral and one through screening of 590 persons. Screening for AHI is feasible and probably cost effective. Primary care providers should include AHI in the differential diagnosis when patients present with a nonspecific viral syndrome. PMID:19637661

  11. Immigration and HIV infection: a pilot study.

    PubMed

    Loue, S; Oppenheim, S

    1994-02-01

    This pilot study was conducted to determine areas in which additional education regarding the human immunodeficiency virus (HIV) is needed by the undocumented and recently immigrated HIV-infected population, and to obtain preliminary information on the ability of this community to access medical treatment for HIV. Information regarding health status, immigration status, and the use of medical services was obtained from all HIV-infected undocumented and recently immigrated individuals who sought services from a Southern California nonprofit agency between July 1, 1990 and December 31, 1990. A total of 54 such individuals presented for services. Thirteen individuals reported participating in shared needle usage for the administration of medication or vitamins, in addition to other known risk factors for HIV. Only one of these 13 individuals had access to nonemergency medical care. Additional research is necessary to determine the reasons for these needle sharing behaviors. Educational outreach is needed to address these behaviors as a possible risk factor for HIV transmission.

  12. [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.

  13. Fatal disseminated toxoplasmosis during primary HIV infection.

    PubMed

    Signorini, Liana; Gulletta, Maurizio; Coppini, Davide; Donzelli, Carla; Stellini, Roberto; Manca, Nino; Carosi, Giampiero; Matteelli, Alberto

    2007-03-01

    Toxoplasmosis is a well recognized manifestation of AIDS, but the disseminated disease is a rare condition and it has not been associated to HIV seroconversion to our knowledge. We describe a fatal episode of disseminated T. gondii acute infection with massive organ involvement during primary HIV infection. The serological data demonstrate primary T. gondii infection. The avidity index for HIV antibodies supports recent HIV-1 infection.

  14. Impact of HIV infection on cardiac deformation.

    PubMed

    Mendes, Lígia; Silva, Daniela; Miranda, Carla; Sá, Joana; Duque, Luís; Duarte, Nelson; Brito, Paula; Bernardino, Leonel; Poças, José

    2014-09-01

    The aim of this study was to detect abnormalities in left ventricular myocardial function due to HIV (human immunodeficiency virus) infection without established cardiovascular disease. An echocardiogram was performed in 50 asymptomatic HIV-infected patients (age 41 ± 6 years, 64% male) and in 20 healthy individuals. Conventional echocardiography and pulsed tissue Doppler imaging (TDI) were performed according to the guidelines. The strain rate of the basal segments was obtained with color tissue Doppler and used to evaluate systolic strain rate (SRS), early diastolic strain rate (SRE) and late diastolic strain rate (SRA). Longitudinal, radial and circumferential strain were assessed by 2D speckle tracking. The mean duration of HIV infection was 10 ± 5 years, CD4 count was 579 ± 286 cells/mm³, 32% had detectable viral load, and 86% were under treatment. Of the HIV-infected patients, one had grade 1 diastolic dysfunction. The groups were not different except for E wave (HIV 0.72 ± 0.17 m/s vs. control 0.84 ± 0.16 m/s, p=0.01), longitudinal strain (-19.5 ± 1.9% vs. -21 ± 2%, p=0.005), SRS (-1.1 ± 0.28 s⁻¹ vs. -1.3 ± 0.28 s⁻¹, p=0.02) and SRE (1.8 ± 0.4 s⁻¹ vs. 2.2 ± 0.4 s⁻¹, p<0.001), but only SRS (p=0.03, 95% CI 0.036; 0.67) and SRE (p=0.001, 95% CI -0.599; -0.168) had independent value. In an HIV-infected population without established cardiovascular disease, myocardial deformation abnormalities can be detected with strain and strain rate, revealing markers of myocardial injury. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  15. Bacterial infections in HIV-infected patients.

    PubMed

    Berger, B J; Hussain, F; Roistacher, K

    1994-06-01

    Although the original opportunistic pathogens described in AIDS were protozoal and fungal organisms, bacterial infections are now recognized with increased prevalence and altered expression in patients with HIV infection. Especially since populations outside of North America and populations of i.v. drug abusers have been studied, bacterial infections have been shown to cause substantially increased morbidity and mortality both early and late in the course of HIV infection. Just as strategies have been developed for primary and secondary prophylaxis of classical HIV-related opportunistic infections, prevention of bacterial complications should be a high priority. Good hygiene and avoidance of unsterile needles in illicit drug use, tattooing, ear-piercing, or other cosmetic or ritual activities should be emphasized in patient education. Patients should be counseled to avoid uncooked or poorly cooked eggs and poultry and to avoid unpasteurized milk products. Pneumococcal vaccine is recommended for all HIV-seropositive patients and should be given as early as possible after recognition of HIV infection for maximal efficacy. Influenza vaccine is also recommended. It may have a role in preventing bacterial pneumonia secondary to influenza. Patient management should include regular dental care and nutritional evaluation. The use of intravenous or central catheters should be limited to essential therapies. When patients present with new febrile illness, a high index of suspicion for invasive bacterial disease is appropriate. The signs of serious bacterial infection in HIV-positive patients are subtle. Diagnostic evaluation should include cultures of blood and other relevant clinical specimens. Empiric antimicrobial therapy based on the clinical presentation may be life saving in patients with invasive bacterial disease complicating HIV infection.

  16. Cardiac manifestations in HIV infected children.

    PubMed

    Singh, Pradeep; Hemal, Alok; Agarwal, Sheetal; Kumar, Dinesh

    2015-03-01

    To determine the occurrence of cardiac involvement in HIV infected children and describe its spectrum using non-invasive tests like ECG and 2-Dimensional Echocardiography (2-D ECHO). A cross sectional observational study was carried out on 100 HIV infected children between 1 and 18 y of age. The various cardiac manifestations were determined clinically, by electrocardiogram (ECG) and 2-D echocardiography. Seventy four percent of the patients were males with a mean age of 9.62 ± 3.62 y. Seventy seven percent children were in WHO stage I. Sixty five percent did not have significant immune suppression. Eighty six percent children were on HAART (mean duration- 35.12 ± 29.48 mo). Fifty nine percent of children were symptomatic and only nine patients were clinically suspected to have cardiac involvement. ECG abnormalities were found in 14 % cases. The most common abnormal echocardiographic finding was left ventricular diastolic dysfunction by tissue Doppler (E/E') observed in 64 % cases followed by systolic dysfunction (37 %), abnormal left ventricular mass (29 %), pericardial effusion (2 %) and dilated cardiomyopathy (2 %); 64.2 % cases with left ventricular systolic dysfunction (LVSD) were in WHO stage III. Involvement of heart in HIV/AIDS is mostly subclinical. HIV myocarditis produces systolic as well as diastolic dysfunction. At present, echocardiography remains the only tool for identifying heart involvement in HIV-infected children. Early diagnosis and intervention may halt the progression of the disease, thereby preventing morbidity and mortality.

  17. New Antiretroviral Therapies for Pediatric HIV Infection

    PubMed Central

    Morris, Jennifer L.; Kraus, Donna M.

    2005-01-01

    Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome affect millions of children worldwide. The development of antiretroviral therapy has significantly improved the morbidity and mortality of pediatric patients infected with HIV. Currently, 4 classes of antiretroviral agents exist: nucleoside / nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and entry inhibitors. A total of 21 single-entity antiretroviral agents and 4 co-formulated antiretroviral products hold Food and Drug Administration (FDA) approval for treatment of HIV-1 infection. However, not all of these agents are indicated for use in patients less than 18 years of age. Since the year 2000, 7 new antiretroviral agents (atazanavir, emtricitabine, enfuvirtide, fosamprenavir, lopinavir/ritonavir, tenofovir, and tipranavir) have been approved by the FDA for use in adult patients as part of combination therapy for the treatment of HIV-1 infection. Although only 3 of these newer agents (emtricitabine, enfuvirtide, and lopinavir/ritonavir) are currently FDA approved for use in pediatric patients, pediatric clinical studies of the other 4 new agents are currently underway. The purpose of this article is to review these 7 new antiretroviral agents and describe their roles in the treatment of pediatric HIV infection. For each drug, the following information will be addressed: FDA-approved indication and age groups, clinical efficacy, pharmacokinetics, adverse drug reactions, clinically relevant drug interactions, pediatric and adult dosing, dosage forms, administration, and place in the treatment of pediatric HIV infection. PMID:23118639

  18. [Cerebral toxoplasmosis in HIV-infected patients].

    PubMed

    Peregudova, A B; Shakhgil'dian, V I; Goncharov, D B; Ermak, T N; Tishkevich, I M; Shipulina, O Iu; Gorlova, N V; Gruzdev, B M

    2007-01-01

    To detect clinical characteristics of cerebral toxoplasmosis in HIV-infected patients, to clarify diagnostic role of detection of DNA and antibodies to Toxoplasma gondii in the cerebrospinal fluid (CSF) and blood. Diagnostic procedures were performed in 156 patients with HIV infection at the stage IVB (AIDS) in 2003-2006. All the patients suffered from diseases of the central nervous system (CNS). Toxoplasmosis was diagnosed in 57 (36%) cases. Lumbar puncture, MR imaging of the brain, reaction of indirect immunofluorescence, polymerase chain reaction and enzyme immunoassay were made to identify IgM and IgG to T. gondii. Typical for HIV-infected patients with cerebral toxoplasmosis were focal symptoms of CNS affection, hemipareses, adynamia, mental disorders, intoxication symptoms. MR imaging data are very important. Toxoplastosis is characterized by multiple destructive foci in the hemispheres and cerebellum with great amount of the parasites along the periphery of brain tissue necrosis. Detection of the infective agent DNA and specific IgG antibodies in cerebrospinal fluid confirms the presence of toxoplasmosis but sensitivity of the markers is low. IgG antibodies to T. gondii have diagnostic implications if they occur in high and moderate titers.

  19. Treatment interruptions in HIV-infected subjects.

    PubMed

    Bongiovanni, Marco; Casana, Maddalena; Tincati, Camilla; d'Arminio Monforte, Antonella

    2006-09-01

    Despite a high antiviral efficacy, the use of highly active antiretroviral therapy (HAART) in clinical practice is often impaired by the long-term toxicity of antiretroviral treatment, the increased rate of human immunodeficiency virus-1 (HIV-1) drug resistance in treated patients and the cost of therapies, so that possible interruption of HAART has to be considered as part of the current clinical practice. However, this strategy is usually followed by a rapid viral rebound with a substantial loss of CD4 T lymphocytes because the HIV suppression with HAART does not result in reconstitution of the HIV-specific immune response. Structured treatment interruption (STI) has already been investigated in HIV-infected subjects with well-controlled viral replication (initiating treatment during primary or chronic HIV infection) and in those with multiple treatment failures. A clear benefit of STI in patients with chronic infection remains controversial and these benefits are more often observed in patients starting treatment during primary HIV infection.

  20. B-cell responses to HIV infection.

    PubMed

    Moir, Susan; Fauci, Anthony S

    2017-01-01

    The induction of neutralizing antibodies directed against the human immunodeficiency virus (HIV) has received considerable attention in recent years, in part driven by renewed interest and opportunities for antibody-based strategies for prevention such as passive transfer of antibodies and the development of preventive vaccines, as well as immune-based therapeutic interventions. Advances in the ability to screen, isolate, and characterize HIV-specific antibodies have led to the identification of a new generation of potent broadly neutralizing antibodies (bNAbs). The majority of these antibodies have been isolated from B cells of chronically HIV-infected individuals with detectable viremia. In this review, we provide insight into the phenotypic and functional attributes of human B cells, with a focus on HIV-specific memory B cells and plasmablasts/cells that are responsible for sustaining humoral immune responses against HIV. We discuss the abnormalities in B cells that occur in HIV infection both in the peripheral blood and lymphoid tissues, especially in the setting of persisting viremia. Finally, we consider the opportunities and drawbacks of intensively interrogating antibodies isolated from HIV-infected individuals to guide strategies aimed at developing effective antibody-based vaccine and therapeutic interventions for HIV. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  1. 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.

  2. [HIV infection and acquired immunodeficiency syndrome].

    PubMed

    Takamatsu, J

    1997-05-01

    On June 4, 1981, MMWR published a report about Pneumocystis carinii pneumonia in homosexual men in Los Angeles. This was the first published report. A years later, this disease was named acquired immunodeficiency syndrome (AIDS). In the following year, Montangier et al in France discovered the causative agent, which they called lymphadenopathy virus (LAV), now known as human immunodeficiency virus (HIV). In 1985, solid-phase enzymeimmunoassay for the detection of the antibody to HIV was developed. Since then, other new techniques for the identification of HIV infection have been become available. These include more sensitive methods (for example; polymerase chain reaction techniques). Although these techniques facilitate early and definite diagnosis of infection, these tests may fail to detect the antibody in sera during window period of infection or overdiagnose infection in sera contaminated with genes not related to HIV. Although preventing blood exposure is the primary means of preventing occupationally acquired human immunodeficiency virus (HIV) infection, appropriate post-exposure management is an important element of workplace safety. Information suggesting that zidovudine (ZDV) postexposure prophylaxis (PEP) may reduce the risk for HIV transmission after occupational exposure to HIV infected blood prompted a Public Health Service (PHS) interagency working group, with expert consultation, and recommendations on PEP and management of occupational exposure to HIV in relation to these findings were discussed.

  3. Projection of HIV infection in Calcutta.

    PubMed

    Basu, A; Basu, S; Chakraborty, M S; Dewanji, A; Ghosh, J K; Majumder, P P

    1998-04-01

    Starting with the base year of 1991, the HIV infection projection for 1992-99 for the total, as well as various high-risk sub-populations of Calcutta, the first of its kind is provided. These projections are based on statistical methodology developed in this paper. Our methodology for spread of HIV infection takes into account various social interactions and practices and also uses available data. Rates of these interactions and practices and estimates of demographic parameters used in making projections were obtained primarily from surveys and census data. Since one of these estimated rates, that of HIV transmission rate through heterosexual encounters between an infected and an uninfected had a large range, we have provided two sets of projections based on the largest of these rates (worst-case scenario) and another that is consistent with the available data. The total projection of the number of HIV infected cases in Calcutta for 1999 is between 49,000 and 1,26,000. Separate projections are also provided for high-risk sub-groups. Among these, the sex workers expectedly will continue to manifest the highest numbers of newly infected cases. The temporal rate of increase in prevalence is projected to be alarmingly higher in the general population than even among sex workers, although the actual prevalence will continue to be the lowest in the general population compared to all other sub-groups of the population.

  4. Psychopharmacology in HIV-infected patients.

    PubMed

    Repetto, Martin J; Petitto, John M

    2008-06-01

    Neuropsychiatric disorders and syndromes may be underdiagnosed and inadequately treated in individuals infected with HIV. Depression in particular is among the most prevalent diagnoses, and data from controlled clinical studies have shown that antidepressant medications are efficacious and safe for treating depression in HIV-infected persons. A significant shortcoming of this literature is that most of the available data are from studies conducted before the advent of highly active antiretroviral therapy. In addition, apart from antidepressant medications, controlled studies systematically assessing efficacy and safety issues for other classes of psychotropic drugs (e.g., antipsychotic and anxiolytic medications) in HIV-infected persons are lacking. This review summarizes essential findings pertaining to the use of psychotropic medications to treat depression and other neuropsychiatric disorders in the context of HIV. It includes a discussion of clinically relevant treatment considerations (e.g., side effects, drug-drug interactions) derived from the existing literature as well as judgments that clinicians face in the absence of research data. Despite some shortcomings of the existing literature, overall there is compelling evidence that the appropriate use of psychotropic medications (coupled with behavioral therapy) can improve the quality of life of mentally ill HIV-infected individuals.

  5. Signatures of selection for environmental adaptation and zebu × taurine hybrid fitness in East African shorthorn zebu

    USDA-ARS?s Scientific Manuscript database

    The East African Shorthorn Zebu (EASZ) cattle are ancient hybrid between Asian zebu × African taurine cattle preferred by local farmers due to their adaptability to the African environment. The genetic controls of these adaptabilities are not clearly understood yet. Here, we genotyped 92 EASZ sample...

  6. The meteorology of the Western Indian Ocean, and the influence of the East African Highlands.

    PubMed

    Slingo, Julia; Spencer, Hilary; Hoskins, Brian; Berrisford, Paul; Black, Emily

    2005-01-15

    This paper reviews the meteorology of the Western Indian Ocean and uses a state-of-the-art atmospheric general circulation model to investigate the influence of the East African Highlands on the climate of the Indian Ocean and its surrounding regions. The new 44-year re-analysis produced by the European Centre for Medium range Weather Forecasts (ECMWF) has been used to construct a new climatology of the Western Indian Ocean. A brief overview of the seasonal cycle of the Western Indian Ocean is presented which emphasizes the importance of the geography of the Indian Ocean basin for controlling the meteorology of the Western Indian Ocean. The principal modes of inter-annual variability are described, associated with El Nino and the Indian Ocean Dipole or Zonal Mode, and the basic characteristics of the subseasonal weather over the Western Indian Ocean are presented, including new statistics on cyclone tracks derived from the ECMWF re-analyses. Sensitivity experiments, in which the orographic effects of East Africa are removed, have shown that the East African Highlands, although not very high, play a significant role in the climate of Africa, India and Southeast Asia, and in the heat, salinity and momentum forcing of the Western Indian Ocean. The hydrological cycle over Africa is systematically enhanced in all seasons by the presence of the East African Highlands, and during the Asian summer monsoon there is a major redistribution of the rainfall across India and Southeast Asia. The implied impact of the East African Highlands on the ocean is substantial. The East African Highlands systematically freshen the tropical Indian Ocean, and act to focus the monsoon winds along the coast, leading to greater upwelling and cooler sea-surface temperatures.

  7. An assessment of the feasibility and acceptability of a friendship-based social network recruitment strategy to screen at-risk African American and Hispanic/Latina young women for HIV infection.

    PubMed

    Boyer, Cherrie B; Hightow-Weidman, Lisa; Bethel, James; Li, Su X; Henry-Reid, Lisa; Futterman, Donna; Maturo, Donna; Straub, Diane M; Howell, Kourtney; Reid, Shirleta; Lowe, Jaime; Kapogiannis, Bill G; Ellen, Jonathan M

    2013-03-01

    OBJECTIVES To examine the feasibility and acceptability of a friendship-based network recruitment strategy for identifying undiagnosed human immunodeficiency virus (HIV) infection within young women's same-sex friendship networks and to determine factors that facilitated and hindered index recruiters (IRs) in recruiting female friendship network members (FNMs) as well as factors that facilitated and hindered FNMs in undergoing HIV screening. DESIGN A cross-sectional study design that incorporated dual incentives for IRs and their female FNMs. SETTING The IRs were recruited through 3 Adolescent Trials Network for HIV/AIDS Interventions sites within their Adolescent Medicine Trials Units. Data were collected from January 1, 2009, through June 30, 2010. PARTICIPANTS The IRs self-identifying as HIV positive, negative, or status unknown were enrolled to recruit FNMs to undergo HIV screening. MAIN OUTCOME MEASURES Self-reports of HIV risk and facilitators and barriers to network recruitment and HIV screening were assessed using an audio-computer-assisted self-interview. Participants were identified as HIV negative or positive on the basis of an OraQuick HIV test with confirmatory enzyme-linked immunosorbent assay and/or Western blot tests. RESULTS Nearly all (156 [98.1%]) eligible IRs agreed to participate and most (78.4%) recruited 1 or more FNMs. Of the 381 FNMs, most (342 [89.8%]) agreed to HIV screening. Although a high acceptance of HIV screening was achieved, the HIV prevalence was low (0.26%). CONCLUSION Our findings provide compelling evidence to suggest that use of a female friendship network approach is a feasible and acceptable means for engaging at-risk young women in HIV screening, as shown by their high rates of agreement to undergo HIV screening.

  8. An Assessment of the Feasibility and Acceptability of a Friendship-Based Social Network Recruitment Strategy to Screen At-Risk African American and Hispanic/Latina Young Women for HIV Infection

    PubMed Central

    Boyer, Cherrie B.; Hightow-Weidman, Lisa; Bethel, James; Li, Su X.; Henry-Reid, Lisa; Futterman, Donna; Maturo, Donna; Straub, Diane M.; Howell, Kourtney; Reid, Shirleta; Lowe, Jaime; Kapogiannis, Bill G.; Ellen, Jonathan M.

    2013-01-01

    Objectives To examine the feasibility and acceptability of a friendship-based network recruitment strategy for identifying undiagnosed human immunodeficiency virus (HIV) infection within young women’s same-sex friendship networks and to determine factors that facilitated and hindered index recruiters (IRs) in recruiting female friendship network members (FNMs) as well as factors that facilitated and hindered FNMs in undergoing HIV screening. Design A cross-sectional study design that incorporated dual incentives for IRs and their female FNMs. Setting The IRs were recruited through 3 Adolescent Trials Network for HIV/AIDS Interventions sites within their Adolescent Medicine Trials Units. Data were collected from January 1, 2009, through June 30, 2010. Participants The IRs self-identifying as HIV positive, negative, or status unknown were enrolled to recruit FNMs to undergo HIV screening. Main Outcome Measures Self-reports of HIV risk and facilitators and barriers to network recruitment and HIV screening were assessed using an audio-computer-assisted self-interview. Participants were identified as HIV negative or positive on the basis of an OraQuick HIV test with confirmatory enzyme-linked immunosorbent assay and/or Western blot tests. Results Nearly all (156 [98.1%]) eligible IRs agreed to participate and most (78.4%) recruited 1 or more FNMs. Of the 381 FNMs, most (342 [89.8%]) agreed to HIV screening. Although a high acceptance of HIV screening was achieved, the HIV prevalence was low (0.26%). Conclusion Our findings provide compelling evidence to suggest that use of a female friendship network approach is a feasible and acceptable means for engaging at-risk young women in HIV screening, as shown by their high rates of agreement to undergo HIV screening. PMID:23338776

  9. HIV associated kidney diseases: Clarifying concordance between renal failure in HIV infection and histopathologic manifestations at kidney biopsy.

    PubMed

    Ellis, Carla L

    2017-07-01

    Patients with HIV infection have a wide spectrum of renal diseases. Some are known to be the direct effect of the viral infection while others are renal diseases that also occur in uninfected populations. HIV associated nephropathy (HIVAN) is considered to be a subtype of primary focal and segmental glomerulosclerosis that is distinct in HIV infected patients. It is more frequent in the African-American population and associated with mutations of the apolipoprotein L1 (APOL1) gene. HIV associated immune complex kidney disease (HIVICD) encompasses a spectrum of HIV associated renal diseases characterized by the presence of immune complex deposition within glomeruli. Thrombotic microangiopathy (TMA) is a complication of HIV infection that presents with hemolytic anemia, thrombocytopenia, and renal failure. TMA in HIV patients is associated with very high mortality. Lastly, the multitude of antiretroviral drugs used for treatment of HIV infections can result in nephrotoxicity. Although a kidney biopsy may not be the first line study for renal disease, knowledge of the different histopathologic features of HIV-associated and unassociated diseases is of paramount importance in the treatment and subsequent outcome of renal function in HIV infected patients. In this review we will describe the histopathologic features and discuss the pathophysiology of the entities previously named. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. 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

  11. Clinical management of acute HIV infection: best practice remains unknown.

    PubMed

    Bell, Sigall K; Little, Susan J; Rosenberg, Eric S

    2010-10-15

    Best practice for the clinical management of acute human immunodeficiency virus (HIV) infection remains unknown. Although some data suggest possible immunologic, virologic, or clinical benefit of early treatment, other studies show no difference in these outcomes over time, after early treatment is discontinued. The literature on acute HIV infection is predominantly small nonrandomized studies, which further limits interpretation. As a result, the physician is left to grapple with these uncertainties while making clinical decisions for patients with acute HIV infection. Here we review the literature, focusing on the potential advantages and disadvantages of treating acute HIV infection outlined in treatment guidelines, and summarize the presentations on clinical management of acute HIV infection from the 2009 Acute HIV Infection Meeting in Boston, Massachusetts.

  12. Transition to Parenthood and HIV Infection in Rural Zimbabwe

    PubMed Central

    Piccarreta, Raffaella; Gregson, Simon; Melegaro, Alessia

    2016-01-01

    Background The relationship between the risk of acquiring human immunodeficiency virus (HIV) infection and people’s choices about life course events describing the transition to parenthood–sexual debut, union (in the form of marriage, cohabitation, or long-term relationship), and parenthood–is still unclear. A crucial role in shaping this relationship may be played by the sequence of these events and by their timing. This suggests the opportunity to focus on the life courses in their entirety rather than on the specific events, thus adopting a holistic approach that regards each individual’s life course trajectory as a whole. Methods We summarise the individual life courses describing the transition to parenthood using ordered sequences of the three considered events. We aim to (i) investigate the association between the sequences and HIV infection, and (ii) understand how these sequences interact with known mechanisms for HIV transmission, such as the length of sexual exposure and the experience of non-regular sexual partnerships. For this purpose, we use data from a general population cohort study run in Manicaland (Zimbabwe), a Sub-Saharan African area characterised by high HIV prevalence. Results For both genders, individuals who experienced either premarital or delayed childbearing have higher HIV risk compared to individuals following more standard transitions. This can be explained by the interplay of the sequences with known HIV proximate determinants, e.g., a longer exposure to sexual activity and higher rates of premarital sex. Moreover, we found that people in the younger birth cohorts experience more normative and safer sequences. Conclusions The shift of younger generations towards more normative transitions to parenthood is a sign of behaviour change that might have contributed to the observed reduction in HIV prevalence in the area. On the other hand, for people with less normative transitions, targeted strategies are essential for HIV

  13. 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

  14. 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

  15. Evaluation of Longitudinal Clinical Outcomes and Adherence to Care among HIV-Infected Refugees

    PubMed Central

    Winston, Susanna E.; Montague, Brian T.; Lopez, Michael J.; Delong, Allison; LeMarchand, Chloe; Bedoya, Armando; Gillani, Fizza S.; Beckwith, Curt G.

    2014-01-01

    Background HIV-infected refugees resettled in the United States face many challenges. Longitudinal data regarding HIV-specific outcomes in this population are limited. Methods We reviewed charts of 51 HIV-infected sub-Saharan African refugees matched to 102 nonrefugees. Outcomes analyzed included CD4 counts, viral loads (VLs), antiretroviral treatment (ART) use, appointment adherence, opportunistic infections, and resistance mutations. Results The ART initiation was similar. Appointment adherence was similar in year 1, but refugees were significantly less adherent beyond year 3. Refugees and nonrefugees spent similar amounts of time in care suppressed (83% vs 80%, P = .93). Refugees had higher odds of viremia following undetectable VL (OR 2.3, P < .05). Discussion Initially, sub-Saharan African HIV-infected refugees have comparable appointment adherence, ART use, and VL suppression to nonrefugees. Overtime refugees were less adherent to appointments and more likely to have postsuppression viremia. The support services provided to refugees early in care may be important for retention in care and treatment success. PMID:23024042

  16. Evaluation of longitudinal clinical outcomes and adherence to care among HIV-infected refugees.

    PubMed

    Winston, Susanna E; Montague, Brian T; Lopez, Michael J; Delong, Allison; Lemarchand, Chloe; Bedoya, Armando; Gillani, Fizza S; Beckwith, Curt G

    2013-01-01

    HIV-infected refugees resettled in the United States face many challenges. Longitudinal data regarding HIV-specific outcomes in this population are limited. We reviewed charts of 51 HIV-infected sub-Saharan African refugees matched to 102 nonrefugees. Outcomes analyzed included CD4 counts, viral loads (VLs), antiretroviral treatment (ART) use, appointment adherence, opportunistic infections, and resistance mutations. The ART initiation was similar. Appointment adherence was similar in year 1, but refugees were significantly less adherent beyond year 3. Refugees and nonrefugees spent similar amounts of time in care suppressed (83% vs 80%, P = .93). Refugees had higher odds of viremia following undetectable VL (OR 2.3, P < .05). Initially, sub-Saharan African HIV-infected refugees have comparable appointment adherence, ART use, and VL suppression to nonrefugees. Overtime refugees were less adherent to appointments and more likely to have postsuppression viremia. The support services provided to refugees early in care may be important for retention in care and treatment success.

  17. 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

  18. 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

  19. 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

  20. Spread of Chikungunya Virus East/Central/South African Genotype in Northeast Brazil.

    PubMed

    Charlys da Costa, Antonio; Thézé, Julien; Komninakis, Shirley Cavalcante Vasconcelos; Sanz-Duro, Rodrigo Lopes; Felinto, Marta Rejane Lemos; Moura, Lúcia Cristina Corrêa; Barroso, Ivoneide Moreira de Oliveira; Santos, Lucineide Eliziario Correia; Nunes, Mardjane Alves de Lemos; Moura, Adriana Avila; Lourenço, José; Deng, Xutao; Delwart, Eric L; Guimarães, Maria Raquel Dos Anjos Silva; Pybus, Oliver G; Sabino, Ester C; Faria, Nuno R

    2017-10-01

    We investigated an outbreak of exanthematous illness in Maceió by using molecular surveillance; 76% of samples tested positive for chikungunya virus. Genetic analysis of 23 newly generated genomes identified the East/Central/South African genotype, suggesting that this lineage has persisted since mid-2014 in Brazil and may spread in the Americas and beyond.

  1. 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

  2. Anthropometrics and Body Composition in East African Runners: Potential Impact on Performance.

    PubMed

    Mooses, Martin; Hackney, Anthony C

    2016-09-15

    Maximal oxygen uptake (VO2max), fractional utilization of VO2max during running and running economy (RE) are crucial factors for running success for all endurance athletes. Although evidence is limited, investigations of these key factors indicate that the East Africans superiority in distance running is to a large exent due to a unique combination of these factors. East African runners appear to have a very high level of RE most likely associated, at least partly, with anthropometric characteristics rather than with any specific metabolic property of the working muscle. That is, evidence suggest that anthropometrics and body composition might have important parameters as determinants of superior performance of East African distance runners. Regrettably, this role is often overlooked and mentioned as a descriptive parameter rather than explanatory one in many research studies. This brief review article provides an overview of the evidence to support the critical role anthropometrics and body composition has on the distance running success of East African athletes. The structural form and shape of these athletes also has a downside, as having very low BMI or body fat increases the risk for Relative Energy Deficiency in Sport (RED-S) conditions in both, male and female runners which can have serious health consequences.

  3. Theorizing, Restructuring and Rethinking Nonformal Education in East and West African Communities

    ERIC Educational Resources Information Center

    Clemons, Andrea; Vogt, Christina

    2004-01-01

    This article presents West and East African nonformal education projects as a platform from which to view the interrelationship of participation and transformation in the educational experiences of community, NGO, and state participants. In the context of neo-liberal pressures, carried by an international free-market movement in the 1980s, a wave…

  4. The impact of the geologic history and paleoclimate on the diversification of East african cichlids.

    PubMed

    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.

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

    PubMed

    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

    2015-12-01

    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.

  6. A review of renal disease in children with HIV infection.

    PubMed

    Jindal, Ankur Kumar; Tiewsoh, Karalanglin; Pilania, Rakesh Kumar

    2017-09-08

    Human immunodeficiency virus (HIV) infection continues to be a leading cause of morbidity and mortality. HIV-infected individuals are now surviving for a relatively longer period and this is because of easy accessibility to antiretroviral therapy these days. As a result, chronic disease-related complications are now being recognized more often. Kidney disease in HIV-infected children can vary from glomerular to tubular-interstitial involvement. We searched the database to identify various kidney diseases seen in HIV-infected children. We describe the epidemiology, pathogenesis, pathology, clinical and laboratory manifestations, management and outcome of commonly seen kidney disease in HIV-infected children. We also provide a brief overview of toxicity of antiretroviral drugs seen in HIV-infected children. Kidney involvement in HIV-infected children may arise because of HIV infection per se, opportunistic infections, immune mediated injury and drug toxicity. HIV-associated nephropathy is perhaps the most common and most severe form of kidney disease. Proteinuria may be a cost-effective screening test in the long-term management of HIV-infected children, however, there are no definite recommendations for the same. Other important renal diseases are HIV immune complex kidney disease, thrombotic microangiopathy, interstitial nephritis and vasculitis.

  7. Low-level Viremia Early in HIV Infection

    PubMed Central

    Chen, Iris; Cummings, Vanessa; Fogel, Jessica M.; Marzinke, Mark A.; Clarke, William; Connor, Matthew B.; Griffith, Sam; Buchbinder, Susan; Shoptaw, Steven; del Rio, Carlos; Magnus, Manya; Mannheimer, Sharon; Wheeler, Darrell P.; Mayer, Kenneth H.; Koblin, Beryl A.; Eshleman, Susan H.

    2014-01-01

    HIV RNA levels are usually high early in HIV infection. In the HPTN 061 study, men were tested for HIV infection every six months; six (21.4%) of 28 men who acquired HIV infection during the study had low or undetectable HIV RNA at the time of HIV diagnosis. Antiretroviral drugs were not detected at the time of HIV diagnosis. False-negative HIV test results were obtained for two men using multiple assays. Antiretroviral drug resistance mutations were detected in HIV from one man. Additional studies are needed to identify factors associated with low HIV RNA levels during early HIV infection. PMID:25140905

  8. Stem-Cell-Based Gene Therapy for HIV Infection

    PubMed Central

    Zhen, Anjie; Kitchen, Scott

    2013-01-01

    Despite the enormous success of combined anti-retroviral therapy, HIV infection is still a lifelong disease and continues to spread rapidly worldwide. There is a pressing need to develop a treatment that will cure HIV infection. Recent progress in stem cell manipulation and advancements in humanized mouse models have allowed rapid developments of gene therapy for HIV treatment. In this review, we will discuss two aspects of HIV gene therapy using human hematopoietic stem cells. The first is to generate immune systems resistant to HIV infection while the second strategy involves enhancing anti-HIV immunity to eliminate HIV infected cells. PMID:24368413

  9. Stem-cell-based gene therapy for HIV infection.

    PubMed

    Zhen, Anjie; Kitchen, Scott

    2013-12-24

    Despite the enormous success of combined anti-retroviral therapy, HIV infection is still a lifelong disease and continues to spread rapidly worldwide. There is a pressing need to develop a treatment that will cure HIV infection. Recent progress in stem cell manipulation and advancements in humanized mouse models have allowed rapid developments of gene therapy for HIV treatment. In this review, we will discuss two aspects of HIV gene therapy using human hematopoietic stem cells. The first is to generate immune systems resistant to HIV infection while the second strategy involves enhancing anti-HIV immunity to eliminate HIV infected cells.

  10. Fewer new cases of HIV infection in Helsinki.

    PubMed

    Pönkä, A

    1990-01-01

    The number of new serologically diagnosed HIV infections has decreased in Helsinki since 1986. The clinical search for infections was started in 1983 and the serodiagnostic search in late 1984. The maximum yearly number of new HIV infections was 40 cases in 1986. In 1987 and 1988 the corresponding numbers were 31 and 29, although the number of tests had increased. During the first nine months of 1989 only 16 HIV infections have been diagnosed. The levelling off, and even decrease, in the number of new cases of HIV infection gives cause for optimism about the chances of success of the campaign against AIDS by means of education, information and active screening programmes.

  11. Poverty, risky sexual behaviour, and vulnerability to HIV infection: evidence from South Africa.

    PubMed

    Booysen, Frederik le R; Summerton, Joy

    2002-12-01

    This paper explores the relationship among poverty, risky sexual behaviour, and vulnerability to HIV infection, using data from the 1998 South African Demographic and Health Survey. Asset index was employed as proxy of socioeconomic status. Inequalities in health were measured using concentration index. Women in poorer households were slightly less knowledgeable about HIV/AIDS, while the socioeconomic inequalities in risky sexual behaviour were negligible. These small health gradients may reflect the limitations of population-based surveys in collection of information on sexual behaviour. The results may also mean that women in general are equally at risk of HIV infection, which means that more work is required to establish how factors other than knowledge on HIV/ AIDS and socioeconomic status stand to enhance the vulnerability of women to HIV/AIDS.

  12. 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.

  13. Fractional Vegetation Cover of East African Wetlands Observed on Ground and from Space

    NASA Astrophysics Data System (ADS)

    Schmidt, M.; Amler, E.; Guerschmann, J. P.; Scarth, P.; Behn, K.; Thonfeld, F.

    2016-08-01

    Wetlands are important ecosystems providing numerous ecosystem services. They are of particular importance to communities in East Africa where agriculture is the most important economic sector and where food availability to households critical. During an intensive field campaign in the dry season of 2013 were Fractional Vegetation Cover (FVC) measurements, botanical vegetation cover and vegetation structure estimates acquired in three wetland test sites within the East African region. FVC cover data were collated in three strata: ground layer, midstorey and overstorey (woody vegetation greater than 2 m). Fractional cover estimates for the green and no-green vegetative fraction were calculated for Landsat MODIS imagery. These FVC data products were evaluated a) with FVC field data and b) relative to each other for their usability in the East African region. First results show some promise for further studies.

  14. Job conditions, job satisfaction, somatic complaints and burnout among East African nurses.

    PubMed

    van der Doef, Margot; Mbazzi, Femke Bannink; Verhoeven, Chris

    2012-06-01

    To describe job conditions, job satisfaction, somatic complaints and burnout of female East African nurses working in public and private hospitals and to determine how these well-being outcomes are associated with job conditions. Insight into job conditions, health and well-being status and their interrelation is virtually lacking for East African nurses. Cross-sectional survey of 309 female nurses in private and public hospitals in Kenya, Tanzania and Uganda. Nurses completed a survey assessing job conditions and job satisfaction (the Leiden Quality of Work Life Questionnaire-nurses version), somatic complaints (subscale of the Symptom CheckList) and burnout (Maslach Burnout Inventory). The East African nurses show high levels of somatic complaints, and nearly one-third of the sample would be labelled as burned out. In comparison with a Western European nurses reference group, the nurses score unfavourably on job conditions that require financial investment (e.g. workload, staffing, equipment and materials). On aspects related to the social climate (e.g. decision latitude, cooperation), however, they score more favourably. In comparison with private hospital nurses, public hospital nurses score similarly on aspects related to the social climate, but worse on the other job conditions. Public hospital nurses have a lower job satisfaction than private hospital nurses, but show comparable levels of somatic complaints and burnout. Strongest correlates of low job satisfaction are low supervisor support and low financial reward. Burnout is mainly associated with high workload and inadequate information provision, whereas somatic complaints are associated with demanding physical working conditions. Improvement in job conditions may reduce the high levels of burnout and somatic complaints and enhance job satisfaction in East African nurses. Efforts and investments should be made to improve the job conditions in East African nurses as they are key persons in the delivery of

  15. Associations of the vaginal microbiota with HIV infection, bacterial vaginosis, and demographic factors.

    PubMed

    Chehoud, Christel; Stieh, Daniel J; Bailey, Aubrey G; Laughlin, Alice L; Allen, Shannon A; McCotter, Kerrie L; Sherrill-Mix, Scott A; Hope, Thomas J; Bushman, Frederic D

    2017-04-24

    We sought to investigate the effects of HIV infection on the vaginal microbiota and associations with treatment and demographic factors. We thus compared vaginal microbiome samples from HIV-infected (HIV+) and HIV-uninfected (HIV-) women collected at two Chicago area hospitals. We studied vaginal microbiome samples from 178 women analyzed longitudinally (n = 324 samples) and collected extensive data on clinical status and demographic factors. We used 16S rRNA gene sequencing to characterize the bacterial lineages present, then UniFrac, Shannon diversity, and other measures to compare community structure with sample metadata. Differences in microbiota measures were modest in the comparison of HIV+ and HIV- samples, in contrast to several previous studies, consistent with effective antiretroviral therapy. Proportions of healthy Lactobacillus species were not higher in HIV- patients overall, but were significantly higher when analyzed within each hospital in isolation. Rates of bacterial vaginosis were higher among African-American women and HIV+ women. Bacterial vaginosis was associated with higher frequency of HIV+. Unexpectedly, African-American women were more likely to switch bacterial vaginosis status between sampling times; switching was not associated with HIV+ status. The influence of HIV infection on the vaginal microbiome was modest for this cohort of well suppressed urban American women, consistent with effective antiretroviral therapy. HIV+ was found to be associated with bacterial vaginosis. Although bacterial vaginosis has previously been associated with HIV transmission, most of the women studied here became HIV+ many years before our test for bacterial vaginosis, thus implicating additional mechanisms linking HIV infection and bacterial vaginosis.

  16. Medical and non-medical expenses for treating babies born to HIV-infected and non-HIV-infected mothers.

    PubMed

    Pansatiankul, Boonchian; Bunnag, Thanyanat; Leowsrisook, Pimsiri

    2003-08-01

    Most human immunodeficiency virus (HIV) infections among children under 5 years are transmitted perinatally. These children require more medical attention and hospitalization than non HIV-infected children. The expenses of HIV-infected children are mostly related to opportunistic infections. To compare the medical and non-medical expenses of treating babies born to HIV-infected and non-HIV-infected mothers at the Queen Sirikit National Institute of Child Health (QSNICH). Consecutive children of HIV-infected and non HIV-infected mothers born at Rajavithi Hospital, Bangkok, were recruited from 1993 to 1995. All of them were followed at QSNICH for free medical services. The demographic and pregnancy data of mothers and the characteristics of the babies of the two groups were compared as well as the number of the hospital visits and reported medical and non-medical expenses. 58 children of HIV-infected mothers and 119 children of non-HIV-infected mother were recruited during this period. Only 30 (51.7%) children of HIV-infected mothers could complete the 18-month requirement, while 90 (75.6%) of the babies born to non-HIV-infected mothers finished the 18 months follow-up period. The two groups did not differ much in terms of demographic characteristics, except that the infant fathers were younger and serology for syphilis was higher in the HIV-infected mothers. This indicated that the HIV-infected mothers had earlier sexual activity. Babies born to the HIV-infected mothers tended to have a lower birth weight and were small for gestational age (SGA). Nine out of 30 babies (30%) born to the HIV-infected mothers were found to be HIV positive at the 18th month of follow-up. The mean medical, non-medical, and total expenses of the babies of the infected group were 2,525.90 +/- 4,328.75, 1,323.07 +/- 1,452.41, 3,848.97 +/- 5,308.90 baht respectively, or were 2.4, 2.0, and 2.2 times those of the non-infected group. These expenses did not include antiretroviral therapy. The

  17. 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

  18. Subclinical hypothyroidism in HIV-infected subjects.

    PubMed

    Bongiovanni, Marco; Adorni, Fulvio; Casana, Maddalena; Tordato, Federica; Tincati, Camilla; Cicconi, Paola; Bini, Teresa; d'Arminio Monforte, Antonella

    2006-11-01

    The correlation between subclinical hypothyroidism [thyroid stimulating hormone (TSH)>4 mIU/L with normal free triiodothyroxine and free thyroxine levels], HIV infection and HAART is still unclear. To evaluate the predictive factors of subclinical hypothyroidism in an HIV-infected population, we identified three groups of subjects: G1, subjects on stable highly active antiretroviral therapy (HAART) (for at least 1 year) at baseline and at month 24 (n=97); G2, subjects naive at both baseline and month 24 (n=47); G3, subjects starting HAART at baseline (n=46). The three groups were comparable with respect to age, gender, body weight and prevalence of HCV infection. At baseline, subclinical hypothyroidism was detected in 14 subjects in G1 (14.4%), 5 in G2 (10.6%) and 4 in G3 (8.7%) (P=0.18) and these were excluded from the analysis. At month 24, 15 subjects had developed subclinical hypothyroidism: 4 in G1 (4.8%), 3 in G2 (7.1%) and 8 in G3 (19.0%). In the multivariable analysis, the higher increase in total cholesterol was predictive of subclinical hypothyroidism (RR: 1.53 for each additional 10 mg/dL, 95% CI 1.23-1.90; P<0.01); other variables, which were statistically significant in the univariate analysis, such as G3 group, body weight and higher increase in CD4+ cell count and in triglyceride serum levels were not confirmed to be associated with TSH alterations. The occurrence of subclinical hypothyroidism in HIV-positive patients seems to be related to the increase in total cholesterol serum levels occurring after HAART initiation. Thyroid function should be monitored in all HIV-infected subjects, especially in those starting HAART.

  19. Prevention of diarrhoea in children with HIV infection or exposure to maternal HIV infection.

    PubMed

    Humphreys, Eliza H; Smith, Nathan A; Azman, Hana; McLeod, Deanna; Rutherford, George W

    2010-06-16

    Diarrhoea is a major cause of morbidity and mortality among infants and children worldwide, especially in low- and middle-income countries. Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a condition that similarly disproportionately affects low- and middle-income countries; of the nearly 2.1 million children under age 15 years living with HIV/AIDS, the large majority reside in sub-Saharan Africa. Infants and children with HIV infection have more frequent and more severe diarrhoea than children without HIV. Interventions including vitamin A, zinc and cotrimoxazole may contribute substantially to preventing diarrhoea in children with HIV infection or exposure to HIV. We perform a systematic review of randomised controlled trials and nonrandomised studies that examine the effectiveness of vitamin A, zinc and cotrimoxazole on mortality and morbidity from diarrhoea in HIV-infected and -exposed infants and children. Electronic databases including Pubmed, Central and EMBASE were searched without limits to language from 1980 to April 2010. Conference database searches were performed, experts were contacted and bibliographies were handsearched. Randomised controlled trials (RCTs) and nonrandomised studies (NRSs) that examined the effectiveness of the three interventions were included. Two reviewers independently assessed citations for eligibility and double-extracted included studies. Assessment of bias of individual studies was performed independently by both reviewers. Only two summary estimates were performed due to heterogeneity in study design and interventions. Four RCTs were identified for vitamin A. One RCT was identified for zinc. One RCT and two NRSs were identified for cotrimoxazole. Vitamin A reduced mortality overall in children with HIV infection (four studies). A pooled estimate of three studies for reduction in mortality from vitamin A compared to placebo had a relative risk (DerSimonian and Laird method, random effects) of 0

  20. [Toxoplasmosis in HIV infection: invasion reactivation criteria].

    PubMed

    Goncharov, D B; Gubareva, E V; Kobets, N V; Domonova, E A; Ievleva, E S

    2012-01-01

    Contemporary representation of toxoplasmosis reactivation criteria in HIV infection is generalized. Significance of the issue is justified: toxoplasmosis is a leading neurological pathology in AIDS with a high lethality percentage due to complexity of clinical confirmation and difficulties of laboratory confirmation of the start of reactivation. Clinical, instrumental, immunologic, molecular genetic invasion reactivation criteria are discussed in the article and analysis of their effectiveness is performed; their most feasible combinations are justified. Further system analysis of the cerebral toxoplasmosis reactivation criteria specified in the article in combination with search of new pathogen dissemination markers will allow to obtain important information that has both fundamental interest and important practical significance.

  1. HIV infection presenting as bone marrow cryptococcosis

    PubMed Central

    Dharwadkar, Arpana; Vimal, Shruti; Buch, Archana C.; Panicker, N. K.

    2014-01-01

    Disseminated cryptococcal infection is an uncommon initial manifestation in immunocompromised patients. We report a rare case of a 40-year-old female presenting with fever and burning epigastrium. Peripheral blood film revealed a leukoerythroblastic picture with thrombocytopenia. Bone marrow aspiration showed granulomas along with cryptococcal yeast forms. The ELISA test for detection of human immunodeficiency virus (HIV) antigen was positive. Disseminated cryptococcosis can develop as the first manifestation of HIV infection in previously healthy individuals and granulomas in such bone marrow aspiration smears are a valuable clue to an underlying opportunistic infection. PMID:25161991

  2. 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

  3. Malignant tumours in patients with HIV infection.

    PubMed Central

    Tirelli, U.; Franceschi, S.; Carbone, A.

    1994-01-01

    One of the most important though somewhat neglected aspects of research in HIV infection concerns the development, clinicopathological characteristics, and treatment of malignant tumours in infected patients. With the improved survival of patients with AIDS owing to the better prevention and treatment of infectious complications there may well be an increase in AIDS related malignancies. This paper reviews the epidemiology, pathology, and treatment of malignant tumours in patients with HIV. Images p1149-a p1149-b p1149-c FIG 1 FIG 2 FIG 3 p1151-a p1151-b p1151-c PMID:8173459

  4. Neurological Complications in Controlled HIV Infection.

    PubMed

    Crossley, Kate M; Brew, Bruce J

    2013-12-01

    In recent years, there have been great advances in therapies for human immunodeficiency virus (HIV) that have allowed suppression of the virus and its effects on the body. Despite this progress, neurological complications persist in HIV-infected individuals. In this review we consider the possible ways that HIV might cause neurotoxicity and neuroinflammation. We discuss the spectrum of neurological disorders caused by HIV and its treatment, with a particular focus on both HIV-associated neurocognitive disorders and peripheral neuropathies. Since there has been a shift to HIV being a chronic illness, we also review the increasing prevalence of cerebrovascular disease and neurodegenerative disorders.

  5. [HIV infection and AIDS in urology].

    PubMed

    Fischer, C; Miller, J; Gahr, M; Ringert, R H

    1994-05-01

    Up to December 1993, a total of 10858 AIDS cases were reported to the central AIDS registry at the Federal Health Office. Human immunodeficiency virus is acquired through needle sharing (i.v. drug users), contaminated blood transfusions, intercourse with infected persons and transplacentally by fetuses. In Germany, about seven people a day are estimated to acquire the HIV infection. Half the patients will develop systemic manifestations of AIDS within 12-13 years. Only a small percentage of these patients suffer from urological manifestations, e.g. urinary tract infection, prostatism or HIV-associated nephropathy. Nevertheless, knowledge of genitourinary pathology caused by HIV makes early diagnosis of AIDS possible.

  6. Maternal HIV infection is an important health determinant in non-HIV-infected infants.

    PubMed

    Rupérez, María; González, Raquel; Maculuve, Sonia; Quintó, Llorenç; López-Varela, Elisa; Augusto, Orvalho; Vala, Anifa; Nhacolo, Arsénio; Sevene, Esperança; Naniche, Denise; Menéndez, Clara

    2017-07-17

    To assess morbidity and mortality in HIV-exposed uninfected (HEU) children to help guiding appropriate clinical care and effective preventive interventions. This is a longitudinal study comparing two cohorts of children; one born to HIV-infected women and the other born to HIV-uninfected women. We have analyzed prospectively obtained information on nutritional status, morbidity and mortality from 966 HEU and 909 HIV-unexposed infants followed up until their first 18 months of life at a referral health facility in southern Mozambique. Determinants for adverse health outcomes in HEU children were also assessed using multivariate logistic regression. Increased incidence of hospital admissions (P = 0.0015), shorter survival in the first 18 months of life (P = 0.0510) and moderate and severe malnutrition (P = 0.0006 and 0.0014, respectively) were observed among HEU children compared with HIV-unexposed children. Incidence of outpatient attendance in HEU children was associated with being men, older age and the mother being on antiretroviral treatment. Among HEU children, those who were never breastfed, or who were weaned or were partially breastfed, had an increased incidence of hospital admissions compared with children who were exclusively breastfed. Maternal HIV infection has important health consequences in non-HIV-infected children. As the prevalence of HIV-infected pregnant women is maintained and the proportion of HIV-infected children declines because of the scale-up of antiretroviral treatment during pregnancy and breastfeeding, more focus should be given to the health needs of HEU children to ensure that the post-2015 sustainable development goals are met.

  7. The HIV-Infected Patient and Family Social Support.

    ERIC Educational Resources Information Center

    Wolf, Thomas M.; And Others

    The goal of this study was to examine the complex interplay among family, neuropsychological, psychosocial, psychiatric, and immunological variables with human immunodeficiency virus (HIV)-infected homosexual/bisexual men and their families. The subjects were a broad spectrum of 29 outpatient HIV-infected homosexual/bisexual men between the ages…

  8. Targeted testing for acute HIV infection in North Carolina.

    PubMed

    Miller, William C; Leone, Peter A; McCoy, Sandra; Nguyen, Trang Q; Williams, Delbert E; Pilcher, Christopher D

    2009-04-27

    Persons with acute HIV infection contribute disproportionately to HIV transmission. The identification of these persons is a critical public health challenge. We developed targeted approaches for detecting HIV RNA in persons with negative serological tests. Persons undergoing publicly funded HIV testing in North Carolina between October 2002 and April 2005 were included in this cross-sectional study. We used logistic regression to develop targeted testing approaches. We also assessed simple approaches based on clinic type and geography. Algorithm development used persons with recent HIV infection, determined by a detuned enzyme-linked immunosorbent assay. Validation used persons with acute HIV infection, identified with an HIV RNA pooling procedure. Among 215 528 eligible persons, 232 persons had recent HIV infection and 44 had acute HIV infection. A combination of five indicators (testing site, sexual preference, sex with a person with HIV infection, county HIV incidence, and race) identified 92% of recent infections when testing 50% of the population. In validation among persons with acute HIV infection, this indicator combination had sensitivities of 98% in years 1 and 2 and 88% in year 3. A simple combination of testing site and county performed nearly as well [development (recent infections): sensitivity = 95%; validation (acute infections): sensitivity = 86% in years 1 and 2; 81% in year 3; cut-off established for testing 50% of population.] Acute HIV infection can be identified accurately using targeted testing. Simple approaches for identifying the types of clinics and geographical areas where infections are concentrated may be logistically feasible and cost-efficient.

  9. Health care delivery for people with HIV infection and AIDS.

    PubMed

    Arkell, S

    Health care delivery for people with HIV infection and AIDS will need to change in the future to accommodate the expected increasing numbers of people affected. Nurses have an important role in preventing the spread of HIV infection and in caring for this group of people.

  10. Primary cutaneous plasmablastic lymphoma revealing clinically unsuspected HIV infection*

    PubMed Central

    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

  11. The HIV-Infected Patient and Family Social Support.

    ERIC Educational Resources Information Center

    Wolf, Thomas M.; And Others

    The goal of this study was to examine the complex interplay among family, neuropsychological, psychosocial, psychiatric, and immunological variables with human immunodeficiency virus (HIV)-infected homosexual/bisexual men and their families. The subjects were a broad spectrum of 29 outpatient HIV-infected homosexual/bisexual men between the ages…

  12. Attitudes, perceptions and behaviours towards HIV testing among African-American and East African immigrant women in Washington, DC: implications for targeted HIV testing promotion and communication strategies.

    PubMed

    De Jesus, Maria; Carrete, Claudia; Maine, Cathleen; Nalls, Patricia

    2015-12-01

    The objective of the study was to examine and compare the HIV testing attitudes, perceptions and behaviours between African-American and East African immigrant women in the Washington, DC metropolitan area. Adopting an inductive, qualitative methodological approach, we conducted a total of 40 in-depth, semistructured interviews between October 2012 and March 2013. Qualitative thematic analysis was used to analyse the data. Overall, African-American women held more favourable views towards HIV testing than East African immigrant women. Very few East African immigrant women sought HIV testing intentionally. The majority of East African participants were tested inadvertently, while others tested for immigration-related or employment-related purposes. There were many barriers that impede women from seeking an HIV test including negative assumptions (eg, "Getting an HIV test implies that I am HIV positive"), negative emotions (eg, "Fear of being diagnosed with HIV and what this will mean for me") and potential negative reactions from partner or others (eg, "Getting an HIV test can signal distrust, disrespect, or infidelity"). There were nuances in how each group articulated some of these barriers and East African women expressed unique concerns that originated from experiences in their home countries. The study shed light into the complexity of factors that constrain women from presenting themselves voluntarily for an HIV test and highlighted the nuances between African-American and East African perceptions. Implications of findings for effective targeted HIV screening promotion and communication strategies among these groups of women are discussed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. Acute pancreatitis: Manifestation of acute HIV infection in an adolescent

    PubMed Central

    Bitar, Anas; Altaf, Muhammad; Sferra, Thomas J.

    2012-01-01

    Summary Background: Pancreatitis in the pediatric age group is not as common as in adults. Etiologies are various and differ from those in adults. Although infectious etiology accounts for a significant number of cases of pancreatitis, acute infection with Human Immunodeficiency Virus (HIV) was rarely reported as a possible etiology for acute pancreatitis in adults. Acute pancreatitis has never been reported as a presenting manifestation of acute HIV infection in children. Case Report: We describe a pediatric patient who presented with acute pancreatitis that revealed acute HIV infection. Conclusions: Acute pancreatitis as a primary manifestation of HIV infection is very rare. It may represent an uncommon aspect of primary HIV infection. We suggest that acute HIV infection should be considered in the differential diagnosis of acute pancreatitis at all ages. PMID:23569476

  14. Liver and kidney transplantation in HIV-infected patients.

    PubMed

    Tan-Tam, Clara C; Frassetto, Lynda A; Stock, Peter G

    2009-01-01

    HIV infection has evolved into a chronic condition as a result of improvements in therapeutic options. Chronic exposure with HIV and associated co-pathogens as well as toxicities from prolonged therapy with antiviral medications has resulted in increased morbidity and mortality rates from end-stage liver and kidney disease in the HIV-infected population. Since the definitive treatment for end-stage organ failure is transplantation, demand has increased among HIV-infected patients. Although the transplant community has been slow to recognize HIV as a chronic condition, many transplant centers have eliminated HIV infection as a contraindication to transplantation as a result of better patient management and demand. This review examines the current clinical strategies and issues surrounding liver and kidney transplantation in HIV-infected patients.

  15. Haemophilia and HIV infection in Hong Kong.

    PubMed

    Lee, S S; Wong, K H; Dickinson, A J

    1996-06-01

    This is a retrospective study of the problems faced and support received by HIV (human immunodeficiency virus) infected haemophilia patients in Hong Kong. Between December 1984 and December 1994, 63 patients were detected to be HIV positive, out of a total of 231 haemophiliacs screened. Infection could be traced back to before August 1985, when safer heat-treated clotting factors were not yet available. Psychosocial impacts were obvious in this group of patients because of the double blow of HIV infection and haemophilia. Amongst the more evident problems were obstacles in schooling, employment difficulties, and disturbed relationships with family and friends, to mention a few. Psychosocial support services have been rendered by both the government and non-governmental organizations in Hong Kong. Financial assistance has also been given by the government since April 1993. To date, only eleven (17.5%) patients were known to have progressed to AIDS. Medical treatment, psychosocial support and financial assistance are integral components of an effective AIDS care programme for HIV-infected haemophilia patients.

  16. Guidelines for antiretroviral therapy for HIV infection

    PubMed Central

    Rachlis, A R; Zarowny, D P

    1998-01-01

    OBJECTIVE: To develop guidelines for health care providers and their HIV-positive patients on the clinical use of antiretroviral agents for HIV infection. OPTIONS: Recommendations published in 1996 by an international panel. OUTCOMES: Improvement in clinical outcomes or in surrogate markers of disease activity. EVIDENCE AND VALUES: The Canadian HIV Trials Network held a workshop on Oct. 19-20, 1996, to develop Canadian guidelines that incorporate information from recent basic and clinical research. RECOMMENDATIONS: Recommendations for the use of antiretroviral drugs in HIV infection are provided for initial therapy, continuing therapy, primary infection, vertical transmission, pediatric therapy and postexposure prophylaxis. VALIDATION: The guidelines are based on consensus of the participants attending the workshop: Canadian investigators, clinicians and invited representatives from the community, government and the pharmaceutical industry. They are subject to review and updating as new information on clinical benefits is published. SPONSORS: The workshop was organized by the National Centre of the Canadian HIV Trials Network. Unrestricted educational grants were provided by 8 pharmaceutical companies. Additional support was provided from the National AIDS Strategy of Health Canada. PMID:9627563

  17. Immune impairment thresholds in HIV infection.

    PubMed

    Iwami, Shingo; Nakaoka, Shinji; Takeuchi, Yasuhiro; Miura, Yoshiharu; Miura, Tomoyuki

    2009-04-27

    Longitudinal studies of patients infected with HIV-1 reveal a long and variable length of asymptomatic phase between infection and development of AIDS. Some HIV infected patients are still asymptomatic after 15 or more years of infection but some patients develop AIDS within 2 years. The mechanistic basis of the disease progression has remained obscure but many researchers have been trying to explain it. For example, the possible importance of viral diversity for the disease progression and the development of AIDS has been very well worked out in the early-1990s, especially by some important works of Martin A. Nowak. These studies can give an elegant explanation for a variability of asymptomatic phase. Here, a simple mathematical model was used to propose a new explanation for a variable length of asymptomatic phase. The main idea is that the immune impairment rate increases over the HIV infection. Our model suggested the existence of so-called "Risky threshold" and "Immunodeficiency threshold" on the impairment rate. The former implies that immune system may collapse when the impairment rate of HIV exceeds the threshold value. The latter implies that immune system always collapses when the impairment rate exceeds the value. We found that the length of asymptomatic phase is determined stochastically between these threshold values depending on the virological and immunological states. Furthermore, we investigated a distribution of the length of asymptomatic phase and a survival rate of the immune responses in one HIV patient.

  18. Fuzzy Modeling and Control of HIV Infection

    PubMed Central

    Zarei, Hassan; Kamyad, Ali Vahidian; Heydari, Ali Akbar

    2012-01-01

    The present study proposes a fuzzy mathematical model of HIV infection consisting of a linear fuzzy differential equations (FDEs) system describing the ambiguous immune cells level and the viral load which are due to the intrinsic fuzziness of the immune system's strength in HIV-infected patients. The immune cells in question are considered CD4+ T-cells and cytotoxic T-lymphocytes (CTLs). The dynamic behavior of the immune cells level and the viral load within the three groups of patients with weak, moderate, and strong immune systems are analyzed and compared. Moreover, the approximate explicit solutions of the proposed model are derived using a fitting-based method. In particular, a fuzzy control function indicating the drug dosage is incorporated into the proposed model and a fuzzy optimal control problem (FOCP) minimizing both the viral load and the drug costs is constructed. An optimality condition is achieved as a fuzzy boundary value problem (FBVP). In addition, the optimal fuzzy control function is completely characterized and a numerical solution for the optimality system is computed. PMID:22536298

  19. 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. © 2016 John Wiley & Sons Ltd.

  20. HIV antibodies for treatment of HIV infection.

    PubMed

    Margolis, David M; Koup, Richard A; Ferrari, Guido

    2017-01-01

    The bar is high to improve on current combination antiretroviral therapy (ART), now highly effective, safe, and simple. However, antibodies that bind the HIV envelope are able to uniquely target the virus as it seeks to enter new target cells, or as it is expressed from previously infected cells. Furthermore, the use of antibodies against HIV as a therapeutic may offer advantages. Antibodies can have long half-lives, and are being considered as partners for long-acting antiretrovirals for use in therapy or prevention of HIV infection. Early studies in animal models and in clinical trials suggest that such antibodies can have antiviral activity but, as with small-molecule antiretrovirals, the issues of viral escape and resistance will have to be addressed. Most promising, however, are the unique properties of anti-HIV antibodies: the potential ability to opsonize viral particles, to direct antibody-dependent cellular cytotoxicity (ADCC) against actively infected cells, and ultimately the ability to direct the clearance of HIV-infected cells by effector cells of the immune system. These distinctive activities suggest that HIV antibodies and their derivatives may play an important role in the next frontier of HIV therapeutics, the effort to develop treatments that could lead to an HIV cure. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  1. Proteomic Analysis of HIV-Infected Macrophages

    PubMed Central

    Colon, Krystal; Rivera, Linda; Rodriguez-Franco, Eillen; Toro-Nieves, Dianedis

    2010-01-01

    Mononuclear phagocytes (monocytes, macrophages, and microglia) play an important role in innate immunity against pathogens including HIV. These cells are also important viral reservoirs in the central nervous system and secrete inflammatory mediators and toxins that affect the tissue environment and function of surrounding cells. In the era of antiretroviral therapy, there are fewer of these inflammatory mediators. Proteomic approaches including surface enhancement laser desorption ionization, one- and two-dimensional difference in gel electrophoresis, and liquid chromatography tandem mass spectrometry have been used to uncover the proteins produced by in vitro HIV-infected monocytes, macrophages, and microglia. These approaches have advanced the understanding of novel mechanisms for HIV replication and neuronal damage. They have also been used in tissue macrophages that restrict HIV replication to understand the mechanisms of restriction for future therapies. In this review, we summarize the proteomic studies on HIV-infected mononuclear phagocytes and discuss other recent proteomic approaches that are starting to be applied to this field. As proteomic instruments and methods evolve to become more sensitive and quantitative, future studies are likely to identify more proteins that can be targeted for diagnosis or therapy and to uncover novel disease mechanisms. PMID:21153888

  2. Low-level HIV infection of hepatocytes

    PubMed Central

    2012-01-01

    Background There are only limited data on whether HIV infection occurs within the liver; therefore, we explored early and late stages of the HIV life cycle in two hepatocyte cell lines – Huh7.5 and Huh7.5JFH1 – as well as in primary human hepatocytes. Results Integrated HIV DNA was detected in Huh7.5 and Huh7.5JFH1 cells, as well as in primary hepatocytes, and was inhibited by the integrase inhibitor raltegravir in a dose-dependent manner. HIV p24 protein was also detected in cell culture supernatants at days 1, 3, 5, and 7 post-infection and was inhibited by AZT, although levels were modest compared to those in a lymphocyte cell line. Culture supernatants from HIV-infected hepatocytes were capable of infecting a non-hepatic HIV indicator cell line. Conclusions These results indicating low-level HIV replication in hepatoctyes in vitro complement evidence suggesting that HIV has deleterious effects on the liver in vivo. PMID:22877244

  3. Pulmonary Hypertension Associated With HIV Infection

    PubMed Central

    Cicalini, Stefania; Petrosillo, Nicola; Flores, Sonia C.

    2010-01-01

    The success of antiretroviral therapies in improving the survival of patients infected with HIV and reducing HIV-associated opportunistic infections is undisputed. Nevertheless, long-term outcomes such as noninfectious cardiovascular complications, including cardiomegaly, pericarditis, myocarditis, and pulmonary arterial hypertension, are now serious concerns. The lung is a frequent target organ for disorders associated with HIV infection. HIV-related pulmonary arterial hypertension (HRPAH) affects more individuals who are infected with HIV than individuals who are uninfected. Moreover, the long-standing estimated prevalence of HRPAH in developed countries (calculated at 0.5%) is increasing as more clinician-scientists unify their efforts to screen patients who are pulmonary asymptomatic for pulmonary arterial hypertension. In order to decrease mortality, efforts are directed at early detection, diagnosis, and therapeutic interventions before the disease compromises patients’ quality of life. This article reviews the logistics of screening approaches for HRPAH and discusses the substantial disease burden currently faced by developing countries, where the prevalence of HIV infection is higher and complicated by hyperendemic risk factors, limited access to antiretrovirals, and lack of screening tools. We also present mechanistic insights into HRPAH, including the role of HIV proteins and their potential use as screening tools, and, finally, areas that still need intense research. PMID:20522575

  4. 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.

  5. Vitamin A deficiency during pregnancy of HIV infected and non-infected women in tropical settings of Northwest Ethiopia

    PubMed Central

    2011-01-01

    Background Vitamin A deficiency (VAD) is known to be a major public health problem among women of reproductive age in South East Asia and Africa. In Ethiopia, there are no studies conducted on serum vitamin A status of HIV-infected pregnant women. Therefore, the present study was aimed at determining the level of serum vitamin A and VAD among pregnant women with and without HIV infection in tropical settings of Northwest Ethiopia. Methods In this cross-sectional study, blood samples were collected from 423 pregnant women and from 55 healthy volunteers who visited the University of Gondar Hospital. Serum concentration of vitamin A was measured by high performance liquid chromatography. Results After controlling for total serum protein, albumin and demographic variables, the mean ± SD serum vitamin A in HIV seropositive pregnant women (0.96 ± 0.42 μmol/L) was significantly lower than that in pregnant women without HIV infection (1.10 ± 0.45 μmol/L, P < 0.05). Likewise, the level of serum vitamin A in HIV seropositive non-pregnant women (0.74 ± 0.39) was significantly lower than that in HIV negative non-pregnant women (1.18 ± 0.59 μmol/L, P < 0.004). VAD (serum retinol < 0.7 μmol/L) was observed in 18.4% and 17.7% of HIV infected and uninfected pregnant women, respectively. Forty six percent of non-pregnant women with HIV infection had VAD while only 28% controls were deficient for vitamin A (P = 0.002). Conclusion The present study shows that VAD is a major public health problem among pregnant women in the tropical settings of Northwest Ethiopia. Considering the possible implications of VAD during pregnancy, we recommend multivitamin (which has a lower level of vitamin A) supplementation in the care and management of pregnant women with or without HIV infection. PMID:21762514

  6. Deferral of blood donors with risk factors for HIV infection saves lives and money in Zimbabwe.

    PubMed

    McFarland, W; Kahn, J G; Katzenstein, D A; Mvere, D; Shamu, R

    1995-06-01

    We compared the cost-effectiveness of three strategies to avert transfusion-associated HIV infection in Zimbabwe: HIV antibody testing, deferral of donors with HIV risk factors, and deferral of donors with risk factors followed by antibody testing ("Defer/Test"). The Defer/Test strategy averted the most HIV infections. Compared with antibody testing alone, the Defer/Test strategy, using history of genital ulcer or any sexually transmitted disease as a criterion for deferral, resulted in net savings. The cost per HIV-infected unit averted using history of paying for sex or having had multiple sex partners was $ 127 and $ 773, respectively. We discern four benefits of risk factor-based deferral before antibody testing. First, deferring donors at risk lessens collection of blood in the window period. Second, deferring donors likely to be HIV positive minimizes the number of units discarded. Third, ascertainment of donor risk provides an opportunity for AIDS education and prevention. Fourth, the number of false negatives is lower with a lower HIV prevalence among accepted donors. The Defer/Test strategy is cost-effective in Zimbabwe because additional recruitment costs are offset by discarding fewer HIV-positive units. We predict the Defer/Test strategy will be cost-effective in other sub-Saharan African donor populations.

  7. HIV/AIDS and Associated Conditions among HIV-Infected Refugees in Minnesota, 2000–2007

    PubMed Central

    Lowther, Sara A.; Johnson, Glenise; Hendel-Paterson, Brett; Nelson, Kailey; Mamo, Blain; Krohn, Kristina; Pessoa-Brandão, Luisa; O’Fallon, Ann; Stauffer, William

    2012-01-01

    In 2010, the requirement for human immunodeficiency virus (HIV) testing of adult refugees prior to US resettlement was removed, thus leading to a potential for missed diagnosis. We reviewed refugee health assessment data and medical charts to evaluate the health status of HIV-infected refugees who arrived in Minnesota during 2000–2007, prior to this 2010 policy change. Among 19,292 resettled adults, 174 were HIV-infected; 169 (97%) were African (median age 26.4 (range: 17–76) years). Charts were abstracted for 157 (124 (79%) with ≥1 year of follow-up). At initial presentation, two of 74 (3%) women were pregnant; 27% became pregnant during follow-up. HIV clinical stage varied (59%, asymptomatic; 11%, mild symptoms; 10%, advanced symptoms; 3%, severe symptoms; 17%, unknown); coinfections were common (51 tuberculosis, 13 hepatitis B, 13 parasites, four syphilis). Prior to arrival 4% had received antiretrovirals. Opportunistic infections were diagnosed among 13%; 2% died from AIDS-related causes. Arrival screening may be needed to identify these HIV-infected refugees and prevent HIV-related morbidity and mortality. PMID:23202841

  8. HIV/AIDS and associated conditions among HIV-infected refugees in Minnesota, 2000–2007.

    PubMed

    Lowther, Sara A; Johnson, Glenise; Hendel-Paterson, Brett; Nelson, Kailey; Mamo, Blain; Krohn, Kristina; Pessoa-Brandão, Luisa; O'Fallon, Ann; Stauffer, William

    2012-11-16

    In 2010, the requirement for human immunodeficiency virus (HIV) testing of adult refugees prior to US resettlement was removed, thus leading to a potential for missed diagnosis. We reviewed refugee health assessment data and medical charts to evaluate the health status of HIV-infected refugees who arrived in Minnesota during 2000-2007, prior to this 2010 policy change. Among 19,292 resettled adults, 174 were HIV-infected; 169 (97%) were African (median age 26.4 (range: 17-76) years). Charts were abstracted for 157 (124 (79%) with ≥ 1 year of follow-up). At initial presentation, two of 74 (3%) women were pregnant; 27% became pregnant during follow-up. HIV clinical stage varied (59%, asymptomatic; 11%, mild symptoms; 10%, advanced symptoms; 3%, severe symptoms; 17%, unknown); coinfections were common (51 tuberculosis, 13 hepatitis B, 13 parasites, four syphilis). Prior to arrival 4% had received antiretrovirals. Opportunistic infections were diagnosed among 13%; 2% died from AIDS-related causes. Arrival screening may be needed to identify these HIV-infected refugees and prevent HIV-related morbidity and mortality.

  9. [Prevalence of HIV infection in patients with pellagra and pellagra-like erythemas].

    PubMed

    Pitche, P; Kombate, K; Tchangai-Walla, K

    1999-01-01

    Pellagra is a systemic disorder caused by severe niacin deficiency. While uncommon in Europe and North America, pellagra and pellagra-like erythema are frequently encountered in undernourished adults in poor African countries. The purpose of this three-year prospective study was to determine the prevalence of HIV infection in patients with pellagra. Between 1996 and 1998, all documented cases of pellagra and pellagra-like erythema diagnosed in the Dermatology Department and Internal Medicine Department of the Teaching Hospital in Lome, Togo were included. Patients underwent screening tests for HIV infection. During the study period, pellagra or pellagra-like erythema was diagnosed in a total of 108 patients (59 women and 49 men) with a mean age of 41 +/- 3.5 years (range, 18 to 68 years). Serology tests for HIV were positive in 6 of these patients (5.5 p. 100; mean age 35 years). In four asymptomatic patients with no opportunistic infection, detection of HIV was an incidental discovery. The other two patients had AIDS symptoms. The principal causes of pellagra were malnutrition (n = 30), alcoholism (n = 15), and combined malnutrition and alcoholism (n = 60). The findings of this study suggest that the incidence of HIV infection in patients with pellagra and pellagra-like erythema is low, i.e., not higher than in the general population. This study also confirms previous etiologic and epidemiological data concerning pellagra in poor countries, i.e., the preponderant role of nutritional deficiency.

  10. 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…

  11. East African wetland-catchment data base for sustainable wetland management

    NASA Astrophysics Data System (ADS)

    Leemhuis, Constanze; Amler, Esther; Diekkrüger, Bernd; Gabiri, Geofrey; Näschen, Kristian

    2016-10-01

    Wetlands cover an area of approx. 18 Mio ha in the East African countries of Kenya, Rwanda, Uganda and Tanzania, with still a relative small share being used for food production. Current upland agricultural use intensification in these countries due to demographic growth, climate change and globalization effects are leading to an over-exploitation of the resource base, followed by an intensification of agricultural wetland use. We aim on translating, transferring and upscaling knowledge on experimental test-site wetland properties, small-scale hydrological processes, and water related ecosystem services under different types of management from local to national scale. This information gained at the experimental wetland/catchment scale will be embedded as reference data within an East African wetland-catchment data base including catchment physical properties and a regional wetland inventory serving as a base for policy advice and the development of sustainable wetland management strategies.

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

    PubMed

    Frolov, Andrey; Akhmetova, Lilia

    2015-11-05

    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.

  13. 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

  14. 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

  15. Predicting and attributing recent East African Spring droughts with dynamical-statistical climate model ensembles

    NASA Astrophysics Data System (ADS)

    Funk, C. C.; Shukla, S.; Hoerling, M. P.; Robertson, F. R.; Hoell, A.; Liebmann, B.

    2013-12-01

    During boreal spring, eastern portions of Kenya and Somalia have experienced more frequent droughts since 1999. Given the region's high levels of food insecurity, better predictions of these droughts could provide substantial humanitarian benefits. We show that dynamical-statistical seasonal climate forecasts, based on the latest generation of coupled atmosphere-ocean and uncoupled atmospheric models, effectively predict boreal spring rainfall in this area. Skill sources are assessed by comparing ensembles driven with full-ocean forcing with ensembles driven with ENSO-only sea surface temperatures (SSTs). Our analysis suggests that both ENSO and non-ENSO Indo-Pacific SST forcing have played an important role in the increase in drought frequencies. Over the past 30 years, La Niña drought teleconnections have strengthened, while non-ENSO Indo-Pacific convection patterns have also supported increased (decreased) Western Pacific (East African) rainfall. To further examine the relative contribution of ENSO, low frequency warming and the Pacific Decadal Oscillation, we present decompositions of ECHAM5, GFS, CAM4 and GMAO AMIP simulations. These decompositions suggest that rapid warming in the western Pacific and steeper western-to-central Pacific SST gradients have likely played an important role in the recent intensification of the Walker circulation, and the associated increase in East African aridity. A linear combination of time series describing the Pacific Decadal Oscillation and the strength of Indo-Pacific warming are shown to track East African rainfall reasonably well. The talk concludes with a few thoughts linking the potentially important interplay of attribution and prediction. At least for recent East African droughts, it appears that a characteristic Indo-Pacific SST and precipitation anomaly pattern can be linked statistically to support forecasts and attribution analyses. The combination of traditional AGCM attribution analyses with simple yet

  16. Comparative Analysis of Breast Cancer Phenotypes in African American, White American, and West Versus East African patients: Correlation Between African Ancestry and Triple-Negative Breast Cancer.

    PubMed

    Jiagge, Evelyn; Jibril, Aisha Souleiman; Chitale, Dhananjay; Bensenhaver, Jessica M; Awuah, Baffour; Hoenerhoff, Mark; Adjei, Ernest; Bekele, Mahteme; Abebe, Engida; Nathanson, S David; Gyan, Kofi; Salem, Barbara; Oppong, Joseph; Aitpillah, Francis; Kyei, Ishmael; Bonsu, Ernest Osei; Proctor, Erica; Merajver, Sofia D; Wicha, Max; Stark, Azadeh; Newman, Lisa A

    2016-11-01

    Triple-negative breast cancer (TNBC) is more common among African American (AA) and western sub-Saharan African breast cancer (BC) patients compared with White/Caucasian Americans (WA) and Europeans. Little is known about TNBC in east Africa. Invasive BC diagnosed 1998-2014 were evaluated: WA and AA patients from the Henry Ford Health System in Detroit, Michigan; Ghanaian/west Africans from the Komfo Anokye Teaching Hospital in Kumasi, Ghana; and Ethiopian/east Africans from the St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. Histopathology and immunohistochemistry for estrogen receptor (ER), progesterone receptor (PR), and HER2/neu expression was performed in Michigan on formalin-fixed, paraffin-embedded samples from all cases. A total of 234 Ghanaian (mean age 49 years), 94 Ethiopian (mean age 43 years), 272 AA (mean age 60 years), and 321 WA (mean age 62 years; p = 0.001) patients were compared. ER-negative and TNBC were more common among Ghanaian and AA compared with WA and Ethiopian cases (frequency ER-negativity 71.1 and 37.1 % vs. 19.8 and 28.6 % respectively, p < 0.0001; frequency TNBC 53.2 and 29.8 % vs. 15.5 and 15.0 %, respectively, p < 0.0001). Among patients younger than 50 years, prevalence of TNBC remained highest among Ghanaians (50.8 %) and AA (34.3 %) compared with WA and Ethiopians (approximately 16 % in each; p = 0.0002). This study confirms an association between TNBC and West African ancestry; TNBC frequency among AA patients is intermediate between WA and Ghanaian/West Africans consistent with genetic admixture following the west Africa-based trans-Atlantic slave trade. TNBC frequency was low among Ethiopians/East Africans; this may reflect less shared ancestry between AA and Ethiopians.

  17. Methadone treatment protects against HIV infection: two decades of experience in the Bronx, New York City.

    PubMed

    Hartel, D M; Schoenbaum, E E

    1998-06-01

    We undertook a study of the role of methadone maintenance in protecting injecting drug users (IDUs) from human immunodeficiency virus (HIV) infection from the earliest days of the HIV epidemic in New York City to the present. The historical context of the epidemic in the Bronx is discussed. For close to two decades, we have been tracking changes in injecting drug use and HIV infection levels in a Bronx cohort study of IDUs. An initial sample of 622 IDUs was recruited from a methadone treatment program in 1985, with historical data going back to 1978. Behavioral interviews and HIV testing were performed and methadone treatment program records (urine toxicology and methadone dose history) were reviewed. We examined both prevalent and incident HIV infections. The sample included African Americans (24.3%), Latinos (50.3%), and white non-Latinos (24.4%). The average methadone dose was 64 milligrams (mg) per day with an average time in treatment of five and a half years. We found a very low rate of incident infection of 1.7 per 100 person-years observation since 1986. Because of this low rate of infection, we were unable to determine the association between methadone treatment factors and HIV seroincidence. We found that our prevalence data on the 622 IDUs enrolled from 1985 to 1988 yielded strong findings on the role of methadone maintenance in a period when most infections occurred in this population. HIV seroprevalence was 42.9%. Logistic regression analysis revealed associations of methadone dose > or = 80 mg (adjusted odds ratio = 3.07/yr, 95% confidence interval (CI): 1.23-7.68) and last year entered methadone treatment (adjusted odds ratio = 1.22/yr, 95% CI: 1.06-1.41) to HIV infection, independent of year of last cocaine injection, needle sharing in shooting galleries, number of IDU sex partners, low income, and African American of Latino ethnicity. Properly dosed, long-term methadone treatment was found to be a central protective factor in preventing HIV

  18. 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.

  19. 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.

  20. Positive association between dietary iron intake and iron status in HIV-infected children in Johannesburg, South Africa.

    PubMed

    Kruger, Herculina S; Balk, Lisanne J; Viljoen, Michelle; Meyers, Tammy M

    2013-01-01

    Anemia is a common complication of pediatric HIV infection and is associated with suboptimal cognitive performance and growth failure. Routine iron supplementation is not provided to South African HIV-infected children. We hypothesized that dietary iron intake without supplementation is sufficient to protect against iron deficiency (ID) in HIV-infected children receiving highly active antiretroviral therapy. In this prospective study, the difference between dietary intakes of iron-deficient children (soluble transferrin receptor >9.4 mg/L) and iron-sufficient children after 18 months on highly active antiretroviral therapy was examined. The association between iron intake and hemoglobin (Hb) concentration was also assessed. Longitudinal data collected for 18 months from 58 HIV-infected African children were assessed by generalized estimation equations, with adjustment for demographic information, dietary intakes, growth parameters, and CD4%. After adjustment for covariates, the longitudinal association between dietary iron intake and Hb concentration remained significant. This association shows that for every 1-mg increase in iron intake per day, Hb increases by 1.1 g/L (P < .001). Mean Hb increased significantly after 18 months of follow-up (106 ± 14 to 129 ± 14 g/L, P < .01), but soluble transferrin receptor also increased (7.7 ± 2.7 to 8.9 ± 3.0 mg/L, P < .01). The incidence of ID increased from 15.2% at baseline to 37.2% after 18 months. Children with animal protein intakes greater than >20 g/d had significantly lower odds for ID at 18 months than did children with lower intakes (odds ratio, 0.40; 95% confidence interval, 0.21-0.77). Dietary iron intake was insufficient to protect against ID, pointing to a need for low-dose iron supplementation for iron-deficient HIV-infected children and interventions to increase the consumption of animal protein.

  1. Alcohol Use, Socioeconomic Status and Risk of HIV Infections.

    PubMed

    Probst, Charlotte; Simbayi, Leickness C; Parry, Charles D H; Shuper, Paul A; Rehm, Jürgen

    2017-03-28

    The present study investigated the associations among alcohol use, socioeconomic status (SES), and human immunodeficiency virus (HIV) status, in the South African context. It was hypothesized that SES (predictor; measured as median split asset score) and alcohol use in the past 12 months (predictor) would interact such that current drinkers of low SES would be at an increased risk of testing HIV-positive (outcome). Nationally representative, cross-sectional survey data from 2005 (N = 16,110), 2008 (N = 13,055), and 2012 (N = 25,979) were analyzed using multinomial regression models. Current drinkers of low SES had an elevated risk of HIV infection in all survey years, ranging from a relative risk ratio (RRR) of 1.94 (95% confidence interval (CI) 1.29-3.00, t = 2.93, p = 0.002) in 2012 to RRR of 3.51 (95% CI 2.02-6.08, t = 4.47, p < 0.001) in 2008. Targeting preventive strategies to alcohol users of low SES could help reduce HIV burden and associated socioeconomic differences.

  2. Post-Pan-African tectonic evolution of South Malawi in relation to the Karroo and recent East African rift systems

    NASA Astrophysics Data System (ADS)

    Castaing, C.

    1991-05-01

    Structural studies conducted in the Lengwe and Mwabvi Karroo basins and in the basement in South Malawi, using regional maps and published data extended to cover Southeast Africa, serve to propose a series of geodynamic reconstructions which reveal the persistence of an extensional tectonic regime, the minimum stress σ3 of which has varied through time. The period of Karroo rifting and the tholeiitic and alkaline magmatism which terminated it, were controlled by NW-SE extension, which resulted in the creation of roughly NE-SW troughs articulated by the Tanganyika-Malawi and Zambesi pre-transform systems. These were NW-SE sinistral-slip systems with directions of movement dipping slightly to the Southeast, which enabled the Mwanza fault to play an important role in the evolution of the Karroo basins of the Shire Valley. The Cretaceous was a transition period between the Karroo rifting and the formation of the Recent East African Rift System. Extension was NE-SW, with some evidence for a local compressional episode in the Lengwe basin. Beginning in the Cenozoic, the extension once more became NW-SE and controlled the evolution in transtension of the Recent East African Rift System. This history highlights the major role of transverse faults systems dominated by strike-slip motion in the evolution and perpetuation of the continental rift systems. These faults are of a greater geological persistence than the normal faults bounding the grabens, especially when they are located on major basement anisotropies.

  3. HIV Infection Affects Streptococcus mutans Levels, but Not Genotypes

    PubMed Central

    Liu, G.; Saxena, D.; Chen, Z.; Norman, R.G.; Phelan, J.A.; Laverty, M.; Fisch, G.S.; Corby, P.M.; Abrams, W.; Malamud, D.; Li, Y.

    2012-01-01

    We report a clinical study that examines whether HIV infection affects Streptococcus mutans colonization in the oral cavity. Whole stimulated saliva samples were collected from 46 HIV-seropositive individuals and 69 HIV-seronegative control individuals. The level of S. mutans colonization was determined by conventional culture methods. The genotype of S. mutans was compared between 10 HIV-positive individuals before and after highly active antiretroviral therapy (HAART) and 10 non-HIV-infected control individuals. The results were analyzed against viral load, CD4+ and CD8+ T-cell counts, salivary flow rate, and caries status. We observed that S. mutans levels were higher in HIV-infected individuals than in the non-HIV-infected control individuals (p = 0.013). No significant differences in S. mutans genotypes were found between the two groups over the six-month study period, even after HAART. There was a bivariate linear relationship between S. mutans levels and CD8+ counts (r = 0.412; p = 0.007), but not between S. mutans levels and either CD4+ counts or viral load. Furthermore, compared with non-HIV-infected control individuals, HIV-infected individuals experienced lower salivary secretion (p = 0.009) and a positive trend toward more decayed tooth surfaces (p = 0.027). These findings suggest that HIV infection can have a significant effect on the level of S. mutans, but not genotypes. PMID:22821240

  4. Autoimmune diseases and HIV infection: A cross-sectional study.

    PubMed

    Virot, Emilie; Duclos, Antoine; Adelaide, Leopold; Miailhes, Patrick; Hot, Arnaud; Ferry, Tristan; Seve, Pascal

    2017-01-01

    To describe the clinical manifestations, treatments, prognosis, and prevalence of autoimmune diseases (ADs) in human immunodeficiency virus (HIV)-infected patients.All HIV-infected patients managed in the Infectious Diseases Department of the Lyon University Hospitals, France, between January 2003 and December 2013 and presenting an AD were retrospectively included.Thirty-six ADs were found among 5186 HIV-infected patients which represents a prevalence of 0.69% including immune thrombocytopenic purpura (n = 15), inflammatory myositis (IM) (n = 4), sarcoidosis (n = 4), Guillain-Barré syndrome (GBS) (n = 4), myasthenia gravis (n = 2), Graves' disease (n = 2), and 1 case of each following conditions: systemic lupus erythematosus, rheumatoid arthritis, autoimmune hepatitis, Hashimoto thyroiditis and autoimmune hemolytic anemia. One patient presented 2 ADs. Thirty patients were known to be HIV-infected when they developed an AD. The AD preceded HIV infection in 2 patients. GBS and HIV infection were diagnosed simultaneously in 3 cases. At AD diagnosis, CD4 T lymphocytes count were higher than 350/mm in 63% of patients, between 200 and 350/mm in 19% and less than 200/mm in 19%. Twenty patients benefited from immunosuppressant treatments, with a good tolerance.ADs during HIV infection are uncommon in this large French cohort. Immune thrombocytopenic purpura, sarcoidosis, IM, and GBS appear to be more frequent than in the general population. Immunosuppressant treatments seem to be effective and well tolerated.

  5. 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.

  6. A study on malarial infection in HIV-infected individuals.

    PubMed

    Muthu, Maharajan; Kumaar, G Sampath

    2007-02-01

    To find out whether malaria occurred at an increased frequency in HIV-infected individuals and to evaluate the clinical course and risk factors for malarial infection in HIV, a prospective study was carried out in a tertiary care centre from June, 1999 to December, 2000 among HIV-infected individuals with HIV-uninfected Individuals taken as control. In this study, out of 250 individuals, 152 were HIV-infected and the remaining were HIV-negative. The odd's ratio (OR) for the occurrence of malaria in the HIV-infected population compared with the HIV-uninfected population was 2.5 (95% confidence interval: 1.01, 6.4; p < 0.02). The prevalence of malaria in HIV infection was 20.4%. The same was 8.3% in asymptomatic stage, and 22.6% and 21.3% in the early and late symptomatic stages of HIV disease respectively. Among those who came for follow-up 44.4% of the HIV-infected individuals had recurrence of malarial infection. Contrary to what was thought before, malaria occurred at an increased frequency in HIV cases. The occurrence of malaria increased in the symptomatic stages of HIV disease compared to the asymptomatic stage. Recurrence was high in the HIV-infected population.

  7. 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.

  8. Impact of Mascarene High variability on the East African `short rains'

    NASA Astrophysics Data System (ADS)

    Manatsa, Desmond; Morioka, Yushi; Behera, Swadhin K.; Matarira, Caxston H.; Yamagata, Toshio

    2014-03-01

    The interannual variability of East African `short rains' (EASR) and its link with the Mascarene High (MH) variation are explored, using observations and reanalysis data. Correlation and composite analyses for flood and drought events reveal that the EASR variability is strongly linked to the MH zonal displacement, in particular, the zonal movement of the MH eastern ridge. When the MH eastern ridge is anomalously displaced to the west (east) of its normal position, the south east (SE) trade winds over the South Indian Ocean (SIO) anomalously strengthen (weaken). This enhances (reduces) the relatively cool and dry SE trade winds and induces cold (warm) sea surface temperature anomaly in the SIO. As a result, convection over the western equatorial SIO is suppressed (enhanced) and leads to rainfall deficits (excess) over East Africa. Droughts in East Africa are associated with a westward migration of the MH eastern ridge, while the relationship is less clear for flood events and their link to an eastward migration of the MH. Therefore, the zonal migration of the MH eastern ridge provides a novel indicator for the EASR extremes especially droughts. This revelation has immense social application for rainfall forecast over East Africa where rainfall deficits have become more prevalent against the background of deteriorating conventional forecasts for EASR droughts.

  9. 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.

  10. 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.

  11. HIV infection, bone metabolism, and fractures.

    PubMed

    Güerri-Fernández, Robert; Villar-García, Judit; Díez-Pérez, Adolfo; Prieto-Alhambra, Daniel

    2014-07-01

    With the advent of high active antiretroviral therapy there was a significant improvement on HIV subjects survival. Thus, bone changes related to HIV became an important aspect of these individuals. HIV affects bone remodeling causing bone fragility. In addition, antiretroviral therapy may also negatively affect bone metabolism. Several studies describe an increased incidence of fractures in these patients when compared with controls without the disease. The European Society of AIDS (EACS), and other societies, have included guidance on management of osteoporosis in HIV-infected patients emphasizing the identification of patients with low bone mass. Supplementation of calcium and vitamin D and the use of alendronate in these individuals should be recommended on a case base.

  12. Lack of endemic HIV infection in Venezuela.

    PubMed

    Azocar, J; Martinez, C; McLane, M F; Allan, J; Essex, M

    1987-01-01

    A seroepidemiological survey of human immunodeficiency virus (HIV) infection was recently conducted in 556 serum samples from donors in rural and urban areas of Venezuela and from aboriginal Amazonian Indians. The samples were tested for the presence of antibodies to HIV by the ELISA technique using several commercially available kits. 19 samples were positive. These samples then were tested by immunofluorescence, Western blot, and radioimmunoprecipitation techniques as confirmatory assays. 4 seropositive control samples from patients from Caracas with Acquired Immune Deficiency Syndrome (AIDS) or AIDS-Related Complex (ARC) were analyzed. None of the samples from rural or aboriginal Indians could be confirmed by these assays. These sera also were evaluated for antibodies to STLV-3 by Western blot analysis. No positive samples were identified. The results fail to support earlier studies suggesting that HIV or a related virus is endemic in the Venezuelan population.

  13. HIV infection and cardiovascular disease in women.

    PubMed

    Womack, Julie A; Chang, Chung-Chou H; So-Armah, Kaku A; Alcorn, Charles; Baker, Jason V; Brown, Sheldon T; Budoff, Matthew; Butt, Adeel A; Gibert, Cynthia; Goetz, Matthew Bidwell; Gottdiener, John; Gottlieb, Stephen; Justice, Amy C; Leaf, David; McGinnis, Kathleen; Rimland, David; Rodriguez-Barradas, Maria C; Sico, Jason; Skanderson, Melissa; Tindle, Hilary; Tracy, Russell P; Warner, Alberta; Freiberg, Matthew S

    2014-10-16

    HIV infection is associated with increased risk of cardiovascular disease (CVD) in men. Whether HIV is an independent risk factor for CVD in women has not yet been established. We analyzed data from the Veterans Aging Cohort Study on 2187 women (32% HIV infected [HIV(+)]) who were free of CVD at baseline. Participants were followed from their first clinical encounter on or after April 01, 2003 until a CVD event, death, or the last follow-up date (December 31, 2009). The primary outcome was CVD (acute myocardial infarction [AMI], unstable angina, ischemic stroke, and heart failure). CVD events were defined using clinical data, International Classification of Diseases, Ninth Revision, Clinical Modification codes, and/or death certificate data. We used Cox proportional hazards models to assess the association between HIV and incident CVD, adjusting for age, race/ethnicity, lipids, smoking, blood pressure, diabetes, renal disease, obesity, hepatitis C, and substance use/abuse. Median follow-up time was 6.0 years. Mean age at baseline of HIV(+) and HIV uninfected (HIV(-)) women was 44.0 versus 43.2 years (P<0.05). Median time to CVD event was 3.1 versus 3.7 years (P=0.11). There were 86 incident CVD events (53%, HIV(+)): AMI, 13%; unstable angina, 8%; ischemic stroke, 22%; and heart failure, 57%. Incident CVD/1000 person-years was significantly higher among HIV(+) (13.5; 95% confidence interval [CI]=10.1, 18.1) than HIV(-) women (5.3; 95% CI=3.9, 7.3; P<0.001). HIV(+) women had an increased risk of CVD, compared to HIV(-) (hazard ratio=2.8; 95% CI=1.7, 4.6; P<0.001). HIV is associated with an increased risk of CVD in women. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  14. HIV infection and HERV expression: a review

    PubMed Central

    2012-01-01

    The human genome contains multiple copies of retrovirus genomes known as endogenous retroviruses (ERVs) that have entered the germ-line at some point in evolution. Several of these proviruses have retained (partial) coding capacity, so that a number of viral proteins or even virus particles are expressed under various conditions. Human ERVs (HERVs) belong to the beta-, gamma-, or spuma- retrovirus groups. Endogenous delta- and lenti- viruses are notably absent in humans, although endogenous lentivirus genomes have been found in lower primates. Exogenous retroviruses that currently form a health threat to humans intriguingly belong to those absent groups. The best studied of the two infectious human retroviruses is the lentivirus human immunodeficiency virus (HIV) which has an overwhelming influence on its host by infecting cells of the immune system. One HIV-induced change is the induction of HERV transcription, often leading to induced HERV protein expression. This review will discuss the potential HIV-HERV interactions. Several studies have suggested that HERV proteins are unlikely to complement defective HIV virions, nor is HIV able to package HERV transcripts, probably due to low levels of sequence similarity. It is unclear whether the expression of HERVs has a negative, neutral, or positive influence on HIV-AIDS disease progression. A positive effect was recently reported by the specific expression of HERVs in chronically HIV-infected patients, which results in the presentation of HERV-derived peptides to CD8+ T-cells. These cytotoxic T-cells were not tolerant to HERV peptides, as would be expected for self-antigens, and consequently lysed the HIV-infected, HERV-presenting cells. This novel mechanism could control HIV replication and result in a low plasma viral load. The possibility of developing a vaccination strategy based on these HERV peptides will be discussed. PMID:22248111

  15. 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. © The Author(s) 2016.

  16. 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.

  17. [New diagnosis of HIV infection in children].

    PubMed

    Guillén, Sara; Prieto, Luis; Jiménez de Ory, Santiago; González-Granado, Ignacio; González-Tomé, María Isabel; Mellado, María José; de José, Maribel; Navarro, María Luisa; Beceiro, José; Roa, Miguel Ángel; Muñoz, María Ángeles; Tomás Ramos, José

    2012-03-01

    The number of children of immigrant origin in the last few years has increased the cohort of HIV-infected children in the Community of Madrid. The objectives of the study were to evaluate the epidemiological and clinical characteristics of the new diagnosed children and describe the different subtypes of HIV-1. The new diagnosed children were analysed from the year 1997, divided into 3 periods: P1 (1997-2000), P2 (2001-2004), P3 (2005-2009). The regions and countries of origin, the clinical, immune and viral characteristics, as well as the response to treatment were analysed. The subtypes of HIV-1 were evaluated by phylogenetic analysis of protease genes and reverse transcriptase. We identified 141 new diagnoses of HIV infection, the percentage of immigrant origin in P1 was (22.5%), P2 (50%) and P3 (68%). The origin had changed from Latin America in P1 to sub-Saharan Africa in P3. There were no differences between Spanish and immigrant children in the age at diagnosis, the CDC clinical stage A/B/C, viral load, percentage of CD4 at diagnosis and actual. Better viral response was more likely in immigrants after the first regimen of HAART (Highly active antiretroviral treatment) independently of the treatment received. A total of 66 subtypes were obtained, 24% were subtypes non-B (56% recombinants forms). All subtypes of Spanish children (43) and Latin American (5) were subtypes B, and all the children from sub-Saharan Africa (14) were subtypes non-B. There were no differences between immigrants and Spanish children infected by HIV, except the different subtypes of HIV-1. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  18. Monitoring wetland changes with remote sensing: An East African example

    NASA Astrophysics Data System (ADS)

    Haack, Barry; Messina, Joe

    1997-01-01

    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 fifteen years as measured by spaceborne 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.

  19. Monitoring wetland changes with remote sensing: An East African example

    NASA Astrophysics Data System (ADS)

    Haack, Barry

    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.

  20. HIV infection-related tuberculosis: clinical manifestations and treatment.

    PubMed

    Sterling, Timothy R; Pham, Paul A; Chaisson, Richard E

    2010-05-15

    Several aspects of human immunodeficiency virus (HIV) infection-related tuberculosis (TB) and its treatment differ from those of TB in HIV-uninfected persons. The risk of TB and the clinical and radiographic manifestations of disease are primary examples. Antiretroviral therapy has a profound effect on lowering the risk of TB in HIV-infected persons, but it can also be associated with immune reconstitution inflammatory disease and unmasking of previously subclinical disease. There are also differences in treatment of HIV infection-related TB because of overlapping drug toxicities and drug-drug interactions between antiretroviral therapy and anti-TB therapy.

  1. Solid organ transplants in HIV-infected patients.

    PubMed

    Harbell, Jack; Terrault, Norah A; Stock, Peter

    2013-09-01

    There is a growing need for kidney and liver transplants in persons living with HIV. Fortunately, with the significant advances in antiretroviral therapy and management of opportunistic infections, HIV infection is no longer an absolute contraindication for solid organ transplantation. Data from several large prospective multi-center cohort studies have shown that solid organ transplantation in carefully selected HIV-infected individuals is safe. However, significant challenges have been identified including prevention of acute rejection, management of drug-drug interactions and treatment of recurrent viral hepatitis. This article reviews the selection criteria, outcomes, and special management considerations for HIV-infected patients undergoing liver or kidney transplantation.

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

    PubMed

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

    2012-07-03

    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.

  3. Prevention of Sexually Transmitted Diseases in HIV-Infected Individuals.

    PubMed

    Quilter, Laura; Dhanireddy, Shireesha; Marrazzo, Jeanne

    2017-04-01

    Prevention of sexually transmitted infections (STIs) is an important part of the care of the HIV-infected individual. STIs have been associated with increased risk of transmission and acquisition of HIV. Among HIV-infected persons, treatment failures and high recurrence rates of some STIs are more common. Despite the recognized importance of prevention and discussion of sexual health, rates of screening for STIs are suboptimal. Moreover, rates of STIs such as syphilis continue to increase particularly in men who have sex with men (MSM). This review focuses on the most common STIs seen among HIV-infected individuals and recommendations for screening and prevention.

  4. Clinical diagnosis of cardiac involvement in HIV infection

    PubMed Central

    Moldovan, L; Branzan, O; Nechita, O; Ardeleanu, C; Teodorescu, M; Geamai, A

    2012-01-01

    HIV infection is continuously raising, and different treatments did not manage to extend the patient's life. Clinical and morphopathological features of respiratory, gastrointestinal, hematological and nervous system are well characterized in HIV infection, but cardiac involvement is not so well known. Cardiac involvement is extremely rare in HIV disease, but demonstrated by echocardiography and anatomo-pathologic methods, it is more frequently met than the clinical features are supposed to be, and it can be demonstrated by positive serologic tests. The main reason of this research is the necessity to obtain data from HIV infection concerning heart involvement. PMID:23049631

  5. Vitamin A and HIV infection: disease progression, mortality, and transmission.

    PubMed

    Kennedy, C M; Kuhn, L; Stein, Z

    2000-10-01

    Among HIV-infected individuals, many nutritional factors that influence disease progress, mortality, and transmission are not well understood. Of particular interest is the role of vitamin A. The benefits of vitamin A have been recognized since ancient times by Egyptian physicians who successfully treated night blindness with vitamin A. Contemporary scientists have since recognized the importance of vitamin A and have provided evidence that it may help in repairing damaged mucosal surfaces; what remains unclear, however, is its role during HIV infection. In this review, we examine the evidence provided in both observational studies and randomized controlled trials that assessed the effect of vitamin A during HIV infection.

  6. 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

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

    PubMed

    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 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 resulted in the evolution

  8. 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

  9. Correlates of Complete Childhood Vaccination in East African Countries

    PubMed Central

    Canavan, Maureen E.; Sipsma, Heather L.; Kassie, Getnet M.; Bradley, Elizabeth H.

    2014-01-01

    Background Despite the benefits of childhood vaccinations, vaccination rates in low-income countries (LICs) vary widely. Increasing coverage of vaccines to 90% in the poorest countries over the next 10 years has been estimated to prevent 426 million cases of illness and avert nearly 6.4 million childhood deaths worldwide. Consequently, we sought to provide a comprehensive examination of contemporary vaccination patterns in East Africa and to identify common and country-specific barriers to complete childhood vaccination. Methods Using data from the Demographic and Health Surveys (DHS) for Burundi, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, we looked at the prevalence of complete vaccination for polio, measles, Bacillus Calmette–Guérin (BCG) and DTwPHibHep (DTP) as recommended by the WHO among children ages 12 to 23 months. We conducted multivariable logistic regression within each country to estimate associations between complete vaccination status and health care access and sociodemographic variables using backwards stepwise regression. Results Vaccination varied significantly by country. In all countries, the majority of children received at least one dose of a WHO recommended vaccine; however, in Ethiopia, Tanzania, and Uganda less than 50% of children received a complete schedule of recommended vaccines. Being delivered in a public or private institution compared with being delivered at home was associated with increased odds of complete vaccination status. Sociodemographic covariates were not consistently associated with complete vaccination status across countries. Conclusions Although no consistent set of predictors accounted for complete vaccination status, we observed differences based on region and the location of delivery. These differences point to the need to examine the historical, political, and economic context of each country in order to maximize vaccination coverage. Vaccination against these childhood diseases is a critical step towards

  10. Carbon dioxide measurements in tropical East African biomes

    NASA Astrophysics Data System (ADS)

    Schnell, R. C.; Odh, S.-A.; Njau, L. N.

    1981-06-01

    From January 1977 through May 1978 atmospheric CO2 concentrations were measured hourly and/or continuously at bimonthly intervals over periods varying from 5 to 8 days at 10 different locations in Kenya, East Africa. During each of these periods, at least two, and in some cases five, vertical profile measurements of CO2 concentrations were conducted above different biomes. A large diurnal CO2 periodicity was observed over land, with daytime drawdowns to 322 ppm and nighttime buildups to more than 400 ppm observed in savannah regions. In and around tropical rain forests, drawdowns to 310 ppm and buildups to more than 400 ppm were regularly observed. On the higher reaches of Mount Kenya, the diurnal CO2 cycle was considerably reduced in amplitude, with variations in the range of 2-6 ppm throughout the 16-month study period. On sunny days, the drawdown of CO2 was measurable to heights of at least 4000 m above ground level. Other CO2 concentration measurements in air over the Indian Ocean (to distances of up to 450 km upwind of the coast) produced fairly consistent concentrations of about 328.5 ppm which did not fluctuate diurnally. The weekly mean CO2 concentrations over Kenya appear to have a bimodal structure, with minima occurring in July and January. On the basis of the data collected during the study it appears likely that regular observations at a high-altitude station on Mount Kenya, either with flask sampling or continuous analyzer measurements, are likely to yield data useful for estimates of CO2 concentration backgrounds and trends. Also, there is strong evidence that Mount Kenya would be a good location to measure large-scale interhemispheric CO2 exchanges and provide a unique base from which to study the effects of the tropical biome on biogeochemical phenomena.

  11. Carbon dioxide measurements in tropical east African biomes

    SciTech Connect

    Schnell, R.C.; Odh, S.A.; Njau, L.N.

    1981-06-20

    From January 1977 through May 1978 atmospheric CO/sub 2/ concentrations were measured hourly and/or continuously at bimonthly intervals over periods varying from 5 to 8 days at 10 different locations in Kenya, East Africa. During each of these periods, at least two, and in some cases five, vertical profile measurements of CO/sub 2/ concentrations were conducted above different biomes. A large diurnal CO/sub 2/ periodicity was observed over land, with daytime drawdowns to 322 ppm and nighttime buildups to more than 400 ppm observed in savannah regions. In and around tropical rain forests, drawdowns to 310 ppm and buildups to more than 400 ppm were regularly observed. On the higher reaches of Mount Kenya, the diurnal CO/sub 2/ cycle was considerably reduced in amplitude, with variations in the range of 2-6 ppm throughout the 16-month study period. On sunny days, the drawdown of CO/sub 2/ was measurable to heights of at least 4000 m above ground level. Other CO/sub 2/ measurements in air over the Indian Ocean (to distances of up to 450 km upwind of the coast) produced fairly consistent concentrations of about 328.5 ppm which did not fluctuate diurnally. The weekly mean CO/sub 2/ concentrations over Kenya appear to have a bimodal structure, with minima occurring in July and January. On the basis of the data collected during the study it appears likely that regular observations at a high-altitude station on Mount Kenya, either with flask sampling or continuous analyzer measurements, are likely to yield data useful for estimates of CO/sub 2/ concentration backgrounds and trends. Also, there is strong evidence that Mount Kenya would be a good location to measure large-scale interhemispheric CO/sub 2/ exchanges and provide a unique base from which to study the effects of the tropical biome on biogeochemical phenomena. 20 references, 12 figures, 2 tables.

  12. The East African monsoon system: Seasonal climatologies and recent variations: Chapter 10

    USGS Publications Warehouse

    Funk, Christopher C.; Hoell, Andrew; Shukla, Shraddhanand; Husak, Gregory J.; Michaelsen, J.

    2016-01-01

    This chapter briefly reviews the complex climatological cycle of the East African monsoon system, paying special attention to its connection to the larger Indo-Pacific-Asian monsoon cycle. We examine the seasonal monsoon cycle, and briefly explore recent circulation changes. The spatial footprint of our analysis corresponds with the “Greater Horn of Africa” (GHA) region, extending from Tanzania in the south to Yemen and Sudan in the north. During boreal winter, when northeast trade winds flow across the northwest Indian Ocean and the equatorial moisture transports over the Indian Ocean exhibit strong westerly mean flows over the equatorial Indian Ocean, East African precipitation is limited to a few highland areas. As the Indian monsoon circulation transitions during boreal spring, the trade winds over the northwest Indian Ocean reverse, and East African moisture convergence supports the “long” rains. In boreal summer, the southwesterly Somali Jet intensifies over eastern Africa. Subsidence forms along the westward flank of this jet, shutting down precipitation over eastern portions of East Africa. In boreal fall, the Jet subsides, but easterly moisture transports support rainfall in limited regions of the eastern Horn of Africa. We use regressions with the trend mode of global sea surface temperatures to explore potential changes in the seasonal monsoon circulations. Significant reductions in total precipitable water are indicated in Kenya, Tanzania, Rwanda, Burundi, Uganda, Ethiopia, South Sudan, Sudan, and Yemen, with moisture transports broadly responding in ways that reinforce the climatological moisture transports over the Indian Ocean. Over Kenya, southern Ethiopia and Somalia, regressions with velocity potential indicate increased convergence aloft. Near the surface, this convergence appears to manifest as a surface high pressure system that modifies moisture transports in these countries as well as Uganda, Tanzania, Rwanda, and Burundi. An analysis

  13. 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

  14. Neutropenia during HIV Infection: Adverse Consequences and Remedies

    PubMed Central

    Shi, Xin; Sims, Matthew D; Hanna, Michel M; Xie, Ming; Gulick, Peter G; Zheng, Yong-Hui; Basson, Marc D; Zhang, Ping

    2016-01-01

    Neutropenia frequently occurs in patients with Human immunodeficiency virus (HIV) infection. Causes for neutropenia during HIV infection are multifactoral, including the viral toxicity to hematopoietic tissue, the use of myelotoxic agents for treatment, complication with secondary infections and malignancies, as well as the patient’s association with confounding factors which impair myelopoiesis. An increased prevalence and severity of neutropenia is commonly seen in advanced stages of HIV disease. Decline of neutrophil phagocytic defense in combination with the failure of adaptive immunity renders the host highly susceptible to developing fatal secondary infections. Neutropenia and myelosuppression also restrict the use of many antimicrobial agents for treatment of infections caused by HIV and opportunistic pathogens. In recent years, HIV infection has increasingly become a chronic disease because of progress in antiretroviral therapy (ART). Prevention and treatment of severe neutropenia becomes critical for improving the survival of HIV-infected patients. PMID:24654626

  15. Interferon responses in HIV infection: from protection to disease.

    PubMed

    Sivro, Aida; Su, Ruey-Chyi; Plummer, Francis A; Ball, T Blake

    2014-01-01

    Interferons, induced early during viral infections, represent important regulators of both innate and adaptive immune responses, and provide protective effects against a wide range of pathogens, including HIV. Several in vitro studies and some in vivo data from HIV-exposed seronegative cohorts indicate that interferons and interferon-mediated immune responses are crucial in preventing early HIV replication. Following establishment of HIV infection, the uncontrolled (aberrant) activation of the immune system, in part regulated by interferon levels, contributes to HIV-1-induced immune activation and disease progression. Modulation of interferon responses prior to and during HIV infection shows promise for development of novel therapeutics to prevent HIV transmission, clear HIV infection, and dampen chronic immune activation. In this review we discuss the role that interferons play in protection from HIV infection, acute infection, and their role in HIV pathogenesis and disease progression. Lastly, we review recent advances in modulating interferon responses for purposes of developing novel HIV therapeutic approaches.

  16. Neutropenia during HIV infection: adverse consequences and remedies.

    PubMed

    Shi, Xin; Sims, Matthew D; Hanna, Michel M; Xie, Ming; Gulick, Peter G; Zheng, Yong-Hui; Basson, Marc D; Zhang, Ping

    2014-01-01

    Neutropenia frequently occurs in patients with Human immunodeficiency virus (HIV) infection. Causes for neutropenia during HIV infection are multifactoral, including the viral toxicity to hematopoietic tissue, the use of myelotoxic agents for treatment, complication with secondary infections and malignancies, as well as the patient's association with confounding factors which impair myelopoiesis. An increased prevalence and severity of neutropenia is commonly seen in advanced stages of HIV disease. Decline of neutrophil phagocytic defense in combination with the failure of adaptive immunity renders the host highly susceptible to developing fatal secondary infections. Neutropenia and myelosuppression also restrict the use of many antimicrobial agents for treatment of infections caused by HIV and opportunistic pathogens. In recent years, HIV infection has increasingly become a chronic disease because of progress in antiretroviral therapy (ART). Prevention and treatment of severe neutropenia becomes critical for improving the survival of HIV-infected patients.

  17. Yellow fever vaccine for patients with HIV infection.

    PubMed

    Barte, Hilary; Horvath, Tara H; Rutherford, George W

    2014-01-23

    Yellow fever (YF) is an acute viral haemorrhagic disease prevalent in tropical Africa and Latin America. The World Health Organization (WHO) estimates that there are 200,000 cases of YF and 30,000 deaths worldwide annually. Treatment for YF is supportive, but a live attenuated virus vaccine is effective for preventing infection. WHO recommends immunisation for all individuals > 9 months living in countries or areas at risk. However, the United States Advisory Committee on Immunization Practices (ACIP) advises that YF vaccine is contraindicated in individuals with HIV. Given the large populations of HIV-infected individuals living in tropical areas where YF is endemic, YF vaccine may be an important intervention for preventing YF in immunocompromised populations. To assess the risk and benefits of YF immunisation for people infected with HIV. We used standard Cochrane methods to search electronic databases and conference proceedings with relevant search terms without limits to language. Randomised controlled trials and cohort studies of individuals with HIV infection who received YF vaccine (17DD or 17D-204). Two authors screened abstracts of references identified by electronic or bibliographic searches according to inclusion and exclusion criteria as detailed in the protocol. We identified 199 references and examined 19 in detail for study eligibility. Data were abstracted independently using a standardised abstraction form. Three cohort studies were included in the review. They examined 484 patients with HIV infection who received YF immunisation. Patients with HIV infection developed significantly lower concentrations of neutralising antibodies in the first year post immunisation compared to uninfected patients, though decay patterns were similar for recipients regardless of HIV infection. No study patient with HIV infection suffered serious adverse events as a result of YF vaccination. YF vaccination can produce protective levels of neutralising antibodies in

  18. Relapsing fever causative agent in Southern Iran is a closely related species to East African borreliae.

    PubMed

    Naddaf, Saied Reza; Ghazinezhad, Behnaz; Kazemirad, Elham; Cutler, Sally Jane

    2017-10-01

    We obtained two blood samples from relapsing fever patients residing in Jask County, Hormozgan Province, southern Iran in 2013. Sequencing of a partial fragment of glpQ from two samples, and further characterization of one of them by analyzing flaB gene, and 16S-23S spacer (IGS) revealed the greatest sequence identity with East African borreliae, Borrelia recurrentis, and Borrelia duttonii, and Borrelia microti from Iran. Phylogenetic analyses of glpQ, flaB, and concatenated sequences (glpQ, flab, and IGS) clustered these sequences amongst East African Relapsing fever borreliae and B. microti from Iran. However, the more discriminatory IGS disclosed a unique 8-bp signature (CAGCCTAA) separating these from B. microti and indeed other relapsing fever borreliae. In southern Iran, relapsing fever cases are mostly from localities in which O. erraticus ticks, the notorious vector of B. microti, prevail. There are chances that this argasid tick serves as a host and vector of several closely related species or ecotypes including the one we identified in the present study. The distribution of this Borrelia species remains to be elucidated, but it is assumed to be endemic to lowland areas of the Hormozgan Province, as well as Sistan va Baluchistan in the southeast and South Khorasan (in Persian: Khorasan-e Jonobi) in the east of Iran. Copyright © 2017 Elsevier GmbH. All rights reserved.

  19. Isolated cerebellar toxoplasmosis as a complication of HIV infection.

    PubMed

    Pott, H; Castelo, A

    2013-01-01

    Isolated cerebellar mass lesion is an uncommon presentation of toxoplasmosis. The authors report one rare case in a 50-year-old HIV-infected male patient who presented with clipped speech, gait ataxia and incoordination. The cerebellar toxoplasmosis was suspected based on imaging findings, despite the atypical location. This case highlights the need for a high index of clinical suspicion among HIV-infected patients with neurological manifestations and suspicious neuroimaging findings.

  20. Live attenuated herpes zoster vaccine for HIV-infected adults.

    PubMed

    Shafran, S D

    2016-04-01

    Multiple guidelines exist for the use of live viral vaccines for measles-mumps-rubella (MMR), varicella and yellow fever in people with HIV infections, but these guidelines do not make recommendations regarding live attenuated herpes zoster vaccine (LAHZV), which is approved for people over 50 years in the general population. LAHZV is made with the same virus used in varicella vaccine. The incidence of herpes zoster remains increased in people with HIV infection, even when on suppressive antiretroviral therapy, and a growing proportion of HIV-infected patients are over 50 years of age. The purpose of this article is to review the use of varicella vaccine and LAHZV in people with HIV infection and to make recommendations about the use of LAHZV in adults with HIV infection. A PubMed search was undertaken using the terms 'herpes zoster AND HIV' and 'varicella AND HIV'. Reference lists were also reviewed for pertinent citations. Varicella vaccine is recommended in varicella-susceptible adults, as long as they have a CD4 count > 200 cells/μL, the same CD4 threshold used for MMR and yellow fever vaccines. No transmission of vaccine strain Varicella zoster virus has been documented in people with HIV infections with a CD4 count above this threshold. LAHZV was administered to 295 HIV-infected adults with a CD4 count > 200 cells/μL, and was safe and immunogenic with no cases of vaccine strain infection. It is recommended that LAHZV be administered to HIV-infected adults with a CD4 count above 200 cells/μL, the same CD4 threshold used for other live attenuated viral vaccines. © 2015 British HIV Association.

  1. Cryptococcal meningitis associated with tuberculosis in HIV infected patients.

    PubMed

    Singh, Urvinderpal; Aditi; Aneja, Pooja; Kapoor, B K; Singh, S P; Purewal, Sukhpreet Singh

    2013-07-01

    Opportunistic infections are common complications of advanced immuno-deficiency in individuals with Human Immunodeficiency Virus (HIV) infection. Following involvement of the lung, the central nervous system (CNS) is the second most commonly affected organ. We report two cases of concurrent cryptococcal meningitis and tuberculosis (TB) in HIV infected persons. A high suspicion of multiple opportunistic infections should be kept in mind in HIV seropositive individuals.

  2. Thyroid function in newly diagnosed HIV-infected patients.

    PubMed

    Noureldeen, Amani Fh; Qusti, Safaa Y; Khoja, Gelan Ms

    2014-11-01

    A variety of HIV-related endocrine dysfunctions including adrenal, gonadal and thyroid disorders have been reported. We aimed to compare between the markers of thyroid function in newly diagnosed HIV-infected patients and healthy volunteers as a control group. The prevalence of the thyroid abnormalities in HIV-infected patients was assessed and the levels of thyroid autoantibodies were also determined. A total of 100 newly diagnosed HIV-infected patients having a CD4 cell count of 180-350 cells/mm(3) were enrolled in the study. Same number of healthy volunteers were also included for comparison. Measurements of thyroid function tests including thyroid-stimulating hormone (TSH), free thyroxin and free triiodothyronine levels beside thyroid autoantibodies, including antithyroglobulin (ATBG) and antithyroid peroxidase (ATPO), were carried out for all patients and volunteers. In total, 70% of HIV-infected patients had normal thyroid function tests when compared with control individuals, while 30% of HIV-infected patients had abnormal thyroid function. Of the 30 cases, 11 cases had abnormal TSH values, with increased TSH predominant (7% of HIV cases) than decreased TSH (4% of patients) values. Incidence of thyroid abnormalities ranging from hypothyroidism (subclinical and overt: 6% and 1%, respectively) to hyperthyroidism (2%) and nonthyroidal illness (9%) were estimated in HIV-infected patients. The values of thyroid autoantibodies were almost normal in HIV-infected patients, except the three cases presented with elevated ATBG, indicating that thyroid abnormalities were not due to elevated ATBG and ATPO. Thyroid hormones are of great importance and due to high prevalence of thyroid function abnormality, it is recommended that thyroid function tests should be monitored in all HIV-infected patients before starting the treatment. © The Author(s) 2012.

  3. 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.

  4. 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

  5. Substance use in older HIV-infected patients.

    PubMed

    Edelman, E Jennifer; Tetrault, Jeanette M; Fiellin, David A

    2014-07-01

    Substance use may persist throughout the life course and has a substantial impact on health outcomes globally. As HIV-infected individuals are disproportionately impacted by substance use and living longer, it is critical that providers and researchers alike understand the impact of substance use on older, HIV-infected patients and potential treatment options. To this end, we conducted a review of the literature focusing on the most commonly used substances to outline the epidemiology, health consequences, treatment options and latest research relevant to older, HIV-infected patients. Substance use impacts older, HIV-infected patients with regards to HIV-related and non-HIV-related outcomes. Counseling strategies are available for marijuana and stimulant use disorders. Brief counseling is useful alongside medications for alcohol, tobacco and opioid use disorders. Many medications for alcohol, tobacco and opioid use disorders are safe in the setting of antiretroviral therapy. Unfortunately, few interventions targeting substance use in older, HIV-infected patients have been developed and evaluated. As older, HIV-infected patients continue to experience substance use and its related health consequences, there will be a growing need for the development of safe and effective interventions, which address the complex needs of this population.

  6. 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.

  7. 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

  8. Substance Use in Older HIV-Infected Patients

    PubMed Central

    Edelman, E. Jennifer; Tetrault, Jeanette M.; Fiellin, David A.

    2014-01-01

    Purpose of the Review Substance use may persist throughout the life course and has a substantial impact on health outcomes globally. As HIV-infected individuals are disproportionately impacted by substance use and living longer, it is critical that providers and researchers alike understand the impact of substance use on older, HIV-infected patients and potential treatment options. To this end, we conducted a review of the literature focusing on the most commonly used substances to outline the epidemiology, health consequences, treatment options and latest research relevant to older, HIV-infected patients. Recent Findings Substance use impacts older, HIV-infected patients with regards to HIV-related and non-HIV related outcomes. Counseling strategies are available for marijuana and stimulant use disorders. Brief counseling is useful alongside medications for alcohol, tobacco and opioid use disorders. Many medications for alcohol, tobacco, and opioid use disorders are safe in the setting of antiretroviral therapy. Unfortunately, few interventions targeting substance use in older, HIV-infected patients have been developed and evaluated. Summary As older, HIV-infected patients continue to experience substance use and its related health consequences, there will be a growing need for the development of safe and effective interventions which address the complex needs of this population. PMID:24824888

  9. 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

  10. Plasma polyunsaturated fatty acids and liver enzymes in HIV-infected subjects: the Prospective Urban and Rural Epidemiology (PURE) Study.

    PubMed

    Stonehouse, Welma; Kruger, Annamarie; Smuts, Cornelius M; Loots, Du Toit; Wentzel-Viljoen, Edelweiss; Vorster, Hester H

    2010-03-01

    Omega-6 (n-6) polyunsaturated fatty acid (PUFA) intake was previously reported to be adversely related to liver function in HIV-infected subjects, when compared with HIV-uninfected subjects, in a black population in South Africa. It was speculated that the use of heavily oxidized vegetable fats (abused fats) could have been responsible. The objectives were to investigate the relation between plasma total PUFA concentrations (a marker of PUFA intake) and liver enzymes in HIV-infected asymptomatic compared with HIV-uninfected black South Africans and to investigate the reuse of oil and the use of abused oils. This was a case-control study nested in an epidemiologic study in 305 HIV-infected cases and 301 HIV-uninfected matched controls (matched according to location, sex, and age), as part of the PURE (Prospective Urban and Rural Epidemiology) Study, a prospective cohort study that includes a representative sample of 2000 apparently healthy black volunteers, aged between 36 and 60 y, from the North West Province of South Africa. Plasma total omega-6 PUFA concentrations were negatively (P < 0.05) associated with liver enzymes (gamma-glutamyl transpeptidase, alanine aminotransferase, aspartate aminotranferase, and alkaline phosphatase) in both HIV-infected and HIV-uninfected subjects (r values ranged from -0.22 to -0.56). Almost all subjects (99%) reported that they did not buy oil that had been used before. Oil was only used a mean (+/-SD) of 2.23 +/- 0.85 times for deep frying before being discarded. The adverse relations between omega-6 PUFA intake and liver enzymes that were previously shown could not be confirmed in this study. In contrast, plasma omega-6 PUFA concentration was inversely related to liver enzymes in both HIV-infected and HIV-uninfected subjects. Subjects in this study did not use abused fats, which could partly explain these findings.

  11. HIV Care Outcomes Among Men Who Have Sex With Men With Diagnosed HIV Infection - United States, 2015.

    PubMed

    Singh, Sonia; Mitsch, Andrew; Wu, Baohua

    2017-09-22

    Gay, bisexual, and other men who have sex with men (collectively referred to as MSM) represent approximately 2% of the U.S. population (1), yet in 2015, MSM accounted for 70% of all diagnoses of human immunodeficiency virus (HIV) infection, including 3% who also were persons who inject drugs (2). During 2008-2014, incidence of HIV infection decreased for groups in all transmission categories except MSM (3). Testing, linkage to and retention in care, and viral suppression are important in reducing HIV transmission. National HIV Surveillance System (NHSS)* data are used to monitor progress toward reaching national goals.(†) To better guide prevention measures, CDC analyzed data from NHSS for MSM aged ≥13 years (excluding MSM who inject drugs) to determine stage at diagnosis of HIV infection and care outcomes. Among the 19,170 MSM with HIV infection diagnosed in 2015 in 38 jurisdictions with complete laboratory reporting, 3,666 (19.1%) had infection classified as stage 3 (acquired immunodeficiency syndrome [AIDS]) at diagnosis and 74.7% and 84.0% were linked to care within 1 month and 3 months, respectively. Among MSM living with diagnosed HIV infection at year-end 2014, 74.1% received any HIV care, 57.7% were retained in continuous care, and 61.2% had achieved viral suppression. Younger MSM and black or African American (black) MSM had the least favorable HIV care outcomes. Strengthening interventions that increase care and viral suppression among MSM, particularly those aged <25 years and black MSM with public and private partners is important.

  12. Lung cancer in HIV-infected patients

    PubMed Central

    Palacios, R; Lebrón, J; Guerrero-León, M; Del Arco, A; Colmenero, J; Márquez, M; Santos, J

    2012-01-01

    Purpose Several studies have shown that HIV patients are at higher risk of lung cancer. Our aim is to analyse the prevalence and features of lung cancer in HIV-infected patients. Methods The clinical charts of 4,721 HIV-infected patients seen in three hospitals of southeast Spain (study period 1992–2012) were reviewed, and all patients with a lung cancer were analysed. Results There were 61 lung cancers, giving a prevalence of 1.2%. There was a predominance of men (82.0%), and smokers (96.6%; mean pack-years 35.2), with a median age of 48.0 (41.7–52.9) years, and their distribution according to risk group for HIV was: intravenous drug use 58.3%, homosexual 20.0%, and heterosexual 16.7%. Thirty-four (56.7%) patients were Aids cases, and 29 (47.5%) had prior pulmonar events: tuberculosis 16, bacterial pneumonia 9, and P. jiroveci pneumonia 4. The median nadir CD4 count was 149/mm3 (42–232), the median CD4 count at the time of diagnosis of the lung cancer was 237/mm3 (85–397), and 66.1%<350/mm3. 66.7% were on ART, and 70% of them had undetectable HIV viral load. The most common histological types of lung cancer were adenocarcinoma and epidermoid, with 24 (40.0%) and 23 (38.3%) cases, respectively. There were 49 (80.3%) cases with advanced stages (III and IV) at diagnosis. The distribution of treatments was: only palliative 23 (39.7%), chemotherapy 14 (24.1%), surgery and chemotherapy 8 (13.8%), radiotherapy 7 (12.1%), surgery 4 (6.9%), and other combined treatments 2 (3.4%). Forty-six (76.7%) patients died, with a median survival time of 3 months. The Kaplan-Meier survival rate at 6 months was 42.7% (at 12 months 28.5%). Conclusions The prevalence of lung cancer in this cohort of HIV-patients is high. People affected are mainly men, smokers, with transmission of HIV by intravenous drug use, and around half of them with prior opportunistic pulmonary events. Most patients had low nadir CD4 count, and were immunosuppressed at the time of diagnosis. Adenocarcinoma

  13. Characteristics of HIV-infected adults in the Deep South and their utilization of mental health services: A rural vs. urban comparison.

    PubMed

    Reif, Susan; Whetten, Kathryn; Ostermann, Jan; Raper, James L

    2006-01-01

    Insufficient utilization of mental health services has been described among HIV-infected individuals in urban areas; however, little is known about utilization of mental health services among rural-living HIV-infected individuals. This article examines use of mental health services by HIV-infected adults in the Southern U.S., where approximately two-thirds of rural HIV cases reside, and compares mental health services use between those in rural and urban areas. Data were obtained from surveys of HIV-infected individuals receiving care at tertiary Infectious Diseases clinics in the Southern U.S. (n = 474). Study findings indicated that participants living in areas with a higher proportion of rural-living individuals were less likely to report seeing a mental health provider (p < .001) in the last year even though there were no differences in level of psychological distress by degree of rurality. Participants living in more rural areas also reported significantly fewer mental health visits in the previous month (p = .025). Furthermore, rural living was significantly associated with being African-American, heterosexual, less educated, and having minor children in the home. Due to differences in characteristics and mental health services use by degree of rurality, efforts are needed to assess and address the specific mental health and other needs of HIV-infected individuals in rural areas.

  14. Interannual modulation of East African early short rains by the winter Arctic Oscillation

    NASA Astrophysics Data System (ADS)

    Gong, Dao-Yi; Guo, Dong; Mao, Rui; Yang, Jing; Gao, Yongqi; Kim, Seong-Joong

    2016-08-01

    In the present study, we analyzed the interannual linkage between the boreal winter Arctic Oscillation (AO) and East African early short rains. When the Indian Ocean Dipole and El Niño-Southern Oscillation variance are excluded by linear regression, the boreal winter AO index is significantly correlated with the October East African precipitation over the domain of 5°N-5°S and 35°-45°E for the period 1979-2014, r =+ 0.46. The upper ocean heat content likely acts as a medium that links the AO and East African precipitation. Significant subsurface warming and positive upper ocean heat content anomalies occur over the western Indian Ocean during the autumn following positive AO winters, which enriches the atmospheric moisture, intensifies convection, and enhances precipitation. Oceanic dynamics play a key role in causing this subsurface warming. Winter AO-related atmospheric circulation creates anomalous wind stress, which forces a downwelling oceanic Rossby wave between 60°-75°E and 5°-10°S, where the thermocline significantly deepens. This Rossby wave propagates westward and accompanies significant subsurface warming along the thermocline. The Rossby wave arrives at the western Indian Ocean in the late summer, significantly warming the region to the west of 55°E at a depth of 60-100 m. This warming remains significant through October. Correspondingly, the upper ocean heat content significantly increases by approximately 2-3 × 108 J m-2 in the region west of 60°E between 5° and 10°S. The role of these oceanic dynamics in linking the winter AO, and anomalous subsurface warming was tested by numerical experiments with an oceanic general circulation model. The experiments were performed with the forcing of AO-related wind stress anomalies over the Indian Ocean in the winter. The oceanic Rossby wave generated in the central Indian Ocean during boreal winter, the consequent subsurface warming, and the anomalous upper ocean heat content in October over the

  15. Micronutrient supplementation in adults with HIV infection

    PubMed Central

    Visser, Marianne E; Durao, Solange; Sinclair, David; Irlam, James H; Siegfried, Nandi

    2017-01-01

    additional trial that compared high-dose multiple micronutrient supplementation with standard doses in people on ART, peripheral neuropathy was lower with high dose supplements compared to standard dose (incidence rate ratio (IRR) 0.81, 95% CI 0.7 to 0.94; 1 trial, 3418 participants), but the trial was stopped early due to increased adverse events (elevated alanine transaminase (ALT) levels) in the high dose group. Single or dual micronutrients None of the trials of single or dual micronutrient supplements were adequately powered to assess for effects on mortality or morbidity outcomes. No clinically significant changes in CD4 cell count (data not pooled, 14 trials, 2370 participants, very low or low certainty evidence) or viral load (data not pooled, seven studies, 1334 participants, very low or low certainty evidence), were reported. Supplementation probably does increase blood concentrations of vitamin D and zinc (data not pooled, vitamin D: 4 trials, 299 participants, zinc: 4 trials, 484 participants, moderate certainty evidence) and may also increase blood concentrations of vitamin A (data not pooled, 3 trials, 495 participants, low certainty evidence), especially in those who are deficient. Authors' conclusions The analyses of the available trials have not revealed consistent clinically important benefits with routine multiple micronutrient supplementation in people living with HIV. Larger trials might reveal small but important effects. These findings should not be interpreted as a reason to deny micronutrient supplements for people living with HIV where specific deficiencies are found or where the person's diet is insufficient to meet the recommended daily allowance of vitamins and minerals. Micronutrient supplements for non-pregnant adults with HIV infection Cochrane researchers conducted a review of the effects of micronutrient supplements for people living with HIV. This is an update of a Cochrane Review previously published in 2010. After searching for relevant

  16. Motivation, management, and mastery: a theory of resilience in the context of HIV infection.

    PubMed

    De Santis, Joseph P; Florom-Smith, Aubrey; Vermeesch, Amber; Barroso, Susana; DeLeon, Diego A

    2013-01-01

    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. 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. 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. 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.

  17. 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

  18. Toxoplasmosis in HIV infection: An overview.

    PubMed

    Basavaraju, Anuradha

    2016-01-01

    Toxoplasma gondii is an obligate intracellular protozoan parasite presenting as a zoonotic infection distributed worldwide. In HIV-positive individuals, it causes severe opportunistic infections, which is of major public health concern as it results in physical and psychological disabilities. In healthy immunocompetent individuals, it causes asymptomatic chronic persistent infections, but in immunosuppressed patients, there is reactivation of the parasite if the CD4 counts fall below 200 cells/μl. The seroprevalence rates are variable in different geographic areas. The tissue cyst or oocyst is the infective form which enters by ingestion of contaminated meat and transform into tachyzoites and disseminate into blood stream. In immunocompetent persons due to cell-mediated immunity the parasite is transformed into tissue cyst resulting in life long chronic infection. In HIV-infected people opportunistic infection by T. gondii occurs due to depletion of CD4 cells, decreased production of cytokines and interferon gamma and impaired cytotoxic T-lymphocyte activity resulting in reactivation of latent infection. The diagnosis can be done by clinical, serological, radiological, histological or molecular methods, or by the combination of these. There is various treatment regimen including acute treatment, maintenance therapy should be given as the current anti T. gondii therapy cannot eradicate tissue cysts. In HIV patients, CD4 counts <100; cotrimoxazole, alternately dapsone + pyrimethamine can be given for 6 months. Hence, early diagnosis of T. gondii antibodies is important in all HIV-positive individuals to prevent complications of cerebral toxoplasmosis.

  19. Post-treatment control of HIV infection

    DOE PAGES

    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

  20. 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.

  1. Lung Cancer in HIV-Infected Patients.

    PubMed

    Mena, Álvaro; Meijide, Héctor; Marcos, Pedro J

    2016-01-01

    The widespread use of HAART for persons living with HIV since 1996 has resulted in a dramatic decline in AIDS-related mortality. However, other comorbidities are increasing, such as metabolic disturbances or cancers, including solid organ malignancies. Among the latest, lung cancer, especially the adenocarcinoma subtype, is on the rise. HIV infection, even controlling for smoking, is an independent risk factor for developing lung cancer. HIV could promote lung cancers through immunosuppression, chronic inflammation, and a direct oncogenic effect. Smoking, lung infections, and chronic pulmonary diseases are risk factors for lung cancer. All may contribute to the cumulative incidence of lung cancer in persons living with HIV. It is double that in the general population. The role of HAART in lung cancer development in persons living with HIV is not well established. Although data supporting it could be too preliminary, persons living with HIV should be considered within high-risk groups that could benefit from screening strategies with low-dose computed tomography, especially those with airway obstruction and emphysema. Current evidence suggests that quitting smoking strategies in persons living with HIV achieve abstinence rates comparable to those in healthy HIV-negative smokers.

  2. Toxoplasmosis in HIV infection: An overview

    PubMed Central

    Basavaraju, Anuradha

    2016-01-01

    Toxoplasma gondii is an obligate intracellular protozoan parasite presenting as a zoonotic infection distributed worldwide. In HIV-positive individuals, it causes severe opportunistic infections, which is of major public health concern as it results in physical and psychological disabilities. In healthy immunocompetent individuals, it causes asymptomatic chronic persistent infections, but in immunosuppressed patients, there is reactivation of the parasite if the CD4 counts fall below 200 cells/μl. The seroprevalence rates are variable in different geographic areas. The tissue cyst or oocyst is the infective form which enters by ingestion of contaminated meat and transform into tachyzoites and disseminate into blood stream. In immunocompetent persons due to cell-mediated immunity the parasite is transformed into tissue cyst resulting in life long chronic infection. In HIV-infected people opportunistic infection by T. gondii occurs due to depletion of CD4 cells, decreased production of cytokines and interferon gamma and impaired cytotoxic T-lymphocyte activity resulting in reactivation of latent infection. The diagnosis can be done by clinical, serological, radiological, histological or molecular methods, or by the combination of these. There is various treatment regimen including acute treatment, maintenance therapy should be given as the current anti T. gondii therapy cannot eradicate tissue cysts. In HIV patients, CD4 counts <100; cotrimoxazole, alternately dapsone + pyrimethamine can be given for 6 months. Hence, early diagnosis of T. gondii antibodies is important in all HIV-positive individuals to prevent complications of cerebral toxoplasmosis. PMID:27722101

  3. Hepatitis B virus and HIV infection.

    PubMed

    Martín-Carbonero, Luz; Poveda, Eva

    2012-05-01

    Approximately 5 to 10% of human immunodeficiency virus- (HIV-) infected persons worldwide have chronic hepatitis B virus (HBV). The management of these patients merits special attention. They experience a faster progression to cirrhosis and more frequent liver-related death than HBV-monoinfected individuals. For this reason, therapy for both HIV and HBV is a priority in most cases. Some antivirals (i.e., tenofovir, lamivudine, emtricitabine) are active against both viruses and should be part of the antiretroviral treatment choice. However, drugs such as entecavir, telbivudine, or adefovir are active against HBV and may display some residual activity against HIV, occasionally leading to the selection of resistance mutations in the HIV polymerase, as is clearly shown with entecavir. Thus, they should be used only in the context of potent antiretroviral treatment. In this review, the authors will provide updated information on the natural history of HIV/HBV coinfected patients, when and which drugs should be used in treatment, and the concern about selection of drug resistance and vaccine escape mutants. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  4. [Diagnosis of HIV infections in legal regulations].

    PubMed

    Zaba, Czesław; Zaba, Zbigniew; Klimberg, Aneta; Swiderski, Paweł

    2007-01-01

    The study aimed at presenting current legal regulations associated with the management of patients suspected of being infected with HIV. Diagnostic management of infections with HIV represents a complex issue that is associated with several problems, not only of a legal, but also practical character. Drawing a blood sample from the patient and its testing for HIV results in infringement of the patient's privacy, and the latter is legally protected. Before conducting the test for HIV infection, the doctor is obliged to obtain the consent of the patient and, when the result is available, he should inform the individual in question and provide recommendations, as recommended by WHO. The patient has the right to be tested anonymously. Blood samples for HIV detection may be collected without the patient's consent in cases of obligatory tests performed as an element of a disease prevention program, in individuals who are charged with or convicted of a crime, or in case of a medical treatment. Unlawful activities result in infringement of the patient's right to self-determination and constitute acts against his/her interests.

  5. Dual antiretroviral therapy for HIV infection.

    PubMed

    Soriano, Vicente; Fernandez-Montero, Jose Vicente; Benitez-Gutierrez, Laura; Mendoza, Carmen de; Arias, Ana; Barreiro, Pablo; Peña, José M; Labarga, Pablo

    2017-08-01

    For two decades, triple combinations of antiretrovirals have been the standard treatment for HIV infection. The challenges of such lifelong therapy include long-term side effects, high costs and reduced drug adherence. The recent advent of more potent and safer antiretrovirals has renewed the interest for simpler HIV regimens. Areas covered: We discuss the pros and cons of dual antiretroviral therapies in both drug-naïve and in treatment-experienced patients with viral suppression (switch strategy). Expert opinion: Some dual antiretroviral regimens are safe and efficacious, particularly as maintenance therapy. At this time, combinations of dolutegravir plus rilpivirine represent the best dual regimen. Longer follow-up and larger study populations are needed before supporting dolutegravir plus lamivudine. In contrast, dual therapy based on maraviroc is less effective. Although dual regimens with boosted protease inhibitors plus either lamivudine or raltegravir may be effective, they are penalized by metabolic side effects and risk for drug interactions. The newest dual regimens could save money, reduce toxicity and spare drug options for the future. For the first time in HIV therapeutics, less can be more. Dual therapy switching has set up a new paradigm in HIV treatment that uses induction-maintenance.

  6. Zidovudine and Lamivudine for HIV Infection.

    PubMed

    Anderson, Peter L; Rower, Joseph E

    2010-01-01

    Zidovudine and lamivudine (ZDV and 3TC) are long-standing nucleoside analog-reverse transcriptase inhibitors (NRTIs) with extensive clinical experience in a wide spectrum of patients from in utero through childhood and adult ages. The safety profiles of both drugs are well-known and side effects for ZDV most commonly include nausea/vomiting, fatigue, anemia/neutopenia, and lipoatrophy; while 3TC is well-tolerated. ZDV-3TC is currently a viable alternative NRTI backbone for initial three-drug therapy of HIV infection when tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) cannot be used because of a relative or absolute contraindication. ZDV-3TC continue to be viable alternatives for children, pregnant women and in resource limited settings where other recommended options are not readily available. ZDV-3TC penetrate the Central Nervous System (CNS) well, which makes ZDV-3TC attractive for use in patients with HIV-associated neurological deficits. Additional benefits of these drugs may include the use of ZDV in combination with certain NRTIs to exert selective pressure to prevent particular drug resistance mutations from developing, and giving a short course of ZDV-3TC to prevent resistance after prophylactic single dose nevirapine.

  7. Crustal evolution in the East African Orogen: a neodymium isotopic perspective

    NASA Astrophysics Data System (ADS)

    Stern, Robert J.

    2002-05-01

    The East African Orogen (EAO) is one of Earth's great collision zones, where East and West Gondwana collided to form the supercontinent `Greater Gondwana' or `Pannotia' at the end of Neoproterozoic time. There is now sufficient Nd isotopic data for basement rocks of the EAO to yield a useful summary. A total of 449 samples were gleaned from the literature, recalculated to a common value for the La Jolla Nd standard, and entered in Excel spreadsheets. This data set was filtered to exclude samples with 147Sm/ 144Nd> 0.165, considered to yield unreliable model ages, leaving 413 suitable data. The crust of the Arabian-Nubian Shield, including Egypt east of the Nile, Sudan east of the Keraf suture, Sinai, Israel, Jordan, most of Arabia, Eritrea, and northern Ethiopia yields overwhelmingly Neoproterozoic model ages. Crust to the east, in the Afif terrane of Arabia, Yemen, Somalia, and Eastern Ethiopia yields much older model ages, averaging 2.1 Ga, demonstrating an abundance of reworked ancient crust. This provides an isotopic link with Madagascar (mean age of 2.4 Ga), which in pre-Jurassic reconstructions lies on the southern extension of this older, remobilized tract. Crust in the far southern extreme of the EAO in Tanzania also yields ancient model ages, averaging 2.3 Ga. The central EAO, in southern Ethiopia and Kenya, yields intermediate ages (mean 1.1-1.2 Ga), interpreted to indicate extensive mixing between Neoproterozoic mantle-derived melts and ancient crust. The Nd isotope data indicate that the northern EAO is composed of juvenile Neoproterozoic crust sandwiched between reworked older crust, whereas the EAO farther south is progressively dominated by ancient crust reworked during Neoproterozoic time. The distribution of juvenile and reworked ancient crust suggests that the most intense collision between East and West Gondwana occurred in the southern part of the EAO.

  8. Sexual behaviors and condom use of HIV-infected men and women of color attending a treatment and care clinic.

    PubMed Central

    Absalon, Judith; Della-Latta, Phyllis; Wu, Fann; El-Sadr, Wafaa M.

    2005-01-01

    INTRODUCTION: Limited data are available regarding high-risk sexual behaviors among HIV-infected African Americans and Latinos who receive ongoing care in clinical settings. OBJECTIVES: To identify high-risk sexual behaviors and risk factors for consistent condom use and Chlamydia trachomatis (CT) infection. METHODS: Cross-sectional study data from interviewer-administered surveys and CT tests. RESULTS: Of 179 sexually active adults in the study, 35% had multiple sex partners, 37% had a partner with unknown HIV status and 49% used condoms consistently. Compared with men, women had fewer partners and were less likely to use condoms with partners of unknown HIV status. Men who have sex with men (MSM) had more partners and more partners with unknown HIV status compared with non-MSM. On multivariate analysis, drug use and having an HIV-infected partner were associated with less consistent condom use. CT prevalence was low (2%). CONCLUSION: This study identified ongoing high-risk sexual behaviors among a clinic-based group of African-American and Latino HIV-infected men and women. The clinical setting may be an ideal place for implementation of secondary prevention interventions. PMID:16080454

  9. 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.

  10. 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.

  11. Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis

    PubMed Central

    Prioreschi, A; Munthali, R J; Soepnel, L; Goldstein, J A; Micklesfield, L K; Aronoff, D M; Norris, S A

    2017-01-01

    Objectives This systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations. Setting Only studies reporting data from Africa were included. Participants A systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively. Main outcome measures Incidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool. Results Of 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I2=87% and 52%, respectively). Conclusions Meta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary

  12. Sub-seasonal Evaluation of East African Rainfall for Improved Hydrologic Forecasting

    NASA Astrophysics Data System (ADS)

    Broman, D.; Hopson, T. M.; Rajagopalan, B.; Riddle, E. E.; Gebremichael, M.; Demissie, S. S.

    2016-12-01

    The East African region contains the headwaters of several major rivers, and is undergoing active construction of multiple dam projects for hydropower production and irrigation. Skillful forecasts days to seasonal timescales have the potential to improve the management and operation of these projects. The operational use of skillful precipitation and hydrologic forecasts at short to seasonal lead times for the management of the hydropower projects in the region is currently limited, but would be a key component of improving decision making tools. An increased understanding of the sub-seasonal behavior of precipitation including links to large-scale drivers and long-term changes can be used to improve existing numerical weather prediction (NWP) forecasting products available for the region. We have investigated the sub-seasonal and spatially-dependent connections between East African precipitation and the El Nino Southern Oscillation (ENSO), showing through composite and correlation analysis the changes in dynamics that correspond to high and low precipitation years. We have also evaluated the long-term trends in precipitation in different sub-regions using a Bayesian Dynamical Linear Model. This increased understanding can be used to identify precursor conditions that NWP forecasting models could potentially utilize to enhance their skill in the region.

  13. 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.

  14. East African origins for Madagascan chickens as indicated by mitochondrial DNA

    PubMed Central

    Herrera, Michael B.; Thomson, Vicki A.; Wadley, Jessica J.; Piper, Philip J.; Sulandari, Sri; Dharmayanthi, Anik Budhi; Kraitsek, Spiridoula; Gongora, Jaime

    2017-01-01

    The colonization of Madagascar by Austronesian-speaking people during AD 50–500 represents the most westerly point of the greatest diaspora in prehistory. A range of economically important plants and animals may have accompanied the Austronesians. Domestic chickens (Gallus gallus) are found in Madagascar, but it is unclear how they arrived there. Did they accompany the initial Austronesian-speaking populations that reached Madagascar via the Indian Ocean or were they late arrivals with Arabian and African sea-farers? To address this question, we investigated the mitochondrial DNA control region diversity of modern chickens sampled from around the Indian Ocean rim (Southeast Asia, South Asia, the Arabian Peninsula, East Africa and Madagascar). In contrast to the linguistic and human genetic evidence indicating dual African and Southeast Asian ancestry of the Malagasy people, we find that chickens in Madagascar only share a common ancestor with East Africa, which together are genetically closer to South Asian chickens than to those in Southeast Asia. This suggests that the earliest expansion of Austronesian-speaking people across the Indian Ocean did not successfully introduce chickens to Madagascar. Our results further demonstrate the complexity of the translocation history of introduced domesticates in Madagascar. PMID:28405364

  15. Evarcha culicivora chooses blood-fed Anopheles mosquitoes but other East African jumping spiders do not.

    PubMed

    Jackson, R R; Nelson, X J

    2012-06-01

    Previous research using computer animation and lures made from dead prey has demonstrated that the East African salticid Evarcha culicivora Wesolowska & Jackson (Araneae: Salticidae) feeds indirectly on vertebrate blood by actively choosing blood-carrying female mosquitoes as prey, and also that it singles out mosquitoes of the genus Anopheles (Diptera: Culicidae) by preference. Here, we demonstrate that E. culicivora's preference is expressed when the species is tested with living prey and that it is unique to E. culicivora. As an alternative hypothesis, we considered the possibility that the preference for blood-fed female anopheline mosquitoes might be widespread in East African salticids. When live-prey choice tests were carried out in 19 additional species, there were no instances in which blood-carrying mosquitoes were chosen significantly more often than other prey. Combined with the findings of previous work, these results suggest that it is possible that specialized predators play a role in the biological control of disease vectors. © 2011 The Authors. Medical and Veterinary Entomology © 2011 The Royal Entomological Society.

  16. Multiple episodic evolution events in V1R receptor genes of East-African cichlids.

    PubMed

    Nikaido, Masato; Ota, Tomoki; Hirata, Tadashi; Suzuki, Hikoyu; Satta, Yoko; Aibara, Mitsuto; Mzighani, Semvua I; Sturmbauer, Christian; Hagino-Yamagishi, Kimiko; Okada, Norihiro

    2014-05-06

    Fish use olfaction to detect a variety of nonvolatile chemical signals, and thus, this sense is key to survival and communication. However, the contribution of the olfactory sense to social-especially reproductive-interactions in cichlids is still controversial. To obtain insights into this issue, we investigated the genes encoding V1Rs-possible candidates for reproductive pheromone receptors-among East-African cichlids. Interestingly, we found an excess of nonsynonymous over synonymous substitutions in four of six V1R genes in multiple cichlid lineages. First, we found that highly dimorphic V1R2 allele groups were shared among the cichlids inhabiting all East-African Great Lakes emerged through the episodic accumulation of the nonsynonymous substitutions prior to the radiation of the Lake Tanganyika species flock. We further detected such episodic events in V1R1 of the tribe Tropheini, and in V1R3 and V1R6 of the tribe Trematocarini. The excess of nonsynonymous substitutions in these examples were indicated as dN/dS > 1, which were all statistically significant by Fisher's exact test. Furthermore, we speculate that the amino acid changes in these episodic events are likely functional switch because they occurred in the putative ligand-binding pocket. Our finding of the occurrence of multiple episodic events and the unexpected gene diversity in one unique gene family is suggestive of the contribution of the V1R to the species diversification and the social interaction in cichlids.

  17. Phylogenetic relationships among East African haplochromine fish as revealed by short interspersed elements (SINEs).

    PubMed

    Terai, Yohey; Takezaki, Naoko; Mayer, Werner E; Tichy, Herbert; Takahata, Naoyuki; Klein, Jan; Okada, Norihiro

    2004-01-01

    Genomic DNA libraries were prepared from two endemic species of Lake Victoria haplochromine (cichlid) fish and used to isolate and characterize a set of short interspersed elements (SINEs). The distribution and sequences of the SINEs were used to infer phylogenetic relationships among East African haplochromines. The SINE-based classification divides the fish into four groups, which, in order of their divergence from a stem lineage, are the endemic Lake Tanganyika flock (group 1); fish of the nonendemic, monotypic, widely distributed genus Astatoreochromis (group 2); the endemic Lake Malawi flock (group 3); and group 4, which contains fish from widely dispersed East African localities including Lakes Victoria, Edward, George, Albert, and Rukwa, as well as many rivers. The group 4 haplochromines are characterized by a subset of polymorphic SINEs, each of which is present in some individuals and absent in others of the same population at a given locality, the same morphologically defined species, and the same mtDNA-defined haplogroup. SINE-defined group 4 contains six of the seven previously described mtDNA haplogroups. One of the polymorphic SINEs appears to be fixed in the endemic Lake Victoria flock; four others display the presence-or-absence polymorphism within the species of this flock. These findings have implications for the origin of Lake Victoria cichlids and for their founding population sizes.

  18. Effects of HIV infection on maternal and neonatal health in southern Mozambique: A prospective cohort study after a decade of antiretroviral drugs roll out.

    PubMed

    González, Raquel; Rupérez, María; Sevene, Esperança; Vala, Anifa; Maculuve, Sónia; Bulo, Helder; Nhacolo, Arsénio; Mayor, Alfredo; Aponte, John J; Macete, Eusébio; Menendez, Clara

    2017-01-01

    The HIV epidemic is concentrated in sub-Saharan Africa. However, limited information exists on its impact on women and infant's health since the introduction of antiretroviral drugs in this region, where health resources are often scarce. The effect of HIV infection on maternal health, birth outcomes and infant health was analysed in two contemporary cohorts of HIV-uninfected and HIV-infected pregnant women from southern Mozambique. Pregnant women attending the first antenatal care visit were followed until one month after delivery. Antiretroviral therapy was administered based on CD4+T cell count and clinical stage. Maternal and neonatal morbidity and mortality, as well as pregnancy outcomes were assessed by mother's HIV status. A total of 1183 HIV-uninfected and 561 HIV-infected pregnant women were enrolled. HIV-infected women were more likely to have anaemia both at the first antenatal care visit and at delivery than HIV-uninfected women (71.5% versus 54.8% and 49.4% versus 40.6%, respectively, p<0.001). Incidence of hospital admissions during pregnancy was increased among HIV-infected women (RR, 2.04, [95%CI, 1.45; 2.86]; p<0.001). At delivery, 21% of HIV-infected women reported being on antiretroviral therapy, and 70% having received antiretroviral drugs for prevention of mother to child transmission of HIV. The risk of stillbirths was doubled in HIV-infected women (RR, 2.16 [95%CI 1.17; 3.96], p = 0.013). Foetal anaemia was also increased among infants born to HIV-infected women (10.6% versus 7.3%, p = 0.022). No differences were found in mean birth weight, malaria, prematurity and maternal and neonatal deaths between groups. HIV infection continues to be associated with significant maternal morbidity and poor neonatal health outcomes. Efforts should urgently be made to identify the barriers that impede improvements on the devastating effects of HIV in African women and their infants. ClinicalTrials.gov NCT 00811421.

  19. Osteoarticular manifestations associated with HIV infection.

    PubMed

    Mehsen-Cêtre, Nadia; Cazanave, Charles

    2017-01-01

    About 150,000 people are HIV-positive in France, and the number of new cases is estimated at 7000-8000 per year, with no tendency to diminish over time. Admissions of HIV-positive patients have been decreasing, in contrast, since 2008, reflecting the dramatic improvements in quality of life and survival provided by triple antiretroviral regimens. HIV infection is now a chronic disease that exposes patients to the virus and antiretroviral drugs for many years. One consequence has been the emergence of new health conditions in HIV-positive patients, such as tumors, cardiovascular disease, and osteoarticular complications. These epidemiological and clinical changes have made it necessary for rheumatologists to learn about the osteoarticular abnormalities associated with the HIV, which they are likely to encounter at some point during their everyday practice. Osteoporosis is one such abnormality, and this review article starts with a discussion of the literature on this topic. Bone loss is common, chiefly in males. Multiple factors are involved. Studies have demonstrated an increase in the fracture risk and, consequently, recommendations about the screening and treatment of osteoporosis have been issued. The focus of this review article then turns to the other rheumatic manifestations seen in HIV-positive patients, including osteomalacia, avascular necrosis, and inflammatory joint disease. Osteoarticular pain is frequently reported by HIV-positive patients. Identifying the cause is essential to determine the best treatment strategy. Interestingly, immunosuppressant drugs, and even biotherapies, have shown a good safety profile in these immunodeficient patients. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  20. Profile of candidiasis in HIV infected patients

    PubMed Central

    Anwar, Khan P; Malik, A; Subhan, Khan H

    2012-01-01

    Background and Objectives Candidiasis is a common opportunistic infection in HIV-infected patients. The spectrum of Candida infection is diverse, starting from asymptomatic colonization to pathogenicforms. The low absolute CD4+ T-lymphocyte count has traditionally been cited as the greatest risk factor for the development of Oropharyngeal Candidiasis and current guidelines suggest increased risk once CD4+ T lymphocyte counts fall below 200 cells/µL. Gradual emergence of non-albicans Candida species as a cause of refractory mucosal and invasive Candidiasis, particularly in patients with advanced immunosuppression and problem of resistance to azoles and other antifungal agents in the Candida species is a point of concern. Materials and Methods A prospective study was carried out over a period of 2 years (2010-2011) on patients suffering from AIDS for the presence of candida infection. After thorough clinical examination relevant specimens were collected and processed specifically to ascertain candida infection. Speciation of candida isolates and antifungal sensitivity testing was also done. The CD4 cell counts of all the patients were estimated and correlated with the presence (or absence) of candidiasis. Results Out of a total of 165 HIV positive patients, a definitive diagnosis of candidiasis was made in 80 patients. Candida albicans was the most common yeast isolated. Patients with candidiasis had CD4 counts less than 200 cells/mm3. Maximum resistance was seen with fluconazole while no resistance was seen with voriconazole. Conclusion The most common opportunistic fungal infection in HIV positive patients is candidiasis, affecting the mucocutaneous system mainly but the invasive form is also common. Resistance to azoles and other antifungal agents in the Candida species is a point of concern. PMID:23205253

  1. 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

  2. Taking Antiretroviral Therapy for HIV Infection

    PubMed Central

    Laws, M Barton; Wilson, Ira B; Bowser, Diana M; Kerr, Sarah E

    2000-01-01

    OBJECTIVE To describe how people with HIV understand and experience the problem of adhering to antiretroviral medication regimens. DESIGN We performed a qualitative study based on interviews with HIV-infected patients, including 46 clients of AIDS service organizations, who were sampled according to age, ethnicity, and injection drug use history, and a convenience sample of 15 patients. Interviews were conducted in English or Spanish and were audiotaped and transcribed. PARTICIPANTS Of 52 respondents who had prescriptions for antiretroviral therapy, 25 were randomly selected for in-depth analysis. Of these, 5 reported having an AIDS diagnosis, 15 reported symptoms they attributed to HIV, and 5 reported having no symptoms of HIV disease. MEASUREMENTS AND MAIN RESULTS Investigators prepared structured abstracts of interviews to extract adherence-related data. One investigator compared the abstracts with the original transcripts to confirm the interpretations, and used the abstracts to organize and classify the findings. Most subjects (84%) reported recent nonadherent behavior, including ceasing treatment, medication “holidays,” sleeping through doses, forgetting doses, skipping doses due to side effects, and following highly asymmetric schedules. Initially, most reported that they were not significantly nonadherent, and many did not consider their behavior nonadherent. Only a minority clearly understood the possible consequences of missing doses. Most said they had not discussed their nonadherence with their physicians. CONCLUSIONS Many people rationalize their difficulty in adhering to HIV treatment by deciding that the standard of adherence they can readily achieve is appropriate. Physicians should inquire about adherence-related behavior in specific detail, and ensure that patients understand the consequences of not meeting an appropriate standard. PMID:11119181

  3. Pneumonia in HIV-infected Persons

    PubMed Central

    Gordin, Fred M.; Roediger, Mollie P.; Girard, Pierre-Marie; Lundgren, Jens D.; Miro, Jose M.; Palfreeman, Adrian; Rodriguez-Barradas, Maria C.; Wolff, Marcelo J.; Easterbrook, Philippa J.; Clezy, Kate; Slater, Leonard N.

    2008-01-01

    Rationale: Bacterial pneumonia is a major cause of morbidity for HIV-infected persons and contributes to excess mortality in this population. Objectives: To evaluate the frequency and risk factors for occurrence of bacterial pneumonia in the present era of potent antiretroviral therapy. Methods: We evaluated data from a randomized trial of episodic antiretroviral therapy. The study, Strategies for Management of Antiretroviral Therapy, enrolled 5,472 participants at 318 sites in 33 countries. Study patients had more than 350 CD4 cells at baseline. Diagnosis of bacterial pneumonia was confirmed by a blinded clinical-events committee. Measurements and Main Results: During a mean follow-up of 16 months, 116 participants (2.2%) developed at least one episode of bacterial pneumonia. Patients randomized to receive episodic antiretroviral therapy were significantly more likely to develop pneumonia than patients randomized to receive continuous antiretroviral therapy (hazard ratio, 1.55; 95% confidence interval, 1.07–2.25; P = 0.02). Cigarette smoking was a major risk factor: Current-smokers had more than an 80% higher risk of pneumonia compared with never-smokers (hazard ratio, 1.82; 95% confidence interval, 1.09–3.04; P = 0.02). Participants who were on continuous HIV treatment and were current smokers were three times more likely to develop bacterial pneumonia than nonsmokers. Current smoking status was significant, but a past history of smoking was not. Conclusions: Bacterial pneumonia is a major source of morbidity, even for persons on potent antiretroviral therapy, including those with high CD4 cells. Efforts to reduce this illness should stress the importance of uninterrupted antiretroviral therapy and attainment and/or maintenance of nonsmoking status. Clinical trial registered with www.clinicaltrials.gov (NCT 00027352). PMID:18617640

  4. 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

  5. Renal manifestations of HIV infected highly active antiretroviral therapy naive children in India.

    PubMed

    Shah, Ira; Gupta, Shradha; Shah, Dhaval M; Dhabe, Harshal; Lala, Mamatha

    2012-08-01

    There are several studies on renal manifestations in human immunodeficiency virus (HIV) infected children from American and African regions, but similar studies from India are lacking. A cross-sectional study was carried out in 28 HIV infected antiretroviral therapy (ART) naïve children coming to the pediatric HIV clinic. Demographic data of the children, clinical presentations including blood pressure, detailed laboratory investigations (serum creatinine, glomerular filtration rate), urine analysis (urine morphology, urine albumin, pus cells, and red blood cells), and CD4 counts were collected. Of the 28 children, 15 (53.6%) had renal manifestations with a male to female ratio of 1:1.5. The most common renal manifestation in our study was abnormal glomerular filtration rate (GFR) in 11 (44.0%) of 25 children. This was followed by pus cells in urine in 6 (21.4%) of the 28 children while 3 (10.7%) of them had proteinuria. The mean age of children with renal manifestations was 5.04±2.75 years as compared to those without renal manifestations who had a mean age of 7.38±2.95 years (P=0.0390). CDC class and sex were not associated with renal manifestations. Our study suggests that reduced GFR is the common renal manifestation, particularly in younger children. Other renal manifestations are related to proteinuria. The lack of correlation of CDC classification with renal manifestations mandates screening of children with HIV for renal disease. A more detailed study of renal manifestations in HIV-infected children is needed.

  6. Pneumococcal colonisation density: a new marker for disease severity in HIV-infected adults with pneumonia

    PubMed Central

    Albrich, Werner C; Madhi, Shabir A; Adrian, Peter V; van Niekerk, Nadia; Telles, Jean-Noel; Ebrahim, N; Messaoudi, Melina; Paranhos-Baccalà, Glaucia; Giersdorf, Sven; Vernet, Guy; Mueller, Beat; Klugman, Keith P

    2014-01-01

    Objective A high genomic load of Pneumococcus from blood or cerebrospinal fluid has been associated with increased mortality. We aimed to analyse whether nasopharyngeal colonisation density in HIV-infected patients with community-acquired pneumonia (CAP) is associated with markers of disease severity or poor outcome. Methods Quantitative lytA real-time PCR was performed on nasopharyngeal swabs in HIV-infected South African adults hospitalised for acute CAP at Chris Hani Baragwanath Hospital, Soweto, South Africa. Pneumonia aetiology was considered pneumococcal if any sputum culture or Gram stain, urinary pneumococcal C-polysaccharide-based antigen, blood culture or whole blood lytA real-time PCR revealed pneumococci. Results There was a moderate correlation between the mean nasopharyngeal colonisation densities and increasing CURB65 scores among all-cause patients with pneumonia (Spearman correlation coefficient r=0.15, p=0.06) or with the Pitt bacteraemia score among patients with pneumococcal bacteraemia (p=0.63). In patients with pneumococcal pneumonia, nasopharyngeal pneumococcal colonisation density was higher among non-survivors than survivors (7.7 vs 6.1 log10 copies/mL, respectively, p=0.02) and among those who had pneumococci identified from blood cultures and/or by whole blood lytA real-time PCR than those with non-bacteraemic pneumococcal pneumonia (6.6 vs 5.6 log10 copies/mL, p=0.03). Nasopharyngeal colonisation density correlated positively with the biomarkers procalcitonin (Spearman correlation coefficient r=0.37, p<0.0001), proadrenomedullin (r=0.39, p=0.008) and copeptin (r=0.30, p=0.01). Conclusions In addition to its previously reported role as a diagnostic tool for pneumococcal pneumonia, quantitative nasopharyngeal colonisation density also correlates with mortality and prognostic biomarkers. It may also be useful as a severity marker for pneumococcal pneumonia in HIV-infected adults. PMID:25113557

  7. European Mitochondrial DNA Haplogroups are Associated with Cerebrospinal Fluid Biomarkers of Inflammation in HIV Infection

    PubMed Central

    Samuels, David C.; Kallianpur, Asha R.; Ellis, Ronald J.; Bush, William S.; Letendre, Scott; Franklin, Donald; Grant, Igor; Hulgan, Todd

    2017-01-01

    Background Mitochondrial DNA (mtDNA) haplogroups are ancestry-related patterns of single-nucleotide polymorphisms that are associated with differential mitochondrial function in model systems, neurodegenerative diseases in HIV-negative populations, and chronic complications of HIV infection, including neurocognitive impairment. We hypothesized that mtDNA haplogroups are associated with neuroinflammation in HIV-infected adults. Methods CNS HIV Antiretroviral Therapy Effects Research (CHARTER) is a US-based observational study of HIV-infected adults who underwent standardized neurocognitive assessments. Participants who consented to DNA collection underwent whole blood mtDNA sequencing, and a subset also underwent lumbar puncture. IL-6, IL-8, TNF-α (high-sensitivity), and IP-10 were measured in cerebrospinal fluid (CSF) by immunoassay. Multivariable regression of mtDNA haplogroups and log-transformed CSF biomarkers were stratified by genetic ancestry using whole-genome nuclear DNA genotyping (European [EA], African [AA], or Hispanic ancestry [HA]), and adjusted for age, sex, antiretroviral therapy (ART), detectable CSF HIV RNA, and CD4 nadir. A total of 384 participants had both CSF cytokine measures and genetic data (45% EA, 44% AA, 11% HA, 22% female, median age 43 years, 74% on ART). Results In analyses stratified by the 3 continental ancestry groups, no haplogroups were significantly associated with the 4 biomarkers. In the subgroup of participants with undetectable plasma HIV RNA on ART, European haplogroup H participants had significantly lower CSF TNF-α (P = 0.001). Conclusions Lower CSF TNF-α may indicate lower neuroinflammation in the haplogroup H participants with well-controlled HIV on ART. PMID:28317034

  8. Oral lesions among HIV-infected children on antiretroviral treatment in West Africa.

    PubMed

    Meless, David; Ba, Boubacar; Faye, Malick; Diby, Jean-Serge; N'zoré, Serge; Datté, Sébastien; Diecket, Lucrèce; N'Diaye, Clémentine; Aka, Edmond Addi; Kouakou, Kouadio; Ba, Abou; Ekouévi, Didier Koumavi; Dabis, François; Shiboski, Caroline; Arrivé, Elise

    2014-03-01

    To estimate the prevalence of oral mucosal diseases and dental caries among HIV-infected children receiving antiretroviral treatment (ART) in West Africa and to identify the factors associated with the prevalence of oral mucosal lesions. Multicentre cross-sectional survey in five paediatric HIV clinics in Côte d'Ivoire, Mali and Sénégal. A standardised examination was performed by trained dentists on a random sample of HIV-infected children aged 5-15 years receiving ART. The prevalence of oral and dental lesions and mean number of decayed, missing/extracted and filled teeth (DMFdefT) in temporary and permanent dentition were estimated with their 95% confidence interval (95% CI). We used logistic regression to explore the association between children's characteristics and the prevalence of oral mucosal lesions, expressed as prevalence odds ratio (POR). The median age of the 420 children (47% females) enrolled was 10.4 years [interquartile range (IQR) = 8.3-12.6]. The median duration on ART was 4.6 years (IQR = 2.6-6.2); 84 (20.0%) had CD4 count<350 cells/mm(3). A total of 35 children (8.3%; 95% CI: 6.1-11.1) exhibited 42 oral mucosal lesions (24 were candidiasis); 86.0% (95% CI = 82.6-89.3) of children had DMFdefT ≥ 1. The presence of oral mucosal lesions was independently associated with CD4 count < 350 cells/mm(3) (POR = 2.96, 95% CI = 1.06-4.36) and poor oral hygiene (POR = 2.69, 95% CI = 1.07-6.76). Oral mucosal lesions still occur in HIV-infected African children despite ART, but rarely. However, dental caries were common and severe in this population, reflecting the need to include oral health in the comprehensive care of HIV. © 2014 John Wiley & Sons Ltd.

  9. Determinants of Oral Diseases in the African and Middle East Region.

    PubMed

    Chidzonga, M M; Carneiro, L C; Kalyanyama, B M; Kwamin, F; Oginni, F O

    2015-07-01

    Oral health policies must be developed that emphasize the role of social determinants in health and oral diseases. The aim of this report is to review literature on determinants of oral diseases and apply the concepts to promoting oral health in the African countries in the African and Middle East region (AMER). Structural and proximal determinants of oral diseases are common to those affected by other noncommunicable diseases (NCDs). Oral diseases are also heavily affected by issues of politics, poor health behaviors, underdeveloped health systems, and low oral health literacy. Wide-scale poverty exists in populations in the AMER. Oral health promotion and preventive oral health programs should therefore be integrated with those for general health and use the common risk factor approach (CRFA). Attempts should be made to improve the daily living conditions and reduce the incline of the social gradient. Oral health practitioners should use the CRFA when dealing with determinants of oral diseases and in the design of preventive oral health programs. The detrimental effects of the social determinants of health may be ameliorated by involving both the individual