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Title: Hysteroscopic female sterilization with Essure in an outpatient setting.
Author: Andersson S; Eriksson S; Mints M
Source: Acta Obstetricia Et Gynecologica Scandinavica. 2009;88(6):743-6.
Abstract: The aim of this study is to evaluate the short and long-term results of hysteroscopic sterilization in an outpatient setting. Sixty-one women underwent hysteroscopic sterilization. At follow-up, all of the women were asked to complete a questionnaire concerning possible pregnancy, bleeding patterns, side-effects, or need for further therapy after sterilization. Technical feasibility, complications, patient satisfaction, and tubal occlusion based on X-ray or ultrasound were measured. Fifty-eight (95%) women were sterilized according to this method. Successful bilateral device placement was achieved in 52 women (85%) during the first attempt and in six (9.8%) during the second. A total of 50 (81.9%) women submitted completed outcome questionnaires. The mean follow-up period was 23 (range 7-67) months. No pregnancies were reported. All questionnaire respondents expressed overall satisfaction with the procedure. To conclude, Essure sterilization is a safe effective method for female sterilization thatis feasible in the outpatient setting.
Language: English
Keywords:
SWEDEN | RESEARCH REPORT | CLIENTS | FEMALE STERILIZATION | HYSTEROSCOPY | COMPLICATIONS | SIDE EFFECTS | TUBAL OCCLUSION | SATISFACTION | SAFETY | Developed Countries | Europe, Northern | Europe | Program Activities | Programs | Organization and Administration | Sterilization, Sexual | Family Planning | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Treatment | Psychological Factors | Behavior | Public Health
Document Number: 341444

Title: Minimally invasive surgery for children with HIV/AIDS.
Author: Banieghbal B
Source: Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A. 2009 Feb;19(1):97-101.
Abstract: AIM: Human deficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) have resulted in millions of deaths in Sub-Saharan Africa from opportunist infections. Children are not spared and are similarly affected. Minimally invasive surgery (MIS) can be used, in a selected number of children, as a mean to establish diagnosis or render a treatment. MATERIALS AND METHODS: This study was comprised of a 7-year retrospective analysis of a single pediatric surgeon's experience in South Africa. Forty-eight children, with ages 3 months to 14 years, with HIV/AIDS underwent laparoscopic/thoracoscopic exploration and treatment. RESULTS: Diagnostic laparoscopy and biopsy were the most common procedures (29 cases) indicated for nonspecific abdominal pain or rectal bleeding. The second most common procedure was laparoscopic antireflux fundoplication (10 cases) for damaged lower esophageal sphincter secondary to chronic candidal infection. The remaining procedures were for other rare surgical conditions, seen often in AIDS patients. No significant procedure-related complications occurred, but there were 2 mortalities from the underlying pathology in this cohort. CONCLUSIONS: This is the largest report on MIS for children with HIV/AIDS in the medical literature. It is shown that laparoscopic/thoracoscopic exploration and treatment in children with HIV/AIDS is safe and indicated for establishing the diagnosis and treatment of these unfortunate children.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | SURGERY | LAPAROSCOPY | PHYSICAL EXAMINATIONS AND DIAGNOSES | PAIN | BLEEDING | CANDIDIASIS | GASTROINTESTINAL EFFECTS | COMPLICATIONS | AIDS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Examinations and Diagnoses | Signs and Symptoms | Bacterial and Fungal Diseases | Infections | Physiology | Biology
Document Number: 330998

4.
Title: Venous thromboembolism in women using hormonal contraceptives. Findings from the RIETE Registry.
Author: Blanco-Molina A; Trujillo-Santos J; Tirado R; Canas I; Riera A; Valdes M; Monreal M
Source: Thrombosis and Haemostasis. 2009;101(3):478-482.
Abstract: There is scarce information on the clinical characteristics of contraceptive users who develop venous thromboembolism (VTE). RIETE is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. We analyzed the clinical characteristics and additional risk factors for VTE in all enrolled women aged <50 years who were using or not using contraceptives at presentation with VTE. Of 1,667 women aged <50 years enrolled in RIETE as of December 2007, 593 (36%) were contraceptive users. Of 270 aged <25 years, 190 (70%) were users. Ninety-two contraceptive users (16%) had overweight, 89 (15%) were obese. Of 951 women with no additional risk factors for VTE (i.e. recent surgery, immobility or cancer) 457 (48%) were contraceptive users. Eighty-seven (15%) users had recent immobility for >/=4 days, 44 (7.4%) were postoperative. The most common reason for immobility was lower limb trauma not requiring surgery; 25% of users with recent immobility had received thromboprophylaxis. The most common type of surgery was non-major orthopaedic surgery. Twenty-one (48%) users with postoperative VTE had received prophylaxis. The percentage of users and non-users who tested positive for thrombophilia was similar. Contraceptive use remains the most frequent risk factor for VTE in women at fertile age. Identifying those at increased risk for VTE seems to be difficult. In the meanwhile, a higher use of thromboprophylaxis during immobility or minor surgery should be warranted.
Language: English
Keywords:
SPAIN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN | PREVALENCE | THROMBOEMBOLISM | RISK FACTORS | CONTRACEPTIVE AGENTS, FEMALE | HORMONES | SIDE EFFECTS | COMPLICATIONS | SURGERY | POSTOPERATIVE PROCEDURES | Developed Countries | Europe, Southwestern | Europe | Research Methodology | Demographic Factors | Population | Measurement | Embolism | Vascular Diseases | Diseases | Health | Contraceptive Agents | Contraception | Family Planning | Endocrine System | Physiology | Biology | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 330607

Peer Reviewed

Title: Use of contraceptive methods by women with current venous thrombosis on anticoagulant therapy: a systematic review.
Author: Culwell KR; Curtis KM
Source: Contraception. 2009 Oct;80(4):337-45.
Abstract: BACKGROUND: As nearly all women with venous thromboembolism (VTE) will be treated with anticoagulant therapy, it is important to consider how anticoagulation affects the safety of contraceptive use. STUDY DESIGN: We conducted a systematic review of the literature regarding use of contraceptive methods in women with current VTE on anticoagulant therapy. Due to the limited direct evidence that was identified, we expanded our search to include women on anticoagulant therapy for indications other than VTE and women with bleeding disorders. RESULTS: Six articles met our inclusion criteria. Three observational studies found the levonorgestrel-releasing IUD (LNG-IUD) was an effective treatment for menorrhagia for women on anticoagulation therapy or with bleeding disorders. Prevention of recurrent hemorrhagic ovarian cysts was seen in women on chronic anticoagulation treated with depot-medroxyprogesterone acetate (DMPA) in one small observational study. Among women with bleeding disorders, no complications were seen in 16 women with placement of the LNG-IUD. One pharmacokinetic study found no statistically significant interaction between combined oral contraceptives and warfarin. Other than one case report, no evidence was found regarding the risk of recurrent thrombosis in women on anticoagulation therapy using a contraceptive method. CONCLUSION: The majority of studies in this review examined treatment effects of the LNG-IUD or DMPA on complications of anticoagulation and found overall beneficial effects of their use in these circumstances. Minimal evidence in women with inherited bleeding disorders suggests that insertion of the LNG-IUD does not pose major bleeding risks in these women with appropriate management.
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | THROMBOSIS | COMPLICATIONS | DRUGS | IUD, HORMONE RELEASING | IUD SIDE EFFECTS | INSERTION | DEPO-PROVERA | BLOOD COAGULATION EFFECTS | HEREDITARY DISEASES | MENSTRUATION DISORDERS | CONTRACEPTIVE SAFETY | Thromboembolism | Embolism | Vascular Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Hematological Effects | Hemic System | Physiology | Biology | Safety | Public Health
Document Number: 342773

Peer Reviewed

Title: Intensified case finding for tuberculosis in prevention of mother-to-child transmission programs: a simple and potentially vital addition for maternal and child health.
Author: Deluca A; Chaisson RE; Martinson NA
Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):196-9.
Abstract: The intersection of HIV and tuberculosis (TB) poses a serious threat to HIV-infected women and their children. The majority of patients with TB in sub-Saharan Africa are infected with HIV, and together the overlapping epidemics synergistically accelerate illness and death. Escalating case rates, increased mortality, and the recent emergence of extensively drug-resistant TB highlights how catastrophic a once preventable and curable disease has become among people with HIV/AIDS. The HIV epidemic requires new strategies to control TB in high-burden areas especially as women of reproductive age are disproportionately affected by the epidemic. Intensified case finding for TB has the potential to reduce morbidity and mortality for people living with HIV, especially pregnant women, their families, and infants. (excerpt)
Language: English
Keywords:
AFRICA, SUB SAHARAN | LITERATURE REVIEW | RECOMMENDATIONS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | COMPLICATIONS | INTEGRATED PROGRAMS | PREVALENCE | INCIDENCE | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Infections | Disease Transmission Control | Prevention and Control | Programs | Organization and Administration | Measurement
Document Number: 330367

Peer Reviewed

Title: Successful integration of tuberculosis and HIV treatment in rural South Africa: the Sizonq'oba study.
Author: Gandhi NR; Moll AP; Lalloo U; Pawinski R; Zeller K; Moodley P; Meyer E; Friedland G
Author: Tugela Ferry Care and Research (TFCaRes) Collaboration
Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Jan 1;50(1):37-43.
Abstract: BACKGROUND: Tuberculosis (TB) is the leading cause of death among HIV-infected patients worldwide. In KwaZulu-Natal, South Africa, 80% of TB patients are HIV coinfected, with high treatment default and mortality rates. Integrating TB and HIV care may be an effective strategy for improving outcomes for both diseases. METHODS: Prospective operational research study treating TB/HIV-coinfected patients in rural KwaZulu-Natal with once-daily antiretroviral (ARV) therapy concurrently with TB therapy by home-based, modified directly observed therapy. Patients were followed for 12 months after ARV initiation. RESULTS: Of 119 TB/HIV-coinfected patients enrolled, 67 (56%) were female, mean age was 34.0 years, and median CD4 count was 78.5 cells per cubic millimeter. After 12 months on ARVs, mean CD4 count increase was 211 cells per cubic millimeter, and 88% had an undetectable viral load; 84% completed TB treatment. Thirteen patients (11%) died; 10 (77%) with multidrug-resistant or extensively drug-resistant TB. There were few severe adverse events or immune reconstitution events. Adherence was high with 93% of study visits attended and 99% of ARV doses taken. CONCLUSIONS: Integration of TB and HIV treatment in a rural setting using concurrent home-based therapy resulted in excellent adherence and TB and HIV outcomes. This model may result in successful management of both diseases in other rural resource-poor settings.
Language: English
Keywords:
SOUTH AFRICA | EVALUATION REPORT | PROSPECTIVE STUDIES | OPERATIONS RESEARCH | PERSONS LIVING WITH HIV/AIDS | RURAL POPULATION | INTEGRATED PROGRAMS | TUBERCULOSIS | AIDS PREVENTION | TREATMENT | RURAL HEALTH SERVICES | COMPLICATIONS | ANTIRETROVIRAL THERAPY | HOME VISITS | DRUG RESISTANCE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Evaluation | Studies | Research Methodology | Program Evaluation | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Infections | AIDS | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Communication
Document Number: 330981

Peer Reviewed

Title: Provision of contraception services and advice for women with cystic fibrosis.
Author: Gatiss S; Mansour D; Doe S; Bourke S
Source: Journal of Family Planning and Reproductive Health Care. 2009 Jul;35(3):157-60.
Abstract: BACKGROUND AND METHODOLOGY: As the prognosis of patients with cystic fibrosis (CF) improves, issues of sexual health, fertility, pregnancy and contraception are increasingly important. In order to plan the provision of a contraception and sexual health service for women with CF we studied their sexual and reproductive history, their current usage of contraception, the sources and quality of advice they had received, and their particular needs using a confidential questionnaire sent to all women over 16 years of age attending a regional CF centre. RESULTS: Of 55 women (mean age 29.7 years) surveyed, 42 (76%) responded. Thirty-three women (79%) were sexually active and 13 (31%) had experienced 19 pregnancies, five (26%) of which were unplanned. Only half of the women who responded were using contraception. No woman used female sterilisation, the progestogen implant, intrauterine system (IUS) or copper-bearing intrauterine device (IUD) for contraception. Twenty-six (62%) women reported not having received contraceptive advice specific to CF and 24 (57%) said that they had not been warned about the potential interaction between broad-spectrum antibiotics and the combined pill. DISCUSSION: Women with CF have a relatively high rate of unplanned pregnancy and do not receive optimal advice or use the full range of contraceptive methods. CF teams lack training in contraception and contraceptive services may not have a detailed knowledge of CF and its complications. New strategies are needed to focus the knowledge and skills of both teams in providing better services for women with CF.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | WOMEN | CLIENTS | HEREDITARY DISEASES | COMPLICATIONS | CONTRACEPTIVE USAGE | FERTILITY | PREGNANCY | QUESTIONNAIRES | ANTIBIOTICS | GENETIC COUNSELING | Developed Countries | Europe, Western | Europe | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Diseases | Contraception | Family Planning | Population Dynamics | Reproduction | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Counseling | Clinic Activities
Document Number: 342139

10.

11.

Title: Cytokine levels in HIV infected and uninfected Indian women: correlation with other STAs.
Author: Guha D; Chatterjee R
Source: Experimental and Molecular Pathology. 2009 Feb;86(1):65-8.
Abstract: Host immune status is an important determinant of disease progression. Infections in the genital tract may alter the immunity in the particular site and hence affect the production of local cytokines. We performed this study to determine whether HIV in association with cervical HPV and CT/GC infections influences the production of local cytokines. Cervical secretions from 100 women with or without HIV infection were collected for measuring IL-1 beta, -6, -10 and -12 concentrations by ELISA. Cervical HPV and CT/GC DNA were detected by HCII test. Significant elevations of IL-6 and IL-10 were observed in patients having HIV infection. Although cervical HPV infection increased the concentrations of both IL-6 and IL-1 beta but HPV induced abnormal cervical smear was associated only with increased IL-6 concentrations significantly. Double infection had marked relation with IL-6 and IL-10. CT/GC had no direct effect on any of these cytokines but in association with HIV and HPV, these bacterial pathogens elevated the concentrations of IL-6 significantly. Thus, our results suggest that the presence of HIV and other STAs in the genital tract can cause imbalance of local cytokine levels which in turn may facilitate other opportunistic infections.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CLINICAL RESEARCH | GENETIC TECHNIQUES | WOMEN IN DEVELOPMENT | IMMUNOLOGICAL EFFECTS | HPV | HIV INFECTIONS | COMPLICATIONS | IMMUNITY, CELLULAR | PAP SMEAR | CHLAMYDIA | GONORRHEA | Developing Countries | Asia, Southern | Asia | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Economic Development | Economic Factors | Immunity | Immune System | Physiology | Biology | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections
Document Number: 330392

12.

Peer Reviewed

Title: The burden of HIV-associated cryptococcal disease [editorial]
Author: Harrison TS
Source: AIDS. 2009 Feb 20;23(4):531-2.
Abstract: In this issue, Park et al. from the Centers for Disease Control, University of Alabama, and Johannesburg, South Africa, have made the first attempt to estimate the global burden of HIV-associated cryptococcal infection. As clearly stated by the authors, the estimates are exactly that -estimates, which rely on the quality of the data on which they are based. Nevertheless, the results are striking, especially for sub-Saharan Africa, where the estimated number of deaths associated with cryptococcal disease, at half a million per year, is comparable with the number attributed to tuberculosis, a much more frequent infection, but one for which we have much more effective and widely available therapy. So are these results credible? The data are sparse, with just three incidence studies driving the estimates for sub- Saharan Africa (ruling out the possibility of evaluating or taking account of possible intraregional differences in incidence); and the reported incidences are variable, resulting in wide ranges for the estimates of cases and associated deaths. However, biases are as possible on the downside as on the upside. As the authors acknowledge, the relatively low incidence estimate from a South African study with which some of the same authors were involved was likely affected by incomplete case ascertainment. (excerpt)
Language: English
Keywords:
GLOBAL | CRITIQUE | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | ESTIMATION TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | COMPLICATIONS | PREVALENCE | CAUSES OF DEATH | DEATH RATE | ANTIRETROVIRAL THERAPY | CENTRAL NERVOUS SYSTEM EFFECTS | Studies | Research Methodology | Viral Diseases | Diseases | Measurement | Mortality | Population Dynamics | Demographic Factors | Population | HIV | Central Nervous System | Physiology | Biology
Document Number: 341160

13.

Title: Outcomes of human immunodeficiency virus-infected and -exposed children undergoing surgery--a prospective study.
Author: Karpelowsky JS; Leva E; Kelley B; Numanoglu A; Rode H; Millar AJ
Source: Journal of Pediatric Surgery. 2009 Apr;44(4):681-7.
Abstract: AIM: Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) is a worldwide pandemic. Mother-to-child transmission programs should theoretically minimize vertical transfer of the virus, but with variable effectiveness of implementation a significant number of children become infected and may present for emergency, diagnostic, and elective surgery. The aim of this study was to prospectively document the clinical presentation, the spectrum of pathology, and surgical outcomes of patients presenting to our hospital. This formed part of a pilot study of a collaborative international working group studying HIV infection in children, which included the Buzzi Children's Hospital Milan, Italy; the University of San Diego, California, USA; and the Red Cross War Memorial Children's Hospital and University of Cape Town, School of Adolescent and Child Health, Cape Town, South Africa. METHOD: Clinical data from all children admitted to the surgical service of the Red Cross War Memorial Children's Hospital between July 2004 and December 2006 with either a history of HIV exposure (born to an HIV-infected mother) or confirmation of HIV infection by ELISA or polymerase chain reaction was collected. The clinical course was documented prospectively for the duration of admission and subsequent follow-up as recorded in case records review. The spectrum of pathology, surgical intervention, outcome, complications, World Health Organization stage of AIDS, and type of antiretroviral therapy were all noted. Comparative outcomes and subgroup analysis were not done in this part of the study. RESULTS: One hundred and thirteen patients were included in the study over the 30-month period. The average age was 24 months (1 day to 11 years). Seventy-nine (70%) of the 113 patients were infected and 34 (30%) were exposed, 9 of whom subsequently tested negative. Of the infected group, 53 (67%) patients were on antiretroviral therapy. The extent of disease in the infected group of patients according to the 2006 World Health Organization criteria was as follows: stage 1, 4 (5%); stage 2, 12 (15%); stage 3, 51 (65%); and stage 4, 12 (15%). All patients had nutritional assessments and were plotted on growth curves. Sixty-two (54%) were found to be malnourished and 41 (36%) of the children were found to have comorbid disease processes. Eighteen patients (16%) were treated with antibiotics or conservative therapy alone. The remaining 95 patients (84%) underwent an average of 1.6 procedures (range, 1-35), 59 (52%) in an elective manner and 36 (31%) as an emergency. When assessing the relationship of HIV to the presenting disease state, 58 (73.4%) had HIV-related diseases and 52 (46%) presented with sepsis. A total of 29 (25%) patients had surgical complications of which 6 (20%) were not considered to be HIV related. Nine (31%) had, in retrospect, incorrect management of the presenting disease, leaving 14 (48%) who potentially had HIV-related complications of poor wound healing and sepsis. A total of 100 (88%) were discharged alive, 6 (5.3%) died, and 7 (6 %) were lost to follow-up. Long-term follow-up of 50 patients for an average of 8 months revealed one further mortality. CONCLUSION: Human immunodeficiency virus-positive and -exposed patients present a unique challenge in management which is complicated by concomitant disease and poor nutrition. These patients require an expanded differential diagnosis. We believe that, although on the surface there may be a higher complication rate, this needs to be confirmed in an expanded comparative cohort study, which is underway and that patients should still receive the benefit of full surgical intervention.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | CHILDREN | AIDS | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | SURGERY | COMPLICATIONS | MALNUTRITION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Nutrition Disorders
Document Number: 342453

14.
Peer Reviewed

Title: Geophagy (Soil-eating) in relation to Anemia and Helminth infection among HIV-infected pregnant women in Tanzania.
Author: Kawai K; Saathoff E; Antelman G; Msamanga G; Fawzi WW
Source: American Journal of Tropical Medicine and Hygiene. 2009 Jan;80(1):36-43.
Abstract: Geophagy, the regular and deliberate consumption of soil, is prevalent among pregnant women in sub-Saharan Africa. We examined the associations of geophagy with anemia and helminth infection among 971 human immunodeficiency virus (HIV)-positive pregnant women in Tanzania. About 29% of pregnant women regularly consumed soil. Occupation, marital status, and gestational age were associated with geophagy. Ascaris lumbricoides infection was associated with the prevalence of geophagy (adjusted-prevalence ratio 1.81; 95% confidence interval [CI] = 1.37-2.40); however, hookworm, Trichuris trichiura, and Strongyloides stercoralis showed no association. Anemia and red blood cell characteristics suggestive of iron deficiency were strongly correlated with geophagy at baseline. In longitudinal analyses, we found evidence suggesting that soil consumption may be associated with an increased risk of anemia (adjusted-relative risk 1.16; 95% CI = 0.98-1.36) and a lower hemoglobin concentration (adjusted-mean difference -3.8 g/L; 95% CI [-7.3, -0.4]). Pregnant women should be informed about the potential risks associated with soil consumption.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | PREVALENCE | PARASITIC DISEASES | ANEMIA | COMPLICATIONS | OCCUPATIONS | MARITAL STATUS | GESTATIONAL AGE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Measurement | Human Resources | Nuptiality | Fetus | Pregnancy | Reproduction
Document Number: 330314

15.

Title: The number of procedures required to achieve optimal competency with male circumcision: findings from a randomized trial in Rakai, Uganda.
Author: Kiggundu V; Watya S; Kigozi G; Serwadda D; Nalugoda F; Buwembo D; Settuba A; Anyokorit M; Nkale J; Kighoma N; Ssempijja V; Wawer M; Gray RH
Source: BJU International. 2009 Aug;104(4):529-32.
Abstract: OBJECTIVE: To assess the number of procedures required to achieve optimal competency (time required for surgery with minimal adverse events) in Rakai, Uganda, and thus facilitate the development of guidelines for training providers, as male circumcision reduces the acquisition of human immunodeficiency virus (HIV) in men and is recommended for HIV prevention. PATIENTS AND METHODS: In a randomized trial, 3011 men were circumcised, using the sleeve method, by six physicians who had completed training, which included 15-20 supervised procedures. The duration of surgery from local anaesthesia to wound closure, moderate or severe surgery-related adverse events (AEs), and wound healing were assessed in relation to the number of procedures done by each physician. RESULTS: The median age of the patients was 24 years. The number of procedures per surgeon was 20-981. The mean time required to complete surgery was approximately 40 min for the first 100 procedures and declined to 25 min for the subsequent 100 circumcisions. After controlling for the number of procedures there was no significant difference in duration of the surgery by patient HIV status or age. The rate of moderate and severe AEs was 8.8% (10/114) for the first 19 unsupervised procedures after training, 4.0% for the next 20-99 (13/328) and 2.0% for the last 100 (P for trend, 0.003). All AEs resolved with management. CONCLUSION: The completion of more than 100 circumcisions was required before newly trained physicians achieved the optimum duration of surgery. AEs were higher immediately after training and additional supervision is needed for at least the first 20 procedures after completing training.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | CLINICAL TRIALS | PHYSICIANS | HIV PREVENTION | MALE CIRCUMCISION | COMPLICATIONS | TRAINING PROGRAMS | SUPERVISION | ANESTHESIA | STANDARDS | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Health Personnel | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Education | Management | Organization and Administration | Treatment | Population Dynamics | Demographic Factors | Population
Document Number: 342642

16.

Title: Immune reconstitution inflammatory syndrome in a resource-poor setting.
Author: Klotz SA; Mohammed AA; Woldemichael MG; Mitku MW; Handrich M
Source: Journal of the International Association of Physicians in AIDS Care. 2009 Mar-Apr;8(2):122-127.
Abstract: The immune reconstitution inflammatory syndrome (IRIS) associated with highly active antiretroviral therapy (HAART) was studied in rural Ethiopian HIV-infected patients. Review of 1002 charts in an outpatient clinic was conducted. The median CD4 count was 89 cells/mm3. Nighty-eight patients were hospitalized after initiation of HAART, of whom 74 were hospitalized for manifestations of IRIS (ie, 7% of patients on HAART). Of the 74 patients hospitalized with IRIS, 27 patients had tuberculosis; 12 patients, cryptococcal meningitis; 7 patients, toxoplasmosis; 6 patients, pneumonia and/or effusion; and 5 patients, Pneumocystis jiroveci pneumonia (PCP). Ten adult patients were admitted with gastroenteritis, heretofore not recognized as a manifestation of IRIS. Eighty-one percent of IRIS patients were hospitalized within 3 months of beginning HAART and 99% by 6 months. Of those hospitalized with IRIS, 4 patients (5%) died while in the hospital (3 with cryptococcal meningitis). Thirty-seven or 50% of those hospitalized with IRS were lost to medical follow up, thus the mortality rate is likely a gross underestimate of the severity of IRIS. In resource-poor settings where the primary goal is to initiate HAART, IRIS may go unrecognized and have fatal consequences.
Language: English
Keywords:
ETHIOPIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | ANTIRETROVIRAL THERAPY | SIDE EFFECTS | HIV INFECTIONS | IMMUNOLOGICAL EFFECTS | TUBERCULOSIS | COMPLICATIONS | TOXICITY | PNEUMONIA | GASTROINTESTINAL EFFECTS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Viral Diseases | Diseases | Measurement | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Immunity | Immune System | Physiology | Biology | Infections | Pulmonary Effects
Document Number: 331334

17.

Peer Reviewed

Title: High mortality among patients with AIDS who received a diagnosis of tuberculosis in the first 3 months of antiretroviral therapy.
Author: Koenig SP; Riviere C; Leger P; Joseph P; Severe P; Parker K; Collins S; Lee E; Pape JW; Fitzgerald DW
Source: Clinical Infectious Diseases. 2009 Mar 15;48(6):829-31.
Abstract: We analyzed mortality among 201 patients with AIDS and tuberculosis in Haiti. Patients who received a diagnosis of tuberculosis during the first 3 months after the initiation of antiretroviral therapy were 3.25 times more likely to die than were other patients with AIDS and tuberculosis. Failure to recognize active tuberculosis at initiation of antiretroviral therapy leads to increased mortality.
Language: English
Keywords:
HAITI | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | PERSONS LIVING WITH HIV/AIDS | TIME FACTORS | ANTIRETROVIRAL THERAPY | AIDS | TUBERCULOSIS | COMPLICATIONS | DEATH RATE | Developing Countries | Caribbean | Americas | Research Methodology | HIV Infections | Viral Diseases | Diseases | Population Dynamics | Demographic Factors | Population | HIV | Infections | Mortality
Document Number: 330706

18.

Peer Reviewed

Title: Population immunity to measles virus and the effect of HIV-1 infection after a mass measles vaccination campaign in Lusaka, Zambia: a cross-sectional survey.
Author: Lowther SA; Curriero FC; Kalish BT; Shields TM; Monze M; Moss WJ
Source: Lancet. 2009 Mar 21;373(9668):1025-32.
Abstract: BACKGROUND: Measles control efforts are hindered by challenges in sustaining high vaccination coverage, waning immunity in HIV-1-infected children, and clustering of susceptible individuals. Our aim was to assess population immunity to measles virus after a mass vaccination campaign in a region with high HIV prevalence. METHODS: 3 years after a measles supplemental immunisation activity (SIA), we undertook a cross-sectional survey in Lusaka, Zambia. Households were randomly selected from a satellite image. Children aged 9 months to 5 years from selected households were eligible for enrolment. A questionnaire was administered to the children's caregivers to obtain information about measles vaccination history and history of measles. Oral fluid samples were obtained from children and tested for antibodies to measles virus and HIV-1 by EIA. FINDINGS: 1015 children from 668 residences provided adequate specimens. 853 (84%) children had a history of measles vaccination according to either caregiver report or immunisation card. 679 children (67%) had antibodies to measles virus, and 64 (6%) children had antibodies to HIV-1. Children with antibodies to HIV-1 were as likely to have no history of measles vaccination as those without antibodies to HIV-1 (odds ratio [OR] 1.17, 95% CI 0.57-2.41). Children without measles antibodies were more likely to have never received measles vaccine than those with antibodies (adjusted OR 2.50, 1.69-3.71). In vaccinated children, 33 (61%) of 54 children with antibodies to HIV-1 also had antibodies to measles virus, compared with 568 (71%) of 796 children without antibodies to HIV-1 (p=0.1). INTERPRETATION: 3 years after an SIA, population immunity to measles was insufficient to interrupt measles virus transmission. The use of oral fluid and satellite images for sampling are potential methods to assess population immunity and the timing of SIAs.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | URBAN POPULATION | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | IMMUNIZATION | HIV INFECTIONS | COMPLICATIONS | SEROCONVERSION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Measurement | Primary Health Care | Health Services | Delivery of Health Care | Health | Immunity | Immune System | Physiology | Biology
Document Number: 330988

19.

Peer Reviewed

Title: Novel relationship between tuberculosis immune reconstitution inflammatory syndrome and antitubercular drug resistance.
Author: Meintjes G; Rangaka MX; Maartens G; Rebe K; Morroni C; Pepper DJ; Wilkinson KA; Wilkinson RJ
Source: Clinical Infectious Diseases. 2009 Mar 1;48(5):667-76.
Abstract: BACKGROUND: Tuberculosis (TB) immune reconstitution inflammatory syndrome (IRIS) is emerging as an important early complication of combination antiretroviral therapy in patients with TB in developing countries. The differential diagnosis of TB IRIS includes deterioration caused by other human immunodeficiency virus-related morbidities and drug-resistant TB. METHODS: We prospectively evaluated consecutive patients with suspected TB IRIS from February 2005 through July 2006 at a community-based secondary hospital in Cape Town, South Africa, by means of clinical case definitions for TB IRIS. Specimens were sent for TB culture and susceptibility testing, and a rapid test (FASTplaque-Response) was performed to expedite determination of rifampin susceptibility. RESULTS: One hundred patients with suspected TB IRIS were evaluated, 26 of whom were being retreated for TB. IRIS symptoms developed a median of 14 days (interquartile range, 7-25 days) after the initiation of combination antiretroviral therapy. In 7 patients, an alternative opportunistic disease was diagnosed. Rifampin-resistant TB was present in 13 patients, 9 of whom received a diagnosis after study entry (7 of 9 had multidrug-resistant TB). Undiagnosed rifampin-resistant TB was thus present in 10.1% of patients (95% confidence interval, 3.9%-16.4%) who presented with TB IRIS, once those with alternative diagnoses and TB with known rifampin resistance were excluded. In the remaining 80 patients, TB IRIS without rifampin resistance was the final diagnosis. CONCLUSIONS: TB IRIS that is clinically indistinguishable from TB IRIS that occurs in the context of drug-susceptible disease may occur in patients with undiagnosed multidrug-resistant TB. Antitubercular drug resistance should be excluded in all cases of suspected TB IRIS, and corticosteroids should be used with caution for patients with presumed TB IRIS until the result of drug-susceptibility testing is known.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | EPIDEMIOLOGIC METHODS | PERSONS LIVING WITH HIV/AIDS | DRUG RESISTANCE | TUBERCULOSIS | ANTIRETROVIRAL THERAPY | SIDE EFFECTS | COMPLICATIONS | IMMUNOLOGICAL EFFECTS | PREVALENCE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | HIV | Immunity | Immune System | Physiology | Biology | Measurement
Document Number: 330355

20.

21.

Peer Reviewed

Title: Management of severe cervical stenosis after conization by detention of nylon threads tied up to intrauterine contraceptive device.
Author: Nasu K; Narahara H
Source: Archives of Gynecology and Obstetrics. 2009 Aug 12;
Abstract: PURPOSE: To investigate the efficacy of the insertion of intrauterine contraceptive device (IUCD) tied up with nylon threads for the treatment of cervical stenosis after conization. METHODS: Dilatation of the cervical canal and insertion of IUCD tied up with nylon threads was performed in four patients with symptomatic cervical stenosis after conization. After three courses of regular menstruation, the IUCD with nylon threads was removed. RESULTS: Total relief of symptoms was achieved in all four patients without any management-related complications. There was no evidence of recurrent cervical stenosis at follow-up in any of the patients. CONCLUSIONS: Detention of nylon threads tied up to IUCD provides an easy and reliable conservative management technique for post-conization cervical stenosis.
Language: English
Keywords:
JAPAN | SUMMARY REPORT | CASE HISTORIES | CLIENTS | CERVIX | MEDICAL PROCEDURES | GYNECOLOGY | HISTOLOGY | COMPLICATIONS | CERVICAL EFFECTS | SIGNS AND SYMPTOMS | TREATMENT | IUD | Asia, Eastern | Asia | Developed Countries | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Contraceptive Methods | Contraception | Family Planning
Document Number: 342488

22.

Peer Reviewed

Title: The effects of acute malaria on Epstein-Barr Virus (EBV) load and EBV-specific T cell immunity in Gambian children.
Author: Njie R; Bell AI; Jia H; Croom-Carter D; Chaganti S; Hislop AD; Whittle H; Rickinson AB
Source: Journal of Infectious Diseases. 2009 Jan 1;199(1):31-8.
Abstract: Background. To investigate how intense Plasmodium falciparum infection predisposes to Epstein-Barr virus (EBV)-positive Burkitt lymphoma (BL), we analyzed the effect of acute malaria on existing EBV-host balance. Methods. EBV genome loads in peripheral blood mononuclear cells were assayed by quantitative polymerase chain reaction, and EBV-specific CD8_ T cell responses were assayed by interferon-y enzyme-linked immunospot assay. Results. Gambian children, from whom samples were obtained during an acute malaria attack and again up to 6 weeks later, had extremely high viral loads, reaching levels that in the United Kingdom are seen only in patients with infectious mononucleosis. Gambian control subjects (children and adults with no recent history of malaria) had lower median viral loads, although they were still >10-fold above the median for healthy UK adults. Limited experiments with EBV epitope peptides (restricted through the HLA-B*3501 and HLA-B*5301 alleles) also suggested an impairment of virus-specific CD8+ T cell function in children with malaria, but only during acute disease. Conclusions. Acute malaria is associated with sustained increase in EBV load and, possibly, a transient decrease in EBV-specific T cell surveillance. We infer that the unusually high set point of virus carriage in P. falciparum-challenged populations, allied with the parasite's capacity to act as a chronic B cell stimulus, probably contributes to the pathogenesis of endemic BL.
Language: English
Keywords:
GAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | CHILDREN | VIRAL DISEASES | IMMUNITY, CELLULAR | MALARIA | COMPLICATIONS | IMMUNOLOGICAL EFFECTS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Immunity | Immune System | Physiology | Biology | Parasitic Diseases
Document Number: 328587

23.

Peer Reviewed

Title: Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS.
Author: Park BJ; Wannemuehler KA; Marston BJ; Govender N; Pappas PG; Chiller TM
Source: AIDS. 2009 Feb 20;23(4):525-30.
Abstract: OBJECTIVE: Cryptococcal meningitis is one of the most important HIV-related opportunistic infections, especially in the developing world. In order to help develop global strategies and priorities for prevention and treatment, it is important to estimate the burden of cryptococcal meningitis. DESIGN: Global burden of disease estimation using published studies. METHODS: We used the median incidence rate of available studies in a geographic region to estimate the region-specific cryptococcal meningitis incidence; this was multiplied by the 2007 United Nations Programme on HIV/AIDS HIV population estimate for each region to estimate cryptococcal meningitis cases. To estimate deaths, we assumed a 9% 3-month case-fatality rate among high-income regions, a 55% rate among low-income and middle-income regions, and a 70% rate in sub-Saharan Africa, based on studies published in these areas and expert opinion. RESULTS: Published incidence ranged from 0.04 to 12% per year among persons with HIV. Sub-Saharan Africa had the highest yearly burden estimate (median incidence 3.2%, 720 000 cases; range, 144 000-1.3 million). Median incidence was lowest in Western and Central Europe and Oceania (Language: English
Keywords:
GLOBAL | AFRICA, SUB SAHARAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | ESTIMATION TECHNIQUES | CROSS-CULTURAL COMPARISONS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | CENTRAL NERVOUS SYSTEM EFFECTS | MENINGITIS | COMPLICATIONS | HUMAN GEOGRAPHY | DEATH RATE | ECONOMIC DEVELOPMENT | Africa | Developing Countries | Research Methodology | Comparative Studies | Studies | HIV Infections | Viral Diseases | Diseases | Measurement | Central Nervous System | Physiology | Biology | Geography | Social Sciences | Science | Sociocultural Factors | Mortality | Population Dynamics | Demographic Factors | Population | Economic Factors
Document Number: 341165

24.

Peer Reviewed

Title: Medical circumcision and manhood initiation rituals in the Eastern Cape, South Africa: a post intervention evaluation.
Author: Peltzer K; Kanta X
Source: Culture, Health and Sexuality. 2009 Jan;11(1):83-97.
Abstract: The objectives of this study were first, to report the adverse events reported following male circumcision performed by medical professionals after a one-day training workshop; second, to report on the attitudes towards, beliefs surrounding and experiences regarding circumcision and initiation; and third, to assess the HIV-risk behaviour of young men attending initiation schools post medical circumcision. Initiates who had been medically circumcised by trained healthcare providers were examined and interviewed on the seventh day after circumcision and, in addition, focus-group discussions were conducted with initiates. Results indicate that of the 78 initiates physically examined on the seventh day after circumcision by a trained clinical nurse, seven (9%) adverse events (complications) were found. Initiates reported mixed attitudes towards combining medical circumcision with traditional initiation. The majority of the initiates (70%) felt that they could be stigmatized as a result of choosing medical rather than traditional circumcision and 20% thought that the relationship between medical and traditionally circumcised men was hostile. Prior to circumcision, most initiates (92%) had been sexually active and had engaged in HIV-risk behaviour. Focus-group discussions revealed that sexually active initiates, when asked about sex after circumcision, indicated they wished to abstain for a short period before resuming sexual activities with intended condom use being high. Findings are promising for efforts to up-scale integrated medical circumcision alongside traditional initiation into manhood.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | SAMPLING STUDIES | YOUTH | MALE CIRCUMCISION | TRADITIONAL CEREMONIES | ATTITUDES | BELIEFS | COMPLICATIONS | SEX BEHAVIOR | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Culture | Sociocultural Factors | Psychological Factors | Behavior | Diseases
Document Number: 341436

25.
Peer Reviewed

Title: Human immunodeficiency virus co-infection increases placental parasite density and transplacental malaria transmission in Western Kenya.
Author: Perrault SD; Hajek J; Zhong K; Owino SO; Sichangi M; Smith G; Shi YP; Moore JM; Kain KC
Source: American Journal of Tropical Medicine and Hygiene. 2009 Jan;80(1):119-25.
Abstract: Plasmodium falciparum malaria and human immunodeficiency virus (HIV)-1 adversely interact in the context of pregnancy, however little is known regarding the influence of co-infection on the risk of congenital malaria. We aimed to determine the prevalence of placental and congenital malaria and impact of HIV co-infection on trans-placental malaria transmission in 157 parturient women and their infants by microscopy and by quantitative real-time polymerase chain reaction (PCR) in western Kenya. The prevalence of placental and cord blood infections were 17.2% and 0% by microscopy, and 33.1% and 10.8% by PCR. HIV co-infection was associated with a significant increase in placental parasite density (P < 0.05). Cord blood malaria prevalence was increased in co-infected women (odds ratio [OR] = 5.42; 95% confidence interval [CI] = 1.90-15.47) and correlated with placental parasite density (OR = 2.57; 95% CI = 1.80-3.67). A 1-log increase in placental monocyte count was associated with increased risk of congenital infection (P = 0.001) (OR = 48.15; 95% CI = 4.59-505.50). The HIV co-infected women have a significantly increased burden of placental malaria that increases the risk of congenital infection.
Language: English
Keywords:
KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | PREVALENCE | HIV INFECTIONS | COMPLICATIONS | MALARIA | CONGENITAL ABNORMALITIES | PREGNANCY COMPLICATIONS | MOTHER-TO-CHILD TRANSMISSION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Measurement | Parasitic Diseases | Neonatal Diseases and Abnormalities | Transmission | Infections
Document Number: 330313

26.

Title: Approaches to tuberculosis screening and diagnosis in people with HIV in resource-limited settings.
Author: Reid MJ; Shah NS
Source: Lancet Infectious Diseases. 2009 Mar;9(3):173-84.
Abstract: Tuberculosis is the main cause of morbidity and mortality in people living with HIV/AIDS worldwide. Early diagnosis and treatment is essential to addressing the dual epidemic of tuberculosis and HIV. Increasing recognition of the importance of integrating tuberculosis services--including screening--into HIV care has led to global policies and the beginnings of implementation of joint activities at the national level. However, debate remains about the best methods of screening for pulmonary tuberculosis among people living with HIV/AIDS in resource-limited settings. Mycobacterial culture, the gold standard for tuberculosis diagnosis, is too slow and complex to be a useful screening test in such settings. More widely available methods, such as symptom screening, sputum smear microscopy, chest radiography, and tuberculin skin testing have important shortcomings, especially in people living with HIV/AIDS. However, until simpler, cheaper, and more sensitive diagnostics for tuberculosis are available in peripheral healthcare settings, a strategy must be developed that uses current evidence to combine available screening tools.
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | RECOMMENDATIONS | EVALUATION | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | SCREENING | COMPLICATIONS | EXAMINATIONS AND DIAGNOSES | INTEGRATED PROGRAMS | LABORATORY EXAMINATIONS AND DIAGNOSES | TIME FACTORS | SIGNS AND SYMPTOMS | PHYSICAL EXAMINATIONS AND DIAGNOSES | COST EFFECTIVENESS | HIV Infections | Viral Diseases | Diseases | Infections | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Population Dynamics | Demographic Factors | Population | Evaluation Indexes | Quantitative Evaluation
Document Number: 330983

27.

Title: HIV/AIDS and disability in Southern Africa: a review of relevant literature.
Author: Rohleder P; Braathen SH; Swartz L; Eide AH
Source: Disability and Rehabilitation. 2009;31(1):51-9.
Abstract: Purpose. HIV/AIDS has grown to become the biggest epidemic in modern history. Southern Africa is at the epicentre of the global epidemic, with just of a third of the world's HIV-positive population living here. It is known that HIV/AIDS affect vulnerable population groups. It is surprising then, that persons with disabilities, one of the world's most vulnerable population groups, particularly in southern Africa, have been largely overlooked with regards to HIV/AIDS. This review sought to establish the state of the knowledge at present. Method. This article reports on findings of a literature review conducted as an initial step in a research project currently underway in South Africa. This article focuses on HIV/AIDS as it affects persons with disabilities in southern Africa, as it is in this region that the majority of people living with HIV live. However, as fewer studies exist that have as its focus southern Africa (particularly looking at HIV/AIDS and persons with disabilities), relevant articles from the international literature were used as indications of what we may find through future research also in the southern African countries. Given the paucity of published literature dealing with HIV/AIDS and persons with disabilities, the review looked at various risk factors associated with HIV infection, and how it affects persons with disabilities. Results. Findings from the literature review suggest that persons with disabilities, particularly in southern Africa, are at significant risk for HIV infection. Conclusions. There is an urgent need for more research on HIV/AIDs and sexuality among persons with disabilities in Africa.
Language: English
Keywords:
AFRICA, SOUTHERN | LITERATURE REVIEW | EPIDEMIOLOGIC METHODS | DISABLED PERSONS AND DISABILITIES | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | AIDS | COMPLICATIONS | RISK ASSESSMENT | POVERTY | SEX BEHAVIOR | RISK BEHAVIOR | EDUCATIONAL STATUS | SEX EDUCATION | PROGRAM ACCESSIBILITY | Developing Countries | Africa, Sub Saharan | Africa | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Evaluation | Socioeconomic Factors | Economic Factors | Behavior | Socioeconomic Status | Education | Program Evaluation | Programs | Organization and Administration
Document Number: 331086

28.

Title: Benefits and risks of stavudine therapy for HIV-associated neurologic complications in Uganda.
Author: Sacktor N; Nakasujja N; Skolasky RL; Robertson K; Musisi S; Ronald A; Katabira E; Clifford DB
Source: Neurology. 2009 Jan 13;72(2):165-70.
Abstract: BACKGROUND: The frequency of HIV dementia in a recent study of HIV+ individuals at the Infectious Disease Institute in Kampala, Uganda, was 31%. Coformulated generic drugs, which include stavudine, are the most common regimens to treat HIV infection in Uganda and many other parts of Africa. OBJECTIVE: To evaluate the benefits and risks of stavudine-based highly active antiretroviral therapy (HAART) for HIV-associated cognitive impairment and distal sensory neuropathy. The study compared neuropsychological performance changes in HIV+ individuals initiating HAART for 6 months and HIV- individuals receiving no treatment for 6 months. The risk of antiretroviral toxic neuropathy as a result of the initiation of stavudine-based HAART was also examined. METHODS: At baseline, 102 HIV+ individuals in Uganda received neurologic, neuropsychological, and functional assessments; began HAART; and were followed up for 6 months. Twenty-five HIV- individuals received identical clinical assessments and were followed up for 6 months. RESULTS: In HIV+ individuals, there was improvement in verbal memory, motor and psychomotor speed, executive thinking, and verbal fluency. After adjusting for differences in sex, HIV+ individuals demonstrated significant improvement in the Color Trails 2 test (p = 0.025) compared with HIV- individuals. Symptoms of neuropathy developed in 38% of previously asymptomatic HIV+ patients after initiation of the stavudine-based HAART. CONCLUSIONS: After the initiation of highly active antiretroviral therapy (HAART) including stavudine, HIV+ individuals with cognitive impairment improve significantly as demonstrated by improved performance on a test of executive function. However, peripheral neurotoxicity occurred in 30 patients, presumably because of stavudine-based HAART, suggesting the need for less toxic therapy.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | CENTRAL NERVOUS SYSTEM EFFECTS | COMPLICATIONS | AIDS | MENTAL DISORDERS | ANTIRETROVIRAL THERAPY | TOXICITY | PSYCHOLOGICAL FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Central Nervous System | Physiology | Biology | HIV | Behavior
Document Number: 330235

29.

Peer Reviewed

Title: Effect of HSV-2 serostatus on acquisition of HIV by young men: results of a longitudinal study in Orange Farm, South Africa.
Author: Sobngwi-Tambekou J; Taljaard D; Lissouba P; Zarca K; Puren A; Lagarde E; Auvert B
Source: Journal of Infectious Diseases. 2009 Apr 1;199(7):958-964.
Abstract: The authors analyzed data collected during a male circumcision trial conducted in Orange Farm, South Africa. They estimated adjusted incidence rate ratios for HIV acquisition, using survival analysis and background characteristics, herpes simplex virus type 2 (HSV-2) status, male circumcision status, and sexual behavior as covariates. Results showed that HSV-2 has a substantial impact on HIV acquisition among young South African men. The study suggests that HSV-2 infection enhances HIV acquisition and is responsible for 25% of incident cases of HIV infection. However, the protective effect of male circumcision against HIV acquisition appears independent of HSV-2 serostatus.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | LONGITUDINAL STUDIES | PERSONS LIVING WITH HIV/AIDS | MEN | YOUTH | PREVALENCE | HERPES GENITALIS | HIV INFECTIONS | COMPLICATIONS | SEX BEHAVIOR | RISK BEHAVIOR | RISK FACTORS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Viral Diseases | Diseases | Demographic Factors | Population | Age Factors | Population Characteristics | Measurement | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Behavior | Health
Document Number: 341074

30.