1.  Peer Reviewed Title: Sexual behavior change in countries with generalised HIV epidemics? Evidence from population-based cohort studies in sub-Saharan Africa. Author: Gregson S; Todd J; Zaba B Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 1):i1-i2. Abstract: This introductory article describes the contents of the current issue which presents 10 recent analyses of sexual behaviour data from longitudinal studies in five countries-Uganda, Tanzania, Malawi, Zimbabwe and South Africa- experiencing different sizes and stages of the HIV epidemic. The results provide valuable information for use in evaluating trends in HIV epidemics and the impact of HIV prevention programmes. An underlying purpose of this is to highlight appropriate methods and to encourage better analysis and presentation of sexual behaviour data, especially as they relate to HIV and HIV prevention. Language: English Keywords: AFRICA, SUB SAHARAN | LITERATURE REVIEW | KAP SURVEYS | COHORT ANALYSIS | DEMOGRAPHIC AND HEALTH SURVEYS | LONGITUDINAL STUDIES | TARGET POPULATION | HIV TRANSMISSION | EPIDEMICS | SEX BEHAVIOR | RISK BEHAVIOR | SURVIVORSHIP | RISK FACTORS | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Program Design | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Behavior | Length of Life | Mortality | Health Document Number: 340100 |
| 2. Peer Reviewed Title: Determinants of survival in AIDS patients on antiretroviral therapy in a rural centre in the Far-North Province, Cameroon. Author: Sieleunou I; Souleymanou M; Schonenberger AM; Menten J; Boelaert M Source: Tropical Medicine and International Health. 2009 Jan;14(1):36-43. Abstract: OBJECTIVE: To analyse the outcomes of antiretroviral therapy (ART) in routine conditions in a rural hospital in the Far-North province of Cameroon. METHOD: Retrospective cohort study of 1187 patients >15 years who started ART between July 2001 and December 2006. The survival time was estimated by Kaplan-Meier analysis and Cox proportional hazard models were fitted to explain survival. RESULTS: Upon enrollment, 90.4% patients were in WHO stage III or IV and 56.1% had a BMI <18.5. Median CD4 count was 105 cells/mm(3) (IQR 40-173). At the end of the study period, 338/1187 had died and 59/1187 were lost to follow-up. The survival probability was 77% at 1 year [95% CI: 75-80] and 47% at 5 years [95% CI: 40-55]. The median survival time was 58 months. CD4 count, haemoglobin, BMI, sex and clinical stage at enrollment were independent predictors of mortality. CONCLUSION: This study confirms the clinical benefit of ART programs in a remote and resource-constrained setting operating in routine conditions. The challenge ahead is to secure earlier access to ART and to maintain its longer-term benefit. Language: English Keywords: CAMEROON | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | RETROSPECTIVE STUDIES | COHORT ANALYSIS | RURAL POPULATION | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | TIME FACTORS | SURVIVORSHIP | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | HIV | Population Dynamics | Length of Life | Mortality Document Number: 330263 |
| 3. Peer Reviewed Title: Impact of HAART therapy on co-infection of tuberculosis and HIV cases for 9 years in Taiwan. Author: Tseng SH; Jiang DD; Hoi HS; Yang SL; Hwang KP Source: American Journal of Tropical Medicine and Hygiene. 2009 Apr;80(4):675-7. Abstract: Free highly active antiretroviral therapy (HAART) was made available by The Department of Health since April 1997. As a result, the incidence rate of tuberculosis (TB)/human immunodeficiency virus (HIV) co-infection among HIV cases rose from 1.90% to 3.82% during 1993 to 1998 and decreased from 3.82% to 0.94% during 1998 to 2006. The incidence rate of TB/HIV co-infection among HIV cases reached its peak in 1998 and then started to reverse, although the next year the TB disease burden (incidence rate: 62.7 cases per 100,000 persons) remained consistently high, and this continued in the following years. The survival rate of TB/HIV co-infection cases was 62.16% during the period 1993-1996 (pre-free HAART era) and increased to 86.60% during the period 1998-2006 (P < 0.0001) (post-free HAART era). Highly active antiretroviral therapy decreased the incidence rate of new TB/HIV co-infection cases among HIV cases and increased the survival rate of TB/HIV co-infection cases. Language: English Keywords: TAIWAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | HIV INFECTIONS | TUBERCULOSIS | COMPLICATIONS | ANTIRETROVIRAL THERAPY | SURVIVORSHIP | Asia, Eastern | Asia | Developed Countries | Research Methodology | Viral Diseases | Diseases | Measurement | Infections | HIV | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 331276 |
| 4. Peer Reviewed Title: The linked survival prospects of siblings: Evidence for the Indian states. Author: Arulampalam W; Bhalotra S Source: Population Studies. 2008;62(2):171-190. Abstract: This paper reports an analysis of micro-data for India that shows a high correlation in infant mortality among siblings. In 13 of 15 states, we identify a causal effect of infant death on the risk of infant death of the subsequent sibling (a scarring effect), after controlling for mother-level heterogeneity. The scarring effects are large, the only other covariate with a similarly large effect being mother's (secondary or higher) education. The two states in which evidence of scarring is weak are Punjab, the richest, and Kerala, the socially most progressive. The size of the scarring effect depends upon the sex of the previous child in three states, in a direction consistent with son-preference. Evidence of scarring implies that policies targeted at reducing infant mortality will have social multiplier effects by helping avoid the death of subsequent siblings. Comparison of other covariate effects across the states offers some interesting new insights. Language: English Keywords: INDIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | SIBLINGS | INFANT | SURVIVORSHIP | INFANT MORTALITY | CHILD SURVIVAL | SEX FACTORS | EDUCATIONAL STATUS | SEX PREFERENCE | SOCIOECONOMIC STATUS | SOCIAL DEVELOPMENT | Developing Countries | Asia, Southern | Asia | Research Methodology | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Length of Life | Mortality | Population Dynamics | Socioeconomic Factors | Economic Factors | Value Orientation | Psychological Factors | Behavior Document Number: 327734 |
| 5. Peer Reviewed Title: Determining an optimal testing strategy for infants at risk for mother-to-child transmission of HIV-1 during the late postnatal period. Author: Brown E; Chi BH; Read JS; Taha TE; Sharma U; Hoffman IF; Pikora C; Goldenberg R; Fiscus SA Source: AIDS. 2008 Nov 12;22(17):2341-6. Abstract: OBJECTIVES: To determine the optimal time for a second HIV-1 nucleic acid amplification assay to detect late postnatal transmission of HIV-1 (first negative test at 4-8 weeks of age) in resource-limited settings. DESIGN: A longitudinal analysis of data from HIV Prevention Trial Network trial 024. METHODS: Children born to HIV-1-infected mothers enrolled in the HIV Prevention Trial Network trial 024 were tested for HIV-1 infection at six intervals within the first year of life. Mothers and infants received nevirapine prophylaxis. We estimated the probability of being alive and having a positive test in each interval after 4-8 weeks and at 30 days after weaning, conditional on having acquired HIV during the late postnatal period. The interval with the highest probability was taken to be the optimal visit interval. RESULTS: A total of 1609 infants from HIV Prevention Trial Network trial 024 had at least one HIV-1 diagnostic test and were included in the analysis. We found that testing at 1 month after weaning or 12 months of age (whichever comes first) identified 81% of those infected during the late postnatal period (after 4-8 weeks) through breastfeeding. In total, 93% (95% confidence interval 89, 98) of all infected infants would be detected if tests were performed at these two time points. CONCLUSION: In resource-limited settings, HIV-1 PCR testing at 4-8 weeks followed by a second test at 1 month after weaning or at 1 year of age (whichever comes first), led to the identification of the vast majority of HIV-1-infected infants. Language: English Keywords: AFRICA, SOUTHERN | RESEARCH REPORT | METHODOLOGICAL STUDIES | LONGITUDINAL STUDIES | CLINICAL RESEARCH | INFANT | PERSONS LIVING WITH HIV/AIDS | HIV TESTING | MOTHER-TO-CHILD TRANSMISSION | HIV TRANSMISSION | ANTIRETROVIRAL THERAPY | PROBABILITY | TIME FACTORS | SURVIVORSHIP | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Transmission | Infections | HIV | Statistical Studies | Population Dynamics | Length of Life | Mortality Document Number: 330277 |
| 6. Title: From birth to adulthood in rural Ethiopia: the Butajira Birth Cohort of 1987. Author: Byass P; Fantahun M; Mekonnen W; Emmelin A; Berhane Y Source: Paediatric and Perinatal Epidemiology. 2008 Nov;22(6):569-74. Abstract: Long-term birth cohorts from developing countries are uncommon. Here a unique birth to 18-years cohort based on all births during 1987 in a rural area of Ethiopia is presented. This was the first year of the ongoing Butajira Rural Health Programme, since when the sampled population has been followed up in regular household visits. A total of 1884 livebirths in 1987 formed the cohort, corresponding to a birth rate of 0.31 per woman per year; the male : female ratio was 1.10. Perinatal mortality was 22 per 1000 livebirths, and infant mortality 65 per 1000 livebirths. Survival from birth to 18 years was 760 per 1000. Living in Butajira town had a considerable survival advantage compared with the surrounding villages. Most deaths were due to infections. Four per cent of the cohort experienced the death of their mothers before the age of 18 years, and 15 of the girls delivered their own children, suggesting that 1 in 25 women may bear a child before their eighteenth birthday in this community. The children in the cohort received no consequent special care or attention, and so they probably accurately represent the harsh realities of growing up in rural Ethiopia at the turn of the Millennium. The huge gaps between their experience and that of their contemporaries in more affluent settings are a scandal of the 21st century. Language: English Keywords: ETHIOPIA | RESEARCH REPORT | COHORT ANALYSIS | LONGITUDINAL STUDIES | RURAL POPULATION | CHILDREN | ORPHANS AND VULNERABLE CHILDREN | BIRTH RATE | PERINATAL MORTALITY | INFANT MORTALITY | DEATH RATE | CHILD SURVIVAL | SURVIVORSHIP | CAUSES OF DEATH | INFECTIONS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Family and Household | Sociocultural Factors | Fertility Measurements | Fertility | Population Dynamics | Mortality | Length of Life | Diseases Document Number: 330038 |
| 7. Peer Reviewed Title: Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in Malawi. Author: Chen SC; Yu JK; Harries AD; Bong CN; Kolola-Dzimadzi R Source: Tropical Medicine and International Health. 2008 Apr;13(4):1-7. Abstract: The objective was to investigate the effect of gender on mortality of HIV-infected adults receiving antiretroviral therapy (ART) and its possible reasons. The method used was a retrospective study to review the records for outcomes of adult cases receiving ART at Mzuzu Central Hospital, Malawi, between July 2004 and December 2006. Over the study period, 2838 adult AIDS patients received ART. Of these, 2029 (71.5%) were alive and still on ART, 376 (13.2%) were dead and 433 (15.3%) were lost to follow-up. Survival analysis with Kaplan-Meier estimator showed significantly higher survival rates among females than males in WHO stage 1, 2 and 3 (both P less than 0.0001) and borderline in stage 4 (P = 0.076). The Cox model revealed a death hazard ratio (males vs. females) of 1.70 (95% confidence interval 1.35-2.15) after controlling for WHO clinical stages, body mass index and age. More men than women were lost to follow-up in all occupations except health workers. The most important reasons for a highermortality in male patients starting ART may relate to their seeking medical care at a more advanced stage of immunodeficiency and poorer compliance with therapy. The issue needs to be addressed in scaling up ART programmes in Africa. (author's) Language: English Keywords: MALAWI | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | RETROSPECTIVE STUDIES | EVALUATION INDEXES | MEN | AIDS | DEATH RATE | USER COMPLIANCE | ANTIRETROVIRAL THERAPY | AIDS PREVENTION | BODY WEIGHT | HEALTH STATUS INDEXES | SURVIVORSHIP | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Behavior | HIV | Physiology | Biology | Health | Length of Life Document Number: 324682 |
8.  Title: Survival of AIDS patients and characteristics of those who died over eight years of highly active antiretroviral therapy, at a referral center in Northeast Brazil. Author: de Melo LS; Lacerda HR; Campelo E; Moraes E; Ximenes RA Source: Brazilian Journal of Infectious Diseases. 2008 Aug;12(4):269-277. Abstract: Introduction of highly active antiretroviral therapy has resulted in a significant reduction in morbimortality and significant changes in the causes of death among HIV/AIDS patients. For this reason, it has become essential to monitor survival and causes of death. We constructed a survival curve based on 597 adult patients notified as AIDS cases between 1997 and 2004, at the Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil. Among those patients, 150 (25%) progressed to death by December, 2005. Of these, 119 were studied in detail. The data were collected from notification files of the State Health Department and the State Mortality Information System, and were complemented by analysis of medical records. These 597 patients had a survival rate of 88%, 86% and 82% after one, two and five years, respectively, and a 75% likelihood of surviving to 1,984 days (66 months). Most of the deaths occurred during the first months after the diagnosis (median, 129 days). Patients who died were predominantly young men who had sexual exposure and came from Recife (the state capital) or its metropolitan region. When the patients were first seen, a large proportion had already presented severe signs of immunodeficiency. Comparing the patients within this group, the characteristics that were associated with lower survival were: male sex, hemoglobin < 10 mg/dL, lymphocytes < 1,000/mm3, use of fewer therapeutic drugs and antiretroviral regimens and non-introduction of protease inhibitors. Most of them died from AIDS-related diseases, particularly undefined respiratory infections. Language: English Keywords: BRAZIL | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | URBAN POPULATION | SURVIVORSHIP | ANTIRETROVIRAL THERAPY | CAUSES OF DEATH | COMPLICATIONS | AIDS | TIME FACTORS | RISK FACTORS | DEMOGRAPHIC FACTORS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Population | Length of Life | Mortality | Population Dynamics | HIV | Health Document Number: 329472 |
| 9. Peer Reviewed Title: Mortality, TB / HIV co-infection, and treatment dropout: Predictors of tuberculosis prognosis in Recife, Pernambuco State, Brazil. Author: Domingos MP; Caiaffa WT; Colosimo EA Source: Cadernos de Saude Publica. 2008 Apr;24(4):887-896. Abstract: This non-concurrent cohort study aims to identify predictors of tuberculosis mortality in a large population database in Brazil. Tuberculosis, death, and TB/HIV cases were validated respectively from the tuberculosis surveillance (SINAN/TB), mortality (SIM), and SINAN/AIDS databases for a five-year period. Analysis included proportional hazard models with relative risk estimates. Out of 5,451 individuals reported with tuberculosis, 320 (5.9%) died (incidence and mortality rates of 98.6 and 12.2/100 thousand inhabitants, respectively). After adjustment, relative risk of dying from tuberculosis was 9.8 for individuals greater than 50 years of age; 9.0 for TB/HIV co-infection; 3.0 for mixed TB clinical presentation; and 2.0 for treatment dropout. In the multivariate model, using cases with HIV/AIDS, all adjusted predictors lost significance except mixed clinical presentation (RR 1.9; 1.1-3.1). TB/HIV co-infection is an important predictor of TB mortality. However, among individuals without HIV/AIDS, mortality is still highly associated with older age, mixed clinical forms, and treatment dropout. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | COHORT ANALYSIS | CLIENTS | TUBERCULOSIS | MORTALITY | HIV INFECTIONS | TREATMENT | DROPOUTS | SURVIVORSHIP | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Infections | Diseases | Population Dynamics | Demographic Factors | Population | Viral Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Length of Life Document Number: 326497 |
| 10. Peer Reviewed Title: Initiating therapy: When to start, what to use. Author: Hirsch MS Source: Journal of Infectious Diseases. 2008 May 15;197 Suppl 3:S252-S260. Abstract: Decisions regarding whether to start combination antiretroviral therapy (cART) during primary infection and when to initiate treatment during chronic infection continue to evolve. Although current data suggest that there may be a benefit to therapy during primary infection, results are inconclusive. Once begun, treatment probably should be continued indefinitely, since its potential advantages disappear over time if treatment is stopped. Recent studies suggest that cART may be useful at higher CD4 cell count thresholds than are currently recommended in several guidelines. Several regimens are acceptable as initial therapy, with tenofovir/emtricitabine/efavirenz favored by many because of potency and ease of administration. Other favored regimens include combinations of 2 nucleoside (or nucleotide) reverse-transcriptase inhibitors and a ritonavir-boosted protease inhibitor. Some new antiretroviral drugs under study, particularly integrase inhibitors, may prove useful in treatment-naive patients. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | TREATMENT | IMMUNITY, CELLULAR | SURVIVORSHIP | PUBLIC HEALTH | HIV PREVENTION | Developed Countries | North America | Americas | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Immunity | Immune System | Physiology | Biology | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 326568 |
| 11. Peer Reviewed Title: Clinical and immunological outcomes of a national paediatric cohort receiving combination antiretroviral therapy in Uganda. Author: Kiboneka A; Wangisi J; Nabiryo C; Tembe J; Kusemererwa S; Olupot-Olupot P; Joffres M; Anema A; Cooper CL; Montaner JS; Mills EJ Source: AIDS. 2008 Nov 30;22(18):2493-9. Abstract: OBJECTIVE: We aimed to evaluate clinical and immunological outcomes of paediatric patients receiving combination antiretroviral therapy (cART) enrolled in The AIDS Support Organization (TASO) Uganda national HIV/AIDS programme. DESIGN: Observational study of patients (age <14 years) enrolled in 10 clinics across Uganda for which TASO has data. METHODS: We extracted patient demographic, immunological and clinical outcomes from the TASO databases regarding age, sex, cART regimen, CD4 cell count and WHO stage at initiation, tuberculosis, mortality and adherence. Outcomes were analysed using Pearson's rank-order correlations, Wilcoxon's rank sum tests, Cox proportional hazard model and survivor functions. RESULTS: Of the total 770 HIV children on cART, median age was 9 years (interquartile range, 5-13 years), and median follow-up time was 377 days (interquartile range, 173-624 days). Seven hundred and fifty-one children (97.5%) initiated nonnucleoside reverse transcriptase inhibitor-based regimens. Three hundred and sixty-five children (47.5%) initiated cART with severe immune suppression (CD4 cell percentage <15). Of the 18 (2.3%) children that died, mortality was associated with lower CD4 cell percentage at initiation (B coefficient -0.144, standard error 0.06, P = 0.02). Of the total, 229 (30%) were single or double orphans and more likely to initiate cART at an older age (mean age, 9.25 vs. 8.35 years, P = 0.02) and have a lower CD4 cell count (median, 268 vs. 422 cells/microl, P < or = 0.0001) and CD4 cell percentage (median 12.8 vs. 15.5%, P = 0.02) at initiation. Pulmonary tuberculosis was present in 43 (5.6%) patients at initiation and 21 (2.3%) after cART. Almost all patients (94.9%) demonstrated more than 95% adherence. CONCLUSION: Children on cART in Uganda demonstrate positive clinical outcomes. However, additional support is required to ensure timely cART access among orphans and young children. Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | CHILDREN | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | AGE FACTORS | SEX FACTORS | USER COMPLIANCE | AIDS PREVENTION | SURVIVORSHIP | DEATH RATE | TUBERCULOSIS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Family and Household | Sociocultural Factors | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | HIV | Behavior | AIDS | Length of Life | Mortality | Population Dynamics | Infections Document Number: 330274 |
| 12. Title: Excess mortality and risk factors for mortality among a cohort of TB patients from rural south India. Author: Kolappan C; Subramani R; Kumaraswami V; Santha T; Narayanan PR Source: International Journal of Tuberculosis and Lung Disease. 2008 Jan;12(1):81-86. Abstract: OBJECTIVES: To estimate the excess general mortality among tuberculosis (TB) patients in a rural area (Tiruvallur) and identify risk factors for TB-related mortality. SETTING: The study population consisted of all TB patients aged >or=15 years who were registered under the Revised National Tuberculosis Control Programme (RNTCP) during the years 2000 to 2003 at Velliyur TB unit (TU) in south India. DESIGN: This is a retrospective cohort study of 3405 patients treated under the DOTS strategy, followed up from the date of start of treatment till the date of interview (for the survivors) or the date of death (for those who died). RESULTS: There were 2710 (79.6%) survivors and 695 (20.4%) deaths. The excess general mortalities for the cohort, expressed as standardised mortality ratio (SMR), was 4.2 (95%CI 3.9-4.5). High SMR values were obtained for patients belonging to the 15-44 years age group (12.1), patients on Category II regimen (9.3), treatment failures (9.1) and defaulters (7.8). The adjusted hazards ratios (aHR) were high for patients aged 45-59 years (1.9), >or=60 years (3.1) and with incomplete treatment due to default or failure (6.4). CONCLUSION: TB is one of the main causes of mortality in the younger age group. Among TB patients, the major risk factors for mortality are old age (>or=45 years) and incomplete treatment. Language: English Keywords: INDIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COHORT ANALYSIS | RETROSPECTIVE STUDIES | RURAL POPULATION | TUBERCULOSIS | RISK FACTORS | EXCESS MORTALITY | MORTALITY DETERMINANTS | SURVIVORSHIP | AGE FACTORS | USER COMPLIANCE | ANTIBIOTICS | Developing Countries | Asia, Southern | Asia | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Biology | Mortality | Population Dynamics | Length of Life | Behavior | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 325807 |
| 13. Peer Reviewed Title: When did HIV incidence peak in Harare, Zimbabwe? Back-calculation from mortality statistics. Author: Lopman B; Gregson S Source: PLoS One. 2008 Mar;3(3):e1711. Abstract: HIV prevalence has recently begun to decline in Zimbabwe, a result of both high levels of AIDS mortality and a reduction in incident infections. An important component in understanding the dynamics in HIV prevalence is knowledge of past trends in incidence, such as when incidence peaked and at what level. However, empirical measurements of incidence over an extended time period are not available from Zimbabwe or elsewhere in sub-Saharan Africa. Using mortality data, we use a back-calculation technique to reconstruct historic trends in incidence. From AIDS mortality data, extracted from death registration in Harare, together with an estimate of survival post-infection, HIV incidence trends were reconstructed that would give rise to the observed patterns of AIDS mortality. Models were fitted assuming three parametric forms of the incidence curve and under nine different assumptions regarding combinations of trends in non-AIDS mortality and patterns of survival post-infection with HIV. HIV prevalencewas forward-projected from the fitted incidence and mortality curves. Models that constrained the incidence pattern to a cubic spline function were flexible and produced well-fitting, realistic patterns of incidence. In models assuming constant levels of non-AIDS mortality, annual incidence peaked between 4 and 5% between 1988 and 1990. Under other assumptions the peak level ranged from 3 to 8% per annum. However, scenarios assuming increasing levels of non-AIDS mortality resulted in implausibly low estimates of peak prevalence (11%), whereas models with decreasing underlying crude mortality could be consistent with the prevalence and mortality data. HIV incidence is most likely to have peaked in Harare between 1988 and 1990, which may have preceded the peak elsewhere in Zimbabwe. This finding, considered alongside the timing and location of HIV prevention activities, will give insight into the decline of HIV prevalence in Zimbabwe. (author's) Language: English Keywords: ZIMBABWE | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | MATHEMATICAL MODEL | LONGITUDINAL STUDIES | PERSONS LIVING WITH HIV/AIDS | MORTALITY CHANGES | HIV INFECTIONS | PREVALENCE | INCIDENCE | DEATH RECORDS | SURVIVORSHIP | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Theoretical Models | Studies | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Measurement | Vital Statistics | Population Statistics | Length of Life Document Number: 325267 |
| 14. Peer Reviewed Title: A public health approach to rapid scale-up of antiretroviral treatment in Malawi during 2004-2006. Author: Lowrance DW; Makombe S; Harries AD; Shiraishi RW; Hochgesang M; Aberle-Grasse J; Libamba E; Schouten E; Ellerbrock T; Kamoto K Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Nov 1;49(3):287-93. Abstract: BACKGROUND: Approximately 1 million people are infected with HIV in Malawi, where AIDS is the leading cause of death in adults. By December 31, 2007, more than 141,000 patients were initiated on antiretroviral treatment (ART) by use of a public health approach to scale up HIV services. METHODS: We analyzed national quarterly and longitudinal cohort data from October 2004 to December 2006 to examine trends in characteristics of patients initiating ART, end-of-quarter clinical outcomes, and 6- and 12-month survival probability. FINDINGS: During a 27-month period, 72,666 patients were initiated on ART, of whom about two-thirds were women. The percentage of patients initiated on ART who were children and farmers increased from 5.5% to 9.0% and 23% to 32%, respectively (P < 0.001 for trends). Estimated survival probability ranged from 85% to 88% at 6 months and 81% to 84% at 12 months on ART. INTERPRETATION: In Malawi, a public health approach to ART increased treatment access and maintained high 6- and 12-month survival. Resource-limited countries scaling up ART programs may benefit from this approach of simplified clinical decision making, standardized ART regimens, nonphysician care, limited laboratory support, and centralized monitoring and evaluation. Language: English Keywords: MALAWI | EVALUATION REPORT | COHORT ANALYSIS | LONGITUDINAL STUDIES | EPIDEMIOLOGIC METHODS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | PUBLIC HEALTH | DELIVERY OF HEALTH CARE | SEX FACTORS | AGE FACTORS | PREVALENCE | SURVIVORSHIP | MONITORING | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Evaluation | Research Methodology | Studies | HIV Infections | Viral Diseases | Diseases | HIV | Health | Population Characteristics | Demographic Factors | Population | Measurement | Length of Life | Mortality | Population Dynamics Document Number: 329404 |
| 15. Peer Reviewed Title: Does the recent evolution of Canadian mortality agree with the epidemiologic transition theory? Author: Lussier MH; Bourbeau R; Choiniere R Source: Demographic Research. 2008 Jun 20;18(19):531-568. Abstract: The last century has been the witness to numerous changes in population evolution, including an important decline in fertility, paired with a regression of mortality due in part to the changing nature of causes of death. The study of the theory of the epidemiologic transition has allowed better insight of the processes behind the evolution of mortality and causes of death in developed countries. However, this theory of the epidemiologic transition has also been a controversial issue among researchers in the last few decades. The object of this analysis is to study the evolution of the late stages of the epidemiologic transition in Canada, and to determine where Canada stands among the theoretical stages of the epidemiologic transition suggested by various researchers. After studying the epidemiologic transition's situation in Canada, it is determined that the delimitation of temporal stages within the epidemiologic transition as put forward by Omran (1971, 1998), Olshansky and Ault (1986), Rogersand Hackenberg (1987) and Olshansky et al. (1998) does not suit the Canadian evolution. Many of the researchers' postulates on the epidemiologic transition were not confirmed, which leads us to assert that, since 1958, the epidemiologic transition in Canada is best described as an evolution process rather than specific stages confined within time limits. (excerpt) Language: English Keywords: CANADA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | THEORETICAL MODELS | POPULATION | EPIDEMIOLOGY | MORTALITY DETERMINANTS | AGE SPECIFIC DEATH RATE | CHRONIC DISEASES | SURVIVORSHIP | MORTALITY DECLINE | SEX FACTORS | AIDS | SOCIAL PROBLEMS | COMMUNICABLE DISEASES | North America, Northern | Americas | Developed Countries | Research Methodology | Public Health | Health | Mortality | Population Dynamics | Demographic Factors | Death Rate | Diseases | Length of Life | Population Characteristics | HIV Infections | Viral Diseases | Sociocultural Factors | Infections Document Number: 327408 |
| 16. Peer Reviewed Title: Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda. Author: Moore CC; Jacob ST; Pinkerton R; Meya DB; Mayanja-Kizza H Source: Clinical Infectious Diseases. 2008 Jan 15;46(2):215-222. Abstract: Prediction of mortality may improve management and outcomes of patients with sepsis in resource-limited settings. Therefore, we evaluated the ability of a hand-held portable whole-blood lactate (PWBL) analyzer to predict mortality of patients who are admitted to the hospital with severe sepsis. A prospective observational study enrolled 253 patients at a national referral hospital in Uganda. Inclusion criteria required (1) >/= 2 systemic inflammatory response syndrome criteria or thermodysregulation, (2) hypotension, and (3) suspected infection. A subset of 72 patients had PWBL and standard laboratory serum lactate measured. The primary measured outcome was in-hospital mortality. Fifty-nine (81.9%) of 72 evaluated patients were infected with human immunodeficiency virus type 1. The in-hospital mortality rate was 25.7% (18 of 70), and the in- and outpatient mortality at 30 days was 41.6% (30 of 72). PWBL was positively associated with in-hospital but not outpatient mortality (P < .001). The receiver operating characteristic area under the curve for PWBL was 0.81 (P < .001). The optimal PWBL concentration for predicting in-hospital mortality (sensitivity, 88.3%; specificity, 71.2%) was >/= 4.0 mmol/L. Patients with a PWBL concentration >/= 4.0 mmol/L died while in the hospital substantially more often (50.0%) than did those with a PWBL concentration < 4.0 mmol/L (7.5%) (odds ratio, 12.3; 95% confidence interval, 3.5-48.9; P < .001). Standard laboratory serum lactate results were inconsistent and less predictive of mortality than were those of PWBL in a multiple logistic regression model. A PWBL concentration >/= 4.0 mmol/L predicts with 81% accuracy a 7-fold higher mortality of patients with sepsis than does a PWBL concentration < 4.0 mmol/L. PWBL testing would be useful in places where clinical decisions are limited by lack of laboratory infrastructure and poor reliability. (author's) Language: English Keywords: UGANDA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | HIV INFECTIONS | BACTERIAL AND FUNGAL DISEASES | INFECTIONS | BLOOD | CARBOXYLIC ACIDS | MANAGEMENT | DEATH RATE | SURVIVORSHIP | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Hemic System | Physiology | Biology | Organic Chemicals | Ingredients and Chemicals | Mortality | Population Dynamics | Demographic Factors | Population | Length of Life Document Number: 323114 |
| 17. Peer Reviewed Title: Modified Kigali combined staging predicts risk of mortality in HIV-infected adults in Lusaka, Zambia. Author: Peters PJ; Zulu I; Kancheya NG; Lakhi S; Chomba E; Vwalika C; Kim DJ; Brill I; Meinzen-Derr J; Tichacek A; Allen SA Source: AIDS Research and Human Retroviruses. 2008 Jul;24(7):919-24. Abstract: We assessed the utility of the modified Kigali combined (MKC) staging system for predicting survival in HIV-infected Zambian adults in a prospective, longitudinal, open cohort. From 1995 to 2004, HIV-discordant couples (one HIV-infected partner and one HIV-negative partner) were recruited from couples' voluntary counseling and testing centers in Lusaka, Zambia and followed at 3-month intervals. MKC stage, which incorporates clinical stage with erythrocyte sedimentation rate (ESR), hematocrit, and body mass index (BMI), was determined at enrollment. Kaplan-Meier survival and Cox proportional hazard methods were used to calculate median survival and relative hazards. We enrolled 1479 HIV-discordant couples with a combined 7305 person-years of follow-up. Among HIV-infected participants over the 9-year study period, there were 333 confirmed deaths. The time to 50% mortality was 8.5 years with MKC stage 1 and 2 disease compared to 3.7 years with MKC stage 4 disease at enrollment. Survival rates at 3 years were 85% with MKC stage 1 and 2 disease, 74% with MKC stage 3 disease, and 51% with MKC stage 4 disease. A total of 275 HIV-negative partners seroconverted during follow-up. In comparison, survival rates at 3 years were 94% for HIV-negative participants and 92% for participants who seroconverted during follow-up. In multivariate analysis, MKC stage 4 disease (HR = 3.7, 95% CI = 2.7-5.0) remained a strong predictor of mortality. Incorporating ESR, hematocrit, and BMI with clinical staging is a powerful, low-cost tool to identify HIV-infected adults at high risk for mortality. Language: English Keywords: ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | LONGITUDINAL STUDIES | MULTIVARIATE ANALYSIS | EPIDEMIOLOGIC METHODS | PERSONS LIVING WITH HIV/AIDS | COUPLES | ERYTHROCYTE SEDIMENTATION RATE | HIV INFECTIONS | VOLUNTARY COUNSELING AND TESTING | BODY WEIGHT | SURVIVORSHIP | LENGTH OF LIFE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Data Analysis | Viral Diseases | Diseases | Family Characteristics | Family and Household | Sociocultural Factors | Laboratory Procedures | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Testing | Physiology | Biology | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 328635 |
| 18. Peer Reviewed Title: The Spectrum projection package: improvements in estimating mortality, ART needs, PMTCT impact and uncertainty bounds. Author: Stover J; Johnson P; Zaba B; Zwahlen M; Dabis F; Ekpini RE Source: Sexually Transmitted Infections. 2008;84(Suppl 1):i24-i30. Abstract: The approach to national and global estimates of HIV/AIDS used by UNAIDS starts with estimates of adult HIV prevalence prepared from surveillance data using either the Estimation and Projection Package (EPP) or the Workbook. Time trends of prevalence are transferred to Spectrum to estimate the consequences of the HIV/AIDS epidemic, including the number of people living with HIV, new infections, AIDS deaths, AIDS orphans, treatment needs and the impact of treatment on survival. The UNAIDS Reference Group on Estimates, Modelling and Projections regularly reviews new data and information needs and recommends updates to the methodology and assumptions used in Spectrum. The latest update to Spectrum was used in the 2007 round of global estimates. Several new features have been added to Spectrum in the past two years. The structure of the population was reorganised to track populations by HIV status and treatment status. Mortality estimates were improved by the adoption of new approaches to estimating non-AIDS mortality by single age, and the use of new information on survival with HIV in non-treated cohorts and on the survival of patients on antiretroviral treatment (ART). A more detailed treatment of mother-to-child transmission of HIV now provides more prophylaxis and infant feeding options. New procedures were implemented to estimate the uncertainty around each of the key outputs. The latest update to the Spectrum program is intended to incorporate the latest research findings and provide new outputs needed by national and international planners. Language: English Keywords: METHODOLOGICAL STUDIES | ESTIMATION TECHNIQUES | ADULTS | PERSONS LIVING WITH HIV/AIDS | ORPHANS AND VULNERABLE CHILDREN | INFANT | DEATH RATE | ANTIRETROVIRAL THERAPY | NEEDS ASSESSMENT | UNAIDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | PREVALENCE | POPULATION PROJECTION | TREATMENT | SURVIVORSHIP | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Family and Household | Sociocultural Factors | Youth | Mortality | Population Dynamics | HIV | Evaluation | UN | International Agencies | Organizations | Political Factors | Disease Transmission Control | Prevention and Control | Measurement | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Length of Life Document Number: 323043 |
| 19. Peer Reviewed Title: Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries. Author: Stringer EM; Chi BH; Chintu N; Creek TL; Ekouevi DK Source: Bulletin of the World Health Organization. 2008 Jan;86(1):57-62. Abstract: Ambitious goals for paediatric AIDS control have been set by various international bodies, including a 50% reduction in new paediatric infections by 2010. While these goals are clearly appropriate in their scope, the lack of clarity and consensus around how to monitor the effectiveness of programmes to prevent mother-to-child HIV transmission (PMTCT) makes it difficult for policy-makers to mount a coordinated response. In this paper, we develop the case for using population HIV-free child survival as a gold standard metric to measure the effectiveness of PMTCT programmes, and go on to consider multiple study designs and source populations. Finally, we propose a novel community survey-based approach that could be implemented widely throughout the developing world with minor modifications to ongoing Demographic and Health Surveys. (author's) Language: English Keywords: GLOBAL | DEVELOPING COUNTRIES | CRITIQUE | RESEARCH PROPOSAL | WHO | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | INTERVENTIONS | PROGRAM EFFECTIVENESS | PROGRAM EVALUATION | MONITORING | STUDY DESIGN | SURVEYS | SURVIVORSHIP | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Disease Transmission Control | Prevention and Control | Diseases | Programs | Organization and Administration | Evaluation | Research Methodology | Sampling Studies | Studies | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 323461 |
| 20. Title: Implementation of a comprehensive program including psycho-social and treatment literacy activities to improve adherence to HIV care and treatment for a pediatric population in Kenya. Author: Van Winghem J; Telfer B; Reid T; Ouko J; Mutunga A; Jama Z; Vakil S Source: BMC Pediatrics. 2008;8:52. Abstract: BACKGROUND: To achieve good clinical outcomes with HAART, patient adherence to treatment and care is a key factor. Since the literature on how to care for pediatric HIV patients is limited, we describe here adherence interventions implemented in our comprehensive care program in a resource-limited setting in Kenya. METHODS: We based our program on factors reported to influence adherence to HIV care and treatment. We describe, in detail, our program with respect to how we adapted our clinical settings, implemented psycho-social support activities for children and their caregivers and developed treatment literacy for children and teenagers living with HIV/AIDS. RESULTS: This paper focused on the details of the program, with the treatment outcomes as secondary. However, our program appeared to have been effective; for 648 children under 15 years of age who were started on HAART, the Kaplan-Meier mortality survival estimate was 95.27% (95%CI 93.16-96.74) at 12 months after the time of initiation of HAART. CONCLUSION: Our model of pediatric HIV/AIDS care, focused on a child-centered approach with inclusion of caregivers and extended family, addressed the main factors influencing treatment adherence. It appeared to produce good results and is replicable in resource-limited settings. Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | THEORETICAL MODELS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | USER COMPLIANCE | PSYCHOSOCIAL FACTORS | LITERACY PROGRAMS | BEHAVIOR CHANGE COMMUNICATION | ANTIRETROVIRAL THERAPY | SURVIVORSHIP | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Behavior | Education | Communication Programs | Communication | Behavior Change | HIV | Length of Life | Mortality | Population Dynamics Document Number: 330259 |
| 21. Title: Untapped potential: displaced youth. Author: Women’s Commission for Refugee Women and Children Source: New York, New York, Women's Commission for Refugee Women and Children, 2007. [4] p. Abstract: Youth, a stage of life marked by uncertainty, change and challenge, is a time of enormous potential, enthusiasm and energy, when young people make choices based on available opportunities to plan for their transition to adulthood. Young people displaced by conflict, however, have few opportunities and, as a result, this stage of life is often characterized by idleness, violence and poverty. As the average length of displacement continues to extend, youth are increasingly vulnerable to sexual and economic exploitation and recruitment into armies and militias. However, despite all the challenges, young people show tremendous resilience and ability to survive. They are crucial actors in post-conflict reconstruction and in the rebuilding of peaceful, more tolerant communities. They can help other young people through peer-to-peer training. They are the leaders of tomorrow; their rights and needs must be recognized and their skills nurtured and developed to ensure a brighter future. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | YOUTH | INTERNALLY DISPLACED PERSONS | EDUCATION | EMPLOYMENT | PROMOTION | SURVIVORSHIP | Age Factors | Population Characteristics | Demographic Factors | Population | Settlement and Resettlement | Migration | Population Dynamics | Macroeconomic Factors | Economic Factors | Marketing | Length of Life | Mortality Document Number: 319349 |
| 22. Peer Reviewed Title: Malignant transformation in mature cystic teratoma of the ovary: report of five cases and review of the literature. Author: Bal A; Mohan H; Singh SB; Sehgal A Source: Archives of Gynecology and Obstetrics. 2007 Mar;275(3):179-182. Abstract: The incidence of malignant transformation in mature cystic teratoma (MCT) of the ovary is less than 2% as reported in gynaecological and pathological literature. Here we present a series of five patients, who developed malignant transformation in MCT of the ovary, over a 6-year period (1999-2004). The morphological and clinico-pathological features of malignant transformation in MCT of the ovary are discussed. (author's) Language: English Keywords: INDIA | LITERATURE REVIEW | RETROSPECTIVE STUDIES | WOMEN | OVARY | OVARIAN CYSTS | TIME FACTORS | OVARIAN CANCER | CYTOLOGY | SURVIVORSHIP | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Diseases | Population Dynamics | Cancer | Neoplasms | Length of Life | Mortality Document Number: 311994 |
| 23. Peer Reviewed Title: Scaling up antiretroviral therapy in developing countries: What are the benefits and challenges? Author: Boulle A; Ford N Source: Sexually Transmitted Infections. 2007;83:503-505. Abstract: In recent years the case for antiretroviral therapy (ART) in those countries hardest hit by the HIV pandemic is seldom contested. Prior to the widespread availability of antiretroviral therapy in many developing countries, there were however frequent concerns expressed about the safety and feasibility of promoting widespread access to ART in countries such as those in Southern Africa. These concerns were premised on the potential "anarchy" that might be the result of weak health systems leading to widespread virological resistance, on the grounds that there were more cost-effective interventions available given the limited funding baskets at the time, and on the potential to do more harm than good if introducing large and complex new interventions into already weak and fragmented health systems, further increasing inequities. The first public-sector ART treatment programmes in developing countries (with the exception of Brazil) date back to 2000,6 and data are now emerging on the effectiveness of the interventions. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | TREATMENT | SURVIVORSHIP | CONTRACEPTIVE USE-EFFECTIVENESS | DRUG RESISTANCE | MONITORING | DELIVERY OF HEALTH CARE | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | HIV | Medical Procedures | Medicine | Health Services | Health | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Contraceptive Effectiveness | Contraception | Family Planning | Evaluation Document Number: 322937 |
| 24. Title: Gender differences in survival in an HIV / AIDS cohort from Sao Paulo, Brazil. Author: Braga P; Cardoso MR; Segurado AC Source: AIDS Patient Care and STDs. 2007 Apr;21(5):321-328. Abstract: Highly active antiretroviral therapy accounted for significant improvement in AIDS prognosis. However, in areas where access to antiretrovirals is universal, the impact of treatment might have been less remarkable among women. To compare survival between men and women living with HIV, we studied a retrospective cohort of 1072 patients who attended a Brazilian reference center. Time to AIDS-related death was the dependent variable. Medical charts were reviewed to obtain sociodemographic data, clinical, and laboratory outcomes. Cumulative survival probability was estimated by the Kaplan-Meier method and hazard ratios by Cox proportional hazards model. At admission, 55% of men and 38% of women had AIDS. Ninety-one AIDS-related deaths occurred in 6004 person-years of follow-up (PYFU). After adjustment for antiretroviral therapy, predictors of death included: female gender (p = 0.02), age at HIV diagnosis (p = 0.005), lowest CD4 count less than 200 cells/mm3 (p < 0.001) and highest viral load greater than 100,000 copies per milliliter during follow-up (p = 0.007), having an AIDS-defining illness before admission or during follow-up (p < 0.001). We provide evidence that women have benefited less from care, though admitted to the clinic at earlier stages of HIV disease and offered standardised therapeutic interventions. However, the reasons for such gender differences in survival still remain unclear. Further studies are thus warranted to help recognize factors associated to a higher vulnerability in care among women, what may help establish strategies to enhance care for all people living with HIV and for women, in particular. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | COHORT ANALYSIS | MATHEMATICAL MODEL | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | SEX FACTORS | ANTIRETROVIRAL THERAPY | AIDS PREVENTION | SURVIVORSHIP | IMMUNITY, CELLULAR | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Theoretical Models | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | HIV | AIDS | Length of Life | Mortality | Population Dynamics | Immunity | Immune System | Physiology | Biology Document Number: 317694 |
| 25. Title: Survival time of HIV-infected patients with cryptococcal meningitis. Author: Chottanapund S; Singhasivanon P; Kaewkungwal J; Chamroonswasdi K; Manosuthi W Source: Journal of the Medical Association of Thailand. 2007 Oct;90(10):2104-2111. Abstract: The objective was to study survival time and risk factors of mortality among HIV-infected patients who had cryptococcal meningitis. Retrospective cohort study was used to collect the data. Patients' medical records of those who had HIV-infection with newly diagnosed cryptoccocal meningitis between January 2002 and December 2004 were reviewed. Each patient was classified into one of two groups, according to their anti-retroviral status (ART). Five hundred and forty nine patients enrolled in the present study: 281 (51.2%) in the ART+ group and 268 (48.8%) in the ART-group. The mean age was 33.4 ± 6.9 years old in the ART + group and 33.6 ± 7.0 years old in the ART-group. There were more male in both groups: 207 males and 74 females in the ART+ group, and 195 males and 73 females in the ART-group. Baseline CD4 cell count of both groups was 20 (6-74) cells/ mL and 24 (9-72) cells/ ml. About 30% of both groups of patients experienced major opportunistic infection before cryptococcal meningitis. All patients were treated by standard amphotericin B for a 2-week duration followed by fluconazole for an additional 8 weeks. There were no differences of baseline characteristics between the two groups (p > 0.05). The survival rates at 12, 24, and 36 months were 92.8%, 87.4%, and 85.4% in the ART+ group and 55.3%, 42.2%, and 36.8% in the ART-group, respectively (p < 0.01). The median survival time in the ART-group was 15 months. From the Cox regression model, the hazard ratio for "not received ART" was 4.87 (95%CI = 2.48-9.44, p < 0.01). The present study demonstrated the substantial increasing of survival time of HIV-infected patients with cryptococcal meningitis by initiated ART, even in a resource limited setting (no flucytosine, local combined antiretroviral drugs with NVP based regimens). (author's) Language: English Keywords: THAILAND | RESEARCH REPORT | RETROSPECTIVE STUDIES | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | EXAMINATIONS AND DIAGNOSES | MENINGITIS | ANTIRETROVIRAL THERAPY | RISK FACTORS | MORTALITY | SURVIVORSHIP | Asia, Southeastern | Asia | Developing Countries | Studies | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Central Nervous System Effects | Central Nervous System | Physiology | Biology | HIV | Population Dynamics | Demographic Factors | Population | Length of Life Document Number: 321960 |
| 26. Title: Intensity of cervical inflammatory reaction as a risk factor for recurrence of carcinoma of the uterine cervix in stages IB and IIA. Author: Fregnani JH; Soares FA; Novik PR; Lopes A; Latorre Mdo R Source: Sao Paulo Medical Journal. 2007 Jul 5;125(4):231-236. Abstract: Inflammatory reaction intensity has been indicated as a possible recurrence risk factor in carcinoma of the uterine cervix. Some authors observed greater risk with weak inflammatory reaction, while others described the opposite. This study aimed to evaluate risk factors for initial-stage uterine cervix carcinoma recurrence (IB and IIA), considering inflammatory reaction intensity. A retrospective cohort study was used at Hospital do Cancer A. C. Camargo. 289 patients with diagnosed uterine cervix carcinoma (stages IB and IIA) who underwent radical surgery between 1980 and 1999 were studied. Data were collected from medical records. Histological sections from tumors and lymph nodes could be reviewed in 247 cases. Five-year disease-free survival rates were calculated using the Kaplan-Meier method and curves were compared using the log-rank test. Cox's proportional-hazards model was used for multivariate analysis. Recurrence risk was estimated using hazard ratios (HR). Forty-three recurrences were found. Multivariate analysis identified the following independent recurrence risk factors: number of metastatic pelvic lymph nodes (one lymph node: HR = 3.3 [1.3-8.3]; two or three: HR = 5.3 [1.5-18.6]; four or more: HR = 7.6 [1.7-33.2]), tumor invasion depth (deepest third: HR = 2.1 [1.1-4.1]) and inflammatory reaction intensity in the uterine cervix (absent or slight: HR = 2.5 [1.1-5.7]). This study identified that absent or slight inflammatory reaction was an independent risk factor for recurrence. The other risk factors were the number of metastatic pelvic lymph nodes and invasion of the deepest third of the uterine cervix. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | RETROSPECTIVE STUDIES | COHORT ANALYSIS | WOMEN | EXAMINATIONS AND DIAGNOSES | UTERINE CANCER | CERVICAL CANCER | SURGERY | SURVIVORSHIP | EVALUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Diseases | Treatment | Length of Life | Mortality | Population Dynamics Document Number: 324110 |
| 27. Title: An investigation into the extent of uncertainty surrounding estimates of the impact of HIV / AIDS in South Africa. Author: Johnson LF; Dorrington RE; Matthews AP Source: South African Journal of Science. 2007 Mar-Apr;103(3-4):135-140. Abstract: HIV/AIDS statistics have been the source of much controversy in South Africa, but often the extent of uncertainty around these estimates is ignored. There is need for an assessment of the range of uncertainty around often-quoted HIV/AIDS statistics. This analysis determines ranges of uncertainty around the inputs and outputs of the ASSA2002 AIDS and Demographic model of the South African HIV/AIDS epidemic, using a generalized likelihood uncertainty estimation approach. A sample of 500 parameter combinations was drawn by weighting randomly generated parameter combinations by likelihood functions defined on the basis of four South African HIV/AIDS data sets. The estimated number of HIV infections in mid-2005 was 5.1 million (95% prediction interval: 4.2-6.0 million), equivalent to an HIV prevalence rate of 11.1% (9.1-13.1%). Between mid-2004 and mid-2005, the estimated number of new HIV infections was 490 000 (370 000-590 000) and the estimated number of AIDS deaths was 320 000 (270 000-380 000). The posterior mean HIV survival time was estimated to be 11.5 years (95% credibility interval: 10.0-12.9 years), longer than estimated for elsewhere in the developing world. This analysis confirms that South Africa is experiencing a severe HIV/AIDS epidemic, and suggests that HIV/AIDS epidemiology in the country probably differs from that elsewhere in Africa. (author's) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | STATISTICS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | AIDS | EPIDEMICS | PREVALENCE | MORTALITY | SURVIVORSHIP | AGE FACTORS | SEX FACTORS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Measurement | Population Dynamics | Demographic Factors | Population | Length of Life | Population Characteristics Document Number: 322936 |
| 28. Title: Progression to AIDS and death and response to HAART in men and women from a multicenter hospital-based cohort. Author: Perez-Hoyos S; Rodriguez-Arenas MA; de la Hera MG; Iribarren JA; Moreno S Source: Journal of Women's Health. 2007;16(7):1052-1061. Abstract: The objective was to study if progression to AIDS and death, as well as clinical and virological response to highly active antiretroviral therapy (HAART), differs between men and women. We studied a multicenter, hospital-based cohort of HIV-infected patients attending 10 hospitals in Spain from January 1997 to December 2003. Kaplan-Meier and Cox regression were used to assess the effect of sex on time to AIDS, survival from AIDS, onset of a new AIDS event or death, and viral suppression from HAART. Of 4643 patients, 27% were women. Women had statistically significant lower viral loads (VL) of 3.9 vs. 4.1 log10/mL (p = 0.02) and higher median CD4 counts of 339 vs. 288 cells/mm3 (p < 0.001) at entry and were more likely to be AIDS free at entry. In univariate analysis, women seemed to show a nonsignificant lower progression to AIDS (HR 0.88) (95 CI% 0.73-1.07), which disappeared in multivariate analyses (HR 1.03) (95% CI 0.82-1.29). Survival from AIDS seemed to be higher in women (HR 0.65) (95% CI 0.40-1.05), but differences became clearly nonsignificant after adjustments (HR 0.71) (95% CI 0.42-1.23). No differences were seen in time to new AIDS condition or death after HAART (HR 1.08) (95% CI 0.80-1.46) in multivariate analyses. No differences were seen for time to VL suppression after initiation of HAART (HR 1.07) (95% CI 0.92-1.24). We have found no differences in HIV progression and response to HAART attributable to gender among patients accessing the Spanish hospital network. (author's) Language: English Keywords: SPAIN | RESEARCH REPORT | CLINICAL RESEARCH | STATISTICAL REGRESSION | MULTIVARIATE ANALYSIS | PERSONS LIVING WITH HIV/AIDS | AIDS | ANTIRETROVIRAL THERAPY | DEATH | HOSPITALS | SEX FACTORS | TIME FACTORS | SURVIVORSHIP | AIDS PREVENTION | Europe, Southwestern | Europe | Developed Countries | Research Methodology | Data Analysis | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | HIV | Mortality | Population Dynamics | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Population Characteristics | Length of Life Document Number: 320989 |
| 29. Peer Reviewed Title: Association of ginseng use with survival and quality of life among breast cancer patients. Author: Cui Y; Shu XO; Gao YT; Cai H; Tao MH Source: American Journal of Epidemiology. 2006 Apr 1;163(7):645-653. Abstract: The authors evaluated the associations of ginseng use as a complementary therapy with survival and quality of life (QOL) in a cohort of 1,455 breast cancer patients who were recruited to the Shanghai Breast Cancer Study between August 1996 and March 1998 in Shanghai, China. Patients were followed through December 2002. Information on ginseng use before cancer diagnosis was collected at baseline recruitment and was linked to survival. Survivors' ginseng use after cancer diagnosis was obtained at the follow-up survey and was correlated to QOL at the same time. The Kaplan-Meier method and Cox regression models were applied to evaluate the association of ginseng use with overall and disease-free survival. The relation of ginseng use and QOL was evaluated by using multiple linear regression models. Approximately 27% of study participants were regular ginseng users before cancer diagnosis. Compared with patients who never used ginseng, regular users had a significantly reduced risk of death; adjusted hazard ratios associated with ginseng use were 0.71 (95% confidence interval: 0.52, 0.98) for total mortality and 0.70 (95% confidence interval: 0.53, 0.93) for disease-specific mortality/recurrence. Ginseng use after cancer diagnosis, particularly current use, was positively associated with QOL scores, with the strongest effect in the psychological and social well-being domains. Additionally, QOL improved as cumulative ginseng use increased. (author's) Language: English Keywords: CHINA | RESEARCH REPORT | CASE CONTROL STUDIES | FOLLOW-UP STUDIES | WOMEN | BREAST CANCER | FOOD SUPPLEMENTATION | SOCIOECONOMIC FACTORS | HORMONES | QUALITY OF LIFE | SURVIVORSHIP | Asia, Eastern | Asia | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Cancer | Neoplasms | Diseases | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Economic Factors | Endocrine System | Physiology | Biology | Social Welfare | Length of Life | Mortality | Population Dynamics Document Number: 298495 |
| 30. Title: HIV positive: a book for caregivers to help children cope emotionally with HIV / AIDS: sickness, sadness, stigma, death, grief. Author: Frost S Source: Northway, South Africa, Media in Education Trust, [2006]. 36 p. For children up to nine years. Abstract: The people whom I live with discriminate against me because I am infected with HIV. They do not want to share their lives with me anymore; they do not even want to share anything with me. Some people have said that I must be killed so I will not spread to their children. At school some of the students are not prepared to be in class with me. Sometimes the teachers, gossip about me. Life is difficult for me to live because when I go to some churches they do not want to worship with them. If you are HIV-positive, some taxis don't allow you in. People move away from you in taxis and they wipe the seat. Priests don't want to have HIV-positive people in the church and don't even want to discuss it in their sermons and most people believe in their preachers. While I was passing by, I saw a nurse who had tested me for HIV/AIDS, I had greeted this nurse and the nurse pointed at me in front of the people and said "this is the one". (excerpt) Language: English Keywords: SOUTH AFRICA | RECOMMENDATIONS | EVALUATION | PERSONS LIVING WITH HIV/AIDS | ORPHANS AND VULNERABLE CHILDREN | ATTITUDES | STIGMA | SELF-PERCEPTION | PLAY | DEATH | SURVIVORSHIP | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | HIV Infections | Viral Diseases | Diseases | Family and Household | Sociocultural Factors | Psychological Factors | Behavior | Social Problems | Perception | Mortality | Population Dynamics | Demographic Factors | Population | |